[The campaign against sexually transmissible diseases and endemic treponematoses]. / La lutte contre les maladies sexuellement transmissibles (MST) et les tréponématoses endémiques.

From the moment WHO was established in 1948, the control of venereal diseases was felt to deserve highest priority, together with activities to control malaria and tuberculosis. International action was needed in view of the high morbidity and mortality from venereal diseases, their serious human and social consequences, and the prevalence of congenital syphilis and other sexually transmitted diseases (gonorrhoea, chancroid, venereal lymphogranulomatosis, granuloma inguinale). WHO immediately set up a global programme for the control of STDs and, with the participation of other agencies, especially UNICEF, furnished countries with assistance in the form of personnel, equipment and funds for the operation of programmes to assess the extent and impact of STDs and to plan and implement practical measure of control. The 1950s witnessed a steady and considerable decline in syphilis and gonorrhoea and many health authorities relaxed their control activities and efforts to maintain public awareness of the problem. In contrast to the prevailing optimism, WHO repeatedly stressed the possibility of a renewed upsurge of STDs. In the 1960s and 1970s, there was a sharp rise in STDs, both in the "classic" diseases (the five venereal diseases mentioned above) and also in the "second generation" STDs (chlamydial infection, genital herpes, human papillomavirus and other infections). Through its programme for the control of STDs, WHO put forward suitably designed control strategies, essentially based on information and education for health, screening for STDs, diagnosis and treatment of cases, contact tracing, and the training of health personnel. By the end of the 1970s, the bacterial, but not the viral STDs, had been contained in the industrialized countries. In many of the developing countries, STDs remained a priority public health problem, above all on account of the seriousness of their sequelae. In 1981, a new sexually transmitted disease-the acquired immunodeficiency syndrome (AIDS)-was identified. As of 1982, the WHO Programme on STDs organized meetings to define the extent of the problem, compare experience, promote and coordinate research and propose strategies for prevention. In 1987, WHO established a Global Programme on AIDS. It is clear that the control of STDs is now more than ever a priority. We have strategies for the prevention and control of STDs and the WHO Programme will continue to collaborate closely with countries in strengthening their national control programmes.(ABSTRACT TRUNCATED AT 400 WORDS)

The control of endemic treponematoses.

In the 1950s and 1960s, following a decision by the Second World Health Assembly in 1949, mass treatment campaigns against the endemic treponematoses were undertaken with the support of the World Health Organization and the United Nations Children's Fund. The control policy was based on recognition of the importance of screening at least 90% of the target population; of conducting periodic resurveys and treating missed, new, and imported cases; of treating the entire treponemal reservoir (including latent cases and contacts); and of using adequate dosages of long-acting penicillin (minimal dosages were recommended). Later, policies on the extent of contact treatment at different levels of endemicity were established. During these mass campaigns, approximately 50 million clinical and latent cases and contacts were treated; prevalence of endemic treponematoses was reduced dramatically. The major reasons for resurgence of yaws and endemic syphilis in some areas are discussed. One important factor has been the failure of many countries to integrate active control measures into local health services after the mass campaigns. Yaws and pinta are continuing to decline to very low levels in the Americas. In West Africa, especially, incidence of yaws and endemic syphilis have returned to high levels. Few significant endemic areas remain in Asia except in Indonesia and Papua New Guinea.

Worldwide microbial resistance to antimicrobial agents.

The resistance of microbial pathogens to antimicrobial agents is a crucial health-related problem. The inappropriate use of antibiotics in human and veterinary medicine, along with the widespread use of these agents in animal breeding and in agriculture, has favored the selection of multiply resistant microbial strains. The policies employed for the monitoring of such microbial resistance must be reviewed, and new policies designed to retard and combat the emergence of resistance must be implemented.

Immunization during a cerebrospinal meningitis epidemic in the Mongolian People's Republic, 1974-75.

An epidemic of cerebrospinal meningitis (CSM) in the Mongolian People's Republic, starting in 1969, reached its peak in 1974. In that year and in early 1975, 65 000 children in the 0-8-years age group in the main towns and in the provinces were immunized with meningococcal vaccine of serogroup A. The morbidity rates due to CSM were 12 times higher in the non-immunized than in the immunized children. This result demonstrates the value of an immunization programme to control epidemics of CSM.

[Surveillance of sexually transmitted diseases: practical approach (author's transl)]. / La surveillance des maladies transmises par voie sexuelle. Approche pratique.

Even today we still do not have enough precise information either on the number of diseases which should be included in this collective concept or on the frequency of the diseases and their complications. Information is also lacking on methods for measuring these frequencies and assuring satisfactory surveillance. Various methods of gauging the frequency of these diseases are examined and evaluated and a practical surveillance programme is suggested.

[Laboratory methods used for the screening and the control of sexually transmitted diseases (author's transl)]. / Methodes de laboratoire utilisables pour le dépistage et la surveillance des maladies à transmission sexuelle.

The most currently used methods by laboratories for the screening of sexually transmitted diseases were reviewed by the authors and their comparative reliability and sensitiivity examined. The authors endeavoured to give guidance to physicians and bacteriologists in the choice of available techniques as regards collection sites, transport of specimens, choice of transport media, serological tests for syphilis screening and diagnostic methods for urethritis or non-gonococcal vaginitis.

Chlamydiae as agents of sexually transmitted diseases.

Chlamydiae are being increasingly recognized as an important cause of human disease. The known geographical distribution of lymphogranuloma venereum and the role of chlamydiae as agents of sexually transmitted diseases are reviewed. The presence of chlamydiae in the urethra and the cervix, and their etiological relationship to genital infections, first recognized in connexion with ocular infections, have been proved in a number of studies in selected populations in a few countries. Chlamydiae appear to be the most important agent of nongonococcal urethritis, which in some cases appears now to be more frequent than gonococcal urethritis. In addition to their association with cervicitis, chlamydiae appear also to be fairly frequent in the cervix of apparently normal, asymptomatic, and sexually active women. The role of chlamydiae as agents of other human diseases still requires to be clarified. The organisms have been found in association with pelvic inflammatory disease, neonatal pneumonia, pharyngitis, and otitis. There is need for additional studies in view of the fact that effective chemotherapy is available. An outline is given of laboratory methods that may be useful for the diagnosis of chlamydial infections.

Venereal disease and treponematoses--the epidemiological situation and WHO's control programme.

PIP: In recent years the epidemiological pattern of venereal disease and endemic treponematoses has undergone important changes in both developing and developed countries. This discussion outlines the present situation and indicates the role that the World Health Organization (WHO) is playing in efforts to combat these infections. About 15-20 years ago 2 contrasting epidemiological situations confronted health authorities around the world. The developed countries were experiencing the lowest recorded incidence of venereal diseases since World War 2. At the same time in developing countries nonvenereal endemic treponematoses were becoming a major health problem because of their widespread endemicity and their disabling effect on the sufferers, which was causing a serious reduction in manpower resources. By the mid 1950s reports from several countries showed an increase in the incidence of early syphilis and gonorrhea and during the subsequent years the rising trend continued and began to affect most countries of the world. Simultaneously, the prevalence of endemic treponematoses dropped markedly in several developing nations as a result of WHO/UN International Children's Emergency Fund (UNICEF) assisted mass treatment campaigns. There can be little question that the introduction of penicillin for the treatment of venereal diseases and treponematoses made a major contribution to the developments outlined. The marked treponemicidal effect of this drug, its ease of administration, and the low incidence of side effects made it almost ideal for the safe, short-term, ambulatory treatment of both venereal and nonvenereal treponematoses as well as of gonorrhea. The immediate result of intensive antivenereal campaigns in the developed countries at the end of World War 2 as well as of the mass treatment campaigns against endemic treponematoses was excellent. Yet, it led some to believe that these infections could be completely eliminated by treatment alone. Subsequent experience has shown this opinion to be unjustified, because the transmission of venereal diseases and treponematoses is closely dependent upon the socioeconomic structure of the society concerned. It is clear at this time that a new approach is required in the field of endemic treponematoses. The era of mass treatment is most likely nearing its end. The endemic treponematoses will remain a longterm public health problem until the hygiene and socioeconomic conditions of the populations concerned are improved so as to eliminate low level transmission of the disease. In regard to the increase of early syphilis and gonorrhea reported from most countries since 1955-57, it should be noted that national statistics are unreliable. Underreporting is general and the statistics are variously estimated to represent between 10% and 50% of the true number of cases.^ieng