The term gonorrhea originates from ancient Greece, refers to the great physician Galen, and dates back to the 2nd century A.D.
The term that is most commonly used is "blenorrhagia" (Swediatur, 1700), which is etymologically composed of blénna meaning 'mucus' and rhḗgnymi 'erompo'. From the latter comes the more popular term scole, which means a discharge of a serous fluid.
Rising to more ancient times, In literature, the condition is also remarkably mentioned by Aristotle and Plato. Moreover, in a dialogue between Emperor Huang Ti and physician Tchi Pa, within the Huangdi Neijing, an ancient medical treatise of the Yellow Emperor, we find referable hints of infectious urethritis traceable to gonorrhea, treated with soybean seed impregnations.
In 1500 B.C.E. we observe further references to gonorrhea in the 18th Dynasty papyrus, later found in Luxor by Georg Moritz Ebers, in which the symptoms of acute urethritis were described and it is suggested that it be treated with endorectal instillations with sandalwood oil.
In 1161, we note that the British Parliament enacted a law to limit the spread of gonorrhea infection. In France, in 1256, symptoms were observed and with Pope Boniface, men and harlots with the disease began to be treated.
The discovery of Gonococcus or Neisseria Gonorrhoeae is due to the German bacteriologist, Neisser Albert, who discovered the pathogen through Gram-stained microscopy of urethral secretion in 1879 and traced it to the kidney-like shape of two cells that are arranged taking on a typical "coffee bean" appearance.
We note how, around 1800, treatments with potassium parchmentate washings were suggested and also in 1800, silver nitrate therapy was imposed even though initially the use of mercury injected through the urethral orifice was widespread in treatments.
For the first vaccine we have to wait until 1890, although it was presented in 1909, by the New York City Department of Health that recommended an injection about every three days for two months.
In 1916 the effect of gonococcal, meningococcal, and colonic bacilli vaccines administered intravenously in cases of gonorrhea, and some with epididymitis or arthritis was compared. The effects were more consistently beneficial with regard to arthritis. However, the responses did not relate specifically to the gonococcal vaccine.
But it was not until after 1936, following the release of sulfa drugs, that gonococcus was positively counteracted. The first treatment was observed at the Johns Hopkins University Clinic and was administered to fifty-eight patients who were asymptomatic in about four days, excluding six cases of relapse.
A much larger investigation was conducted in London, where the effect of sulfanilamide was compared with the results of standard therapy in 1936. In fact, sulfanilamide cases gave much earlier responses and showed far fewer relapses. The best results were obtained in patients whose treatment began during the second week of symptoms gonorrheali, instead of during the first week.
Sulfapyridine, soon followed by sulfathiazol, analogs of sulfanilamide, became available in 1940-41. A one-week course of sulfapyridine proved capable of curing three-fourths of the cases for which sulfanilamide had instead failed, as well as 87 percent of previously untreated patients.
These cases were cured by sulfapyridine.
When individual countries, during the late 1980s, especially in industrialized settings, undertook prevention and treatment of STDs based on established determinants of STDs, it was possible to observe a significant decline in rates of gonococcal infections.
Subsequently, the first penicillin-resistant gonococcus subjects were identified, due to a chromosomal mutation. Recall that, in 1983, a local outbreak derived from such a strain occurred in North Carolina, and these patients were successfully treated with spectinomycin.
These patients were treated with spectinomycin.
Because of concern about patients with an allergy to penicillin and the increase in cases, attempts were initiated to find an antibiotic alternative to penicillin for the treatment of gonococcal infections. In 1949 chlortetracycline proved effective, with the added advantage of oral administration. In 1966, 94% of gonococcal strains were found to be highly sensitive to tetracycline, while 22% of these showed increased resistance to penicillin.
Resistance continued to develop after several years against each new antibiotic that was initially effective. Spectinomycin, introduced in 1967, thus replaced tetracycline as an alternative to penicillin in the 1970s, and ceftriaxone began to be recommended for primary anti-gonococcal therapy in 1989.
Bibliography
Edward W Hook, III, Robert D Kirkcaldy, A Brief History of Evolving Diagnostics and Therapy for Gonorrhea: Lessons Learned, Clinical Infectious Diseases, Volume 67, Issue 8, October 15, 2018, Pages 1294-1299
Huang Ti. Nei Ching Su Wen, edited by Ilza Veith, Ro- ma, Ed. Mediterranee, 1983.
CDC. Gonorrhea surveillance reports, 1975-1983.
Joachim H. Papyros Ebers. In Aelteste Buch ueber Heilkunde. Berlin, Reiner, 1890.
