Between 1908 and 1912, clinics for the care of venereal disease were packed with sufferers from all ranks of society; whispers circulated in the dormitories of the colleges about students whose entire careers had been ruined by attacks of venereal disease. The end-results of gonorrhea were horribly depicted, as were those of syphilis, in fake clinics conducted by venereal disease quacks. The museums of horrors were conspicuous in the districts devoted to honky-tonks and night clubs in every great city. The armies of the world were overwhelmed with the costs of caring for venereal disease; great numbers of men had constantly to be hospitalized and taken away from military service because of these infections. Moreover, at that time one hardly dared to speak either the word "gonorrhea" or "syphilis."

The steady progress of medical science has now enabled us to determine the exact cause of each of the venereal diseases; to establish positive methods of diagnosis; to develop capable technics of prevention; and, best of all, to find methods of treatment which can cure gonorrhea within twenty-four to forty-eight hours and bring syphilis under control within a week.

With the elimination of gonorrhea has gone the host of complications, including infected tubes and prostate glands and infected sex organs, with accompanying sterility. Surgical operations necessitated by gonorrheal infections are no longer frequent. Gonorrheal arthritis, a terrible disabling and crippling disease, is so infrequent that it is hardly suspected in making a diagnosis.

Gonorrhea

Gonorrhea is caused by a germ known as the "gonococcus." The finding of the germ in the secretions that come from the infected tissues is a means by which the presence of the disease is determined with certainty. When this germ invades the sex organs a purulent exudate appears, and the presence of the infection is accompanied by burning and frequency of urination, which begins two to fourteen days after the exposure. When the condition infects women the symptoms are not easily detectable; the infection may proceed for a long time before the woman seeks medical attention. With men treatment is begun just as soon as the obvious symptoms appear and is not delayed while the necessary laboratory studies to confirm the diagnosis are being made.

The treatment which has brought about such magnificent results is the use of penicillin. When the organisms are found to be resistant to penicillin, some of the other antibiotics, such as aureomycin, chloromycetin and terramycin, may be used. If the infected person has not shown positive signs of recovery by the third or fourth day a further treatment is undertaken.

The success of the treatment is so definite that complete disappearance of signs and symptoms is taken as evidence of cure.

Because gonorrhea sometimes masks a simultaneous infection with syphilis, every patient should be instructed to have a blood test for syphilis four months after the treatment for gonorrhea, and is watched for any of the usual signs of syphilis.

Syphilis

First in importance in the history of the control of syphilis by scientific medicine is the discovery of the organism that causes the disease, known as the Treponema pallidum, or the Spirochaeta pallida, which means the pale, corkscrewlike organism. Next is the discovery of positive blood tests for syphilis, of which there are now several generally accepted, most important being the original Wassermann test and the Kahn test, with later modifications.

From ten to sixty days, but usually about three weeks, after sexual exposure the first sign of syphilis appears, as a sore on the genital organs. This sore is called a chancre. Every person with a sore of any kind on the genital organs should be suspected of having syphilis. Examinations of the material from the sore must be made with the special microscope that permits what is called "dark-field examination." Moreover, blood tests determine positively the nature of the disease. A single positive test is not usually accepted as being certain; it is customary to repeat the tests once a week for a month, and perhaps once a month for six months, to make certain that the condition is not present.

If the initial infection with syphilis is not controlled, the secondary forms may appear within a few weeks. The blood test is necessary to confirm the diagnosis. Syphilis is an infection which may attack any or all parts of the human body.

The serious character of this infection is recognized in the recommendations that repeated blood tests be made and also, to make certain that the condition has not invaded the central nervous system, that tests be made of the spinal fluid.

If patients fail to respond to penicillin, the doctor's armament against the disease now permits the use of arsenical preparations like mapharsen; this is given by injections into the veins over a long period. Also, bismuth subsalicylate is injected into the muscles once a week for five weeks, followed by subsequent periods of treatment with both mapharsen and bismuth.

Occasionally a mother may be infected with syphilis, and the infection is discovered during pregnancy. The proper treatment of syphilis in pregnancy will prevent infection of the child in practically every case. Penicillin is the drug that is used, and it is given as soon as the infection is discovered.

When the child is born, repeated examinations are made to be certain that the child has not been infected. If infection is found, again the use of penicillin has been found sufficient in most instances to bring about cure of the disease.

Chancroid

Chancroid is a localized venereal disease caused by a germ known as the Ducrey bacillus. This germ attacks the sex organs, and produces ulcers and infections of the lymph glands in the groin. In the United States this condition is seen relatively infrequently, but it is rather frequent in tropical and semitropical countries. The condition is usually spread from one person to another during sexual contacts.

The ulcer is usually shallow, with ragged and undermined edges and covered with a grayish flow of pus. The glands in the groin are enlarged in at least half the cases they may eventually develop abscesses. If they are not treated they become soft and rupture to the surface. In every case a careful examination of the material from the ulcer needs to be made to make certain that the condition is not syphilis. Moreover, the necessary blood tests must be made to rule out a syphilitic condition.

Fortunately, sulfadiazine has been found most effective in controlling this condition. Streptomycin has also been found effective, as are also chloromycetin and aureomycin.

Lymphqgranuloma Venereum

Another venereal condition is called lymphogranuloma venereum. This condition is due to a virus which is usually acquired by sexual contact. Associated with this infection are large glands in the inguinal region and also systemic symptoms.

Lymphogranuloma venereum is seen in all parts of the world, but mostly in tropical and semitropical climates. A positive skin test determines with certainty the diagnosis of this condition; it is called the Frei test.

Usually from one to four weeks after exposure, the condition begins with an ulcer or an erosion at the place where the organism attacks the body. Frequently this little spot will be considered insignificant, and nothing done about it. Gradually the lymph glands in the groin will begin to swell and form a large mass, which may later break down.

Here sulfadiazine is the drug most commonly recommended for treatment. The antibiotic aureomycin has also been found effective.

Granuloma Inguinale

Another chronic ulcerative venereal disease of the skin and mucous membranes, caused by a germ known technically as the Donovania granulomatis, is called granuloma inguinale. This condition is spread all I over the world but is seen most widely in tropical and semitropical countries. Although the condition is generally believed to be transmitted by sexual contact, the condition is not especially infectious and is not seen nearly as frequently as are other venereal diseases.

Fortunately, granuloma inguinale heals rapidly when the patient is treated' with streptomycin, chloromycetin, aureomycin, or terramycin.

Prevention Of Venereal Infection

Early treatment of people with venereal disease is absolutely necessary to secure maximum benefits and to prevent the spread of infectious venereal diseases. The information is kept confidential, but it is absolutely necessary that such information be secured, in order to control the spread of venereal disease. While the person is under treatment he must abstain from all sex contact and he must, of course, be informed of the great danger to himself and to others of any sex contact while he is infected.

There are nowadays many excellent methods of preventing venereal infection, including, principally, cleanliness. Thorough washing with soap and water is of utmost importance in getting rid of infection of all kinds. The taking of a tablet of penicillin in a dosage of 250,000 units is said to be effective in preventing gonorrhea, and usually does not mask an infection with syphilis.