WORLD OF MICROBIOLOGY AND IMMUNOLOGY Sexually transmitted diseases (STDs)511•
more than four months dormant before it showed itself.”
Cellini’s reference to syphilis as the “French disease” was typ-
ical 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 (1800–1889) reported that
syphilis and gonorrhea were separate illnesses. The late nine-
teenth 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.
Further advances occurred quickly. August von
Wassermann (1866–1925) developed a blood test for syphilis
in 1906, making testing for syphilis a simple procedure for the
first time. Just four years later in 1910, the first effective ther-
apy for syphilis was introduced in the form of Salvarsan, an
organic arsenical compound. The compound was one of many
effective compounds introduced by the German physician
Paul Ehrlich(1854–1915), whose argument that specific drugs
could be effective against microorganismshas proven correct.
The drug is effective against syphilis, but it is toxic and even
fatal to some patients.
The development of Salvarsan offered hope for individ-
uals with syphilis, but there was little public understanding
about how syphilis was transmitted in the early twentieth cen-
tury. In the United States, this stemmed in part from govern-
ment enforcement of laws prohibiting public discussion of
certain types of sexual information. One popular account of
syphilis from 1915 erroneously warned that one could develop
syphilis after contact with whistles, pens, pencils, toilets, and
toothbrushes.
In a tragic chapter in American history, some members
of the U.S. Public Health Service exploited the ignorance of
the disease among the general public as late as the mid-twen-
tieth century in order to study the ravages of untreated
syphilis. The Tuskegee Syphilis Study was launched in 1932
by the U.S. Public Health Service. The almost 400 black men
who participated in the study were promised free medical care
and burial money. Although effective treatments had been
available for decades, researchers withheld treatment, even
when penicillin became available in 1943, and carefully
observed the unchecked progress of symptoms. Many of theparticipants fathered children with congenital syphilis, and
many died. The study was finally exposed in the media in the
early 1970s. When the activities of the study were revealed, a
series of new regulations governing human experimentation
were passed by the government.
A more public discussion of sexually transmitted dis-
ease was conducted by the military during World Wars I and
II. During both wars, the military conducted aggressive public
information campaigns to limit sexually transmitted disease
among the armed forces. One poster from World War II
showed a grinning skull on a woman dressed in an evening
gown striding along with German Chancellor Führer Adolf
Hitler and Japanese Emperor Hirohito. The poster’s caption
reads “V.D. Worst of the Three,” suggesting that venereal dis-
ease could destroy American troops faster than either of
America’s declared enemies.
Concern about the human cost of sexually transmitted
disease helped make the production of the new drug penicillin
a wartime priority. Arthur Fleming (1881–1955), who is cred-
ited with the discovery of penicillin, first observed in 1928
that the penicillium moldwas capable of killing bacteria in the
laboratory; however, the mold was unstable and difficult to
produce. Penicillin was not ready for general use or general
clinical testing until after Howard Florey (1898–1968) and
Ernst Boris Chain(1906–1979) developed ways to purify and
produce a consistent substance.
The introduction of penicillin for widespread use in
1943 completed the transformationof syphilis from a
life–threatening disease to one that could be treated relatively
easily and quickly. United States rates of cure were 90–97%
for syphilis by 1944, one year after penicillin was first distrib-
uted in the country. Death rates dropped dramatically. In 1940,
10.7 out of every 100,000 people died of syphilis. By 1970, it
was 0.2 per 100,000.
Such progress infused the medical community with
optimism. A 1951 article in the American Journal of Syphilis
asked, “Are Venereal Diseases Disappearing?” By 1958, the
number of cases of syphilis had dropped to 113,884 from
575,593 in 1943, the year penicillin was introduced.
Venereal disease was not eliminated, and sexually trans-
mitted diseases continue to ravage Americans and others in the
1990s. Though penicillin has lived up to its early promise as
an effective treatment for syphilis, the number of cases of
syphilis has increased since 1956. In addition, millions of
Americans suffer from other sexually transmitted diseases,
many of which were not known a century or more ago, such
as Acquired Immune Deficiency Syndrome (AIDS) caused by
the HIVvirus. By the 1990s, sexually transmitted diseases
were among the most common infectious diseases in the
United States.
Some sexually transmitted diseases are seen as growing
at epidemic rates. For example, syphilis, gonorrhea, and chan-
croid, which are uncommon in Europe, Japan and Australia,
have increased at epidemic rates among certain urban minor-
ity populations. A 1990 study found the rate of syphilis was
more than four times higher among blacks than among whites.
The Public Health Service reports that as many as 30 million
Americans have been affected by genital herpes. Experts havewomi_S 5/7/03 8:20 AM Page 511