PERHAPS THE STEALTHIEST of the most common STIs, syphilis has been known by many names, including a sort of nickname coined by the British medical scholar Sir Jonathan Hutchinson in 1879. He called it “The Great Imitator” because its symptoms can seem to mimic so many other diseases. That is, if you experience any symptoms at all.
Syphilis is also probably the only STI to have been immortalized in a three-volume epic poem. The Italian poet Girolamo Fracastoro actually gave syphilis its name in his 1530 Latin poem “Syphilis sive morbus gallicus” (“Syphilis, or the French disease”). The French disease? That’s what the Italians and Germans called it, Fracastoro explains. And the French called it the Italian disease, the Dutch called it the Spanish disease, and Turks and Arabs called it the Christian disease.
Until Fracastoro named it syphilis, it was also commonly known as the great pox (as opposed to smallpox). A description of a syphilis sore written by Ulrich von Hutten in 1519 certainly makes the poxes sound large:
Boils that stood out like Acorns, from whence issued such filthy stinking Matter, that whosoever came within the Scent, believed himself infected. The Colour of these was of a dark Green and the very Aspect as shocking as the pain itself, which yet was as if the Sick had laid upon a fire.
Now, that sure doesn’t sound like a stealthy disease, does it? And the modern experience of syphilis isn’t like that at all. Today, when someone is first infected with syphilis, it usually produces a single blister, called a chancre, at the site of the initial infection. Syphylitic chancres are usually small, round, and painless; last for a few weeks; and then disappear without treatment—which many people don’t seek, precisely because chancres are small and painless.
Chancres are symptoms of the primary stage of syphilis. Untreated, the infection moves into its secondary stage, usually six to eight weeks after infection. Symptoms during the secondary stage include a rash or rashes on the body. Typically they occur as a rough rash on the palms or the soles of the feet, although outbreaks can occur just about anywhere on the body and, in keeping with syphilis’s status as a Great Imitator, often resemble rashes caused by other conditions. Like chancres, secondary stage syphilis will also resolve without treatment in most people with a competent immune system.
After primary and secondary stage symptoms clear up, syphilis moves into its latent stage where it can remain hidden for years. For many people, latent syphilis will never cause additional problems, but in about 15 percent of those infected with syphilis who do not receive treatment, syphilis can enter its very serious and sometimes even deadly third stage. Tertiary stage syphilis, which can appear decades after the initial infection, is characterized by the growth of tumorlike masses called gummas that often appear in the liver, but can manifest in the brain, heart, bone, and elsewhere throughout the body. Tertiary syphilis can cause dementia, paralysis, blindness, and death.
Medical historian Deborah Hayden sees a pattern of syphilislike symptoms in the lives of a diverse group of historic figures, including Adolf Hitler, Friedrich Nietzsche, Oscar Wilde, Ludwig van Beethoven, and Vincent Van Gogh. In her book Pox: Genius, Madness and the Mysteries of Syphilis, Hayden describes how these and nine other figures experienced a series of symptoms, from muscle and joint pain to internal disorders that were capped by varying degrees of late-life mental imbalance that she finds characteristic of syphilis.
But how did a disease that was described as one producing sores the “size of Acorns” end up as such a silent threat? Biologist Robert Knell of Queen Mary University in London believes that evolution favored strains of syphilis that didn’t cause such visible sores. Knell argues that nobody would want to have sex with someone displaying large, pus-ridden sores. And since the bacterium that causes syphilis depends on sex for transmission, strains of the organism that left infected people in a more attractive state were likely to do better from an evolutionary perspective. If people with strains of syphilis that didn’t cause big sores had more sex (because their prospective partners wouldn’t detect the infection), those specific strains of syphilis could then become dominant and thus more common, and end up infecting more people.
Which just might have turned Treponema pallidum pallidum, the bacterium that causes syphilis, into the sneaky infectious player it is today. And it is yet another reason why you should talk to your doctor if you ever experience an unexplained sore on your genitals. Syphilis can be treated with antibiotics—but only if you know you’ve been infected.
LAST, BUT BY no means least, let’s return to the STI that I saw infect too many young children. Human immunodeficiency virus, or HIV, the virus that causes acquired immune deficiency syndrome, or AIDS. Much has been reported about HIV and AIDS over the last twenty years, but a quick review of the numbers is in order. In the 2008 Report on the Global Aids Epidemic, the Joint United Nations Task Force on HIV/AIDS and the World Health Organization report that 33 million people, including more than 2 million children, were living with HIV in 2007. More than 25 million people have died of AIDS since 1981, when the disease was first recognized. And there are 11.6 million AIDS orphans in Africa.
HIV, like so many other STIs, is also a sneaky stowaway, which helps it to move from one person to another. The first symptoms of HIV infection, which usually appear around two to four weeks after infection, look and feel like the flu, making diagnosis very difficult, even if the infected individual visits a health-care professional. HIV then moves into a latent period. Behind the scenes, though, HIV is very busy, winding its way into its host’s DNA and taking up residence in the cells of the immune system. During this period of latency, which can last as long as twenty years or even longer, sexual activity gives the virus many opportunities to spread itself to new hosts—there are no boils standing out like acorns or purulent discharge to warn potential sexual partners that sexual activity poses a risk to their health. Eventually, most people infected with HIV develop AIDS, the complex of symptoms and infections that results from immune system failure caused by HIV infection.
Most people in the developed world understand that unprotected sexual intercourse is a risk factor for HIV transmission. But, surprisingly, there are still many people who don’t recognize that this means lots of different kinds of sexual practices, including of course anal sex. A sweeping survey of girls of high school age by Dr. Avril Melissa Houston, who is now the deputy chief medical officer of Baltimore, revealed that 20 percent didn’t know that penile-anal intercourse exposed them to increased HIV risk. In fact, a 2005 report by the Centers for Disease Control and Prevention (CDC) estimates that receptive anal sex is five times more likely to result in HIV transmission than traditional penile-vaginal intercourse. What about the use of protection? Condoms aren’t perfect, but, if used consistently, they can reduce transmission of HIV by about 87 percent, and some studies have found them to be even more effective.
Although highly improbable, oral sex can also be a transmission method for HIV. A new study suggests that the tonsils, which are especially rich in immune cells (that some think can facilitate HIV infection), may provide a pathway for the virus to infect someone who’s giving their male partner oral sex. Of course, the authors of the study are quick to point out that removing people’s tonsils doesn’t make sense as an HIV protection measure, when there are much less drastic and more affordable options available—condoms.
The more sexual partners one has over the course of a lifetime, the more the risk of infection climbs. Now, a new study conducted by Dr. Adaora A. Adimora and colleagues at the University of North Carolina, Chapel Hill, suggests that having multiple partners at the same time increases risk even further. In part because people engaged in multiple contemporaneous sexual relationships are more likely to engage in other risky behavior, such as drug and alcohol use during sex, and not use barrier contraception like condoms. The report, which was published in the American Journal of Public Health, also found that Hispanics and African Americans were as much as three times more likely as whites to have mult
iple sexual partners at the same time. Hispanics and African Americans are also more likely than whites to have HIV. “This study sheds light on the epidemic of heterosexually transmitted HIV in the U.S.,” Dr. Adimora stated, “especially among African Americans and Hispanics.”
It stands to reason that multiple concomitant sexual partners would increase the risk of HIV transmission. Scientists have long known that individuals are especially contagious when newly infected, especially during the phase of acute disease when they are experiencing those first flulike symptoms. So, if an individual becomes infected while in more than one sexual relationship, he or she exposes multiple individuals to infection. “People—especially women—need to avoid partnerships with people who have other partners,” says Dr. Adimora.
Let us shatter the prejudicial myth once and for all. HIV is not just the province of homosexuals and swinging heterosexuals. Viagra and other drugs, along with better healthcare and social changes, have contributed to a sort of senior sexual revolution—more and more elderly people are having more and more sex. And with sex comes sexually transmitted infections. Sure enough, along with other STIs, HIV is on the rise among seniors. Tom Liberti, the chief of the Florida Bureau of HIV/AIDS, surprised the medical community when he reported that 16 percent of new HIV cases reported in 2005 were in people over fifty. I witnessed this senior sexual revolution first hand while doing my gynecology rotation. We had many patients, who being newly divorced, acquired HPV and then cervical cancer because they skipped using condoms. Unfortunately for these women they were thinking, being menopausal, that they couldn’t get pregnant, and completely forgot about STIs.
The rising rate of HIV in seniors poses a whole new challenge for health-care professionals and other advocates promoting safer sex. Many elderly people today grew up in the pre-HIV era, before safer sex campaigns and so don’t see the point in protection. And even if they do, they figure they’ll die of old age before they die of AIDS. Of course, it’s not right to assume that HIV won’t cause additional health problems. Jolene Mullins works for the Broward County Florida Health Department on their Senior HIV Intervention Project. As Mullins points out, “The virus attacks the immune system and your immune system naturally breaks down with aging. If HIV is put on top of that, it naturally enhances the problems.”
It all comes down to the same thing: infections don’t discriminate. So whether you’re gay or straight, old or young, having sex in the missionary position, orally, anally, or any other way—unless you are in a long-term monogamous relationship and you know your partner has a clean bill of STI health—be safe.
CHAPTER 8
jagged little pill
One of the side effects of nature’s decision to encourage reproduction by making the reproductive act so pleasurable is that lots of people are interested in sex for its own sake, and not for evolution’s. The technologically sophisticated society in which we live has led to the development of many methods to foil nature’s reproductive aims. Of course, it didn’t take the advent of modern technology for humans to find ways to prevent pregnancy: contraception actually has a long and varied history around the globe; modern science and technology have just made it more effective. And it actually didn’t even take humans to find ways to prevent pregnancy—new research has shown that contraception, maybe deliberate, but often accidental, occurs in the animal kingdom too.
CHEMICAL CONTRACEPTION—LIKE THE famous birth-control pill—involves the ingestion of female hormones, or chemicals that mimic them (more in a moment), to essentially trick the body into thinking it’s pregnant. When a woman is pregnant, she doesn’t usually ovulate. If she doesn’t ovulate, she can’t get pregnant.
Animals, of course, are not lining up at the local animal pharmacy to fill their prescriptions. Instead, they unintentionally eat specific foods that contain either phytoprogestogens or phytoestrogens—which are naturally occurring chemicals that mimic female sex hormones. Why would plants be producing chemicals that can mimic human or mammalian hormones? The simple answer is, it’s their way of quietly defending themselves, keeping their predators under control by reducing their fertility. When animals eat enough phytoprogestogen-or phytoestrogen-rich food, it’s as if they’re taking a natural oral contraceptive pill. So which animals line up at the birth control buffet? And, more to the point, why?
James Higham, a research fellow at Britain’s Roehampton University, studied two troops of olive baboons living in the rain forest of Nigeria’s Gashaka-Gumti National Park. They discovered that levels of phytoprogestogens in the waste product of the troop’s females climbed sharply every year from August to October. They also identified only one food that was eaten by both troops during that time of year—Vitex doniana, the African black plum and its leaves. And, sure enough, laboratory tests of the black plum’s chemical makeup revealed it is chock full of phytoprogestogens. The scientists’ study of the troops revealed that all that phytoprogestogen consumption had a visible effect on female fertility. Unlike humans, whose bodies don’t visibly change during ovulation although as we discussed some women may dress and behave differently during their most fertile period, many animals display obvious physical evidence that they’re ovulating. In olive baboons, their hindquarters swell and redden, and that’s what draws males to mate with them. But, during the months when the troops feasted on African black plums, that sexual swelling was markedly reduced. The combined internal and external effects of all those plums led the researchers to conclude that the plums pulled double duty as a contraceptive, preventing the physical cues that led to mating and hampering ovulation. The plum “appears to act on cycling females as both a physiological contraceptive (simulating pregnancy in a similar way to some forms of the human contraceptive pill) and a social contraceptive (preventing sexual swelling, thus reducing association and copulation with males),” write the authors.
Why the baboons go on “the plum” every year is still subject to speculation. Dr. Higham himself told the Times of London that he couldn’t determine whether the baboons were deliberately dosing themselves with the contraceptive fruit or not. But one primate expert, Patricia Whitten of Emory University in Atlanta, Georgia, said she thinks the baboons may be inadvertently eating the plums to prevent disease transmission. August to October is the rainy season in that part of Nigeria, which also makes it the disease season. By eliminating copulation, the baboons are reducing the possibility of catching a contagious disease from another baboon through sexual intercourse.
If the baboons are intentionally going on “the plum” (which at this point seems highly unlikely), then this is the first evidence of an animal (besides humans, of course) deliberately consuming a food product that has contraceptive properties. There are other examples of animals eating foods that impede their reproduction; however, they just tend to be defense mechanisms of the dietary product in question. In the 1940s, agricultural specialists in Australia discovered that the cause of the sheep-breeding crisis they faced was the European clover their sheep were grazing on. Red clover produces a compound called formononetin that is converted into a powerful estrogen mimic by microorganisms in the guts of the animals that eat it. When a crop of clover is struggling due to bad weather, insects, or, in this case, transplantation from Europe to the drier Australian climate, it kicks up its production of formononetin. What does that do? It cuts down on the next generation of animals that would otherwise overwhelm it with grazing by sterilizing their potential parents. It’s almost as if the plants were producing their own Pill as a defense mechanism.
Phytoestrogen consumption may not be the only way animal pregnancies are impeded. One controversial theory, called the Bruce effect (after British biologist Hilda Bruce, who first postulated it), suggests that exposure to unfamiliar males can terminate new pregnancies in female rodents of a variety of species. The Bruce effect has so far been observed only in the laboratory, which means some condition created by the laboratory environment itself may be entirely or partially responsible. S
till, scientists have observed the Bruce effect in about a dozen different species, including domestic mice, deer mice, and voles. One study documented miscarriages in 88 percent of the female mice exposed to unknown males.
If the Bruce effect actually occurs in nature, scientists think it may be related to animal infanticide, which occurs with a fair degree of frequency among some animals, including lions, primates, and rodents. Typically, infanticide involves one or more dominant males who join a community in which fertile females have young children. The theory is that they kill the offspring to make their mothers sexually available to bear and nurture their own offspring. The Bruce effect may have evolved as an adaptation to male infanticide—instead of investing her energy and physical resources in bearing offspring that may later be killed, the female who encounters the unfamiliar male essentially cuts her losses. By aborting her current pregnancy, she can mate with the new male or males and will possibly have increased her future offspring’s chance of survival.
Natural forms of contraception don’t just occur in animals—humans experience them too. Immediately after a woman gives birth, and for some time afterward, she can be infertile; her body has yet to return to its normal cycle of ovulation and menstruation. Most people understand that you can’t get pregnant the day after you give birth; what they may not realize is that regular breast-feeding can prolong this period of infertility by six months or more, through a phenomenon known as lactational amenorrhea. The technical term for failure to menstruate in a woman of normal reproductive age is amenorrhea. When this is caused by postpartum breast-feeding, it is called lactational amenorrhea. A study by the World Health Organization (WHO) found that nursing kept pregnancy rates down to just 1 percent during the first six months after delivery.
How Sex Works Page 17