STDs and Common Sense

Sexually transmitted diseases will never be eliminated, but their impact can be reduced.

Dr. Eleanor Rodgerson was the features editor for this issue's focus on sexually transmitted diseases.

As long as there have been males and females on this planet Earth, there have been sexually transmitted diseases. At first, diagnoses were obscure and treatment non-specific, or non-existent. Cases entered a world of secrecy, hidden and private. Diagnosing an STD was often incidental to other problems. Some-times symptoms disappeared. And yet, STDs spread.

Recall syphilis, once known for horrible disfigurements in its secondary phase and dementia and paralyses in its last. Cases were diagnosed and treated with IV and IM injections, contacts found and treated, and the incidence began to drop. Until recently, antibiotics hastened the decrease.

Recall tuberculosis. While technically not an STD, it can be spread through intimate contact. Once, cases were isolated in sanitaria and contacts treated. When antibiotics appeared, sanitaria closed. Now, with new cases entering the country and not being followed closely and immune suppressed individuals increasing in number, tuberculosis is again rampant.

The incidence of STDs rises and falls and rises again. Why? Careless lifestyles and easygoing philosophies are to blame in part, and also inadequate medical care and unenforced public health policies.

Personal experience opens one's eyes. For the first 10 years of private practice, I mostly delivered babies. There were not many vaginitis complaints. I suppose some vaginitis cases were overlooked. Then, while my children were small, I stopped active practice. When I reopened the office, I eliminated maternity cases and vaginitis cases appeared.

These cases had been seen by other doctors and clinics and had received palliative advice. Setting up a microscope near a patient and making smears and hanging drops and cultures were not difficult procedures and usually specific diagnoses could be made and curative drugs prescribed. Notification of husband, or significant other, for examination and treatment were stressed, and post-treatment checkups advised and performed. The original cases had been overlooked, mistreated or not treated at all.

During this period articles appeared discussing the problem of vaginitis cases whose numbers seemed to be stationary, or increasing. The vagina harbors many bacteria, and there was uncertainty as to which organisms caused the infections and what could be done about them.

There was an interval when vaginitis was labeled "non-specific" even though it was obvious there must be some specific irritant. Then a few bacteria were named "haemophilus" or "Gardnerella" and assigned disease status. Trichomonas was usually present also and, fortunately, the same treatment eliminated everything for awhile. Those organisms have gradually faded from the literature and chlamydia has come to the fore. Sexually transmitted diseases march on.

What more needs to be done? The papillomavirus with its warts and herpes simplex type 2 have no specific treatment. Neither have cases of HIV and AIDS. The viruses live forever. Control seems the only way to go, and that includes communication with contacts. There must be emphasis on how infections lead to sterility, to various forms of cancer, to death.

HIV and AIDS have been handled with sympathy rather than as public health menaces and millions of persons have been lost or disabled, and are dying today. Consider the terrible oversight of not making HIV reportable. Pregnant mothers are not required to have testing for HIV even though treatment of positive cases will almost surely result in healthy babies! The casual attitude toward these deadly diseases is picked up by impressionable teens. Warnings are ignored. Hope for miraculous antibiotics in the face of bacterial and viral mutations is thoughtless. Common sense has flown out the window.

Recall the avian influenza in Hong Kong of only two years ago, 1997. It threatened to become a pandemic like the 1918 influenza that killed millions. The heroic method used to control it-killing all the chickens in Hong Kong-was not popular, but the virus was contained and did not spread to the rest of the world.

When all the statistics are gathered and the graphs with their up and down lines drawn, the well and the unwell interviewed, experiences recounted, opinions expressed, results come out the same. Cases have to be diagnosed and treated as specifically as possible and contacts located, treated and sometimes isolated. Feelings and politics must jump from passive to active. STDs will never be eliminated, but they can be decreased in number and their spread and complications limited. Renew common sense. And actually save lives and improve living.

ebr8809@aol.com