So This Weeks Talk is Called: Sexs, Drugs, and Resistance or why I came to Peru. About four years ago now, I was a first year medical student, generally impressed with the inside of the (dead) human body and its nearly non-sensical ability to construct a defense mechanism capable of recognizing (for decades on end) literally billions of foriegn entities. But generally unimpressed with Baltimore, with it's unflapable history of abject poverty and congenital racism. I missed California (where, lest I forget, I really truly always wanted to be). I met an older medical student who spent his first summer of medical school (the first and only break usually spent traveling, researching, or relaxing) working for an STD guru out in San Francisco. I thought I liked infectious disease and was sure I loved San Francisco. A phone and lunch time interview later, I had my most influential mentor of my young career. Jeffrey Klausner has the perfect job. By day he directs the world's best public STD clinic, formulates health policy to prevent disease transmission, works at an HIV clinic, and rounds at the SF general hospital. By night and weekend he hops from Peru to Africa to Thailand consulting and directing international studies. In between he has a wife and three kids, with soccer practice, school plays, and a two week per summer beach house in Mairn County. Hopefully he'll move on in about 6 years when I'm done with my training.
My first job for Jeff was to conduct a small study to analyze rapid tests for syphilis, an STD which usually requires a blood draw to diagnose. I spent a summer comparing these rapid tests (a finger stick much like a test for diabetes) to standard tests, and published an article showing they work very well (and acting as phil the syphilis sore in the SF gay pride parade).

About a year and a half later, I called Jeff asking him if he had any projects for me abroad. He sent me to Peru for a month, where, with a laboratory doctor, I worked to develop a new test for gonorrhea. Gonorrhea has been resistant to Penicillin for years, it has mutated a Penicilllin binding protein that Penicillin must bind to in order to exact its effect. So the choices to treat Penicillin in many places have decreased, to a newer Penicillin-like antibiotic (called a cephalosporin) which often requires an injection, or a new class of drugs, called Fluoroquinolones. Unfortunately, gonorrhea has recently become resistnat to fluoroquinolones in much of the world too, again through mutation of a protein that the antibiotic binds too. Mark Pandori (the laboratorian) and I developed a new test that looks specifically at the DNA (using PCR) to see if the bacteria has the normal (or sensitive protein) or the mutant (resistant protein). I came to Peru to test the new assay and see if we could find any Quinolone resistant Neisseria gonorrhea (QRNG). And we did! About 16% of the samples we tested were QRNG. That is important in Peru, because, unlike in the United States, were people are often treated after a specific gonorrhea test, in Peru people are treated clinically, which means that if a patient has discharge from the penis or cervis, a doctor gives them an antibiotic without a test. In Peru, because they are cheap and do not require injection, quinolones are usually used. This could be a major problem if 16% of the bacteria are resistant! We need to test many more samples to be sure, but for now, we have made an interesting finding.
In the meantime, I am doing some other similar work. Most notably we have also developed a new test that does a similar thing for Syphilis (looks to see if the syphilis is resistant to antibiotics) and a test looking for specific kinds of chlamydia that can cause specific symptoms and problems in gay men (or as they are called in scientific literature - MSM - men who have sex with men, to include those who may not consider themselves gay or who also have sex with women). All and all, it has been an interesting line of work. Ultimately, in Peru and SF, STD work is mostly working with MSM. Other sub-populations are much less affected. The social and political charactersitics of this work are facsinating and certainly add to the intrigue of the field. However, ultimately, as a straight male in the field, I do not think it is my fight. This year, working with TB, may have helped me shift my gears to diseases with less political complexity and more widesweeping impact on the poor, irrespective of sexual orientation.

I´ll have to entice you a second time with promises about sex and disease for another week. Today I write from Santiago, Chile. About 1,200 miles and at least one and half worlds (in a development sense) from Peru. If I recall correctly you´ve done time down here. So perhaps this is old hat to you. But the differences between the two countries harken questions about humanity, equality, and yes, even, raw fish. I suppose a PhD would better suffice to truly comprehend differences in economic development. Chile is all first world roads, parks, achitecture, and a subway system that makes MTA feel obsolete. Peru is all lack of clean running water, tuberculosis (since last weeks lesson), and want want want. The border crossing is more drastic than San Diego - Tijuana. So whats the story. Probably mostly has to do with the lack of an indigenous population in Chile (whatever did exist was quickly decimated). Peru has always had millions of underattended, discriminated, and continually forgotten lower castes (darker shades to be precise). It is this 60% of the Peruvian 30 million who live by and large far below the poverty line, often out in the mountains where clean water, schools, and hospitals are still not being built for lack of a tax base (the governments wax exstatic about decentralization, but I suspect that just means more tax revenue diverted to their pockets - literally (See Alberto Fujimori)). Futhermore, Chile has exerted its dominance over the region in a series of wars (most notable in 1879 where it fought against the poorer Peru and Bolivia, took the Peruvian capital, and what was left of the Bolivian coastline for good - thus relegating Bolivia to a landlocked, portless, economically enslaved country which continues to this day to be by far the poorest in S. America.). It seems every profitable business in Peru (movie theaters, car dealerships, grocery stores) are owned by Chileans (only the phone company which literally disables communication is owned by the Spaniards). Visiting Chile now (to run my fourth marathon - which I did yesterday in a time of 3 hours 52 minutes - keeping me on ice for most of the day yesterday and preventing this email from being scribed until now), those differences are intense. It´s gorgeous. A valley embraced by mountain ranges on each shouder, hardly a vista exists without breathtaking repercussions. The streets are lined with sunny parks, people dress the business part and signs of abject poverty are rare. But it was not until I sat to eat a meal with some Chilean friends did I realize how all-encompassing Chilean continental domination was. I asked what the specialties were - the food and drink I cannot leave Chile without savoring. My hosts´ responses - Pisco Sours and Cebiche, to my agape amazement - the national drink and food of Peru!