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One hundred years of STIs: the expansion of venereal medicine through the pages of its journal
  1. Leslie Goode
  1. Correspondence to Dr Leslie Goode, Heythrop College, London W8 5HN, UK; lesliegoode.blogmaster{at}blogs.bmj.com

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For STI journal, this is a centenary year. Not of the original British Journal of Venereal Diseases (BJVD) in 1925, but of the profession for which that journal is an organ. Our profession dates from 7 years before, when the Venereal Diseases Act was passed in 1917.

Early issues of the journal reveal the distance we have come since the days when the pages of the BJVD were largely dominated by issues around the management of ‘the clap and the pox’.

But we can also trace through the pages of the journal the evolution of that remote world into the STI world that we know today. Where, for example, did all those other conditions that we know today come from? And when did they first make their entry onto the stage of STI medicine?

This centenary is an occasion to look back briefly over the key stages in this process, though the lens of the journal.

1938–1950: the old medical conditions become curable

With little apparent warning, the era of relatively ineffective treatment passes. Hanschell first reports sulphonamides as an effective cure for gonorrhoea in 1938.1 This announcement is followed by a torrent of papers in the issues of 1939. As for syphilis, the end of the era of arsphenamine awaited 1944 and the arrival of penicillin—a development first heralded in a paper by Fleming himself,2 before the antibiotic was introduced wholesale by the military in 1945.3 4 The role of old-style syphilis treatments as ‘adjuvants’ continues to be debated in the later '40s, especially in neurosyphilis.5 As late as 1950, Lees et al report the loss of a patient through arsenical encephalopathy.6

1950–1970: new medical conditions emerge

Over the following 20 years, the journal records a more gradual change of a social as much as a medical nature, affecting the individuals attending the clinic. Seen retrospectively from 1970 by Morton,7 and Chief Medical Officer’s (CMO) Report,8 there are increasing numbers of young women attendees. In parallel with this, we find a perception in the '50s that the ‘promiscuity’ causing venereal disease was not necessarily commercial in character,9 and (by the early '60s) that it is the effect of a fast-growing adolescent population and its failure to abide by conventional marital norms.10 By the end of our period, this is compounded by the arrival of the contraceptive pill.11

The changing clientele of the clinic is accompanied by a transformation in the medical conditions seen.12 Earlier contributors were sceptical as to the existence of non-gonococcal conditions of the genital tract.13 14 Bourne proposes the term ‘metropathia’ as a useful catch-all for a doubtful range of conditions that come his way from the direction of the gynaecology department.13

All this was about to change. The '50s see an expanding, though inconclusive, debate around the nature of ‘non-gonococcal’, or ‘non-specific’, urethritis—a category officially recognised by the CMO’s report of 1951. To this is added, thanks no doubt to the changing gender balance, a growing interest in vaginal conditions. These are no longer restricted to gonorrhoea, Trichomonas and ‘unspecified’, but include relative new-comers like Candida albicans,15 Mycoplasma hominis,16 Haemophilus vaginalis (Gardnerella)17 and genital warts.18

1970–1990: the rise of the ‘viruses’

In the '60s, we see increased interest in an infection (hitherto considered a virus)19 at the root of Lymphogranuloma venereum, neonatal conjunctivitis and (more tentatively) certain genital conditions. Here begins the history of chlamydia—isolated as a bacterium in the early '70s,20 confidently associated with genital infections, in the mid-1970s,21 and increasingly associated with pelvic inflammatory disease by the end of the decade.22

True viruses had to bide their moment. Herpes had always been with us, but was less prevalent, or not serious enough to attract the venereologist’s attention.23 Heightened interest in the late '70s24 probably reflects rising prevalence.25 Effective treatment emerges with Acyclovir, first reported in 1983.26

The concern over human papilloma virus (HPV), on the other hand, was only just beginning by the early '80s. The association of HPV vulvar warts and cervical abnormalities seems to arrive all of a rush in 1983–198427—though the link of warts and HPV is reported in a paper of 1978.28 Previously, cervical anomalies had often been associated with herpes simplex virus.29 The link with HPV is contested at first,30 and is confirmed over the next few years.

Finally, in 1985, around the time of the emergence of HPV, there arrives first wind of HIV/AIDS—or human T-lymphotropic virus type III, as it is called at this time.31

HIV/AIDS is not alone in being related to the ‘homosexual’ population. While ‘the promiscuous adolescent’ forms the social backdrop of the second phase in the evolution of venereal medicine, the ‘homosexual’ plays this role in the third. Earlier, it is surprising how rarely homosexuals are specifically mentioned—though by 1962, Braff comments on the large proportion of clinic attendances accounted for by this group.32 The obvious question is how much the emergence of men who have sex with men as a distinct population owes to the outbreak of HIV/AIDS in the late '80s. Evidence in the journal suggests a growing recognition as the '80s go by—with an increasing volume of publications on more specific conditions and issues (hepatitis B, cytomegalovirus, gonorrhoea resistance)33–35 and a heightening awareness of the distinctiveness of this group.36

Finally …

By the '90s, the range of conditions covered in the journal has come to resemble what it is today. The next 25 years would see the introduction of new interventions (eg, combination antiretroviral therapy and pre-exposure prophylaxis), and ever greater internationalisation of our content. All this and more you can see in the journal’s archive at sti.bmj.com

References

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Footnotes

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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