Venereal disease

Before the antibiotics were invented, infections with syphilis and gonorrhea were common, but effective treatments were rare. The medications that actually had an affect on the disease were also toxic to the patient, heavy metal compounds being the best of them. Patent medicines were widely available in the USA in the 19th century- whether they worked or not.

Venereal diseases are infections spread through sexual contact. What is special about such diseases is the germs that cause them- these agents, whether they be bacteria, viruses, or other types of microorganisms, can only remain infectious if kept at the conditions that exist inside a living person. Unlike the virus that causes the common cold, once they leave the body's warm environment, with its supples of oxygen and nutrients and living cells, they cannot survive. The pathogens that cause venereal disease can infect solely by passing directly from one body into another, through living fluids. When the term, "venereal disease" was coined, in the 19th century, sexual activity was the only "intimate" means of sharing body fluids that occured with any regularity. Since that time, with the advent of blood transfusion, organ transplant, and groups of substance abusers who share hypodermic equipment for injecting drugs, some of the same fastidious organisms that could only survive transmission from an infected person to a new host through sexual contact now are also able to survive through these other forms of transport.

Some venereal diseases can be passed from an infected mother to her baby: either during pregnancy, birth, or through breastfeeding. This fact has changed the utility of breastfeeding in some areas, like sub-Saharan Africa, where the rate of HIV (which is transmitted in breast milk) is very high. It also had an influence on the social mores of Europe, where, after syphilis became epidemic in the 15th century, women warned their daughters about the dangers of marrying the wrong man, lest the children bring tragedy.

Sexually transmitted diseases (STD) include both the venereal diseases and other infections. These other kinds of infections can be spread in many ways, but are so likely to be transmitted by sexual contact with an infected person that they are included in the category. This article reviews the history and significance of the venereal diseases in human society.

Venereal disease of bacterial origin

Syphilis

An electron micrograph of the spirochete, Treponema Pallidum, that causes syphilis.

Syphilis in historical perspective

As far as recorded history is concerned, syphilis made its debut in 15th century Europe. Whether it came from the sailors returning from the new world, or from a new strain of a locally established organism (perhaps related to the spirochete that causes yaws) is unknown. What is known is that "the great pox" began and, by the 17th century, epidemics of syphilis had not only spread through the population of Europe but had been carried by travelling Europeans to other areas of the world. In this early era of syphilis that disease was as devastating to the populations it infected as a later epidemic of a sexually transmitted illness, AIDS, has been. Until the discovery of antibiotics, the incidence and prevalence of syphilis rose dramatically after every war, beginning with the Neopolonic and ending with War World II. Public education and treatment with penicillin have both been important in changing this pattern.

In the pre-antibiotic era, when toxic heavy metal containing compounds were the only effective remedies for the dread venereal disease, syphilis, the standing joke among medical students was " one night on Venus and the rest of your life on Mercury". These compounds did kill the spirochete, and sometimes cured the syphilis infection, but also made the patient sick and sometimes caused life long side effects, whether or not the syphilis was cured.

By the middle of the 20th century, the treatment situation suddenly changed and syphilis became easily curable- at least in its early stages. Penicillin, along with sex education, changed the demographics of the disease. In the United States, because of "widespread screening and treatment by the Surgeon General Thomas Parran after the Second World War, reported cases of primary and secondary syphilis dropped to an all-time low in 1955." However, rates did rise again, and have shown a 10-year cycle of rising and falling in a fairly regular fashion.

"In North America and the developed countries of northern Europe, syphilis had become predominately a disease of homosexual men by the 1970s. During the late 1980s, there were renewed outbreaks of heterosexual and congenital syphilis in North America in the wake of the HIV epidemic."(George R Kinghorn Chapter 75 – Syphilis in Cohen & Powderly: Infectious Diseases, 2nd ed. copyright 2004). That epidemic ended, to be replaced, in terms of global infection, with a large increase in cases in Eastern Europe and parts of Asia. In the Soviet Union (1918–1992), public health, including sexually transmitted disease (STD) control, was carefully monitored, with rights of personal freedom and privacy secondary to the control of disease. These strict and enforced measures controlled syphilis in the USSR. The incidence of syphilis never exceeded 40 cases per 100,000 in St. Petersburg, during the soviet regime. The collapse of the USSR in the early 1990s caused not only a collapse of the syphilis control program, but a fundamental change in the economic, social, and psychologic makeup of life in Russia. This period marked the rise of a Russian syphilis epidemic.

Stages of syphilis

Syphilis is an unusual infectious disease in that the disease is qualitatively different at different stages of infection. There are 3 such stages, and the disease is accordingly named primary, secondary, and tertiary syphilis. Although antibiotic treatment is effective for early syphilis, tertiary syphilis is often associated with permanent damage, whether or not the infecting organisms can be completely eradicated. In some ways, this is similar to another spirochete infection, one that is not venereal in nature but spread by the bite of infected ticks, Lyme disease.

Gonorrhea

"The history of sexually transmitted diseases is thought to date back to earliest times, and many ancient texts describe conditions that may be those of syphilis and gonorrhea, which at one time were thought to be the same disease."(ref: Ligon BL. Albert Ludwig Sigesmund Neisser: discoverer of the cause of gonorrhea. Seminars in Pediatric Infectious Diseases. 16(4):336-41, 2005 Oct. UI: 16210113]] Ulcers on the genitals that appeared on men and women after sexual intercourse are described in Egyptian papyri. "A 12th century commentator, Rabbi Shlomo Yitzhati, wrote that the Hebrew word "Zav" (issue) described a discharge the colour of "rice water". Celsus (25 BC--50 AD) described profusio seminis as the shedding of semen which occurs without sexual desire or erotic dreams, and in such a way that in time, the patient is consumed by wasting. [4] Galen (130-200 AD) originated the word gonorrhoea (Greek gonos, semen, and rhoia, to flow). He defined it as "an unwanted secretion of semen without erection."" (reference for quote:Oriel JD. The history of non-gonococcal urethritis. Genitourinary Medicine. 72(5):374-9, 1996 Oct. UI: 8976858)

After the epidemic of syphillis in the 16th century, some physicians thought that it was the same illness as that of gonorrhea, but by the 18th century, it was accepted that there was a distinction in the two diseases. Certainly, we know that some patients are infected with both, and that must have added to the confusion over diagnosis.

"The introduction of treatment for gonorrhea also resulted in a decline in incidence during the 1950s, but, unlike syphilis, periodic oscillations did not ensue". The organism that causes Gonorrhea is also a bacteria, but unlike the spirochete that causes syphilis, this is a bacteria that is of a much more common shape and kind in terms of human infection, and that has remained much more sensitive to complete eradication by antibiotics throughout all stages of infection. None the less, although gonorrhea is generally a much more limited disease than syphilis, it can cause lesions in multiple organs and, in women, is associated with pelvic inflammatory disease.

The infecting organism is the diplococcus bacteria Neisseria gonorrhoeae, which is negative on Gram stain.

Rates of gonorrhea reported to the United States CDC1970–1997. A peak of aproximately 500 reported cases per 100,000 population in 1975 fell to below 125 cases per 100,000 population in 1996. The presumed cause of this decline is greater use of condoms and caution about venereal disease in the wake of the AIDS crisi. (From Division of STD Prevention. Sexually Transmitted Disease Surveillance, 1997. U.S. Department of Health and Human Services. Atlanta: Centers for Disease Control and Prevention, September 1998;)

"There is no known protective immunity for uncomplicated gonococcal infection; a person can have repeated infections. The highly variable surface antigens help gonococci to evade antibodies and repeatedly infect humans."(ref Chapter 280- GONOCOCCAL INFECTIONS in H. David Humes, Herbert L. DuPont et al (Eds) :Kelley's textbook of internal medicine.—4th ed.ISBN 0781717876)

Chancroid

Buboes: greatly enlarged inguinal lymph nodes, the skin is discolored over them, rupture is likely to occur.

Chancroid is a venereal disease most common in Africa, and the developing world. Caused by the bacteria Hemophilius ducreyi, the hallmark of this disease is giant genital ulcers. Although some women are colonized by the bacteria without developing lesions, others do develop ulcers. It is men, however-particularly uncircumcised men, that bear the bulk of the lesions of this disease.Since women may be infected and harbor the bacteria without obvious disease, it is asymptomatic infected women who are primary carriers. About half of the men and women with ulcers also have enlarged lymph nodes in the groin (inguinal lymphadenopathy). The tissue in the center of these lymph glands often dies, becoming necrotic, and the mass in the groin then becomes soft and fluctuant. Rupture of these masses with spontaneous drainage may occur. Greatly enlarged lymph nodes with spontaneous rupture in this manner are sometimes called buboes, and are also a mark of plague.

Many people have called AIDS a modern plague, and chancroid is particlularly harmful in areas where HIV, the human immunodeficiency virus that causes AIDS, is prevalent . The patent with chancroid is at higher risk for HIV infection because the open ulcers offer a wide portal of entry. These open ulcers in men are one route of female-male HIV infection that helps account for the equal incidence of AIDS seen in men and women in Africa.

Venereal disease of viral origin

Herpes simplex

Genital herpes, syphilis, and chancroid are the most prevalent causes of genital ulcers.