Cases Of Infectious Syphilis Research Articles

Selective mass treatment in a venereal disease control program.

To control syphilis among prostitutes and seasonal farm workers in Fresno County, California, we developed a program of selective mass treatment of prostitutes. From August 1976 to July 1977, 512 women entered the program. Overall, 4.6 per cent of women treated prophylactically for syphilis were actually infected. Compared to cases in the previous year, infectious syphilis cases among prostitutes and seasonal farm workers decreased 51.3 per cent and 26.8 per cent, respectively.

The Effect of Treatment on the Treponema Pallidum Haemagglutination Test in Early Syphilis

The response of the Treponema Pallidum Haemagglutination Assay (TPHA) to treatment was studied in 61 cases of early infectious syphilis. In none of the 55 cases of early syphilis in which the pre-treatment TPHA was positive did the TPHA test become consistently negative after treatment. In primary and early latent syphilis it was not possible to demonstrate any significant changes, but in some cases of secondary syphilis a significant and rapid fall in TPHA titre occurred with treatment. It is suggested that the post-treatment TPHA titre need not necessarily reflect the stage at which the disease was arrested.

The National Veneral Disease Problem

The regularly rising incidence since 1919 of both syphilis and gonorrhea has ranked gonorrhea as one of the most prevalent of all diseases. In fiscal year 1971 624371 cases of gonorrhea 23336 cases of infectious syphilis and 71047 cases of noninfectious syphilis were reported in the U.S. Compared to reported cases in 1970 these figures represent increases of 8.9% 15.6% and 4.5% respectively. In addition to reported cases there are indications that over 2 million cases of gonorrhea and 80000 of syphilis actually occurred in 1971 and that there are presently over 1 million undetected untreated or inadequately treated cases of V. D. among both sexes. Distribution of the diseases is similar despite the greater frequency of gonorrhea cases. The ratio of males to females in infectious syphilis of 2:1 while it is nearly 3:1 in gonorrhea. 95% of syphilis patients and 98% of gonorrhea patients acquire the disease between the ages of 15 and 50 with higher incidence of occurrence in nonwhites. The diseases are also concentrated within specific demographic regions. The chief problem in controlling the disease is the lack of intensive application of existing methods. Because the duration of gonorrhea is longer in women than in men the infected reservoir is larger than the infected male reservoir thus indicating the need for more efficient means of gonorrhea detection in women. Although the culture for gonorrhea is an effective diagnostic test its usefulnes is limited to women receiving pelvic examinations. To obtain high rates of cure the most frequently recommended drug for treatment of these diseases is injectable penicillin in large doses. With proper education in schools proper staffing in venereal disease programming and less costly screening tests the control of VD specifically of gonorrhea although difficult can be achieved.

Diagnosis and Treatment of Venereal Disease

Gonorrhea is the first and syphilis the third most commonly reported of the infectious diseases. In 1970 there were an estimated two million new cases of gonorrhea and 200,000 new cases of infectious syphilis in the United States. Each year finds 10 to 15 percent more cases of gonorrhea being reported, while the number of new cases of syphilis has been about the same over the last decade. The diseases are similar in that they are spread venereally and occur predominantly in persons under 25 years of age. Both diseases respond well to appropriate antibiotic therapy. However, they differ significantly in their clinical presentation and methods of diagnosis. This discussion presents both their similarities and differences.

Diagnosis and treatment of syphilis.

IN spite of excellent methods for diagnosing and treating syphilis, the disease is still widespread. There was a marked upsurge in the reported cases of infectious (primary and secondary) syphilis in the United States in the late 1950's and early 1960's, which reached a peak in 1965, when over 25,000 cases were reported.1 A gradual decrease in reported cases of infectious syphilis occurred after 1965, but in the first seven months of 1970 a steady, 10 to 12 per cent, increase in cases is again being reported.2 Moreover, the true incidence is undoubtedly much higher. Fleming et al. recently mailed . . .

Physician reporting of venereal disease in the USA.

The article summarizes results of a survey of the number of cases of infectious syphilis other syphilis and gonorrhea treated by all medical and osteopathic physicians in private practice in the U.S. from April 1 to June 30 1968. The purpose of the survey was to supplement information gathered by public agencies and to provide more accurate breakdown of incidence by state and major city. The survey utilized mail questionnaires to elicit information from 206283 medical and osteopathic physicians in private practice including fulltime medical school faculty whose names appeared in lists maintained by the American Medical and American Osteopathic Associations covering the U.S. and Puerto Rico. 65.3% of physicians approached responded; 43720 or 32.5% of these respondents had treated 1 or more cases. The survey found that only 12% of infectious syphilis cases 33.1% of other syphilis cases and 10.9% of gonorrhea cases treated by private physicians are reported to the public health authorities. Comparison of the findings of this survey with a similar national survey conducted by the American Social Health Association in 1962 shows improvement in reporting by private physicians. Percentage reporting in 1962 computed by 1962 method was 11.3 for infectious syphilis 37.5 for other syphilis and 10.8 for gonorrhea and went up to 18.7 51.2 and 16.9 respectively 1968. Computation by a different 1968 method shows a similar trend: the percentage reporting in 1962 was 8.1 for infectious syphilis 26.9 for other syphilis and 7.7 for gonorrhea and rose to 12.0 33.1 and 10.9 respectively in 1968. The total number of cases estimated shows a net decline of 31235 for infectious syphilis but a net increase of 378456 for gonorrhea between 1962 and 1968. The findings support the view of public health authorities that vigorous identification and treatment of all sexual contacts of all persons with infectious syphilis will progressively reduce incidence further and that there is urgent need for increased planning and financing of gonorrhea control programs.

National Survey of Venereal Disease Treated by Physicians in 1968

Private physicians in the United States were questioned regarding treatment of venereal disease in a three-month period of 1968. Of those queried, 134,633 physicians (65.3%) responded—43,720 (32.5% of responding physicians) indicated treatment of syphilis or gonorrhea in the period; 4,370 (3.2% of responding physicians) indicated treatment of 8,849 cases of infectious syphilis; 10,934 physicians had treated 22,022 cases of "other syphilis"; and 39,392 had treated 185,548 cases of gonorrhea. Comparison of survey indications of cases treated with cases reported in the period showed only 12% (18.7%) of infectious syphilis cases and 10.9% (16.9%) of gonorrhea cases had been reported if estimates for nonresponding physicians are included (or excluded). Syphilis and gonorrhea remain vastly underreported although the reporting of syphilis and gonorrhea has slightly improved since 1962.

Current Serodiagnosis and Treatment of Syphilis

In recent years there has been a resurgence of syphilis in the United States. 1 Reported cases of primary and secondary syphilis rose from a low of 6,399 in 1956 to 22,969 in 1964, with nearly half of the recent cases occurring in teen-agers and young adults. Reported cases of infectious syphilis among teen-agers have increased by more than 213% since 1956. Apparently there are many additional cases which, for various reasons, are not reported, and a consideration of these raises the probable number of cases in 1964 to more than 120,000. 2 Thus it seems timely to consider both the interpretation of serologic tests for syphilis and the treatment of this infection. Consideration of Serologic Tests Although there have been a number of changes in the serologic testing and therapy of syphilis since a publication in 1961 by one of us, 3 much of that basic information is still

Teaching Syphilology to Physicians

1957 MARKED the beginning of the alarming and widely publicized increase in number of reported cases of infectious syphilis in Philadelphia, similarly noted in other urban areas across the nation.^1,2The Philadelphia Department of Public Health responded with increased venereal disease control activity, and now conducts a broad program consonant with the US Public Health Service's<i>Task Force Report to the Surgeon General</i>³of recommendations for the eventual eradication of syphilis. In Philadelphia, particular progress has been made in the field of professional venereal disease education, point four of the<i>Task Force Report</i>. This article will show that syphilis eradication depends upon community physicians who are competent in syphilology and sympathetic to health department efforts. It will also discuss successful project activities in the field. In the past, the bulk of the infectious syphilis cases in Philadelphia were treated in public venereal-disease clinics. The Table, however, shows that

Teaching syphilology to physicians. An essential to successful eradication of the disease.

1957 MARKED the beginning of the alarming and widely publicized increase in number of reported cases of infectious syphilis in Philadelphia, similarly noted in other urban areas across the nation.1,2The Philadelphia Department of Public Health responded with increased venereal disease control activity, and now conducts a broad program consonant with the US Public Health Service'sTask Force Report to the Surgeon General3of recommendations for the eventual eradication of syphilis. In Philadelphia, particular progress has been made in the field of professional venereal disease education, point four of theTask Force Report. This article will show that syphilis eradication depends upon community physicians who are competent in syphilology and sympathetic to health department efforts. It will also discuss successful project activities in the field. In the past, the bulk of the infectious syphilis cases in Philadelphia were treated in public venereal-disease clinics. The Table, however, shows that

THE TREATMENT OF SYPHILIS.

IT may be some grim comfort to know that infectious syphilis has increased not only in the United States but in many other countries as well. At home, reported cases of infectious syphilis reached their peak in 1947 and then began a precipitous decline, which lasted for almost a decade. Clinic and public-health physicians congratulated themselves and waited for syphilis to disappear, as smallpox had. Clinicians began to think of syphilis as an exotic disease, all but abandoned the routine use of the blood test and no longer taught courses on syphilis in the medical schools.Public-health medicine should have . . .

Recent Advances in Diagnosis and Treatment of Venereal Diseases

T HE VENEREAL DISEASES, particularly syphilis and gonorrhea, and to a lesser degree the minor venereal diseases, chancroid, granuloma inguinale, and lyinphogranuloma venereum, are still major public health problems. From 1957 through 1961 a marked increase occurred in reported cases of early infectious syphilis (primary and secondary) and gonorrhea. As shown in the table on page 612, the minor venereal disea.ses showed a decrease in reported cases from 1957 to 1960, but an increase in 1961 (1). Perhaps if private physicians are alerted to the increasing incidence of early infectious syphilis, they will become more suspicious regarding the possibility of this infection in their patients. The following review of the diagnosis and management of syphilis and gonorrhea, summarizing selections from recent literature, provides a ready reference.

Infectious syphilis of the anal canal.

Infectious syphilis is being reported in increasing numbers and the prevalence of homosexuality in males is one reason for its increase. An improved awareness of the possibility that syphilis may be the cause of anal infections is necessary. Eleven cases of infectious syphilis of the anal canal are presented.

Recent developments in the laboratory diagnosis of syphilis.

From 1947 to 1955, one of the most unusual and precipitous declines in the reported morbidity of a chronic, social, communicable disease ever observed in the history of our country was recorded. Th...

Challenge to the private physician in the epidemiology of syphilis.

Reported cases of infectious syphilis declined between the peak years of 1947 and 1954, but since 1954 the number has remained practically unchanged each year. Public health officials understand well the responsibility of the general practitioner to protect the confidence of the physician-patient relationship, as well as his reluctance to suggest that his private patient be interviewed for contacts by a third person, but such personnel have been trained to keep all information in strict confidence and to bring to the investigation the same high professional standards as apply to diagnosis and treatment. If the trend of infectious syphilis is to turn down again, physicians must report all cases to the health department and arrange to have patients interviewed for information about sexual contacts. Examples of effective cooperation along these lines are cited.