The Tuskegee Syphilis Study (1932–1972)

In 1932, the United States Public Health Service, or USPHS, began the Tuskegee Syphilis Study, initially known as the Tuskegee Study of Untreated Syphilis in the Negro Male, as an experiment to understand the effects of untreated syphilis in Black men. When the study began, there was no known cure for syphilis. The study involved 600 Black men in Macon County, Alabama, and took place on the campus of Tuskegee Institute, now Tuskegee University. The study leaders did not tell the men the truth about the purposes, risks, or benefits of the study. Moreover, despite the development of an effective drug against syphilis—penicillin, available beginning in the late 1940s—the study investigators withheld treatment and continued to examine the untreated progression of the disease in the men. The study went on for forty years. The US government officially shut it down in 1972 after information about the study leaked to the public. The researchers’ unethical practices, including not obtaining informed consent from the participants, led to changes in federal laws regarding human clinical trials and to the creation of the Belmont Report, which outlines ethical human research guidelines.

1. Syphilis
2. The Study and Its Background
3. The Study's End
4. Impact

Syphilis

The bacterium Treponema pallidum causes syphilis, a sexually transmitted infection, or STI. Syphilis occurs in four distinct stages: primary, secondary, latent, and tertiary. The bacteria initially enters the body through a break in the skin or mucous membrane through sexual or congenital contact. The primary stage consists of the bacteria entering the body and causing sores around the site of entry that heal with or without treatment in three to six weeks. After six weeks, if the patient does not take the proper treatment, the sores begin to heal on their own, but the infection continues into the secondary stage which can last up to six weeks. In the secondary stage, a rash develops around the hands and spreads to other body parts. The bacteria spread through the bloodstream into various body parts. At that point, if patients do not obtain treatment, the infection will progress to the latent stage. In the latent stage, there are no distinct symptoms, but the infection continues to spread and can stay in the body for years. Even though the infection does not present more symptoms, a person is still infectious at that stage. After years of lying dormant in the body, the infection may enter the tertiary stage in an untreated individual, which damages the internal organs, including the brain. Antibiotics such as penicillin are an effective treatment for syphilis. Before the availability of penicillin in the late 1940s, doctors used heavy metals such as mercury, arsenic, and bismuth as treatments, but those were of limited efficacy and were also toxic.

The Study and Its Background

The Tuskegee Syphilis Study grew out of a previous study conducted by the USPHS with funding from the Julius Rosenwald Fund, a philanthropic charity. In 1929, the Rosenwald Fund sponsored a syphilis seroprevalence study in six Southern US states. Initially, the Rosenwald Fund team sought to establish clinics in Mississippi, Alabama, Tennessee, North Carolina, Georgia, and Virginia for the treatment of syphilis. After seeking advice from the USPHS on how to establish the clinics, the fund changed directions after then Surgeon General Hugh Smith Cummings proposed to conduct a serological survey instead. A serological study measures the concentration of antibodies against a specific pathogen.

Within the six states, the study administrators chose one county from each that were sites for lumber or tobacco manufacturing, as well as sites with no history of civil disobedience. The chosen communities were Bolivar County, Mississippi; Tipton County, Tennessee; Glynn County, Georgia; Albemarle County, Virginia; Macon County, Alabama; and Pitt County, North Carolina. To detect the prevalence of syphilis, the study administrators used a modification of the Wassermann test, a blood test that detects the presence of antibodies that protect against syphilis. Researchers found high rates of syphilis as determined by a positive Wassermann tests among adults and children in the six areas tested. However, according to physician Benjamin Roy, writing in the Journal of the National Medical Association, there was no standardized procedure, each state had its own protocol, and researchers did not account for previous childhood infections that could cause positive tests, which led to high false-positive rates. Nonetheless, researchers used the results of the study to choose Macon County, Alabama, as the research location for a follow-on study, the Tuskegee Syphilis Study, which took place on the campus of Tuskegee Institute, which in 1985 became Tuskegee University.

The Tuskegee Study originators and leaders were all officers with the USPHS. Hugh Smith Cumming was then the Surgeon General of the United States, while Taliaferro Clark and Raymond Vonderlehr were assistant surgeons general. All three individuals were graduates of the University of Virginia Medical School in Charlottesville, Virginia. Historians Paul Lombardo and Gregory Dorr have argued that the medical teachings at the University of Virginia Medical School at that time were heavily influenced by racial science and eugenic thinking, which may have shaped the researchers’ decisions to conduct the study in the way they did. For example, they may have been influenced by the eugenic idea that there were hereditary differences between the so-called Black and White races, and that diseases behave differently in the bodies of Black versus White individuals. According to Lombardo and Dorr, all three men were active in the American eugenics movement, including as members of organizations such as the American Eugenics Society.

The Tuskegee Syphilis Study began in 1932 in Macon County with 600 Black men with and without syphilis. Most of the participants were sharecroppers who were poor and illiterate. According to Tuskegee University's National Center for Bioethics in Research and Health Care, when recruiting the participants for the project, researchers told the potential participants they would receive treatment for so-called bad blood, which was a local term that referred to conditions like anemia, fatigue, and syphilis. In return for participating and remaining in the study, researchers offered free medical treatment for minor ailments, free meals on visit days, and burial insurance to cover the cost of a funeral. However, according to a 1973 task force convened by the US government, the researchers did not obtain informed consent from the study participants, meaning they did not inform the participants about the true purposes, risks, and benefits of participating in the study. 

From the recruited 600 Black men, researchers created two groups: the experimental and the control group. The experimental group consisted of 399 men who presented with some form of syphilis, while the control group was 201 men who did not present signs of syphilis. The researchers monitored the study participants using X-rays and lumbar punctures, or spinal taps, but did not treat the participants for syphilis. Researchers initially designed the project to last only six to eight months. They extended the project for an indefinite amount of time to collect more information about the progression of untreated syphilis. After the project’s extension in late 1932, Clark left the study.

In 1936, the researchers published some of their findings in the Journal of the American Medical Association. They emphasized that untreated syphilis patients had high morbidity and increased chances of early adult disabilities. Among patients younger than forty years old, twenty-five percent of the untreated syphilitic patients had cardiovascular disease, compared to the five percent incidence rate among non-syphilitic patients. The authors reported many more conditions, which communicated that untreated syphilis causes substantial long-term health deterioration.

Throughout the study, researchers continued to observe the effects of the disease until the study’s conclusion in 1972. Penicillin became available as a treatment for syphilis in the late 1940s. However, researchers made the decision to withhold treatment from both groups as a part of the study. As a result, patients who had late-stage syphilis and might have been treated with penicillin died, and the disease progressively worsened in those in the earlier stages.

The Study’s End

The study continued until a whistleblower named Peter Buxtun leaked government documents to the Associated Press in 1972. Buxtun was an epidemiologist for the USPHS in San Francisco, California. After overhearing his colleagues discussing a syphilis project in Alabama, he contacted the USPHS center in Atlanta, Georgia, about the study. In response, the agency sent Buxtun a collection of reports from the study. The reports contained information about the men involved in the experiment, the location, and methods being used to further investigate syphilis. From 1966 to 1969, Buxtun sent a series of letters questioning the ethicality of the study to supervisors, the USPHS, and the Centers for Disease Control and Prevention, or CDC. Following a lack of action, Buxtun leaked the obtained reports to the Associated Press, and then reporter Jean Heller published a story about the study on 25 July 1972.

Physicians Derek Kerr and Maria Rivero wrote in a 2014 blog post on the Government Accountability Project website that Buxtun leaked the documents to the media because of the similarities the study and Nazi atrocities revealed during the 1947 Nuremberg Trials. Those Trials charged Nazi physicians with murder and torture because of the deadly and non-consensual experiments they conducted on victims of the Holocaust during World War II. After Buxtun leaked the documents to the Associated Press, the US government shut down the project and began conducting an internal investigation. The results of the investigation indicated that the study was ethically unjustifiable.

The US government panel officially terminated the study in 1972. Throughout the next few years, the US government advised researchers to give each study participant, and later their spouses and children, the necessary medical care for syphilis, as well as medical and health benefits. Many researchers have linked the Tuskegee Syphilis Study to why African Americans have greater mistrust of medical science and health programs.

Impact

The Tuskegee Syphilis Study left its surviving participants and their families vulnerable to the effects of the disease, so the US government took several steps to provide compensation. Around forty wives and nineteen children were infected with syphilis due to the study. After the end of the project, the US government instructed the researchers to provide medical care and insurance for all of the surviving participants. In 1973, Fred Gray, on behalf of the participants’ families, filed a class action lawsuit, which resulted in a settlement of $10 million split between the participants and the surviving families of those who died as a result of the project. In 1975, widows, wives, and children of the subjects were given health insurance. In 1997, then President Bill Clinton issued a formal apology to the participants and their descendants as a form of acknowledgment from the US government.

The US government also created the National Research Act and the Belmont Report in response to the study. In 1974, Congress passed the National Research Act, which created a group that outlined the basic principles of research and mandated institutional review board, or IRB, approval of human studies. Following that, a government ethics advisory board created the Belmont Report, which is a set of federally established collection of guidelines that researchers must follow to direct human trials. The Belmont Report enshrines the principles of respect for persons, beneficence, and justice as pillars of ethical decision-making.

Aside from the immediate effects, the study is one of many events that reinforced mistrust between the African American community and the US healthcare system. Participants in a qualitative study published in 2010 in the Journal of Health Care for the Poor and Underserved cited the Tuskegee Syphilis Study as the explicit or implicit reason for their mistrust. Some explain how the knowledge of the experiment causes mistrust. Others state that they target their mistrust toward the US government because they funded the experiment. Alongside the mistrust, many individuals in the African American community, regardless of age or socioeconomic status, state that they believe researchers knowingly injected participants with the syphilis virus.

The lack of informed consent and unethical practices of the researchers performing the Tuskegee Syphilis Study resulted in improvements in research ethics. However, it has also resulted in mistrust among the African American community toward medical research.

Sources

1. Centers for Disease Control and Prevention. “About Syphilis.” Centers for Disease Control and Prevention. www.cdc.gov/syphilis/about/index.html (Accessed June 11, 2025).
2. Heller, Jean. “AP Exposes the Tuskegee Syphilis Study: The 50th Anniversary.” Associated Press, July 25, 2022. https://apnews.com/article/tuskegee-study-ap-story-investigation-syphilis-53403657e77d76f52df6c2e2892788c9 (Accessed June 11, 2025).
3. Jones, James H. Bad Blood: The Tuskegee syphilis experiment. Simon and Schuster, 1993.
4. Kerr, Derek, and Maria Rivero. “Whistleblower Peter Buxtun and the Tuskegee Syphilis Study.” Government Accountability Project. https://whistleblower.org/uncategorized/whistleblower-peter-buxtun-and-the-tuskegee-syphilis-study/ (Accessed June 11, 2025).

5. Lombardo, Paul A., and Gregory M. Dorr. "Eugenics, medical education, and the Public Health Service: Another perspective on the Tuskegee syphilis experiment." Bulletin of the History of Medicine 80, no. 2 (2006): 291-316.

    

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16. Tuskegee University “About the USPHS Syphilis Study.” Tuskegee University. www.tuskegee.edu/about-us/centers-of-excellence/bioethics-center/about-the-usphs-syphilis-study (Accessed June 11, 2025).
17. UC Law San Francisco. “UC Law SF Remembers Tuskegee Experiment Whistleblower Peter Buxtun ’71.” UC Law San Francisco. https://www.uclawsf.edu/2024/07/26/tuskegee-whistleblower-peter-buxtun/ (Accessed June 11, 2025).
18. Vonderlehr, R. A., Taliaferro Clark, O. C. Wenger, And J. R. Heller Jr. “Untreated Syphilis in the Male Negro.” Journal of the American Medical Association 107 (1936): 856–60.