The Ancient History of “Gonorrhea”

Brent Arehart // Did the Greeks and Romans have gonorrhea? If you do some light Googling and read the introduction to a few articles on PubMed, then the answer appears to be yes. After all, the word gonorrhea itself is a Latinized loanword from Greek (gonos “seed” + rhein “to flow”). We can also find passages where Galen mentions it, so they must have had it—or at least you may be led to believe.

One of the problems—or perhaps mixed blessings—that historians of ancient medicine face in particular is the use of Greek and Latin in modern medical terminology. On the one hand, the utilization of words drawn from dead languages helps to keep our field from dying too. But on the other, it can obscure the historical valence of words by creating an illusion of terminological continuity. “Gonorrhea” is a good example: whereas other Greek words for disease have become so old-fashioned that they fall out of common usage, this one remains a standard part of the modern lexicon. It is that tension, born out of overlapping nomenclature and diverging semantics, that we will investigate in my first piece for Synapsis.  

Before tackling the problem of ancient vs. modern terminology, let’s take a step back for a moment and reflect on what is at stake. To ask if the ancients “had gonorrhea” is to ask at least two questions. First, did Neisseria gonorrhoeae (a.k.a. gonococcus), the causative bacterial agent of gonorrhea, exist in antiquity? Second, did it interact with humans in the same way as it does now, with the same pathology and symptoms? At present, neither of these questions has a definitive answer. Weyrich et al. [1] identified possible aDNA (i.e. ancient DNA) evidence of gonococcus using Neanderthal dental calculus from El Sidrón cave in northwestern Spain, but they were unable to unambiguously distinguish gonococcus from other Neisseria species. This is unsurprising, not only because aDNA proves challenging to work with, but also because there are many Neisseria species that inhabit the oral cavity.

But let’s assume for the sake of argument that these Neanderthals had gonococcus in their mouths and that gonococcus must have also been present in humans, whether already or shortly thereafter. We still cannot tell if gonorrhea had existed yet, as it is unclear when gonococcus began to colonize the urogenital tract as the pathogen responsible for this infectious disease. One current proposal is that gonococcus evolved from a commensal ancestor—that is, an organism whose colonization does not typically elicit a response from the host [3,4]. (The reasons for this proposal are beyond my area of expertise, so curious readers should consult the original studies.) Furthermore, gonorrhea does not leave behind unique bone lesions, meaning that skeletal remains cannot help pinpoint victims or provide a precise timeline for its emergence [4].

So where do we start the history of gonorrhea? One option would be to wait until the late 19th Century, when Albert Neisser’s identification of the microbial gonococcus in pus samples sparked debates on its causative role. But to do so seems unsatisfactory. As important as the microscope was to understanding gonorrhea, it was only part of the puzzle [5,6]. Another option—and the one that some have already preferred—is to turn to the Greeks and Romans in search of written evidence that can be used to retrospectively diagnosis gonorrhea.   

While retrospective diagnosis has the potential to aid in analysis, many historians have grown wary of its application [7,8]. One of the common methodological pitfalls is assuming that ancient descriptions of symptoms readily translate into modern diagnostic criteria. Thus, one of the core assumptions would be that the substance said to be involuntarily excreted in ancient accounts of gonorrhoea is urethral or vaginal discharge. In the original Greek, that substance was either gonos/gonē or sperma. While both terms can be translated as “seed,” gonos/gonē was variously used to refer to offspring, lineage, the act of procreation itself, and even reproductive organs. Moreover, depending on which ancient source we privilege, gonos/gonē and sperma were either synonymous (Galen, Loc.Aff. 8.440K) or different (Pseudo-Galen, Med.Def. 19.450-451K) in meaning.  If this all sounds confusing to you, then you’re getting the problem. Ancient terminology was imprecise by modern standards. They were unaware of the difference between semen and sperm, let alone subtle differences between other genital fluids. Basically, it was all reproductive residue to them. It is therefore possible that this so-called seed was discharge caused by gonococcal infection, but only a few disparate sources noted differences in its texture (Aretaeus of Cappadocia, SD 2.5; Paul of Nicaea 79).

Yet, discharge alone isn’t enough to identify gonorrhea. Urethritis, vulvovaginitis, chlamydia—all of these can entail similar symptoms. Hence, another roadblock to the ancient history of gonorrhea: the evidence available does not permit differential diagnosis [4]. Looking for what we want to see instead of what they actually wrote can distract us from important clues. For example, Galen recognizes the existence of multiple gonorrheas (in the plural!). One form has to do with spasms of the genitalia, the other with weakness in the body’s “retentive capacity” (Sym.Caus. 7.150-151 & 266-267K). This points to the likelihood that what we are dealing with in ancient descriptions of gonorrhoea is not necessarily one disease, but multiple bodily phenomena consolidated under one term. The ancients were operating with a framework other than our own, so it makes sense that they had different priorities when describing and correlating symptoms.  

If you started reading this to find out whether the Greeks and Romans had gonorrhea, then you may be disappointed. There’s no definitive evidence either way, no smoking gun for the clever detective to spot. But they did have gonorrhoea, and like all the other modern terms with an ancient “counterpart,” it is just as fascinating and worthy of study.

References:

1. Weyrich, Laura S. et al. “Neanderthal behaviour, diet, and disease from ancient DNA in dental calculus.” Nature 544 (2017): 357-361.

2. Priniski, Lauren L. and H. Steven Seifert. “A Case for the Evolution from Commensalism to Pathogenicity and Possibly Back Again: Lessons Learned from the Human-Adapted Neisseria Species.” Molecular Mechanisms of Microbial Evolution, edited by Pabulo H. Rampelotto, Springer, 2018, pp. 327-370.

3. Seifert, H. Steven. “Location, Location, Location—Commensalism, Damage and Evolution of the Pathogenic Neisseria.” Journal of Molecular Biology 431.16 (2019): 3010-3014.

4. Grmek, Mirko. Diseases in the Ancient World. Translated by Mireille and Leonard Muellner, The John Hopkins University Press, 1989.

5. Worboys, Michael. “Unsexing Gonorrhoea: Bacteriologists, Gynaecologists, and Suffragists in Britain, 1860-1920.” Social History of Medicine 17.1 (2004): 41-59.

6. Benedek, Thomas. “Gonorrhea and the Beginnings of Clinical Research Ethics.” Perspectives in Biology and Medicine 48.1 (2005): 54-73.

7. Mitchell, Piers D. ” Retrospective diagnosis and the use of historical texts for investigating disease in the past.” International Journal of Paleopathology 1 (2011): 81-88.

8. Cunningham, Andrew. “Identifying Disease in the Past: Cutting the Gordian Knot.” Asclepio 54.1 (2002): 13-34.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s