Ashley, Alta

Maine Department of Health and Welfare

English

Maine State Documents (Maine State Library)

Maine State Library Digital Maine Health & Human Services Documents Health & Human Services 7-1-1959 Gonorrhea as an Increasing Problem Maine Department of Health and Welfare Alta Ashley Maine Department of Health and Welfare Follow this and additional works at: https://digitalmaine.com/dhhs_docs Recommended Citation Maine Department of Health and Welfare and Ashley, Alta, "Gonorrhea as an Increasing Problem" (1959). Health & Human Services Documents. 29. https://digitalmaine.com/dhhs_docs/29 This Text is brought to you for free and open access by the Health & Human Services at Digital Maine. It has been accepted for inclusion in Health & Human Services Documents by an authorized administrator of Digital Maine. For more information, please contact statedocs@maine.gov. Reprinted from the July 1959 issue ofThe Journal of The Maine Medical AssociationD e a n  H.  F i s h e r . M. D.  c o m m i s s i o n e rState Of MaineDepartment of Health and WelfareGonorrhea As An Increasing ProblemA lta A shley, M.D.In the past two years the number of reported cases of gonorrhea has risen nation-wide, particularly among teenage boys and girls.1 How great is the rise in actual incidence is difficult to determine because of the notori­ously poor reporting of cases where venereal disease is concerned.About a year ago this office ( the District Office of the Department of Health & W elfare) was approached by the Armed Forces because of an increased incidence of gonorrhea among the air forces personnel, asking that we try to find the sources of infection in the civilian population and bring them under control.Physicians were approached, both individually and at staff and county meetings, but no cause for alarm was voiced on the part of practicing physicians. In most instances it was stated that no new cases of venereal disease had been seen for several years.Early in May of this year several positive urethral cultures were reported by the laboratory and in the past six weeks, within a ten mile radius of a Central Maine city, nine cases of gonorrhea among civilians and four in servicemen, who have been in this area, have been reported. Twelve of these cases were males. Only one female has been reported even though six other girls were named as contacts of reported cases. The one female case was also named as a contact and her con­tact ( male) was also named as a case. Thus, eighteen different individuals have been involved in this local outbreak.The ages of the persons involved ( with the excep­tion of the four service men whose ages are not known ) range from sixteen to twenty-six. Several are at pres­ent high school students and most are of high school age. All but two of the girls named as contacts or as a case were eighteen years of age or younger, one was only sixteen. The boys, as is to be expected, were somewhat older. Of the eight whose ages are known four were 18, two were 23 and two were 26. The oldest girl was only 22.Thus it is evident that Maine is sharing in the nation­wide increase in incidence of venereal disease and, like in the rest of the country, the disease is being found largely among teenage boys and girls.The control of venereal disease requires adequate treatment of cases and search for contacts so that these contacts can be examined and treated. Only in this way can the spread of infection be prevented.Adequate treatment requires follow-up examination within two weeks of initial treatment, at which time blood should be obtained for standard tests for syphilis, since this disease may have been acquired simultaneously with gonorrhea.All persons who have had intimate relations with cases, both during the incubation period and until the disease has been adequately treated, are to be considered contacts. Every available means should be used to get these persons under treatment or observation.Rules and Regulations of the Bureau of Health re­quire all cases of venereal disease to be reported on special forms directly to the Bureau within forty-eight hours. Reporting may be by number, age, sex and color ex cep t :a. All cases who fail to take the necessary treat­ment and who fail to remain under the observa­tion of the attending licensed physician until a cure of the disease has been effected according to standards set up by the Bureau of Health.b. All Cases who conduct themselves in such a manner as to be dangerous to the public health or fail to observe the necessary precautions in­dicated in the treatment of the disease.c. All Cases where financial obligation for diag­nosis treatment of hospitalization is incurred by the Bureau of Health.(Revised Statutes of Maine, 1944, Chapter 22, Sections 87-92)when name and address must also be given so thatpublic health workers can find the cases and get them under care.Only in this way can the Bureau seek out those per­sons who are delinquent in their treatment. Persons who fail to name their contacts or see that these con­tacts are brought to the attention of medical practi­tioners are considered as "conducting themselves in such a manner as to be dangerous to the public health" and so should be reported by name and address.It is well known that the diagnosis of chronic disease in males and acute or chronic disease in females is often difficult. Ordinary urethral and cervical smears are often negative and a false sense of security is obtained when diagnosis is made solely on the examination of these smears. When the clinical picture and history of exposure indicate that infection has probably taken place, full treatment should be instituted even in the absence of a positive smear. If facilities are available cultures should be taken and material from Skene’s and Bartholin’s glands should be obtained. It should be remembered that in early cases or cases inadequately treated smears may show only extracellular organisms.The purpose of this paper is to bring to the atten­tion of the medical profession the rising problem of venereal disease among our teenage population and to point out some of the pitfalls in diagnosis and treat­ment. For a full discussion of the subject the reader is referred to the excellent articles by Nicholas J.Fiumara, M.D., M.P.H., Bernard Appel, M.D., William Hill, M.D., and Herbert Mescon, M.D.2 appearing in the New England Journal of Medicine for April 23 and April 30, 1959.Control of these diseases can best be accomplished by coordinated effort on the part of both private practi­tioners of medicine and public health workers. Promis­cuity is the means of spread. Until our social values are changed, and promiscuity among our teenage chil­dren and young adults is reduced our young people are under constant threat of serious illness as long as un­discovered and inadequately treated cases of venereal disease are present in our communities. Modern treat­ment is effective when adequately applied. Let us hope that through it we can see a reversal of the present up­ward trend in the incidence of venereal disease. To paraphrase Thomas Parran, M.D., we must Find ( cases and contacts)Treat (those infected or suspected of infection) Teach (physicians, public health workers, patients and the public)R e f e r e n c e s1- VD Fact Sheet: Fifteenth Revision, U. S. Department of Health Education, and Welfare. Public Health Service, Jan­uary 1959.2. Fiumara, N. J., Appel, B., Hill, W., Venereal Diseases To­day. New Eng. J. Med. 260: 863-868, 917-924, 1959.

Gonorrhea as an Increasing Problem

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Gonorrhea as an Increasing Problem

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