Venereal Disease

Throughout the twentieth century, doctors, educators, social reformers, churches, the government, and the media have warned adolescents about venereal disease (VD), a group of bacterial infections transmitted primarily during sexual contact. Less attention has been paid to children, especially girls, who are presumed not to be sexually active and to be protected within their homes from sexual predators. Medical views about how girls become infected changed dramatically in the nineteenth and twentieth centuries. From the 1890s to the 1940s, doctors did not rely on medical research, but modified their medical views to conform to their assumptions about the type of men they believed capable of sexually abusing children.

A Historical Perspective

Venereal disease has a long history, with major epidemics recorded, for example, in the late fifteenth century in Europe. In popular belief, problems were usually associated with adults, not children, and particularly with the growth of cities and, in the United States, with the arrival of new immigrant groups whose sexual habits seemed suspect. Growing awareness of prostitution and urban red light districts fed concern. Again, actual problems focused primarily on adults, but venereal disease warnings to children amplified nineteenth-century sexual advice, providing yet another reason to urge children to avoid premarital sexual activity. Warnings of this sort continued in the twentieth century, and by the 1960s new patterns of adolescent sexuality, and new venereal diseases, redefined the whole problem both in advice and in actual disease incidence.

Historically, venereal disease has referred primarily to syphilis and gonorrhea, for which no effective cure existed until researchers discovered penicillin in the 1940s. Although antibiotics have nearly eliminated syphilis from the United States, many new infections, which physicians now refer to as sexually transmitted diseases (STDs), have been discovered. The Centers for Disease Control and Prevention (CDC) have identified twenty-five STDs and estimate that each year in the United States more than 15 million people become infected with at least one; 65 million people in the United States are infected with an incurable STD, such as human immunodeficiency virus (HIV) or genital herpes. Most of the children who acquire HIV, which can lead to AIDS, acquire it from their mothers. As of December 2000, more than 9,000 children and 45 adolescents in the United States had died of AIDS.

A Statistical Perspective

Rates of STD infection in the United States may differ by race, ethnicity, class, age, and geographic location, and because of factors such as inadequate health education or access to medical care. But there is no way to know how many people are infected. Statistics are unreliable because only doctors in public health clinics, where most of the patients are poor and people of color, consistently report new infections. In addition, some people never experience any symptoms and others hide infections because they carry a social stigma.

One quarter of the reported infections are among adolescents, who are particularly vulnerable to chlamydia and gonorrhea. The CDC estimate that 3 million people become infected with chlamydia, and over 1 million with gonorrhea, each year; 40 percent of reported chlamydia infections are among adolescent girls, who also have the highest rates of gonorrhea. The CDC has found not only that untreated infections can lead to infertility but that gonorrhea infection, coupled with unprotected sexual contacts, can also facilitate the transmission of HIV, drastically increasing the risk of infection.

As troubling as these numbers are, very little data exist about the numbers of infected children. Most doctors never test children for STDs except as part of a medical investigation for evidence of child abuse; when they do, gonorrhea is the single most common diagnosis. Physicians report more than 50,000 gonorrhea infections in children each year. A sexually transmitted disease can spread without penetration, and because genital bruises may disappear quickly, an STD may be the only physical evidence of sexual assault. Gonorrhea is particularly important evidence because the bacteria cause an infection at the point where they enter the body. Boys and girls both suffer from gonorrhea in the rectum and throat, but the vast majority of children diagnosed with an STD, in 1900 as well as 2000, were prepubescent girls with vaginal gonorrhea. What has changed is the medical explanation for how girls become infected.

STDs and Sexual Assault

Although most doctors in the nineteenth century believed that venereal (by which they meant "immoral") diseases originated with prostitutes and spread during sexual intercourse, doctors knew that children also became infected. Doctors expected to find children infected with syphilis or gonorrhea of the eyes, which mothers transmit to their babies. But genital gonorrhea was neither routine nor acquired at birth; most infected children were poor, working-class, or African-American girls who claimed to have been sexually assaulted. Doctors considered these infections important evidence that a girl had been raped, sometimes by her father.

However, when scientific advances at the end of the nineteenth century improved doctors' ability to detect venereal disease, their belief about the link between child sexual assault and infection suddenly changed. Physicians realized not only that venereal disease had spread among Americans from every race, class, and ethnicity, but that genital gonorrhea was so widespread among girls that doctors feared it was epidemic. Most of these girls were between the ages of five and nine and did not claim they had been assaulted. By the time record-keeping systems were in place in the late 1920s, girls under age thirteen accounted for 10 percent of reported infections among females.

Doctors were vexed as to how so many girls had become infected, particularly those from white middle- and upper- class families, which white professionals considered respectable. Many white professionals believed that only foreign or ignorant men abused their daughters and so assumed that incest occurred only in poor, working-class, immigrant, or African-American families. When the evidence increasingly pointed to men from their own class, doctors, public health officials, social reformers, and educators speculated that girls could become infected from nonsexual contacts with toilet seats, towels, or bedding–modes of transmission doctors had already rejected for adults and boys. Doctors based their speculation on the fact that the epithelial lining of girls' genitals is so thin that it provides little protection against bacteria. They knew it was unlikely that soiled objects could spread gonorrhea because the bacteria dry quickly when exposed to air, yet without proof that even one girl had become infected after using the school toilet, from 1900 to the 1940s, health care professionals ignored the possibility of sexual assault and insisted instead that girls faced the greatest risk of exposure in the school lavatory.

After penicillin was introduced in the 1940s as the first effective cure for gonorrhea, medical interest in the source of girls' infections disappeared. It was not until the 1970s that physicians who specialized in treating abused children began to emphasize the link between gonorrhea infection and child sexual abuse. In 1998 the American Academy of Pediatrics instructed physicians to assume that a child infected with an STD has been assaulted. But many practitioners remain unwilling to believe that white middle- and upper-class fathers abuse their daughters. These doctors and others, whose motivation is to avoid becoming involved in legal proceedings, may simply attribute a child's infection to "source unknown" and send her home.

See also: Contagious Diseases; Epidemics; Pediatrics.

bibliography

American Academy of Pediatrics. 1998. "Statement." Pediatrics 101: 134–35.

Brandt, Allan M. 1987. No Magic Bullet: A Social History of Venereal Disease in the United States since 1880. Expanded ed. New York: Oxford University Press.

Division of STD Prevention, National Center for HIV, STD, and TB Prevention. 2001. Tracking the Hidden Epidemics: Trends in STDs in the United States, 2000. Rev. ed. Atlanta, GA: Centers for Disease Control and Prevention.

Gutman, Laura T. 1999. "Gonococcal Diseases in Infants and Children." In Sexually Transmitted Diseases, 3rd edition, ed. King K. Holmes, et al. New York: McGraw-Hill.

Hamilton, Alice. 1908. "Gonorrheal Vulvo-Vaginitis in Children: With Special Reference to an Epidemic Occurring in Scarlet-Fever Wards." Journal of Infectious Diseases 5: (March) 133–57.

Nelson, N.A. 1932. "Gonorrhea Vulvovaginitis: A Statement of the Problem." New England Journal of Medicine 207: (21 July) 135–40.

Sgroi, Suzanne M. 1977. "'Kids with Clap': Gonorrhea as an Indicator of Child Sexual Assault." Victimology 2: 251–67.

Taylor, Alfred S. 1845. "Rape." In Medical Jurisprudence, ed. R. Egglesfield Griffith. Philadelphia: Lea and Blanchard.

Wolbarst, Abraham L. 1901. "Gonorrhea in Boys," Journal of the American Medical Association 33: (September 28) 827–30.

Lynn Sacco

VENEREAL DISEASE

Public-Health Concerns

In 1940, 46 percent of Americans polled listed syphilis as their number one public-health

[This text has been suppressed due to author restrictions]

concern. Of the major venereal diseases gonorrhea is the oldest and most common. In males it is self-limiting and tends to subside in four to six days. Women appear to be at least three times more susceptible than men, and ninety percent of them show no symptoms. In women the disease can persist for a long time and render them infertile. For both men and women the gonococci can enter the bloodstream and attack joints, the endocardium, or the eyes. Children born to mothers with gonorrhea often become blind, although washing the eyes of the newborn with silver nitrate helps reduce this risk. Gonorrhea is neither a killing disease nor a major crippler, but it severely reduces the health of its victims. Syphilis, another form of venereal disease, is, on the other hand, a crippler and a killer. It can be a long-term, insidious, degenerative disease that can lead to insanity and severe damage to the cardiovascular system and nervous system. It is estimated that 66 percent of those infected with the disease who go untreated may suffer few effects, but a full 30 percent may expect to develop serious problems later in their lives. Before antibiotic treatment became widely available in the 1940s, insanity caused by syphilis may have accounted for as much as 10 percent of admissions to insane asylums. Before the age of antibiotics Americans had much to fear from these diseases.

A Social Problem

Before the Great Depression venereal disease was viewed as the outcome of personal lack of control and immorality. By 1940, however, many physicians, including Surgeon General Thomas Parran, viewed the illness as a social problem worthy of government intervention. As World War II loomed, the American military developed an antidisease regime emphasizing a combination of education, control of prostitution, medical treatment of the infected with arsenic compounds, and extensive case finding and contact tracing. Sulfonamides were available for treating gonorrhea, but penicillin did not become widely available until 1944.

Just Say, "No."

Venereal education in the military tried to create "syphilophobia" among the men, but with little success. "It may surprise you, indeed, to know what little importance the average enlisted man attaches to venereal infections," noted Lt. Commander Leo Shifrin. "Most of them think as little of a gonorrheal infection as they do of the ordinary common cold." With the introduction of antibiotics in late 1943, the very nature and meaning of venereal infection changed. Now that venereal diseases were more treatable, fear and "syphilophobia" were no longer effective as preventatives. Instead the army inaugurated a program to ensure that troops were provided with both condoms and drug treatments.

VD and "Victory Girls."

The war also revised the classic American debates about the military and prostitution and the sexual double standard: should prostitution be regulated or outlawed? The army attempted complete repression of prostitution, but many physicians argued that prostitution was best dealt with by regulation and medical inspection. It was, they argued, a lesser evil, an outlet for uncontrollable sexual drives, and would protect society against the greater evils of homosexuality, seduction, and rape. Military officials arrested thousands of prostitutes, but army physicians reported these women were only a minority of the soldiers' sexual contacts. So the military turned its attention to the "promiscuous" girl next door. "Victory girls" were the young women of "loose morals," eager to support the war effort and "to have one fling or better" with soldiers. Unable to control the activities of such women, the army redoubled its protection efforts, implicitly sanctioning the sexual activities of men, even as authorities lambasted the sexual activities of the "victory girl." Some physicians suggested that the whole situation might be better handled by a "stern father and a good doctor."

A "Magic Bullet?"

The discovery of the effectiveness of penicillin changed the approach to the control of venereal diseases both during the war and afterward. As penicillin became widely available, disease rates began to fall. The demands of the war dramatically shortened the time for testing, research, production, and distribution. The rapid deployment of penicillin may have prevented a major venereal-disease epidemic that public-health officials feared would occur during demobilization. After the war public-health officials shifted their attention to identifying and treating preexisting cases of venereal disease. The U.S. Public Health Service sponsored nationwide health campaigns in an attempt to seek out and treat sufferers. Rates of venereal disease quickly dropped. However, the new cures were short-lived. Sulfa-resistant strains of gonococci appeared, and syphilis and gonorrhea developed resistance to penicillin. Both diseases today are rapidly increasing worldwide.

Source:

Allan M. Brandt, No Magic Bullet. A Social History of Venereal Disease in the United States Since 1880 (New York: Oxford University Press, 1985).

Venereal Disease. Although gonorrhea, syphilis, and other sexually transmitted diseases existed in colonial America, considerable confusion surrounded the distinctions among them, their causes, and their effects. Sexual activity itself was often blamed for symptoms now recognized as third‐stage syphilis. The Revolutionary Era physician Benjamin Rush popularized such causal explanations, focusing especially on masturbation. The linking of masturbation and venereal disease continued through the nineteenth century. Medical knowledge about these diseases gradually increased, however. In A Practical Treatise on Venereal Diseases (1842), the American‐born French researcher Philippe Ricord identified syphilis's three stages and the tertiary stage's devastating effects.

Increasingly, researchers focused on prostitution as a means of transmission. In History of Prostitution: Its Extent, Causes, and Effects throughout the World (1858), the New York City physician William W. Sanger estimated that at least 40 percent of the prostitutes he interviewed in New York's Indigent and Convict Hospital in the mid‐1850s had syphilis or gonorrhea. At New York Hospital, the city's preeminent nineteenth‐century medical institution, syphilis and gonorrhea were the most often treated diseases. This connection gave rise in the late nineteenth and early twentieth centuries to a concentrated attack on prostitution, or “the social evil.” The influential American Medical Association actively supported this campaign. The New York City dermatologist Prince A. Morrow (1846–1914), a prominent figure in the venereal‐disease field in the later part of his life, worked to dispel the silence surrounding these diseases and their spread. Only the elimination of prostitution, not just its regulation, Morrow insisted, would suffice. Because of the reformers' emphasis on sexual self‐control, the U.S. Army during World War I resisted issuing prophylactics to the troops, a decision that resulted in such rapid spread of venereal disease among U.S. soldiers in France that American military officers at the front were forced to ignore the government's policy.

Despite the public‐education efforts of Morrow and others, venereal disease remained a generally taboo subject until the later 1930s, when the U.S. surgeon general, Thomas Parran, mounted a campaign to increase awareness of how these infections spread and how they could be prevented. The result was a dramatic decrease in venereal disease in the United States, even during World War II, when the government required that all cases be reported and assigned investigative teams to trace the source. The postwar development of penicillin, tetracycline, and other antibiotics provided powerful new weapons against venereal diseases, although some strains proved resistant. Nevertheless, infection rates began to rise in the 1950s, especially among teenagers and young people, with changing patterns of sexual behavior. The public paid little attention until the early 1980s, however, when the advent of acquired immunodeficiency syndrome (AIDS) reinvigorated the campaign to eradicate these ancient scourges, now renamed sexually transmitted diseases.
See also Disease; Medicine; Prostitution and Antiprostitution; Public Health; Sexual Morality and Sex Reform.

Bibliography

Alan M. Brandt , No Magic Bullet; A Social History of Venereal Disease in the United States Since 1880, 1985.

Vern L. Bullough

VENEREAL DISEASE

War and Sex

In the decade after World War II, reported cases of both syphilis and gonorrhea dropped dramatically. There were two reasons. First, during war-time many people tend to relax their standards of sexual behavior, with the result that venereal diseases increase. With the return to normality, there is a corresponding decrease in sexually transmitted diseases. The pattern also occurred during and after World War I.

Case Finders

The second reason for the decrease was that after World War II public health offices, bolstered by generous federal, state, and local budgets, devised a system called case finders to diagnose venereal disease in patients and then to locate and treat every person who had sexual contact with a disease carrier. The case-finder system actively sought out disease carriers and cured them, effectively controlling the spread of disease.

The Cost of Success

The system was so successful in reducing reported cases of venereal disease that the expense-conscious federal government concluded in the early 1950s that expenditures for the control of venereal disease could be sharply reduced. The decade-long decline in syphilis rates ended in 1956, and it was estimated that there were about one million cases a year of gonorrhea. In 1947 the federal government provided about $17 million for control of venereal diseases. In 1957 activists boldly requested federal funding of $5 million to begin reestablishing the case-finder program.

Source:

"Blood on the Sidewalks," Time (18 May 1953): 75.

venereal disease (VD) Any of a number of diseases transmitted through sexual contact, chief of which are syphilis, gonorrhoea, and chancroid. Syphilis is caused by the bacterium Treponema pallidum. Penicillin and its derivatives can still cure syphilis in its early stages. Gonorrhoea is caused by the gonococcus bacterium and if diagnosed early may be treated with sulphonamide drugs. See also sexually transmitted disease (STD)

ve·ne·re·al dis·ease • n. a disease typically contracted by sexual contact with a person already infected; a sexually transmitted disease.

venereal disease (VD) (vin-eer-iăl) n. see sexually transmitted disease.

VENEREAL DISEASE

VENEREAL DISEASE. SeeSexually Transmitted Diseases .

venereal disease : see sexually transmitted disease .

Venereal Diseases. See Diseases, Sexually Transmitted.

Venereal Disease

SeeSexually Transmitted Diseases