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Archive for January, 2012

Call for papers on Criminalizing Contagion

31 Jan, 12 | by Jackie Cassell, Editor of STI

The BMJ Group journals Sexually Transmitted Infections (impact factor 3.029) and the Journal of Medical Ethics (impact factor 1.391), in conjunction with academics at the Centre for Social Ethics and Policy (University of Manchester) and the Health Ethics and Law Network (University of Southampton), would like to publish a collection of articles on the criminalization of disease and sexually transmitted infections. We invite article contributions to be published as part of this themed collection.[1]


The use of criminal law to respond to infectious disease transmission has far-reaching implications for law, policy and practice. It presupposes co-operation between clinicians and criminal justice professionals, and that people who infect others can be effectively and fairly identified and brought to justice. There is a potentially difficult relationship between criminal justice and public health bodies, whose priorities do not necessarily coincide. We are interested in receiving papers of broad interest to an international readership of medical ethics scholars and practicing clinicians on any of the following topics:

  • Legislative and policy reform on disease and sexually transmitted infections
  • Health services and the police: privacy, state interference and human rights
  • Evidence and ethics: prosecuting ‘infectious’ personal behaviours
  • Clinicians and the courts: the role of health professionals and criminal justice
  • The aims of criminalization and public health: a compatibility problem?
  • International comparative studies on disease and criminalization: policy, practice and legal issues


1. Up to eight articles will published in a special section in an issue of Sexually Transmitted Infections in 2013.

2. Two articles will be published in a special section in an issue of Journal of Medical Ethics in 2013.

All articles will be blind peer reviewed according to each individual journal’s editorial policies. Final publication decisions will rest with the Editors in Chief: Professor Jackie Cassell (STI) and Professor Julian Savulescu (JME).

Important Dates

Please submit your article to either journal no later than December 14th 2012.

Submission Instructions

For Sexually Transmitted Infections:

Articles for STI should be a maximum of 2,500 words and submitted via the journal’s website: Please choose the special issue ‘Criminalizing Contagion’ during the submission process.

For Journal of Medical Ethics:

Articles for JME should be a maximum of 3,500 words, and submitted via the journal’s website: Please choose the special issue ‘Criminalizing Contagion’ during the submission process.

Further submission instructions are on the journals’ respective websites. If you would like to discuss any aspect of your submission, including possible topics and the journals involved, please contact the guest editors in the first instance: Dr David Gurnham (, Dr Catherine Stanton ( or Dr Hannah Quirk (

[1] Some of the contributors may also be invited to present their papers at one of three sessions of a proposed ESRC seminar series on the same topic, to be organised by the guest editors. If funding for the seminar series is awarded by the ESRC (in April 2012), they will take place in winter 2012/13 and summer 2013 (Southampton), and winter 2013/14 and summer 2014 (Manchester).

Did syphilis really originate in the New World? An old theory reconsidered.

31 Jan, 12 | by Leslie Goode, Blogmaster

Outside Naples, 1495, an unknown epidemic struck the mercenary army of the French King Charles VIII, subsequently considered to be the first recorded outbreak of syphilis in the Old World.  As early as the sixteenth century, the sudden emergence of the disease was popularly attributed to Columbus’ recent voyage to the New World.  Yet doubts have frequently been raised.  Did syphilis really originate in the Americas?  Or had it always existed in the Old World, and just by coincidence emerged with exceptional virulence shortly after Columbus’ return?

Twenty years ago, a comprehensive review of evidence for treponemal disease in the New and Old Worlds (Baker & Armalagos 1988) lent support to the popular theory of Columbian origin.  Since then, however, a growing number of cases of treponemal disease have been reported in the pre-Columbian Old World.  A paper published last month (Harper & Armelagos) returns to the old question in the light of the new evidence, and provides a comprehensive assessment of the evidence to date.

The evidence is hard to assess – for two reasons.  The first is the difficulty of the identification of dry bone lesions that are specific to treponemal disease – let alone syphilis.  The second relates to the dating of the evidence; this is rendered more complex by the so-called “marine reservoir effect”, as a result of which ante-mortem consumption of marine foods can generate dates that are too early by a factor of hundreds of years.

On the first issue Harper et al. argue that it is impossible with certainty to distinguish syphilis from other treponemal disease in the fossil record, but concur with Hackett (1976) that there are two macroscopic features that may be considered diagnostic of treponemal disease.  These features do occur in the fossil record.  Ultimately, it is the second issue, that of dating, which poses the greater obstacle to any conclusive argument on the origin of syphilis.  Of the 54 papers reviewed 12 include information on radiocarbon dating, and of these only 4 discuss the effect of marine reservoir.  None of the cases considered can with certainty be assigned to the pre-Columbian period.  Ultimately, therefore, the evaluation of Harper et al. concludes that there is not a single published case from the Old World that can be confidently diagnosed as treponemal, and that has a radiocarbon date that places it firmly in the pre-Columbian period.  Yet there is overwhelming evidence for its prevalence in the New World before this date, and for its occurrence in the Old World thereafter.

Thus, 20 years after Baker & Armelagos’ comprehensive review, the evidence still suggests that syphilis or its progenitor arose in the New World.

Kristin N. Harper, George J. Armelagos et al., “The Origin and Antiquity of Syphilis Revisited: An Appraisal of Old World Pre-Columbian Evidence for Treponemal Infection”, Yearbook of Physical Anthropology 54: 99-133, 2011.

Baker B. & Armelagos G., “The origin and antiquity of syphilis: paleopathological diagnosis and interpretation”, Current  Anthropol ogy, 29:703–738, 1988.

Hackett C.,  Diagnostic criteria of syphilis, yaws and treponarid (treponematoses) and of some other diseases in dry bones (for use in osteo-archaeology), Berlin: Springer-Verlag, 1976.

Bloodless circumcision procedure opens the way to HIV prevention in Rwanda

19 Jan, 12 | by Leslie Goode, Blogmaster

As three recent randomized control trials undertaken in Africa have shown, male circumcision can reduce risk of HIV transmission by 53-60%.  But sub-Saharan African countries will need to scale up voluntary male medical circumcision (VMMC) hugely if they are to achieve these preventative benefits.  (See our earlier blog: Costing the Scale-Up of Voluntary Male Medical Circumcision).  In these settings the availability and deployment of the necessary resources poses a great challenge.

The development of new medical technologies adapted to resource-limited settings may be the way to make such a scale-up achievable.  Last month saw the successful completion of safety and efficacy trials in Rwanda on a device – the Prepex – designed to achieve circumcision by non-surgical means.  This certainly brings Rwanda’s goal of circumcising 2 million men over the next two years a step closer (and with it the goal of reducing HIV transmission by a half); but is also good news for other sub-Saharan countries facing similar challenges.  Results of the three trials on the Prepex were presented to the 16th International  Conference on Aids and Sexually Transmitted Infections in Africa (ICASA) at Addis Ababa.  The importance of non-surgical circumcision can be imagined in a country with only 300 trained physicians for a population of 10 million, and 90% of them living in rural areas remote from surgical facilities. But such conditions are replicated in other sub-Saharan countries which share Rwanda’s ambition to achieve HIV reduction through circumcision, and the challenge which this poses for the availability and deployment of resources.

The device itself operates by controlled radial elastic pressure so as to cut off circulation to the foreskin distally.  The necrotic foreskin can be removed bloodlessly from 4 days after the fitting of the device.  The Prepex offers a number of advantages over surgical circumcision that are particularly relevant to resource-limited settings.  The Prepex device does not require anaesthetic or sutures, may consequently be deployed in non-sterile conditions by non-medically trained staff.  Total time required for the procedure is just over 8 minutes, as opposed to the 25-36 minutes required for surgical circumcision.

Of the three Prepex trials successfully undertaken in Rwanda, the first was a non-controlled study of the feasibility of the procedure in 55 adult males; the second was a randomized controlled study comparing the non-surgical Prepex with surgical male circumcision; the third set out to demonstrate that the procedure could be performed safely and effectively by nurses.

The only results as yet published (JAIDS (15th December 2011) relate to the first of these trials. Following the procedure the 55 subjects were monitored regularly for signs of bleeding, oedema and infection.  Levels of pain experienced at each stage of the procedure were assessed using VAS scores.  The paper makes detailed comparisons between the Prepex device and another circumcision devise – the Shang Ring.  The latter removes the live distal foreskin immediately after placement, and consequently requires anaesthesia and a sterile setting.

The Prepex procedure achieved complete circumcision in all cases with a median healing time of 21 days following removal of the device.  The only adverse event was a case of diffused oedema as a result of chronic urethritis from a belatedly reported STI.  This compares favourably with the six mild adverse events observed in a trial of 40 patients circumcised with the Shang Ring (M.A. Barone & F. Ndede et al., “The Shang Ring device for adult male circumcision: a proof of concept study in Kenya”, JAICS 2011;57: E7-E12).  The most serious issue with the Prepex device appears to be the experience of considerable pain during device removal (mean VAS score 5.4) which was not alleviated by paracetemol.

Jean Paul Bitega, Agnes Binagwaho et al., “Safety and Efficacy of the PrePex Device for Rapid Scale-Up of Male Circumcision for HIV Prevention in Resource-Limited Settings”, JAIDS, Vol. 58, no. 5, December 15 2011

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