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1. Venereal Disease Today
- University of Nebraska Press
- Chapter
- Additional Information
1 Venereal DiseaseToday Our present knowledge of health and disease results not from any cleverness on our part but rather from the fact that we are the heirs of centuries of dedicated observers. A wholly unearned sense of omnisciencemayseizeusaswethinkof how‘‘ignorant’’medicalpeople were two hundred years ago. But two centuries from now our currentstateofunderstandingwillnodoubtlookevenmoreprimitive . We, like the men of Lewis and Clark’s time, know what we know, and that is useful enough. Today the list of sexually transmitted diseases usually includes all of those listed in table 1. Only the last two, syphilis and gonorrhea, are mentioned in the Lewis and Clark journals, and only those two will be discussed here. Gonorrhea is spread almost exclusively by sexual contact. In men the first symptoms appear two to fourteen days after contact with an infected partner. Painful urination and a purulent discharge appear first; as the infection spreads upward into the posterior urethra , the need to urinate becomes more frequent and more urgent. A diagnosis of infection can be confirmed by examination of the discharge under the microscope or by an incubated specimen. Left untreated, gonorrhea may, in perhaps 10 percent of infected men, spread throughout the body, causing painful infections of the epididymis , abscesses around the urethra, and prostatic infection. A very unpleasant late effect is scarring and narrowing of the urethra, which must be treated by forceful dilation using curved metal rods. Gonorrhea in women may lie hidden with mild or no symptoms, 5 6 Venereal DiseaseToday especially in the early stages,yet still be contagious to a partner.The cervix and the Fallopian tubes are the areas most usually infected. The latter may become the site of voluminous abscesses,which may produce few symptoms until they burst, rendering thewoman desperately ill with an almost instantaneous peritonitis. Another form that gonorrhea may take in women is the disseminated type, spread widelythroughthebloodstreamwithskinlesionsandarthritisfrom the gonococcus bacteria growing in the joint fluid. A generation ago, a major cause of blindness in newborn babies was gonorrhea of the eyes, contracted from an infected motherduring childbirth. Silver nitrate orantibiotics are now routinely placed in the eyes of newborns, rendering neonatal blindness from gonorrhea largely a thing of the past. Inmaleparlance,thevisibleexternaldischargeismostcommonly called ‘‘the clap’’ or ‘‘a drip.’’ A century ago the term ‘‘gleet’’ was in common usage. Since military organizations are common locations forwidespreadgonorrhea,the‘‘short-arminspection’’haslongbeen part of army lore. In this procedure, each man is required to expose his member and manipulate it in a way that would cause any hidden discharge to become manifest. In individuals employing routes of sexual connection other than conventional heterosexual intercourse , gonorrheal infections of the tonsils or rectum are common. Forty years ago, the treatment of gonorrhea was simple: a shot of penicillin.Thanks to the improper use of antibiotics, thewondrous adaptabilityofmicroorganisms,andtheperniciousinfluenceofthe sex industry (particularly in Southeast Asia), penicillin is now next touselessforthetreatmentofgonorrhea.1 As of this writing, a combination of ceftriaxone (Rocephin) and doxycycline (Vibramycin) – the latter for the chlamydia so often found with gonorrhea today – is more likely to prove curative.2 In 1995 therewere 400,000 reported cases of gonorrhea in the United States and almost 2 million cases [54.211.203.45] Project MUSE (2024-03-29 01:51 GMT) 7 Venereal DiseaseToday worldwide. The number of cases at the time of Lewis and Clark is unknown. The other relevant sexually transmitted disease,very well known to the Corps of Discovery,was syphilis, also called Lues venereum or the pox.The cause is a delicate spirochete, Treponema pallidum, hard toseewithaconventionalmicroscopeandevenmoredifficulttoculture .Outsidethebody,itquicklydies;insidethebody,itcancausea vastcatalogofmischief.Themanypossiblemanifestationsofsyphilis , and its dozens of guises, caused the great Canadian-AmericanBritish physician Sir William Osler (1849–1919) to exclaim, ‘‘Know syphilis in all its manifestations and relations, and all other things clinicalwillbeaddeduntoyou.’’3Osler’sinterestsrangedwidely,but his observation was strongly endorsed by men who made syphilis their life’s work. Sir Jonathan Hutchinson, in his 1887 tome simply entitled Syphilis, advised his readers that ‘‘syphilis has no lesions or type-forms of disease which are peculiar to itself.’’ This view was echoed a generation later by John Stokes in Modern Clinical Syphilology (1926), when he wrote that ‘‘syphilis apes every disease in any field of medicine’’ with a ‘‘Machiavellian facility in disguise, deceit and malevolence.’’ In brief, while general statements may be made about the appearance of syphilis, the exceptions may be as likely as the rule.4 Afterthevictimhascontactwithaninfectedpartner,threeweeks usually elapse before the first symptom appears, most commonly in the...