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The Spread of Gonorrhœa
511
LEADING ARTICLES
seafarers, military personnel, prostitutes, and practising
THE LANCET LONDON
The
5
SEPTEMBER
Spread
1964
homosexuals. The W.H.O. committee urge all health administrations to enforce compulsory notification of gonococcal infections by age and sex of the patients in order to provide accurate statistics of incidence. W.H.O. should try to determine the extent of the reservoir of infection in selected areas, particularly in Africa; and a study group should be established to define more " clearly such terms as subacute", latent," chronic," and carrier state " as applied to gonococcal infections. Studies should be undertaken in suitable areas to determine the true incidence of complications such as salpingitis and sterility. Other activities should include the intensification of contact tracing, an estimate of the value of mass treatment in an area where prevalence is high, and improvement of facilities for diagnosis in rural areas, at maternal and child health centres, and at clinics and hospitals, especially in developing countries. It was also proposed that W.H.O. establish international reference methods for determination of sensitivity of strains of gonococci to various drugs; that assays be continued between reference laboratories in Chamblee, London, Paris, Moscow, and Copenhagen; and that W.H.O. should continue to provide technical information about changes of sensitivity of strains of gonococci, on the basis of sampling in various areas, and about the relative efficacy of present and future remedies "
of Gonorrhœa
"
"
AN expert committee of the World Health Organisation reviewed the technical aspects of the management of gonococcal infection, so that they might form recommendations and advise W.H.O. on what it can do to help. The committee’s disturbing report1 leaves no doubt about the failure to control this disease.2 It refers to the recent increase in gonococcal infections throughout the world and to the estimate of 60-65 million new cases each year. A large reservoir of undiagnosed infection exists, particularly among females, and the infection is becoming prevalent in the very young. Complications, such as ophthalmia neonatorum, vulvovaginitis of children, and pelvic inflammation and resulting sterility in females continue to appear, and they are commoner than is generally supposed. Improved methods of treatment have made no impact on the epidemiological problem. The infectiousness of the disease, its short period of incubation, and the mode of transmission have made it impossible to bring cases and contacts to treatment quickly enough to overtake the rapid spread of infection in the community. Modern means of travel have accelerated the spread of disease between countries and continents. All the accepted methods of control, such as case-finding, treatment of contacts, " clustertesting," prophylactic treatment, mass treatment of special groups, obligatory isolation in hospital, and compulsory notification of contacts have proved of limited value. Failure of control is worldwide and must be recognised by health administrations, the medical profession, and the public. A recent study of the trends of incidence of gonorrhoea in 111 countries and areas in 1950-60 showed that no less than 53 (47-7%) had suffered a persistent and significant increase in incidence since 1957. The increase was most evident in Europe, though the largest reservoir of infection was probably in Africa and after that in the Americas, followed by some countries in the Eastern Mediterranean, South-East Asia, and Europe. Often, however, the data from different countries were not strictly comparable. Those countries where laboratory facilities for diagnosis were good and where casereporting was most efficient seemed to have a higher incidence of infection. On the other hand, over-reporting might result from inadequate laboratory support and the practice of making diagnoses on purely clinical
grounds. "
Epidemiological control was complicated by problem groups," including those who acquired repeated infections, patients who defaulted after relief of symptoms but before tests for cure, teenagers ", migrants, "
1. Wld Hlth Org. tech. Rep. Ser. 1963, no. 262. 2. See Lancet, 1963, i, 1248.
for gonorrhoea. The relative importance of some of these recommendations may be debated, but there can be no doubt that this report is an excellent summary of the situation and that it advocates action which is long overdue. Though the gonococcus was discovered as long ago as 1879, methods of control have lagged far behind those of most other infections. The main reason is neglect of fundamental research in a subject which medical opinion has too long despised and ignored-an attitude once determined by moral reprobation and later by overconfidence in the effects of treatment. In fact, most of the advances that have been made have been asides from research in other areas. The time has come for an entirely new attitude to this major source of human illness and unhappiness-and the W.H.O. report points the way.
Endoreduplication, Polyploidy, and Leukæmia As two of
our
Peripatetic Correspondents lately
noticed-since ARISTOPHANES, satirists have nearly always been too late as well as reactionary-this journal is nowadays sprinkled with pictures of chromosomes. During the past year or so a new and rather striking pattern, that of endoreduplication, has been seen several times. One of the first and best to look at was that of REISMAN et al.l; another report2 appeared on Aug. 22; and this week there are two more (pp. 494 and 496). As seen in standard preparations, endoreduplication consists in doubling (rarely more) of all or nearly all the 1. 2.
Reisman, L. E., Zuelzer, W. W., Mitani, M. Lancet, 1963, ii, 1039. Marquez-Monter, H., Benitez-Gurrola, S., Chavarria, C. ibid. Aug. 22, 1964, p. 419.
LEADING ARTICLES
seafarers, military personnel, prostitutes, and practising
THE LANCET LONDON
The
5
SEPTEMBER
Spread
1964
homosexuals. The W.H.O. committee urge all health administrations to enforce compulsory notification of gonococcal infections by age and sex of the patients in order to provide accurate statistics of incidence. W.H.O. should try to determine the extent of the reservoir of infection in selected areas, particularly in Africa; and a study group should be established to define more " clearly such terms as subacute", latent," chronic," and carrier state " as applied to gonococcal infections. Studies should be undertaken in suitable areas to determine the true incidence of complications such as salpingitis and sterility. Other activities should include the intensification of contact tracing, an estimate of the value of mass treatment in an area where prevalence is high, and improvement of facilities for diagnosis in rural areas, at maternal and child health centres, and at clinics and hospitals, especially in developing countries. It was also proposed that W.H.O. establish international reference methods for determination of sensitivity of strains of gonococci to various drugs; that assays be continued between reference laboratories in Chamblee, London, Paris, Moscow, and Copenhagen; and that W.H.O. should continue to provide technical information about changes of sensitivity of strains of gonococci, on the basis of sampling in various areas, and about the relative efficacy of present and future remedies "
of Gonorrhœa
"
"
AN expert committee of the World Health Organisation reviewed the technical aspects of the management of gonococcal infection, so that they might form recommendations and advise W.H.O. on what it can do to help. The committee’s disturbing report1 leaves no doubt about the failure to control this disease.2 It refers to the recent increase in gonococcal infections throughout the world and to the estimate of 60-65 million new cases each year. A large reservoir of undiagnosed infection exists, particularly among females, and the infection is becoming prevalent in the very young. Complications, such as ophthalmia neonatorum, vulvovaginitis of children, and pelvic inflammation and resulting sterility in females continue to appear, and they are commoner than is generally supposed. Improved methods of treatment have made no impact on the epidemiological problem. The infectiousness of the disease, its short period of incubation, and the mode of transmission have made it impossible to bring cases and contacts to treatment quickly enough to overtake the rapid spread of infection in the community. Modern means of travel have accelerated the spread of disease between countries and continents. All the accepted methods of control, such as case-finding, treatment of contacts, " clustertesting," prophylactic treatment, mass treatment of special groups, obligatory isolation in hospital, and compulsory notification of contacts have proved of limited value. Failure of control is worldwide and must be recognised by health administrations, the medical profession, and the public. A recent study of the trends of incidence of gonorrhoea in 111 countries and areas in 1950-60 showed that no less than 53 (47-7%) had suffered a persistent and significant increase in incidence since 1957. The increase was most evident in Europe, though the largest reservoir of infection was probably in Africa and after that in the Americas, followed by some countries in the Eastern Mediterranean, South-East Asia, and Europe. Often, however, the data from different countries were not strictly comparable. Those countries where laboratory facilities for diagnosis were good and where casereporting was most efficient seemed to have a higher incidence of infection. On the other hand, over-reporting might result from inadequate laboratory support and the practice of making diagnoses on purely clinical
grounds. "
Epidemiological control was complicated by problem groups," including those who acquired repeated infections, patients who defaulted after relief of symptoms but before tests for cure, teenagers ", migrants, "
1. Wld Hlth Org. tech. Rep. Ser. 1963, no. 262. 2. See Lancet, 1963, i, 1248.
for gonorrhoea. The relative importance of some of these recommendations may be debated, but there can be no doubt that this report is an excellent summary of the situation and that it advocates action which is long overdue. Though the gonococcus was discovered as long ago as 1879, methods of control have lagged far behind those of most other infections. The main reason is neglect of fundamental research in a subject which medical opinion has too long despised and ignored-an attitude once determined by moral reprobation and later by overconfidence in the effects of treatment. In fact, most of the advances that have been made have been asides from research in other areas. The time has come for an entirely new attitude to this major source of human illness and unhappiness-and the W.H.O. report points the way.
Endoreduplication, Polyploidy, and Leukæmia As two of
our
Peripatetic Correspondents lately
noticed-since ARISTOPHANES, satirists have nearly always been too late as well as reactionary-this journal is nowadays sprinkled with pictures of chromosomes. During the past year or so a new and rather striking pattern, that of endoreduplication, has been seen several times. One of the first and best to look at was that of REISMAN et al.l; another report2 appeared on Aug. 22; and this week there are two more (pp. 494 and 496). As seen in standard preparations, endoreduplication consists in doubling (rarely more) of all or nearly all the 1. 2.
Reisman, L. E., Zuelzer, W. W., Mitani, M. Lancet, 1963, ii, 1039. Marquez-Monter, H., Benitez-Gurrola, S., Chavarria, C. ibid. Aug. 22, 1964, p. 419.