Editorial

Syphilis 100 years later: Another lost opportunity?

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According to a report from the US Centers for Disease Control and Prevention (CDC) on the incidence of sexually transmitted diseases (STDs), “Total combined cases of chlamydia, gonorrhea, and syphilis reported in 2015 reached the highest number ever”1 since the CDC was founded in July 1946.

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Nearly 24,000 cases of primary and secondary syphilis were reported in 2015, a 19% increase from the previous year. And Dr. Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, reported, “We have reached a decisive moment for the nation. STD rates are rising, and many of the country’s systems for preventing STDs have eroded. We must mobilize, rebuild, and expand services—or the human and economic burden will continue to grow.”1

Dr. Mermin stressed the need to rebuild services because, “In recent years more than half of state and local STD programs have experienced budget cuts, resulting in more than 20 health department STD clinic closures in one year alone. Fewer clinics mean reduced access to STD testing and treatment for those who need these services.”1

The CDC also reports that STD treatment costs the US healthcare system nearly $16 billion each year.

The CDC has identified several players whose engagement is necessary to stem the tide of this epidemic:

  • Providers must make STD screening a standard part of medical care, especially in pregnant women, and integrate STD prevention and treatment into prenatal care and other routine visits.
  • People need to talk openly about STDs, get tested regularly, and reduce risk by using condoms or practicing mutual monogamy if sexually active.
  • Parents and providers need to offer young people safe, effective ways to get information and services.
  • State and local health departments should continue to direct resources to people hardest hit by the STD epidemic and work with community partners to maximize their impact.1

STD CAMPAIGNS 100 YEARS AGO

This message sounds familiar. Let’s go back 100 years to World War I. The book No Magic Bullet by Allan M. Brandt2 provides fascinating details about this period in America’s battle against venereal diseases. While the book is well worth reading in its entirety, I will attempt here to summarize the pertinent facts.

In the late 1910s, antivenereal campaigns were in full swing, with publicly shown movies such as “Fit to Fight” to train soldiers about STD symptoms and prevention to keep them physically healthy for fighting in the war. Similar information was widely available stateside for both men and women in open, matter-of-fact formats to encourage STD prevention.

After the war ended, the national sentiment became split between sexual revolution and social moralism. “Social hygienists” blamed the widespread increase in promiscuity on the newly introduced sexually explicit philosophy of Sigmund Freud, the widespread availability of automobiles (ie, a mobile, private, backseat location for sex), popular “vulgar” dances, and social feminism, among many others. The sexual revolution clearly led to an increased risk of STDs. But the antivenereal campaigns that had been appropriate in wartime came to be considered amoral and unfit for public consumption, and a period of silence about venereal diseases ensued.

By the 1930s, the situation had worsened:

  • Approximately 1 out of every 10 Americans suffered from syphilis.
  • Each year, Americans contracted almost half a million new syphilis infections (twice as many cases as tuberculosis, and 100 times as many cases as polio).
  • 18% of all deaths from organic heart disease could be attributed to syphilis.
  • Up to 20% of all mental institution inmates suffered from tertiary syphilis.
  • 60,000 children were born each year with congenital syphilis.2

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