Coordinates	50°48′18″N21°25′29″N
{{infobox disease | name	Syphilis | Image Treponema pallidum.jpg | Caption Electron micrograph of ''Treponema pallidum'' | ICD10 - | ICD9 - | ICDO | OMIM | DiseasesDB 29054 | MedlinePlus 001327 | eMedicineSubj med | eMedicineTopic 2224 | eMedicine_mult | MeshID D013587 | }}

Syphilis is a sexually transmitted infection caused by the spirochete bacteria ''Treponema pallidum'' subspecies ''pallidum''. The primary route of transmission is through sexual contact however it may also be transmitted from mother to fetus during pregnancy or at birth resulting in congenital syphilis. Other human diseases caused by related ''Treponema pallidum'' include yaws (subspecies ''pertenue''), pinta (subspecies ''carateum'') and bejel (subspecies ''endemicum'').

The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, and tertiary). The primary stage classically presents with a single chancre (a firm, painless, non-itchy skin ulceration), secondary syphilis with a diffuse rash which frequently involves the palms of the hands and soles of the feet, latent syphilis with little to no symptoms, and tertiary syphilis with gummas, neurological, or cardiac symptoms. It has however been known as "the great imitator" due to its frequent atypical presentations. Diagnosis is usually via blood tests however the bacteria can also be visualized under a microscope. Syphilis can be effectively treated with antibiotics, specifically intramuscular penicillin G and in those who are allergic ceftriaxone is recommended.

Syphilis is believed to have infected 12 million people worldwide in 1999, with greater than 90% of cases in the developing world. After decreasing dramatically since the widespread availability of penicillin in 1940s, rates of infection have increased since the turn of the millennium in many countries often in combination with human immunodeficiency virus (HIV). This has been attributed partly to unsafe sexual practices among men who have sex with men, increased promiscuity, prostitution and decreasing use of barrier protection.

Signs and symptoms

Syphilis can present in one of four different stages: primary, secondary, latent, and tertiary and may also occur congenitally. It was referred to as "the great imitator" by Sir William Osler due to its varied presentations.

Primary

Primary syphilis is typically acquired via direct sexual contact with the infectious lesions of another person. Approximately 3–90 days after the initial exposure (average 21 days) a skin lesion appears at the point of contact called a chancre. This is classically (40% of the time) a single firm, painless, non-itchy skin ulceration with a clean base and sharp borders between 0.3 and 3 cm in size. The lesion however may take on almost any form. In the classic form it evolves from a macule to a papule and finally an erosion or ulcer. Occasionally multiple lesions may be present (~40%) with multiple lesions more common when coinfected with HIV. Lesions may be painful or tender (30%) and they may occur outside of the genitals (2–7%). The most common location in women is the cervix (44%), the penis in heterosexual men (99%), and anally and rectally relatively commonly in men who have sex with men (34%). Lymph node enlargement frequently (80%) occurs around the area of infection occurring 7–10 days after chancre formation. The lesion may persist for three to six weeks without treatment.

Secondary

thumb|Reddish papules and [[Nodule_(dermatology)#Primary_lesions|nodules over much of the body due to secondary syphilis]] Secondary syphilis occurs approximately four to ten weeks after the primary infection. While secondary disease is known for the many different ways it can manifest, symptoms most commonly involve the skin, mucus membranes, and lymph nodes. There may be a symmetrical reddish-pink non-itchy rash on the trunk and extremities including the palms and soles. The rash may become maculopapular or pustular. It may form flat, broad, whitish, wart-like lesions known as condyloma latum on mucous membranes. All of these lesions are infectious harboring bacteria. Other symptoms may include fever, sore throat, malaise, weight loss, hair loss, and headache. Rare manifestations include hepatitis, kidney disease, arthritis, periostitis, optic neuritis, uveitis, and interstitial keratitis. The acute symptoms usually resolve after three to six weeks however about 25% may present with a recurrence of secondary symptoms. Many people who present with secondary syphilis (40–85% of women, 20–65% of men) do not report previously having the classic chancre of primary syphilis.

Latent

Latent syphilis is defined as having serologic proof of infection without symptoms of disease. It is further described as either early (less than 1 yr after secondary syphilis) or late (more than 1 year after secondary syphilis) in the United States. The United Kingdom uses a cut-off of two years for early and late latent syphilis. Early latent syphilis may have a relapse of symptoms. Late latent syphilis is asymptomatic and not as contagious as early latent syphilis.

Tertiary

Tertiary syphilis may occur approximately 3 to 15 years after the initial infection and may be divided into three different forms: gummatous syphilis (15%), late neurosyphilis (6.5%), and cardiovascular syphilis (10%). Without treatment a third of infected people develop tertiary disease. People with tertiary syphilis are not infectious.

Gummatous syphilis or late benign syphilis usually occurs 1–46 years after the initial infection, with an average of 15 years. This stage is characterized by the formation of chronic gummas, which are soft, tumor-like balls of inflammation which may vary considerably in size. They typically affect the skin, bone, and liver, but can occur anywhere.

Neurosyphilis refers to an infection involving the central nervous system. It may occur early being either asymptomatic or in the form of syphilitic meningitis, or late as meningovascular syphilis, general paresis, or tabes dorsalis, which is associated with poor balance and lightning pains in the lower extremities. Late neurosyphilis typically occurs 4 to 25 years after the initial infection. Meningovascular syphilis typically presents with apathy and seizure, and general paresis with dementia and tabes dorsalis. Also, there may be Argyll Robertson pupils, which are bilateral small pupils that constrict when the person focuses on near objects, but do not constrict when exposed to bright light.

Cardiovascular syphilis usually occurs 10–30 years after the initial infection. The most common complications is syphilitic aortitis which may result in aneurysm formation.

Congenital

Congenital syphilis may occur during pregnancy or during birth. Two thirds of infants are born without symptoms. Common symptoms that then develop over the first couple years of life include: hepatosplenomegaly (70%), rash (70%), fever (40%), neurosyphylis (20%), and pneumonitis (20%). If untreated, late congenital syphilis may occur in 40% including: saddle nose deformation, Higoumenakis sign, saber shin, or Clutton's joints among others.

Cause

Bacteriology

''Treponema pallidum'' subspecies pallidum is a spiral-shaped, Gram-negative, highly mobile bacterium. Three other human diseases are caused by related ''Treponema pallidum'' including yaws (subspecies ''pertenue''), pinta (subspecies ''carateum'') and bejel (subspecies ''endemicum''). Unlike subtype ''pallidum'' they do not cause neurological disease. Humans are the only known natural reservoir for subspecies ''pallidum''. It is unable to survive without a host for more than a couple of days. This is due to its small genome (1.14 MDa) and thus its inability to make most of its macronutrients. It has a slow doubling time of greater than 30 hours.

Transmission

Syphilis is transmitted primarily by sexual contact or during pregnancy from a mother to her fetus being able to pass through intact mucus membranes or compromised skin. It is thus transmissible by kissing, oral, vaginal, and anal sex. Approximately 30 to 60% of those exposed to primary or secondary syphilis will get the disease. Its infectiousness is exemplified by the fact that an individual inoculated with only 57 organisms has a 50% chance of being infected. Most (60%) of new cases in the United States occur in men who have sex with men. It can be transmitted via blood products. However, it is tested for in many countries and thus the risk is low. The risk of transmission from sharing needles appears limited. Syphilis cannot be contracted through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing.

Diagnosis

Syphilis is difficult to diagnose clinically early in its presentation. Confirmation is either via blood tests or direct visual inspection using microscopy. Blood tests are more commonly used as they are easier to perform. Diagnostic tests are, however, unable to distinguish between the stages of the disease.

Blood tests

Blood tests are divided into nontreponemal and treponemal tests. Nontreponemal tests are used initially and include venereal disease research laboratory (VDRL) and rapid plasma reagin. However, as these tests are occasionally false positives, confirmation is required with a treponemal test such as treponemal pallidum particle agglutination (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs). False positives on the nontreponemal tests can occur with some viral infections such as varicella and measles, as well as with lymphoma, tuberculosis, malaria, endocarditis, connective tissue disease, pregnancy. Treponemal antibody tests usually become positive two to five weeks after the initial infection. Neurosyphilis is diagnosed by finding high numbers of leukocytes (predominately lymphocytes) and high protein levels in the cerebrospinal fluid in the setting of a known syphilis infection.

Direct testing

Dark ground microscopy of serous fluid from a chancre may be used to make an immediate diagnosis. However, hospitals do not always have equipment or experienced staff members, whereas testing must be done within 10 minutes of acquiring the sample. Sensitivity has been reported to be nearly 80%, thus can only be used to confirm a diagnosis but not rule one out. Two other tests that can be carried out on a sample from the chancre are direct fluorescent antibody testing and nucleic acid amplification tests. Direct fluorescent testing uses antibodies tagged with fluorescein which attach to specific syphilis proteins while nucleic acid amplification uses techniques such as the polymerase chain reaction to detect the presence of specific syphilis genes. These tests are not as time sensitive as they do not require living bacteria to make the diagnosis.

Prevention

, there is no vaccine effective for prevention. Abstinence from intimate physical contact with an infected person is effective at reducing the transmission of syphilis, as is the proper use of a latex condom. Condom use, however, does not completely eliminate the risk. Thus the Center for Disease Control and Prevention recommends a long-term mutually monogamous relationship with an uninfected partner and the avoidance of substances such as alcohol and other drugs that increase risky sexual behavior.

Congenital syphilis in the newborn can be prevented by screening mothers during early pregnancy and treating those who are infected. The United States Preventive Services Task Force (USPSTF) strongly recommends universal screening of all pregnant women. While the World Health Organization recommends that all women are tested at their first antenatal visit and again in the third trimester. If they are positive they recommend that their partners also be treated. Congenital syphilis is however still common in the developing world as many women do not receive antenatal care at all, and the antenatal care others do receive does not include screening. Congenital syphilis still occasionally occurs in the developed world as those most likely to acquire syphilis (through drug use, etc.) are least likely to receive care during pregnancy. A number of measures to increase access to testing appear effective at reducing rates of congenital syphilis in low to middle income countries.

Syphilis is a notifiable disease in many countries including Canada, the European Union, and United States. This means that health care providers are required to notify public health which will then ideally provide partner notification to the person's partners. Physicians may also encourage patients to send their partners to seek care. The Center for Disease Control and Prevention recommends that sexually active men who have sex with men are tested at least yearly.

Treatment

Early infections

The first-choice treatment for uncomplicated syphilis remains a single dose of intramuscular penicillin G or a single dose of oral azithromycin. Doxycycline and tetracycline are alternative choices; however, they cannot be used in pregnant women. Antibiotic resistance has developed to a number of agents including macrolides, clindamycin, and rifampin. Ceftriaxone, a tetracycline group antibiotic, may be as effective as penicillin based treatment.

Late infections

For neurosyphilis due to the poor penetration of penicillin G into the central nervous system it is recommended that those affected be given large doses of intravenous penicillin for a minimum of 10 days. If a person is allergic, ceftriaxone may be used or penicillin desensitization attempted. Other late presentations may be treated with once weekly intramuscular penicillin G for three weeks. If allergic as in the case of early disease doxycycline or tetracycline may be used but for a longer duration. Treatment at this point will limit further progression but has only slight effect on damage which has already occurred.

Jarisch-Herxheimer reaction

One of the potential side effects of treatment is the Jarisch-Herxheimer reaction. It frequently starts within one hour and lasts for 24 hours with symptoms of fever, muscles pains, headache, and tachycardia. It is caused by cytokines released by the immune system in response to lipoproteins released from rupturing syphilis bacteria.

Epidemiology

thumb|[[Age adjustment|Age-standardized death from syphilis per 100,000 inhabitants in 2004. ]] Syphilis is believed to have infected 12 million people in 1999 with greater than 90% of cases in the developing world. It affects between 700,000 and 1.6 million pregnacies a year resulting in spontaneous abortions, stillbirths, and congenital syphilis. In Sub Saharan Africa syphilis contributes to approximately 20% of perinatal deaths. Rates are proportionally higher among intravenous drug users, those who are infected with HIV, and men who have sex with men. In the United States rates of syphilis as of 2007 where six times greater in men than women while they where nearly equal in 1997.

Syphilis was very common is Europe during the 18th and 19th century. In the developed world during the early 20th century, infections declined rapidly with the widespread use of antibiotics until the 1980s and 1990s. Since the year 2000, rates of syphilis have been increasing in the USA, UK, Australia and Europe primarily among men who have sex with men. Rates of syphilis among American women have however remain stable during this time period and rates among UK women have increased but at a rate less than that of men. Increased rates among heterosexuals have occurred in China and Russia since the 1990s. This has been attributed to unsafe sexual practices such as sexual promiscuity, prostitution, and decreasing use of barrier protection.

Untreated it has a mortality of 8% to 58% with a greater death rate in males. The symptoms of syphilis has become less severe over the 19th and 20th century in part due to widespread availability of effective treatment and partly due to decreasing virulence of the spirochete. With early treatment, few complications result. Syphilis increases the risk of HIV transmission by two to five times and co-infection is common (30–60% in a number of urban centers).

History

The exact origin of syphilis is unknown. There are two primary hypotheses, one which proposes that syphilis was carried to Europe by the returning crewmen from Christopher Columbus's voyage to the Americas, the other which proposes that syphilis existed in Europe previously but went unrecognized. These are referred to as the "Columbian" and "pre-Columbian" hypotheses respectively. The Columbian hypothesis is best supported by the available evidence. The first written records of an outbreak of syphilis in Europe occurred in 1494/1495 in Naples, Italy during a French invasion. Due to it being spread by returning French troops, it was initially known as the “French disease.” It was not until 1530 that the name syphilis was first applied by the Italian physician and poet Girolamo Fracastoro. It was also known historically as the "Great Pox".

The causative organism ''Treponema pallidum'' was first identified by Fritz Schaudinn and Erich Hoffmann in 1905. The first effective treatment (Salvarsan) was developed in 1910 by Paul Ehrlich which was followed by trials of penicillin and confirmation of its effectiveness in 1943. Before the advent of effective treatment, mercury and isolation were commonly used with treatments often worse than the disease. Many famous historical figures including Franz Schubert, Arthur Schopenhauer, Édouard Manet and Adolf Hitler are believed to have had the disease.

Society and culture

Arts and literature

The earliest Europe work of art to depict syphilis is Albrecht Dürer's ''Syphilitic Man''. A wood cutting believe to represent a Landsknecht, a Northern European mercenary. The myth of the femme fatale or "poison women" of the 19th century is believed to be partly derived from the devastation of syphilis with classic examples in literature including John Keats' La Belle Dame sans Merci.

The artist Jan van der Straet painted a scene of a wealthy man receiving treatment of syphilis with the tropical wood ''guaiacum'' sometime around 1580. The title of the work is "Preparation and Use of Guayaco for Treating Syphilis." That the artist chose to include this image in a series of works celebrating the New World indicates how important a treatment, however ineffective, for syphilis was to the European elite at that time. The richly colored and detailed work depicts four servants preparing the concoction while a physician looks on, hiding something behind his back while the hapless patient drinks.

Tuskegee and Guatemala studies

One of the most infamous United States cases of questionable medical ethics in the 20th century was the Tuskegee syphilis study. The study took place in Tuskegee, Alabama, and was supported by the U.S. Public Health Service (PHS) in partnership with the Tuskegee Institute. The study began in 1932, when syphilis was a widespread problem and there was no safe and effective treatment. The study was designed to measure the progression of untreated syphilis. By 1947, penicillin had been validated as an effective cure for syphilis and was becoming widely used to treat the disease. Study directors however continued the study and did not offer the participants treatment with penicillin. This however is debated and some have found that penicillin was given to many of the subjects. The study did not end until 1972.

Syphilis experiments where also carried out in Guatemala from 1946 to 1948. They were United States-sponsored human experiments, conducted during the government of Juan José Arévalo and with the cooperation of some Guatemalan health ministries and officials. Doctors infected soldiers, prisoners, and mental patients with syphilis and other sexually transmitted diseases, without the informed consent of the subjects, and then treated them with antibiotics. In October 2010, the U.S. formally apologized to Guatemala for conducting these experiments.

References

Further reading

Parascandola, John. ''Sex, Sin, and Science: A History of Syphilis in America'' (Praeger, 2008) 195 pp. ISBN 978-0-275-99430-3 excerpt and text search

Shmaefsky, Brian, Hilary Babcock and David L. Heymann. ''Syphilis'' (Deadly Diseases & Epidemics) (2009)

Stein, Claudia. ''Negotiating the French Pox in Early Modern Germany'' (2009)

External links

"Syphilis - CDC Fact Sheet" Centers for Disease Control and Prevention (CDC)

UCSF HIV InSite Knowledge Base Chapter: Syphilis and HIV

Category:Bacterial diseases Category:Bacterium-related cutaneous conditions Category:Infections with a predominantly sexual mode of transmission Category:Spirochaetes

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Demetri Martin (born May 25, 1973) is an American comedian, actor, artist, musician, writer and humorist. Martin is best known for his work as a stand-up comedian, contributor on ''The Daily Show'' and for his Comedy Central show ''Important Things with Demetri Martin''.

Early life

Demetri Martin was born to a Greek American family in New York City, New York, and grew up in Toms River, New Jersey. He is the son of Lillian, a nutritionist, and Dean C. Martin, a Greek Orthodox priest. Martin graduated from Yale University in 1995. Although he was accepted into Harvard Law School, he went to New York University School of Law after he received a full scholarship. In 1996 Martin interned for the Domestic Policy Council at the Clinton White House, then after completing his second year of law school he dropped out.

Career

In 2001, Martin caught his first big break in stand-up comedy when he appeared on Comedy Central's stand-up showcase ''Premium Blend''. At the 2003 Edinburgh Festival Fringe he won the Perrier award with his show ''If I...''. The show was turned into a British television special in 2004. From 2003 to 2004, Martin wrote for ''Late Night with Conan O'Brien''. In 2004, Martin had his own ''Comedy Central Presents'' stand-up special. His special was divided into three parts. In the first, he performed in traditional stand-up comedy fashion. In the second segment, he used humorous drawings as visual aids, which would serve either as the punchline or a background. During the third segment, he played a guitar and put on a pseudo-play where he would strum his guitar while talking; some of his comedian friends dressed as fairies and dragons acted according to the story he was telling, detailing the magical land where his jokes came from. Martin's mother and grandmother also appeared.

Since late 2005, he has been credited as a contributor on ''The Daily Show'', on which he has appeared as the named "Senior Youth Correspondent" and on which he hosts a segment called "Trendspotting". He has used this segment to talk about so-called hip trends among youth such as hookahs, wine, guerilla marketing and Xbox 360. A piece about social networking featured his profile on MySpace. On March 22, 2007, Demetri made another appearance on ''The Daily Show'', talking about the Viacom lawsuit against Google and YouTube.

He has recorded a comedy CD/DVD titled ''These Are Jokes'', which was released on September 26, 2006. This album also features ''Saturday Night Live'' member Will Forte and stand-up comedian Leo Allen.

Martin returned to ''The Daily Show'' on March 22, 2006, as the new Youth Correspondent, calling his segment "Professional Important News with Demetri Martin". In 2007, he starred in a Fountains of Wayne music video for "Someone to Love" as Seth Shapiro, a character in the song. He also starred in the video for the new Travis single "Selfish Jean", in which he wears multiple t-shirts with lyrics written on them.

On September 2, 2007, Martin appeared on the season finale of the HBO series ''Flight of the Conchords''. He appeared as a keytar player named Demetri.

He also had a part in the movie ''The Rocker'' (2008) starring Rainn Wilson. Martin played the part of the videographer when the band in the movie was making their first music video.

In 2009, he hosted and starred in his own television show called ''Important Things With Demetri Martin'' on Comedy Central. Later in June, it was announced his show had been renewed for a second season. The second season premiered, again on Comedy Central, on February 4, 2010. Martin has stated that ''Important Things'' will not return for a third season.

Prior to completing work on his second season, Martin starred in the comedy-drama film ''Taking Woodstock'' (2009), directed by Ang Lee, which premiered at the 2009 Cannes Film Festival. In the film Martin plays Elliot Tiber, a closeted gay artist who has given up his ambitions in the city to move upstate and help his old-world Jewish family run their Catskill Mountains motel. The film is based on the book written by Tiber.

On April 25, 2011, Martin released his first book, titled ''This Is a Book''.

Future plans

Martin sold his movie concept ''Will'' to DreamWorks; he is expected to play a key supporting role. He will play the lead in the film ''Moon People'', a pitch that he sold to Columbia Pictures.

Martin also signed a blind script deal with CBS in October 2010 to produce, write, and star in his own television series.

After CBS was shown the pilot for the series, they decided not to air it.

On August 11, 2011, Fox ordered a presentation of a new animated show they might air.

''If I''

''If I'' is a Perrier Comedy Award-winning comedy one-man show written and performed by Demetri Martin at the 2003 Edinburgh Festival Fringe. It was also aired on British television as a special. The show is an autobiographical examination of Martin's life, as seen through various definitions of the word "if."

The title of the special comes from a lengthy palindromic poem that Martin wrote; the words "if I" are at the center of the poem.

Comedic style

Martin is known for being an unconventional stand-up comic. He uses extensive wordplay (particularly paraprosdokians), one-liners, and drawings on a "large pad", as well as accompanying his jokes with music on either guitar, harmonica, piano, keyboard, glockenspiel, toy bells, ukulele, or tambourine, sometimes all at once. He has cited comedian Steven Wright as an important influence (both use deadpan one-liners in their acts) and he is also a fan of Bill Cosby.

Personal life

According to a July 2011 interview on the WTF with Marc Maron podcast , Demetri had a short-lived marriage to a girl he knew from high school. They began dating after high school and got married when he was in NYU Law School and she was attending NYU Medical School. He was aged 25 and in the end of his marriage/going through divorce when his stand-up career began .

Martin moved to Santa Monica, California in 2009.

Discography

''Invite Them Up'' (2005)

''These Are Jokes'' (2006)

''Demetri Martin. Person.'' (2007)

Filmography and television work

''If I'' ''12:21'' ''Late Night with Conan O'Brien'' "''Someone to Love (Fountains of Wayne song) ''Flight of the Conchords (TV series) ''The Rocker (film) ''Paper Heart'' ''Post Grad'' ''Moon People'' ''Taking Woodstock'' ''Important Things with Demetri Martin'' ''Take Me Home Tonight (film) ''Contagion (film) ''Conan''

Year	! Title	! Role	Notes
2002	''Analyze That''	Personal Assistant
2003	|	Himself	British television special, also writer
2004	|	Himself	short film, also writer
2004	|	Himself	1 episode, series writer
2007	Someone to Love''" ||	Seth Shapiro	''Fountains of Wayne'' music video
2007	Flight of the Conchords'' ||	Demetri	Season 1, Episode 12
2008	The Rocker'' ||	Kip (a music video producer)
2009	|	Himself
2009	|	Ad Exec
2009	|		lead role and writer
2009	|	Elliot Tiber	lead role
2009–2010	|	Himself / Various	lead role, writer, series creator, executive producer, and composer
2011	Take Me Home Tonight'' ||	Goldman Sachs Employee	supporting role
2011	Contagion'' ||
2011	|	Himself	guest

Written works

''This Is a Book'', April 2011, .

Awards and nominations

AwardPerrier Comedy AwardEmmy Awards Shared with Mike Sweeney (writer)Writers Guild of America Award Shared with Mike Sweeney (writer)Barry Award (for comedy)

Year	|	For	Category	Result	Other notes
2003	|	''If I''		Won	At the Edinburgh Festival Fringe
2004	|	''Late Night with Conan O'Brien''	Outstanding Writing for a Variety, Music, or Comedy Program	Nominated	Mike Sweeney (head writer), Chris Albers, Jose Arroyo, Andy Blitz, Kevin Dorff, Daniel J. Goor, Michael Gordon, Brian Kiley, Michael Koman, Brian McCann, Guy Nicolucci, Conan O'Brien, Allison Silverman, Robert Smigel, Brian Stack, Andrew Weinberg
2005	|	''Late Night with Conan O'Brien''	Comedy/Variety (Including Talk) - Series	Won	Mike Sweeney (head writer), Chris Albers, Jose Arroyo, Andy Blitz, Kevin Dorff, Daniel J. Goor, Michael Gordon, Brian Kiley, Michael Koman, Brian McCann, Guy Nicolucci, Conan O'Brien, Allison Silverman, Robert Smigel, Brian Stack, Andrew Weinberg
2006	Barry Award ||	''Dr. Earnest Parrot Presents Demetri Martin''		Won	Award for best show at the Melbourne International Comedy Festival

References

External links

Interview from November, 2006, in Onion AV Club

Interview from October 2006, in The DePaulia

Article, in ''The Scotsman''

Article, in ''Gelf Magazine''

Interview by Brian M. Palmer

MP3 Audio Interview on ''The Sound of Young America'' public radio show and podcast

Interview Believer Mag

New Jersey Monthly Magazine

Fresh Air, NPR.org

Category:1973 births Category:Actors from New Jersey Category:Actors from New York City Category:American comedians Category:American comedy musicians Category:American comedy writers Category:American film actors Category:American humorists Category:American people of Greek descent Category:American stand-up comedians Category:American television actors Category:American television writers Category:Living people Category:New York University alumni Category:Writers from New Jersey Category:Writers from New York City Category:Writers Guild of America Award winners Category:Yale University alumni

cs:Demetri Martin da:Demetri Martin de:Demetri Martin fr:Demetri Martin gl:Demetri Martin it:Demetri Martin simple:Demitri Martin fi:Demetri Martin sv:Demetri Martin

This is a list of people whose names in English are commonly appended with the phrase "''the Great''", or who were called that or an equivalent phrase in their own language. Other languages have their own suffixes such as ''e Bozorg'' and ''e azam'' in Persian and Urdu respectively.

In Persia, the title "the Great" at first seems to be a colloquial version of the Old Persian title "Great King". This title was first used by the conqueror Cyrus II of Persia.

The Persian title was inherited by Alexander III of Macedon (336–323 BC) when he conquered the Persian Empire, and the epithet "Great" eventually became personally associated with him. The first reference (in a comedy by Plautus) assumes that everyone knew who "Alexander the Great" was; however, there is no earlier evidence that Alexander III of Macedon was called "''the Great''".

The early Seleucid kings, who succeeded Alexander in Persia, used "Great King" in local documents, but the title was most notably used for Antiochus the Great (223–187 BC).

Later rulers and commanders began to use the epithet "the Great" as a personal name, like the Roman general Pompey. Others received the surname retrospectively, like the Carthaginian Hanno and the Indian emperor Ashoka the Great. Once the surname gained currency, it was also used as an honorific surname for people without political careers, like the philosopher Albert the Great.

As there are no objective criteria for "greatness", the persistence of later generations in using the designation greatly varies. For example, Louis XIV of France was often referred to as "The Great" in his lifetime but is rarely called such nowadays, while Frederick II of Prussia is still called "The Great". A later Hohenzollern - Wilhelm I - was often called "The Great" in the time of his grandson Wilhelm II, but rarely later.

Rulers

Abbas I of Persia (1571-1629), Shah of Iran

Akbar (1542-1605), ruler of the Mughal Empire of South Asia, mainly India

Alain I of Albret (1440-1522), French aristocrat

Alexander the Great (356-323 BC), King of Macedonia, Persia, Greece, Egypt, and all of Mesopotamia

Alexander I of Georgia (1386–1446), King of Georgia

Alfonso III of León (c. 848-910), King of León, Galicia and Asturias

Alfred the Great (848/849-899), King of Wessex

Antiochus III the Great (c. 241–187 BC), ruler of the Seleucid Empire

Ashoka the Great (c. 304–232 BC), Indian emperor of the Maurya dynasty

Ashot I of Iberia “the Great”(died 826/830), presiding prince of Iberia (modern Georgia),

Askia Mohammad I (c. 1442–1538), ruler of the Songhai Empire

Bhumibol Adulyadej (born 1927), King of Thailand

Bolesław I Chrobry (967-1025), sometimes called "the Great", first King of Poland

Bruno the Great (925–965), Archbishop of Cologne and Duke of Lotharingia (also listed in the following section)

Buddha Yodfa Chulaloke (1736-1809), founder and ruler of the Rattanakosin Kingdom (in what is now Thailand)

Cnut the Great (c. 985 or 995-1035), King of Denmark, England, Norway and parts of Sweden

Casimir III the Great (1310-1370), King of Poland

Catherine the Great (1729-1796), Empress of Russian

Chandragupta II (reigned 375-413/415), also known as Vikramaditya, ruler of the Gupta empire in India

Charlemagne (died 814), King of the Franks and Emperor of the Romans

Chulalongkorn (1853-1910), King of Siam (now Thailand)

Chlothar II (584-629), King of Neustria and King of the Franks

Conrad, Margrave of Meissen (c. 1097-1157), Margrave of Meissen

Constantine I (c. 272-337), Roman Emperor

Cyrus the Great (c. 600 BC or 576 BC–530 BC), founder and ruler of the Persian or Achaemenid Empire

Darius the Great (550 – 486 BC), third ruler of the Persian Empire

Devapala (died 850), ruler of the Pala Empire in the Indian subcontinent

Dionysius I, Greek tyrant of Syracuse

Ferdinand I of León and Castile (c. 1015–1065), King of León and Count of Castile

Frederick the Great (1712-1786), King of Prussia

Genghis Khan (1162?-1227), founder and Great Khan of the Mongol Empire

Gero (c. 900–965), ruler of Marca Geronis, a very large march in Europe

Gustavus Adolphus of Sweden (1594-1632), King of Sweden, founder of the Swedish Empire, and noted military leader

Gwanggaeto the Great, King of Goguryeo, one of the Three Kingdoms of Korea

Hanno the Great, the name of three leaders of Carthage, in the 4th, 3rd, and 2nd centuries BC

Henry I, Duke of Burgundy (946–1002)

Henry IV of France (1553-1610), King of France and King of Navarre

Herod the Great (73/74 BC-4 BC), King of Judea

Hugh the Great (898-956), Duke of the Franks and Count of Paris

Hugh Magnus of France (1007-1025), co-King of France

Hugh I, Count of Vermandois (1057-1101)

Humphrey I de Bohun (died c. 1123), Anglo-Norman aristocrat

Ivan III of Russia (1440-1505), Tsar of Russia

John I of Portugal (1358-1433), King of Portugal and the Algarve

John II of Aragon (1398-1479), King of Aragon and, through his wife, King of Navarre

Justinian I (483-565), Byzantine Emperor

Kamehameha I (c. 1758-1819), first King of Hawai'i

Kanishka (died c. 127), ruler of the Kushan Empire in Central Asia and parts of India

Kvirike III of Kakheti (1010-1029), King of Kakheti in eastern Georgia

Kublai Khan (1215-1294), Mongol ruler in the 13th century and Emperor of China; founder of the Yuan Dynasty

Llywelyn the Great (c. 1172–1240), Prince of Gwynedd and de facto ruler of most of Wales

Louis I of Hungary (1326-1382), King of Hungary, Croatia and Poland

Mangrai the Great (1238-1317), Lanna, northern Thailand

Emperor Meiji (1852-1912), Emperor of Japan

Mircea I of Wallachia (1355–1418)

Mithridates II of Parthia (died 88 BC), ruler of the Parthian Empire (in present day Iran)

Mithridates VI of Pontus (134 BC–63 BC), ruler of Pontus and the Bosporan Kingdom

Mstislav I of Kiev (1076-1132), Grand Prince of Kievan Rus

Narai (1633-1688), King of Ayutthaya (in what is now modern Thailand)

Naresuan (1555-1605), King of Ayutthaya

Odo the Great (died c. 735), Duke of Aquitaine

Otto I, Holy Roman Emperor (912-973)

K'inich Janaab' Pakal (603-683), ruler of the Mayan city-state of Palenque

Parakramabahu I of Polonnaruwa (1123–1186), King of Sri Lanka

Peter Krešimir IV of Croatia (died 1075), King of Croatia

Peter the Great (1672-1725), Tsar of Russia

Peter III of Aragon (1239-1285), King of Aragon and King of Sicily

Pompey (106 BC-48 BC), military and political leader of the late Roman Republic, rival of Julius Caesar

Radama I (1793–1828), first king of greater Madagascar

Raja Raja Chola I (c. 947-1014), Indian emperor of the Cholas.

Rajendra Chola I (reigned 1014-1044), Tamil King of India

Ramesses II (reigned 1279 BC – 1213 BC), considered the greatest pharaoh of Ancient Egypt

Ram Khamhaeng (around 1237 to 1247-1298), King of Sukhothai (in present day Thailand)

Ramon Berenguer III, Count of Barcelona (1082-1131), also Count of Provence and various other counties

Rhodri the Great (c. 820–878), King of Gwynedd (in present day Wales)

Roman the Great (after 1160-1205), Grand Prince of Kiev

Samudragupta (c. 335–375), ruler of the Gupta empire in the Indian subcontinent

Sancho III of Navarre (c. 992-1035), King of Kingdom of Navarre

Sargon of Akkad (died c. 2215 BC), ruler of the Akkadian Empire

Sejong the Great (1397-1450), Korean king

Shapur II (309-379), king of the Sassanid Empire, Persia

Simeon I of Bulgaria (864/865-927), ruler of the First Bulgarian Empire

Stephen III of Moldavia (1433-1504), Prince of Moldavia (Romania)

Stephen Uroš IV Dušan of Serbia (c. 1308-1355), King of Serbia and Emperor of the Serbs and Greeks

Taksin (1734-1782), King of the Thonburi Kingdom (Thailand)

Timur (1336-1405), better known as Tamerlane, founder of the Timurid Dynasty

Theobald II, Count of Champagne (1090–1151), Count of Blois and of Chartres as Theobald IV, Count of Champagne and of Brie

Theodoric the Great (454-526), King of the Ostrogoths, regent of the Visigoths and a viceroy of the Byzantine Empire

Theodosius I (347-395), Roman emperor

Tigranes the Great (140-55 BC), Emperor of Armenia

Tiridates III of Armenia (285-339), King of Armenia

Umar (c. 586 to 590–644), second caliph of the Muslim Empire

Valdemar I of Denmark (1131-1182), King of Denmark

Valentinian I (364-375), Roman Emperor

Vladimir I of Kiev (c. 958-1015), ruler of Kievan Rus

Vytautas (c. 1350-1430), archduke of the Lithuanian Grand Duchy

William I, Count of Burgundy (1020-1087), Count of Burgandy and Mâcon

William V, Duke of Aquitaine (969-1030), also Count of Poitou

Xerxes I (519-465 BC), King of Kings of the Achaemenid Empire (Persia)

Yu the Great (c. 2200-2100 BC), legendary ruler in ancient China

Religious figures

Abraham the Great of Kashkar (ca. 492-586), monk and saint of the Assyrian Church of the East

Abraham Kidunaia (died c. 366, hermit, priest, and Christian saint of Mesopotamia

Albertus Magnus (1193/1206–1280), medieval German philosopher and theologian

Anthony the Great (c. 251–356), early Christian saint of Egypt

Babai the Great (c. 551–628), Assyrian church leader

Basil of Caesarea (330-379), Greek bishop and theologian

Bruno the Great (925–965), Archbishop of Cologne and Duke of Lotharingia (also listed in the previous section)

Euthymius the Great (377-473), abbot and Roman Catholic and Eastern Orthodox saint

Gertrude the Great (1256-c. 1302), German Benedictine, mystic, theologian and Roman Catholic saint

Pope Gregory I (c. 540-604)

Hiyya the Great, 3rd-century rabbi, Palestine

Pope John Paul II (1920-2005)

Pope Leo I (c. 391 or 400-461)

Macarius of Egypt (c. 300-391), Egyptian hermit

Pope Nicholas I (c. 800-867)

Photius I of Constantinople (c. 810–c. 893), Eastern Orthodox saint and Patriarch of Constantinople

William of Maleval (died 1157), founder of the Catholic congregation of Williamites

Other

Beli Mawr, a figure in medieval Welsh literature and genealogies

Emmy the Great, folk singer

Matteo Rosso the Great, Roman politician and father of Pope Nicholas III

Prokop the Great, Hussite general in Bohemia

See also

Epithet

List of monarchs by nickname

List of nicknames of European Royalty and Nobility: G-I

James, son of Zebedee, also known as James the Greater, one of the twelve apostles of Jesus

Ajax (mythology), called Ajax the Greater

Notes

Category:Monarchs Great, List of people known as The Category:Greatest Nationals Category:Epithets

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