Chlamydia
Chlamydia is an infection of the bacterium Chlamydia trachomatis, which can only live and reproduce inside host cells. In the picture on
the previous page you can see the bacteria as small granules inside
inclusion bodies. Eventually the infected host cell dies, bursts open and
the bacteria are set free to infect neighboring host cells.
Chlamydia is the main cause of blindness in low and middle
income countries.
Chlamydia can also be sexually transmitted and cause infections of the mucosal linings of the genitals and rectum. In many cases these anogenital infections go unnoticed but with complaints they can lead in some women to late complications like infertility. There is an aggressive chlamydia variant that causes a severe disease called lymphogranuloma venereum. Lymphogranuloma venereum mostly
affect gay and bisexual men and transgender persons who have sex
with other men or transgender persons and causes painful infections
of the anal canal.
An Alternative Route for the Transmission of Lympho- granuloma Venereum
Throughout millions of years, Chlamydia trachomatis evolved from a
commensal inhabitant of the gastro-intestinal tract microbiome to become
the pathogen causing eye infections and sexually transmitted infections
nowadays. This is an often-seen evolutionary process where microorganisms
in their fight for survival, adapt to their host and to their ever-changing environment. This process exemplifies the blurring boundaries of an ally that is part of the hosts’ protection on one side, and a bug that causes disease on the other side. The human microbiome consist of billions of micro-organisms that live in symbiosis with us on the grounds of mutual benefit.
Anogenital Infections
Lymphogranuloma venereum affects gay and bisexual men and transgender persons who have sex with other men or transgender persons. Most cases develop a painful and destructive ano-rectal infection; yet, we rarely see genital infections. This leads to the assumption that ano-genital sex (buttfucking) is not the only, or most important route of transmission. Oral-anal sex (rimming) might be an alternative route for the transmission of chlamydia. Rimming someone with anorectal lymphogranuloma exposes the oral cavity of the partner to chlamydia. The theory holds that the bacterium can spread via the gastro-intestinal tract to cause an infection of the anal canal in the partner.
Transmission Routes
Depiction of proposed transmission patterns of lymphogranuloma venereum in men who have sex with men. Genito-anal transmission occurs between men (grey arrows), but ano-oral infection (white solid arrows) may also occur via ano-oral sex (rimming). Oral infection may result in clinical or subclinical pharyngitis, and the organisms may pass through the gastrointestinal tract (dashed lines) to the large intestine and rectum, where they can be shed to sex partners. From: The Enigma of Lymphogranuloma Venereum Spread in Men Who Have Sex With Men: Does Ano-Oral Transmission Plays a Role? de Vries HJ. Sex Transm Dis. 2016 Jul;43(7):420-2
The Atlas of Queer Anatomy is a commentary on the legendary
Atlas of Human Anatomy composed by Frank H Netter. Many of the Netter’s
depictions are heteronormative, and his models were solely white and
Western oriented. This reflects the general perception of Western medicine of his generation. Alternative lifestyles, sexual- or gender orientations, the variety of cultural and ethnic backgrounds, none of these aspects were reflected in Netter’s original work.
Sex is a life’s necessity and source of universal pleasure, bonding and
identity. Netter discussed sexuality only in the context of reproduction or sexually transmitted diseases; and by doing so medicalized and pathologized sexual contact.
In The Atlas of Queer Anatomy we try to represent the spectrum of
sex in a postive way, outside the narrow focus of heteronormative sexuality. We cross the boundaries of what Gayle Rubin described as the “good” charmed circle into the “dirty or bad outer limits”. Sex can be enjoyed in many different ways, and as long as there is mutual consent of all parties involved the boundaries are unnecessary, artificial and exclude essential parts of society. Bounderies are there to be crossed.
Rubin, Gayles S. 1993. Thinking Sex: Notes for a Radical Theory of the Politics of Sexuality. In TheLesbianandGayStudiesReader,editedbyH.Abelove,M.A.Baraleand D. M. Halperin. NY: Routledge.
Gonorrhea
The bacterium Neisseria gonorrhoeae causes gonorrhea by attaching to
mucosal tissues of the genitalia, the anal canal and the throat. In about half of the cases it leads to localized symptoms such as discharge, pain, redness. Under rare conditions it can cause a systemic infection when it enters the bloodstream. If not treated timely, it can lead to irreversible damage such as scarring, strictures, and infertility.
Gonorrhoea is highly infectious via genital contact but also
via mutual masturbation and all kinds of foreplay. Since it can infect
many body cavities it is important to take the spectrum of human sexual
acts in all its abundance and variety into account. When it came to sex, Netter took a binary approach and only considered genitals (penis in vagina) in the sexual transmission of infections. Yet, there is so much more to consider when gonorrhoea is at stake: oral, anal, genital sex in any combination, the use of toys & dildo’s, fingers, feet & hands, and the exchange of all sorts of bodily fluids like urine & faeces. As said, the queer atlas crosses the boundary between Gayle Rubins “charmed” circle and the “bad outer limits”, as discussed next. Territories Netter had never
dreamed of exploring!
Transmission Routes
The Fear of Falling Dominoes
Persons living queer life styles are often confronted with stigma and fear. This is addressed by Gayle Rubin in another concept, called the domino theory, which is build upon the “charmed circle”. People consider themselves part of the charmed circle, and driven by fear or disgust reinforce the line between acceptable and unacceptable sex, believing it to stand between order and chaos. In Gayles words: “Instead of judging sexual tastes according to an arbitrary line, we should emphasise the way partners treat one another, the level of mutual consideration, the presence or absence of coercion, and the quality of the pleasures they provide.” Queer theory and the queer anatomy atlas question the binary approach of sexuality, gender and the many roles imposed by society, governments, religion, science and medicine.
Mpox
Mpox surprised the World in the spring of 2022, and in response the WHO
secretary general designated the outbreak the highest status of alert PHEIC (Public Health Emergency of International Concern). Mpox is an example of a zoonosis that prevails predominantly among animals but can occasionally also infect humans. The COVID-19 pandemic, and the mpox outbreak, are recent examples of diseases caused by zoonotic viruses that adapt and gain the capacity to pass on from human to other humans. Climate change, deforestation (with increasing human interference in the natural habitats of wild life) and globalization (with rapid international transmission ) contribute to new and unexpected zoonotic outbreaks.
For years, mpox caused limited outbreaks in West- and Central
African countries, affecting especially children and pregnant women (with
mortality rates ranging from 1-10%). Transmission was mainly via skin-skin contact, airways and contaminated blankets.
In the 2022 outbreak in over 100 countries worldwide the main route
of transmission is sexual contact and over 95% of cases are gay and bisexual men who have sex with men. It is yet unknown if the virus adapted to make sexual transmission more efficient, or that the sexual network of men who have sex with men facilitated transmission. In 2024, once more WHO issued a PHEIC alert for mpox, this time for uncontrolled concurrent outbreaks of 3 different strains in several sub-Saharan countries. One strain was mainly transmitted via heterosexual networks, while another affected especially children and seems more deadly than the other 2. Although vaccination is a very effective intervention to curb these outbreaks, international solidarity to implement vaccination campaigns in African countries is stalling. Not only does this lead to unnecessary suffering in the affected regions, this also increases chances of a widening global epidemic as seen in 2022.
Mpox is the name for the disease caused by the monkeypox virus (hMPXV). In November 2022, the World Health Organization (WHO) renamed the disease previously named monkeypox to mpox because the former name was considered colonial, racist and stigmatizing. It caused severe stigma of black people 1, gay men of colour 2 and patients with chronic skin conditions 3. Stigma shies persons with a chance of having mpox from seeking help and thus fuels ongoing transmission. Moreover, monkeypox is a misnomer since the animal reservoir are rodents and not primates.
Skin-skin contact, airways and contaminated blankets can be the common transmission routes of Mpox
Trypophobia 4 (Fig. 1) is an aversion to the sight of irregular patterns or clusters of small holes or bumps. Trypophobia is deeply entrenched as an evolutionary fear of contamination evoking fight flight and fright responses. From an evolutionary perspective, signs of sickness and disease (such as infections causing holes and bumps) bring about strong and negative responses in society. We recently saw this during the 2022 human mpox outbreak in social media posts shaming and stigmatizing alleged mpox patients, often innocent people affected by chronic skin diseases like neurofibromatosis and eczema, mistaken as mpox.
2. https://www.wbur.org/cognoscenti/2022/09/19/monkeypox-hiv-vaccines-epidemic-jo- siane-martinez
3. https://www.tiktok.com/@redm3at/video/7129236475547274539?_r=1&_t=8VLtFY- 70ove&is_from_webapp=v1&item_id=7129236475547274539
4. Not to be mistaken with trypanophobia, a pathological fear of needles and medical interventions.
Scabies
Scabies is an extremely itchy skin condition caused by Sarcoptes scabiei. It is a mite, has eight legs, and belongs to the arachnids (like spiders 5). In low and middle income countries scabies is extremely common in the general population (especially in young children) where it is transmitted during play, sharing the same sleeping place and crowding. In higher income countries, the main route of transmission is sexual contact. Homeless people, students, backpackers, institutionalized persons and healthcare workers are the key populations affected by scabies.
Scabies is transmitted during skin-skin contact that takes longer than 15 minutes. This is often the case during sex and foreplay, but also cuddling, snuggling, nuzzling, nestling, embracing, hugging & cocooning. When it comes to intimate contact, any boundary is artificial! Again, the borders are ambiguous and often transgressed in the daily lives of humans.
Syphilis
Syphilis is caused by Treponema pallidum pallidum, a cork shaped organism that has plagued humanity for centuries. Its origin has been debated for decades, and 2 theories have been proposed: the New-World theory and the Old-World theory 6. According to the New World theory, Columbus and his fellow travelers brought syphilis to Europe, upon their return from what they called Hispaniola. Subsequently, the disease spread over the European continent via national armies that invaded the territories of neighboring countries. As with most epidemics, the enemy was to be blamed which can be traced back to the various names under which syphilis was described: the Spanish pox (in the Low Countries), Mal de Naples (in France), and French disease (in Italy).
Initially syphilis was very deadly; an estimated 10 to 15% of the European population succumbed to the disease.
According to the Old World theory, syphilis was already present in Europe, Africa and Asia long before the 15th century. This is supported by syphilis specific bone deformations in Egyptian mummies.
Like with mpox, syphilis can cause a spectrum of stigmatizing skin symptoms and horrific bodily destruction. Syphilis has been feared by society at large before an effective drug, penicillin, became available after the Second World War.
In the fight against syphilis, medicine took an often misogynous and binary approach. The goal was to isolate those having syphilis from those considered “healthy”. Women were demonized (as sex workers and “loose” women), whereas men (soldiers and sailors) were considered victims, to be protected from evil and infectious women.
6. The binary approach to divide the earth in an Old and a New world is a Eurocentric, colonial concept starting with the exploration of Columbus by the end of the 15th century. Columbus and subsequent sailors claimed to have “discovered” the America’s and called this territory the New World as if not inhabited by humans for millennia.