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The disruptive influence of syphilis cures within specialist venereal systems: implications for HIV cure preparedness
  1. Joseph D Tucker1,2,
  2. Adriane Gelpi2,3,
  3. David R Bangsberg4,5,6,
  4. Mary E Grewe2,3,
  5. Raul Necochea3
  1. 1International Diagnostics Centre, London, UK
  2. 2Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3Social Medicine Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  4. 4Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5Harvard Medical School, Boston, Massachusetts, USA
  6. 6Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Joseph D Tucker, International Diagnostics Centre, Keppel Street, WC1E 7HT, London, UK; joseph.tucker{at}post.harvard.edu

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The twentieth century has witnessed the rise of medical breakthroughs that have substantially decreased morbidity and mortality. Breakthroughs in curing specific diseases may transform the health systems designed to administer new cures. As potential cures move from the bench to the bedside, what was often originally conceived as a biomedical, frictionless intervention will be tested in the thorny, friction-filled and resource-constrained world of health service delivery. The historical trend of new cures influencing the social context of diseases and the health service delivery continues today. Clinical advances in curing HIV infection confirm the possibility of a cure, but these exciting research findings are still well in advance of implementation.

In contrast to earlier historical research that has focused on clinical consequences of new cures, this themed issue expands the analytical lens to consider the broader impact of sexually transmitted infection cures on health systems. For example, scholarship has examined several unanticipated clinical consequences of penicillin, including drug resistance, allergy and failure to treat viruses. But these clinical consequences may be less important than the dynamic health systems landscapes that shaped and were shaped by new cures. Prior to the development of Salvarsan, health systems intended to improve sexual health were fragmented.1 Paul Ehrlich's discovery of Salvarsan2 fundamentally reframed health systems to facilitate delivery of the new syphilis cure. …

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