Venereal disease
Before
antibiotics were invented, infections of
syphilis and
gonorrhea
were common, but effective treatments were rare. The medications that
actually had an effect 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 supplies 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 prolonged "intimate"
means of sharing body fluids that occurred with any regularity, except
for the special case of mother and infant during pregnancy and at birth.
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.
[1]
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.
Public health and infectious disease experts relate the incidence
of venereal diseases to several factors. The first is the rate of
spread, in venereal diseases that is related both to the number of
infected people, how often susceptible people have sex with those who
are infected, and how frequently each infected person has sex with new
contacts. The second is how long the infected people remain both
infected and sexually active, the longer that duration, the greater the
spread. The third is how efficiently the disease is spread with each
exposure to a susceptible person. Although
male condoms
can markedly decrease the efficiency of spread of these diseases, they
do not prevent spread altogether. Some of the diseases, like chancroid
or herpes, that cause open "wounds" on the genitals, increase the
chances of catching other venereal diseases from an infected partner,
notably HIV. HIV, by decreasing immune response, lowers the resistance
to the HIV infected person to most infections, and notably to certain of
the venereal diseases, like
syphilis. For example, co-infection with HIV increases syphilis' severity, and, in particular, increases the likelihood that
syphilis will affect the
brain and
central nervous system
Venereal disease of bacterial origin
Syphilis
- For more information, see: Syphilis.
"Worldwide, there are an estimated 12 million new
syphilis
cases every year, over 90% of which occur in developing
countries."(reference for quote:Gaudio PA. Update on ocular syphilis.
Current Opinion in Ophthalmology. 17(6):562-6, 2006 Dec. UI: 17065926).
Since early syphilis is now curable with medical treatment, persistent
cases are the result of either (1) the lack of available medical care
(which accounts for the predominance of cases in the developing world),
(2) medical negligence or misdiagnosis, or (3) the failure of the
infected individual to seek medical attention or to complete recommended
treatment. That failure generally occurs either because the individual
does not understand that he or she may have an infection that requires
treatment, or because of apathy towards self-care.
Gonorrhea
- For more information, see: Gonorrhea.
When men and women are newly infected with gonorrhea, the symptoms
depend on the route of entry. For both men and women the genital tract
is usually infected. In men, there is usually a discharge from the
penis. In women, the infection in the early stages is rarely has any
signs or symptoms. Despite that, it is women who more commonly have the
more serious problems from gonorrhea. That's because she is unlikely to
seek treatment unless informed of the risk of disease by the man who
infected her, and, without antibiotic treatment, the bacteria will
often go on to infect the upper reproductive tract, causing inflammation
and scarring of the fallopian tubes (salpingitis) and go on to cause
infertility.
Gonorrhea in historical perspective
"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."
[2]
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.""
[3]
After the epidemic of syphilis began in the 15th and 16th centuries, some
physicians
thought that it was the same illness as 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 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."The
introduction of treatment for gonorrhea also resulted in a decline in
incidence during the 1950s, but, unlike syphilis, periodic oscillations
did not ensue".
Rates
of gonorrhea reported to the United States CDC1970–1997. A peak of
approximately 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."
[4]
Disseminated gonorrhea
Congenital gonorrhea
This young infant was born to a mother infected with gonorrhea and developed this bacterial infection of both eyes (
gonococcal ophthalmia neonatorum). It was completely cured with antibiotics.
When infants are born to mothers with gonorrhea infections of the
cervix
and birth canal, their fate is highly dependant upon the medical
treatment that is received. In many hospitals, there is a routine
placement of dilute silver nitrate drops in the eyes of all newborns.
This measure has been very effective in preventing the most common
problem that such babies develop, a bacterial
conjunctivitis
that can cause blindness if no medical care is available for the
baby.Less commonly, infants may have skin abscesses, vaginal infections,
and arthritis from gonorhea contracted from their mother during birth.
There are more serious problems that babies who are delivered through a
birth canal infected with N. gonorrhea face however, and that is a
disseminated gonorrheal infection. Although this infection, which occurs
when the bacteria enter the baby's bloodstream, may be fatal without
treatment, with aggressive intravenous antibiotic treatment the baby may
recover completely.
Gonorrhea infections have a very different impact on babies in
the developed world than on those infants born to mothers in parts of
the world where medical attention and antibiotic treatment are not
generally available. In the developing world, permanent disability and
death are not uncommon when a neonate contracts gonorrhea at birth.
[5]
http://en.citizendium.org/wiki/Venereal_disease
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