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151   We Need Widespread Tests
      For Venereal Diseases
      The Washington Post  May 17, 1969

     Syphilis and gonorrhea are the subject of declamatory news
articles from time to time.  We are told that we are experiencing
a new epidemic of venereal diseases.  We hear many speculations
about sexual promiscuity and methods of contraception that no longer
afford mechanical obstacles to infection.  

     But we do not often see the factual statistics by which to judge
the severity of the "epidemic", nor are we advised of the concrete
measures by which it might be contained.

     Reliable statistics are, in fact, not readily available, for
the great majority of cases treated by private physicians are simply
not reported.  Comparisons of case reports with the results of sample
surveys suggest that only about a tenth of the cases are reported.
This fact alone may account in large part for the much higher
prevalence of reported venereal disease in the Negro as compared
to the white population, for a much larger proportion of Negro cases
are treated in publicly supported clinics and enter the statistical
reports.  No good data exist by which to make any quantitative
judgment of the obviously higher incidence of venereal disease in
poorer strata of all races.

     Syphilis in the United States had been subject to only a gradual
decline up to the end of World War II, when the introduction of
penicillin accomplished a dramatic drop in the number of new cases.

     A peak of over 100,000 cases was reported in 1947; we saw only
6251 in 1967 and might have concluded that the disease was on the
point of eradication.  Over 20,000 were reported in 1967, however,
and the actual incidence may have been ten times higher, or about
1 per thousand of the population.

     A disproportionate part of this resurgence must be attributed
to adolescents, as is inevitably true for new infections.  The Public
Health Service believes that over 1 million Americans may be still
infected with syphilis, with the possibility of progressive disease
long after they are actively contagious to others or show obvious
external symptoms.

     In certain respects, the abrupt drop during the postwar decade
was even more puzzling than the present resurgence.  Dr. Willard L.
Fleming of the Department of Preventive Medicine at the University
of North Carolina, in an article in the Archives of Environmental
Health, pointed out some time ago that rather similar statistics
were being observed the world over, despite many differences in
the vigor of public health control measures.  Many epidemiologists
speculate that the drop in syphilis infection may have been a by-
product of the indiscriminate and medically mis-advised use during
that period of penicillin and other antibiotics for a wide variety
of conditions in people unaware that they were infected with
syphilis.

     Since then, this kind of abuse of antibiotics has probably
lessened, in part as many people have become allergic to them.  
Furthermore, the syphilis spirochete may be expected to have evolved
some degree of resistance to such antibiotics, although this is not
yet a major factor in the controlled treatment of the disease.

     The situation for gonorrhea is, if anything, even more alarming,
in the light of many reports of greatly increased antibiotic
resistance of the gonococcus microbe and even more resurgent
statistics on case numbers.

     In these circumstances, the prevalence of poorly treated cases of
venereal disease is a double threat: first as a reservoir of the
microbes and second, as making inevitable the further development
of antibiotic-resistant strains.

     The Public Health Service rightly gives case-finding the
highest priority, since we still have very effective methods for
treating syphilis and gonorrhea.  It has encouraged hospitals to
make blood tests routine for all hospital admissions.  At the very
least, the law should make them mandatory where Federal funds help
support hospital care; Blue Cross and other private insurance schemes
could do likewise.

     Furthermore, there is every reason to demand that every child
of any age obtain an annual certificate of good health (including 
evidence, where relevant, to rule out venereal disease) as a condition
of attendance at school, including high school and college.  Where
a private physician is not available, it is in the community's own
highest interests to provide the service.

     Couples about to marry no longer regard the universally required
premarital examination as an unwarranted intrusion.  Only a misplaced
delicacy about a serious medical problem stands in the way of a far
more relevant response to these burgeoning threats to the public
health.
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