Sexually Transmitted Diseases at 50: Historical Notes

This issue of Sexually Transmitted Diseases commemorates the 50th anniversary of the Journal since its inauguration on September 1, 1974. That date also marked the end of a 20-year hiatus in the publishing of a United States-based scientific journal that was solely focused on sexually transmitted infections (STIs). As part of our semicentennial, we reflect on our origins, how our discipline has evolved, accomplishments and controversies, and how the Journal has facilitated scholarly communication. The precursor of the Journal was established in 1917 as the American Journal of Syphilis. These were heady times in syphilis research. Fritz Schaudinn and Erich Hoffman had identified Spirochaeta pallida, later renamed Treponema pallidum, as the etiologic agent of syphilis in 1905, followed by the introduction of darkfield microscopy for the detection of T. pallidum in syphilitic lesions by Karl Landsteiner in 1906. In 1910 August Paul von Wassermann introduced the first serologic test for syphilis, the precursor of the rapid plasma reagin (RPR) test. Remarkably, both darkfield and RPR diagnostic tests are still used over a century later. In 1908, Paul Ehrlich was awarded the Nobel Prize for the discovery of arsphenamine, which was the standard syphilis treatment until the efficacy of penicillin was described in 1944 by John Mahoney. These diagnostic and therapeutic advances, coupled with the publication of authoritative clinical texts, the establishment of academic departments and training of clinicians specialized in syphilis and its complications, fed a growing interest in syphilis clinical and microbiological research in the United States and abroad, resulting in the establishment of the new Journal. Until the 1960s, tertiary syphilis was a major cause of neurological and psychiatric complications leading to long-term psychiatric hospitalization (general paresis), which became a lively clinical research topic. To acknowledge this broadening of the field, the journal's name was changed to the Journal of Syphilis and Neurology in 1934. The etiology of gonorrhea was elucidated in 1879 with the discovery and description of Neisseria gonorrhoeae by Albert Neisser, followed 5 years later by Hans Christian Gram's discovery of his eponymous stain, which is still widely used 140 years later. As microbiological knowledge of Neisseria species advanced, interested microbiologists and clinicians in New England formed the Neisserian Medical Society of Massachusetts in 1934, and in 1936 broadened its scope to become the American Neisserian Medical Society. As the syphilis and gonorrhea scientific communities developed in parallel, it was only a matter of time for the Society and the Journal to join forces, which they did in 1936, changing the name of the journal to the American Journal of Syphilis, Gonorrhea and Venereal Diseases. This name change reflected an acknowledgement that there were other STIs besides syphilis and gonorrhea, including chancroid, lymphogranuloma venereum and granuloma inguinale. The name change ultimately also inspired the society, which in 1947 became the American Venereal Disease Association (AVDA). During the World War II, with the mobilization of 16,000,000 persons of reproductive age, there was enormous public health and clinical interest in a growing epidemic of STIs. The postwar period, however, saw dramatic reductions in syphilis and gonorrhea rates, driven, in part, by the widespread availability and increased use of penicillin, which provided a curative and inexpensive treatment with minimal side effects. As a result, except for a small number of clinicians and researchers, scientific interest in STIs declined, and in 1956 after almost 40 years, the Journal ceased publication. Dr. Joseph Earle Moore, who was a prominent syphilologist and the editor at the time wrote: “the JOURNAL now discontinues publication with the completion of its thirty-ninth volume, in part because of diminished clinical interest of physicians and students, in part because investigators, turning to disease problems of more immediate importance, are no longer providing worthwhile manuscripts in sufficient numbers to fit its pages.” He further observed that the passing of the journal “leaves the British Journal of Venereal Diseases (which changed its name to Genitourinary Medicine in 1984 and then to Sexually Transmitted Infections in 1998, eds) as the sole periodical publication in English devoted to this field. It is profoundly to be hoped that our British Colleagues will keep the torch burning…” This may be a good place to thank our former colleagues at our (friendly) competing journal to have done just that! We should not be surprised, however, that the organisms that we study, diagnose and treat (and we have to admit, love and admire as well), were not aware of pronouncements of their impending demise. The 1960s and 1970s were characterized by two phenomena that drove the renaissance of our specialty. First, this era witnessed enormous social transformation, including development of effective contraception, feminism, gay liberation, changing sexual mores, and the simple demographics of the post-war baby boom, leading to increased rates of gonorrhea and syphilis. Second, advances in microbiological methods led to the discovery of, for example, chlamydia and human papillomavirus (HPV), followed by clinical epidemiology that linked these organisms to what are now well known complications, including pelvic inflammatory disease, cervical cancer and neonatal disease. Although genital herpes was known, key work in the 1980s documented its natural history, widespread prevalence and the high rates of asymptomatic infections, to the point where HSV was termed the “The New Scarlet Letter.” This was only to be overshadowed by the deadliest STI of them all, HIV, which was described in 1981 as a clinical syndrome (AIDS) and etiologic virus discovered in 1983, but whose sexual transmission was not fully appreciated for several years. In the early 1970s, increased STI research activities prompted members of the AVDA to express growing interest in resurrecting the journal, and after 2 years of intense deliberations, the Journal of the American Venereal Diseases Association became a reality with its first issue in September 1974. Rudolph Kampmeier (pictured), who was an internationally renowned syphilologist and venereologist and a Professor of Medicine at Vanderbilt since 1936, was the journal's first editor. Already in his late 1970s he agreed “to do so for about 2 years, recognizing that the younger shoulders of one active in the investigation of the sexually transmitted diseases should carry this burden,” as he wrote in “An Adieu” to the journal. As it turned out, these shoulders belonged to William McCormack who took over the reins of the journal in 1976 until his retirement in 1990. Starting with the 1977 volume, the name of the journal was changed to Sexually Transmitted Diseases. The AVDA followed suit in 1996 and became the American Sexually Transmitted Diseases Association (ASTDA). Julius Schachter assumed the leadership of the journal in 1990 and completed his 25-year stewardship in 2015, when Bill Miller took over. Julie, a mentor to many, including all of us who were associated with the journal, sadly passed away from COVID-related complications in 2020. So here we are celebrating the Journal 50 years later, of which, remarkably 48 years without a name change! Over these years, growth has been remarkable. Initially published quarterly, then bimonthly (since 1992), the Journal is now published every month (since 1994), reflecting a remarkable collaboration between ASTDA as the Journal's owner and Wolters Kluwer/Lippincott as its publisher. The Journal's scope broadened from syphilis and gonorrhea to now cover over 30 known sexually transmissible pathogens. Moreover, where the focus was once on clinical and microbiological science, the scope has widened to epidemiology, behavioral sciences, health policy, program management and public health. Importantly, the Journal has reflected the more recent societal and scientific discourse that has embraced a focal shift from sexual disease to sexual health. This dynamic bodes very well for the next 50 years! Note: For much of the historical details, we have drawn from the inaugural editorials by R.H. Kampmeier published in the first issue of the journal in 1974.1,2Rudolf Kampmeier (1898–1990)