MEDICAL FACTS ABOUT V. D.

by Dr. M. P. Vora
The Home Doctor
A Practical Guide to Good Health
Vol. I, No.2 of June 1962
Page No. 40 to 46

Venereal diseases constitute a great hazard to the health of the public and their impact on the national economy is not sufficiently appreciated. They are the most social ills of man, the least confined, the least manifest and the least likely to be static. They provide the perfect opportunity for quackery. Whatever medicine is given, it seems to work. When the symptoms disappear, the patient credits the medicine with a cure.

They, like any other infectious diseases, are diseases and the persons suffering from them are patients deserving our sympathy. People have often associated these diseases with misconduct of the people and looked upon them as manifestations of misbehaviour or sin. Because, of this notion, the person suffering from these diseases have been frequently subjected to untold hardships. It is, therefore, necessary that these deep rooted prejudices and misconceptions, often current in the minds of the people about these afflictions, be removed and replaced by correct knowledge about them. Development of the new, rational, right and healthy attitude on the part of the public towards those afflicted with these diseases is essential for the successful campaign against the scourge. If we fail to recognize them for what they are, it will certainly be difficult to tackle them and to protect the health of the public. It is quite possible that a person may have a venereal infection without knowing or suspecting it. To get V.D is an accident but to neglect it or pass it on to others is a great sin.

There are several venereal diseases but only two of them, syphilis and gonorrhoea are important and widely prevalent. They are two distinct and different diseases, but; both are caught from people who have them, both are caught by millions of people high and low, rich and poor, guilty and innocent alike, both are spread unusually through sex contacts, both are very dangerous if neglected in early stages.

Syphilis may be called pox, lues or bad blood. It can cause skin rash, arthritis, and pain in bones, blindness, deafness, paralysis, heart disease, nervous disease, insanity and even death. It can be passed on to the unborn through the infected mother. It is caused by the cork screw like germ, spirochete pallidum or trepenoma pallidum which enters the body through the mucus membrane or skin.

Gonorrhoea may be called clap, morning drop, gleet or strain. It is a dangerous disease of the urogenital tract caused by a germ, gonococcus.

................................Fig. 1 ............................................................Fig. 2

Photograph of a film of the discharge ....................Photomicrograph of Spirochaete pallida (a)
from a case of Acute Gonorrhoea, .........................Magnification, 1000 diameters.
showing pus cells, intracellular and
extracellular Gonococci.
Magnification, 1,000 diameters.

It is almost entirely transmitted by genital contact. In two to three days after the infection, there is burning and smarting in the urinary pipe and a purulent discharge begins to dribble. These early signs are often noticed by boys but not by girls. When neglected in its early stage, it causes serious harm both in men and women. It can cause difficulty in passing urine, sterility by damaging the sex organs, arthritis, blindness and even death.

Syphilis and gonorrhoea do not just happen. It is fallacy to suppose as many people do, that these diseases are spread through contact with toilet seats or door knobs. They are not spread by air, food or water. They are not caught from public latrines, drinking fountains or weight-lifting. They are caught from persons who have them usually through sex relations or close body contacts.

Just because a person has one of the diseases, it does not mean that he cannot have another. He may have both at the same time or he may get cured and catch the same disease again if he is exposed again to someone who has it.

Both syphilis and gonorrhoea are easily curable in the very early stages. The earlier the diagnosis is made and the treatment is begun, the easier and quicker the diseases are to cure. Usually it takes only a few weeks to cure either disease. Early diagnosis and treatment of venereal infections are of paramount importance from the point of cure and reduction of the chances of spread of infection in the community.

But it is very important that one goes to the venereologist or public clinic right away if either disease is suspected. There the proper steps will be taken at once, either to clear the suspicion or to clinch the diagnosis in the most scientific way. The patient will be treated well and the information will be kept strictly confidential. It should be remembered that the relief of early symptoms does not mean cure in these diseases.

How syphilis works : - Syphilis affects men and women very much the same way. Syphilis germ usually enters the body through the skin in or around the sex parts. The first sign of syphilis may be a sore or an ulcer. This probably will show up sometime between 10 to 90 days after the day of inoculation. This sore usually appears on the genitals but it may appear on the lip, breast, tongue or anus at times. When a person has such a sore he or she is said to have syphilis in the ‘primary stage’. Occasionally such a sore does not show up at all; or it may be hidden deep inside a woman’s sex organs where it cannot be easily seen or it may be so small that it goes unnoticed. At any rate it does not hurt or pain unless secondarily infected. This first sore is called as ‘chancre’. It may look to begin with, like a pimple, scratch or a crack. When a person has such a sore, he or she is very dangerous to another person. The sore is full of germs and the disease may be passed along very easily.

Long before the first sign of syphilis shows up, the germs have spread through the body and in about 4 to 6 weeks’ period a blood test will tell the presence of the disease.

If a person has such a sore, it will go away by itself in the course of time even if no treatment is taken or it may go away as the result of some treatment. But it does not mean that syphilis is gone, the germs are still hiding inside the body, increasing in number and spreading throughout the whole system. It must be remembered that healing the sore does not mean cure of the syphilis.

From 3 to 6 weeks later, a rash on the body will show up. This rash may look like food-heat or measles rash. It may cover the whole body or a part of it. Sores may appear on the mouth or inside of the lips. Sore throat, hoarse voice, fever, headache, pains in the bones and joints may develop. This is called a ‘secondary stage’ of syphilis. In this stage the disease is very infectious and may be passed on even by kissing, for germs are present in the mouth. In this stage syphilis can imitate many other diseases and hence called “the great imitator”. Because of this, many persons have syphilis in this dangerous stage and do not even know that they have it. Of course the blood test will invariably tell the truth.

Like the signs of primary syphilis, the signs of secondary syphilis will disappear in the course of time even without treatment. By this time the disease is well settled inside the body and if it is not treated, it now begins to attack the vital organs in the body such as heart, brain or spinal cord. After all the outward signs have disappeared, the disease is said to be ‘latent’ or quite. The latent stage may last 5 to 20years or more.

A person may feel fine. He may go along for years thinking he is healthy. But some time he may become blind, insane or crippled. He may die of heart disease prematurely. Even in this stage, one could be treated and cured of the disease; but the damage done to the vital organs of the body could never be repaired.

Syphilis and babies : - In most civilized countries, it is obligatory on people, who want to get married, to have a blood test first to make sure that they do not have syphilis. Obvious reasons for this are to protect the marital partner and their unborn child. Of course syphilis may be caught after marriage, if either the husband or wife has sex relations with a third person who has syphilis.

A father with syphilis cannot pass his disease to his unborn child directly, but he can pass it to the mother. Then if she is not treated, she can pass the disease to her baby before it is born. If the baby gets syphilis this way, it is said to have ‘congenital syphilis’. Such a baby may be born too soon (miscarriage), it may be born dead (stillbirth), or it may be born alive with the signs of syphilis. It may have running of the nose, skin rash and body sores from which syphilis may spread to other people. Some times the child may be born deformed or imbecile, unintelligent or it may be born with hidden syphilis which, later on, can cause it become blind, deaf, paralyzed, and insane or even to die.

The best way to avoid such a tragedy is for every expectant mother to have blood test as soon as possible after she knows she is expecting. If a pregnant woman is found to have syphilis, she should get herself treated at once. If she gets treated before fifth month of pregnancy, her child almost certainly will be born without syphilis. But a mother with syphilis who does not get herself treated has only one chance in six of having a healthy child. The congenital syphilis is preventable. It is undoubtedly better to prevent congenital syphilis than to treat it.

How to tell it is syphilis : - in the early stages of syphilis- primary and secondary- a doctor can take scrapings from the sores and look at these under special microscope to find actually living spirochetes. It is therefore essential that no antiseptics applied to the primary lesions. For it only hinders the early diagnosis and postpones right treatment. After the sores have gone away, the only way to tell is by having a check up and a blood test. However it is not wise for the patient to take upon him or her grave responsibility of interpreting the results of the blood test. This difficult task should be left entirely to the specialist, for the results of the test have to be interpreted in conjunction with the history and clinical findings in the particular case. For those who are exposed to the dangers of infection, it is important to have a blood test occasionally just to be sure.

How gonorrhoea works : - if a man has sex relation with some one who has gonorrhoea, in a few days, he probably will notice burning and smarting when he passes water. Then in two to three days he will notice pus-like discharge from the urinary pipe. After some days these signs and symptoms may pass off. On the other hand, and in general, a woman almost never notices any pain or any other sign or symptom when she has gonorrhoea. She can thus pass the disease on to any man with whom she has sex relation and not realize what she is doing.

A woman with gonorrhoea may not feel sick in the early stages of the disease and there is no sign of the disease until it spreads up through her womb into her tubes. Then she has great pain and may have to be operated. After that she may not be able to have babies.

Unlike in men, it is not easy to tell easily if a woman has gonorrhoea. There is no blood test for this disease. Even the laboratory test is not easy to do and takes a few days to confirm the presence of germs. Sometimes, the germs may show in the discharge at once, especially in a fresh untreated male case because the pus is teaming with germs. But in women the germs may be few and far between, and so one has to do repeated examinations and to grow and study the germs in special laboratory to decide the presence of gonorrhoea.

Gonorrhoea from a mother can get into a baby’s eyes either while it is being born or afterwards. This can make the baby blind. This is why medicinal drops are put as a routine into the eyes of the baby when it is born, just to make sure, even if its mother is not known to have gonorrhoea.

If a man has gonorrhoea and does not get himself treated, the infection may spread to other parts. His sex glands may be affected and he may not be able to be a father. The disease can also cause arthritis, blindness, narrowing of the urinary pipe, retention of urine, inflammation of the kidneys and the bladder, abscesses and even heart disease leading to death.

How to tell it is gonorrhoea : - If a person thinks he or she has gonorrhoea, it is best to go at once to a qualified venereologist or a public clinic. The doctor will take a small drop of pus from the sex organ and spread it on a glass slide. After having it treated it with certain stains, he will place the slide under the microscope to find the germs. He can also culture the germs if necessary in a suitable medium. In a few days the germs grow and can be identified after usual staining and microscopy. Then the doctor is able to tell for certain if it is gonorrhoea. The test of culture is not often necessary in men as germs grow fast in man’s urine pipe and can be easily found on microscopic examination especially in a fresh untreated case. But in a woman this is not the case and often repeated examinations have to be resorted to for confirmation.

Proper, regular, and adequate treatment : - venereal diseases in early stages are easily and completely curable. But for a ‘cure’ the treatment must be adequate regular and proper. Inadequate and irregular treatment makes vital organs of the body more susceptible and vulnerable to the attack of the disease. Once the infection becomes chronic, it becomes difficult to eradicate or cure.

Follow-up : - apart from proper and adequate treatment, subsequent check up and proper tests of cure extending over a certain period, are absolutely essential in venereal diseases. Then and then alone a clean bill of health can be given. It is therefore the duty of every patient to co-operate with his medical attendant in this important work. If every person keeps himself or herself clean and healthy, there will be no danger of a venereal disease.

Epidemiology : - the process of finding the infected sex contacts and bringing them for examination and treatment is known as “contact tracing”. As patient are diagnosed, they are interviewed and asked to name those persons to whom they were exposed sexually since the beginning of the incubation

period of the disease up to the time when treatment renders them non-infectious. These contacts are than located, interviewed, examined and treated if necessary. All information is kept in the strictest confidence. In this way a large number of venereal affected persons, the reservoirs of infection in the society, are dealt with. Now to trace the disease through these chains of sex contacts has been an accepted procedure. Every patient ought to co-operate in this effort without the slightest hesitation.

Preventable nature : - Venereal diseases belong to a group of preventable diseases. They are almost if not quite completely preventable, a fact which has been proved and confirmed by fairly long experience. Infection can be avoided in a great proportion of cases by taking certain precautions in time. The use of prophylaxis is based on the fact that every sexual exposure is a potential source of infection and necessarily requires prophylaxis before the germs have had sufficient time to enter the body. In this way not only syphilis but gonorrhoea and chancroid may be prevented. To be successful, the prophylaxis must be applied immediately and methodically within an hour’s interval after the exposure to infection. Then and then alone the application is most effective. Its effectiveness rapidly deteriorates as the interval between the exposure and prophylaxis lengthens. The importance of prevention of venereal diseases cannot be over-rated.

Prophylaxis may prevent at times the early appearance of signs and symptoms of a disease but not the infection; so that those who use it should resort afterwards to periodic check ups and blood tests to make sure and certain that they do not develop syphilis or gonorrhoea later.

A venereal disease is eradicable only if every infectious case is located and reported, its source as certained, all contacts followed up to find possible infection, and all infected persons treated everywhere almost simultaneously. Every case of infectious syphilis or gonorrhoea must be regarded as medical emergency which could lead to epidemic.