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  • Title: Role of preventive methods in the control of venereal disease.
    Author: Hart G.
    Journal: Clin Obstet Gynecol; 1975 Mar; 18(1):243-53. PubMed ID: 1091387.
    Abstract:
    The role of prophylactic techniques in controlling venereal disease (VD) continues to be disputed despite the fact that prophylactic techniques have been used for centuries. Focus in this discussion is on the effectiveness of available prophylactic methods and some factors influencing the impact of effective prophylaxis on disease control. For practical purposes there are 3 categories of personal prophylaxis: mechanical (of which the condom is most important), locally acting measures, and systemic chemotherapy. Fallopio reported in the 16th century the 1st use of the condom to protect 1100 men from syphilis. Since then the condom has been an important element of many control programs. Condoms should be undamaged, of good quality, and used at the right time in the correct manner. Frequently the condom fails to prevent VD because of deficiencies in these conditions. Several studies have suggested that the condom may be of prophylactic value: venereal infection was detected in 9.5% of those using a condom or early treatment, but in 22% of those using inadequate prophylaxis and in 68.5% of those using none. There is inadequate evidence to support the effectiveness of available local acting prophylactic agents. Systemic antibiotics offer an effective form of prophylaxis. In addition, due to their potent specific antimicrobial properties, systemic antibiotics offer the unique advantage of aborting infection when administered a considerable time after exposure. A recent study demonstrated that 200 mgm minocycline, given as a postexposure prophylactic, decreased the attack rate of gonococcal urethritis by 55%, but those patients developed infection experienced a prolonged incubation period and tended to be infected with relatively resistant strains. These findings suggest the possibility of a more serious sequel: production of a chronic asymptomatic carrier state. Abortive VD therapy in managing a rape victim requires special consideration. Assessment of management should be based on the following: the likelihood of infection, the risks of treatment, the efficacy of treatment, and patient follow-up. Even when safe and effective techniques are available, their impact on VD control may be minimal if they are only rarely used. In many environments condom use ranges 3-20% among VD clinic patients and rarely exceeds 25% in the general male population. Condoms are used least by those who need them most. If utilization is to be increased, the motives for not using condoms must be understood. The primary objective in disease control is to reduce the reservoir of infected individuals while minimizing their contact with the uninfected population.
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