Author: Thappa Devinder Mohan
Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
How to cite this article:
Thappa DM. Evolution of venereology in India. Indian J Dermatol Venereol Leprol 2006;72:187-196
How to cite source URL:
Thappa DM. Evolution of venereology in India. Indian J Dermatol Venereol Leprol [serial online] 2006 [cited 2006 Jun 19];72:187-196. Available from: http://www.ijdvl.com/article.asp?issn=0378-6323;year=2006;volume=72;issu...
The older terminology of 'venereal diseases' (VDs) largely has been superseded in the past 50 years by 'sexually transmitted diseases' (STDs) and more recently by 'sexually transmitted infections' (STIs).[1] To some, venereal diseases came to be viewed as a narrow and pejorative term limited to gonorrhea, syphilis, chancroid, lymphogranuloma venereum and granuloma inguinale and related VD control laws.
The term 'sexually transmitted diseases' more easily incorporates the many newly discovered sexually transmitted agents and syndromes.[1],[2] Sexually transmitted disease (STD) includes diseases that are transmitted by sexual intercourse. Sexual transmission requires the agent to be present in one partner, the other partner to be susceptible to infection with that agent and that the sex partners engage in sexual practices that can transmit the pathogen.
Sexually transmitted infection (STI) differs from sexually transmitted disease (STD) in that STD conventionally includes infections resulting in clinical diseases that may involve the genitalia and other parts of the body participating in sexual interaction, e.g., syphilis, gonorrhea, chancroid, donovanosis, nongonococcal urethritis, genital warts, herpes genitalis, etc. STI, in addition, includes infections that may not cause clinical disease of genitals but are transmitted by sexual interaction, e.g. all STDs and hepatitis B, HIV, HTLV-1, etc. Nowadays, the term STI is preferred, since it covers all the diseases that can be transmitted by sexual intercourse. However, for all practical purposes, both STI and STD are used synonymously and in European countries, they come under the specialty of genitourinary medicine.[3]
Venereology (the study of venereal diseases) today encompasses more than the five classical venereal diseases (syphilis, gonorrhea, chancroid, donovanosis and lymphogranuloma venereum).[4] A growing number of other diseases are being identified that might be considered the new generation of sexually transmitted diseases (STDs). Their importance is newly recognized due to the development of laboratory techniques of diagnosis and increasing awareness of the consequences of STDs in areas of health and society.[4] This article briefly deals with various facets of evolution of venereology in India.
ORIGIN OF STDS
The origins of venereal (sexually transmitted) diseases are obscure.[2] Medical and other historians have often suggested that well-known diseases such as syphilis, gonorrhea, chancroid and lymphogranuloma venereum have existed since earliest times. This may or may not be true and some of these individuals may have drawn conclusions from ancient texts and manuscripts that may not be accurate. While the infections certainly exist in Homo sapiens , did they occur in the preceding species Homo erectus prior to 150,000 BC? No one knows, but the French philosopher Voltaire summed it up well when he declared in his Dictionnaire philosophique that venereal diseases are like the fine arts - it is pointless to ask who invented them.[2] Among the uneducated and uninformed people in India, we often hear remarks to the effect that the occurrence of venereal disease is a 'visitation from God,' 'a sign of growing adolescence,' 'a sign of maturity,' 'the result of eating nettle leaves' and 'from sexual intercourse with menstruating woman'.[5] Such fallacious ideas about the causation of venereal diseases are still prevalent all over the world with varying emphasis.
In the field of medicine, the ancient Hindus carried their researches farther than any of their contemporaries.[6] The Upanishads contain the most convincing evidence of their passion for enquiry into the nature of things. Padmini, or the Lotus woman, is the symbol of woman beauty in Hindu literature.[6] According to Hindu mythology, in the beginning, the Lord of Beings (Brahma) created men and women and laid down rules for regulating their existence with regard to Dharma (acquisition of religious merit), Artha (acquisition of wealth, property, etc.) and Kama (love, pleasure and sensual gratification).[6] The commandments related to Kama were expounded by Nandi, the follower of Mahadeva. This document written by Nandi, known as Kama Sutra (aphorisms on love), was transformed into a small volume of Sanskrit literature by Vatsyayana between the 1st and 6th century of the Christian era. This manuscript is known by the name of Vatsyayana Kama Sutra. This document was withheld from public gaze as sex was considered a taboo amongst Hindus. This Sanskrit document was later translated into English by Sir Richard Burton and F. F. Arbuthanot and was published in England in 1883. There is no mention of venereology in the days of Kama Sutra.[6]
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SYPHILIS
In the past, some attempts have been made to identify syphilis and gonorrhea in ancient Hindu (Ayurvedic) texts, but evidence strongly suggests that syphilis, at least, was unknown in India before the early 16th century.[7] .................
GONORRHEA
...........................In regiments of the British army stationed in India, the percentage of troops admitted to hospital with venereal diseases (identified in almost equal proportion as primary syphilis and gonorrhea) rose to 205 per 1,000 in 1875 and peaked at 522 per 1,000 in 1895.[7] For unexplained reasons, syphilis was relatively more common and gonorrhea less common in the army personnel of Indian origin than in the British army in India.[9].................
CHANCROID
Chancroid, one of the five classic venereal diseases, was first described by Brassereau in 1852 in France.[10] ................. In the Army in India (71,001 men), the venereal disease rate in the year 1912 was 55.5 per 1,000 (10.1% of all admissions).........................
DONOVANOSIS
Historically, donovanosis, formerly called as granuloma inguinale, was first recognized and described in India. It was first described in 1881 in Madras, India, under the name of 'serpiginous ulcer' by Kenneth MacLeod, a Scot, who joined the Indian Medical Service and became professor of surgery in Calcutta.[12]............................
LYMPHOGRANULOMA VENEREUM
In 1902, Caddy was the first to record cases of lymphogranuloma venereum (LGV) in India under the title 'Climatic bubo'.[17] ..........................
OTHER STDS
However, no description of genital warts, herpes genitalis and trichomoniasis is found in the comparatively modern Indian literature of the early 20th century.[4] Despite considerable doubt by most observers, by 1920s and 1930s many venereologists had concluded that genital warts are sexually transmitted diseases.[2] ............................
BRITISH INDIA AND STD CONTROL MEASURES
In 19th century India, the British military authorities did not rely solely upon mercury to try to deal with STDs, especially syphilis, in the army (mainly contracted from prostitutes).[7] From about the 1780s onwards, lock hospitals were used to confine and treat prostitutes associated with the army and found to be suffering from STDs.[9] .........................
INDEPENDENT INDIA AND STD CONTROL MEASURES
There were practically no control measures adopted either on a limited or a large scale in India until about 1949.[5] At the request of the Government of India (GoI), World Health Organization (WHO) sent a venereal disease demonstration team in 1949 to work side by side with a national matching team to establish a center for a survey and mass treatment of syphilis in Himachal Pradesh in India. The Venereal Disease (VD) Main Clinic and Laboratory at Shimla, in Himachal Pradesh, was established in May 1949..............................
ADVENT OF AIDS IN INDIA
The first reported cases of HIV infection diagnosed in India were among Madras sex workers in May 1986.[28] The epidemic of HIV in India was similar in many ways to the experience in sub-Saharan Africa and Thailand. The advent of AIDS in India in the 1980s was not at first regarded as a serious threat, with probable thinking that it is a white man's disease and is due to Western immorality.[7] In 1988, AIDS began to spread rapidly in India, thus awakening the health authorities..............................
CURRENT STATUS OF HIV EPIDEMIC IN INDIA
........................ By 2003, it was estimated that 5.1 million people were living with HIV/AIDS in India, second only to South Africa in absolute numbers.[30]...............
SETTING UP OF GOVERNMENT NODAL AGENCIES IN INDEPENDENT INDIA
There has been a program for the control of STDs among the population of India for many decades.[4] India was plagued by many life-threatening diseases and as in most other countries, STD services were a low priority.[9] .........................
ACADEMIC DEVELOPMENTS
Europeans introduced modern medicine to India. At the time of independence, there were already 19 medical colleges in undivided India (including two in the princely states of Mysore and Hyderabad).[31] ....................
EMERGING STIS SCENARIO
....................In India, the main strategy aimed at achieving effective management for people with established infections has been to integrate STD services into the existing health care system, with special emphasis on integration at the primary health care (PHC) level......................
FUTURE DIRECTIONS
Donovanosis will be eradicated in several nations, but syphilis eradication will be successful only by 2020.[42] Gonorrhea, chlamydial infections, chancroid and trichomoniasis may also persist despite their curability. With the exception of hepatitis B, HIV and other blood-borne pathogens will continue to flourish until blood supplies and medical injections, as well as illicit drug use and tattooing, are made safe.........................
