Colliding Bodies: Prostitutes, Soldiers, and Venereal Diseases in Colonial Egypt.

This article explores attempts to control outbreaks of venereal diseases among prostitutes and imperial soldiers in Cairo and Alexandria leading up to and through World War I. Seeking to move beyond the usual colonial framing of center-periphery, it considers two British imperial outposts-Egypt and Australia-in conversation. The war brought thousands of Australian soldiers to Egypt, leaving their mark on Egypt and becoming marked by their time there, sometimes in indelible and deadly ways, as bodies and bodily fluids collided, and microbes passed between colonial and imperial subjects. The article argues that the highly racialized and classed system for regulating foreign and local prostitution that British officials implemented in Egypt to protect soldiers exacerbated rather than contained the spread of venereal diseases.

Noddle Pox: Syphilis and the Conception of Nosomania/Nosophobia (c. 1665-c. 1965).

Hypochondriac or phobic reactions to venereal disease, specifically syphilis, have invited over three centuries of medical reification and nosological reframing. This bibliographic overview establishes that the early specification and psychiatricization of early modern concepts of melancholy and hypochondriasis, imaginary syphilis or syphilophobia, animated the early respective territorializations of venereology, infectiology more broadly, neurology, and mental medicine. Together with mercuriophobia and a wider emergent clinical sensitivity to sexual angst, the diagnosis, while evidently only sporadically made, functioned as a durable soundboard in the confrontation of emergent medical rationale with various confounders and contenders: medically literate and increasingly mobile but possibly deluded patients; charlatans and putative malpractitioners; self-referral laboratory serology (after 1906); and eventually, through psychoanalysis, the patient's unconscious. Requiring medical psychology early on, syphilology became and remained self-conscious and circumspect, attentive to the casualties of overdiagnosis, overtreatment, and iatrogenesis. Finally, patient apprehension led to makeshift forms of "moral treatment," including fear-instilling and placebos.

Availability of Injectable Antimicrobial Drugs for Gonorrhea and Syphilis, United States, 2016.

We estimated the availability of the injectable antimicrobial drugs recommended for point-of-care treatment of gonorrhea and syphilis among US physicians who evaluated patients with sexually transmitted infections in 2016. Most physicians did not have these drugs available on-site. Further research is needed to determine the reasons for the unavailability of these drugs.

100 years of STIs in the UK: a review of national surveillance data.

OBJECTIVES: The 1916 Royal Commission on Venereal Diseases was established in response to epidemics of syphilis and gonorrhoea in the UK. In the 100 years since the Venereal Diseases Act (1917), the UK has experienced substantial scientific, economic and demographic changes. We describe historical and recent trends in STIs in the UK. METHODS: We analysed surveillance data derived from STI clinics' statistical returns from 1917 to 2016. RESULTS: Since 1918, gonorrhoea and syphilis diagnoses have fluctuated, reflecting social, economic and technological trends. Following spikes after World Wars I and II, rates declined before re-emerging during the 1960s. At that time, syphilis was more common in men, suggestive of transmission within the men who have sex with men (MSM) population. Behaviour change following the emergence of HIV/AIDS in the 1980s is thought to have facilitated a precipitous decline in diagnoses of both STIs in the mid-1980s. Since the early 2000s, gonorrhoea and syphilis have re-emerged as major public health concerns due to increased transmission among MSM and the spread of antimicrobial-resistant gonorrhoea. Chlamydia and genital warts are now the most commonly diagnosed STIs in the UK and have been the focus of public health interventions, including the national human papillomavirus vaccination programme, which has led to substantial declines in genital warts in young people, and the National Chlamydia Screening Programme in England. Since the 1980s, MSM, black ethnic minorities and young people have experienced the highest STI rates. CONCLUSION: Although diagnoses have fluctuated over the last century, STIs continue to be an important public health concern, often affecting more marginalised groups in society. Prevention must remain a public health priority and, as we enter a new era of sexual healthcare provision including online services, priority must be placed on maintaining prompt access for those at greatest risk of STIs.

Effective Reparation for the Guatemala S.T.D. Experiments: A Victim-Centered Approach.

Discussion of reparations for U.S.-Guatemala STD experiments of the 1940s and 50s should be informed by a range of international and U.S. reparation experiences, so that features that impair the effectiveness of repair are avoided, and features that enhance effectiveness of repair are emulated. Two features have contributed to the effectiveness or ineffectiveness of repair elsewhere but have not been critically examined in relation to the Guatemalan experiments: Whether experimental subjects or their families have the opportunity to participate in reparations processes, and whether any group of experimental subjects is intentionally denied recognition. Three advantages of victim participation are explored, and a critique provided of one narrow delimitation of victims. Even if political and moral failings ultimately prevent reparations for Guatemalan experimental subjects, an emphasis on effectiveness and victim-centeredness should nonetheless shape reparations for other, future victims of human rights abuses in experimentation.

Despite Being "Known, Highly Promiscuous and Active": Presumed Heterosexuality in the USPHS's STD Inoculation Study, 1946-48.

The Sexually Transmitted Disease Inoculation Study of the United States Public Health Service (USPHS) was a short-term deliberate exposure experiment into the prevention of venereal diseases. Between 1946 and 1948, over 1,300 Guatemalan prisoners, psychiatric patients, soldiers, and sex workers were exposed to syphilis, gonorrhoea, and chancroid. USPHS researchers initially proposed hiring sex workers to "naturally" transmit venereal diseases to male subjects who would then be given various prophylaxes. The researchers were interested in studying the effectiveness of new preventative measures. In other words, the USPHS study was designed to transmit venereal diseases heterosexually from an "infected" female body to the men who, it was assumed, were sexually isolated subjects. However, the researchers did record instances of male-to-male disease transmission among their subject populations, instances that challenged the presumption of heterosexuality on which the study was based.

Increased Sexually Transmitted Disease Testing Among Sexually Active Persons Receiving Medical Care for Human Immunodeficiency Virus Infection in the United States, 2009-2013.

Background: Current guidelines recommend that all sexually active human immunodeficiency virus (HIV)-infected persons be tested at least annually for syphilis, chlamydia, and gonorrhea. We examined temporal trends in syphilis, chlamydia, and gonorrhea testing among sexually active HIV-infected adults receiving medical care in the United States during 2009-2013. Methods: Using medical record data from the Medical Monitoring Project, a population-based HIV surveillance system, we assessed the proportion of adults receiving HIV medical care who were tested for syphilis, chlamydia, and gonorrhea in the past 12 months by year and stratified by sex and sexual behavior, age, and race/ethnicity. Results: During 2009-2013, the proportion of sexually active HIV-infected adults receiving medical care who were tested in the past year for all 3 examined sexually transmitted diseases (STDs) increased from 20% to 36% (PTREND < .01). Overall testing for syphilis increased from 55% to 65% (PTREND < .01), and significant increases were noted for the following subgroups: men who have sex with men (58% to 69%), non-Hispanic whites (48% to 64%), and all age groups with the exception of persons aged 18-29 year. Overall testing for chlamydia and gonorrhea increased from 22% to 42% (PTREND < .01), and significant increases were noted for most subgroups. Conclusions: STD testing significantly increased among sexually active HIV-infected adults receiving medical care; however, the majority of persons were not tested for all 3 STDs in 2013. While increased testing indicates progress, testing remained far below recommended guidelines. Our findings suggest enhanced efforts may be warranted to screen all sexually active HIV-infected adults for syphilis, chlamydia, and gonorrhea.

Increase in Urgent Care Center Visits for Sexually Transmitted Infections, United States, 2010-2014.

During 2010-2014, urgent care centers saw a ≈2-fold increase in the number of visits for chlamydia and gonorrhea testing and a >3-fold increase in visits by persons with diagnosed sexually transmitted infections. As urgent care becomes more popular, vigilance is required to ensure proper management of these diseases.

Linking Public Health and Individual Medicine: The Health Policy Approach of Surgeon General Thomas Parran.

Surgeon General Thomas Parran Jr was once viewed as a path-breaking leader, but his legacy is now highly contested. Scholars of national health insurance have viewed Parran as an impediment to government-backed insurance, and revelations about his role in the Tuskegee Study and in the Public Health Service's experiments in Guatemala have cast a shadow over his career. Surgeon General from 1936 to 1948, Parran led the Public Health Service during the development of key features of the modern American health system and was involved in critical debates over the role of the national government in health. I argue that Parran is best understood not as an opponent of insurance but as the proponent of an approach to health policy that sought to link public health and individual medicine. A pragmatic bureaucrat, Parran believed that effective policymaking required compromise with the American Medical Association.

Safe Sex in the 1970s: Community Practitioners on the Eve of AIDS.

In the 1970s, groups of gay and gay-allied health professionals began to formulate guidelines for safer sexual activity, several years before HIV/AIDS. Through such organizations as the National Coalition of Gay Sexually Transmitted Disease Services, Bay Area Physicians for Human Rights, and the Sisters of Perpetual Indulgence, these practitioners developed materials that would define sexual health education for the next four decades, as well as such concepts as "bodily fluids" and the "safe sex hanky." To do so, they used their dual membership in the community and the health professions. Although the dichotomy between the gay community and the medical establishment helped define the early history of HIV/AIDS, the creative work of these socially "amphibious" activists played an equally important part. Amid current debates over preexposure prophylaxis against HIV and Zika virus transmission, lessons for sexual health include the importance of messaging, the difficulty of behavioral change, and the vitality of community-driven strategies to mitigate risk.

Treating the Secret Disease: Sex, Sin, and Authority in Eighteenth-Century Venereal Cases.

This article looks at cases of venereal disease from the early 1700s and how healers presented themselves as shrewd interpreters of patients' bodies and souls. Because the disease was so stigmatizing, patients were said to be unreliable narrators of their own symptoms and health histories. Practitioners, in turn, exhibited diagnostic expertise by sagely navigating such constraints. They characterized themselves as medical detectives who gathered clues and made diagnoses in spite of patients' alleged lies and omissions. Such work entailed moral integrity, astute observations, and the ability to persuade patients to divulge their most shameful sexual secrets. These findings illuminate how a particular disease shaped constructions of medical expertise, as well as the details of early modern medical practice that we rarely have the privilege of seeing.

Medical and Social Aspects of Syphilis in the Balkans from the mid-19th Century to the Interwar.

The current study presents some aspects of syphilis in the Balkan Peninsula from the 19th century until the Interwar. Ever since the birth of modern Balkan States (Greece, Bulgaria, Turkey and Serbia), urbanization, poverty and the frequent wars have been considered the major factors conducive to the spread of syphilis. The measures against sex work and sexually transmitted diseases (STDs) were taken in two aspects, one medical and the other legislative. In this period, numerous hospitals for venereal diseases were established in the Balkan countries. In line with the international diagnostic approach and therapeutic standards, laboratory examinations in these Balkan hospitals included spirochete examination, Wassermann reaction, precipitation reaction and cerebrospinal fluid examination. Despite the strict legislation and the adoption of relevant laws against illegal sex work, public health services were unable to curb the spread of syphilis. Medical and social factors such as poverty, citizen's ignorance of STDs, misguided medical perceptions, lack of sanitary control of prostitution and epidemiological studies, are highlighted in this study. These factors were the major causes that helped syphilis spread in the Balkan countries during the 19th and early 20th century. The value of these aspects as a historic paradigm is diachronic. Failure to comply with the laws and the dysfunction of public services during periods of war or socioeconomic crises are both factors facilitating the spread of STDs.

How World War 1 changed global attitudes to war and infectious diseases.

World War 1 was a key transition point towards scientific medicine. Medical officers incorporated Louis Pasteur's discoveries into their understanding of microorganisms as the cause of infectious diseases, which were therefore susceptible to rational control and treatment measures even in the pre-antibiotic era. Typhoid vaccination led to the successful evasion of the disastrous epidemics of previous wars. The incidence of tetanus was probably decreased by giving millions of doses of horse antitoxin to wounded soldiers. Quinine treated but could not control malaria; its use required mass compulsion. Tuberculosis was not a great military problem during World War 1, although mortality in civilian populations increased substantially. Treatment of sexually transmitted infections remained a matter of aversive conditioning, with invasive antiseptics used in the absence of antibiotics. Pandemic influenza in 1918-19 killed more people than died during the entire war, showing how much remained beyond the capability of the scientists and doctors who fought infectious diseases during World War 1.

"A word from man to man". Interwar Venereal Disease Education Films for Military Audiences in France.

In the 1910s, in the wake of the glorious decade of syphilography (1900-1910), the early health education films lay the groundwork for a pragmatic approach to the containment of venereal diseases combining (early) diagnosis, treatment and prophylaxis. Realizing that WWI was turning into a durable military conflict, the French Army created a Cinematographic Section (SCA) in 1915 for the purposes of war propaganda and documentation. In 1916, secretary of war Justin Godard declared syphilis a "national public danger" and initiated information campaigns in military and civilian spheres. Conferences accompanied with film screenings were organized for all new military recruits, resulting in the production of a series sex hygiene films for military audiences characterized by a short, evocative and precise documentary style, contrasting with the romantic sex hygiene films aimed at the general public. This contribution examines the cinematographic origins of the instructional films for the military, as well as their evolution up to WWII and their influence on public sex hygiene films for civilians in the interwar period in France.

Mapping the war: gender, health, and the medical profession in France and Germany, 1914-1918.

This article compares the gender and health politics of the German and the French medical professions, which incorporated military command structures into their civilian self-conception. Mobilized doctors committed themselves to the new circumstances and opportunities offered by the war. They applied the established military spatial 'map' which distinguished between the male-dominated front and the female-dominated home front and turned it into an epidemiological map, identifying danger zones which arose from points of contact between men and women. The analysis singles out two case studies: the rapid spread of venereal disease and psychiatric disorders. These case studies allow for a comparative analysis of the following questions: How did doctors assess the impacts of the war on the individual and the society as a whole? How did they view the war's impact on conventional gender orders, individual and national health? And how did they see their own role as a part of an independent civilian profession?

The best possible intentions testing prophylactic approaches on humans in developing countries.

Debates on human experiments in developing countries focus on ethical principles such as informed consent, accountability, involvement of the concerned communities, and the improvement of local health services. Public health specialists who conducted human experiments in Rio de Janeiro (1902-1905) and in Guatemala (1947-1948) believed, however, that they were acting in the best interests of local populations, were aware of the importance of informed consent, were closely collaborating with local health professionals, and were contributing to the development of local health structures. Nevertheless, their investigations went dramatically wrong. An initial desire to conduct ethically and scientifically sound studies was undermined by pressure to obtain results and to save the researchers' initial investment, the possibility of freely using hospitalized patients as experimental participants, uncritical help from local professional elites, and structural pitfalls of experimenting with severely deprived people. These elements can still be found in trials of preventive methods in the Global South.

Epidemiology of sexually transmissible infections in New South Wales: are case notifications enough?

BACKGROUND: Surveillance of sexually transmissible infections (STI)s is important to assess the disease burden in the population and to monitor and evaluate changes in trends over time. Routinely collected surveillance data in New South Wales are reliant on case reporting, which for many infections is an inadequate mechanism for capturing incidence and prevalence. Increasing rates of chlamydia over the past decade have sparked intense debate as to whether the current notification system is optimal and whether the true burden of infection are being measured. This study describes the current surveillance for STIs in New South Wales. METHODS: New South Wales-specific data for the years 2000-2009 were analysed. Notification data were used to examine the rate of the 4 STIs that are notifiable in New South Wales; chlamydia, gonorrhoea, infectious syphilis and HIV notifications. Hospital admissions and chlamydia-associated pelvic inflammatory disease were analysed using admitted patient data. RESULTS: Chlamydia was the most frequently reported of the notifiable STIs in New South Wales. Despite the higher rates of notification compared with other STIs, chlamydia-related hospitalisations contribute less than a 5th of all STI-related hospital admissions. Infectious syphilis contributed to the highest proportion of all STI-related hospitalisations in New South Wales and rates increased from 2000 to 2009. For other STIs such as anogenital herpes and gonorrhoea, hospital admissions remained stable for the same period. CONCLUSIONS: Notifications data for STIs should be complemented with hospital admission and other data sources to better describe STI morbidity. A synthesis of these data sources is needed to improve current surveillance and allow for better comparisons and trend analysis of STIs in New South Wales.