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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.

In a study of the prevalence of nine different micro-organisms in the female genital tract in a Swedish population, significantly higher isolation rates occurred among women attending a venereal disease clinic than among those attending a gynaecological health control department. The prevalence of Candida albicans, however, was similar in different groups, individual susceptibility being the most important factor. Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma hominis occurred concomitantly with Neisseria gonorrhoeae, indicating a similar epidemiology for all these agents. Younger patients seemed to have an increased susceptibility to C. trachomatis whereas older patients had an increased susceptibility to T. vaginalis.

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.

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.

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.

Results:

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.

Conclusions:

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.

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.

During the period October 1976 to January 1978, 290 patients were examined for sexually transmitted diseases in three venereal clinics in Khartoum Providence. Clinical and laboratory findings showed that nongonococcal urethritis was the commonest STD in men (35.1%), with gonorrhoea the second commonest (25.9%). Most of the patients with STDs were aged between 20 and 30 years. Of the infected men, 49.3% had acquired their infections from prostitutes.

The isolation rates of group B streptococci for 457 men and 300 women attending a venereal disease clinic were 16-4 and 20-6% respectively. The frequencies were significantly increased by using a selective medium and by taking specimens from the female urethra as well as the cervix. In contrast to gonorrhoea the presence of group B streptococci could not be related to promiscuity. In addition, the isolation of group B streptococci was found to be independent of a concomitant gonococcal infection. This study indicates that group B streptococci have little relation to the clinical signs and symptoms of genital infection, such as dysuria, discharge and inflammatory mucosal reaction.

A total of 2515 people attending a large military hospital in Saudi Arabia was studied clinically, serologically, and (when appropriate) radiologically for evidence of treponematosis. The indications are that non-venereal endemic syphilis (bejel) is prevalent among the nomadic communities living in rural areas. In contrast, venereal syphilis is much less common, and is found almost exclusively in urban populations. Some of the high risk regions for bejel have been identified, and many people from these locations complained of persistent pain in the legs, which was often associated with radiological evidence of osteoperiostitis of the long bones. Bejel also seems to have become clinically "attenuated" within the last 30 years, with the majority of seroreactors having latent disease. A hypothesis suggesting a reason for this change is put forward, and ways of controlling the infection are outlined.

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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.

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.

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.

Pharyngeal colonisation by Neisseria gonorrhoeae and Neisseria meningitidis was studies in 2000 patients attending a venereal disease clinic. Of these patients, 64% were white and 36% were black. The incidence of gonococcal infections was highest in the period from June to August. The incidence of genital or rectal infections or both was higher in the black patients. Pharyngeal colonisation by gonococci was present in 1.3% of the patients. There was no significant associations between pharyngeal colonisation and the pharyngeal symptoms, race, sex, or marital state of the patients. Pharyngeal colonisation was more frequent in patients with gonococcal infections at other sites. However, in 40.7% of the patients with pharyngeal colonisation, the pharynx was the only culture-positive site. There was no significant difference in the auxotypes or in the antibiotic susceptibility of the pharyngeal and the rectal-genital isolates except in the susceptibility to spectinomycin. Our findings do not indicate that gonococci isolated from the pharynx differ significantly from gonococci isolated from rectal or genital sites. It was notable that meningococcal colonisation of the pharynx was significantly more frequent in the white patients. This may be a genetically determined phenomenon.

Routine cervical viral cultures (and cultures from lesions if present) were performed on 2630 female patients attending a venereal diseases clinic over a period of four years. Of these patients 96 (3.7%) had genital herpetic infection; of these 23 (24%) were asymptomatic. The association of herpesvirus with other genital infections is considered, but no increase in the incidence of Neisseria gonorrhoeae, Trichomonas vaginalis, and genital warts was found; there was an increased incidence of Candida albicans. A significantly higher percentage of the patients with herpesvirus took oral contraceptives. The findings are discussed and compared with previous reports.

Ureaplasma urealyticum organisms (ureaplasmas) and Mycoplasma hominis organisms (mycoplasmas) were sought in mid-stream urines collected from 200 men and 200 women attending hospital with conditions of a non-venereal nature. In addition, the urines from 100 male and 100 female healthy volunteers were examined. Overall, ureaplasmas were isolated four times more often than mycoplasmas. In individuals less than 50 years of age, the organisms were found in about 20% of men and about 40% of women. In individuals 50 years or older, they were found about one-third to one-half as frequently. Centrifugation of urine and examination of the resuspended deposit did not increase the isolation rates. In men, the numbers of organisms in the urine were usually small (less than or equal to 10(3) c.c.u./ml) with less than tenfold more in the urine of women. The occurrence of 51- greater than 1000 leucocytes per mm3 in some of the urines was not associated with either the presence or an increased number of ureaplasmas/mycoplasmas, whereas they were associated with the presence of 10(5) or more bacteria/ml. The significance of these findings in the context of defining the role of ureaplasmas/mycoplasmas in genital-tract disease is discussed.

Of 50 rabbits, otherwise regarded as normal, three adult females and two adult males (10 per cent) have been found to have in their genitoperineal region certain papulosquamous, often ulcerating, lesions. A recently purchased group of twenty rabbits contained six females (30 per cent) with similar lesions. This condition runs a chronic course and is characterized by the presence of a spiral organism closely resembling Treponema pallidum. The rabbit spirochete has the same morphological features as Treponema pallidum; it is possibly a trifle thicker and longer than the average pallidum. Long specimens measuring 30 µ are frequently encountered, and they show a tendency to form loosely entangled knots. A stellate arrangement of several organisms in a mass is frequently observed. In the lesion of one rabbit there were two types of spirochete, one of the variety just described, the other a somewhat coarser organism, closely resembling Treponema calligyrum found in a human condyloma, but a trifle thinner and longer. This organism is perhaps merely a variant type of the rabbit spirochete. The histological reactions are similar to, but considerably less cellular, than those occurring in typical primary syphilitic lesions. There is a marked hyperkeratosis and interpapillary infiltration not observed in scrotal chancre. The disease is transmissible to normal rabbits, in which the usual papular lesions can be readily reproduced in the genitoperineal region. In the first passages the incubation period varied from 20 to 88 days; subsequently one of the strains produced a lesion in 20 days on the second, and in 5 days on the third passage. No typical orchitis or keratitis was produced in the rabbits of the present series, although in one of the original rabbits (No. 4) scaly, papular lesions have developed on the nose, lips, eyelid, and paws. Monkeys (Macacus rhesus) failed to show any lesions within a period of 4 months after inoculation. In one instance transmission was accomplished through the mating of an infected female with a normal male. The Wassermann reaction was uniformly negative in the five rabbits with spontaneous lesions and in eighteen rabbits experimentally infected. Salvarsan had the same therapeutic effect on the lesions produced by the rabbit spirochete as on the experimental pallidum lesion of the rabbit. The organism belongs to the genus Treponema, and may be designated Treponema cuniculi.

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.

The canine transmissible venereal tumor (CTVT) is found mainly in dogs' sexual organs. Currently, it is widely accepted that all samples of CTVT show similar histopathological characteristics and share common genetic alterations. Despite the common genetic origin of CTVT, mutations in the P53 gene have been reported. In this study, we proposed that tumor samples can be genetically grouped using this gene. The presence of different subgroups of CTVT was determined in Mexican dogs using the TP53 gene sequence in CTVT samples. Four new polymorphisms were found and therefore, the CTVT samples were classified in five subgroups.

Examination of sera from blood donors, from patients attending a special treatment clinic, a family planning clinic, and an antenatal clinic showed that the prevalence of herpes virus hominis type 2 antibodies among the adult population in Ibadan is similar to that in other parts of the world. The possibility of non-venereal transmission of herpes virus infection was confirmed by the finding that herpesvirus hominis type 2 could survive on cloth samples under humid tropical conditions for long enough to allow transmission of infection via fomites.

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.

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.

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.

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.

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.

Screening tests—absorbed fluorescent treponemal (FTA-ABS), the Reiter protein complement-fixation (RPCFT), VDRL slide test, automated reagin—and cardiolipin Wassermann reaction—were carried out on 1922 consecutive new patients attending the Whitechapel Clinic over a three-month period.

Taking the FTA-ABS test results as an index, the most efficient combination of conventional tests was found to be the RPCFT and automated reagin test. The cardiolipin WR proved to be under-sensitive and of little value compared with the other tests.

Forty-two per cent of the 107 sera reactive in the FTA-ABS test were not detected by the RPCFT or ART tests. An assessment based on the TPI test results and clinical findings in these patients is presented.

The scope and limitations of the FTA-ABS test as a screening procedure are discussed.