sexually transmitted diseases: a brief history

sexually transmitted diseases: a brief history Sexually transmitted diseases (STDs) have been known since antiquity: gonorrhoea was certainly described by the ancient Egyptians, and was recognized by Greek and Roman medical writers. The prevalence and spread of these diseases was exacerbated by war or other travel, and the rise of city dwelling, with the concomitant increase of people living in close proximity to each other. By the Middle Ages both gonorrhoea and syphilis were widespread. One view, by no means unchallenged, was that syphilis was brought to Europe by Christopher Columbus' sailors on their return from the New World. The differentiation of the 2 diseases from each other was often a matter of medical debate, from the sixteenth up until the nineteenth century, many authors believing that the symptoms of gonorrhoea (clap or gleet) were the early stages of syphilis (the pox). This view was substantiated by the British surgeon John Hunter (1728–93), who undertook heroic self-experimentation by injecting his own penis with material taken from a patient with gonorrhoea. On developing the signs of syphilis he concluded the two infections were the same — little realizing that his patient, like many others, actually suffered from both infections at the same time.

The main orthodox treatment for syphilis from the Middle Ages until the early years of the twentieth century consisted of the application of a mercury ointment, a favourite treatment for skin lesions. But sufferers from the disease were particularly susceptible to the blandishments of quacks and charlatans, and many successful businesses profited during the seventeenth through to the twentieth centuries from selling useless remedies.

In the middle of the nineteenth century a French physician, Philippe Ricord (1799–1889), convincingly demonstrated the differentiation of the two main STDs and determined the three stages — primary, secondary, and tertiary — of syphilis. Shortly afterwards Rudolph Virchow (1821–1902) established that syphilis was spread through the body by the blood, explaining the known cardiovascular, muscular, and psychiatric complications. At the turn of the twentieth century up to a third of inmates in mental asylums were reckoned to be suffering form tertiary syphilis.

During the nineteenth century an increasing number of public health measures, usually aimed at prostitutes, were taken to prevent or control the spread of STDs. The Contagious Disease Acts of Great Britain clearly tolerated prostitution, as they permitted, amongst other regulations, the compulsory examination and incarceration of infected women, often in the so-called Lock hospitals. A vociferous campaign was mounted by women's groups, civil rights activists, and members of the medical profession, and the Acts were repealed in 1886.

Advances against the diseases were notably improved by the discovery of their causative microorganisms. That of gonorrhoea was found in 1879 and that of syphilis in 1905. Shortly after this the German bacteriologist Paul Ehrlich (1854–1915) announced the efficacy of Salvarsan, an arsenic-based treatment for syphilis. Also a diagnostic test was devised, which was enormously important as it allowed the disease to be detected in sufferers not yet displaying the symptoms; they could then be advised on how to prevent or minimize passing on the infection. The development of the sulpha drugs and more potent antibiotics provided a wider range of effective drugs against these diseases. However, it rapidly became apparent that the provision of appropriate treatments did not eradicate these diseases, and that public health advice and personal hygiene education were also necessary. The appearance and world-wide spread of AIDS (Acquired Immune Deficiency Syndrome), for which an effective treatment is still unavailable, during the 1980s, has emphasized the complex nature of these diseases.

E. M. Tansey

Bibliography

Brandt, A. M. (1993). Sexually transmitted diseases. In Companion encyclopaedia of the history of medicine, (ed. W. F. Bynum and R. Porter), Vol. 1. Routledge, London.