It is Christmas today, and while many around the world celebrate and commemorate the birth of Jesus Christ of Nazareth, one also recalls the rumor that the Existentialist Philosopher Friedrich Nietzsche’s insanity apparently surfaced suddenly just in time for Christmas when he was barely 44 years of age.
Some scholars, and notably Nietzsche’s critics, alleged that his madness was due to the last stages of syphilis. And despite the fact that neither syphilis serology nor an autopsy was made available at that time, the renowned neurologist Paul Möbius popularized the diagnosis of neurological syphilis for Nietzsche’s mental deterioration. However, the German composer Richard Wagner disagreed, and perceived that Nietzsche’s illness was due to excessive masturbation.
Whether Nietzsche indeed had chronic schizophrenia, dementia, a slow growing meningioma, or neurosyphilis, his philosophical concept of Übermensch (Superman) was suspected to be a by-product of a diseased mind by some interpreters of Nietzsche. Whatever the hermeneutical methodology adopted by the Nietzsche interpreter, it is still difficult to distinguish whether his writings were the work of a lunatic or a genius. And if in fact his brain was infested with spirochetes, the concept of the Third Reich was likewise credited to Hitler’s spirochete-infested brain. Truly, many famous personalities from history were thought to have suffered from syphilis – or died from syphilis – including Leo Tolstoy, Benito Mussolini and Adolf Hitler.
It is in the shadow of these great men from history past, and in the likes of Charles VIII of France, Ivan the Terrible, Napolean Bonaparte and Oscar Wilde that Harry of Singapore consulted me for some sores on his manhood. Of course, Harry isn’t his real name. I could have used the pseudonym Zarathustra, and the rest of this case study could have been entitled “Thus spoke Zarathustra” – which is a really cool title for a case study. But I chose to avoid any perceived association with a potentially spirochete-infested mind.
Harry (of Singapore) was a married man in his late thirties. He had a history of recurrent genital herpes. His problem that day was not really herpes, although he was convinced that his herpes problem was back to haunt him.
He had two penile ulcers on the shaft of his penis, and very close to the glans. The ulcers were indurated, slightly tender, and had adherent white exudates at the bases. Examination also revealed bilateral non-tender inguinal lymphadenopathy (non-painful lymph node swelling at the groin area).
On questioning, he confessed to having sexual intercourse with several commercial sex workers in the past, as well as anonymous sex with women in bars and parks. He was also treated many years ago for secondary syphilis. Harry (not Truman) was adamant that he was “usually” safe, although there were times when condoms were not worn.
His test results came back positive for syphilis (VDRL reactive with high titer), and negative for both HSV culture and HIV serology.
It is notable that his primary syphilis presentation was fairly atypical. The chancre of primary syphilis is usually a single, painless round or elliptical ulcer, with a clean base with little or no purulent exudate. The presence of this classic chancre is highly specific for diagnosis of syphilis. This means that, although many chancres lack a classic appearance, typical chancres are usually syphilitic.
Also, confirmatory treponemal antibody test (such as TPHA or TPPA) was not performed in this case, as his prior history of secondary syphilis would render the test positive.
Treponema pallidum, the causative organism of syphilis, is transmitted most commonly via direct contact with moist mucosal or cutaneous lesions during vaginal, anal and oral-genital sexual intercourse. In other words, sexual contact with syphilitic lesions on the mucous membrane or skin can transmit syphilis. As fomite transmission is impossible, sex toys and sports cars do not transmit syphilis.
Individuals with syphilis are most infectious during their first year of infection. It has been estimated that the rate of transmission is around 90% during this time period. After the first anniversary of syphilis infection, transmission rate decreases to 5% by the second year. By the end of the fourth year of infection, syphilis is no longer transmissible by sexual contact.
Harry had to endure an intramuscular injection of benzathine penicillin G for primary syphilis, and his wife was advised to undergo a syphilis screen. Fortunately, his wife’s results came back negative.
Harry was scheduled for repeat HIV serology in 3 months, and was also referred for psychological counseling for his risky and compulsive sexual behavior. His VDRL will also be monitored for therapeutic efficacy over the next 12 months. All in all, Harry was expected to make a full recovery.
It wasn’t that fortunate in Nietzsche’s case. In his magnum opus “Thus spoke Zarathustra,” Nietzsche concluded that God is a dead God. When he started to lose his mind, he began speaking of himself as the successor of this “dead God.” One fine morning, when this process of self-apotheosis had advanced considerably, he attempted to undress himself in order to bathe in a puddle of water on the streets. It was here when he suddenly deteriorated, collapsed and died.
Thus ended the life of the existentialist philosopher.
If there is an ulcer down below, and you believe that you were exposed to transmissible infections, do consult an HIV STD clinic in Singapore for STD and HIV testing. Do not risk disease progression, or wait for signs of dementia or mental deterioration in order to write your magnum opus.
