Genitourinary Infections

Stages Syphilis

m 1 Ithough some historians argue that syphilis was trans-r 1 ported to Europe from the New World by Columbus's JL JL crew, others find convincing evidence, including biblical references, that syphilis existed in the Old World for many years before Columbus returned. History and literature record that kings, queens, statesmen, and heroes degenerated into madness or mental incompetence or were otherwise seriously disabled as a result of the later stages of syphilis. Henry VIII (King of England, 1509-1547), Ivan the Terrible (Czar of Russia, 1547-1584), Catherine the Great (Empress of Russia, 1762-1796), Merriwether Lewis (Lewis and Clark Expedition, 1803-1808), and Benito Mussolini (Premier of Italy, 1883-1945) are a few of the famous people who probably suffered from syphilis.

Syphilis was first named the "French pox" or the "Neapolitan disease" because it was believed to have come from France or Italy. In 1530, Girolamo Fracastoro, an Italian physician who suggested the germ theory long before the discovery of microorganisms, wrote a poem about a shepherd named Syphilis who had ulcerating sores covering his body. The description matched the symptoms of syphilis, and from that time on, the disease was known by the shepherd's name. Initially, the method of transmission was unknown, but gradually it became generally recognized that the disease was sexually transmitted. The symptoms of syphilis were very severe in the early years of the epidemic, often causing death within a few months. Treatment, consisting of doses of mercury, and guaiacum, the resin from a tropical American tree of the genus Guaiacum, had little beneficial effect. As the decades went by, mutations and natural selection resulted in more resistant hosts and a less virulent microbe, and the disease evolved into the chronic illness known today.

By the late nineteenth century, the disease was shown to be transmissible to certain laboratory animals, but although various bacteria could usually be cultivated from lesions on the infected animals, all proved to be contaminating organisms because when isolated in pure culture, they could not reproduce the disease. Thus, the causative agent of syphilis remained a mystery.

In 1905, Fritz Schaudinn, a German protozoologist, examined some fluid from a syphilitic sore and saw a faintly visible organism "twisting, drilling back and forward, hardly different from the dim nothingness in which it swam." When Schaudinn used dark-field illumination, he was able to see the organism much more clearly. It appeared very thin and pale, similar to a corkscrew without a handle. The spirochetes appeared in specimens from other cases of syphilis, and Schaudinn later succeeded in staining them. By this time, he felt certain he had discovered the cause of syphilis, but the organism could not be cultivated on laboratory media. Schaudinn named the organisms Spirochaeta pallida, "the pale spirochete." This organism is now called Treponema pallidum, from treponema, "a turning thread."

—A Glimpse of History

INFECTIONS OF THE REPRODUCTIVE AND URINARY tracts are very common, often uncomfortable or quietly destructive, and sometimes tragic in their consequences. Urinary infections lead the list of infections acquired in hospitals and are the chief source of fatal nosocomial bacterial blood-stream invasions. Nosocomial uterine infections, once a common cause of maternal deaths from childbirth, still require strict medical vigilance to be prevented. Much of this chapter will be devoted to sexually transmitted diseases (STDs).

The United States leads the industrialized nations in the reported incidence of STD even though other countries are more permissive in their attitudes toward sexual activity. About 1 million unintended pregnancies occur among the estimated 12 million college and university students each year. Only about 15% of the students have never engaged in sexual intercourse, and almost 35% of the remaining students have had six or more

634 Chapter 25 Genitourinary Infections lifetime sexual partners. About 20% of women students say they have been forced to have sexual intercourse against their will. Approximately 70% of sexually active students report that they or their partner rarely or never use a condom. These data suggest a lack of knowledge or concern about the high risk of contracting and transmitting an STD.

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