Unleashed on the world five centuries ago, apparently after Spanish explorers took it home from the Americas, venereal syphilis spread largely unabated until the 1940s. Penicillin tamed the disease during the ‘5Os, and it was largely forgotten until the mid-1980s, when drug abuse, poverty and declining health care fueled new innercity outbreaks. Syphilis is still rare compared with other sexually transmitted diseases, but reported cases have doubled since 1984. The rate among black males (157 cases per 100,000) is now more than 54 times the corresponding rate for whites.
The syphilis bacterium (Treponema pallidum) often causes genital lesions known as chancres within six weeks of infection. The sores heal readily by themselves, but without treatment the disease advances. Within 12 weeks, most sufferers experience fevers, aches, rashes, hair loss and mouth sores. Only at later stages does syphilis invade the heart, eyes, brain and other organs. The greater risk is that an infected woman will unknowingly pass the disease to her unborn baby. The germ can cross the placenta any time after the fourth month of pregnancy, causing meningitis, deformities or stillbirth. Antibiotics can stop the disease at any stage, but they can’t undo its damage. Syphilis testing is a good idea for any sexually active person who develops genital sores or who learns that a partner was infected. Blood tests can detect antibodies to the bacterium, but antibodies may not show up in the blood for six weeks or more. Specialized microscopes can spot the bacterium in tissue taken from a chancre.
Gonorrhea declined markedly during the 1980s, suggesting that large segments of the population have gotten the message about safer sex. But the disease is still 10 times as common as syphilis, and the racial disparities are more striking than ever. The rate of new infections, 12 times higher among blacks than whites a decade ago, is now 39 times higher. Like syphilis, the condition is easily treated with antibiotics.
The gonococcus bacterium thrives in moist, warm cavities, including the mouth and throat as well as the rectum, cervix and urinary tract. Genital symptoms such as burning, itching or unusual discharge normally show up two to 10 days after infection. If those symptoms go unnoticed, as often happens in women, the infection can spread into the fallopian tubes, causing such complications as infertility and tubal pregnancy. Doctors can readily detect gonococcal infection by analyzing penile or cervical discharge under a microscope. Testing is recommended for anyone who experiences symptoms or who has unprotected sex with more than one partner. Since the germ can infect a child’s eyes at birth, many experts also favor testing for all pregnant women and antibiotic eyedrops for all newborns.
The government has never tracked chlamydia as closely as syphilis, gonorrhea or AIDS, but health officials rank it the nation’s most common sexually transmitted disease. An estimated 4 million Americans contract this bacterial infection each year. The most common symptom is an inflammation of the urethra that causes painful urination or a discharge of pus or mucus. In addition to painful urination and vaginal discharge, women sometimes experience general pain in the lower abdomen. Like gonorrhea, chlamydia can lead to sterility in women who don’t receive treatment.
Unfortunately, the disease is easy to miss until complications set in. One in four infected men, and at least half of all infected women, experience no initial symptoms at all. So experts recommend that anyone with more than one sex partner-especialIy women still in their childbearing years-be tested annually. Until recently, testing for chlamydia involved culturing genital secretions. The process took several days, and because gonococcal bacteria don’t grow readily in culture, the results were unreliable. Using new diagnostic techniques, doctors can reliably analyze the secretions in the course of a 30-minute office visit. Tetracycline is the usual treatment for chlamydia. The drug can’t be taken during pregnancy, but substitutes are available.
Gonorrhea and chlamydia can both lead to pelvic inflammatory disease, or PID, the most frequent complication of sexually transmitted disease in women. The trouble begins when an infection spreads from the cervix into the fallopian tubes (a process that vaginal douching and the use of intrauterine devices may hasten). The tubes become scarred, and the scar tissue impedes passage of fertilized eggs to the uterus. Besides obstructing pregnancy, PID can cause fertilized eggs to lodge in the wall of the fallopian tube, destroying the embryo and endangering the mother’s life.
PID seems to be waning along with gonorrhea; a recent study by the Centers for Disease Control showed a sharp drop in incidence between 1982 and 1988. But the disease still afflicts nearly 11 percent of the nation’s childbearing-aged women–one in 10 whites and one in six blacks. Some 420,000 sufferers seek treatment every year, at a cost of $2 billion. The warning signs of PID, easily spotted during a routine pelvic exam, include swelling or tenderness in the cervix, uterus or surrounding tissue. A cervical smear can confirm that the lower reproductive tract is infected or inflamed. But diagnosing more widespread PID often requires laparoscopy, an outpatient surgical procedure that involves inserting a scope into the abdomen through a small incision below the navel. Antibiotics can stop the disease. To avoid reinfection, women who develop PID should get their partners tested for the responsible bacteria.
Unlike a bacterial infection, genital herpes can’t be cured with antibiotics. Once infected with a herpes simplex virus, you’re infected for life. Some 30 million Americans carry these common pathogens (there are two types), and most never suffer any consequences. But an estimated halfmillion people develop new cases of active genital herpes each year. The number of patients seeking treatment has grown sevenfold since the late 1960s.
In adults, the condition is more an annoyance than a health threat. The virus causes cold-sorelike lesions on the genital area. They normally appear within 10 days of infection and heal within three weeks. But many carriers experience occasional flareups, and anyone with an active lesion can pass the virus to a sex partner–even if the lesion is unnoticeable. Women with active herpes can also infect their babies during delivery, causing brain damage or death. Though no drug can root out the infection, daily doses of acyclovir, an antiviral drug, can help control it. And Caesarean delivery can reduce the risk to a newborn.
Like herpes sores, genital warts are caused by viruses that medical science has yet to tame. No one knows just how many people carry the culpable strains of human papilloma virus (HPV). Nor is it clear whether symptom-free carriers can spread the infection. But health officials estimate that 1 million Americans develop active warts every year and that two thirds of their sex partners contract the infection. The hard, fleshy bumps typically appear within three months of exposure to the virus, and they can show up well inside the vagina or the cervix, making self-diagnosis difficult for women.
The warts themselves are more unpleasant than dangerous; doctors can usually remove them by freezing, burning, chemical solutions or, when necessary, surgery. But experts worry about possible links between HPV and cancers of the penis, vulva and cervix. Cervical cancer strikes 14,000 American women a year, and kills 6,000. The malignancy is treatable if detected early, so women with a history of genital warts should have annual Pap smears as a precaution.
Hepatitis B isn’t generally thought of as a sexually transmitted disease, but it should be. The virus infects an estimated 300,000 Americans every year, causing 5,000 deaths, and sex is the leading mode of transmission. Overall incidence hasn’t changed much in recent years. But while the rate among gay men plummeted during the ’80s-apparently in response to AIDS-inspired precautions-heterosexual transmission surged by 38 percent. Anyone with more than one partner is at risk.
The hepatitis B virus (HBV) attacks the liver, causing a tenacious flulike illness marked by jaundice. There is no cure; most people recover naturally and develop immunity to future infection. But HBV can take root in the body, remaining contagious and leading slowly to cirrhosis or liver cancer. There is a proven hepatitis B vaccine; the government recommends it for all sexually active gay men and for heterosexuals with more than one partner. But while 28 million heterosexuals are at risk, less than 1 percent have taken advantage of it.
An estimated 1 million Americans are infected with the AIDS virus-many of them unknowingly-and any infected person can pass the virus to sexual partners. Gay men still constitute the largest risk group for AIDS, followed by intravenous drug users. Only 6 percent of all U.S. cases have been traced to heterosexual contact. But heterosexual transmission is the norm throughout much of the world, and experts agree it will become more common here as the epidemic matures.
HIV often causes a brief, flulike illness at the time of infection, but it can remain silent for a decade or more before causing the fatigue, fevers, diarrhea, weight loss and susceptibility to infections that mark the onset of full-blown AIDS. Within a month or two of infection, the body produces antibodies that a blood test can detect. Testing is recommended for anyone with multiple partners or a history of sexually transmitted disease. The antiviral drugs AZT and ddI can slow the progress of HIV disease, and new treatments have made some AIDS-related infections more manageable. But safer sex is still the best medicine. The disease is incurable, and unlike the others, it always kills.
*Through October 1991.
title: “Sleeping With The Enemy” ShowToc: true date: “2022-12-10” author: “Mitchell Whorley”
Business as usual? Lately, Russia isn’t just continuing its tradition of schmoozing with rogue states around the world. It’s actually stepping up relations with several of them. As if in conscious response to George W. Bush’s diatribes against an “Axis of Evil,” Russia has forged its own axis of friendship, recently announcing a series of deals that extend and deepen its cooperation with Iraq, Iran and North Korea. Late last week, Vladimir Putin traveled to the Far East city of Vladivostok for talks with North Korean dictator Kim Jong Il, who recently arrived on his private train to examine opportunities for business cooperation with Moscow. A new trade agreement with Baghdad, set for signing in the coming weeks, is said to be worth from $40 billion to $60 billion and encompasses 70 different projects from food production to oilfield equipment. And just in case Washington didn’t get the message, Moscow has also declared its intention to expand a project to help the Iranians build a nuclear reactor–an undertaking that has been bedeviling Russia-U.S. relations for years.
One could argue that there’s nothing new about Moscow’s cultivating ties with international pariahs. Ties with Iraq and North Korea date back to Soviet days, and the reactor-building project in the Iranian city of Bushehr started under Boris Yeltsin in 1995. But that was before 9-11 and the astounding turnaround in Russian-American relations that followed. Earlier this year Vladimir Putin and George W. Bush met in Moscow to seal a new alliance against the common enemy of terrorism. Officials from the White House and Pentagon fell over each other to express thanks for Russia’s contribution to the war in Afghanistan. Commentators have been taking it as given that the United States can count on Russian oil to buoy the Western economy if Washington launches an attack on Iraq.
To anyone paying close attention, though, it was clear from the start that Russia’s coziness with the terrible trio would complicate things. Even during the sweetness-and-light Moscow summit, senior U.S. officials could be heard behind the scenes, warning about Russian courting of Iran in particular. Those fears proved justified earlier this month, when Moscow announced not only that it was planning to finish the $800 million nuclear reactor in Bushehr, but was also giving the go-ahead to an additional 10-year program for five more reactors–a contract worth up to $10 billion. That left American officials speechless–among them, Energy Secretary Spencer Abraham, who just happened to be visiting Moscow and pointedly avoided any public comment about the problem during his visit.
Russia’s latest initiatives with Iraq, though, seem to be provoking a more strenuous response. A congressional delegation led by Rep. Henry Hyde came to Moscow last week asking for clarification of Russia’s policy toward rogue states and admonishing the Kremlin that the new Russian-American alliance could suffer as a result. But that was nothing compared with the broadside delivered by Defense Secretary Donald Rumsfeld late in the week. Friendliness toward rogues, he said, “sends a signal across the globe that that is what Russia thinks is a good thing to do, to deal with the terrorist states, to have them as their relationship developers.” He warned the Russians that cozying up to the rogues could scare off investors from the West, a not-too-thinly veiled warning that U.S. promises of intensified commercial engagement with Russia were already under threat.
So why has Moscow persisted in its dealings with these less-than-savory customers? Essentially, the Russians say, the payoff they were hoping for from the U.S.-Russia alliance hasn’t come. While they had hoped for more Russian imports to U.S. markets, they instead got Bush steel tariffs, a hard knock to their own industry. They seek more American investment in the Russian oil industry, but so far such plans have remained just that–plans, not backed up by dollars. They wanted U.S. support for WTO membership; instead, Russia must wait another two years. “After September 11, there were great expectations, and they have ended in nothing,” says Dmitry Yevstafiev of the PIR Center, a leading Moscow think tank. “In fact, Russia got less in this cycle of cooperation with the West than it did in the early ’90s. There has been zero economic benefit to this warming with the West. Both the military and the political elite are unhappy about it.”
Well, maybe not that unhappy. Many members of that elite are now connected with private economic empires, in industries ranging from oil to arms, that stand to benefit from Russian trade with rogues. President Putin has said repeatedly that Russian foreign policy should unsentimentally follow the money, obeying the dictates of Russian commercial interests rather than the ideological or geopolitical principles that once applied.
Russia’s relations with the West are still of immense importance, to be sure, and will clearly remain so. But trade with the rogues is catching up fast. Last year, despite U.N. sanctions, Russia’s trade with Iraq amounted to $4 billion. That’s only half of its total $10 billion with the United States, but the dealings with Iraq in some ways offer more potential. While Russia’s customers in the West are interested almost exclusively in buying raw materials–oil and natural gas to Europe, for example–the rogue states, which can’t shop where they’d like, are more than happy to buy Russian manufactured goods, ranging from weapons to whole factories and power plants. “If we had good economic relations with the West, and earned some good revenue from them, we’d be very happy,” says ultranationalist parliamentary deputy Vladimir Zhirinovsky. “But they don’t want to buy from us, so we’re dependent on the East, where they’re ready for any deal and able to pay.”
Often derided as a buffoon, Zhirinovsky is actually in the Russian mainstream as far as his fondness for the rogues is concerned. Earlier this year he visited Pyongyang to discuss plans for connecting the Korean Peninsula rail network with Russia’s Trans-Siberian railroad, a project that pleases Putin. That’s in addition to Zhirinovsky’s regular trips to Iraq, where he claims to have told leading politicians that they should sign “the biggest possible deal” with Russia as a hedge against military action. Surely, he and others in Moscow argue, Washington will be less inclined to attack Saddam if there are large numbers of Russian technicians on the ground in Iraq–which, in turn, will mean a huge payoff for Russian oil companies once U.N. sanctions are lifted. As for Iran, says Zhirinovsky, “I haven’t been there since last year. But I hope to be getting back soon.” No doubt the likes of Yevgeny will be hard on his heels.
