Wednesday, August 19, 2015

Finding Gonorrhoea

Long term followers of this blog will know that here at medical history we enjoy a good story about a sexually transmitted infection.

Normally it's syphilis but today I thought we'd make a side track into gonorrhoea. 

Gonorrhoea is an illness that has afflicted humans as long as recorded history exists.  It is speculated that there are even references in the Bible.  A law passed by the British parliament in 1161 was designed to reduce spread of the 'perilous infirmity of burning'.  Louis IX preferred banishment.

Interestingly it appears a gonorrhoea epidemic may also gave been the driver behind the secularisation of medical training under Pope Boniface (1294-1303). Prior to this physicians were required to undertake training as lower order catholic priests. They tended not to be willing to treat commoners and certainly not prostitutes. Secular doctors on the other hand had no such qualms. Many medieval cities in this period hired doctors under the understanding that they would not have right of refusal and would be obliged to treat anyone who needed it.

And, of course, we've previously been over the problem of gonorrhoea during periods of war.

Gonorrhoea remains a major public health concern today with an estimate that it is responsible for 88 million of the 448 million curable STI cases yearly. (Around 20% for those of you playing at home).

Symptoms include burning on urination and discharge from the penis or vagina. Left untreated it can cause infertility, arthritis, conjunctivitis, endocarditis and skin infection. Pregnant women can miscarry or give birth to children infected with gonorrhoea -usually manifesting as a conjunctival infection that can cause blindness.

Infection with gonorrhoea also significantly increases the risk of confection with HIV.

So we may laugh initially but it's actually not that funny.

Gonorrhoea is caused by a bacteria Neiserria  gonorrhoeae named for its discoverer, Albert Neisser.

You would remember Neisser, hopefully, from our previous discussion of leprosy and his contentious role in stealing another mans work.

Albert Ludwig  Siegsmund Neisser was a German physician born in 1855.  He completed his medical studies in 1877 and initially planned to be an internist.  When he was unable to find a position he took a job as the research assistant of dermatologist Oskar Simon who was studying sexually transmitted disease and leprosy.

In 1879 Neisser was able to demonstrate a similar sized and shaped bacteria was grown from the infected fluid of 26 cases of urethritis, 7 neonatal cases and 2 cases of adult eye infection.  He was able to demonstrate the presence of bacteria but unable to grow it independently. He solved this problem in 1893 by managing to grow a similar shaped bacteria in infected joint fluid. '

Neisser worked on various other diseases during his research carer - including leprosy and syphilis.  He also became very interested in treatment and prevention of STDs - organising the German Society for Combating Venereak Disease in 1902.  He also devised a new silver urethral infusion (which was largely ineffective).

Effective treatment for gonorrhoea did not arrive until Florey and the discovery of penicillin in 1929. As we have discussed previously this made a huge difference - particularly to military forces.

Unfortunately gonorrhoea is now resistant to penicillin.  Which does leave us in an uncertain future.

Hopefully without the return of mercury and silver.

1 comment:

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