Cardiovascular syphilis; a clinical study of 578 cases.

Review of the Literature With the perfection of penicillin schedules and improved epidemiological procedures during World War II and the ensuing years, the incidence of early syphilis has reached its lowest level. It is feared that, as interest in early syphilis wanes because of its relative scarcity, interest in late syphilis will also diminish. This would be unfortunate, since there are 2,100,000 persons in the United States with undetected or inadequately treated syphilis (U.S. Publ. Hlth Service, 1953). With the present promiscuous use of penicillin, persons with masked syphilis may develop lesions of late syphilis through inadequate therapy. There seems to be general agreement with the opinion expressed by one group (Diseker and others, 1944) that adequate metal chemotherapy of early and latent syphilis prevented the appearance of cardiovascular lesions, but we feel that though it markedly decreased late syphilitic involvement, it by no means halted progression in all patients. For the purposes of this study we have classified cardiovascular syphilis into three main categories: aortitis, aneurysm, and aortic insufficiency. Coronary ostial involvement is also considered as it occurs as a complication of these conditions; other less frequently encountered lesions of the cardiovascular system will be considered briefly. The earliest and most important phase of cardiovascular involvement is uncomplicated aortitis, since it is at this stage that we believe adequate penicillin therapy can prevent further progression of the lesion. One investigator (Howe, 1943) is of the opinion that adequate arsenic and bismuth therapy accomplished this purpose, but others (Hood and Mohr, 1937) felt that such treatment was of little value. The diagnosis of syphilitic aortitis is not easy, the reported incidence of cardiovascular involvement in patients having latent and late syphilis on