The Impact of Molecular Technology on STD Control

Abstract

Sexually transmitted diseases have afflicted humankind for millennia, based on references to apparent gonorrhea or nongonococcal urethritis in the Old Testament (Leviticus). For most of history there has been no means of specific diagnosis, and clinical diagnosis of syndromes was fraught with error. Usually, this made no difference because there was no specific therapy and no means of prevention other than abstinence or monogamy, which was slightly effective at best (witness the very high prevalence of syphilis in much of Europe and the USA before advent of specific therapy, approaching 10% in many populations and 25% in some). Occasionally, syndromic diagnosis did cause serious consequences. If we could talk with John Hunter today, he certainly would bemoan the absence in his time of specific diagnostic tests for gonorrhea and syphilis. Had he had access to such tests, he certainly would not have inoculated himself with urethral exudate from a patient with gonorrhea and subclinical syphilis, resulting in the acquisition of both gonorrhea and syphilis (1)! Not only did he suffer from both diseases, but he also understandably but incorrectly concluded that both diseases had the same etiology, which held back the entire field until the discovery that Neisseria gonorrhoeae and Treponema pallidum were separate causes of the very distinctive diseases.