When Thou Liest Howling

There are some things we just don’t want to acknowledge aren’t there? Some things that we would rather not hear, not so much because we don’t think they’re important, but because they embarrass us… Or maybe offend us. Sexually transmitted diseases are prime examples.

For some reason, many of us find them difficult to talk about. Admittedly they require rather special venues, and the very subject casts long shadows on the interlocutors no matter how discreetly it is introduced. Rather than appearing as an intimate trust issue, the very fact of its being raised in the first place tends to arouse suspicion -accusations by proxy.

At first, I wondered if this attitude might be a generational thing. I was raised in an era when the most feared unintended consequence of premarital sex (as we called it then), was assumed to be pregnancy; VD -another time-specific term for sexually-acquired disease- was confined to clearly recognizable and therefore potentially avoidable people. This naïveté, of course, didn’t prepare us for the inevitable consequences of our wide-eyed ignorance and even nowadays, those of us still around could yet be dragged, aged and surprised, into the vortex as I outlined in an essay elsewhere:  https://musingsonretirementblog.com/2016/10/16/too-good-to-be-true/

The initial solace of antibiotic treatment also proved too good to be true. Throughout history, sexually transmitted infections were a scourge –the wages of sin as they were considered then. But with the advent of effective treatments, those debts were forgotten –although clearly not forgiven.

Syphilis, gonorrhea, and the more recently characterized chlamydia exacted a terrible toll on fertility and long term health, but until recently, all were fairly amenable to antibiotic therapy –albeit a necessarily changing one. Gonorrhea, however, seems to be particularly adept at developing resistance to the various antibiotics thrown at it.

There are various mechanisms by which a bacterium can become antibiotic-resistant but a common and easily appreciated reason is inadequate initial treatment. Even if an antibiotic is effective, there will usually be some bacteria that are less sensitive to it for whatever reason, and hence require longer antibiotic exposure for it to affect them. People tend to continue treatment only until they feel well –in other words, until the number of bacteria infecting them has fallen below whatever level was required to cause the symptoms. Unfortunately, the few bacteria that remain, are the less sensitive ones that weren’t so easily killed off at the beginning.

Physical barriers to the acquisition of sexually transmitted infections –condoms, for example- are certainly helpful, but men don’t tend to wear them with oral sex, the World Health Organization (WHO) has warned:  http://www.bbc.com/news/health-40520125  This has led to an increasing problem with throat infections according to the BBC News article. ‘Gonorrhoea can infect the genitals, rectum and throat, but it is the last of these that is most concerning health officials.

‘Dr Wi [from the WHO] said antibiotics could lead to bacteria in the back of the throat, including relatives of gonorrhoea, developing resistance. She said: “When you use antibiotics to treat infections like a normal sore throat, this mixes with the Neisseria species in your throat and this results in resistance.” Thrusting gonorrhoea bacteria into this environment through oral sex can lead to super-gonorrhoea.’

The problem is that a throat infection with gonorrhea may be relatively asymptomatic and hence more likely to be inadvertently transmitted to someone else. And ‘It’s hard to say if more people around the world are having more oral sex than they used to, as there isn’t much reliable global data available. Data from the UK and US show it’s very common, and has been for years, including among teenagers.

‘The UK’s first National Survey of Sexual Attitudes and Lifestyles, carried out in 1990-1991, found 69.7% of men and 65.6% of women had given oral sex to, or received it from, a partner of the opposite sex in the previous year. By the time of the second survey during 1999-2001, this had increased to 77.9% for men and 76.8% for women, but hasn’t changed much since.

‘A national survey in the US, meanwhile, has found about two-thirds of 15-24 year olds have ever had oral sex. Dr Mark Lawton from the British Association for Sexual Health and HIV said people with gonorrhoea in the throat would be unlikely to realise it and thus be more likely to pass it on via oral sex.’

And apparently there are only ‘three drug candidates in the entire drug [development] pipeline and no guarantee any will make it out.

‘Prof Richard Stabler, from the London School of Hygiene & Tropical Medicine, said: “Ever since the introduction of penicillin, hailed as a reliable and quick cure, gonorrhoea has developed resistance to all therapeutic antibiotics. In the past 15 years therapy has had to change three times following increasing rates of resistance worldwide. We are now at a point where we are using the drugs of last resort, but there are worrying signs as treatment failure due to resistant strains has been documented.”’

So, we’ve got a potentially untreatable, possibly asymptomatic, and very definitely prevalent infection out there, and a societal reluctance to talk about it… Perhaps it’s time for another approach. Fortunately there is an active search for a gonorrhea vaccine –and a serendipitous observation may have suggested a possible route –although, in retrospect, it seemed an obvious place to start. http://www.bbc.com/news/health-40555702

‘The vaccine, originally developed to stop an outbreak of meningitis B, was given to about a million adolescents in New Zealand between 2004 and 2006. Researchers at the University of Auckland analysed data from sexual health clinics and found gonorrhoea cases had fallen 31% in those vaccinated.

‘The bacterium that causes meningitis, Neisseria meningitidis, is a very close relative of the species that causes gonorrhoea – Neisseria gonorrhoeae. It appears the Men B jab was giving “cross-protection” against gonorrhea.’ This is very early in the work, however, and it seemed only to be effective in a third of those vaccinated. But it is certainly encouraging.

Be that as it may, however, I can’t help but worry that if there is development of an effective vaccine against gonorrhea, it will once again fool us into forgetting about the other diseases potentially transmissible by oral sex, including viruses such as hepatitis, herpes, and HPV (for which, thank god, there is also an effective vaccine), not to mention the bacterially-caused ones like syphilis, chlamydia, and many others that don’t make for salacious headlines.

But I’m not advocating for the formation of a Temperance League to combat a practice that is likely as old as humanity, nor do I have any religious or ideological objections to its persistence in our society, but I do believe that the Past informs the Future. I think that it would be prudent to ensure that all participants –newcomers to the field, as well as those who have already passed through and are merely nibbling at memories- have a working knowledge of those risks that should not be placed, as Shakespeare put it, on the windy side of care

I just wonder if those who are entrusted with sexual education nowadays would put it so beautifully.

 

 

 

 

 

 

 

 

 

 

 

 

http://www.bbc.com/news/health-40555702

 

 

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Sweet Flowers are Slow

 

 

It never ceases to amaze me what unfettered minds can discover. Sometimes I wonder how they do it. How they set out 180 degrees from the target and still end up hitting it. Of course, the world is full of answers scattered like flowers in a field, in plain sight for anybody who has learned to see them. It’s not the answers that are hidden, just the appropriate questions. But maybe that’s the point –questions are often like detours pointing away from where you think you want to go, and yet arrive you do, having learned unexpected things along the way –Frost’s Road not Taken.

Socrates, although he initially disavowed the Delphic Oracle’s apocryphal pronouncement that he was the wisest man in Athens, knew that Truth, like Wisdom, was slippery. He realized he didn’t possess all the truth and so he asked many questions, whereas others -those who never thought to investigate- were complacent about their knowledge, unpuzzled by what they experienced, content with their grasp, however tenuous.

Maybe that’s just the way we’ve been taught to interrogate reality, though: if A equals C, and B also equals C, then we need look no further –A, B and C are equivalent, or at least interchangeable and otherwise individually uninteresting. Perhaps it takes a Socrates to ask why that is –or at least why we are satisfied with our assessment.

An article in the BBC News about an unusual approach to decreasing the spread of malaria brought this to mind: http://www.bbc.com/news/health-40495958  While researchers are trying desperately to engineer a vaccine, there have been many interesting attempts to ameliorate the prevalence of the disease. Some are relatively high tech –like genetically altering mosquitoes to produce genes to prevent the development of the malarial parasite within themselves and therefore stop its transmission to people when they bite; some are more humble methods, more attainable in the short term -such as pyrethroid-treated mosquito netting around beds. I suppose the boundaries between discovery and invention are fluid, but even so, either of them can lead to uncharted territories. New possibilities.

Still, until we do have an effective and safe vaccine, we need to use as many other methods to decrease the ravages of the female Anopheles mosquito as possible –however indirectly they may achieve this. Sometimes you just have to try stuff. Sometimes, you have to think inside the garden.

‘Gardening could be a powerful weapon against malaria, culling mosquito populations by cutting off their food supply, say researchers.’ The idea is to starve the mosquitoes before they get a chance to pass on the malarial parasite. A pilot project in Mali, West Africa, found that ‘Removing flowers from a common shrub appeared to kill off lots of the older, adult, female, biting insects that transmit malaria. Without enough nectar the “granny” mosquitoes starve, experts believe.

‘These Anopheles mosquitoes carry the malaria parasite in their salivary glands and pass it on to people when they bite and draw blood. The infected person can then infect other younger, biting, female mosquitoes – which are looking for a rich blood meal as they become fertile and make eggs – because their blood now contains the parasite. It takes about 10 days for a newly infected young female mosquito to become contagious to humans. By the time she can transmit malaria, she’s pretty old. Although she will feed on blood, she also relies on flower nectar for energy to stay alive.’

So, ‘Experts in Mali, along with researchers from the Hebrew University of Hadassah Medical School, Israel, and the University of Miami in the US, set up a horticultural experiment to see if removing the flowers from this plant might help kill off local mosquitoes. […]Villages where they removed the flowers saw mosquito numbers collected in the traps fall – the total number of mosquitoes across these villages decreased by nearly 60% after removal of the flowers.’

Admittedly, as the researchers concede, although it was an appropriate technique in a place like Mali, ‘it might not work so well in lush tropical regions where nectar-rich plants are in abundance.’

I suppose one of the reasons why this approach intrigued me so much, was that it seemed like a rather simple –albeit laborious- technique for mosquito control. Much like removing standing water that has collected in puddles or old tires where the mosquitoes can lay their eggs, it could be a community-led project that requires no additional external resources. But even more than that, as Professor Jo Lines, from the London School of Hygiene and Tropical Medicine, has observed, ‘”It appears to show that by changing the landscape, not using insecticides or drugs, we can make a difference.”’

What a thought –changing, not destroying something to achieve an aim. Being clever and asking the right questions about what was already in front of the eyes of anyone inquisitive enough to actually notice. Curious enough to ask ‘what if…?’

So, back to Socrates who, in the end, conceded that perhaps the Delphic Oracle had been right all along about him being the wisest man in Athens. He was still searching for knowledge, still questioning the completeness of what others had already decided was necessary for them to understand. He was still unprepared to pretend that he knew something he didn’t. To the end, he refused to accept that there weren’t always more questions to ask.

After all, it’s not what you look at that matters, it’s what you see; it’s not what you hear, so much as what you understand… The rest, as Hamlet said, is silence.