NOTABLE NORMS IN THE TREATMENT OF V.D.
by Dr. M. P. Vora
The Social Service Quarterly
The Organ of the Social service League
Volume No. LIII, No . 4 of April 1968
Page No.125 to 129
Sir William Osler, a militant crusader against venereal diseases, once spoke of them as “the most formidable enemy of the human race, entrenched behind the strongest human emotions and the deepest of the prejudices. They are related to sex life of man, shrouded in reticence and secrecy, treated by silence, concealment and taboo.” In spite of improved methods of diagnosis and control, and the availability of effective and specific drugs, there has been a rude re-awakening by the rising trends in the incidence of these diseases especially among adolescents and young adults. They pose a far more serious public health problem than many other infectious diseases such as malaria, tuberculosis, leprosy etc. One is appalled however, by the gross ignorance of the public about these diseases. Without showing any outward signs and symptoms, these diseases can be present in a person. They are passed with great ease from person to person often without their knowledge. They have serious effects on the marital partner and future progeny. The basic principles in the control are: -
The treatment of these diseases is not so simple as is often taken for granted V.D. cannot be cured by taking a few shots here and there at one’s liking and that too without proper physical examination and precise and accurate diagnosis. Such a treatment helps only to suppress or relieve the symptoms temporarily and creates more problems for the patient and difficulties for the doctor. Before the start of treatment, a venereal patient needs to submit to an adequate and painstaking history, interrogation, careful physical examination and laboratory investigations. It also involves complicated procedures and some inherent implications. These must be clearly understood by every patient.
Venereal diseases are not necessarily the result of leading an immoral life or the inevitable result of promiscuous sex behaviour. It may affect both the guilty and the innocent alike and should be regarded as an unfortunate accident. It is unfair to associate these diseases with a person’s misconduct or to look upon them as manifestations of misbehaviour there is a huge reservoir of infected persons in society. Some of these are or will be married soon. If untreated, their infections will be passed on to their conjugal partners and children through legitimate activity. Besides, there is an occasional possibility of indirect or accidental infection. It is, therefore, incumbent on doctors to be sympathetic, considerate and understanding towards these patients.
An early diagnosis and a prompt confirmation by laboratory tests are of utmost importance. Treatment of V.D. without correct and precise diagnosis is considered reprehensible and amounts to quackery. Correct diagnosis of these diseases, especially in early stages, is practically impossible by the naked-eye examination or on clinical impressions. Unless one has an access to laboratory aids, early and accurate diagnosis of syphilis or gonorrhoea is impossible even for an expert. The laboratory aid provides the conclusive etiologic evidence, helps to avoid pitfalls in diagnosis, and to proceed with various essential procedures such as the education of the patient with regard to his or her disease, institution of right treatment, investigations of contacts, tests of cure etc. Earlier the diagnosis is made and the treatment is started, greater are the chances of cure, and lesser are the opportunities for the spread of infection both in the patient and the community.
An authentic information about these diseases is of vital importance, and has a very high place in the preventive and curative medicine. Few sources there are to offer any trustworthy information on the subject. At present, there is a good deal of ignorance, superstition, secrecy and prejudice among the public. It is ignorance of the patient about V.D., which leads him or her to conceal first signs and symptoms, to try self medication on friend’s advice, or to go to quacks for treatment, and finally to accept disappearance of early sign and symptoms as “cure”. The total ignorance of the public about these diseases is mainly responsible for the present ills of the health of the nation. Every patient needs to know about the potential seriousness of these diseases, their infectious nature, the necessity to avoid sexual contacts till the disease is either made non-infectious or cured, dangers of inadequate or irregular treatment, their latent or concealed nature, their effects on marital partner and future progeny and finally how to prevent these diseases. It must be clearly understood that disappearance of signs and symptoms does not mean “Cure”, and that the patient must leave himself or herself in the hands of doctor till he or she is definitely told, that his or her infection is completely eradicated.
As these diseases pass on person to person, contact- tracing or investigation of contacts is an essential procedure. It means tracing, as quickly as possible, patient to patient, all contacts that are then unearthed, investigated and treated, if necessary. The usual questions asked are, “What about the person from whom you caught it, and what about the persons whom you may have given it before coming here?” The doctor has to know the names and addresses of all the persons with whom the diagnosed case had contacts. However, all the information thus obtained is kept strictly confidential and secret. No doctor worth the name will do anything that will bring discredit or slander to his patient. The main object of this enquiry is to help these contacts before they suffer damage to their health, and to stop spread of infection from them to others. The chief achievement of this procedure is the removal of the focus of infection from the community. If patients will cooperate without hesitation, the incidence of these diseases will be reduced to a great extent. It is the most effective way of eliminating the reservoir of infection from the society. It is the duty of every responsible person to cooperate in this vital task.
Venereal diseases are curable. They can be easily cured by early, proper, regular and adequate treatment. Effective and specific drugs are now freely available. But here is the rub. If the treatment is inadequate or irregular especially in the early stage of infection, it merely relieves the signs and symptoms for the time being, makes the germs resistant to the drugs and results in the irreparable damage to the vital organs of the body at a future date. It may mean crippling and permanent disability. Most of the patients lack, patience and wish for “all right’” for the moment. Hence defaulters in the list are common. This is very dangerous. In their ignorance, they often consider it unnecessary to continue attendance, treatment and follow up tests of cure, when all the visible signs and symptoms have disappeared. They must bear in mind the significance of latency or dormant or concealed existence of these diseases, which become inwardly active and damage vital organs of the body. These patients must give up harmful tendency to default in treatment at their free will. It is absolutely necessary that they clearly understand the risks involved and continue to attend regularly till they are advised to do.
Anti-venereal drugs must be taken only when necessary in adequate dosage over an adequate period to reap the best results. Indiscriminate use of the specific drugs must be avoided at all costs. It impairs the body-defense built-up, promotes resistant organisms, and makes vital organs of the body more susceptible to the attacks of the infection. The precious opportunity for early and accurate diagnosis and permanent cure is simply wasted, and sub clinical and latent infections are let loose to spread in the community. It is, therefore, of utmost importance that these patients realize the serious consequences of taking a few shots here and there at their free will.
Every patient who has received the treatment must undergo series of tests spread over a certain period. Treatment however perfect and at the hands of an expert is not a guarantee of a real and permanent cure, unless it is followed by periodic physical check-ups and laboratory tests. In absence of a full check-up bacteriologic, serologic and physical, one is likely to enlarge the pool of infected persons in society. These patients need a very careful clinical and laboratory investigations and merit full attention of their physicians. A patient, who wishes well for himself, his family and progeny, ought to be particular about the tests of cure. He must not rely on a single test however comprehensive it may be. Only the results of series of tests carried over a definite period can be taken as reasonable and reliable evidence of cure.
As these patients need an observation period, extending from a few months to a few years, during which they have to undergo a series of tests, proper records of the treatment and the results of tests have to be always kept ready for evaluation of the effects of treatment? These records enable the doctor to declare the patients cured of disease. Hence it is important that every patient preserves his case notes and presents them to his doctor whenever asked for. It must be clearly understood that a successful outcome in the treatment of V.D. depends entirely on the closest attention to the above instructions by the patient. He must never take judgement in his own hands with regard to the treatment, interpretation of results performed, and discontinuation of attendance. He must remember that disappearance of signs and symptoms does not mean a permanent cure. It only means relief of symptoms for the time being. He must also know that “Cure” must be based on the consistency of negative results on physical health, bacteriologic and serologic examinations carried over a specific period.
If every patient takes care of his own health and keeps himself healthy, - and it is his duty and on this depends the health of the nation, - there will be no danger what-so-ever of dissemination of these diseases in society.