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Last Updated: Sunday, 16 October 2005, 21:03 GMT 22:03 UK
The fight against STIs

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Sexually Transmitted Infections (STIs) are nothing new - attempts to prevent their spread date back almost 1000 years, with recorded efforts to control disease amongst prostitutes as far back as 1152. But it is in the last century that the most significant battle has been waged worldwide.

At the turn of the 20th century, measurement of the diseases was almost impossible. The rigorous methods used today were unknown and the calculations used were incomplete or inaccurate. The stigma attached to syphilis meant registrars did not certify deaths as due to syphilis for fear of offending relatives. But one expert at the time estimated that up to 60,000 people a year were dying from syphilis - compared with just 2,252 new diagnoses in the UK last year.

In 1913 a Royal Commission on Venereal Diseases was set up, which three years later recommended that local authorities should provide a free service for the early diagnoses and prompt treatment of venereal diseases. The service would be strictly confidential and available on demand.

But the Commission shied away from the controversy of sex education. Many influential people believed that teaching the benefits of using prophylactics (condoms) would lead to moral corruption.

The First World War

Meanwhile, the British Army was facing a significant problem in France during WW1. France had regulated brothels, and whilst the women were inspected regularly, the examination was often cursory, and there were soon high levels of infection amongst troops. Venereal Ablution rooms were established in all barracks, and soldiers who had "risked infection" were ordered to attend for treatment within 24 hours.

In 1917 at a meeting of the Imperial War Conference, it was acknowledged that venereal diseases were not being contained either in France or England and they were seriously impeding the fighting capacity of the forces. In that year 23,000 British soldiers were hospitalised for treatment and the French government reported over a million cases of syphilis or gonorrhoea since the start of the war.

The ablution rooms had some success, but the pressure to return men to the front line meant minimal time for therapy, and many patients remained infected after apparently successful treatment.

Between the wars, there was an attempt to emphasise education. Books and pamphlets were supplied to lecturers for public meetings, and there were public performances of information films. The events were well attended, but stigma was a huge issue as the people with VD were portrayed as immoral and lacking self control.

Both the army and those responsible for civilian sexual health had learned from their experiences during the First World War, and were much better prepared for WWII.

They needed it. Between 1939 and 1941 the number of new cases of venereal disease reported from clinics in England nearly doubled. There was a further massive increase with the influx of American troops in 1942.

The breakthrough

But treatment was transformed by the "magic bullet". Penicillin could treat both gonorrhoea and syphilis quickly and effectively. The nations sexual health improved greatly during the forties and early fifties. With the creation of the NHS in 1948 guaranteeing a comprehensive service, experts could be forgiven for believing that the battle against STIs was won.

But it was not to be. The world changed and a complex pattern of demographic and social variables evolved, including population movements, increasing affluence, more holiday travel, the advent of the Pill and the relaxing of attitudes towards sex and sexuality.

The so called "sexual revolution" had consequences. Positive cases of Gonorrhoea trebled between 1955 and 1975and the sexual revolution of the 1960s had significant effects on the number of cases of gonorrhoea.

The only pause in the seemingly inexorable rise of STIs came in the late 1980s, when the prospect of a sexually transmitted infection which was both incurable and fatal stirred the government into action.

AIDS was to have a profound change on British sexual behaviour.

Sources

"Scars of Venus: A History of Venereology" by JD Oriel. Springer-Verlag New York, 1994 "The Terrible peril: a historical perspective on the venereal diseases" by M W Adler, British Medical Journal 19 July 1980 p206.



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