Sexually Transmitted Diseases

Countermeasures for mpox (formerly known as monkeypox), primarily vaccines, have been in limited supply in many countries during outbreaks. Equitable allocation of scarce resources during public health emergencies is a complex challenge. Identifying the objectives and core values for the allocation of mpox countermeasures, using those values to provide guidance for priority groups and prioritisation tiers, and optimising allocation implementation are important. The fundamental values for the allocation of mpox countermeasures are: preventing death and illness; reducing the association between death (...) or illness and unjust disparities; prioritising those who prevent harm or mitigate disparities; recognising contributions to combating an outbreak; and treating similar individuals similarly. Ethically and equitably marshalling available countermeasures requires articulating these fundamental objectives, identifying priority tiers, and recognising trade-offs between prioritising the people at the highest risk of infection and the people at the highest risk of harm if infected. These five values can provide guidance on preferable priority categories for a more ethically sound response and suggest methods for optimising allocation of countermeasures for mpox and other diseases for which countermeasures are in short supply. Properly marshalling available countermeasures will be crucial for future effective and equitable national responses to outbreaks. (shrink)

Vaccination can protect vaccinated individuals and often also prevent them from spreading disease to other people. This opens up the possibility of getting vaccinated for the sake of others. In fact, altruistic vaccination has recently been conceptualized as a kind of vaccination that is undertaken primary for the benefit of others. In order to better understand the potential role of altruistic motives in people’s vaccination decisions, we conducted two focus group studies with a total of 37 participants. Study 1 included (...) three focus groups on the subject of HPV vaccination for boys. Study 2 included three focus groups on the subject of pertussis and measles vaccination for childcare workers. We found substantial evidence of other-regarding motives across all focus groups, which suggests that altruistic motives could be an important factor when it comes to people’s vaccination decisions. We address the significance of these findings for vaccination policy surrounding HPV vaccination for boys and vaccination for childcare workers. We also extend the findings to normative work on vaccination for the sake of others more generally. (shrink)

The ethics of safe sex in the gay community has, for many years, been focused on debates surrounding the responsibility regarding the use of condoms to prevent HIV transmission, once the only tool available. With the development of Truvada as a pre-exposure prophylaxis for HIV, for the first time in the history of the HIV/AIDS epidemic there is the potential to significantly reduce the risk of HIV transmission during sex without the use of condoms. The introduction of PrEP necessitates a (...) renewed discussion about the politics and ethics of safe sex for men who have sex with men. We present the arguments of authors who hold radically opposite positions with regard to the ethics of condom use by gay men, but who currently both criticize the use of PrEP. We offer a critique of their arguments and advance the position that the use of PrEP, even without condoms, can be acceptable and part of a safe sex ethics framework for MSM. (shrink)

Syphilis is a bacterial sexually transmitted disease (STD), whose main route of infection is through sexual contact. In order to diagnose syphilis, Treponema pallidum must be detected in the material sampled from a lesion and a blood test must be performed in order to detect serological response to syphilis. Since 1946, a statutory obligation to report all cases of syphilis has been in force in Poland, which is why data concerning the incidence is available. The aim of this paper is (...) to analyse trends in syphilis incidence in the years 1950–2017 using Joinpoint Regression and to present the impact of prophylaxis and education of society on syphilis prevention. The Joinpoint Regression method indicated the splitting time points of the trend corresponding to real changes in incidence, which corroborates the purpose of using the method in question in epidemiological studies. (shrink)

In this paper, we have considered a dynamical model of Chlamydia disease with varying total population size, bilinear incidence rate and pulse vaccination strategy. We have defined two positive numbers $$R_{0}$$ R 0 and $$R_{1}$$ R 1. It is proved that there exists an infection-free periodic solution which is globally attractive if $$R_{0} 1.$$ R 1 > 1. The important mathematical findings for the dynamical behaviour of the Chlamydia disease model are also numerically verified using MATLAB. Finally epidemiological implications of (...) our analytical findings are addressed critically. (shrink)

The sexually transmitted disease known as “The French Pox,” a forerunner of modern syphilis, represented a significant departure from early modern European knowledge of disease. Particularly distinctive was the gendered nature of the disease; females were labeled responsible for the formation of disease and thus associated with the moral corruption of the pox. This article examines the roots of this societal sexism in the Christian Pauline theory, using the binary between male and female to appreciate the development of the pox (...) and the social differentiation that occurred as a result of its contagion. (shrink)

The rapid changes that syphilis underwent after the first major outbreak that occurred in Naples in the mid-1490s are believed to constitute the first well-documented example of a human disease. The new plague was of exceptional virulence, highly contagious and causing severe ulceration at the site of infection. According to medical and other historical sources, the ‘genius epidemics’ changed some years after this onset, and a slower-progressing form of syphilis seems to have replaced the initial severe form, as do many (...) virulent epidemic infectious diseases that appear in devastating forms in a previously uninfected population. But what exactly were the features of the disease at the moment of its appearance in Europe at the end of the fifteenth century? How many years did it take for the early, virulent form to be replaced and become endemic? What was the pace of these changes through the decades following the onset of the epidemic? In this essay, I review these issues through an analysis of a large number of chronologically-ordered primary historical sources. (shrink)

This paper focuses on the role of regulation in the shaping new scientific facts. Fleck chose to study the origins of a diagnostic test for a disease seen as a major public health problem, that is, a ‘scientific fact’ that had a direct and immediate influence outside the closed universe of fundamental scientific research. In 1935, when Fleck wrote his book, Genesis and development of a scientific fact, he believed that the tumultuous early history of the Wassermann reaction had come (...) to an end, and that this reaction was successfully stabilized through the standardization of laboratory practices and thanks to the rise of a specific professional segment—the serologists. He could not have predicted that in the 15 years that followed the publication of his book, regulatory measures—barely metioned in his historical narrative—would play a key role in the destabilization of the original meaning of this reaction. The introduction of mass screening for syphilis—mainly via legislation that introduced obligatory premarital tests and promoted the testing of pregnant women—weakened in fine the link between Wassermann serology and infection by the etiological agent of syphilis, the bacterium Treponema pallidum. Fleck elected to study the Wassermann reaction because of its novelty, its complexity, and because it became the focus of a controversy regarding its origins. However, the Wassermann reaction was also one the first examples of a medical technology regulated by the state and incorporated into legal dispositions. It may therefore be seen as an exemplary case of the close intertwining of scientific investigations, their practical applications and regulatory practices. (shrink)

This paper focuses on the role of regulation in the shaping new scientific facts. Fleck chose to study the origins of a diagnostic test for a disease seen as a major public health problem, that is, a ‘scientific fact’ that had a direct and immediate influence outside the closed universe of fundamental scientific research. In 1935, when Fleck wrote his book, Genesis and development of a scientific fact, he believed that the tumultuous early history of the Wassermann reaction had come (...) to an end, and that this reaction was successfully stabilized through the standardization of laboratory practices and thanks to the rise of a specific professional segment—the serologists. He could not have predicted that in the 15 years that followed the publication of his book, regulatory measures—barely metioned in his historical narrative—would play a key role in the destabilization of the original meaning of this reaction. The introduction of mass screening for syphilis—mainly via legislation that introduced obligatory premarital tests and promoted the testing of pregnant women—weakened in fine the link between Wassermann serology and infection by the etiological agent of syphilis, the bacterium Treponema pallidum. Fleck elected to study the Wassermann reaction because of its novelty, its complexity, and because it became the focus of a controversy regarding its origins. However, the Wassermann reaction was also one the first examples of a medical technology regulated by the state and incorporated into legal dispositions. It may therefore be seen as an exemplary case of the close intertwining of scientific investigations, their practical applications and regulatory practices. (shrink)

The outbreak of syphilis in Europe elicited a variety of responses concerning the disease's origins and cure. In this essay, I examine the theory of the origins of syphilis advanced by the 16th-century Italian surgeon Leonardo Fioravanti. According to Fioravanti, syphilis was not new but had always existed, although it was unknown to the ancients. The syphilis epidemic, he argued, was caused by cannibalism among the French and Italian armies during the siege of Naples in 1494. Fioravanti's strange and novel (...) theory is connected with his view of disease as corruption of the body caused by eating improper foods. His theory of bodily pollution, a metaphor for the corruption of society, coincided with Counter-Reformation concepts about sin and the social order. (shrink)

Ludwik Fleck’s Genesis and Development of a Scientific Fact is an extended argument for the inclusion of social factors in the history and philosophy of science. Fleck uses the history of syphilis as his case study, which falls into two parts. In the first two chapters of his book, Fleck presents a history of the change of the concept of syphilis as a “carnal scourge with strong moralistic connotations” in the middle ages to the modern concept of syphilis as an (...) infectious disease (1979, 77). In the second part of the book, he presents a detailed account of the development of a serum test for syphilis, the Wasserman reaction. Fleck also argues that perception is theory-laden, for example, in his comparative study of anatomical drawings, and for the importance of social pressures on the development of science, for example, in his discussion of the rivalry between nations to first develop a cure for syphilis, as demanded by politicians (1979, 133 ff. and 68). (shrink)

The enlightenment period is often considered a dark age within the history of medicine. Contrary to this sentiment, I argue that the enlightenment spirit of inquiry regarding venereal disease was vibrant, dynamic, and profoundly influenced how syphilis was understood in the subsequent century. Historiography frequently minimises advances of medical knowledge made in the eighteenth century by focusing on the inefficacy of treatments, rather than on developments in medical theories and concepts. This thesis attends to this gap by examining a case (...) study within venereology to demonstrate that physicians engaging in public debate significantly advanced knowledge of syphilis. In doing so, this counters a historiographical trend that claims that French physician Philippe Ricord was the first to distinguish syphilis from gonorrhoea in the nineteenth century. It uses historical evidence to show that the nature of syphilis was debated throughout the preceding centuries and that this distinction was clearly established in 1793 by Scottish surgeon, Benjamin Bell. This thesis uses the epistemic concepts devised by Ludwik Fleck in his Genesis and Development of a Scientific Fact to illustrate how enlightenment ways of thinking substantially contributed to the development of modern medicine. This thesis therefore invites a reconsideration of the era, not as a dark age, but as a rich period of scientific endeavour. (shrink)