Sign Out

Insights and reflections from Contemporary OB/GYN Editorial Board members.

I love pus

By Mara J. Dinsmoor, MD, MPH

My interest in infectious disease started in grade school, when I'd examine myself for the mysterious and fascinating rashes I saw in my parents' handbook on childhood illnesses. (If memory serves, they were illustrated by Frank Netter.) Although I originally planned to be a veterinarian, I settled for medical school, where I did an elective in infectious disease. A horrendous case of synergistic gangrene of the penis impressed upon me the destructive potential of infectious diseases.

I knew I had found my niche when my mentor during residency, Dr. Philip Mead (a former member of Contemporary OB/GYN's editorial board), ascribed his broad knowledge base to the fact that as a resident, he had read every article on infectious disease in women, and then "just kept up with the literature." Infectious disease was something I could master! I interviewed for maternal-fetal medicine fellowships with this in mind, and completed my training under the guidance of Dr. Ronald Gibbs, another bastion in the ID world.

Some say the study of infectious disease can ruin your life: No more unprotected sex, alien foods, or travel to exotic locales. No problem for me. As I get older and night call gets tougher, I have learned to value a good night's sleep. I, for one, was happy to give up those raw oysters, with their slimy texture and God-only-knows-what microbes hidden within. Thankfully, there are vaccines and prophylactic antibiotics to protect us while we travel, but I guess that tattoo and navel ring will just have to wait.

While I haven't even come close to mastering the subject of infectious disease, it remains fascinating to me. The history of medicine is replete with the stories of pioneers whose seemingly simple observations resulted in extraordinarily important changes in public health and medical practices. Examples include Semmelweiss, whose descriptions of the epidemiology of childbed fever eventually led to the widespread use of handwashing, and John Snow, who related cholera outbreaks to contaminated community water wells in 19th-century London.

In the 20-odd years that I have been studying infectious disease, there have been new diseases to learn about every year. Some are new epidemics due to old diseases, such as the Hantavirus outbreak of 1993 or the epidemic of West Nile fever that began in 1999 in the United States. (Editor's note: see "Should pregnant patients be worried about West Nile virus?" by Dr. Dinsmoor of our July issue.) Others are newly recognized problems, such as the staphylococcal toxic shock syndrome (TSS), severe acute respiratory syndrome (SARS), and the "flesh-eating bacteria." (See "Coping with necrotizing fasciitis" in our June issue.)

Even more amazing is the ingenuity and hard work of the epidemiologists, microbiologists, and virologists who have managed to control and even eradicate many of these outbreaks. Increasingly we are finding that a wide spectrum of disease is associated with—if not caused by—infection and inflammation. Examples include cervical cancer, peptic ulcer disease, and even schizophrenia. Unfortunately, in the past 20 years, we've also seen HIV/AIDS become a dominant, albeit malignant, force in our world. Although effective treatments have been developed for HIV/AIDS, a majority of people afflicted with the disease do not have access to them. Malaria, a disease with which we have been grappling for centuries, also remains at epidemic levels in many parts of the world.

In infectious disease, unlike some areas of medicine, we continue to make strides in understanding and controlling diseases. New insights into the molecular pathways of infection, newer and better antibiotics, vaccines that prevent cancer as well as infection—so many advances have helped reduce morbidity and mortality due to infection. While a pessimist would say that pathogens are always one step ahead of us, as an optimist, I would say that we are never more than one step behind.

For all of these reasons, I continue to be fascinated by the study of infectious disease. And, I love pus.

DR. DINSMOOR is Director of Research in Obstetrics and Gynecology at Evanston Northwestern Healthcare, Evanston, Ill., and a member of the Contemporary OB/GYN Editorial Board. She is also Associate Professor of Obstetrics and Gynecology at Northwestern University's Feinberg School of Medicine. A Board Examiner for the American Board of Obstetrics and Gynecology, Dr. Dinsmoor is a member of the Infectious Disease Society for Obstetrics and Gynecology. Her research interests are in outcomes research and infectious disease in pregnancy.

Mara Dinsmoor. Sign Out: I love pus.

Contemporary Ob/Gyn

Aug. 1, 2004;49:104.