> An Epidemiological Case Study > by SockPuppet > -------------------------------------------------------------------------- > Putting the "Open" in "Open Science." > -------------------------------------------------------------------------- An Epidemiological Case Study of a New Sexually Transmitted Infection By Redheart1,2,*, S. Glimmer3, T. Lulamoon4, Zecora5, T. Hugger6, Cadance7, and Cheerilee8 Supervisory Nurse, Ponyville Hospital Emergency Room First Sergeant & Combat Medic, Ponyville Militia, 14th Battalion, Equestrian Home Guard Headmare, School of Friendship, Ponyville Counselor, School of Friendship, Ponyville Independent Herbalism Consultant, Everfree Forest Herbalism Legislation Activist, Ponyville Her Royal Highness, Her Imperial Majesty, Protector of the Empire, Marchioness of the Frozen North, Mother of the Year, Crystallographer of the Order of Bragg, Organizer of the Saddle Hawkins, Baroness of White Woods, Serene Highness of Veneighzia, Holder of the Patent on the Flavored Condom, Wine Mom, Looker of Sauce, Instigator of Baking Contests, Geocaching Grandee, Philately Phanatic, Honorary Yak, Patroness of Pillow Talk, Her Most Sublime Excellency Ambassador Extraordinary and Plenipotentiary to Yakyakistan, Hott to Plott, Knight-Commander of the Order of the Crystal Heart, Canterlot High School Prom Queen, etc., Mi Amore Cadenza, and Empress, Crystal Empire Teacher, Ponyville *: Corresponding author. Address correspondence to: 1SGT Redheart, Ponyville Home Guard Armory, Basement of Ponyville Town Hall, Ponyville, Duchy of Canterlot. Conflict of interest statement: Author Z sells herbal sexually transmitted infection remedies. Author TL sells thaumaturgical sexually transmitted infection remedies. All other authors declare no financial conflict of interest. All authors except TL declare that the remedies TL sells are ineffective. TL objects to that statement. Editor's note: This article is submitted by co-author Redheart in partial fulfillment of the requirements for the degree of Masters of Science from the Correspondence School of Royal University Canterlot, program in Medico-Magical Epidemiology.  Abstract A new and highly virulent sexually transmitted infection (STI) was observed. It afflicted roughly 97% of the teenage population (both town residents and students from a private boarding school) of the locality, over the course of less than two weeks. Findings vary from individual to individual but were indicative of a Poison Joke-aided mutation of the bacterial strain. Species affected during the outbreak included pony (all four tribes), griffon, hippogriff, and dragon. This STI appears to have arrived from Griffonstone and/or Shire Lanka and been mutated by exposure to Poison Joke. Individual case reports are described, along with the developed treatment, which was determined to be 100% effective. Case Details All subjects will be referred to by letters to protect their privacy. The location of this case study is withheld in the interest of privacy as well, but will be referred to as "PV" and is a moderate-sized farming community containing a Royal castle and a large private boarding school that hosts students from around Equestria and allied nations. Patients Zero, a teenage pegasus female, Subject SL, and a teenage griffon male, Subject G, presented separately but simultaneously at PV hospital emergency room— "Hey!" Sweetie Belle said, lowering the medical journal. "Subject SL must be you, Scootaloo, and G must be you, Gallus." Gallus buried his face in his claws and Scootaloo clenched her eyes, ears trembling.  "No, Sweetie," Scootaloo growled, "they're anonymous, remember? We have no idea who those subjects are. We don't even know that 'PV' is 'Ponyville.' You sure can't prove that my... uh... cloud-sitter and I are forever in the medical literature as 'Patient Zero'." "And to think Big Mac said we never accomplished nothin'," Apple Bloom mused. They all sat in the Crusader Clubhouse, Scootaloo and Gallus in opposite corners, ignoring each other. Diamond Tiara sat in Apple Bloom's lap on a beanbag chair, Apple Bloom's forelegs wrapped around Diamond's waist, the two of them rubbing their cheeks together sensuously. Sandbar, Ocellus, Silver Spoon, and Smolder played a game of cards in the middle of the floor. Sweetie continued reading: "—emergency room complaining of pain during urination, severe itching/irritation of the external genitalia, and helium bloating/inflation of the abdomen resulting in unwanted flight. This was particularly dangerous in Subject SL, who was born with aerofoil hypotrophy and is therefore flightless." Sweetie looked at Scootaloo again. "Subject SL, a flightless pegasus teenager?" "Happens to one in ten thousand pegasi, could be anypony," Scootaloo said with a dismissive wave of her hoof.  Silence. "Okay, fine, it was us," Scootaloo said. "Speak for yourself," Gallus grumped. "I don't want to be forever 'patient zero'." "Subject SL was counterweighted with a decorative concrete garden cragadile—referred to as Irwin—via three-quarter inch hemp rope. The concrete cragadile 'Irwin' was placed on a wheelbarrow and Subject SL was brought thusly to the emergency room by her paternal aunts. Subject G was able to fly to the emergency room under his own power, although counteracting the buoyancy of the abdominal helium inflation left him exhausted." "My aunts took it pretty cool, all things considered," Scootaloo said. "They asked me what griffons were like in bed." "What did you say?" Gallus asked. "I said, 'Pointy'." Gallus gave a little shrug and nod. Sweetie continued to read out loud. "Both subjects' abdomens were lanced and deflated of helium. Upon interview, Subject SL and Subject G admitted to being sexual partners, having first engaged in unprotected vuh-guy-nil—" "Vaginal," corrected Diamond Tiara. "—unprotected vaginal intercourse with each other about two days before presenting to the emergency room. Further interview determined that Subject SL had visited Shire Lanka recently and contracted an exotic sexually transmitted infection (STI) there, and Subject G, the same in Griffonstone." Sweetie lowered the journal again. "You got lucky while visiting your parents? And you didn't write to us? And you didn't tell us when you got back? And you didn't take pictures to show us?" Scootaloo shrugged her wings. "Shire Lanka is nice. He's just a little younger than me, really tall, athletic, bright red eyes with slit pupils, he only came out at night so my parents didn't notice him hanging around the bungalow, and had the sleekest, smoothest bat wings... Also, batponies aren't visible in mirrors or on camera film." "So you did take pictures while you were with him?" Sandbar asked. "Yeah?" Scootaloo replied. "But they're just pictures of you?" Sandbar continued. "Yeah?" Scootaloo frowned, confused. "Can I see them?" Scootaloo threw an empty can of apple juice at him. Then they all looked at Gallus. "Gabby makes deliveries to every country on the continent. No telling where she got it from. Blame the 'Griff, not the Griffonstone." Sweetie brought the journal back up. "Subjects further admitted to having had their liaison outdoors, and further investigation indicated it took place in a Poison Joke-infested glade. Therefore, it appears the combination of distinct Shire Lankan and Griffonstone STIs with Poison Joke resulted in this new and virulent infection." Silver Spoon rubbed her nose with her hoof. "You two don't know Poison Joke when you see it?" "No," Gallus said. "I'm not from Equestria, remember? Griffonstone's pollution killed all the nasty plants. And killed all the regular plants. And killed all the decorative plants. And killed most of my ancestors." Then they all looked at Scootaloo. "I was horny." Sweetie shook her head, then looked back at the medical journal. "During this interview stage, a teenage female dragon, Subject SM—" Smolder blushed deeply. "—presented at the emergency room, complaining of burning urination, loss of fire breath, and uncontrollable ovo-incontinence."  Sweetie Belle looked at Smolder, over the top of the journal. "What does 'oh-voh-ink-ent-eh-nince' mean?" "Did you notice," Smolder growled, "how that week, every restaurant in town was selling cheap, large omelets?" "Oh," Sweetie whispered. "Oh!" "Ovo," Diamond Tiara muttered. "I did the math," Ocellus said. "She dropped seventeen times her own body volume in eggs." "What is that in body weight?" Silver Spoon asked. Ocellus's wings buzzed. "Does it really matter, once you get past a factor of ten?" "Subject SM admitted," Sweetie continued reading, "to having had cloacal intercourse with Subject G a few hours after Subject G's liaison with Subject SL." "Hey!" Scootaloo shouted. "Subject G admitted to not washing or cleaning himself between his liaisons with Subject SL and Subject SM." "Hey!" Smolder shouted. "The next day, a female earth pony teenager, Subject AB, presented at the emergency room complaining of burning urination, itchy/irritated genitalia, a sudden-onset allergy to apples, and a desire to consume only pears." "That weren't me!" Apple Bloom shouted. "Upon interview, Subject AB admitted to having engaged in tree-buh-dis-sisium—" "Tribadism," Diamond Tiara said, inching forward off Apple Bloom's lap. "—tribadism with Subject SL, thus proving female-to-female transmission, indicating a surprisingly high infectivity of this new strain." "Sweetie?" Apple Bloom asked. "Yeah?" "Stuff an apple in yer mouth." "Is that what 'tri-buh-dee-sim' means?" Sweetie asked with a frown. "Stuffing an apple in yer mouth?" "Diamond Tiara stuffed an Apple in her mouth," Silver Spoon said sourly. "Which is why I'm going to show up in a page or two." "Subject AB had been brought to the emergency room by her elder sister. This sister, being a farm pony familiar with the husbandry of chickens and geese, was able to lend assistance to the medical team when Subject SM became bound up by a particularly large egg." "Did I say thanks at the time, or was I too distracted?" Smolder asked. "Tell Applejack I said 'thanks'." "How big was the egg?" Ocellus asked. Apple Bloom replied, "We done thought she was havin' a hydra."   Gallus licked his beak. "Tasted good though." Apple Bloom frowned. "Applejack brought me to the hospital because Granny was so sore at me. Granny yelled, 'Apple Bloom, yer half a pear on yer momma's side so I guess I have to countenance ya eating them blasted things, but ain't no grand-daughter o' mine goes anaphylactic at apples!'" "What did you say?" Diamond Tiara asked. "I said, 'Epi-pen! Epi-pen! Epi-pen!'" "About a half-hour later," Sweetie Belle continued to read, "A pair of Earth Pony female teenagers, Subject Ag and Subject DT—" Everycreature looked at Silver Spoon and Diamond Tiara. "—and an earth pony male teenager, Subject SB—" Sandbar pounded his face on the floor of the clubhouse. "—arrived. The three admitted to having engaged in group intercourse, and all three complained of the now-familiar symptoms of burning urination and itching/irritation, but each of the three showed distinct symptoms from the Poison Joke manifestation." Sweetie Belle lowered the journal again and looked at them. "Anything I touched," Silver Spoon said, "turned into silver. I put on boots and they turned silver, but at least that stopped the range of effect so I didn't turn the road to silver with every step." "I thought silver was anti-microbial," Ocellus asked. "It didn't cure your infection?" "You think I was going to touch my..." she flapped her forelegs, searching for a word "... touch my chafing dish while I'm turning door knobs and fence gates into solid silver?" "Point," Ocellus said. She frowned, then: "How did you pee?" "Carefully."  They all then looked at Sandbar. "So..." he said. "My cutie mark is sea turtles?" They all nodded. "My hooves turned into flippers. And I wanted to eat only jellyfish. And I wanted to dig a nest in the sand and fill it with eggs." "Is that where my missing eggs got to?" asked Smolder. Sandbar mumbled. They all looked at Diamond Tiara. She started sobbing and Apple Bloom pulled her into a hug, rubbing her back. Diamond buried her face in Apple Bloom's shoulder. Apple Bloom said, "Her head doctor said she ain't ready to talk about it yet." "I'll skip ahead," Sweetie Belle said, flipping a page in the journal. "Skipping Rumble, skipping Silverstream, skipping Terramar—weird, Silverstream and Terramar are right next to each other in symptom onset time, must be a coincidence—skipping Alula, skipping Dinky, skipping Dinky, skip-ping-ping-ping-ping Dinky, Dinky is, like, fifteen pages, skipping Button Mash, definitely skipping me..." The others looked at each other, eyebrows raised in question. "Here we go... section 'Treatment Attempts.' Standard antibacterial potion injections failed because the magically enhanced nature of the pathogen resulted in a defensive response. After the fires were extinguished, the holes in the walls patched, and the emergency room returned to service, two of the present co-authors (Princess Cadance, Zecora) were invited to consult." "Cadance was giving a guest lecture at the school," Ocellus said. "You all were lucky she happened to be in town." "How'd you avoid the plague, Ocellus?" Scootaloo asked Ocellus smiled. "How did I not... catch the bug?" The others groaned. "I didn't avoid it. But I'm not a mammal, so it didn't infect me. I couldn't get sick if I had sex with ten prostitutes while swimming in Manehattan's East River and eating big spoonfuls of spoiled mayonnaise." "Lucky," Sandbar said. "And I'm not just saying that, that was actually my last hatchday party." Silver Spoon's ears perked straight up. "What... what happened to the prostitutes?" "Um," Ocellus said, the chitin of her face turning harder than usual. "Um." "Okay," Scootallo said with a facehoof, "different question. Why did you have a birthday—" "Hatchday."  "—hatchday like that?" "Because Uncle Pharynx was supposed to be watching me, but instead he left his wallet where I could find it while he polished his ovipositor inside Rarity's Manehattan shopgirl." "That sounds like a party," Scootaloo conceded. "We Changelings have our own problems, though." Ocellus rubbed her horn. "I'm immune to your pathogens, but utterly helpless against your lightbulbs." "This article doesn't use the word 'yak'," Sweetie Belle said, flipping the pages back and forth. "How did Yona avoid it?"  "Nocreature's that horny," Sandbar replied.  Sweetie Belle read further: "Next, it was attempted for one of the co-authors (Princess Cadance) to engage two of the male Subjects (G, SB) in vaginal intercourse, because sexual liaison with an alicorn often results in the immediate clearance of more mundane STIs [c.f. bibliography, references 1-45]." Stroking Diamond Tiara's mane, Apple Bloom asked, "I'm jealous. Y'all two got to... uh... crystal your spires?"  "That mare is horny," Gallus said. "It was a little like getting in a cage fight with a rabid pink weasel." Sandbar whimpered and nodded. "Afterwards, they had to give me IV electrolytes and fluids." Sweetie Belle then read, "Approximately two days later, Subject PC, female alicorn, age 30-40, presented at the emergency room with burning urination, itchy/irritated external genitalia, an explosive molt of the coat, mane, tail, and feathers, and massive edema of the horn." "Hey, Sweetie, what were your symptoms?" Scootaloo asked. "I was already admitted upstairs to the hospital and missed that. Did your horn swell up, too?" Sweetie Belle blushed and rubbed her chin and throat. "I had to sing everything. I couldn't talk. But not, like, regular singing. It was all Bitalian opera. They had to call in the pasta chef from Café Hay to translate." "Mi Amore Cadenza doesn't speak Bitalian?" Scootaloo asked. Sweetie shrugged. "Different dialect, apparently?" "You had to sing because you've got a musical cutie mark?" Ocellus asked. "She had to sing," Silver Spoon said, "because unlike the rest of us, she contracted it in the end close to her voice box." "Co-author Zecora," Sweetie read, ignoring Silver's smirk, "Brewed the standard Poison Joke curative and Subject SW was chosen to be the first to attempt it." "Why were you first?" Smolder asked. "I was dropping my own body weight in eggs every six hours. I should have been first." "Her singing was disturbing the other patients," Diamond Tiara said. "Me, for instance." Gallus patted his belly. "Also, the eggs were good." "This remedy proved ineffective," Sweetie continued, "and in fact made the manifestations worse. Subject SW began singing the orchestral parts of the opera instead of lyrics." Sweetie looked up from the journal. "That part was fun, actually. Moving on: Next, co-author T. Lulamoon attempted to use fireworks to treat the subjects. The other co-authors tackled co-author T. Lulamoon, beat her up, and tied her up in a storage closet... Huh. Then why is she a co-author?" Scootaloo said, "Academia is weird?"  "Oh, this looks good," Sweetie said, glancing at Diamond Tiara. "Subject DT's mother arrived and began berating the hospital staff for not curing the STI quickly enough, for not providing her daughter with high-quality farm-to-table artisanal organic meals in the emergency room, and for using pine-scented disinfectant. Co-author Cheerilee reminded Subject DT's mother that, as President of the local School Board, she was personally responsible for removal of safe-sex education from the curriculum and therefore responsible for the entire outbreak. Co-authors Redheart and Cheerilee then forcibly ejected Subject DT's mother from the emergency room to the delight of all. ...Why did your mom get safe sex banned from school? I heard that Miss Cheerilee taught it in past years." Sweetie rubbed her throat. "I'm wishing we'd had that class." Silver Spoon facehoofed and Diamond Tiara buried her face deeper into Apple Bloom's shoulder.  Voice muffled, Diamond said, "She once caught Silver and I in my room, trying to figure out how two girls were supposed to use a condom." "Ah," said everycreature. "The next day," Sweetie read, turning the page, "co-author T. Hugger presented at the emergency room with gastric distress after having eaten 'Something, like, wicked-old from the back of my fridge, and probably gone a little too organic.' Subject G then spoke to co-author S. Glimmer, stating that Subject G had, during his asymptomatic incubation period, engaged in unprotected intercourse with T. Hugger. T. Hugger, however, showed no symptoms of the new, virulent STI." "You screwed Tree Hugger?" Scootaloo said to Gallus. He smirked and put his claws behind his head.  Sandbar hoofbumped him. Sweetie Belle said, "Ew," then read further: "T. Hugger refused anti-emetic medication for her gastric distress, but lit up a hoof-rolled cigarette roughly the size of a golden retriever puppy. Subject PC was close enough to be subjected to secondhoof smoke and her symptoms of painful urination, itchy/irritated genitalia, etc., were reduced markedly, and her horn edema completely subsided. Subject PC demanded 'a great big imperial toke on that fatty' and was quickly cured. T. Hugger identified the smoked material as a compound of dried Poison Joke, Griffonstone Green, and 'those crumbs from the bottom of the toaster.' (60/30/10 percent by volume.) One by one, all the Subjects were treated by offering them 'big imperial tokes' of the cigarette. Each Subject's symptoms completely subsided within ten minutes. Swabs at five, ten, and sixty days confirmed complete clearance of the bacteria in all Subjects, and no recurrence of symptoms were reported." Sweetie lowered the journal. "The fatty made my head feel funny. I didn't like it." "But at least you all got better!" Ocellus said. "Hardly," Diamond Tiara grumped, sitting up and turning around, no longer burying her face into Apple Bloom's neck. She sniffled and her eyes were red. "My mom refused consent for me to take a hit, so I had to suffer for two extra days before Dad got home from his business trip and signed the form." "Goodness, that's awful," Ocellus said. Diamond Tiara shrugged. "It's fine, mom and I are even." Ocellus's wings buzzed. "She agreed to let your dad be your sole legal guardian?" "No," Diamond Tiara said. Ocellus cocked her head. "She agreed to never let something like that happen again?" "No," Diamond Tiara said. "She apologized and tried to make it right?" Ocellus asked. "And you both sang Pone Ba Yah around a campfire while hugging and crying and agreeing to let bygones be bygones?" Diamond laughed. Ocellus frowned. "Well, what then?” Diamond Tiara smiled. It wasn't the warm smile of the new, older Diamond Tiara; it was the cold smile of the old Diamond Tiara, from back before the CMCs had turned her around and helped her break her mother's emotional deathgrip. With a voice as icy as that smile, she said, "Before dad signed the form so I could get cured, I snuck into Mom's bedroom and used her favorite dildo."