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October 06, 1985|Harry V. Vinters | Vinters is a pathologist at UCLA Medical Center. and

STD's: Sexually Transmitted Diseases

WHAT YOU SHOULD KNOW AND HOW TO PROTECT YOURSELF by Stephen H. Zinner MD (Summit: $14.95; 160 pp.)

In the newspeak of the 1980s, they are no longer called venereal diseases, but rather sexually transmitted diseases--STD's for short. This time newspeak has an advantage over oldspeak. STD is a more accurate, less off-putting term for the variety of ailments it describes.

Unfortunately, sexually transmitted illnesses are still very much with us--in epidemic proportions. The old standbys, gonorrhea and syphilis are at least treatable and often curable, though the microbes that produce them (especially the gunococcus) show a remarkable resilience in the face of potent antibiotic therapy. Penicillin-resistant strains of the organism that causes gonorrhea, for instance, are emerging with alarming speed, though new and effective drugs are swiftly being added to the current armamentarium.

Stephen Zinner, a specialist in infectious diseases on the medical faculties of Harvard and Brown universities, has provided a practical "how to"--and, more importantly, "how not to"--guide that should successfully steer any sexually active individual through the STD jungle. For make no mistake, it is indeed a jungle. At the outset, he states his objective simply: "To allay the fears and clear the confusion that surround these diseases, what is needed is a frank and open discussion of the means by which they are transmitted, the expectations for treatment and cure, and, most important, the potential for prevention of infection without having to limit sexual expression."

In plain, factual language, Zinner presents the history, causes, symptoms, diagnostic features, modes of therapy and prevention of both the better known and the more obscure STD's--everything from chancroid to Donovanosis (caused by, you guessed it, Donovania granulomatis to lymphogranuloma venereum. There is also a thorough if somewhat lackluster discussion of a group of disorders that might more accurately be called "sexually related"; for example, urinary tract infections in women and hepatitis.

Along the way there are fascinating historical tidbits--too few, alas--that place STD's in a historical context. Gonorrhea afflicted the likes of Samuel Johnson's biographer James Boswell, Napoleon, and (no surprise here) Giovanni Casanova. That venerable term the clap probably originates from the Middle French word clapoir , meaning bordello. Syphilis was named in 1530 by the Italian poet Fracastoro, and is said to derive from the Greek term for companion of love.

In the 16th Century, every STD-conscious country in Europe seemed prepared to point the accusing finger at any other nation. Syphilis was called the French disease by Italians, the Italian disease by the French, the French pox by the Germans, and the Spanish disease by the Dutch. During World War I, soldiers with venereal disease were labeled "sexual offenders," venereal camps were planned for such criminals, and "the virtues of chastity were preached as a part of basic training." World War II saw the introduction of the Pro-Kit, contents of which included calomel, a sulfa drug, and a supply of condoms.

Sadly, the STD's that have emerged with a vengeance in these enlightened times are ones over which modern medicine has thus far exercised little control. The venereal "plagues" of the late 20th Century, genital herpes and AIDS, are caused by viruses that do not consistently yield to any known drug. Luckily, genital herpes is essentially a self-limited condition, one that has a tendency to get better over time with or without medical intervention. AIDS is almost uniformly fatal. Small wonder that, as the author states, "If the 1960s represent the years of sexual revolution, then the 1980s reflect postrevolutionary confusion, dismay, and uncertainty."

Diseases caused by viruses are all the more insidious, as Zinner repeatedly points out, because a partner in a sexual relationship may unknowingly harbor or incubate an organism and transmit it long before he/she has any overt symptoms. The notoriously long incubation period of the AIDS virus, HTLV-III, is a key factor in the rapid spread of this syndrome, the first case of which was not even recognized until the late 1970s.

Zinner's graphic descriptions of the consequences of infection or infestation by any one of the numerous STD's provide sobering reading for all, especially those prone to enter into sexual relationships with "reckless abandon." However, "Fear of venereal diseases has rarely been an effective means of prevention. Sexual activity is a basic aspect of life and sexual expression is a major human need." Human nature being as it is, the most prudent advice given by the author to one victimized by STD--abstain!--is that least likely to be heeded.

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