The War Against Venereal Diseases: Engineering Protective Practices during World War II in Sweden – CORRIGENDUM

We review the effects of war on HIV and STI transmission and critically appraise short- and medium-term approaches to prevention. Our intent is to stimulate thinking about the potential for increased HIV/STI transmission in current and future armed conflicts with particular reference to Afghanistan and to encourage timely interventions to prevent a worsening HIV epidemic in Central and South Asia. (excerpt)

Women's and men's number of sexual partners and protective practices such as condom use can have a direct effect on their risk of contracting sexually transmitted diseases (STDs), including HIV. The 1988 and 1995 cycles of the National Survey of Family Growth and five rounds of the General Social Survey conducted from 1988 to 1996 are used to examine women's and men's numbers of recent sexual partners. Levels of direct risk for STDs (two or more partners in the past year) and the social and demographic correlates of multiple partnership are analyzed among women and men. In addition, women's indirect risk for STDs (their partners' involvement with other partners in the past year) is used to estimate their overall risk of STDs through multiple partnerships. At least three-quarters of sexually active U.S. women and men in the late 1980s and mid-1990s had had only one sexual partner in the preceding 12 months. Moreover, there is no indication that the proportion with more than one partner in the past year changed substantially over that period. Nevertheless, combining women's and men's partnership reports suggests that about 17 million women aged 15-44--34% of those sexually active in the past year--were at risk for STDs because of direct exposure to multiple partners (5.4 million), indirect exposure (6.3 million) or both direct and indirect exposure (5.5 million). In all, 21% of women were at direct risk and 23% were at indirect risk. In comparison, among men aged 18-44, 24% were at direct risk for STDs and an unknown proportion were at indirect risk. Multivariate analyses indicated that unmarried individuals, women younger than 40 and men aged 20-29, blacks and women in the South were all at elevated risk for STDs because of multiple partnership. Overall, in 1995, 19% of sexually active women aged 15-44 had used condoms to protect against STDs over the preceding year, and 19% of those sexually active in the three months before the survey were current condom users. Condom use specifically for STD prevention was more common among women reporting both direct and indirect risk for STDs (58%) and among those at direct risk (46%) than among other women; women whose partners put them at indirect risk only were less likely to be current or recent condom users than women who were not at risk or were only at direct risk. There is a continuing need to educate people regarding their risk for STDs, to increase the use of existing barrier methods and to develop new methods that protect against STD infection. In addition, if we are to develop a better understanding of the extent of STD risk through multiple partnership, the collection of information on number of partners and relationships between partners must be expanded and improved.

Associations between forced sex, sexual and protective practices, and sexually transmitted diseases among a national sample of adolescent girls

Associations between forced sex, sexual and protective practices, and sexually transmitted diseases among a national sample of adolescent girls

FRII-01 THE IMPACT OF VENEREAL DISEASE DURING WORLD WAR I: HUGH HAMPTON YOUNG AND THE CHASTE OF AMERICAN SOLDIERS

After the First World War, Serbia was ravaged and in ruins, whereas the Health Care Service was destroyed. Organization and reorganization of the Health Care Service started with a fight against the spread of infectious diseases. Foundation of specialized health institutions was among the first tasks. As early as 1920, an Outpatient Service forSkin and Venereal Diseases was established and managed by Prof. Đorđe Đorđević. In 1922, after he was appointed as Associate Professor at the newly established Faculty of Medicine in Belgrade, he founded a Clinic for Skin andVenereal Diseases, and acted as its first director. In 1928, a Municipal Outpatient Clinic for Skin and Venereal Diseases was founded, whereas in 1938 a modern organization of the Service was established in a new building. After a break during the I World War, the Dermatovenereology Department of the General Military Hospital in Belgrade, founded in 1909, continued working until the Second World War. In Novi Sad, the City Hospital was founded in 1909, including a Dermatovenereology Department. After the First World War, in 1921, Dr. Jovan Nenadović founded a Department of Skinand Venereal Diseases (100 beds) in the General Public Hospital, as well as, an independent Public Outpatient Clinic for free-of-charge treatment of patients with venereal diseases. In Niš, the first Organization Unit for Venereal Diseases was founded in 1912, but the Department of Venereal Diseases was founded in 1921, and it was managed by Dr. Petar Davidović, while in 1927 a Department of Skin and Venereal Diseases was established within the General PublicHospital. In 1920, a Dermatovenereology Department of the Military Hospital in Niš was established. Apart from these, as early as 1921, there was a total of 7 Outpatient Clinics in Serbia, and in 1923 there were 14 venereal departments, and 1 dermatovenereology department.

After the First World War, Serbia was facing the lack of hospitals and physicians, and organization of the health care system was a real challenge. Both problems were closely associated with dermatovenereology. Between the two world wars, a great contribution to the development of Serbian dermatovenereology as a current discipline was given by Prof. Dr. Đorđe Đorđević, who was the first director of the Clinic for Skin and Venereal Diseases in Belgrade (1922 - 1935), and by his closest associate Prof. Dr. Milan Kićevac (1892 - 1940) who was his successor at the position of the director of the Clinic (1935 - 1940). In 1922, Prof. Dr. Đorđe Đorđević was the founder of two institutions significant for Serbian dermatovenereology: Clinic for Skin and Venereal Diseases, where he also acted as a director, and the Department of Dermatovenereology at the School of Medicine in Belgrade, where he was the first teacher of dermatovenereology. In 1927, Prof. Dr. Đorđe Đorđević initiated the foundation of the Dermatovenereology Section of the Serbian Medical Society, and he and his associate and successor, Prof. Dr. Milan Kićevac were the main organizers of the Association of Dermatovenereologists of Yugoslavia. With this Association, all other regional dermatovenereology sections in the County became parts of the Pan-Slavic Dermatovenereology Association. Prof. Dr. Đorđe Đorđević and Prof. Dr. Milan Kićevac also organized the First, Second and the Third Yugoslav Dermatovenereology Congresses (1927, 1928, and 1929), and in 1931, the Second Congress of Pan-Slavic Dermatovenereology Association. Their teamwork resulted in legislation concerned with health care, eradication of venereal diseases and prostitution, and finally with setting the foundation for professional and scientific dermatovenereology in Serbia. Prof. Đ. Đorđević investigated current problems of venereal diseases and organized professional expeditions in Serbia and Montenegro studying the expansion of syphilis. However, in his experimental work, Prof. M. Kićevac investigated photo-dermatoses and the IV venereal disease, at the same time pointing to immunological phenomena in streptococcal and staphylococcal infections. Dr. Vojislav Mihailović (1879 - 1949) was a significant figure in Serbian dermatovenereology and acted as the Chief of the Department of Skin and Venereal Diseases within the General Public Hospital in Belgrade. His scientific papers and books on the history of dermatovenereology and general medicine had a great impact on the Serbian dermatovenereology. His books dealing with the history of dermatovenereology: “The History of Venereal Diseases till 1912” and “Out of the History of Sanitary Health Care in the Rebuilt Serbia from 1804 - 1860”. Associate Professor Dr. Sava Bugarski (1897 - 1945), a student of Prof. Dr. Kićevac and later the director of Clinic for Skin and Venereal Diseases in Belgrade (1940 - 1945), was engaged in the field of experimental dermatovenereology. Dr. Jovan Nenadović (1875 - 1952), one of the most eminent physicians in Novi Sad, took part in the foundation and work of the Dermatovenereology Section of the Serbian Medical Society as well as its honorary life president. In 1919, he founded the Dermatovenereology Department within the Novi Sad Hospital, as well as an Outpatient Dermatovenereology Clinic, outside the Hospital, although he was the director of both institutions. In the period between the two world wars, among the most prominent physicians of the Military Sanitary Headquarters who contributed the development of dermatovenereology were the chiefs of the Dermatovenereology Department of the General Military Hospital in Belgrade: Major, later on, Brigadier General, Dr. Božidar Janković (1874 - 1936), and the Sanitary Brigadier General, Dr. Milivoje Pantić (1885 - 1959). Dr. B. Janković wrote important professional papers, among which the following are most significant: ”Fight against Venereal Diseases in the Army” and ”Treatment of Syphilis with Silber-Salvarsan.” Distinguished physicians of the military sanitary service, such as Dr. Petar Davidović, made significant contributions to the work of civilian dermatovenereology institutions of that time. In 1921, Dr. Petar Davidović was the director of the newly founded Venereal Department of the Niš Public Hospital, which was on a high professional level.

"Total War" calls upon combatant countries to mobilize all of their resources and energies for war and their civilians to contribute in their own ways to the "war effort" of their respective governments. Carrying out such war, some governments try to redefine the distinction between the private sphere and the public sphere in their people's lives. Even sexual life, the most private sphere in people's lives, may be exposed to various forms of supervision and control from their states in the name of the national "war effort." In particular, the government in war does not hesitate to scrutinize the most private sphere of their people's lives when certain aspects of their lives do considerable harm to "war effort" or "national efficiency." The British society in the First World War intensively experienced some kind of "social control" due to the increasing spread of venereal disease (VD) both among civilians and troops. Like British society as a whole, the British army, who had primary responsibility to fight the war in the field, had to fight another hard battle against an enemy within VD, throughout the war. During the First World War, VD caused 416,891 hospital admissions among British and Dominion troops. Excluding readmissions for relapses, approximately five percent of all the men who served in Britain's armies in the course of the war became infected. During the war, at least a division was constantly out of action because so many troops had to treat VD. This disease caused a huge drain on the British army's human and material resources and consequently undermined, to a considerable extent, its military efficiency. However, a series of measures of the British Army to improve the high rate of infection among their troops have been simply considered ineffective by both contemporaries and subsequent researchers. This article aims to provide a more balanced perspective on the efforts of the British Army to fight VD during the war and reconsider the existing understandings in regard to their general effectiveness. It argues that the overall measures of the British Army regarding VD have to be examined in the context of the national efforts of British society to fight against VD as a whole. Their supposed ineffectiveness well-reflected the indecisiveness of the overall British society in terms of both how to view VD and how to fight against it.

As we observed in Chapter 4, from time immemorial, sexually transmitted diseases (STDs) have been a scourge of military personnel and of the wars in which they were deployed. So, in her excellent historical review, Venereal Diseases in the Major Armies and Navies of the World, Josephine Hinrichsen (1944, 1945a, 1945b) traces the military problem of female prostitution—and, by implication, the associated spread of STDs—to the great army camps of classical Greece and Rome. In more recent times, the Italian War of Charles VIII (1494–5) provides one of the most dramatic instances of the intersection of armies, STDs, and war—the pan-European dissemination of venereal syphilis by the disbanded mercenary troops of France, Germany, and Italy (see Sect. 2.3.3). Thereafter, epidemics of syphilis and other venereal diseases followed wave-like on wars in Europe and elsewhere (Prinzing, 1916: 18). In Sweden, the syphilis epidemics of 1762 and 1792 were sparked by military returnees from the Seven Years’ (1756–63) and the Russo-Swedish (1788–90) Wars. In the nineteenth century, the Russo-Turkish Wars (1806–12, 1828–9) contributed materially to the spread of the disease in the Balkans (Hinrichsen, 1944). Elsewhere, in World War II (1939–45), the high-level transmission of gonorrhoea, chancroid, and syphilis among Allied personnel in the Burma–India, Africa–Middle East, and Mediterranean Theatres provides a twentieth-century example of the war-related problem of STDs (Sternberg et al., 1960). As Berg (1984: 90) notes, the historical concern of the military wth STDs was eminently a practical one. Prior to the era of antibiotics (penicillin was first used in the military treatment of syphilis and gonorrhoea in 1943), STDs were associated with extended periods of hospital treatment with correspondingly high economic and medical manpower costs to the armed forces. Some impression of the dimensions of the STD problem for one army (US Army) and war (World War I) can be gained from Table 10.1. During a 21-month period of military engagement, April 1917–December 1918, three STDs (chancroid, gonorrhoea, and syphilis) accounted for over 6.8 million days of lost service in the US Army.

BACKGROUND: Sexual activity among adolescents who are unaware of how to prevent sexually transmitted infections (STI) is of public health importance because they can be asymptomatic with long-term deleterious effects on their sexual and reproductive health. OBJECTIVE: This study aimed to assess the knowledge and practice of adolescents towards sexually transmitted infections. METHODOLOGY: A cross-sectional study design and systematic sampling technique was used in this study. The data collection was analysed using IBM SPSS version 26. P-value < 0.05 was accepted as statistically significant and results were presented in tables. RESULTS: More females (60.1%) participated in the study. Most respondents were aged between 13-15 and 16-19 (48.9%). 47 (20.2%) respondents were sexually active and of this number, most (38.3%) had their first sex between the ages of 16 and 19. 80.7% were aware of the benefits of condoms but only 9% used them. Respondents used mostly drugs (48.5%) and prayers (36.4%) to protect against STIs. The majority correctly identified common STIs while 12.4% incorrectly reported malaria as sexually transmitted. Infertility (56.2%), abdominal pain (45.9%) and abnormal discharge from private parts (56.2%) were recognized by the respondents as complications that can follow STI. CONCLUSIONS: Findings from this study reveal that most adolescents were aware of the symptoms, causes and complications of STIs. However, there is still a need to emphasize correct protection practices against STIs.

The epidemiology of sexually transmitted infections (STIs) is complex due to the coexistence of various pathogens, the variety of transmission modes derived from sexual orientations and behaviors at different ages and genders, and sexual contact hotspots resulting in network transmission. There is also a growing proportion of recreational drug users engaged in high-risk sexual activities, as well as pharmacological self-protection routines fostering non-condom practices. The frequency of asymptomatic patients makes it difficult to develop a comprehensive approach to STI epidemiology. Modeling approaches are required to deal with such complexity. Membrane computing is a natural computing methodology for the virtual reproduction of epidemics under the influence of deterministic and stochastic events with an unprecedented level of granularity. The application of the LOIMOS program to STI epidemiology illustrates the possibility of using it to shape appropriate interventions. Under the conditions of our basic landscape, including sexual hotspots of individuals with various risk behaviors, an increase in condom use reduces STIs in a larger proportion of heterosexuals than in same-gender sexual contacts and is much more efficient for reducing Neisseria gonorrhoeae than Chlamydia and lymphogranuloma venereum infections. Amelioration from diagnostic STI screening could be instrumental in reducing N. gonorrhoeae infections, particularly in men having sex with men (MSM), and Chlamydia trachomatis infections in the heterosexual population; however, screening was less effective in decreasing lymphogranuloma venereum infections in MSM. The influence of STI epidemiology of sexual contacts between different age groups (<35 and ≥35 years) and in bisexual populations was also submitted for simulation.IMPORTANCEThe epidemiology of sexually transmitted infections (STIs) is complex and significantly influences sexual and reproductive health worldwide. Gender, age, sexual orientation, sexual behavior (including recreational drug use and physical and pharmacological protection practices), the structure of sexual contact networks, and the limited application or efficiency of diagnostic screening procedures create variable landscapes in different countries. Modeling techniques are required to deal with such complexity. We propose the use of a simulation technology based on membrane computing, mimicking in silico STI epidemics under various local conditions with an unprecedented level of detail. This approach allows us to evaluate the relative weight of the various epidemic drivers in various populations at risk and the possible outcomes of interventions in particular epidemiological landscapes.

In the 1920s, so-called prophylactoria were established in the USSR. In these institutions, sex workers with sexually transmitted diseases (STDs) were treated. After the end of World War II, care homes for patients with STDs were established in the Soviet Occupation Zone of Germany (SOZ). These institutions were also intended to treat people suffering from STDs. This article compares these two types of medical institutions. Sources from the State Archive of the Russian Federation in Moscow, the German Federal Archives in Berlin and the City Archive Zwickau were used. The analysed sources were evaluated by using the historical-critical method. The prophylactoria were novel institutions that combined education and medical treatment of people with STDs. Similar strategies were followed in the care homes for STD patients. In both institutions, the sick persons had to follow a regular daily routine and work every day. The political indoctrination served to educate 'socialist personalities'. Nevertheless, various differences can be found between the facilities: the length of stay was different. The women in Soviet prophylactoria were cared for there for up to 2 years. However, the standard duration of stay in the care homes for STD patients was 3-6 months. The prophylactoria had a long-term programme not only to treat sick women but also to reeducate them. The aim was to enlighten and integrate them into the new Soviet society. The care homes for STD patients had a short-term programme of combating venereal diseases. Their main goal was to treat patients with STDs as quickly as possible, while education was an additional measure. Whether both institutions were successful in educating and treating these patients can hardly be assessed from today's perspective.

Gonorrhea and other infectious diseases were introduced to Ghana prior to the colonial period by European settlers. By the 1920s, both gonorrhea and syphilis were widespread in southern Ghana (3760 and 1503 cases, respectively, in 1925-26) and soon disseminated throughout the country. By 1946, there were 82,430 cases of gonorrhea and 9340 cases of syphilis--an increase exacerbated by the influx of laborers and troops during World War II. Although there was no government department responsible for the control of sexually transmitted diseases (STDs), sulpha drugs were widely utilized and distributed through the black market. It was not until 1986, when the first case of acquired immunodeficiency syndrome (AIDS) was diagnosed in Ghana, that government health officials gave serious attention to STDs. At that time, the most prevalent STDs were gonorrhea, chlamydia, and trichomonas. By 1992, 10,285 AIDS cases had been reported to the National AIDS Control Program and high rates of human immunodeficiency virus (HIV) infection existed in prostitutes and blood donors. Awareness of the role that STDs play as co-factors in HIV acquisition prompted in 1993 the decision to integrate AIDS and STD control programs. Campaigns to train health workers in AIDS/STD detection, treatment, and prevention were initiated. Women's subordinate socioeconomic status, which renders them unable to insist on condom use and denies them access to STD treatment, remains a major obstacle.

Tuberculosis and Sexually Transmitted Infections

Before organization of Department of Skin and Venereal Diseases at the University, these diseases were presented by therapists and surgeons. The Department of Skin and Venereal Diseases was created at the Moscow University on May 27, 1869. At the end of the 19 th century N.P.Mansurov found a sponsor for the constraction of the clinical base of the Department - Gavriil Gavriilovich Solodovnikov, a merchant. The Clinic of Skin and Venereal Diseases was opened on February 19, 1895, and in 1897 at the International Congress of Physicians in Moscow it was unanimously acknowledged to be the best in Europe. The first head of the Clinic was A.I.Pospelov The clinic continued working during the Great Patriotic War. In 2013-2014 the building was reconstructed at the initiative of the University and is now working again.