Speaker 1: Okay, so this is a small disclaimer for this episode,
Speaker 1: since a lot of you either are kids, high kids,
Speaker 1: or you listen with your kids. Hi, parents and kids.
Speaker 1: We are discussing a sexually transmitted disease today, which means
Speaker 1: we're going to be talking about sex and genitals. So
Speaker 1: if you want to veto that for your five year
Speaker 1: old that's listening, put your earbuds in now.
Speaker 2: January eighteenth, seventeen sixty three. I this day began to
Speaker 2: feel an unaccountable alarm of unexpected evil, A little heat
Speaker 2: in the members of my body sacred to Cupid, very
Speaker 2: like a symptom of that distemper with which Venus when
Speaker 2: Cross takes it into her head to plague her votaries.
Speaker 2: But then I had run no risks, I had been
Speaker 2: with no woman but Louisa, and sure she could not
Speaker 2: have such a thing. Away then, with such idle fears,
Speaker 2: such groundless, uneasy apprehensions. January nine, eighteenth, the evening was
Speaker 2: passed most cheerfully when I got home, though then came
Speaker 2: sorrow to too. Plain was signor gonorrhea. Wait there's more.
Speaker 2: Thus ended my intrigue with the fair Luisa, which I
Speaker 2: flattered myself so much with and from which I expected
Speaker 2: at least a winter's safe copulation. It is indeed very hard.
Speaker 2: I cannot say, like young fellows who get themselves clapped
Speaker 2: in a body house, that I will take better care again,
Speaker 2: for I really did take care. However, since I am
Speaker 2: fairly trapped, let me make the best of it. I
Speaker 2: have not got it from imprudence. It is merely the
Speaker 2: chance of war. I mean, it goes on and on
Speaker 2: like there's a much more of it. That's just yeah,
Speaker 2: Oh my gracious, isn't it so good?
Speaker 1: What is that?
Speaker 2: What is that? Okay? So that is from James Boswell.
Speaker 2: So James Boswell was the He was the biographer of
Speaker 2: Samuel Johnson, who's a literary Okay, yeah, James Boswell throughout
Speaker 2: his life, throughout his journal entries at least became infected
Speaker 2: with GONERIEA at least nineteen separate times nineteen So this
Speaker 2: is merely one of them. I just he really you
Speaker 2: should take some time and just go and seek out
Speaker 2: the entirety read his.
Speaker 1: Whole journal entry.
Speaker 3: Yes, yes, man, Hello, Hello, I'm Aaron Welsh and I'm
Speaker 3: Erin Almond updyke and put your hands together for hands
Speaker 3: together for Goneriea, the subject of today's episode.
Speaker 1: Of this podcast Will Kill You. Welcome, Welcome, We're gonna
Speaker 1: have fun today, I can tell.
Speaker 2: Oh yeah, I mean if that journal entry is any indication, right, okay,
Speaker 2: So what are we drinking to talk about GONERIEA.
Speaker 1: We're drinking, of course, burning love.
Speaker 2: And it is burning because it does Jalipino simple syrup
Speaker 2: and tequila, lemon juice and a cucumber slice.
Speaker 1: Just for freshness.
Speaker 2: It's pretty delicious.
Speaker 1: I gotta say it is delicious. I'm really enjoying it.
Speaker 1: And as always, we'll post the full recipe for this
Speaker 1: quarantine as well as our Placeyburrita, our non alcoholic version
Speaker 1: on all of our social medias. You can find us
Speaker 1: on Twitter at TPWKY, on Instagram and Facebook at this
Speaker 1: Podcast will Kill You, and on our website at this
Speaker 1: Podcast will Kill You dot com.
Speaker 2: And if you ever feel like reaching out to us,
Speaker 2: you can email us at this Podcast will Kill You
Speaker 2: at gmail dot com, or go to our website for
Speaker 2: an entry or a contact form.
Speaker 1: Yep. Cool, All right, let's do it right after this
Speaker 1: short break. All right, GONERIEA, gottareea. Let's get into it.
Speaker 1: So gonerhea is caused by a bacterium. It's called Nicia
Speaker 1: gonneriee goner rhea. Ee. I never know how to pronounce
Speaker 1: all those vowels.
Speaker 2: There are so many vowels at the end of that word.
Speaker 1: I know it's a lot. Niceria gonerie is closely related
Speaker 1: to another bacteria that some listeners and you, Aaron, will
Speaker 1: definitely have heard of. Do you remember what.
Speaker 2: It is, meningitis?
Speaker 1: Yes, Niceria meningititis, which causes meningitis. So all the Niceria
Speaker 1: are gram negative diplocoxie, which means that they stain pink
Speaker 1: when we use stains to look at them under a microscope,
Speaker 1: and they're just these two little balls gonna yeah, yeah, okay,
Speaker 1: So let's just I'm just gonna really we're gonna get
Speaker 1: right into this how all this goes. So we all
Speaker 1: know how goneria is transmitted.
Speaker 2: I think, right, well, maybe you should just do a
Speaker 2: refresher just in case.
Speaker 1: I mean, okay, So goneria is transmitted via sexual relations,
Speaker 1: so you can get it from all the kinds of
Speaker 1: sexual intercourse, vaginal, oral, anal and in any direction giving
Speaker 1: receiving doesn't matter. And for adults that's pretty much the
Speaker 1: only way that you're going to get goneriea is via
Speaker 1: sexual intercourse of some design, Okay, in neonates, so in
Speaker 1: tiny baby infants, it can be passed from mother to
Speaker 1: baby during delivery, during birth, during passage through the birth canal.
Speaker 1: So in general, in this country and in most other countries,
Speaker 1: we screen pregnant people for gonococcal infection. This is often
Speaker 1: called ganococcus or ganococcal infection or just gonerrhea, So I'll
Speaker 1: probably use all those words interchangeably, but yeah, infection in
Speaker 1: a newborn is actually pretty serious, and so you screen
Speaker 1: for it during pregnancy and then you treat it and
Speaker 1: that reduces the risk of neonatal infection. Cool, Okay, so cool.
Speaker 1: So what happens when you get exposed after a fun
Speaker 1: night to gonerhea? Basically, the bacterium which has been deposited
Speaker 1: into your body will adhere to your epithelial cells, okay,
Speaker 1: either along the vaginal canal or on the endocervix, or
Speaker 1: in the anal canal or I wrote penile canal, and
Speaker 1: then I realized that's just called your your ethra, you're urethra,
Speaker 1: and it attaches to these epithelial cells. Using pilli, which
Speaker 1: are basically isn't that fun? I didn't know that until
Speaker 1: I started researching this. Yeah, so pilli are basically these long,
Speaker 1: stringy protein bits that bacteria have. They're kind of like
Speaker 1: you remember those sticky hands that you used to get
Speaker 1: from the twenty five cent machines. Oh yeah, you like
Speaker 1: throw them out and stick them on your wall, and
Speaker 1: then your mom gets mad at you because you ruin
Speaker 1: her white walls well.
Speaker 2: And then they get covered in fuzz and they don't
Speaker 2: stick anymore. Yes, just like that.
Speaker 1: But so you know, like if you throw that out
Speaker 1: and stick it and then you let it go, it
Speaker 1: like flings towards the wall, right, So that's kind of
Speaker 1: what these pill i do. They reach out, they grab
Speaker 1: onto the epithelial cells and then they contract and that
Speaker 1: sucks the bacteria up against the epithelial cells.
Speaker 2: That's so cool.
Speaker 1: It's very cool. And it's great if you're in something
Speaker 1: like a urethra or up against the cervix, because you're
Speaker 1: probably gonna have fluid rushing through those tubes and so
Speaker 1: you want to be able to stick on and grab
Speaker 1: on real type. Yeah, so ganeria is good at that,
Speaker 1: and once it sticks on it starts to replicate basically
Speaker 1: right then and there, it doesn't it's not a virus,
Speaker 1: so it doesn't have to infect your cells. It just
Speaker 1: grabs a hold and then starts replicating. Oh pretty fun. Yeah,
Speaker 1: and then once it colonizes, once it starts growing, it
Speaker 1: stimulates the release in your body of a whole bunch
Speaker 1: of pro inflammatory molecules. So this basically stimulates your immune response.
Speaker 1: So then a whole bunch of immune cells, especially neutrophils
Speaker 1: and macrophages, which are kind of the first line defense
Speaker 1: against bacteria. They come in and in normal bacterial or
Speaker 1: other bacterial infections, they'd be able to pagosatize, which means
Speaker 1: swallow up, essentially eat the bacteria and then help clear
Speaker 1: the infection. But Gonnerrhea are sneaky little suckers and they
Speaker 1: can actually survive inside of neutrophils.
Speaker 2: Oh that's amazing, I know.
Speaker 1: So when you look at like a swab from someone
Speaker 1: who has a goneriinfection, if you stain it, you'll actually
Speaker 1: see neutrophils just full of Gonnerhea bacteria.
Speaker 2: Oh my gosh, it's very cool. Like a trojan horse. Yeah, yeah,
Speaker 2: maybe sure.
Speaker 1: The neutrophils normally kill bacteria by using reactive oxygen species,
Speaker 1: but the niceria can actually what sort I'm looking for,
Speaker 1: neutralize those because they have an enzyme called catalase which
Speaker 1: helps to neutralize that. So they can just survive inside
Speaker 1: of the neutrophils, which I think is very cool. That's awesome,
Speaker 1: And because they're recruiting a bunch of neutrophils and macrophages,
Speaker 1: that is also what kind of results in the symptoms
Speaker 1: that we see. So if you get a genito urinary infection,
Speaker 1: let's talk about what kind of symptoms you'll actually have.
Speaker 1: First of all, most of the time you won't have
Speaker 1: any Most infections are straight up asymptomatic, which is part
Speaker 1: of why it can spread so easily, because anything that's
Speaker 1: spread by sexual contact in certain populations is going to
Speaker 1: be pretty easy to spread. And if it's asymptomatic, then
Speaker 1: it never gets detected or treated, so you just keep
Speaker 1: sharing the burning love. So for a genito urinary infection,
Speaker 1: if you get infected in the urethra, you're going to
Speaker 1: see dysurea, so that means painful urination because you've got
Speaker 1: basically inflammation going on along the lining of your urethra.
Speaker 1: And then you'll also get a discharge, and that discharge
Speaker 1: will be either white or yellow or greenish, okay, CoRIS
Speaker 1: and it's mostly neutrophils. It's mostly neutrophills, dead cells, and bacteria.
Speaker 1: And then even those neutrophils are often full of gonococcal
Speaker 1: bacteria as.
Speaker 2: Well, So all of the stuff that you are secreting
Speaker 2: is full of it's like packed with Gottrhea bacterial cells.
Speaker 1: Absolutely, yeah, yeah, so that discharge is super infectious.
Speaker 2: Okay.
Speaker 1: You also can get infection of the epidymus. So if
Speaker 1: it travels through their urethraat and back down into the epididymus,
Speaker 1: which is the tubes that surround the testis where the
Speaker 1: sperm actually have to travel through. Then you can get
Speaker 1: what's called epididymitis, which is infection inflammation of the epidymus,
Speaker 1: and that can be very very painful, So you can
Speaker 1: have testicular and scrotal pain on top of painful urination
Speaker 1: and urethral discharge. If you get an endocervical infection, so
Speaker 1: an infection of the vaginal canal and the cervix at
Speaker 1: the top there, it's even more likely to be asymptomatic.
Speaker 1: Than a urethral infection. Okay, if you do get symptoms,
Speaker 1: they're often mistaken for a bladder infection or aaginal infection
Speaker 1: like a yeast infection or a bacterial vaginosis or something.
Speaker 1: So you might have some dysyria, you might have some
Speaker 1: vaginal discharge or some bleeding in between periods. But more
Speaker 1: often there are no symptoms in people with an endocervical
Speaker 1: or a vaginal infection.
Speaker 2: And when you say more often, like can you give
Speaker 2: me a pee, put in number to the percentage of cases.
Speaker 1: I don't have a number. I was trying to find
Speaker 1: solid numbers. And it's just like most of the time
Speaker 1: in endocervical infections it's asymptomatic, and most of the time
Speaker 1: in your reath roll. In penile infections, it is symptomatic
Speaker 1: or it's more likely to be symptomatic, though in both
Speaker 1: cases it can be asymptomatic. The problem with endocervical infections
Speaker 1: is that they can spread. They're asymptomatic, so they're less
Speaker 1: likely to be detected, and they can spread from the
Speaker 1: endocervix to the uterus or the fallopian tubes, which causes
Speaker 1: what's called pelvic inflammatory disease. Or pid pid is a
Speaker 1: very serious disease. It can cause abdominal and pelvic pain, fever, abscesses.
Speaker 1: It kind of is considered a more systemic infection and
Speaker 1: it can lead to infertility because it can really severely
Speaker 1: damage the filipian tubes and the uterus itself, and it
Speaker 1: also can cause scarring on the filippian tubes that can
Speaker 1: increase the risk for future ectopic pregnancy, which is when
Speaker 1: an embryo implants outside of the uterus, and that can
Speaker 1: be very dangerous in rare cases. Epididymitis can also lead
Speaker 1: to infertility, but it's more common that in people with
Speaker 1: a uterus or ovaries you end up with infertility as
Speaker 1: a complication of a gonococcal infection. You can also get
Speaker 1: rectal infection all holes here. It's usually asymptomatic, but you
Speaker 1: kind of do have the same symptoms discharge, anal itching, soreness, bleeding.
Speaker 1: You can also get a pharyngeal infection, an oral infection.
Speaker 1: So I have heard stories from people who work at
Speaker 1: the student health clinics of kids coming in they think
Speaker 1: they've got sore throat and it turns out it's gonnerrhea.
Speaker 2: Oh gosh, oh I got a kick out of it.
Speaker 2: So it causes the same symptoms as like sore throat.
Speaker 1: Yeah, it's basically just a sore throat. It's a pretty
Speaker 1: minor infection, and even in your throat, it's usually asymptomatic.
Speaker 2: Okay, So that's.
Speaker 1: Why gonerrhea is so easily spread is because in so
Speaker 1: many cases it's just completely asymptomatic. So yeah, but gonerhea,
Speaker 1: while it can cause these symptoms, and this type of
Speaker 1: infection just kind of right away right after it attaches
Speaker 1: and starts to colonize, it can also pass through that
Speaker 1: epithelial cell border, which is essentially your body's protection against bacteria.
Speaker 1: It's like first line defense. So it can make its
Speaker 1: way past that epithelial cell border and then make it
Speaker 1: into your bloodstream. And if, yeah, if nicia makes it
Speaker 1: into your bloodstream, it's very, very bad. It's called a
Speaker 1: disseminated ganococcal infection because it's disseminated amongst your whole body
Speaker 1: through your bloodstream, and it most often will then go
Speaker 1: to your joints and your synovial fluid around your joints
Speaker 1: and your skin, and it'll cause dermatitis and arthritis and
Speaker 1: in very rare cases. It can infect your meninges just
Speaker 1: like its cousin. I don't know, do you call bacteria
Speaker 1: in the same genus cousins relative, just like it's relative
Speaker 1: Niceria meningititis, which is a very common cause of meningitis.
Speaker 1: Niceria gono rhea can also cause meningitis if it infects
Speaker 1: your mininges, of your spinal cord or your brain. Wow. Yeah,
Speaker 1: so that's bad news bears. In neonatal infections, when an
Speaker 1: infant gets infected, it most commonly results in an ocular infection.
Speaker 1: It'll get into their eyes as they pass through the
Speaker 1: birth canal, and this can cause blindness. It's really, really,
Speaker 1: really bad. Yeah, So that's why we screen pregnant women
Speaker 1: and most neonates when they come out, they give them
Speaker 1: erythromycin eye drops just in case. Yeah, so that's just
Speaker 1: to cover all the bases, because that would be terrible.
Speaker 1: It also can infect babies. It can go pass through
Speaker 1: their eyes and get because that's a mucous membrane where
Speaker 1: there's a lot of blood flow, it can get into
Speaker 1: their bloodstream and cause disseminated infection in babies as well,
Speaker 1: which can be life threatening, especially because babies have basically
Speaker 1: no immune system to help protect them. Also bad, Yeah,
Speaker 1: also bad. It's not a great disease.
Speaker 2: Nope, they never are.
Speaker 1: They never are. It is preventable, though, which is cool.
Speaker 1: Condoms work, right, so that's great.
Speaker 2: What about uh treatment?
Speaker 1: Treatment? Great question. It is still treatable today. So yeah,
Speaker 1: as of now, there is one recommended treatment, and that's
Speaker 1: recommended by the CDC and the WHO. If you get
Speaker 1: diagnosed with gonorrhea, you will get an injection of CEF triaxone,
Speaker 1: which is an extended spectrum cephalosporin antibiotic. You get an
Speaker 1: injection of that, and then you also get a single
Speaker 1: dose of a whole gram of azethromycin and you pop
Speaker 1: that oral and then that will take care of the gonerrhea.
Speaker 1: It also takes care of chlamydia because it's extremely common
Speaker 1: to have coinfection. I was trying to find one solid
Speaker 1: number on how common gonerrhea and chlamydia co infections are
Speaker 1: and I couldn't find one solid. But in some studies
Speaker 1: I found it was like up to forty percent of
Speaker 1: people who were diagnosed with gun we're also diagnosed with chlamydia.
Speaker 2: That's really interesting. Do they colonize the same areas. Is
Speaker 2: there competition or is it facilitation or what.
Speaker 1: That's a really good question. I don't know specifically. I
Speaker 1: don't know if it's just because it's they're transmitted in
Speaker 1: exactly the same way and have the exact same risk factors,
Speaker 1: so if you have one, it's really likely to have
Speaker 1: the other, yeah, Or if there's any kind of interactions
Speaker 1: that go on between the two bacteria, I'm not sure.
Speaker 2: Interesting.
Speaker 1: It's a great question though. Yeah, but it's super common
Speaker 1: as if thromycin will clear both a resistant gonereal infection
Speaker 1: that's resistant to the sef triaxone, but it will also
Speaker 1: additionally take care of the chlamydia. So that's why we
Speaker 1: give both. Okay, So if you've ever been diagnosed and
Speaker 1: been like, why do I need this giant horse pill
Speaker 1: and a shot in my butt? I assume they put
Speaker 1: it in your butt. I'm not positive though, that's why. Yeah, okay,
Speaker 1: So yeah, that's that's the bio. It's a pretty it's
Speaker 1: a pretty straightforward bacteria as far as they go.
Speaker 2: I feel like, yeah, it seems it goes there to
Speaker 2: do the job that it came there for. It does
Speaker 2: the job, and then you treat it. Yeah, fully hopefully.
Speaker 1: Yeah, so how did we get here? Eron, where did
Speaker 1: this bacteria come from?
Speaker 2: Okay?
Speaker 1: And oh my gosh, tell me how it got its name?
Speaker 1: I can't wait. Okay, right after this break.
Speaker 2: Ganorrhea is an oldie, and we've got the Holy Trinity
Speaker 2: of ancient Egypt, the Bible, and Hippocrates to back that up.
Speaker 1: The Holy Trinity, I like that.
Speaker 2: There's a papyrus from thirty five hundred BCE and ancient
Speaker 2: Egypt that recommends some certain plant extracts for painful urination.
Speaker 2: There's a passage in Leviticus in the Old Testament that
Speaker 2: declares that men with runny penises are unclean, not in
Speaker 2: those words, but more or less in those words. And
Speaker 2: Hippocrates describes genital ulceration and how it is sectually transmitted.
Speaker 2: We've also got Abubakar Muhammad ebn Zakaria al Razi, so
Speaker 2: again yeah, yeah, he's everywhere. And even Senna, so Avicenna
Speaker 2: also is the okay Latinised name. They seem to describe
Speaker 2: urethrilled discharge and urine retention, both which are characteristics of ganarrhea.
Speaker 2: Now any I mean, any one of these could be
Speaker 2: referring to many other sexually transmitted infections. But goneria is
Speaker 2: definitely old, as is its name, which was given by
Speaker 2: the Greek physician Galen in the second century CE, so likes,
Speaker 2: it's a long time ago. For a long time it
Speaker 2: was tied in with syphilis and so and it had.
Speaker 2: It went by many different names in different places and
Speaker 2: so on, so it's interesting that this one was the
Speaker 2: one to make it through the whole way. But Goneriea
Speaker 2: is from Ghanos for seed and row for flow, so
Speaker 2: it's just sort of flow seed flow.
Speaker 1: Yeah, it's kind of yucky.
Speaker 2: I mean. By at least the tenth and eleventh centuries,
Speaker 2: goneria seemed to be pretty prevalent, or at least prevalent
Speaker 2: enough to lead to the creation of laws that were
Speaker 2: to prevent any activity that spread the disease of burning pea.
Speaker 2: It also may have had a hand in secularizing medicine
Speaker 2: in some places, because physicians were ordered to treat everyone
Speaker 2: whip the disease without being able to refuse based on
Speaker 2: moral objections. Oh interesting, So yeah, along with like leprosy
Speaker 2: and some other sort of stigmatized diseases. But even so,
Speaker 2: no one really paid much attention to gonarrhea alone for
Speaker 2: another few hundred years. But before I get into that,
Speaker 2: where did it come from?
Speaker 1: Yeah?
Speaker 2: And I couldn't find a ton of good info on
Speaker 2: its evolutionary origins, but according to one of my sources,
Speaker 2: there are two possibilities, and neither of which is particularly exciting.
Speaker 2: But one is that it came from an a virulent
Speaker 2: strain in the vaginal and rectl mucosa which mutated into
Speaker 2: a virulent strain. Okay. Another was that it came from
Speaker 2: the naso pharynx and mutated into a virulent strain via
Speaker 2: oral sex. So yeah, I don't know when this occurred
Speaker 2: or where, but it would have required a decent pipe
Speaker 2: ulation density to be sustained and then spread throughout medieval times,
Speaker 2: though not as big of a population as something like measles.
Speaker 2: And that's because the long duration of infectivity and the
Speaker 2: possibility of sort of these latent infections.
Speaker 1: Yeah, probably helped symptomatic Yeah yeah, Okay.
Speaker 2: Around the fifteen hundreds is when it began to be
Speaker 2: called the clap, which it's colloquial, one of its colloquial names.
Speaker 1: I had no idea that it was gonorrhea that was
Speaker 1: called the clap oh.
Speaker 2: Yeah, well, because I think a lot of people think
Speaker 2: it's uh, chlamydia because.
Speaker 1: C yeah, that's what makes sense, chlamydia.
Speaker 2: Yay, yeah, okay, So why did Why was it called
Speaker 2: the clap There are a couple of hypotheses, One which
Speaker 2: is the most likely one is that it refers to
Speaker 2: less clapiers c L A p I e r s
Speaker 2: clapiers there we go, which is the French word for
Speaker 2: brothels reallyble source of infection, that's what they were called. Yeah,
Speaker 2: I never knew that. Another I read somewhere is that
Speaker 2: it causes a clapping sensation when you pee. And the
Speaker 2: most horrifying one I found was that it refers to
Speaker 2: a common treatment for gannere infections in men, where you
Speaker 2: were supposed to clap the penis hard to get the
Speaker 2: pea flowing again, maybe using your hands, maybe using a
Speaker 2: book and a hard surface, Oh no, yikes. Yeah. But
Speaker 2: for much of its history, ganerrhea was overshadowed by syphilis,
Speaker 2: which we will definitely be doing an episode on some time.
Speaker 1: Absolutely, syphilis is major.
Speaker 2: It's huge, Yeah, But syphilis had settled down enough around
Speaker 2: the fifteen sixteenth century for people to start taking note
Speaker 2: of this other disease and describing it. And one of
Speaker 2: the tracing this early history, of course, relates to that
Speaker 2: where goneria and syphilis were assumed to be the same disease,
Speaker 2: with goneria to be more the mild precursor to full
Speaker 2: blown pocks of syphilis.
Speaker 1: That makes sense.
Speaker 2: One guy in the seventeen hundreds decided to settle this
Speaker 2: once and for all. He wanted to prove that they
Speaker 2: were the same, and that gonorrhea was the secreting form
Speaker 2: and syphilis was the skin form. So he took the
Speaker 2: postular discharge from an infected person and then smeared it
Speaker 2: onto himself, onto his yeah, onto his genus. Unfortunately, he
Speaker 2: came down with syphilis, so he didn't really prove anything,
Speaker 2: but I guess so, yeah.
Speaker 1: He he swabbed somebody's like ulcer or something and then
Speaker 1: or what did he.
Speaker 2: What it seemed like is that he took the discharge.
Speaker 2: So the direct quote was pustular discharge. Okay, So I
Speaker 2: don't know if it was from the like, from the urethra,
Speaker 2: or if it was from a sore apox. Yeah, in any.
Speaker 1: Case, I mean, yeah, you get discharged with ooh that's
Speaker 1: so yucky.
Speaker 2: Yeah. Well, Anyway, the path of physiology of ganerrhiea was
Speaker 2: still under debate. Maybe the discharge was caused by ulcers
Speaker 2: in the urethra, maybe it was from the seminal vesicles.
Speaker 2: No one really knew, but as was the root of transmission.
Speaker 2: One popular view, as you might imagine, is that it
Speaker 2: came from women. Of course, originated in women. I should
Speaker 2: say it.
Speaker 1: Would only originate in women. It's the only logical explanation.
Speaker 2: Yep. One surgeon said, quote this thing resteth in their
Speaker 2: secret places, forming therein pretty little sores full of venomous poison,
Speaker 2: being very dangerous for those who unknowingly meddle with them.
Speaker 1: That's our title, resteth in your secret places.
Speaker 2: Other theories acknowledge that intercourse was a likely source of infection,
Speaker 2: along with non sexual things like gout or rheumatism. Eventually, though,
Speaker 2: goneria and syphilis got their separate entries and as result,
Speaker 2: separate cures. I think you know that one of my
Speaker 2: favorite parts of doing this research for the history is
Speaker 2: coming across the old treatments that were used.
Speaker 1: I think this is one of everyone's favorite parts.
Speaker 2: Okay, are you ready for goneria?
Speaker 1: I can't wait.
Speaker 2: Let's start with the easy ones. Rest, avoid alcohol, avoid sex.
Speaker 1: Yeah, okay, okay, seems reasonable.
Speaker 2: Inject some mercury into the head of your penis. It
Speaker 2: worked for syphilis, why not, conneriea. It didn't work for goneria.
Speaker 2: It did not atropine. Throw back to Belladonna. Yeah, whyden,
Speaker 2: that urethra. All right, Let's let's take it up a notch.
Speaker 2: Maybe some bleeding and purging, maybe some leeches.
Speaker 1: Yeah, it seems right on your ween or what?
Speaker 2: Uh huh? Yeah okay, yeah, so uh let's see, where's
Speaker 2: another one. Take the milk of a woman, like breast milk, milk,
Speaker 2: a little sugar, oil of violets, and barley water, and
Speaker 2: administer it with a syringe. I mean, that could have
Speaker 2: been our quarantini.
Speaker 1: But yeah, good God, don't have any source of breast
Speaker 1: milk around here?
Speaker 2: Sure not, why craigslist exists. And if that doesn't work,
Speaker 2: you can always resort to urinating with your penis in
Speaker 2: warm cow's milk.
Speaker 1: Just PLoP it into cow's milk and ye pee. That's
Speaker 1: a very interesting idea, you know, I'm I'm not opposed
Speaker 1: to that idea in concept.
Speaker 2: Yeah, yeah, Well, Eventually the treatments became a bit more tame,
Speaker 2: with levage or washing out of the urethraa as the
Speaker 2: most common treatment. Often, the symptoms of virulent gonorrhea would
Speaker 2: disappear after a few weeks. Can't really say cured because
Speaker 2: microbial confirmation was not possible, and something called gleat g
Speaker 2: l e e T was left in their place. Ooh,
Speaker 2: a new word for me too. What is gleat is
Speaker 2: basically the post gonerrhea clear or cloudy discharge without any
Speaker 2: other symptoms such as pain or urination problems. It's also
Speaker 2: probably what gave goneria its other nickname, the drip. Ah.
Speaker 1: Yeah, gleat, that's a good word for that. I can
Speaker 1: imagine exactly. Yeah it is.
Speaker 2: Yeah, I'm never gonna forget it. Gleat was usually treated
Speaker 2: with a stringence, which probably didn't do anything because gleat
Speaker 2: usually disappeared around the same time that the person stopped
Speaker 2: using the astringents. It's probably just irritating your penis more. Yeah,
Speaker 2: but wait, there's more.
Speaker 1: Of course there is.
Speaker 2: So the word bougie. Have you come across bougiees in
Speaker 2: med school?
Speaker 1: I don't know how to answer this question.
Speaker 2: Okay, so then doesn't sound like you have Okay, bougie
Speaker 2: didn't always mean bourgeois. Okay, no, no, no. Sometimes after
Speaker 2: male became infected with gonnerrhea and recovered, his urethra would
Speaker 2: remain obstructed and urination was difficult, maybe from the gonnerhea itself,
Speaker 2: maybe from the treatment. Physicians didn't really know. But to
Speaker 2: treat this, bougies were used. Bougie meaning a thin, flexible
Speaker 2: instrument made of silver, lead or wax. They're still used today,
Speaker 2: by the way, like bougies are still around like a sound,
Speaker 2: but not really a sound anyway. After giving the person
Speaker 2: a painkiller, the bougie would be inserted into the urethra.
Speaker 2: Sometimes it would be left there for days, only removing
Speaker 2: it when you needed to pee.
Speaker 4: Other times, I'm sorry, So this is like you said,
Speaker 4: silver lead or whacks.
Speaker 2: Yeah, it's got to be a little flexible.
Speaker 1: Okay, And it's like a rod, the flexi wire rod,
Speaker 1: and you just poke it up there, yeah and leave it.
Speaker 2: Yeah. We will post some pictures of bougies.
Speaker 1: Excellent.
Speaker 2: Oh yeah, there are some great old illustrations of like
Speaker 2: the variety of bougies, especially once once they became more
Speaker 2: popular in like throughout the eighteen hundreds and things, and
Speaker 2: then there was like electro something bougie, and then there
Speaker 2: were oh no, and then there were ones that were
Speaker 2: like linked together with tubing and yeah, okay, but one
Speaker 2: of the most horrific ones is that there were some
Speaker 2: bougies that would have a corrosive crystal at its tip
Speaker 2: which was designed to clear the passage by like eroding
Speaker 2: whatever the inflammation was. So people actually died from that.
Speaker 2: Uh yeah, yeah, But a surgeon's reputation could be made
Speaker 2: or destroyed on how well he could work his way
Speaker 2: around a urethroat with a bougie.
Speaker 1: Yeah, aweso.
Speaker 2: And so we don't really see throughout history, we don't
Speaker 2: really see a lot of descriptions of gonorrhea in females.
Speaker 2: We just get sort of this male specific thing, and
Speaker 2: as such we also don't get very many women's specific
Speaker 2: treatments right. Treatments for female patients, though the ones that
Speaker 2: are listed weren't much better. Most included a frequent and
Speaker 2: thorough cleaning of the volva and vagina and treatment with
Speaker 2: silver salt or the chemicals. Irrigation of the urethrow was
Speaker 2: also done, sometimes with a treated solution, and finally, sometimes
Speaker 2: the cervix was cauterized with silver nitrate or a medicated
Speaker 2: wick was inserted. Mm yeah. More often than not, though,
Speaker 2: the prescribed treatment was just weighted out, which often led
Speaker 2: to infertility.
Speaker 1: Mm hmm yeah.
Speaker 2: If these early venereologists had anything to say about gonnerhea
Speaker 2: and females, it was that they were surprised at how
Speaker 2: much milder the infection seemed. Diagnosing gonnerie in females was
Speaker 2: more difficult because physicians had a tough time distinguishing between
Speaker 2: normal vaginal discharge and gonerrhea discharge. So doctors often relied
Speaker 2: on the next best thing, patient history, but not firsthand. No. No,
Speaker 2: doctors took the word of quote, those whom we look
Speaker 2: upon as men of veracity, meaning a dude could say,
Speaker 2: I up with her and now I have gonerhea, so
Speaker 2: she must have given it to me, and that would
Speaker 2: be basically the diagnosis.
Speaker 1: Wow, yeah, awesome. Cool.
Speaker 2: In the case of gonorrhea, it was pretty much always
Speaker 2: a one way street from vagina to penis. That was
Speaker 2: how it was perceived throughout most of history. Some physicians
Speaker 2: did note other signs of goneriea infections and females, including
Speaker 2: inflammation of the labia and clitterists, but there wasn't a
Speaker 2: lot of attention paid to any internal indications of the disease.
Speaker 1: Shocking right.
Speaker 2: The cervix, which is recognized today as a principal side
Speaker 2: of infection, was rarely mentioned. And that's because up to
Speaker 2: the nineteenth century, physicians who were almost without exception male,
Speaker 2: pretty much never performed vaginal exams.
Speaker 1: They're never going to be looking up there.
Speaker 2: No no God forbid. They take a speculum and peek inside,
Speaker 2: and if the woman was unmarried, forget about it. In
Speaker 2: the eighteen hundreds, people finally started talking about where gonerhea
Speaker 2: came from and how to prevent it. Was it a
Speaker 2: specific infectious particle, was it just random inflammation? According to
Speaker 2: someone named Sweetear, I don't know how you pronounced that,
Speaker 2: sweet Hour, it was the latter, and he set to
Speaker 2: prove this by injecting an aqueous solution of ammonia strong
Speaker 2: enough to give it a quote burning taste into his
Speaker 2: urethra twice. What yeah, He said that the second injection
Speaker 2: caused the most pain he had ever experienced. So the
Speaker 2: next morning, no surprise, he had some seepage, a considerable
Speaker 2: evacuation of purulent matter of the same yellow green color
Speaker 2: as that of a virulent child piss aka hot hot
Speaker 2: pea goner rhea. So he concluded. His conclusion was that
Speaker 2: Goneriel was nothing more than simple irritation of the urethra.
Speaker 1: Oh dear, uh huh. And he did this by to himself.
Speaker 2: Weirdo, man, I mean, do you not like I am
Speaker 2: amazed at the self experimentation that went on? Yeah, that's fold.
Speaker 2: These are precious parts. Yeah, I mean, don't worry. There
Speaker 2: is some human experimentation for prisoners, and people will care
Speaker 2: who can't advocate for themselves.
Speaker 1: Just wait for our syphilist episode for plenty of that. Yeah.
Speaker 2: Others attribute it to something female specific, like if you
Speaker 2: had sex the woman who had a certain vaginal discharge
Speaker 2: or maybe she was on her period, and then there
Speaker 2: were predisposing factors too much sex, sex that goes on
Speaker 2: too long, and unnatural sizes of the male organ I
Speaker 2: don't know which direction, which direction, alcohol or rich diet,
Speaker 2: et cetera, et cetera. By the late eighteen hundreds, we're
Speaker 2: finally getting to the age when the mysteries of so
Speaker 2: many infectious diseases are revealed. The age of microbiology, or
Speaker 2: the beginning, and gonerhea is no exception, and the name
Speaker 2: that you might most associate with gonerhea is nicer. It's
Speaker 2: nicer Goneree. But there was another mostly forgotten physician who
Speaker 2: made huge contributions to the understanding of the disease. His
Speaker 2: name was Emil Nogath, and he was a German physician
Speaker 2: who was especially interested in pelvic inflammatory disease.
Speaker 1: Hmm, he was.
Speaker 2: I wanted to put this tidbit in here. He was
Speaker 2: a workaholic who spent hours and hours at his desk,
Speaker 2: keeping himself awake with tons of coffee and putting his
Speaker 2: feet in a bowl of cold water under his desk.
Speaker 1: Just to keep him awake. Yeah, so funny.
Speaker 2: I feel like we could have used that when we
Speaker 2: were finishing our dissertations. Anyway, After many clinical examinations, of
Speaker 2: which the majority of subjects for female, he announced his
Speaker 2: findings that one goner rihe was likely a latent infection
Speaker 2: and that gleek could still cause infection in women. Two
Speaker 2: Goneriea did affect females and that it was a common
Speaker 2: cause of infertility in both sexes, and three Goneriea was
Speaker 2: extremely prevalent. He estimated that sixty percent of men in
Speaker 2: large cities in the US had had gonerhea at some point,
Speaker 2: and that sixty percent of those men would infect their wives,
Speaker 2: and that men could give the disease to women was
Speaker 2: itself kind of a revolutionary thought, but unfortunately his conclusions
Speaker 2: were not well received at the time, primarily because American
Speaker 2: physicians took those prevalence estimates as a direct attack on
Speaker 2: the morality of American males. But the suggestion of goneriea
Speaker 2: as a latent infection made it more difficult to treat clinically.
Speaker 2: How could you tell when an infection was over if
Speaker 2: you couldn't use gleek to guide you. Fortunately, in eighteen
Speaker 2: seventy nine, just a few years after no Garrath announced
Speaker 2: his findings, Albert Nisser, the namesake of Niceria gunoia, isolated
Speaker 2: the bacterium, making it possible to identify exactly when a
Speaker 2: person was no longer cape of transmitting the infection.
Speaker 1: WHOA, which is pretty cool.
Speaker 2: Yeah, Gonerhea had been fairly well described in adult males
Speaker 2: and very poorly described in adult females. But as you mentioned,
Speaker 2: there is another group that is commonly affected by the disease, infants.
Speaker 2: Gonerhea can cause this conjunctivitis in newborns, which can lead
Speaker 2: to blindness if left untreated. Like you said, and despite
Speaker 2: the fact that GUNNERIEA and females was so poorly characterized,
Speaker 2: the link between the infection and this outcome and infants
Speaker 2: was discovered in the early nineteenth century, helped along by
Speaker 2: more horrific experiments in which the eyepuss of one of
Speaker 2: these infants was inserted into a male urethra, producing goner
Speaker 2: rhea within a few days. WHOA. Yeah, Still, it wasn't
Speaker 2: necessarily conclusive because sometimes babies were born to mothers who
Speaker 2: did not appear to have gonerrhea, but the discovery of
Speaker 2: asymptomatic infections would clear that up over time. But even
Speaker 2: though the lane between gonorrhea infection and a mother and
Speaker 2: ie infection and the newborn was discovered, it was still
Speaker 2: not able to be treated, and that was a huge
Speaker 2: problem because cases were growing. So by the mid eighteen hundreds,
Speaker 2: up to twelve percent twelve percent of neonates and European
Speaker 2: hospitals developed the eye infection WHOA. Twenty percent of those
Speaker 2: developed corneal ulceration, and thirty percent of those became blind.
Speaker 1: Oh my goodness.
Speaker 2: So that's huge numbers.
Speaker 1: That is huge numbers. Twelve percent of babies infected. Good gracious.
Speaker 2: Yeah, okay, So let me introduce you now to a
Speaker 2: German obstetrician named Karl Siegmund Franz crid Creede, Crede, I
Speaker 2: don't know, Craid who in the eighteen fifties founded one
Speaker 2: of the first gynecology departments in Europe at our favorite,
Speaker 2: one of our favorite historical hospitals, Charitay, still in existence today,
Speaker 2: and featured on that amazing show that we have talked about. Anyway,
Speaker 2: So when he was at this hospital, he noticed the
Speaker 2: high rate of eye infections born to mothers infected with gnarrhea,
Speaker 2: and he tried all manner of things to try to
Speaker 2: lower the cases. He tried to douche the vagina prior
Speaker 2: to delivery. Didn't work. He tried to wash the eyes
Speaker 2: of the infant with a borax solution, didn't work. He yeah,
Speaker 2: Finally he tried wiping the eyes with cotton wool and
Speaker 2: plain water and then adding a drop of two percent
Speaker 2: silver nitrate, and that worked like a charm. And the
Speaker 2: technique was picked up all over the continent. Okay, and
Speaker 2: then we've got finally the isolation of the bacterium itself,
Speaker 2: which happened in eighteen seventy nine by the twenty four
Speaker 2: year old Albert Nisser. Unfortunately, there was no suitable animal
Speaker 2: model for ganerrhea, so because this is an exclusively human bacterium,
Speaker 2: so what remained but to conduct human experiments? Oh dear,
Speaker 2: human volunteers were produced, inoculated and subsequently found to have
Speaker 2: gonerrhea volunteers volunteers in quotes. Ye, So finally it was
Speaker 2: accepted that this bacterium caused gonorrhea. Even though a lot
Speaker 2: of progress had been made towards identifying the causative agent
Speaker 2: of gonerhea and describing its clinical symptoms, treatment still had
Speaker 2: a really long way to go. And this was a
Speaker 2: problem because gonerhea can be fatal, and frequently was in
Speaker 2: the eighteen hundreds as a result of bacterial endocarditis. But
Speaker 2: fortunately goneriea reached a turning point when antibiotics were developed.
Speaker 2: In nineteen thirty seven, clinical trials of sulfonamides were shown
Speaker 2: to be moderately effective against the disease, but the victory
Speaker 2: was short lived. By nineteen forty four, only seven years later,
Speaker 2: only twenty five percent of people with gonerrhea were being
Speaker 2: cured due to the emergence of resistant strains, and doctors
Speaker 2: had to dust off their bougies. Fortunately, penicillin took over
Speaker 2: as a primary and very effective treatment for the disease,
Speaker 2: and by the late nineteen forties was widely used. Initially,
Speaker 2: because goneriea was so sensitive to penicillin, doctors were like, well,
Speaker 2: we don't foresee any resistance occurring, but within yeah, right,
Speaker 2: I mean, come on, history repeats itself, people, But within
Speaker 2: ten years resistant strains had emerged and become obviously a
Speaker 2: major problem. Then streptomycin was introduced and resistant strains emerged
Speaker 2: once again. Blah blah blah. It's been this continual struggle
Speaker 2: to find one drug to effectively treat gonorrhea. So, and
Speaker 2: I'm sure you'll tell me all about the oh yeah,
Speaker 2: the horror show that's going on today. You might expect
Speaker 2: that the prevalence of gonerhea would decline over the twentieth
Speaker 2: century with the availability of antibiotics, but if you look
Speaker 2: at a figure of rates over time for certain countries,
Speaker 2: you actually see a huge increase starting in the sixties
Speaker 2: and that increase actually represent sense what is called a
Speaker 2: gonerhea pandemic that peaked in the mid nineteen seventies, occurring
Speaker 2: in places like the US, Sweden, Canada, and the UK.
Speaker 2: Epidemiologists point toward a few things that could have caused
Speaker 2: a huge increase, and it was probably a combination of
Speaker 2: things like changing perceptions and sexual practices. People were having
Speaker 2: a lot more sex with a lot more partners, a
Speaker 2: huge population boom as the baby boomers became sexually active
Speaker 2: young adults, and the greater availability of contraceptives such as
Speaker 2: the birth control pill, which did not protect against STIs.
Speaker 2: In any case, the disease began to decline again. And
Speaker 2: I don't really know why and if there were certain
Speaker 2: public health campaigns that went on, but goneria today continues
Speaker 2: to make headlines as these super bug resistance strains have
Speaker 2: totally gotten out of control. So Aaron, tell me more
Speaker 2: about those guys and about where we stand with gonerhea today.
Speaker 1: I don't wait too So let's talk quickly just about
Speaker 1: the status of how how many people are we talking
Speaker 1: when we talk about gonorrhea, and then we'll talk a
Speaker 1: little more in depth about the antibiotic resistance because that
Speaker 1: is sort of the main part of the current story
Speaker 1: of gonohea. Okay, okay. So in the US, according to
Speaker 1: the CDC, they estimate about eight hundred and twenty thousand
Speaker 1: new infections of gonorrhea every year twenty thousand. It is
Speaker 1: the second most commonly reported communicable disease in the US
Speaker 1: after chlamydia. Wow, which is the number one, goes hand
Speaker 1: in hand, seems to makes sense. So in twenty seventeen
Speaker 1: there was over five hundred and fifty five thousand cases
Speaker 1: that were actually reported, and so the number eight hundred
Speaker 1: and twenty thousand is the estimate. So that means that
Speaker 1: it's estimated that two hundred and seventy thousand people each
Speaker 1: year are getting infected with GONERIEA and just don't know it.
Speaker 1: So that's a bummer.
Speaker 2: That's a lot of people.
Speaker 1: It's a lot of people. Worldwide, the World Health Organization
Speaker 1: estimates seventy eight million people are newly infected with GONERIEA
Speaker 1: every year. Seventy eight million. Wow, that's a lot.
Speaker 2: This is much more prevalent than I realized.
Speaker 1: Me too, let me I talk about it that much.
Speaker 1: I knew that it was one of the most common STIs,
Speaker 1: but I had no idea that it was. Yeah, So
Speaker 1: the US Public Health Task Force currently recommends screening only
Speaker 1: for certain populations of people. Recommends screening for any women
Speaker 1: with vaginas who are sexually active under the age of
Speaker 1: twenty five, in any kind of sexual relationship, women who
Speaker 1: are over the age of twenty five if they have
Speaker 1: multiple partners every year, and any men who have sex
Speaker 1: with men. That is the US Public Health Task Force recommendations.
Speaker 1: And a study that I found that looked at whether
Speaker 1: this type of screening protocol, so screening every year regardless
Speaker 1: of if you're in a monogamous relationship or not, just
Speaker 1: if you're sexually active. I found a paper that looked
Speaker 1: at from two thousand to twenty fifteen whether this type
Speaker 1: of screening actually reduced the incidents of gonorrhea, and it
Speaker 1: found that it did. But what's interesting is that they
Speaker 1: also looked at other screening scenarios. So what if we
Speaker 1: did universal screening of everyone of a certain age group,
Speaker 1: regardless of their sexual practices, just whether or not they're
Speaker 1: sexually active, and you can actually reduce incidents even more,
Speaker 1: is what they found. If you did more universal screenings.
Speaker 2: That makes complete sense people who are in monogamous relationships.
Speaker 2: Maybe one person doesn't realize they're in a monogamous relationship
Speaker 2: or exactly what.
Speaker 1: They are, right, yeah, yeah, so yeah. So overall, it's
Speaker 1: a very common disease, so screening in general makes a
Speaker 1: lot of sense, especially because there's such high rates of
Speaker 1: asymptomatic infections. But the big story with gonerrhea is antibiotic resistance.
Speaker 1: It's definitely the most important part of the story. Antibiotic
Speaker 1: resistance has been detected in basically every country that has
Speaker 1: gonerrhea on its reportable diseases list, so everywhere where there
Speaker 1: is gonerrhea, there is antibiotic resistance. There's resistance to all
Speaker 1: of the drugs that you mentioned that used to be
Speaker 1: used to treat gonorrhea, so the penicillins or the betaalactams, streptomycin,
Speaker 1: and all of the floral quinolones as well. In addition,
Speaker 1: there's also resistance to some cephalosporins, which is why now
Speaker 1: the only drug that's recommended that is still considered effective
Speaker 1: are the extended spectrum cephalosporins like cef triaxone, which is
Speaker 1: what we treat with. The scary thing is that in
Speaker 1: over fifty countries they have reported resistance to these drugs
Speaker 1: as well. Ooh yeah, that's.
Speaker 2: Bad and it's what you'd expect.
Speaker 1: Right, And we're also seeing increasing resistance to a zythromycin,
Speaker 1: which is what we give as a backup in case
Speaker 1: gunnerhiea is resistant to CEF triaxone. So now it's our
Speaker 1: main line of defense and our backup line of defense
Speaker 1: that is becoming resistant. So the reason or one of
Speaker 1: the reasons that we see such high rates of antibiotic
Speaker 1: resistance is that there's a lot of different mechanisms by
Speaker 1: which bacteria can evolve antibiotic resistance. They can evolve ways
Speaker 1: to inactivate drugs, so just sort of attacking the drug
Speaker 1: itself and inactivating it. They can alter their cell membranes
Speaker 1: that the antibiotics use as targets so that the antibiotics
Speaker 1: can no longer bind and actually do their job. They
Speaker 1: can also evolve new mechanisms to export the drugs out
Speaker 1: of the bacteria once they make it in or to
Speaker 1: prevent the bacteria from getting in sorry, to prevent the
Speaker 1: antibiotic from getting into the bacteria to begin with. And
Speaker 1: all different classes and groups of antibiotics that we've developed
Speaker 1: so far have different mechanisms of action, and some bacteria
Speaker 1: are good at developing resistance against maybe one class of antibiotics,
Speaker 1: so they can change their cell membrane so that penicillins
Speaker 1: can't bind as well, But then maybe they can't figure
Speaker 1: out a way to export it, so they can't be
Speaker 1: resistant to all antibiotics.
Speaker 2: Gotcha.
Speaker 1: It turns out that Nicia gonnerihe has shown the ability
Speaker 1: to develop resistance in basically all of the ways that
Speaker 1: bacteria can develop resistance.
Speaker 2: Cool.
Speaker 1: Yeah, so it's really good. They're really good naturally at
Speaker 1: uptaking and recombining, so shuffling around DNA from the environment,
Speaker 1: and because they have those pili which they use to
Speaker 1: grab onto the walls, they can also use pili for
Speaker 1: what's called conjugation, which is kind of like bacteria sex,
Speaker 1: where they transfer DNA from one bacteria to another, and
Speaker 1: what they often transfer are plasmids, which are those little
Speaker 1: round pieces that usually or very often have antibiotic resistance
Speaker 1: genes on them. So Niceria are really good at that.
Speaker 1: So that's why we see such high rates of antibiotic resistance,
Speaker 1: and very quickly, because you can have like a single
Speaker 1: Nicia bacterium just giving its gene to all of the
Speaker 1: other bacteria around them.
Speaker 2: Yeah, it's great, that's amazing.
Speaker 1: Yeah. So obviously there's a lot of interest in developing
Speaker 1: better methods of treatment. Unfortunately, from what I found on
Speaker 1: the World Health Organization website, there's only three candidate drugs
Speaker 1: in the pipeline in development for treatment of resistant gonorrhea.
Speaker 1: Uh oh, yep, there's only three new drugs in the pipeline.
Speaker 1: One of them is I think either in or just
Speaker 1: finished phase three trials. I don't know if those trials
Speaker 1: went well, and then the other two are still in
Speaker 1: phase two clinical trials, so they've still got a long
Speaker 1: way to go before they're on the market. Okay, So
Speaker 1: then the next natural question is if we can't develop
Speaker 1: better antibiotics vaccine, what about vaccines. There's a lot of
Speaker 1: discussion about this. There's nothing very close on the horizon, Okay.
Speaker 1: Progress for a gonerial vaccine in general has been very
Speaker 1: very slow. So we have seen development of vaccines for
Speaker 1: other STIs like HPV, which is excellent. There's also a
Speaker 1: vaccine in development for HSV so Herpes simplex virus GONERIEA.
Speaker 1: Not so much gonneria and syphilis are proving to be very,
Speaker 1: very difficult to try and develop vaccines for. However, I
Speaker 1: did find one paper that was very interesting that was
Speaker 1: just looking at a mouse model that suggests that at
Speaker 1: least in theory, it should be possible to stimulate the
Speaker 1: right kind of immune response that you would need to
Speaker 1: even be able to develop a vaccine. Because we'll talk
Speaker 1: more about this in the Vaccine's episode, But basically, for
Speaker 1: a vaccine to be able to work, whatever bacteria or
Speaker 1: virus you're trying to fight has to stimulate an immune
Speaker 1: response that creates a memory response, right, And so if
Speaker 1: the bacteria don't do that to begin with, then your
Speaker 1: body never develops memory, and so your body can't just
Speaker 1: fight them off every time you get infected. Right, So
Speaker 1: it does seem that at least in theory, it's possible
Speaker 1: to generate that type of response with some Gonerihea antigens,
Speaker 1: which are the surface proteins of goneriea.
Speaker 2: Why does it not create a memory?
Speaker 1: Goneriea have huge amount of anagenic variation, like massive anagenic variation,
Speaker 1: So there's tons of different strains and there's tons of
Speaker 1: variation in those cell membrane proteins, and so they're really
Speaker 1: good at evating our immune system. And then on top
Speaker 1: of that, they're really good at fighting off our body's
Speaker 1: first line defenses, which are those neutrophils and macrophages, because
Speaker 1: they can just live inside of those cells.
Speaker 2: So okay, yeah, that makes sense.
Speaker 1: So people are working on it. It seems it's definitely
Speaker 1: far in the future. Sure it's nothing that's going to
Speaker 1: be happening in the next few years or anything like that.
Speaker 1: But yeah, that's gonorrhea. Wow.
Speaker 2: Yeah, that was a good one.
Speaker 1: Yeah it was. I had fun.
Speaker 2: I did too. I learned a lot, me too.
Speaker 1: One clap, clap, clap, to.
Speaker 2: Get ourselves around of applause.
Speaker 1: That's another good title it is. I really like that.
Speaker 1: I like that a lot. Well, should we do sources?
Speaker 2: Yeah, sources, Okay. I read sections of a book called
Speaker 2: The Scars of Venus, A History of Venereology by jd Oriole,
Speaker 2: and I'm sure I'll be going back to that for
Speaker 2: future episodes. I also use the Cambridge World History of
Speaker 2: Human Disease edited by Kenneth Kipple, and some papers that
Speaker 2: I will put on the website.
Speaker 1: Awesome, and I have several really interesting papers, mostly about
Speaker 1: the current epidemiology of gonorrhea. So, as always, we will
Speaker 1: post our full source list on our website This Podcast
Speaker 1: will Kill You dot com. Just go to the episodes
Speaker 1: tab and you can find every source that we used
Speaker 1: in all of our episodes. Yep.
Speaker 2: Thank you to Bloodmobile for providing the music for this
Speaker 2: episode and all of our episodes.
Speaker 1: And thank you guys for listening. We love making this
Speaker 1: podcast and we love that you listen to it. Oh
Speaker 1: and if you haven't heard already, we have merch. We
Speaker 1: have merch, so go check that out. You can get
Speaker 1: to it from our website This Podcast will Kill You
Speaker 1: dot com slash merch. You can also get to it
Speaker 1: from the Exactly Right Media website Exactly Rightmedia dot com
Speaker 1: slash merch. So yeah, all right, wash your hands, you
Speaker 1: filthy animals.
Speaker 4: Bum bu.
Speaker 2: Bu bu bum bum bu