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STD Awareness: The Curious Case of Chancroid

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Haemophilus ducreyi arrange themselves in parallel rows, which researchers have called “railroad tracks,” “schools of fish,” and “fingerprints.” Image: Mike Miller, CDC

Earlier this year, I asked a room full of scientists and medical professionals to raise their hands if they’d ever heard of chancroid. Everyone sat there, motionless, confused by the odd syllables I had uttered — shan kroyd. If you’ve never heard of chancroid, you’re not alone.

Chancroid is a sexually transmitted disease (STD) brought to you by Haemophilus ducreyi, a type of bacteria that can pass through microscopic tears in the skin during sexual contact. When one partner is infected, there is a 1 in 3 chance the other will become infected. An infection can cause painful sores and swollen lymph nodes, most often in the genital region. About half of people with chancroid infections will experience “buboes,” or swollen lymph glands that might rupture. Before it could be cured with antibiotics, a persistent infection could cause permanent skin damage.

Humanity can make chancroid the first STD to go extinct.

One reason you probably haven’t heard of chancroid is that, in the developed world at least, it has mostly disappeared. In fact, researchers believe chancroid can be completely wiped off the planet — which would make it the first STD ever to be forced into extinction. How amazing would that be?

Chancroid has been hopping from loin to loin since at least the days of the ancient Greeks, and was common until the 20th century, when rates began to decline. Thanks to antibiotics, U.S. chancroid rates decreased 80-fold between 1947 and 1997, all but vanishing by the late 1950s. It was virtually unheard of until there was another spike in the 1980s, correlating with the crack epidemic. But, since 1987, cases have been steadily declining. Continue reading →

World AIDS Day: Fighting the Stigma Is Half the Battle

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RibbonThey say words can never hurt you, but in certain parts of the world, there are three letters that can take away everything dear to you: HIV.

Can you imagine having your family disown you? What if doctors refused to treat you, even with basic care? What would it feel like if you were not allowed to pursue any form of education? How about if you had no possibility of a future with a romantic partner?

We will never make strides in preventing HIV transmission until we confront the taboos that surround it.

This is reality for millions of men, women, and children in sub-Saharan Africa who have been diagnosed with HIV/AIDS. As of 2013, that number was 24.7 million, which accounts for the vast majority of the world’s total reported cases, which by 2014 approached 37 million people, 2.6 million of whom were children. In 2013 alone, 1.5 million sub-Saharan Africans were newly infected. Since the first case was reported in 1981, a certain stigma has always lingered around the disease. Many in the United States refer to it as the “gay disease” or accuse those infected of bestiality. They may say that someone who has been diagnosed should avoid intimacy, believing that a person with HIV is incapable of functional relationships without infecting their partner. In Africa, the implications are even more harsh. Often believed to be a “curse from God,” many regions exile an infected person from their community.

Worse, the stigma does not stop with individuals. It bleeds into the legal, political, and economic arenas as well. This is true worldwide. Some places have prosecuted women for transmitting the virus to their child, or have prosecuted individuals for not disclosing their positive status even if they have reached an undetectable viral load through antiretroviral therapy (ART). The discrimination surrounding a positive diagnosis is cited as the primary hurdle in addressing prevention and care. Continue reading →

STD Awareness: The History of Syphilis

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Have 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 →

The State of Girls in the World: International Day of the Girl Child

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Content note: This article discusses sexual assault and violence against women and girls.

afghan girlOctober 11, 2014 will be the third International Day of the Girl Child. UNICEF began this day in 2012, a day that focused on the issue of child marriage. Last year, the subject was education for girls. This year the theme is Empowering Adolescent Girls: Ending the Cycle of Violence.

I am excited that violence is this year’s focus. When I worked in another state as a child therapist in an inner-city neighborhood, I once had a 14-year-old girl bring in two friends for her session. She and another girl around her age wanted me to talk to their 11-year-old friend, who was thinking about having sex with her older boyfriend. The boyfriend was insisting on it. The older girls agreed with the general idea that “spreading your legs” (in their words) is part of having a boyfriend, but were worried that their friend was too young. Though they could not see any coercion in their own lives, even they could tell that in their 11-year-old friend’s case, something was wrong. At one point I asked them, “Do you enjoy it?” All three looked at me as if I were talking a foreign language. The idea that sex could be pleasurable had never occurred to them.

We need to work to prevent violence against girls where it begins — with the perpetrators and their enablers.

These girls were not alone, and although they reflected a particular cultural setting, partner violence is not unusual anywhere. According to the United Nations, one in three women worldwide experiences partner violence, many of them as children and teens. The statistics in this article include countries where teenage girls are often married, and in several countries the proportion exceeds 50 percent.

Violence against girls is often considered acceptable where the social structure gives men dominance over women. Practices like female genital mutilation, which is often strongly supported and facilitated by the women of a culture group, reinforce violence as a social norm. Female genital mutilation is restricted to a group of northern African countries as well as Iraq and Yemen, but the practice has been carried by immigrants into Western countries, including our own. While the practice was made illegal in the United States in 1996, the law was not amended until 2012 to include transporting girls abroad to have the procedure done; this was done as a provision of the Defense Authorization Act that year. Continue reading →

Book Club: The Origins of AIDS

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The Origins of AIDS
By Jacques Pepin
Cambridge University Press, 2011

Most sexually transmitted diesases go back thousands of years. Gonorrhea, for example, was first described by a Greek physician in A.D. 150, and pubic lice have been evolving right along with us since before we became Homo sapiens. This might have been one reason why it was such a shock when a strange new virus came to our attention in the early 1980s. We soon discovered that it was transmitted sexually and through infected blood, but where did it come from?

We have intriguing evidence that HIV as we know it has been in existence since at least the 1930s.

HIV has been around since before the 1980s, though it remained unnoticed and unidentified by medical science. The earliest confirmed case of HIV was in 1959, the proof found in a sample of blood from the Belgian Congo, saved in a freezer for decades and later analyzed for the virus. Other early cases of HIV infection that have retrospectively been confirmed include that of a Norwegian sailor, who must have been infected while visiting African ports in the early 1960s. He, his wife, and his child (who was apparently congenitally infected) all died in 1976, and their tissues were tested 12 years later and found positive for HIV.

Jacques Pepin — a professor and microbiologist, not to be confused with the chef of the same name — does some serious detective work to find the most plausible explanation for HIV’s origins. While he doesn’t skimp on the science, the story of AIDS’ origins can’t be told without getting into the history of Europe’s colonization of Africa in the 20th century. This period, followed by the era of post-colonization, found many societies in upheaval. Urbanization, unemployment, and migration facilitated the spread of HIV in Africa during much of the 1900s, and once it left the continent it was able to hitch a ride from host to host, traveling the world. Continue reading →