By Dr Ananya Mandal, MD
Gonorrhea is a sexually transmitted infection that has been known to mankind since medieval times. It was referred to as the “clap” before the actual cause was discovered.
Discovery of the infection and its cause
The exact time when gonorrhea started cannot be ascertained. Earliest records of the disease are found from 1611 when the English parliament enacted a law to ensure that the spread of the infection is decreased and curbed. This shows the magnitude of the public health problem this infection had posed then. However, even then the cause of the infection was unknown.
This was followed by a similar law in 1256 in France during the reign of Louis IX. The symptoms of the infection were observed when the crusaders lay siege of Acre. After the Pope Boniface secularized the practice of medicine, the doctors began to treat common men as well as prostitutes for this infection.
In 1879 Neisser discovered the gonococcus or Neisseria gonorrhoeae and it was soon proven to be the causative agent of gonorrhoea. He demonstrated its presence consistently in patients with symptoms. In addition, when discharge and cultures of gonococci was introduced into the urethra of healthy men, it caused the disease
Gonorrhoea was referred to as the clap. According to some historians the name came about because the infected person would experience a clapping sensation that appeared suddenly when urinating.
Others say that the name originated because in order to remove the pus-like discharge from the penis, the penis had to be clapped on both sides. Still others believe that the name comes from French brothels, which were known as les clapiers, and men who visited these brothels invariably ended up with the infection.
History of gonorrhea treatments
The earliest treatment of gonorrhea was with the use of mercury. Earliest findings from an English warship “Mary Rose” show that several special surgical tools were used to inject mercury via the urinary opening.
In the 19th century gonorrhea was treated with the help of silver nitrate. Silver nitrate was soon discontinued and instead protargol was used which was a type of colloidal silver sold by Bayer from the year 1887.
Around 1859 another treatment was popular. These were cubebs, an Indonesian variety of pepper of which the dried powdered unripe fruit was used, and balsam of copaiba (or copaiva), which was extracted from a South American tree. The indication of their effectiveness was cessation of the discharge.
In the 1890s the first vaccine prepared from killed gonococci taken from Neisser’s laboratory. This vaccine was introduced in 1909.
Before antibiotics came into being metals were tried against the infection this included arsenic, antimony, bismuth, gold etc.
The use of other drugs for treatment continued right until the 1940s till antibiotics – notably Penicillin - came into use. Other antibiotics that arose during this time were the sulphur compounds or Sulphanilamide, Sulfapyridine and sulfathiazol.
Penicillins continued to be mainstay of therapy until 1970’s. In 1980 the first gonococcus isolates were identified that were resistant to penicillin. In 1983 a local epidemic caused by a penicillin resistant strain occurred in North Carolina. Patients were successfully treated with spectinomycin.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)