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Sexually Transmitted Diseases

The Great Imitator

The history of sexually transmitted disease is controversial. Some historians believe that syphilis emerged as a new disease in the fifteenth century. Others cite ancient texts as proof that syphilis and perhaps gonorrhea were ancient as well as contemporary burdens. The dispute can best be understood with some knowledge of the elusive nature of gonorrhea and syphilis, called "the great imita tor" by the eminent physician William Osler (1849–1919).

No laboratory tests existed to diagnose gonorrhea and syphilis until the late nineteenth and early twentieth centuries. This means that early clinicians based their diagnosis exclusively on symptoms, all of which could be present in other illnesses. Symptoms of syphilis during the first two of its three stages include chancre sores, skin rash, fever, fatigue, headache, sore throat, and swollen glands. Likewise, many other diseases have the potential to cause the dire consequences of late-stage syphilis. These range from blindness to mental illness to heart disease to death. Diagnosis of syphilis before laboratory tests were developed was complicated by the fact that most symptoms disappear during the third stage of the disease.

Symptoms of gonorrhea may also be elusive, particularly in women. Men have the most obvious symptoms, with inflammation and discharge from the penis from two to ten days after infection. Symptoms in women include a painful sensation while urinating or abdominal pain. However, women may be infected for months without showing any symptoms. Untreated gonorrhea can cause infertility in women and blindness in infants born to women with the disease.

The nonspecific nature of many symptoms linked to syphilis and gonorrhea means that historical references to sexually transmitted disease are open to different interpretations.

There is also evidence that sexually transmitted disease was present in ancient China, according to Frederic Buret, a nineteenth-century scholar cited by Theodor Rosebury. Buret argued that the ancient Chinese had used mercury as treatment for sexually transmitted disease. Mercury was also used widely to treat sexually transmitted disease in Europe and the United States until the modern era.

During the Renaissance, syphilis became a common and deadly disease in Europe. It is unclear whether new, more dangerous strains of syphilis were introduced or whether the syphilis which emerged at that time was, indeed, a new illness. Historians have proposed many theories to explain the dramatic increase in syphilis during the era. One theory suggests that Columbus and other explorers of the New World carried syphilis back to Europe. In 1539, the Spanish physician Rodrigo Ruiz Diaz de Isla treated members of the crew of Columbus for a peculiar disease marked by eruptions on the skin. Other contemporary accounts tell of epidemics of syphilis across Europe in 1495. Another theory suggests that syphilis developed as a consequence of mixing the germ pools of European and African people in the New World.

The abundance of syphilis during the Renaissance made the disease a central element of the dynamic culture of the period. The poet John Donne (1572–1631) was one of many thinkers of that era who saw sexually transmitted disease as a consequence of man's weakness. Shakespeare (1564–1616) also wrote about syphilis, using it as a curse in some plays and referring to the "tub of infamy," a nickname for a common medical treatment for syphilis. The treatment involved placing syphilitic individuals in a tub where they received mercury rubs. Mercury, which is now known to be a toxic chemical, did not cure syphilis, but is thought to have helped relieve some symptoms. Other treatments for syphilis included the induction of fever and the use of purgatives to flush the system.

The sculptor Benvenuto Cellini (1500–1571) is one of many individuals who wrote about their own syphilis during the era: "The French disease, for it was that, remained in me more than four months dormant before it showed itself." Cellini's reference to syphilis as the "French disease" was typical of Italians at the time and reflects a worldwide eagerness to place the origin of syphilis far away from one's own home. The French, for their part, called it the "Neapolitan disease," and the Japanese called it the "Portuguese disease." The name syphilis was bestowed on the disease by the Italian Girolamo Fracastoro (1478–1553), a poet, physician, and scientist. Fracastoro created an allegorical story about syphilis in 1530 entitled "Syphilis, or the French Disease." The story proposed that syphilis developed on Earth after a shepherd named Syphilis foolishly cursed at the Sun. The angry Sun retaliated with a disease that took its name from the foolish shepherd, who was the first individual to get sick.

For years, medical experts used syphilis as a catch-all diagnosis for sexually transmitted disease. Physicians assumed that syphilis and gonorrhea were the same thing until 1837, when Philippe Ricord (1800–89) reported that syphilis and gonorrhea were separate illnesses. The late nineteenth and early twentieth centuries saw major breakthroughs in the understanding of syphilis and gonorrhea. In 1879, Albert Neisser (1855–1916) discovered that gonorrhea was caused by a bacillus, which has since been named Neisseria gonorrhoeae. Fritz Richard Schaudinn (1871–1906) and Paul Erich Hoffmann (1868–1959) identified a special type of spirochete bacteria, now known as Treponema pallidum, as the cause of syphilis in 1905.

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