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From Summer of Love to ‘superbug,’ gonorrhea rises again in San Francisco

Flickr Creative Commons
"dis-earnment," a window sculpture in the Haight Ashbury district.


The Summer of Love was San Francisco’s most celebrated party — but it came with a massive collective hangover. Free love had a hidden cost: sexually transmitted diseases. Gonorrhea spread through the nation in the late 1960s and '70s. Now it’s back, 50 years later.

The Summer of Love: psychedelic art, mind-altering drugs, sex. Ten thousand young people from all over the nation descended on San Francisco to sample hippie culture. They lived in communes, slept in the park, wore tie-dye and dropped LSD. They got it on.

“It was a sexual revolution and everyone was having sex with everybody,” says Dr. David Smith.

Smith was working at San Francisco General Hospital in the fevered summer of ‘67. He saw a lot of revelers overdose. So he opened the Haight-Ashbury Free Clinic with $600 and a vision of nonjudgmental healthcare.

“We had 350 patients a day coming into our clinic,” he explains, “You have to remember that you're right in the middle of the hurricane, so it felt huge.”

Dr. Smith was interviewed about drug use during the Summer of Love a number of times this past summer. But his clinic also treated a lot of STDs. He says that of those 350 patients per day, about 15 percent were infected gonorrhea. That’s a lot, considering just a decade before, the national infection rate was only 1 percent, according to the Centers for Disease Control.

“Suddenly you had a public health epidemic that the system was totally unprepared to deal with,” Smith says.

His medical school instructors told young doctors that the disease would be all but extinct in a matter of years. They were wrong.

People were pouring into San Francisco, making love, swapping diseases, and then going home to their respective cities around the country, sometimes with a party favor: gonorrhea.

Just to get the clinical information out there — gonorrhea is a bacteria. It’s spread by sexual contact. You usually can’t see the symptoms in women. But for men, the main symptom is hard to miss: Dr. Smith described it to me as “discharge that flows from the tip of the penis.”

"Sometimes the organism gets ahead of us and sometimes we're ahead of the organism. And we don't know how long that's going to last." —Dr. David Smith

Condoms protect against it. And once you have it, it’s easy to treat with antibiotics. But there’s no immunity. After treatment, you can get it again.

Gonorrhea overseas

Many American soldiers who fought in the Vietnam War caught it and brought it back home with them.

Dr. Dale Smith is a military medical historian at the Uniformed Services University in Bethesda, Maryland. He says that about a third of the soldiers fighting in Vietnam got gonorrhea.

“Some troops without question came back to the United States with active cases of gonorrhea,”

He explains that the army was young in Vietnam, away from home for the first time and in a high-risk environment. He says that once on leave, the young troops would engage in behavior that older soldiers might not consider, like binge drinking and unprotected sex.

He says military commanders weren’t too worried about their risk-taking because gonorrhea didn’t stop them from fighting.

“It was something you did at sick call and went about your business. Kind of like having a headache. You got a pill and moved on. Although this pill tended to be given through a hypodermic needle,” Smith says — treatment in the ‘60s was a simple penicillin shot.

Many soldiers were given leave in neighboring Bangkok, which had a growing problem with drug-resistant gonorrhea and one of the densest populations of sex workers in the world. Antibiotics weren’t regulated in Thailand. Anyone could buy them. Dr. Smith says sex workers were under the mistaken impression that they could take antibiotics to prevent STDs. That only made the disease more resistant.

“Before you to work for the weekend, you might take a handful of penicillin or tetracycline, anything you could get over the counter, and you'd hope that it would kill the germs and keep you from getting sick. It doesn't really work that way,” Smith says.

So the Army took a big step — they gave condoms to soldiers. Back home, condoms were usually kept behind the pharmacy counter. It was kind embarrassing to ask for them. But the army gave them out freely, and even experimented with colorful ones to encourage use.

“But young men ... prefer to go au natural and so they tend not to use them.” Dr. Dale Smith admits.

So, the Army developed a vaccine for gonorrhea. But when the researchers were ready for a clinical trial, command decided that the infection was easy enough to treat, and shelved their work before testing it on soldiers.

“I think there’s a subtext in that they didn't want to admit to the mothers of America that gonorrhea was significant in the military community,” Dr. Smith adds.

While the Army was proactive about treating and curing the disease, behaviors in Southeast Asia meant that some particularly tenacious strains made it back to port cities. Like San Francisco.

The contraceptive pill

While the soldiers were fighting and all this free love was being given and taken, something else was happening: the Pill.

The contraceptive birth-control pill was approved as a birth control measure in 1960, and only five years later, 6.5 million women in the United States were using it.

If you didn’t come of age in the ‘60s, it’s hard to imagine the impact. Sexually enfranchised women could enjoy sex without worrying about pregnancy or condoms.

Kate Coleman started college at UC Berkeley in 1965 and lived through the sexual revolution in the Bay Area.

“The pill — it made things freer. But on the other hand, the mores were dropping,” Coleman reflects.

She went to New York before the Summer of Love, and when she came back a few years later, she was shocked by how much things have changed.

“I felt the culture I was in already of having affairs was already in place but not this running around and frolicking in the summer of love and f—ing strangers.”

We’ve come a long way since ‘67. But even though we’ve put a man on the moon and invented the Internet, we still don’t have a vaccine for gonorrhea. And we still get it.

Gonorrhea today

The birth-control pill prevents pregnancy. But only condoms prevent the spread of gonorrhea.

“Condoms are wonderful! Condoms are wonderful tools for prevention. They should always be part of our arsenal for sexual health,” Dr. Susan Philip gushes. She’s the Director of the Disease Prevention and Control for the San Francisco Public Health Department.

She says gonorrhea cases are up 20 percent over last year in San Francisco.

“Gonorrhea is a very wily organism and it has developed resistance, meaning that certain antibiotics don't work against it after awhile,” she says.

She’s hearing reports about antibiotic resistant and untreatable gonorrhea from overseas. Sound familiar?

“Untreatable gonorrhea is keeping a lot of public health and STD people up at night because it has happened elsewhere in the world.” She’s quick to add: “That hasn't happened so far in the U.S.”

Yet, according to the CDC, gonorrhea is substantially underdiagnosed and underreported. They think they only hear about half of the cases.

The City Clinic

“I’m going to take your blood pressure,” Dr Oliver Bacon says as he wraps an armband around a patient’s bicep. “Okay, it looks good. 120 over 80.”

Dr. Bacon is giving a checkup at the San Francisco City Clinic. The Haight-Ashbury Clinic gets a lot of press, but San Francisco’s unsung hero is the City Clinic. They focus on sexual health and have been around since 1911. They see over 1,500 patients a year.


Credit Claire Stremple / KALW News
In the waiting room at San Francisco City Clinic.

“In terms of STD screening, we’ll do the standard testing. Blood draw for syphilis. You've not bottomed in the last three to six? Like a zero nothing’s been in there?” Dr. Bacon asks.

Screenings like this one are the best defense against the spread of drug-resistant gonorrhea.

“I can’t imagine being sexually active in San Francisco without making this a part of your sex life. As a regular visit to the clinic. I found out here once that I had gonorrhea in my throat,” said the patient, who is anonymous since he’s sharing intimate information.

The bacteria doesn’t just live in the urethra — it can also thrive in the throat and rectum.

“Okay, I won’t do a rectal swab, but I will do a throat swab and urine. That's for gonorrhea and chlamydia,” Dr. Bacon decides.

Half of the new gonorrhea cases in San Francisco were not genital infections. That means no drip, maybe no symptoms at all. And people can transmit gonorrhea without even knowing it.

"There was no symptom at all. Nothing. I wouldn't have noticed unless they told me." —San Francisco City Clinic client

  “There was no symptom at all. Nothing. I wouldn’t have noticed unless they told me,” the patient says. “It’s scary.”

He’s here for a checkup because he takes PreP, which stands for pre-exposure prophylaxis. It’s a new preventative medication against HIV/AIDS.

“STDs are cyclical and they fluctuate with other things that are happening in society and in cities in particular. There are some parallels that we’re seeing now with PreP and the conversation that was occurring when women were getting access to oral contraception,” Susan Philip says.

In other words, PreP is to men who have sex with men what the Pill was to women in the 1960s — insurance against the biggest risk that comes with unprotected sex.


PreP and the Pill might be reasons people use condoms less. Condom use in the U.S. has been dropping for years and public health experts don’t know exactly why. What they do know is that bacterial diseases get more resilient as our treatments get better.

Dr. David Smith says it’s a race. “Sometimes the organism gets ahead of us and sometimes we’re ahead of the organism. And we don’t know how long that’s going to last.”

If Susan Philip had one wish, she says it would be for a vaccine. When I told her that the Army had one ready back in 1980, but decided against clinical trials, she didn’t sound too surprised. But she told me that since we spoke, she heard about a meningitis vaccine that also reduced the risk of gonorrhea infection. She hopes it will point the way to a vaccine.

Until then, the best defense is to get tested.


And an extra couple micrometers of latex between you and the one you love might not be such a bad thing either.


Crosscurrents San Francisco