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

Nature and extent of penicillin side-reactions, with particular reference to fatalities from anaphylactic shock.

PIP: An appraisal is made of toxic, microbiogenic, and allergic side effects occurring in man as a result of large amounts of penicillin increasingly used in medical and veterinary practice. The allergic reactions constitute the most common and significant side effects of penicillin. The major antigenic determinant in penicillin allergy, the penicilloyl group derived from the penicillanic acid nucleus, is common to all penicillins and explains, at least in part, the cross-reactivity of man to any penicillin derivative or preparation. Available data do not permit conclusions as to the true frequency of allergic reactions to penicillin which are reported to vary from 0.7-10% in different studies in different countries. Among the side effects, the anaphylactic type may occur in about 0.015-0.004% with a fatality rate from shock of 0.0015-0.002% among treated patients. There is no convincing evidence that the frequency of allergic side effects to penicillin has increased in the last 10 years in relation to the increasing, worldwide use of penicillin. Persons in contact with penicillin may respond by producing antibodies, the presence of which can be determined by immunological procedures, and these are believed to be partly responsible for sudden penicillin side reactions. Routine prospective skin testing prior to penicillin administration cannot, however, be generally advocated at present but, in special instances, it can be undertaken in cooperation with specialists and competent laboratories. The present investigation includes a study of 151 anaphylactic fatalities reported to have followed penicillin administration. Of these persons, 14% had evidence of previous allergies of some kind, 70% had received penicillin previously, and 1/3 of these had already experienced prior sudden allergic reactions. In most of these fatal cases, the symptoms leading to death occurred within 15 minutes. An Expert Committee of the World Health Organization has emphasized that most anaphylactic fatalities can be prevented by measures to reduce penicillin sensitization environmentally in the population on the 1 hand, and by the preparedness of doctors on the other. (author's modified)^ieng