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1.  Behavioural and social characteristics of the patient with repeated venereal disease and his effect on statistics on venereal diseases. 
The current study investigated personality characteristics and social circumstances in patients repeatedly infected with venereal diseases. An effort was made to identify characteristics that would differentiate a repeat patient (RP) from a non-repeat patient (NRP). Two studies were carried out. In the first, a group of patients from a venereal disease clinic in a large general hospital was first interviewed and then the patients were asked to complete a questionnaire. In the second study, an attempt was made to validate the findings from the first study by comparing data from RP and NRP venereal disease patients drawn from medical and social case histories from a second hospital. Results of both studies support the hypothesis that repeat patients are different from non-repeat venereal disease patients in terms of social and psychological characteristics. The significance of these findings is discussed.
PMCID: PMC1045373  PMID: 576846
2.  Social factors in homosexually acquired venereal disease. Comparison between Sweden and Australia. 
The prevalence of venereal disease was studied in homosexuals in two countries, Sweden and Australia, which are similar apart from their different legal and social attitudes to homosexuality. Social attitudes were not generally associated with differences in the numbers of infections and reinfections in homosexual men with sexually transmitted diseases. Using a non-clinical sample there was some evidence that sexually transmitted diseases in homosexuals are grossly overestimated if cases rather than individuals are used as an index. Furthermore, the incidence of syphilis was related to the numbers of partners and the latency of symptoms in both societies.
PMCID: PMC1046063  PMID: 6896667
3.  Some aspects of venereal diseases in Greenland. 
For many years venereal diseases have been a major problem in Greenland. Since the early 1950s gonorrhoea has been widely prevalent; in the middle of the 1960s the incidence increased rapidly. Since the early 1970s syphilis has become widespread in the population, and in 1977 an epidemic of chancroid occurred. The high figures for venereal diseases are basically due to the social change towards a modern industrial society. Improvements in the health services could be made by encouraging health education on venereal diseases, training Greenlander health personnel, and appointing a venereologist.
PMCID: PMC1045733  PMID: 6893008
4.  Historical account of venereal diseases in Mexico. 
Genitourinary Medicine  1993;69(6):462-466.
This paper reviews the history of sexually acquired diseases in Mexico. It is divided into four major chronological sections which discuss social attitudes and values, the development of services and of official policy, and historical epidemiology.
PMCID: PMC1195153  PMID: 8282302
5.  Changing pattern of male homosexual registrations in a venereal disease clinic, 1964-1974. 
Registrations of heterosexual and homosexual men, with and without gonorrhoea, as recorded at Ward 34, Newcastle General Hospital, from 1964 to 1974, show substantial rises. During this time, the number of cases of gonorrhoea in men, both heterosexually and homosecually acquired, has approximately doubled. However, the incidence of individual gonococcal re-infection would not appear to have changed significantly. More men attend with non-venereal conditions and show an increasing willingness to return. A greater co-operation between homosexuals with gonorrhoea and the social unit has evolved and a greater number of sexual contacts are now traced and examined.
PMCID: PMC1045246  PMID: 1276864
6.  Venereal disease education and a selected group of American college students. 
Education is considered to be an important factor in the control and possible eradication of venereal diseases. A study was undertaken to discover what effect education had had on a selected group of university students so as to determine suitable avenues for future educational programmes. Many of the schools attended by the students had issued information on venereal diseases; most students considered that this information was useful. The study did not generally show a significant relationship between previous health education, current attitude and behaviour, and the contraction of venereal disease. However, the data did appear to reveal a correlation between the lack of education at junior high school and the acquisition of venereal disease. The university student health service, together with books and pamphlets made available outside the school of classroom, were regarded as being important in venereal disease education. These findings can help those planning venereal disease education for young adults.
PMCID: PMC1045345  PMID: 576588
7.  Survey of venereal disease treated by Manitoba physicians in 1972 
A personally conducted survey of 829 Manitoba physicians has been carried out in order to obtain data of practical value to future medical planning for the management of venereal disease. Two thirds of the physicians interviewed see and treat venereal disease in office practice, although only a limited number of cases are fully investigated. The annual number of cases of confirmed and unconfirmed disease in the province is estimated to be approximately 16,000. Notification of disease to the public health authorities is extremely limited and therefore epidemiological measures necessary for proper control are rarely activated. Organized medicine should develop an awareness of the responsibility which must be assumed in this situation by its individual members, responsibility which can rarely be handled alone.
PMCID: PMC1947127  PMID: 4405815
8.  Health education policy 1916-1926: venereal disease and the prophylaxis dilemma 
Medical History  1980;24(1):70-87.
This paper seeks to account for the development of a public health education policy with respect to venereal disease during the period 1916-1926. Two competing pressure groups, the National Council for Combatting Venereal Disease and the Society for the Prevention of Venereal Disease, defended opposing programmes; the one based on moral education (NCCVD) and the other (SPVD) on medical prophylaxis. Many of the interests represented by the groups and the political dimensions that they took, were influenced by factors only very tangentially connected to health education.
Any account of the development of policy in this field needs placing in the context of the early history of nineteenth-century anti-vice crusades; the role of the Army Medical Corps during the 1914-18 war; and the bureaucratic protectionism of the Ministry of Health personnel.
PMCID: PMC1082620  PMID: 6990122
9.  Venereal disease education in West Virginia, USA. 
A venereal disease educational programme entitled Venereal Disease Education in West Virginia was constructed. It consisted of a preliminary test to assess the level of general knowledge of venereal diseases, a value survey list, a lecture illustrated by colour slides, and a final test. The programme was presented to 3210 students in Northcentral West Virginia who ranged in age from 12 to 20 years (7th to 12th grade). The mean score in the preliminary test was 7.97 (53%) correct answers out of 15, and the mean score for the final test was 11.55 (77%) correct answers out of 15. The ability of students to retain the information given to them was measured by testing the same class of 53 students one year later. These students obtained a mean score of 11.41 (76%) correct answers out of 15 in the later test which demonstrates that the students had retained much of the information.
PMCID: PMC1045517  PMID: 581067
10.  Epidemiologic Treatment in Venereal Disease—A Method to Aid in VD Control 
California Medicine  1972;117(6):35-36.
Epidemiologic therapy refers to the treatment of infectious syphilis or gonorrhea contacts without proof of laboratory diagnosis. This method of treatment is considered essential by public health authorities in the management of venereal disease, but has long been neglected in the private sector of medicine. The majority of venereal disease patients are treated by private practitioners, but apathetic attitudes, insufficient training, lack of case reporting, differing and often inadequate treatment schedules, poor follow-up and ignorance about or reluctance to use epi-treatment are all factors in our losing struggle against the current venereal disease epidemic.
PMCID: PMC1518744  PMID: 4635397
11.  Reactivity of microhemagglutination, fluorescent treponemal antibody absorption, Venereal Disease Research Laboratory, and rapid plasma reagin tests in primary syphilis. 
Journal of Clinical Microbiology  1983;17(3):405-409.
Seroreactivity of sera from 109 patients with first-infection primary syphilis was 98.2% in the fluorescent treponemal antibody absorption test, 92.7% in the rapid plasma reagin 18-mm circle card test, 72.5% in the microhemagglutination test (MHA-TP), and 72.5% in the Venereal Disease Research Laboratory test. Seroreactivity of sera from 18 patients with primary syphilis with documented previous infection(s) was 100% in the fluorescent treponemal antibody absorption test, the rapid plasma reagin 18-mm circle card test, and the MHA-TP test and 88.9% in the Venereal Disease Research Laboratory test. The MHA-TP test failed to confirm reactivity in 13 of 79 sera which were reactive in the Venereal Disease Research Laboratory test and in 24 of 101 sera which were reactive in the rapid plasma reagin 18-mm circle card test. Testing another production lot of MHA-TP reagents resulted in even poorer correlation. The reactivity of the MHA-TP test in primary syphilis appeared to vary with the sensitivity of the production lot of reagents.
PMCID: PMC272655  PMID: 6341398
12.  Enzyme-linked immunosorbent assay for detection of antibodies to the venereal disease research laboratory (VDRL) antigen in syphilis. 
Journal of Clinical Microbiology  1987;25(9):1711-1716.
An enzyme-linked immunosorbent assay (ELISA) for detection of immunoglobulin G (IgG) and IgM to cardiolipin, lecithin, and cholesterol (VDRL [Venereal Disease Research Laboratory] ELISA) is described. The specificity of the VDRL ELISA for IgG and IgM was 99.6 and 99.5%, respectively, with sera from 1,008 persons without syphilis. For a group of patients with false-positive results in traditional nontreponemal tests and for patients with autoimmune diseases, the VDRL ELISA for IgG had a higher specificity than the VDRL ELISA for IgM. The sensitivity for IgG and IgM with 118 sera from patients with untreated syphilis was 96.6 and 94.9%, respectively, which was equivalent to the sensitivities of the traditional nontreponemal tests. The performance of the VDRL ELISA was compared with that of an ELISA that uses cardiolipin as the antigen (cardiolipin ELISA). The VDRL ELISA was significantly more sensitive (P less than or equal to 0.01) than the cardiolipin ELISA with 25 sera from syphilis patients but was less sensitive (P less than or equal to 0.01) with 53 sera from patients with autoimmune diseases. The antibody reactivity in the VDRL ELISA could not be absorbed out by lecithin and cholesterol, and the sera from patients with syphilis did not react in an ELISA that uses cholesterol and lecithin as the antigen. This indicates that cholesterol and lecithin, although not antigenic by themselves, may change the structural form of the epitope on cardiolipin so that it becomes more recognizable for antibodies in syphilis and less recognizable for antibodies in autoimmune diseases. The results of the VDRL ELISA were expressed in percentages of the absorbance value of a positive control. The VDRL ELISA gave, without titration of sera, quantitative results that correlated with the quantitative results of the traditional nontreponemal tests obtained by titration. The VDRL ELISA will be well suited for large-scale testing for syphilis and may replace other nontreponemal tests.
PMCID: PMC269313  PMID: 3308951
13.  Homosexuality and venereal disease in the United Kingdom. A second study. British Co-operative Clinical Group. 
The proportion of homosexually acquired cases of primary and secondary syphilis in patients attending venereal disease clinics in the United Kingdom has risen from 42.4% to 54% over a six-year period. Similarly, over the same period, the proportion of homosexually acquired cases of gonorrhoea has risen from 9.8% to 10.9%. The increase in incidence of homosexually acquired infections in both diseases occurred in all areas but particularly in London. Thus the very considerable epidemiological importance of male homosexuals as a high-risk group should receive more, not less, emphasis.
PMCID: PMC1045717  PMID: 7370722
14.  The value of a psychiatric service within the venereal disease clinic. 
A significant proportion of attenders at venereal diseases clinics can be regarded as potential psychiatric patients. However, there have been few reports on the value of readily available psychiatric advice at such clinics. The findings during a three-month period when a psychiatrist attended a venereal disease clinic are described. Twenty-two patients were referred for psychiatric assessment. Of the 20 who kept their appointment, 18 were diagnosed as mentally ill or as having a personality disorder. Of these two were already under psychiatric care, but 11 had never previously sought psychiatric assistance. The major sources of common venereological and psychiatric concern appeared to be among the promiscuous and the hypochondriacal patients. The former consisted of persons with personality disorders who were thought unlikely to respond to psychiatric treatment; but some of the latter improved after treatment with pimozide. Some patients defaulted and not all who persevered were helped. Nevertheless the results of a questionnnaire showed that the staff considered there was an important place for a psychiatrist within their clinic.
PMCID: PMC1045516  PMID: 581066
15.  Hepatitis-B surface antigen and antibody in Black and White patients with venereal diseases. 
The prevalence of both the hepatitis-B surface antigen (HBsAg) and its specific antibody (anti-HBs) was significantly greater in the sera of White patients suffering from sexually transmitted diseases than that in White blood donors. However, Black patients with venereal diseases did not show an increased prevalence of either HBsAg or anti-HBs. These findings support the view that heterosexual transmission of the hepatitis-B virus is less likely to occur in populations in whom this infection is largely acquired before the age of sexual maturity.
PMCID: PMC1045446  PMID: 580069
16.  Teenage girls and venereal disease prophylaxis. 
One of the main aims of venereal disease education is to encourage the use of prophylactic techniques by sexually-active persons. To do this educators must convey information about prophylaxis that is relevant. This study was designed to assess the knowledge, attitude, and behaviour regarding prophylaxis of a group of 200 American adolescent girls. The findings suggest areas of prophylaxis that should be emphasised and ways that might encourage the acceptance and use of prophylactic measures. The study showed there were some misunderstandings and that it was important, for example to clarify the relationship of the oral contraceptive to possible venereal disease infection. Education involving both the cognitive and affective domains was indicated by the partial acceptance of the use of the condom, particularly by persons who had more than one partner.
PMCID: PMC1045372  PMID: 576845
17.  Increased serum immunoglobulin E concentrations in venereal diseases. 
Total serum immunoglobulin E (IgE) concentrations were determined by a competitive solid phase radioimmunoassay technique in serum samples from patients with a variety of venereal diseases. The mean IgE concentrations for groups of normal persons without venereal diseases was significantly lower then the means for groups of appropriately matched patients with primary syphilis and gonorrhoea. There were also relatively higher IgE values in patients with trichomoniasis. Our data indicate that patients with urogenital infections have higher concentrations of IgE in the serum than matched control patients without such infections.
PMCID: PMC1045276  PMID: 989469
18.  Clinical course and treatment of venereal spirochaetosis in New Zealand white rabbits. 
Ten sporadic cases of venereal spirochaetosis, caused by Treponema paraluis-cuniculi, were seen in New Zealand white rabbits in two years. An equal number of males and females were affected. Females tended to have milder clinical signs than males. Lesions were usually found on the prepuce in males and the vulva in females, although the anus and skin of the perineum were also affected. Facial lesions were rare. Lesions healed in seven to 28 days in rabbits treated with penicillin. Eight rabbits had antibodies reactive in the Venereal Disease Research Laboratory (VDRL), rapid plasma reagin (RPR), and fluorescent treponemal antibody absorbed (FTA-ABS) tests when the disease was first diagnosed. In several rabbits followed longitudinally, RPR test results became negative two to four months after antimicrobial treatment, VDRL antibody titres diminished but usually persisted at low levels, while FTA-ABS antibodies declined slowly and were still evident 12 months after treatment.
PMCID: PMC1046312  PMID: 6547627
19.  A comparison of three educational techniques used in a venereal disease clinic. 
Public Health Reports  1975;90(2):159-164.
The communications methods that could be used in educational programs for venereal disease patients were examined as to their relative effectiveness: a programed learning guide, an audiovisual (cinematographic) technique, and an interview method. An experimental design was used to study three groups of patients at a venereal disease clinic; (a) persons who were pretested, exposed to an educational method, and tested again, (b) a control group whose members were pretested and post-tested but not exposed to an educational method, and (c) another control group whose members were exposed to an educational method and then took a post-test. Each of those groups exposed to the educational techniques was further subdivided according to the technique applied. Analysis of the data collected from 443 subjects led to the following tentative conclusions: 1. Representation in the nine groups was demographically uniform as measured by age, sex, marital status, and ethnic origin. 2. All three educational techniques significantly raised the subjects' level of knowledge about venereal disease, as measured by their test scores. 3. All three techniques were favorably received by the subjects. The majority reported that the techniques were the right length (10 to 15 minutes), interesting, informative, useful, and anxiety-reducing. The three techniques apparently accounted for an increase of more than 20 percent in subjects' scores on tests about venereal disease, and the subjects perceived all three techniques as interesting and beneficial. The interview method proved significantly more effective than the other two techniques in raising the knowledge level. It was also the technique most favorably received by the subjects. As expected, those persons who entered the clinic with a low level of knowledge learned much more when exposed to an educational techniques than persons entering the clinic with a high level of knowledge. Reaction to the three methods did not differ significantly by the subjects' age or sex.
PMCID: PMC1435396  PMID: 48267
20.  John Hunter and venereal disease. 
John Hunter's contribution to the understanding of venereal disease is reviewed. Hunter's evidence for the unitary nature of these diseases is examined and the advances he made in diagnosis, pathology, and management are considered.
PMCID: PMC2493930  PMID: 7018353
21.  Evaluation of the usefulness of Treponema pallidum hemagglutination test in the diagnosis of syphilis in weak reactive Venereal Disease Research Laboratory sera 
Background and Objectives:
Biological false positive (BFP) reactivity by the Venereal Disease Research Laboratory (VDRL) test used for diagnosis of syphilis is a cause for concern. The use of the VDRL as a screening procedure is challenged by some studies. The aim of this study is to determine the prevalence of BFP reactions in different subject groups and to assess the usefulness of Treponema pallidum hemagglutination (TPHA) test in low titre VDRL reactive sera.
Materials and Methods:
A total of 5785 sera from sexually transmitted diseases (STD) clinic attendees, antenatal clinic attendees, husbands of antenatal cases, peripheral health centres attendees (representing community population) and from patients referred from different OPDs/wards were screened for BFP reactions by the VDRL test. Sera reactive in the VDRL test were confirmed by the TPHA test.
Out of 80 qualitative VDRL reactive sera, 68 had <1:8 titre on quantitation and TPHA was positive in 59 samples, indicating BFP reactivity in 0.2% in all the subject groups. BFP was nil in the community population. The male-to-female ratio of BFP reactions was 2:1. VDRL and TPHA positivity was highest (76%) in the age group of 20-29 years. The seroprevalence of syphilis varied from 0.4% to 3.5% in different patient groups.
The results of this study highlight that the TPHA positivity was high (86.8%) in sera with VDRL titre less than 1:8. Therefore, for the diagnosis of syphilis, it is recommended that a confirmatory test such as TPHA should be performed on all sera with a reactive VDRL regardless of its titre.
PMCID: PMC3505284  PMID: 23188934
Biological false positive; Syphilis; Treponema pallidum hemagglutination; Venereal disease research laboratory
22.  Comparison of a new rapid plasma reagin card test with the standard rapid plasma reagin 18-mm circle card test and the venereal disease research laboratory slide test for serodiagnosis of syphilis. 
Journal of Clinical Microbiology  1983;17(2):249-254.
The rapid plasma reagin (RPR) card test manufactured by Beckman Instruments, Inc., was compared, qualitatively and quantitatively, with the Venereal Disease Research Laboratory (VDRL) slide test and the standard RPR 18-mm circle card tests for the serodiagnosis of syphilis. Sera from 638 individuals were used in this study. Two pilot lots and two production lots of antigen were submitted by Beckman Instruments, Inc., for evaluation. Qualitative agreement among the three RPR card tests was 98.1%; between the Beckman RPR card and the VDRL slide tests, 95.0%; and between the reference RPR card and the VDRL slide tests, 95.5%. The Beckman RPR card test was 95.3% specific, whereas the specificities of the reference RPR card and the VDRL slide tests were 98.8% and 96.1%, respectively. Sensitivities of the three nontreponemal tests were: Beckman RPR card test production lots, 94.7%; reference RPR card test, 96.8%; and VDRL slide test, 90.6%. Quantitative agreement +/- 1 dilution among the three RPR card tests was 93.0%, whereas quantitative agreement was approximately 40% when both RPR card tests were compared with the VDRL slide test. We found the Beckman RPR card test comparable to the standard RPR card tests. Therefore, the decision of which test to use for the serodiagnosis of syphilis is at the discretion of the user.
PMCID: PMC272616  PMID: 6833479
23.  Reactivity of microhemagglutination, fluorescent treponemal antibody absorption, and venereal disease research laboratory tests in primary syphilis. 
Journal of Clinical Microbiology  1980;12(4):629-630.
Seroreactivity in 130 cases of primary syphilis was 91.5% by fluorescent treponemal antibody absorption test, 82.3% by microhemagglutination (MHA-TP test), and 68.5% by the Venereal Disease Reseach Laboratory (VDRL) test. The MHA TP test generally became reactive earlier than the VDRL test and confirmed all reactive and most weakly reactive VDRL results.
PMCID: PMC273654  PMID: 6999029
24.  Use of Synthetic Cardiolipin and Lecithin in the Antigen Used by the Venereal Disease Research Laboratory Test for Serodiagnosis of Syphilis 
The Venereal Disease Research Laboratory (VDRL) test is a microflocculation test for syphilis that uses an antigen containing cardiolipin, lecithin, and cholesterol. For more than 50 years, the preparation of natural cardiolipin and lecithin for this test has been based on the Pangborn method which involves isolating and purifying these components from beef hearts. This process is tedious and time-consuming and results in a variable purity range. In our studies, we found that a VDRL antigen using synthetic tetramyristoyl cardiolipin and synthetic 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (lecithin) was as specific in detecting syphilis as a VDRL antigen made with natural components. In 85% of the cases, we obtained an endpoint titer of 1/2 or 1 dilution more than a titer obtained with a VDRL antigen made with natural components. The use of these pure synthetic compounds, with a purity of 99%, would offer advantages in the standardization and stability of the VDRL antigen. Because this antigen is the basic ingredient in the preparation of nontreponemal reagents such as the rapid plasma reagin, toluidine red unheated serum test, and the unheated serum reagin, the use of this synthetic VDRL antigen should also increase the reactivity of these reagents.
PMCID: PMC95930  PMID: 10882668
25.  Whole-Blood Hemagglutination Inhibition Test for Venereal Disease Research Laboratory (VDRL) Antibodies 
Journal of Clinical Microbiology  2000;38(9):3413-3414.
Nontreponemal antibody tests such as the Venereal Disease Research Laboratory (VDRL) test are carried out on serum and widely used as screening tests for syphilis. The aim of the present study was to develop a screening test for syphilis making use of whole blood and VDRL liposomes. Antibody to human red blood cells was conjugated to VDRL liposomes and reacted with a diluted sample of patient whole blood. A total of 951 samples were tested by the new test and the VDRL tube test. All 49 VDRL samples positive by the VDRL test showed inhibition of hemagglutination in the whole-blood test (sensitivity, 100%). Of 902 samples with negative results by the VDRL test, 901 caused hemagglutination when tested with the liposomes (specificity, 99.9%). The hemagglutination inhibition method tests for syphilis in a simple one-step procedure in which whole blood is added to a tube containing liposomes. The new test has potential for point-of-care testing in developing countries.
PMCID: PMC87396  PMID: 10970393

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