Aortic Regurgitation In The Tuskegee Study Of Untreated Syphilis

Aortic regurgitation in the Tuskegee study of untreated syphilis
I. Introduction:
Syphilis is a sexually transmitted disorder caused by the treponema pallidum, a spirochete class of bacteria. This disorder consists of three stages that develop throughout the years. Two-thirds of the patients affected by it only get to the second stage, while the other third goes through all the stages. Whilethe two first stages mostly cause superficial lesions either visible or not, the third stage goes directly into the damaging of certain vital organs like the stomach and the liver and can affect the skin and bones. The effects of syphilis may be seen even after ten years, since the third stage develops after that time. Since this disorder is based on a bacteria, it is treatable in all its phases,though the more time it is left untreated in the body, the more lethal it becomes.
Aortic regurgitation (or insufficiency) results from the inability of an aortic valve to close tightly. Through the years, aortic regurgitation seen in older patients had been proved to have resulted from previously having syphilis. The Tuskegee Study of untreated syphilis decided to follow the course ofuntreated syphilis and aortic valvular disease in patients. What the investigators wanted to research was the incidence of longterm complications of untreated syphilis, specifically, in the Negro male. A study previously made in Oslo by Brusgaard in the 1920’s had shown that, in Caucasians, untreated syphilis affected the males more than it affected females.
During the 1920’s study, it was concludedthat syphilis was more pathogenic in males. Before making the investigation official, the Tuskegee Study had previously speculated that syphilis affected Negroes in a more lethal way than it affected Caucasians. Due to this thought, the research was based on studying 611 Negro men. 410 of these men had been previously diagnosed with syphilis while the other 201 had no evidence in their bodies ofhaving it either previously or at the moment of the study. The research would include five-year interval check-ups on these men. This article emphasizes the cardiovascular findings of the 1968-1970 check-ups.
II. Experimental design/method:
The study was based, originally, on 625 patients. Out of all these patients, 127 were examined from 1968-1970, 413 were dead, 68 were presumed dead due to thefact of the age they’d be at the time, and 7 others that were eventually found and examined. It could be inferred that the other 10 patients were never located and could not be presumed dead by their expected age. 114 patients of the 127 examined during the two-year period of time were found in Macon County, Alabama (also Russell and Bullock Counties), while other patients were found in thefollowing states: Indiana (3), Ohio (3), Indiana (1), Illinois (1), Ohio (2), Georgia (1), and other two patients found in different regions of Alabama. The examinations generally included medical history and physical examination, electrocardiogram, chest X-ray, serologic tests, rarely lumbar puncture, phonocardiogram, and pulse pressure recordings. 26 of the examinations had to be made in the home ofthe patient, meaning that some of the examinations could not be done. Other laboratories were done to verify the existence and effects of the syphilis in the patients.
For further analysis, the records of 229 patients were reviewed. 126 patients actually had syphilis while the other 63 were controls (they had no evidence of syphilis). The criteria evaluated to analyze the effects of syphiliswith the aorta were: gross thickening of the aortic wall, medial necrosis, adventitial fibrosis, medial scarring, intramural perivascular infiltration, thickened vasa vasorum, and adventitial perivascular infiltration. These observations would be made in each patient to analyze any valvular change in the aorta. To avoid any bias opinions, antimicrobial and antisyphilitic treatment histories were...