You'd be forgiven for thinking that the most common sexually transmitted infections started with a bang. However, the history of STIs is far more opaque and shrouded in mystery than you might expect. While the origins of HIV is incredibly well documented, let's explore the murky and somewhat grim past of chlamydia, gonorrhea, and syphilis. First of all, let's lay down the differences between STIs and STDs. Having an STI means that a person is infected, but that doesn’t necessarily mean it has yet developed into the disease. Many women, for example, carry with them HPV and remain asymptomatic. Only if it were to develop further, such as into cervical cancer, would they then have an STD. Chlamydia There are two main forms of the condition, both caused by the bacterium Chlamydia trachomatis – one affects the eyes and the other infects the genitals. The earliest description of chlamydia infecting the eyes – known technically as trachoma – goes back to 1553 BCE, with an Ebers papyrus from Egypt referencing the condition. It is thought that humans have been dealing with the bacterium for a long time and that when civilizations pushed people into increasingly dense population centers, the disease spread. The cause of trachoma was only identified as C. trachomatis in 1907 when Halberstaedter and von Prowazek experimentally infected orangutans in Java. However, for many decades following this, it was misidentified as a virus, confusing the picture somewhat. An Ancient Egyptian tomb showing blind singers who likely had trachoma. It would be another 50 years before the bacterium was first isolated, finally allowing detailed structural and morphological studies of the isolate to take place. In the 1990s, genetics finally showed that there were multiple species and that C. trachomatis likely split from its last common ancestor an astonishing 700 million years ago. Unfortunately, there is no accurate evolutionary clock in the bacteria, meaning anything more precise cannot be determined. But given its deep ancient origin, it may well have evolved with humans as a species from the very beginning. It is only recently that it was acknowledged as a sexually transmitted infection, of which it is one of the most common. Globally, there are around 61 million new cases, with 4.2 percent of women and 2.7 percent of men infected. In the US, around 1.4 million cases were reported in 2014, with women roughly twice as likely to have chlamydia as men. Gonorrhea Infections of gonorrhea have been known about since at least the Medieval period, but it was not until the 17th century that people understood that the discharge from the penis was not semen but pus. In fact, the word “gonorrhea” even means “flow of seed” due to this early misunderstanding. However, some have argued that mentions in the Torah of "zav" and "zavah" are actually talking about gonorrhea. One of the first solid references to the disease is in 1161 in the Acts of the English Parliament, which describes a law to reduce the spread of “the perilous infirmity of burning”. It is thought it was around this period that the disease became an epidemic in Europe. Because of the high prevalence of the condition, doctors were not allowed to refuse patients thought to be infected. Treatment involved injections of mercury into the penis using a very early syringe, eventually moving on to silver nitrate. It was around the 16th century that the term “the clap” was also used to describe the condition, although no one is exactly sure where this originates. One suggestion is due to a “clapping” (an old term for burning) sensation felt when infected people peed, although others prefer the story that it is derived from the old French word for prostitute: “clapier”. If women infected with gonorrhea give birth, their newborns can get gonococcal ophthalmia neonatorum. As early as 1878, Albert Neisser managed to isolate the bacterium responsible. It was named Neisseria gonorrhoeaei in his (dubious) honor after it was proved to be the causative agent of gonorrhea. This was determined by the intentional infection of medical students, prisoners, and mental patients over the years. It wasn’t until the 1940s that a reliable treatment emerged in the form of penicillin. Today, it is thought that somewhere between 33 and 106 million new cases of the disease occur worldwide, equating to around 0.8 percent of women and 0.6 percent of men. Syphilis The exact origin of syphilis is actually unknown, but there are two leading theories. One states that it was endemic to the Americas, and when Christopher Columbus returned to Europe in 1492 from his travels to the New World, his infected crew brought it back as an unfortunate stowaway. The other is that the disease was already prevalent across much of the world but simply went unrecognized, probably lumped together with leprosy. The first major outbreak of syphilis occurred among French troops in Naples in 1495, earning it the moniker the “French disease” (although the French decided to call it the “Italian disease”). By the start of the 20th century, it is thought that as many as 10 percent of Londoners, 15 percent of Parisians, and 20 percent of US army recruits had the disease, which causes rashes and sores on the palms of the hands and feet, and in serious cases tumor-like growths all over the body. A man with advanced syphilis, taken in 1905. Wellcome Collection It was in 1905 that the causative bacterium Treponema pallidum was first identified, but it was not until the development of antibiotics that the levels of infection could finally be brought under some control. That said, syphilis is still a major problem with around 45 million people thought to be infected globally in 2015. Recent advances in genetics, however, have helped shed some light on where the disease may have come from. The bacterium is actually a subspecies, T. pallidum pallidum, alongside the bacterium that causes yaws (T. pallidum pertenue) and bejel (T. pallidum endemicum). By collecting strains of all three subspecies, researchers could build a family tree of the bacterium and trace the origin of syphilis back to the non-sexually transmitted yaws, specifically a strain collected from indigenous children in remote Guyana, South America. Unfortunately, if you thought this settled the matter of where syphilis came from, then you might not be too happy to learn that even the authors of that analysis can’t say for sure. They admit their sample size was small due to a limited availability of specimens and that they were mostly derived from American strains. Whether its the French disease or the Italian, the history of sexually transmitted diseases is fascinating and disturbing in equal measure. But let's just all be glad we've moved on from injecting mercury up the penis. It turns out that the non-sexually transmitted disease yaws is a subspecies of the same bacteria that causes syphilis. CDC A URETHRAL DILATOR FROM THE BEGINNING OF THE 20TH CENTURY, USED TO TREAT GONORRHEA IN LONDON. Source
