Venereal Infections

In one sense venereal infections do not differ from others. They are caused by specific disease organisms which can be seen and studied by means of a microscope and other facilities avail­able in almost any clinical laboratory. But there are two important respects in which such infections differ. First, they are usually transmitted by sexual intercourse, and more often than not by illicit activities of this kind. So long as prostitution continues, we shall have such infections to deal with. Also wide­spread promiscuity among teen-agers and college students has increased the problem to almost epidemic propor­tions in some areas. So the fight against venereal infections is at least as much a social problem as it is a medical problem. Second, with the most com­mon of all venereal infections, gonor­rhea, one attack does not immunize against future attacks; and there is no vaccine that can do this.

CHANCROID (SOFT CHANCRE).
Chancroid is a specific infection, transmitted as a rule by sexual contact. It may appear from one to ten days after exposure or contact. A small pim­ple appears first, nearly always some­where on the genital organs. The pimple rapidly forms pus and ruptures, becoming a painful and pus-bathed ul­cer, with considerable swelling in the surrounding tissues. The adjacent lymph nodes in the groin, usually on one side only, become swollen, tender, and often abscessed. The ulceration may become extensive and destructive if treatment is not begun early, but by use of the proper remedies most cases can be cured in a few days. Chan­croids may be easily confused with syphilitic chancres, and for this reason a thorough examination by a physician is important, the treatment for the two conditions being entirely different.
What to Do
1. When a chancroid is suspected, immediately consult a physician, preferably a skin specialist, for a definite diagnosis. He will order such treatments as may be needed.
2. Avoid alcohol, stimulants, and unnecessary exercise. In severe cases hospitalization may be needed.
3. If abscessed nodes develop in the groin, the pus in them may have to be drawn out with a special nee­dle.
4. Careful cleaning of the ulcers twice a day with mild soap and warm water is recommended.
5. Compresses wet with a 1:10,000 solution of potassium permanganate and kept applied to the ulcers two hours out of every three will hasten the healing.
6. Suitable sulfas and tetracycline antibiotics are effective medical rem­edies, but these must be prescribed by a physician.

GONORRHEA.
Gonorrhea is caused by a specific germ, the gonococcus. This germ is ex­tremely active in invading mucous membranes, especially those of the eyes and the genital organs. As soon as infection takes place, the white cells of the blood attack the intruders by passing through the invaded mem­branes. The gonococci are mostly en­gulfed or swallowed by them, and may be seen inside of these cells, as well as outside of them, with the aid of a mi­croscope.

The mass of germs and white blood cells forms pus in abundance.
In men, gonorrheal infection causes inflammation, pain, burning, and a profuse discharge of rather thick, light-yellow pus from the urethra. In some parts of the world the great majority of all males have this disease at least once in their lifetime.

The male urethra, be­ing much longer than that of the fe­male, and having many glands and passages connected with it, is subject to a more severe early reaction to the germs of gonorrhea. Anterior urethri­tis, or disease in the terminal part of the urinary tract, easily becomes pos­terior urethritis also by backward ex­tension of the infection. The germs may then gain access to the bladder, the prostate, the glands along the ure­thra, the seminal vesicle, the ductus deferens, and the epididymis; and they may cause inflammation in any or all of these organs or structures.

A condition which may follow gonor­rhea, sometimes a long time after the acute infection has cleared up, is a narrowing or stricture of the urethra, which makes urination difficult and at times impossible, thus causing danger­ous distention of the bladder. Stricture also develops in women, though much less often; but it does not develop in either sex until the, disease becomes chronic. It tends to persist indefinitely, and must be treated by dilating or cut­ting the constriction. The treatment is painful and must be continued for many weeks and perhaps repeated la­ter to prevent complications.

Stricture of the ductus deferens may also occur. If it does, sterility is the usual result. Epididymitis may develop. It is a painful and sometimes serious com­plication.
Gonorrhea is less prevalent among women than among men, probably the chief reason being that a smaller pro­portion of women engage in illicit sex­ual relations. Many of the women who do become infected get the disease from their husbands who have con­tracted it before marriage and have not been entirely cured, or who have be­come infected through illicit sexual intercourse after marriage.

But, being internal, women's organs cannot be so readily treated as can those of men. Then, too, a married woman is not likely to begin treatment early, because, not suspecting that her husband has the disease, she does not apprehend any trouble until severe leucorrhea or pain compels her to seek medical aid. By that time the disease has become fully established.

Gonorrhea in a woman may begin with pain and burning on urination and a discharge of pus from the ure­thra, similar to the early symptoms in a man; but much more often the first no­ticeable sign is a profuse discharge of pus from the vagina, sometimes with fever and pain and tenderness in the lower part of the abdomen on one or both sides. Gonorrhea may be present and may persist in a woman, however, even though she has no noticeable symptoms; and sometimes it is difficult to determine definitely whether or not she has a gonorrheal infection.


The infection may travel up through the uterus and the oviducts until it passes out through the open ends of these tubes into the abdominal cavity and causes peritonitis. If peritonitis is not caused, or if it quiets down with­out causing death or severe illness, the infection tends to become chronic in the oviducts and eventually to seal them shut in one or more places. Ovi­ducts thus sealed shut will not allow ova to pass from the ovaries to the uterus, resulting in sterility.

An ovi­duct sealed shut in two or more places forms one or more closed pus pockets. These pus pockets are dangerous foci of infection, and may lead to much pain, distress, and general ill health. Surgery finally becomes necessary in a considerable proportion of such cases to prevent complete invalidism.

In women, glands near the outlet of the vagina, especially the Bartholin's glands, may become infected and form painful and tender pus-filled pockets, requiring surgical drainage.

A very serious, though not very comb moan, form of gonorrheal infection is called ophthalmia neonatorum, or sore eyes of the newborn. It is caused by the germs' getting into the child's eyes during birth. So serious is infection of this kind that failure on the part of a physician to treat every newborn child so as to prevent this disease is consi­dered a crime in many countries. The result of gonococcic infection in the eyes of an infant, if left untreated, is blindness in almost every case. The infection shows itself a few days after birth as a profuse discharge of pus from the eyes. It requires intensive and expert treatment if the little one's sight is to be saved.

Sometimes gonorrheal ophthalmia oc­curs in older children or adults. A per­son with genital gonorrhea may carry the germs to his eyes if he is not care­ful to disinfect his hands after urinat­ing or changing dressings. If he tries to conceal his condition from other members of the household, they may unknowingly contaminate their hand by touching or handling objects whit he has carelessly contaminated, at then carry the germs to their eyes by rubbing them, though this rarely happens.

Sometimes—also rarely—gonerheal ophthalmia results from a blood borne infection.
Gonorrhea sometimes occurs little girls. It is characterized by a discharge of thick yellow pus from the vagina. The infection may come from diapers handled by the mother or a nurse who has the disease, from abnormal sex practices of older persons, occasionally from contaminated toilet seal or from sleeping in the same bed with older persons who have gonorrhea. Jot all vaginal discharges from little girls are due to gonorrhea, however, and it may require special laboratory procedures to determine whether or iot gonorrhea germs are present. Furthermore, in little girls there is less tendency for the infection to travel upward beyond the vagina, so the dis­ease is less likely to have serious complications with them than it is with older girls and women.

Gonorrhea, while local in its early and usual manifestations, may become t general infection by getting into the Blood. As a blood disease, it may gain access to the joints, causing painful ar­thritis; it may be carried to the eyes, pausing ophthalmia; or it may result in infection of the heart valves, causing a usually fatal type of valvular heart disease.

Gonorrheal arthritis occurs much more commonly in men than in women, is might be expected. The knee, the elbow, the ankle, and the hip are the joints most frequently attacked. The joints become hot and very tender and painful. When the acute symptoms subside, the joints are likely to be left stiff; and vigorous and painful treat­ment by a physician is necessary to re­store them to their normal motion.

In its early stage, gonorrhea can usually be cured in a short time by proper treatment. For this reason, one who notices any smarting or burning or discharge from the urethra or the vagina a few days after sexual rela­tions with a person not known to be free from the disease should immedi­ately consult a physician for diagnosis, and for treatment if needed.

It must be remembered that accurate diagnoses cannot be made without microscopic examinations and that it cannot be surely known that a cure has been ac­complished until repeated microscopic examinations and cultures fail to find the germs. Relapses are not uncom­mon. Indulgence in alcohol and in sex­ual intercourse are the most potent causes, of relapse.

What to Do
1. If any symptoms suspicious of gonorrhea are noticed, consult a physician without delay, preferably a urologist. It is perilous to post­pone any needed treatment, to at­tempt self-treatment, or to depend on remedies sold without a physi­cian's prescription.

2. Treatment of gonorrhea has been revolutionized by the use of certain sulfas, and especially of peni­cillin and certain other antibiotics. The use of these drugs can in most cases bring the infection under con­trol within a very few days; but these remedies can be used safely and properly only under a physi­cian's supervision.

3. Since exposure to infection with gonorrhea may carry with it the danger of exposure to infection with syphilis, anybody being treated for gonorrhea should also have a blood test for syphilis, and, if the first test proves to be negative, have it re­peated one month later.

GRANULOMA INGUINALE (GRANULOMA VENEREUM).
Granuloma inguinale is a venereal in­fection, spread by sexual contact. It is believed to be caused by very small germs called Donovan bodies, which by microscopic examination can be seen packed inside the walls of certain rather large characteristic cells.
The first stage of this disease is a blister or small, flat pimple or nodule appearing on the external, genital or­gans. Then a spreading ulcer develops, usually with new nodules forming around it as it extends. In severe cases there is much scarring and tissue de­struction. More than one spot may be involved from the first, and the de­structive ulceration may spread not only to the genital organs but to the groins and thighs, or even farther. With proper treatment most cases are curable, but an occasional case is so resistant to treatment that it may pro­gress until it comes to a fatal end.

What to Do
If granuloma inguinale is sus­pected, do not try self-treatment. Call a physician at once. If he finds the condition actually present, he can use chloramphenicol, streptomy­cin, chloromycetin, or tetracycline antibiotics; all prove effective.
LYMPHOGRANULOMA VENE­REUM (LYMPHOGRANULOMA INGUINALIS, CLIMATIC BUBO).
Venereal lymphogranuloma, which has at least a dozen other names, is an infectious virus disease, usually transmitted by sexual contact. A typi­cal case begins as a papule or small ul­cer somewhere on the external genital organs about two weeks after exposure. Next, the neighboring lymph nodes, usually in one or both groins in male patients but fairly often about the anus in females, become swollen and tender.

The skin over these nodes turns pur­plish and then breaks down, forming persistent, tender ulcers into which more or less pus drains from the nodes beneath. During the period of swell­ing and ulceration there may be some fever and other general symptoms of an acute infection. The ulcers tend to heal, but very slowly and with much scarring. This scarring, especially in female patients, may cause a stricture of the anus or rectum, which is one of the most common and most trouble­some of the late complications.

One of the most useful procedures in diagnosis is the Frei test. The material used for this test—Frei antigen—is pre­pared from pus obtained from the in­fected nodes of a person known to have lymphopathia venereum.

What to Do
1. As soon as venereal lympho­granuloma is suspected, consult a physician, preferably a skin special­ist, to help find out the true nature of the disease. If needed, he can give or prescribe suitable sulfona­mide and antibiotic remedies.
2. Choose foods that leave a small, or at least a smooth, residue after digestion.
3. Alternate hot and cold com­presses over the swollen nodes in the groin will help to relieve pain and clear up the infection.

SYPHILIS (LUES VENEREA, PDX).
Syphilis is caused by a specific germ, Treponema pallidum, corkscrew-shaped and much larger than most bac­teria. To contract syphilis, a person must get the germs from a living source, as a rule. They must enter the body through a break in the skin or mucous membrane, or be transmitted by a mother through the placenta to her unborn child.

Syphilis contracted because of entrance of the germs into the body after birth is called acquired syphilis. Syphilis transmitted before birth is called congenital syphilis.

Syphilis is usually contracted during sexual intercourse. Sometimes sur­geons or dentists are infected through pricking or cutting their hands while operating on syphilitic patients. A few people are infected by using contami­nated silverware, drinking glasses, or other utensils, but more by kissing peo­ple who have lesions of the disease in their mouths or on their lips. Even in such cases, the moist, living germs must enter through a break in the skin or penetrate a mucous membrane and get into the circulation before they can produce the disease. Drying kills syphi­lis germs very quickly. That is one reason why so few people get syphilis except by sexual intercourse.
The first sign of acquired syphilis is an ulcer called a chancre—sometimes called a hard chancre or Hunterian sore. The ulcer usually has well-de­fined edges and a small amount of slightly blood-tinged, watery discharge, but it is not painful.

It may be easily seen, or entirely obscured by overlap­ping skin or mucous membrane. It ap­pears from ten days to three or four weeks after exposure, and lasts from a few days to several weeks. It may dis­appear and soon be forgotten, but it usually leaves a scar.

The chancre oc­curs most often on the mucous sur­faces of the genital organs, but it may be on the skin. It may be in the mouth or on the lips. Women often contract syphilis without knowing it, because the chancre is likely to develop on the cervix or some other location within the vagina where it can be neither seen nor felt. This inability to detect early syphilis in a woman makes intercourse with prostitutes a frequent source of syphilitic infection.

From a few weeks to a few months after the appearance of the chancre, an eruption •usually appears on the body. This may consist of only a few red, pimply blemishes, or it may be a profuse crop of various types of blotches. At this stage the germs are already widely distributed throughout the body. The infected person may have chills, fever, swollen lymph nodes, anemia, and pains in the bones and joints.

The eruptive stage lasts for a few weeks, a few months, or, rarely, years. During this and a still later stage, very infectious lesions, known as mucous patches, are formed in the mouth and on other mucous surfaces of the body. From these, a considerable proportion of the new cases of syphilis are contracted.

The third stage of syphilis occurs generally from three to twenty years after the first lesion. Hard tumor masses called gummas appear in differ­ent parts of the body. These gummas may slough away and leave ulcers; they may form tumor masses in the ab­domen, the lungs, the pelvis, or other parts of the body; and they may form in the bones and thus weaken them, causing fractures. Large sores, difficult to heal, may develop on the skin and cover a large part of the body.

The most distressing features of syphilis come as late effects of the dis­ease. A man, perhaps in the prime of life, begins to have abdominal pains which he cannot account for. These in­crease in severity, resembling a girdle-like constriction about his trunk. Excruciating pains shoot through his legs and body. He soon finds that he can­not walk well in the dark. He loses control of his legs. He cannot control the discharges from his bowels and bladder. He becomes a helpless inva­lid for the rest of his life because syphi­lis has wrecked his nervous system; yet he may live on for years in this pitiful state, for syphilis seldom kills quickly.
Tabes dorsalis, or locomotor ataxia, the terrible condition just described, is only one of many serious conditions or diseases caused by the germs of syphi­lis. Senile dementia or some cases of apoplexy, epilepsy, insanity, paralysis, and partial or complete blindness may have syphilis as their cause.

Many of the rapidly fatal cases of heart disease are brought on by syphilis. In such cases that part of the aorta near the heart is usually attacked first, and the aortic valve is so badly damaged that it cannot hold. The resultant excessive leakage throws such a heavy burden on the heart that it first enlarges greatly and finally fails completely.

Many inmates of mental institutions are there because of syphilis. The mental disease resulting from syphilis has various names, among which are general paresis, dementia paralytica, and general paralysis of the insane (GPI) .

While the victims of general paresis rarely suffer pain and often act as if they were "on top of the world," there is no cure for their condition; and they are a burden on public finances for the rest of their lives, which may drag on for many years.

The innocent children of syphilitic parents show some of the most pitiful effects of this disease. A large propor­tion of the babies born with syphilis die early, usually during their first year of life. A typical syphilitic baby has fissures about the angles of its mouth, a nasal discharge with "snuffles," a cop­pery-brown-colored rash, and/or blis­ters on its buttocks and face. If it lives, it develops slowly, both physically and mentally, and is troubled with restless­ness and disturbed sleep. Its bones
grow in an abnormal, characteristic manner, easily detectable by X ray. When the teeth come in, especially the permanent teeth, they are likely to be notched and peg-shaped. The eyes and ears may be diseased in various ways, with impairment or even loss of eyesight and hearing.

Besides all this trouble, the unfortunate child has a strong chance of being an idiot or of being epileptic or neurotic in various ways; and he may later have any or all of the third-stage developments that characterize acquired syphilis.

Syphilis must be diagnosed and proper treatment begun early if grave aftereffects are to be avoided. Any ulcer or persistent sore on the genital organs, especially following illicit sex relations, should be immediately examined by a physician. No person should attempt to treat the sore himself; for improper treatment may so obscure the disease germ that the real condition cannot be reliably diagnosed, yet the disease will be permitted to go on and produce its terrible aftereffects.

When a doctor sees a sore which he suspects may be a chancre, he will probably make what is called a dark-field microscopic examination of scrap­ings or serum from the ulcer, or have such an examination made.

This test offers about a fifty-fifty chance of discovering the germs if they are present. If they are found, treatment can begin at once. If not, a little later he will draw a specimen of blood for special tests which are much more likely than a dark-field examination to detect the true condition, though waiting for the results of such tests means unavoidable delay in starting treatment.

These blood tests, of which there are several kinds, are applicable in all suspected cases of syphilis a few weeks after the initial infection—usually in time to make treatment fairly sure of success. Probably the best known of these blood tests is the Wassermann test.

Late syphilis is frequently detected by applying the Wassermann test or some equivalent test to fluid drawn from the spinal canal. When the dis­ease has disappeared from all other tis­sues or fluids, the spinal fluid often gives evidence of its presence.

The fluid must be drawn with great care by a physician and tested even more ex­pertly than the blood is tested. While not all of the late ill effects of syphilis can be prevented if treatment is de­layed until the central nervous system is invaded as shown by the spinal fluid test, modern treatment is so efficient that it can do a great deal of good if begun before actual symptoms of the third stage of syphilis have appeared.

If begun during the first half of preg­nancy, the treatment of an expectant mother who has syphilis may enable her to give birth to a baby who is free from the disease. If all such expectant mothers were thus treated, congenital syphilis could be practically wiped out, because a syphilitic child "catches" the disease from its mother and does not inherit it from its father.

Most people, at least most men, who have syphilis know they have been ex­posed; but many of them do not know they have the disease. An even larger number of women, especially married women, who have syphilis neither know they have it nor know that they. have been exposed. The chancre is painless, and may develop in a place where it escapes notice.

The skin erup­tions and other signs and symptoms of the second stage may be so mild that they either go unnoticed or are mis­taken for something of little impor­tance. The interval between the second and third stages of the disease may be very long. During this time the disease is called latent syphilis, and it shows no signs or symptoms of any kind; but a blood test taken during this period is likely to be positive.

Treatment taken during this period will usually prevent the deplorable damage that comes with the third stage.
There are more than a few people scattered here and there who have la­tent syphilis and do not know it, but its presence could usually be detected by a blood test, and its progression to the third stage could be checked.

Knowl­edge of this fact has given rise to the almost universal practice of giving all expectant mothers blood tests fairly early in their pregnancy, so that if any of them happen to have latent syphilis its presence can be detected and they can be treated so as to prevent their passing the disease on to their unborn children.

In many hospitals all pa­tients admitted are given blood tests; and cases of latent syphilis are fairly often discovered in this way. In many communities blood-testing campaigns are carried on from time to time. Such practices, plus the vigorous case-find­ing programs of health departments, have greatly reduced the prevalence of syphilis; but much still remains to be done before the disease is stamped out.

What to Do
1. As soon as a suspicious sore or ulcer is discovered or there is any other reason to suspect a syphilitic infection, have a physician, prefer­ably a urologist or a skin specialist, make such examinations and tests as are needed to determine the true con­dition.
2. Meanwhile, avoid sexual inter‑
course.
3. Remember that neither diet, hydrotherapy, nor any home treat­ment can cure syphilis; but there are remedies that can, and doctors can use them.
4. All effective remedies must be given or prescribed by a physician, but proper remedies correctly given can come as near to curing syphilis in two weeks in our day as used to be possible in two years.
5. To help make medical treat­ments more effective, especially in cases of late syphilis, certain general health-building principles should re­ceive attention. Some of these are:
A. Foods made largely from grains, fruits, nuts, and vegetables, together with milk and eggs in moderation, compose the best diet.
B. Alcohol, tobacco, stimulants, tea, coffee, and highly seasoned foods should be avoided.
C. The patient should drink wa­ter freely, especially between meals.
D. Plenty of sleep and a reason­able amount of outdoor exercise are important.
E. Frequent bathing is helpful. The practice of taking a hot bath for ten minutes before retiring, cooling the water to a little below body tem­perature at the end, and doing this at least two or three times a week, is recommended.