Sexually transmitted infection

• 1. Introduction

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  A sexually transmitted infection often announces nothing at all. It moves quietly, frequently without symptoms, which leaves an infected person free to pass it to others without knowing. That silence sits at the center of how these infections spread, and it shaped the very name we use. The term is preferred over sexually transmitted disease or venereal disease precisely because it covers cases where there is no symptomatic disease at all. The numbers behind that silence are enormous. In 2015, about 1.1 billion people had infections other than HIV. So how does an infection hide so well, and why did the language used to describe it keep changing? Who treated it in the medieval period, and what did a French army besieging Naples have to do with the way the world came to fear it?

• 2. The Quiet Spread

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  Not all of these infections produce symptoms, and when they do, the signs may not appear immediately after infection. A disease can be carried with no symptoms at all, which leaves a greater risk of passing it to others. Vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain are among the signs that can surface. The category spans several kinds of microbe. Bacterial infections include chlamydia, gonorrhea, and syphilis, caused respectively by Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. Viral infections include genital warts, genital herpes, and HIV/AIDS. The parasite Trichomonas vaginalis causes trichomoniasis, while the crab louse and Sarcoptes scabiei spread crabs and scabies. Even a fungus, Trichophyton mentagrophytes type VII, is an emerging infection spread through sexual activity and close contact. Mucous membranes are the reason so many pathogens get in. They line the penis, vulva, rectum, and urinary tract, and unlike skin they allow certain pathogens into the body. The presence of one of these infections in a prepubescent child may indicate sexual abuse, a sign that something is badly wrong.

• 3. Curable And Incurable

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  Syphilis, gonorrhea, chlamydia, and trichomoniasis are all treatable and curable. Trichomoniasis is usually treated with an antibiotic called metronidazole, which is very effective. Chlamydia can be cured with antibiotics, though if left untreated it can lead to pelvic inflammatory disease, infertility, or a potentially deadly ectopic pregnancy. Antibiotic resistant strains of gonorrhea are a significant concern, but most cases can still be cured with existing drugs. Other infections do not yield to treatment. HIV/AIDS and genital herpes are not curable. Herpes, caused by herpes simplex virus, settles into a nerve bundle and can return in recurring attacks. There is no cure, but antiviral medications such as Valtrex treat its symptoms and lower the risk of transmission. HIV damages the immune system by killing CD4 cells, the white blood cells that help fight infection. Its advanced stage is AIDS, where people fall prey to opportunistic infections and die. When the disease was first discovered in the 1980s, those who had AIDS were not likely to live longer than a few years. Antiretroviral drugs now suppress the virus, allowing people to lead longer and healthier lives, though they can still spread it. Human papillomavirus tells a gentler story for most. In 90% of cases the immune system clears it naturally within two years. Some cases persist and lead to genital warts or cervical cancer, which is why pap smears matter.

• 4. Numbers And Geography

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  In 2015, infections other than HIV resulted in 108,000 deaths worldwide. About 500 million people had syphilis, gonorrhea, chlamydia, or trichomoniasis, at least an additional 530 million had genital herpes, and 290 million women carried human papillomavirus. The burden falls unevenly across the map. Diagnostic tests are usually easily available in the developed world but often unavailable in the developing world. AIDS is among the leading causes of death in present-day Sub-Saharan Africa. More than 1.1 million persons are living with HIV/AIDS in the United States, where it disproportionately impacts African Americans. Hepatitis B follows its own geography, with the highest rates found in Asia and Africa and lower rates in the Americas and Europe. Approximately two billion people worldwide have been infected with the hepatitis B virus. Individual countries reveal sharp trends. Over 400,000 infections were reported in England in 2017, with more than 20% increases in confirmed cases of gonorrhea and syphilis. Since 2008, syphilis cases there rose by 148%, from 2,874 to 7,137, mostly among men who have sex with men. Yet first cases of genital warts among girls aged 15-17 years fell to just 441 in 2017-90% less than in 2009, a drop attributed to the national HPV immunisation programme.

• 5. Barriers And Prevention

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  The most effective way to prevent sexual transmission is to avoid contact of body parts or fluids that can transfer infection from an infected partner. Cybersex, phone sex, and masturbation from a distance are methods of avoiding contact entirely. Proper use of condoms reduces contact and risk, though some transmission may still occur. Condoms protect only the area they cover, and uncovered areas remain susceptible. In the case of HIV, sexual transmission almost always involves the penis, because HIV cannot spread through unbroken skin, so a properly worn condom from the vagina or anus effectively stops transmission. Latex, polyurethane, or polyisoprene condoms block even viral infections, while natural skin condoms have pores large enough for some viruses to pass through. Vaccines guard against some viral infections, including hepatitis A, hepatitis B, and some types of HPV, with vaccination advised before sexual contact begins. The development of a vaccine against gonorrhea is ongoing. Some hoped-for tools failed. Researchers had expected nonoxynol-9, a vaginal microbicide, to help, but trials found it ineffective and it may put women at higher risk of HIV. Vaginal dapivirine probably reduces HIV in women who have sex with men. Screening catches what prevention misses. The CDC recommends that sexually active women under 25, and those over 25 at risk, be screened for chlamydia and gonorrhea yearly, using nucleic acid amplification tests.

• 6. From Naples To The Lock Hospital

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  The first recorded syphilis outbreak in Europe occurred in 1494, when it broke out among French troops besieging Naples in the Italian War of 1494-98. Most Renaissance writers blamed its rapid spread on the troops of the French King Charles VIII travelling throughout Italy. The French tried to deflect blame by calling it the mal de Naples, but the most common term at the time was the French Disease. The disease may have originated from the Columbian Exchange, though historians widely debate this. The apothecary Luca Landucci wrote in his diary in 1496 that there began a certain sickness called the French boils, like a large pock. Weeks later he recorded that Florence and its countryside were full of French boils, as was every city in Italy. The Bianchina chronicler of Bologna described a disease that had eaten away the nose and half the face. Ser Tommaso di Silvestro, a non-medical man who contracted it in late 1496, documented his worsening symptoms until 1498. Two main treatments emerged by the 1500s: mercury and guaiacum. Guaiac wood, first mentioned in 1516, was a hard resinous wood imported from the West Indies and considered a wonder drug, but so expensive only the affluent could afford it. Mercury, first used against syphilis in 1497, was applied as an ointment over up to 30 days and remained popular among the lower class until the 19th century. Care needed buildings. In 1500 in Bologna, citizens converted the hospital of St. Lorenzo de' Guarini into a centre for treating the Great Pox, the first documented medical building dedicated to incurable diseases. It was not until 1746 that the first voluntary hospital for these infections was founded at London Lock Hospital.

• 7. Shame And The Search For A Name

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  Syphilis quickly became associated with sexual promiscuity, woven into European literary tropes of female beauty, prostitution, and undisciplined masculinity. Beautiful women were blamed not only for spreading the disease but for creating it within their own bodies. In early modern London, many patients diagnosed with syphilis lost their jobs or their housing. The stigma pushed people toward self-treatment and home remedies, because seeking a trained physician was deemed too shameful. The historian Laura J. McGough studied mortality in Italy during the 16th and 17th centuries and found deaths almost equal between the sexes, men at 52% and women around 48%. Yet Rome's Incurabili hospital admitted women in only 20% of cases, a gap she reads as bias toward male patients rather than the disease favoring men. Language carried that judgment. Until the 1990s these infections were commonly known as venereal diseases, a euphemism from the Latin venereus, the adjectival form of Venus, the Roman goddess of love. In the post-classical era the euphemistic effect was lost entirely, and the abbreviation VD held only negative connotations. Former euphemisms also included blood diseases and social diseases. The World Health Organization has recommended the more inclusive term sexually transmitted infection since 1999. Treatment was not always voluntary. In the second half of the 19th century, the Contagious Diseases Acts were used to arrest suspected prostitutes under the guise of screening. Against that judgmental current stood Nora Wattie, OBE, Venereal Diseases Officer in Glasgow from 1929, who encouraged contact tracing and volunteering for treatment, and published her own research on sex education and maternity care.

• 8. Tracing The Spread

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  Salvarsan was the first effective treatment for one of these infections, aimed at syphilis. With the discovery of antibiotics, a large number of infections became easily curable. Combined with effective public health campaigns, this fed a public perception during the 1960s and 1970s that the infections had ceased to be a serious medical threat. The recognition of contact tracing changed how clinics fought back. By tracing the sexual partners of infected individuals and testing their contacts, clinics could suppress infections in the general population. In the 1980s, it entered public consciousness that certain infections, such as genital herpes and HIV, could not be cured by modern medicine. AIDS has a long asymptomatic period during which HIV can replicate and the disease can be transmitted, followed by a symptomatic period that leads rapidly to death unless treated. HIV/AIDS entered the United States from Haiti in about 1969. The fear of a global pandemic produced public information campaigns and treatments that managed AIDS by suppressing HIV replication for as long as possible. The earliest written traces of these infections reach much further back. Historical documentation in antiquity dates to at least the Ebers Papyrus, around 1550 BCE, and the Hebrew Bible, from the 8th or 7th century BCE, a reminder that the silence and the stigma are nearly as old as the records themselves.