Steve Pokin | SPOKIN@NEWS-LEADER.COM

Hey Answer Man! I remember a time when people had to have a blood test before they could get married. What was the test for? When did it end? Why did it end? — Sharon Anhalt of Springfield

I didn't immediately have your answers, Sharon, as I often don't in my role as Answer Man. That's why you will never see "The Answer Man Live!"

It would be a loop of me saying, "I have no idea."

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But being a reporter, I found someone who does — County Commissioner Harold Bengsch, who worked in the Springfield-Greene County Health Department for 45 years, retiring in 2004 after 20 years as director.

The blood test you mentioned was for syphilis. It ended in 1980. If either person tested positive, Bengsch says, the county would not grant a marriage license until the infection was treated.

Missouri was not alone in doing this. Most states required the same blood test.

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For you Puritans who might not know, syphilis is a bacterial infection contracted chiefly through oral, anal or vaginal sex. It once was a major public health problem.

It was such a scourge that in the late 1920's, Bengsch tells me, people here in Greene County were tossed in the clink for not seeking treatment — or not refraining from sex — and knowingly spreading the disease.

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Syphilis doesn't just affect the man or woman, Bengsch says. It can harm the fetus.

"Really serious things could happen to a baby if the woman gets pregnant — heart problems, congenital abnormalities, neurological problems."

The mandatory test for syphilis ended in 1980 because it was yielding few positive results and was not cost effective. Many other states ended the test, as well.

In 1980, for example, 34 states required a blood test for syphilis before a couple could get married. Now, only the District of Columbia and Montana mandate one. The Montana test is for women only, according to the website www.nolo.com. Nolo provides legal information in layman's terms.

Syphilis makes comeback

Today, the number of Greene County cases is small but has risen in recent years, says Kathryn Wall, spokeswoman for the health department. In 2011, there were eight cases; in 2015 there were 20.

The Centers for Disease Control and Prevention reported in November that cases of chlamydia, gonorrhea and syphilis — all venereal diseases — increased for the first time since 2006. The biggest increase for syphilis was among men having sex with men.

"After penicillin in the 1940s, syphilis almost disappeared," says Dr. Patricia Dix, who specializes in maternal and fetal medicine with CoxHealth.

"Syphilis really is a scourge because it affects the baby so terribly — bones, teeth, and even death."

Dix, 70, says she once saw a fetus die from the disease after it had spread from the mother.

Decades ago, there never was a mandatory blood test for either gonorrhea or chlamydia, which both occur more often than syphilis. That's because no such blood test exists, Dix says.

Fortunately, gonorrhea is far easier for a woman to detect because there are symptoms, including vaginal discharge. Syphilis, on the other hand, can carry no symptoms in its early stages, Dix says. As a result, women are more likely to get quicker treatment for gonorrhea than for syphilis.

Like syphilis, gonorrhea and chlamydia can harm the fetus. They can cause neo-natal conjunctivitis, which can lead to blindness.

Fortunately, in the United States an ointment is applied to the eyes of infants born in hospitals, she says. This prevents eye problems.

Gonorrhea is a health risk for another reason, too. It can lead to premature birth, which can create a multitude of health problems for an infant.

Even though couples who plan to marry no longer must take a blood test for syphilis, doctors routinely administer the test at the first pre-natal visit, Dix says.

Stopping the spread

Instead of blood tests, county health departments track syphilis in different ways. First, Missouri doctors must report the disease to health departments.

The Greene County Health Department, like other health departments, attempts to stop the spread of infectious diseases, including syphilis, through contact tracing.

What this means is that when someone is diagnosed with a sexually transmitted disease the department works backward to inform prior partners they might have been exposed to the disease.

According to Bengsch, this is far more effective and less costly than requiring a blood test for all people seeking to get married.

The cure for syphilis came with the advent of the antibiotic penicillin, discovered in 1928 and first used to treat infections in 1942.

Back in the 19th century, Bengsch says, treatments often were as dangerous as the disease.

"They treated it with mercury and a lot of people died from mercury poisoning," he says. "Arsenic was used, as well as other heavy metals.”

Arsenic is highly toxic to humans.

The Springfield-Greene County Health Department offers free testing for various sexually-transmitted diseases at the Bengsch Building (named after Harold) at 227 E. Chestnut Expressway. No appointment is necessary. Call 417-864-1684 for more information.

Syphilis stages and symptoms

Primary stage

Usually marked by the appearance of a single, painless sore or chancre at the spot where syphilis entered the body. Multiple painless sores are possible. Time between infection and the first appearance of symptoms is from 10 to 90 days, with an average of three weeks. The chancre typically lasts 3 to 6 weeks and heals on its own. Without treatment, the infection progresses to the secondary stage.

Secondary stage

Characterized by a skin rash on one or more areas of the body and mucous membrane sores. The characteristic rash might appear as rough, red or reddish-brown spots both on the palms and the bottoms of the feet, but rashes with varying appearances might occur elsewhere on the body. Some are so faint they are not noticed. Other symptoms might include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches and fatigue.

Late or latent stage

Begins when other symptoms disappear. Without treatment, the infection remains in the body and might damage the internal organs, including the brain, nerves, eyes, heart and liver. Signs and symptoms such as difficulty coordinating muscle movements, paralysis, numbness, gradual blindness and dementia might not show up for many years, and the damage might be serious enough to cause death.

Source: Springfield-Greene County Health Department