STD Awareness: Prevention vs. Punishment

Before antibiotics, syphilis could kill and gonorrhea was responsible for most cases of infertility. Both diseases could spread from husband to wife to baby, potentially destroying families. So you’d think medical breakthroughs in prevention and cures would be welcomed with open arms.

The actual history, like the humans who create it, is much more complicated.


Compassion, rather than fear and guilt, should guide medical practice.


During World War I, sexually transmitted diseases were a huge problem — second only to the 1918 flu pandemic in the number of sick days they caused (7 million, if you’re counting). The Roaring Twenties saw a sexual revolution, and by World War II, the military was once more fretting about losing manpower to debilitating infections that drew men away from the front lines and into the sick bays.

The armed forces did what it could to suppress prostitution and distract soldiers with recreational activities. But the human sex drive could not be contained: The vast majority of U.S. soldiers were having sex — even an estimated half of married soldiers were not faithful to their wives during WWII. Victory depended on soldiers’ health, so during both WWI and WWII, the military provided its sexually active soldiers with “prophylaxis,” medical treatments that could reduce risk for venereal disease — or VD, as sexually transmitted diseases were called back then.

Anyone who thinks condoms are a hassle or “don’t feel good” should read medical historian Allan M. Brandt’s description of a WWI-era prophylactic station, which soldiers were instructed to visit after sexual contact: Continue reading

STD Awareness: The History of Syphilis

syphilisHave you ever heard that syphilis originated in the New World, and was imported to Europe by unwitting explorers? Some say it’s a fitting revenge for Europeans, who brought deadly diseases like smallpox and measles to the Americas. Others say that, while it’s an interesting hypothesis, it’s mostly speculation backed by some intriguing circumstantial evidence.

The predominating theory of syphilis’ origin is that it was transmitted from the Americas to Europe via sailors on Christopher Columbus’ ships — sailors who, in addition to other horrific acts, probably raped the natives of Hispaniola, from whom they could have contracted the infection. Historical records show that syphilis popped up in Europe in the last decade of the 1400s, coinciding with the return of Columbus and his crew — when Europe was deeply mired in war. With war came the far and wide travel of troops, who could have introduced the pathogen to prostitutes and other members of local populations.


In the era before antibiotics, syphilis was the world’s most feared sexually transmitted disease.


But we don’t know for certain that Columbus’ crew brought syphilis back from the West Indies in 1493. Some scholars point to ancient writings, from Biblical texts to Chinese records, that contain descriptions of diseases that are consistent with syphilis — though they might merely have described tuberculosis or leprosy. There are also pre-Columbian skeletons from Europe, Africa, and Asia that seem to exhibit evidence of syphilis infection — though diagnosing syphilis based on bone samples is problematic at best. Is it possible that syphilis had existed in the Old World all along, but didn’t become an epidemic until the wars of the Renaissance era allowed syphilis to conquer the continent?

Or perhaps the New World was home to a mild strain of the disease that mutated once it hit European soil. One team of researchers, studying Guyana’s remote Akwio tribe, discovered a disease that was a lot like syphilis, but was not an STD — it spread by skin-to-skin contact and infected about 1 in 20 children. Genetic analysis showed that it was caused by a bacteria that was closely related to the same bug that causes syphilis. Could Columbus’ men have picked up this transitional strain of bacteria and brought it back to Europe, where it mutated to evolve into the virulent pathogen we know today? Continue reading

National Infant Immunization Week: A Timely Reminder to Protect Your Child

babyVaccinations, or immunizations, are important for the health of your baby. National Infant Immunization Week, in its 20th year, continues to educate and inform parents of this important information. In the first two years of your infant’s life, vaccines can protect against 14 diseases.


How wonderful that science enables us to protect our little ones from serious diseases like polio, tetanus, and diphtheria!


Under five years of age, a child’s immune system is not developed enough to defend against some infections that can cause disability and even death. Vaccination schedules for infants are designed to protect them at times when they are most vulnerable to potentially serious diseases — diseases that are easily transmitted and quickly overwhelm an immature defense system. Vaccines contain “germs,” such as inactivated or weakened bacteria or viruses, that can stimulate an immune response. The amount and type of “germs” in vaccines are designed to help infants’ immune systems develop protection from the serious consequences of getting that disease.

Watching your baby undergo painful injections that may give them some uncomfortable reactions like fever and aches can make any parent worry, but these short-term effects are much less serious than getting the disease. For example, mothers — who may not even know they have hepatitis B because they do not show symptoms — can transmit the disease to their baby during childbirth. Years later, that child may develop serious liver disease. By routinely receiving a hepatitis B vaccine at birth, babies are protected from this life-threatening disease. Continue reading

STD Awareness: Antibiotic-Resistant Syphilis

Treponema pallidum under a microscope. Image: Dr. Edwin P. Ewing, Jr., CDC

The image to your right, with lively yellow splotches against a pale green background, is not a long-lost Jackson Pollack piece, and the dark squiggly lines aren’t strands of paint haphazardly splattered onto a canvas. In fact, those squiggly lines are magnified images of the spiral-shaped bacteria species Treponema pallidum. You might not have heard of T. pallidum, but you’ve probably heard of syphilis, the sexually transmitted disease (STD) that these bacteria cause. While syphilis isn’t as common as other STDs, like chlamydia and HPV, it’s still out there, and occasionally communities experience outbreaks. It’s always best for sexually active people to be screened for STDs and practice safer sex.


The evolution of syphilis strains that are resistant to certain antibiotics underscores the need to use antibiotics properly.


Syphilis can inflict serious long-term damage — in fact, before the introduction of antibiotics, syphilis was the worst STD out there! Known as the Great Pox when it descended upon Europe 500 years ago, it could cause large and painful boils. Eventually, natural selection led to T. pallidum’s evolution into a form with milder symptoms, which benefited the bacteria by enabling its less boil-ridden (and presumably more attractive) human hosts to spread it farther and wider. Nevertheless, the symptoms of syphilis, if present, still include infectious sores, and when the disease goes untreated, it can cause severe, possibly fatal, damage to the nervous system.

Back in the day, there were myriad inadequate “treatments” for syphilis, ranging from straight-up quackery to the use of partially effective but toxic chemicals such as mercury. But a century ago, in 1912, a new arsenic-based chemical called Neosalvarsan was hailed as a “magic bullet.” Unfortunately, this treatment took weeks or even more than a year to administer — and had dangerous side effects. Quack treatments continued to flourish, and it wasn’t until the widespread adoption of penicillin in the 1940s that an effective cure with few side effects was available.

But natural selection endures; in fact, by flooding T. pallidum’s habitat with certain antibiotics, we’ve created an environment that favors the organism’s evolution against us. While not as immediately threatening as antibiotic-resistant gonorrhea, syphilis has been quietly evolving resistance to some of the antibiotics we use to treat it. This underscores the importance of using antibiotics correctly and emphasizing safer-sex practices, such as using latex condoms during vaginal or anal intercourse and during oral contact with a penis. Continue reading

“I Didn’t Want to Believe It”: Lessons from Tuskegee 40 Years Later

Located among longleaf pine and hardwood trees, low ridges, and broad floodplains, Tuskegee, Alabama, is a small town that’s been a big part of American history. Despite a modest population of less than 10,000 people, Tuskegee has been able to boast many notable residents who have made names for themselves in everything from sports to the arts. Among them have been the Tuskegee Airmen, the first African American Air Force unit, which served during World War II, and Rosa Parks, the icon of the civil rights movement, who sparked the Montgomery bus boycott in 1955.


The Tuskegee syphilis experiment, conducted from 1932 to 1972, examined the natural progression of untreated syphilis in poor, rural black men — without their informed consent.


Tuskegee, though, is also remembered for one of the worst chapters in the history of medical research. Forty years ago, in 1972, newspapers revealed the story of a syphilis study that was callous in its deception of research participants, and damaging, even today, in the distrust it sowed among black Americans. The study had started another 40 years prior, in 1932, when the United States Public Health Service (USPHS) needed to rescue a financially troubled syphilis intervention in Macon County, Alabama. The intervention was first established in partnership with a Chicago-based philanthropic organization, but its future was uncertain when the organization’s funds dried up during the Great Depression.

Syphilis, the sexually transmitted disease caused by the bacterium Treponema pallidum, was the subject of conflicting scientific hypotheses at the time, including the hypothesis that the disease behaved differently in blacks and whites. Interested in testing those hypotheses and faced with disappearing funds for treatment, the USPHS turned its project into a study of untreated syphilis. Also influencing the decision was the fact that the USPHS was discouraged by the low cure rate of the treatments at the time, mercury and bismuth. But by the mid-1940s, penicillin was in use as a proven treatment for syphilis. In spite of that medical advance, the USPHS withheld treatment from a total of 399 infected patients by the time the study ended in 1972. Continue reading

STD Awareness: Syphilis

Treponema pallidum, the causative agent of syphilis, is seen in this electron micrograph adhering to a surface with the tapered end of its structure. Image obtained from the CDC’s Public Health Image Library.

Treponema pallidum, the causative agent of syphilis, is seen in this electron micrograph adhering to a surface with the tapered end of its structure. Image: Public Health Image Library, CDC

When syphilis first descended upon Europe, it was seen as a new plague, and anxiety and blame coalesced around this mysterious scourge. Was it a punishment from God? Was it introduced by a hated Other? Was it caused by the stars’ alignment or the presence of “bad air”? The panic it provoked foreshadowed the hysteria that surrounded the emergence of HIV in the 1980s, as syphilitics were discriminated against, feared, or thought to have received punishment for their “unbridled lust.”

We now know that syphilis is not caused by supernatural forces, foreigners, or “bad air,” but rather by a species of spiral-shaped bacteria called Treponema pallidum, which can cause infections in the vagina, anus, urethra, or penis, as well as the lips and mouth. It is mostly spread by sexual contact — vaginal or anal intercourse, as well as oral sex — in which one person comes into contact with a syphilis sore. These sores can be hidden on the cervix or in the vagina, urethra, rectum, or mouth, making it not immediately apparent that one is infected with syphilis. Syphilis can also spread to a fetus during pregnancy. Sexually active people can reduce their risk of contracting syphilis by using latex barrier methods such as condoms or dental dams. Continue reading