Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum. The signs and symptoms depend on the stage it presents: primary, secondary, latent or tertiary. The primary stage classically presents with a single chancre though there may be multiple sores. In secondary syphilis, a diffuse rash occurs, which frequently involves the palms of the hands and soles of the feet. There may also be sores in the mouth or vagina. Latent syphilis has no symptoms and can last years. In tertiary syphilis, there are gummas, neurological problems, or heart symptoms. Syphilis has been known as "the great imitator" because it may cause symptoms similar to many other diseases.
The Tuskegee Study of Untreated Syphilis in the Negro Male was a study conducted between 1932 and 1972 by the United States Public Health Service (PHS) and the Centers for Disease Control and Prevention (CDC) on a group of nearly 400 African American men with syphilis. The purpose of the study was to observe the effects of the disease when untreated, though by the end of the study medical advancements meant it was entirely treatable. The men were not informed of the nature of the experiment, and more than 100 died as a result.
The Wassermann test or Wassermann reaction (WR) is an antibody test for syphilis, named after the bacteriologist August Paul von Wassermann, based on complement fixation. It was the first blood test for syphilis and the first in the nontreponemal test (NTT) category. Newer NTTs, such as the RPR and VDRL tests, have mostly replaced it. During the mid-20th century, in many jurisdictions, including most US states, applicants for a marriage license were required by law to undergo a Wassermann test.
A marriage license is a document issued, either by a religious organization or state authority, authorizing a couple to marry. The procedure for obtaining a license varies between jurisdictions, and has changed over time. Marriage licenses began to be issued in the Middle Ages, to permit a marriage which would otherwise be illegal.
Albert Ludwig Sigesmund Neisser was a German physician who discovered the causative agent (pathogen) of gonorrhea, a strain of bacteria that was named in his honour.
A vertically transmitted infection is an infection caused by pathogenic bacteria or viruses that use mother-to-child transmission, that is, transmission directly from the mother to an embryo, fetus, or baby during pregnancy or childbirth. It can occur when the mother has a pre-existing disease or becomes infected during pregnancy. Nutritional deficiencies may exacerbate the risks of perinatal infections. Vertical transmission is important for the mathematical modelling of infectious diseases, especially for diseases of animals with large litter sizes, as it causes a wave of new infectious individuals.
Sexual health clinics specialize in the prevention and treatment of sexually transmitted infections.
Neurosyphilis is the infection of the central nervous system in a patient with syphilis. In the era of modern antibiotics, the majority of neurosyphilis cases have been reported in HIV-infected patients. Meningitis is the most common neurological presentation in early syphilis. Tertiary syphilis symptoms are exclusively neurosyphilis, though neurosyphilis may occur at any stage of infection.
Marriage law is the body of legal specifications and requirements and other laws that regulate the initiation, continuation, and validity of marriages, an aspect of family law, that determine the validity of a marriage, and which vary considerably among countries in terms of what can and cannot be legally recognized by the state.
Venereology is a branch of medicine that is concerned with the study and treatment of sexually transmitted diseases (STDs). The name derives from Roman goddess Venus, associated with love, beauty and fertility. A physician specializing in venereology is called a venereologist. In many areas of the world, the specialty is usually combined with dermatology.
A nontreponemal test (NTT) is a blood test for diagnosis of infection with syphilis. Nontreponemal tests are an indirect method in that they detect biomarkers that are released during cellular damage that occurs from the syphilis spirochete. In contrast, treponemal tests look for antibodies that are a direct result of the infection thus, anti-treponeme IgG, IgM and to a lesser degree IgA. Nontreponemal tests are screening tests, very rapid and relatively simple, but need to be confirmed by treponemal tests. Centers for Disease Control and Prevention (CDC)-approved standard tests include the VDRL test, the rapid plasma reagin (RPR) test, the unheated serum reagin (USR) test, and the toluidine red unheated serum test (TRUST). These have mostly replaced the first nontreponemal test, the Wassermann test.
Gonorrhoea or gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. Infection may involve the genitals, mouth, or rectum. Infected males may experience pain or burning with urination, discharge from the penis, or testicular pain. Infected females may experience burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain. Complications in females include pelvic inflammatory disease and in males include inflammation of the epididymis. Many of those infected, however, have no symptoms. If untreated, gonorrhea can spread to joints or heart valves.
A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, oral sex, or sometimes manual sex. STIs often do not initially cause symptoms, which results in a risk of transmitting them on to others. The term sexually transmitted infection is generally preferred over sexually transmitted disease or venereal disease, as it includes cases with no symptomatic disease. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. Some STIs can cause infertility.
The Public Health Advisor, or "PHA" is a type of public health worker which was established in 1948 by the United States Public Health Service in the Venereal Disease Control Division. Today they are hired primarily by the U.S. Centers for Disease Control and Prevention (CDC) and serve in many public health programs. This type of worker is unique in public health, because they begin their service at the entry level of public health doing what is known as "field work" or "contact epidemiology" which refers to the interviewing and locating of people who have been exposed to an infectious disease so as to offer them treatment and to reduce the epidemic. Following their initial work experiences, PHAs are exposed to a variety of public health programs across the United States, learning to function at all levels of the public health system. During their time of service, PHAs are called upon to respond to public health or humanitarian crisis. This article will briefly describe the history of the Public Health Advisor and will mention a few notable contributions made over the course of their history with the Public Health Service and later with the Centers for Disease Control and Prevention.
The Guatemala syphilis experiments were United States-led human experiments conducted in Guatemala from 1946 to 1948. The experiments were led by physician John Charles Cutler, who also participated in the late stages of the Tuskegee syphilis experiment. Doctors infected 1,300 people, including at least 600 soldiers and people from various impoverished groups with syphilis, gonorrhea, and chancroid, without the informed consent of the subjects. Only 700 of them received treatment. In total, 5,500 people were involved in all research experiments, of whom 83 died by the end of 1953, though it is unknown whether or not the injections were responsible for all these deaths. Serology studies continued through 1953 involving the same vulnerable populations in addition to children from state-run schools, an orphanage, and rural towns. However, the intentional infection of patients ended with the original study.
John Charles Cutler was a senior surgeon, and the acting chief of the venereal disease program in the United States Public Health Service. He is known for leading several controversial and unethical human experiments of syphilis, done under the auspices of the Public Health Service. He willfully spread syphilis and gonorrhea to unwitting patients including soldiers, prisoners, adults with leprosy, mental patients and orphan children as young as nine in the Guatemala syphilis experiments. He also conducted the Tuskegee syphilis experiments, in which African American men, not informed of the nature of the experiment, were deliberately denied treatment for syphilis.
Applicants for immigration into the United States must meet certain medical standards, as assessed by the Report of Medical Examination and Vaccination Record (I-693). The purpose of the medical exam is to ensure that an applicant is “not inadmissible to the United States on public health grounds." Inadmissibility is defined in Act 212 of the Immigration and Nationality Act (INA). Accordingly, an alien is inadmissible if he or she has a communicable disease of public health significance, lacks the required vaccines, is a drug abuser or addict, or has a physical or mental disorder with a behavior, or history of a behavior, that is a threat to “the property, safety, or welfare of the alien or others”.
The outbreaks of sexually transmitted infections in World War II brought interest in sex education to the public and the government. During the late 1930s and early 1940s, military maneuvers increased worldwide and sexual hygiene and conduct became major problems for the troops. Soldiers and sailors on assignment overseas were often lonely, had time to spare, got homesick, or were just looking for female companionship. This resulted in many men having multiple sex partners, and as a result, became a major health concern. During the Great War, venereal diseases (V.D.) had caused the United States Army to lose 18,000 servicemen per day. Although by 1944, this number had been reduced 30-fold, there were still around 606 servicemen incapacitated daily. This drop in numbers was partly because of the Army's effort to raise awareness about the dangers faced by servicemen through poor sexual hygiene, and also because of the important developments in medicine. In late 1943, a case of gonorrhea required a hospital treatment of 30 days, and curing syphilis remained a 6-month ordeal. By mid-1944, the average case of gonorrhea was reduced to 5 days, and in many cases the patient remained on duty while being treated.
John Friend Mahoney was an American physician best known as a pioneer in the treatment of syphilis with penicillin. He won the 1946 Lasker Award.
The Terre Haute prison experiments were conducted by Dr. John C. Cutler in 1943 and 1944 under Dr. John F. Mahoney, the head of the Venereal Disease Research Laboratory of the US Public Health Service, to determine the effectiveness of treatments for sexually transmitted diseases. The experiment focused on creating prophylaxis treatments for gonorrhea. The test subjects were prisoners at the U.S. Penitentiary in Terre Haute, Indiana. They were given disclosures and consented to the experiments. A total of 241 prisoners participated in the study and received $100, a certificate of merit, and a letter of commendation to the parole board at the end of the study. The researchers deposited various strains and concentrations of gonorrhea into the penises of the test subjects. After several months, Mahoney noted that the method of inducing gonorrhea in humans was unreliable and could not provide meaningful tests of prophylactic agents.
