Control of sexually transmitted diseases in the United States-A federal perspective.

In 1972 federal assistance to states to support venereal disease control programs increased to 22. 3 million and a national gonorrhea control program began in the US. Although partly a symptom of changes in the field of venereal disease the new federal initiative has itself stimulated change. This discussion provides an overview of the current situation. Anderson reviewed venereal control in the US between 1912-64 describing the initiation of the grant in 1939 the establishment of rapid treatment centers for treating syphilis and gonorrhea during the early 1940s as an emergency wartime measure and the postwar dismantling of the control apparatus between 1946-55. 2 events that require special comment are the discovery of penicillin as a cure for syphilis and the postwar decision to terminate direct federal assistance for treating patients with venereal disease. In 1964 Thayer and Martin reported the development of a selective culture medium for Neisseria gonorrhoeae and Neisseria meningitidis. The availability of this new diagnostic technique coupled with an alarming increase in reported cases of gonorrhea during the 1960s led the federal government in 1968 to invest in 6 gonorrhea control pilot projects. These emphasized the importance of widespread casefinding of infected women and the identification and treatment of sexual partners of infected men. Although effectiveness was not proved these projects did show the feasibility of such an approach and the federal government increased its assistance in 1972. From the many changes which accompanied this national commitment to control gonorrhea 2 were particularly important: one concerned the sexually transmitted diseases (STDs) as a group; and the other was a modification of strategies for the prevention of syphilis and gonorrhea. Federal concern with gonorrhea quickly broadened to include other common STDs. Improved diagnostic facilities stimulated national concern with the STDs as a group. A 2nd stimulus was the increasing incidence of the diseases themselves. A 3rd stimulus resulted from the follow-up and contact referral strategies used with gonorrhea patients. Modifications have been made to both syphilis and gonorrhea control. The challenge was to design control strategies which allowed a maximum of strategies to be concentrated on the core where the greatest impact on disease transmission was expected. A set of such strategies was described in mid 1975 and circulated to state and local health departments. The trends of both syphilis and gonorrhea changed markedly during 1976. Early syphilis declined by 4. 1% the 1st decline since 1967 and gonorrhea increased by 0. 4% the smallest increase since 1962. It is difficult to judge the impact of each method of control. Much remains to be done. The single greatest impediment is attitude toward this group of diseases.