Sexually transmitted.diseases Syphilis and gonorrhea continue to concern all those involved in community health. Elsewhere in this issue (pages 250 and 251) are the schedules of treatment recommended by the federal advisory committee on venereal disease (VD) control. This committee, responsible to the health protection branch of Health and Welfare Canada, comprises senior health officials from the provinces and territories. For the week ending May 14, 1977, Statistics Canada'. reported 706 new cases of gonorrhea and 27 new cases of syphilis. This brings the cumulative totals for cases of gonorrhea and syphilis for the 19 weeks of 1977 to 17 768 and 1072, respectively. In addition, penicillin-resistant gonococcus is being found increasingly often in Canada. Why is VD reaching near-epidemic proportions? The answer is complex, involving many factors. We are moving into an increasingly urban society and the "nuclear family" is no longer the axis around which people function. Permissiveness in all things is de rigueur. Our affluent society stresses materialism, and the adolescent who is constantly faced with barriers designed to delay maturity starts seeking immediate gratification as an antidote. We are advised by media advertising that the attributes of a good life are those in which sex is a status symbol for happiness. It is now "wrong" for an individual to have inhibitions, and the adolescent is urged to seek liberty in "meaningful relationships" with the opposite sex. Add to this libertarianism the plethora of oral contraceptives and the availability of antibiotics and it is easy to see why VD is often regarded by those infected as just a nuisance. Less than three generations ago VD was considered a disaster and a stigma; now it is looked upon as no more inconvenient than the common cold. Sexual intercourse can fulfil some needs, but young persons too often fail to appreciate that the sexual act is not necessarily an act of love. Casual intercourse is advocated in paperback novels, in TV soap operas, in the titillating publications and in hard-core pornography. It is no wonder that society is faced with a rising rate of VD; perhaps one should be surprised that the rate is not higher if the morals of today are given close scrutiny. In most countries 60% of all sexually transmitted diseases (STD) occur in people under the age of 24 years. Prostitutes flourish, in spite of the increasing number of enthusiastic amateurs, and in North America their

number is increasing; their activities account for up to 20% of STD. Homosexuality is an important factor in the transmission of syphilis and gonorrhea; in some metropolitan centres the infection rate among homosexuals is 30%. In spite of the opinion of the Canadian customs official who prevented entry of the May 1976 issue of Penthouse into Canada that "the Canadian public is anti- oral sex", cases of oral gonorrhea are being reported more frequently. Physician-reported STD is but a small percentage of the number of cases treated, and the apparent unwillingness of physicians to report and so establish the contact-tracing machinery does not endear them to public health officials and epidemiologists. At the meeting of General Council of the Canadian Medical Association (CMA) in 1976, the following resolution, which had come from the council on community health for consideration by the CMA and Canadian Bar Association (CBA), was approved: 1. Existing legislation in the provinces respecting VD control be repealed, except insofar as the patient refusing treatment is concerned. 2. Section 253 of the Criminal Code of Canada be repealed. 3. Mandatory incident reporting, without patient name, be instituted in order to provide statistical analysis. 4. The CMA and CBA offer leadership in seeking other methods of control. In a speech at a Toronto community health seminar in April 1977, Dr. RaJ.h Persad, senior medical consultant in VD, Ontario Ministry of Health, said: fhe average private physician is incompetent in dealing with patients with STD." He presented figures to show. that 630 of 1000 persons with gonorrhea treated by Ontario physicians received either inadequate or inappropriate treatment. It behooves all physicians to be aware of the incidence of STD, the urgent need for adequate reporting and followup, and the need for adequate and appropriate treatment. Because of the widespread concern by health authorities over the spread of STD, Health and Welfare Canada and the minist.re des Affaires sociales de Quebec are cosponsoring an international symposium on STD to be held in Montreal Oct. 31 to Nov. 2, 1977. The scientific program will cover the widespread occurrence of STD, the new outlook on their physiopathology, as well as recent advances in diagnosis and treatment. Internationally recog-

nized experts in the treatment of STD will be featured speakers. J.S. BENNETT, MB, FRC5[C], FACOG

Director Professional affairs Canadian Medical Association

Reference 1. Statistics Canada: Notifiable Diseases Weekly Summary; New Cases Reported for the Week Ending May 14, 1977, Ottawa

BOOKS This list is an acknowledgement of books received. It does not preclude review at a later date.

ANTI-DIURETIC HORMONE. Mary L. Forsling. 158 pp. Eden Press, Montreal, 1977. 520. ISBN 0-90440651-2

BRITISH PHARMACOPOEIA 1973. Addendum 1977. Published on the Recommendation of the Medicines Commission Pursuant to the Medicines Act 1968. Effective Date: 1 December, 1977. 72 pp. Department of Health and Social Security, London, 1977. Price not stated. ISBN 0-11-320228-8

DRUGS, BIOGENIC AMINES AND BODY TEMPERATURE. Edited by D.E. Cooper, P. Lomax and E. Schonbaum. 283 pp. IlIust. S. Karger AG, Basel, 1977. 544.75. ISBN 3-8055-2395-5

PHYSICAL DIAGNOSIS. The History and Examination of the Patient. 5th ed. John A. Prior and Jack S. Silberstein. 504 pp. Illust. The C.V. Mosby Company, Saint Louis, 1977. 517.60. ISBN 0-80164053-9

PROSTAGLANDINS AND THE GUT 1976. Alan Bennett. 69 pp. Eden Press, Montreal, 1977. 515. ISBN 0-904406-49-0

PURINE AND PYRIMIDINE METABOLISM. Ciba Foundation Symposium 48. 369 pp. Illust. Elsevier! Excerpts Medica/North-HoI land, Amsterdam; Excerpta Medica, Amsterdam 1977. 530.95. ISBN 90-219-4054-x, Excerpta Medics; ISBN 0-444-15256-3, Elsevier North-Holland, Inc

RECENT ADVANCES IN DERMATOLOGY. Number Four. Edited by Arthur Rook. 395 pp. IlIust. Churchill Livingatone, Edinburgh; Longman Canada Limited, Don Mills, 1977. 535. ISBN 0-443-01318-7

REHABILITATION MEDICINE. 4th ed. Howard A. Ruak. 375 pp. Illust. The C.V. Mosby Company, Saint Louis, 1977. 531. ISBN 0-8016-4213-2

SCHEDULE-INDUCED BEHAVIOR. Research & Theory. Walter P. Christian, Robert W. Schaeffer and Glen D. King. 106 pp. Eden Press, Montreal, 1977. 515. ISBN 0-904406-52-0

TEXTBOOK OF OTOLARYNGOLOGY. 5th ed. David D. Deweese and William H. Saunders, 516 pp. Illust. The CV. Mosby Company, Saint Louis, 1977. 519.45. ISBN 0-8016-1272-1

CMA JOURNAL/AUGUST 6, 1977/VOL. 117

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Sexually transmitted diseases.

Sexually transmitted.diseases Syphilis and gonorrhea continue to concern all those involved in community health. Elsewhere in this issue (pages 250 an...
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