My 25 Years as Editor of Sexually Transmitted Diseases

Bill Miller asked me to write a paper about my 25 years as Editor of Sexually Transmitted Diseases (STD). It was not part of my master plan to someday become a journal editor. In 1989, the journal was in trouble. It was an urgent situation. There was no time for a search. Officers of the American Venereal Disease Association (this was before the name change to the American Sexually Transmitted Disease Association) together with a group of what could be considered senior researchers in the STD field met to try to figure out how to deal with the situation. Something had to be done quickly; someone had to take the task. I was able to do it, and I wound up being the Editor designate.

The first challenge was to actually get an issue of the journal out. The urgency had to do with meeting mailing requirements. I don’t quite remember the exact details, but apparently, we were threatened with loss of mailing privileges if we did not get at least one issue out each year. There was no backlog of accepted, but unpublished manuscripts. There was a box with unprocessed submissions that could, once reviewed, provide enough papers to cobble together an issue. I still remember, with much gratitude, how responsive members of the STD community were in reviewing the papers on a turnaround basis. This was a pre–e-mail and Web site review process. Potential reviewers were contacted by telephone, hard copies were mailed, and the reviews were returned by snail mail. As is typical, most accepted manuscripts required revision. With cooperation from all involved, we got enough papers accepted to publish an issue. In 1989, STD was a quarterly, and we put out the last 2 issues of the year, belatedly, with 41 and 42 pages, respectively. Through 1991, we published less than 60 pages 4 times a year. The journal was obviously gaining the confidence of the STD research community, and submissions increased. In 1992, we went bimonthly. In 1994, STD became a monthly, and in recent years, we have published more than 1000 pages/year.

When I took the job, I had no experience as an Editor. Just as most of us in research do, I had reviewed papers for many journals. But here, I was faced with making final decisions, not just recommendations. My philosophy for the journal’s reviewers has always been that we should act as proponents for the authors. In other words, we would take the role of trying to see that what is good and deserving of publication gets published. We would be critics in the most positive sense of the word. And we should seek the best possible paper. It is unrealistic to expect perfection. Ultimately, in the revision process, it reaches a stage where you have the best possible product. It really won’t get substantively better. There comes a time when massaging is a waste of time. The paper is as good as it will get. And a final decision must be made: accept or reject. There are many reasons for publishing papers in a journal like STD: does it add to our fount of knowledge? are there potential public health benefits? how helpful is it to people in the field? and generalizability is always a consideration.

These points were discussed with editorial board members, and there were times when they carried them well beyond my expectations. Every once in a while, a reviewer saw more in a manuscript (or in the data) than was presented by the authors and suggested a different analysis or emphasis. And when the authors agree and appropriately revise the paper, reviewers can feel proud of the role they have played. There have been papers that have gone through 3 or 4 revisions before being accepted. The reviewer, although remaining anonymous, really should have been a coauthor, if only contributions to the manuscript counted. This scenario wasn’t a common one, but it happened often enough. I hope the reviewers know what pleasure I got from this process and how proud and thankful I was of their efforts. It was one of the things that made STD a special journal.

Of course there were more unhelpful reviews than the ones described above. Reviews of “A good paper,” “I like it,” “terrible,” or “unpublishable” make a point, but are not helpful to an editor who has to communicate with an author. I know reviewers are busy people, and often the brief review is because the paper really didn’t hit a “sweet spot” that turned the reviewer on. A real problem for an editor is when you get all 4 of the above quotes as reviews of the same paper. If the paper was in my areas of expertise, I would make the decision and write the review. If not, I would explain the situation to another reviewer and request an expedited review to use as a “tie breaker.”

Another challenge for an editor is when there are highly favorable reviews for a paper that you see as seriously flawed. Early in my tenure, I would just write an additional review, discussing the problems, and reject the paper. After the addition of associate editors (AEs), this was a bit more difficult, as I would be overriding the AE’s recommendation, as well as the other reviews. I did that occasionally, but if the problem was really something that deserved further discussion, I would accept the paper and request an editorial to focus on what I thought was a problem. This was a good solution for me, as I liked editorials. I think they are very useful. Our field (as others) gets more fragmented and specialized over time. Editorials, or expert opinions, provide interpretation and criticism that helps us to understand relevance.

In 1989, STD had an editorial board of 36 members with 9 AEs. The AE position was essentially an honorific one. The editor assigned papers to reviewers, which might include AEs, and the editor made all the decisions. This is in marked contrast to today, where there are 6 hardworking AEs and an editorial board of about 83 members. Now the editor assigns 80% of submissions to the AEs who, in turn, assign reviewers and make recommendations concerning disposition of manuscripts. Of course, the editor still makes the final decisions.

There was a long period when I read every submission and then assigned them to members of the editorial board for further review (if I did not reject them at first read). The reviewers would send their comments to me, and I would come to a decision. Many papers were rejected and never seen again. Rarely, a paper was accepted with no suggestions for revision. Most accepted papers did require a revision, and I also read the revised, resubmitted paper before reaching a final decision. As the number of submissions approached 400 papers/year, the task became unmanageable. In practice, this meant that every day there were a couple of papers to be read. And the journal is an unrelenting master….skip a day, and the papers just accumulate. Take a vacation, and you have a backlog. Part of my education under K.F. Meyer emphasized the concept of service to our scientific community. I took this seriously, and there is no question…. I felt the STD journal was an important part of our community. I loved what I was doing. But I did not love the doing of it.

So, to reduce the editor’s burden, in 2005 a group of working AEs were appointed, covering some of the more specialized areas within the greater STD arena. Initially, there were 4: Sevgi Aral covering behavioral issues, Jeanne Marrazzo and Hunter Handsfield to deal with submissions with a clinical focus, and Mike Cohen, who covered HIV, which was the subject of an increasing proportion of submissions. Kees Rietmeijer was added in 2008 as the clinical load was heavy. Later, reflecting the more sophisticated epidemiologic papers we were receiving, Joan Chow was added. These 6 AEs have worked hard, improved our review process, and have made my life more livable. I owe them. But I owe the most to Jeanne Moncada (!), Assistant Editor. She has been with me for most of the 25 years and has ably dealt with all the administrative aspects of handling manuscripts. This was a burden that I did not have to worry about, and I could not have functioned as editor for the 25 years without her.

Over the years, I tried to emphasize certain areas of specialization. I tried hard to get a section in the clinical arena, with a focus on the STD clinic and patient management. This was far from my area of expertise, but I always felt it was needed. But we could never find someone who was willing to take over that task. Kees Rietmeijer while an AE was also actively running the blog STD Prevention Online.org. Kees has tried to blend what he was already doing there into the “Real World of STD Prevention” section of STD that debuted in 2013, and I think this will thrive. I tried to make STD a home for those working on mathematical models or simulations for STD epidemiology. I think these may guide future interventions. It is a valuable and exciting area that can very thought provoking, as long as workers don’t consider it as TRUTH. I regret that I was never able to attract enough basic science papers into STD. Researchers in this area have their own target journals, and most of the STD readership is not particularly interested in molecular biology (as an example). I can understand this, but such intellectual isolationism is a loss to both. Interactions between people in the basic sciences and those of a more epidemiological or clinical bent have the potential to ultimately make both more productive. This is a missed opportunity for both.

Obviously the STD world has changed dramatically in the last 25 years. Papers are more sophisticated, more heavily based on statistics, and more structured. Although this can be a strength, it has potential drawbacks. Rigid adherence to research guidelines has the potential to stifle creativity and make some research devoid of original thinking. Ultimately, really good research comes from gifted observers and original thinking, not rigid adherence to research guidelines. Looking at the development of the STD field, it is certain that there have been changes over the past 25 years, but although there may be a different spin put on some of the papers, there was research being reported 25 years ago that could comfortably fit in the table of contents of the journal in 2015. For example, in 1989, Dennis Fortenberry was coauthoring an article on chlamydia reinfection in adolescent girls,¹ Ned Hook and Hunter Handsfield were coauthors of an article on ceftriaxone treatment for gonorrhea,² and Sevgi Aral and Ward Cates had an article differentiating those who are sexually active from the sexually experienced (probably more relevant personally for those of us who have been involved with STD since 1989).³

In the 25 years, the journal has presented a tableau of what is going on in this field, defining the public health problems, and presenting relevant research. The growth in page count reflects not only increases in research, but greater acceptance of the STD journal as a good place to publish that research. And the most cited articles during my tenure highlight the key issues during that time. The most cited was Wasserheit’s⁴ 1992 article on the synergy between current STDs and enhanced HIV transmission. Obviously this is still a high-profile subject. The second most cited article was by Weström and colleagues⁵ on the most serious outcomes of bacterial STDs, pelvic inflammatory disease, and infertility. Other heavily cited articles were on the association of Trichomonas vaginalis infection with low birth weight and preterm delivery by Cotch and colleagues,⁶ on the validity of self-reported condom use by Zenilman and colleagues,⁷ Cates’⁸ presentation of a panel’s conclusions on incidence and prevalence of STDs in the US; Laumann and Youm’s⁹ article on racial and ethnic disparities in STD prevalence; and Bauer and colleagues’¹⁰ study of determinants of genital papillomavirus infection in low-risk women.

I look forward to keeping current by reading STD. I expect it to get better in the future. Bill Miller is superbly equipped to edit the journal. I wish him the very best. And I will no longer have my daily imperative: log on to Editorial Manager, see what reviews have been posted to make a final decision and what new submissions have come in, and have to be sent out for further review. Free at last.