February, the month of love; love has a different meaning in the biological world. As you will see in the magazine’s Valentine Special, it can be broken down into brain chemistry and animal instincts. To the microbiologist, however, it also conjures up images of sexually transmitted diseases (STDs). It does in my mind at least, which may go some way to explain why I’m often not invited out to dinner. So for the loveliest time of the year, I’ll give you all a short history of the microbes and viruses that make themselves at home in our naughty parts. Beware. This might just turn you celibate.
When most people think of STDs, they tend to think of HIV or the much more common Chlamydia. We also often assume that STDs are a 20th century problem, originating from the hedonistic heyday of the 60s. But as long as man has had dangly bits and enjoyed using them, there have been vermin that have hitched a ride.
Prior to the invention of antibiotics, venereal diseases were a big problem. Epic poems were written about STDs as plagues from the Gods visited upon disloyal followers and blasphemers. Some were also far more deadly then we think of them today. Syphilis is a prime example. Nowadays, syphilis is by no means a pleasant experience, but in comparison to the symptoms from a few hundred years ago, we seem to have it rather easy. For example: today most cases of syphilis present as single lesions that aren’t particularly painful or itchy. Now compare that to the historic syphilis where your face might “slough off”. One writer portrays a person with syphilis as “having boils that covered him from knee to head, causing flesh to fall from his face”. These boils were not small pimple-sized lesions but could grow to around the size of a cricket ball.
The emergence of syphilis is hotly debated, but here’s what we think we know. The first well recorded cases of syphilis hail from the 15th century during a French besiegement of Naples. However, examination of some remains found in Pompeii show clear signs of a syphilis-like disease that occurred much earlier. These remains date back to AD79. Some argue that syphilis was a disease bought back from the new world, since its appearance coincides with the “discovery” of the Americas. This would be, in some way, poetic justice as travellers to the new world wrought death on epic proportions from the diseases they and their animals brought (small pox and measles to name just a few).
It was estimated that in the 16th century, around one million people in Europe had syphilis; which works out as roughly 1 in 40 people having the disease. But that number would naturally vary depending on the location, being far higher in the urban centres. Soon after this time (17th century) syphilis began to decline in virulence. It no longer manifested itself as a whole body condition and began to resemble its modern day version. Why syphilis has become less severe is a bit of a mystery, but it can still be a killer today. In cases of Neuro-syphilis, the spirochetes (the bacteria responsible for the disease) begin to feast on your brain. Clearly a bacterium chomping away at your gray matter is something of an issue!
Syphilis has gone by many names and has often had some sort of racial nomenclature. For example, the Italians, Polish and Germans called syphilis the French disease. The Dutch called it the Spanish disease. The Russians called it the Polish disease. The Turks called it the Frank or Christian disease. And for some odd reason the Tahitians (a group of islands about 2000 miles northeast of New Zealand) called it the British disease.
Historically, treatments for syphilis have been almost as bad as the disease itself. The phrase “a night in the arms of Venus leads to a life time on mercury” gives us a strong hint as to one of the most popular treatments of the time: Mercury. Mercury was either applied directly, ingested, injected or, perhaps my favourite, fumigated. Fumigation of the body was used to treat many aliments. Galen suggested schizophrenia in women should be treated by fumigation of the vagina, but fumigating mercury was probably the least effective way of delivering mercury into the body. Nevermind that the treatment was not overly effective, mercury is one of the most toxic natural substances that we know of. Other treatments did exist; the most effective probably would have been the use of wild pansy, which has subsequently been shown to have some antimicrobial properties. Still, none one of these treatments were as efficient as the first antibiotics.
Although the first modern antibiotic, penicillin, was not discovered until 1928, an arsenic containing drug developed in 1908 was highly effective at treating early stage infections. Of course, as with the case of using mercury, one has to question the effectiveness of a deadly toxin to treat the disease, but it worked. Another brilliantly bizarre treatment for syphilis was founded on the notion that some people, who had developed high fevers from other conditions, had been cured of their syphilitic infection. So in order to give syphilis patients a high fever, they were infected with Malaria. The Malaria would induce a massively high fever and night sweats which would essentially cook off the syphilis. The Malarial infection would then later be treated with quinine. It’s important to note that this was not some “quack” treatment; this treatment strategy won its inventor, Julius Wagner-Jauregg, the noble prize in 1927.
Another interesting time in the history of STDs were the first and second world wars. Here was an era when young virile soldiers were sent away from home into foreign countries. As they were men, they tended to try and have sex with anything that is willing or at least not overly reluctant. Naturally, a soldier who has succumbed to venereal disease is not going to be of much use on the battle field, or at least be at a diminished capacity. The army essentially did not want its privates to be ineffective.
During this time, the war office invested a lot into the soldier’s having an understanding of how sexually transmitted diseases are spread. This effort was mainly in the form of training videos and posters depicting a femme fatale with stern warnings. However, it is an urban myth that some went a bit further and actually tried to blunt the troop’s libido by having rations laced with anti-aphrodisiac. Although the idea may seem plausible on the surface, when one thinks about it, most of the chemicals that will reduce certain desires will also have other effects such as depression and exhaustion. Randy soldiers are probably better than depressed ones.
The major breakthrough in reducing STDs during the 20th century was the use of antibiotics and condoms. During the Second World War antibiotics became widely available for the first time, and one of their earliest applications was in treating soldiers for STDs along with preventing infection from battle wounds. Post-antibiotics, diseases such as Chlamydia, Syphilis and Gonorrhoea could be, for the first time in history, cured and widely prevented. It is important to note that no other diseases humans suffer from could be controlled as easily as STDs, if people would just act carefully, get checked regularly and rubber up. This should mean with increased education and availability to treatment the number of cases of STDs should be falling; alas, overall cases of STDs are on the rise in the UK.
Viral venereal diseases cannot be treated by antibiotics; you need to have a vaccine or an antiviral drug. The popular account of the rise of HIV in the 80s is well known. A group of homosexual males began exhibiting similar symptoms of chronically depleted immune systems. It was suggested that the disease should be termed Gay Related Immune Disease or GRID for a short while. This soon changed when it became clear that the disease had no affinity to homosexuals. Nevertheless, public prejudices remained and HIV-AIDs was and still is informally called a range of bigoted terms, from the gay plague to anally inserted death. Public perception in certain groups has also begun to question the use of anti-retrovirals as an effective treatment, which any respectable doctor will tell you is plain nuts. Alternative, non-medical treatments for HIV spring from the same mentality as anti-vaccine groups and crackpot new age mysticism.
Currently, virologists do not think that HIV sprang into existence in the 1980s but may have in fact, evolved from Simian immunodeficiency virus (SIV), the ape-form of this virus which was present during as early as the 1930s. Reports from the 1950s of sailors returning from Africa with unusual immune diseases are well known. Arvid Noe was just such a sailor and he was known to be sexually active in Africa. Arvid, his wife and subsequently their daughter, all died of this condition around a decade before the formal discovery of HIV (1983). Another interesting case is that of David Carr, who reportedly never visited Africa and died in 1959. David Carr succumbed to an immune disease that very closely resembled typical HIV-AIDS progression. Yet, testing of his samples, while at first seeming positive for the virus, could not be repeated and hence will remain a mystery.
An event known to biologists as Zoonosis, which is where a microbial disease jumps from one species to another, must have occurred for SIV to form HIV. This is the same process that allowed swine flu to go from infecting pigs to humans. It is not yet known how HIV jumped the species gap, but, again contrary to bigoted ideas, it is unlikely to have been due to bestiality.
Since its discovery, HIV has played a massive role in biological research. Many labs around the world have been working since the late 1980s on a cure and more effective treatments. Mercifully, the actual rate of HIV infection has begun to decline since it was first discovered. This is mainly due to the actions of many groups working to educate and treat people with the disease. While it is currently not possible to cure a person of HIV, excluding the recent bone marrow patient, treatment of the virus has progressed to a great extent in recent years. We are able to greatly reduce the likelihood that a HIV positive mother will pass on the virus to her unborn child, allowing HIV positive mothers to give birth to HIV free children. If you are not impressed with that go back and read that last sentence again and think about the implications. This is something that I, as a biologist, am truly proud of.
It’s all thanks to the current drugs available. The anti-retrovirals in today’s clinics are among the most fascinating drugs ever developed and anyone who takes an interest in biology and drug design would be impressed by their function. Furthermore, the current antiretroviral drugs are so effective at treating people with the virus that the life expectancy of someone with HIV is now only around 5 years off that of any other person alive today. This is the root of the claim that AIDS is no longer a death sentence.
I doubt there will ever be a time when all STDs are “conquered” by science. Diseases change and evolve all the time and while we might make strides in reducing and curtailing some STDs with medical breakthroughs, in some way they are monsters of our own making. Thankfully, they can all be readily screened for and highly effective means of preventing them from being transmitted already exist.
(Image courtesy of Juan Pablo Colasso)