placed on the use of condoms for promiscuous
Investigation of contacts includes as a
minimum the prophylactic treatment of regular
sexual contacts; treatment of ali sexual contacts,
whether or not symptomatic, is recommended.
Gonococcal Infection of the
The symptoms, severity, and ease of recogni-
tion of the bacterial disease gonorrhea are dif-
ferent in males and females.
For urethral infections in males, 2 to 7 days
after an infecting exposure, a purulent discharge
appears from the anterior urethra with burning
upon urination. The infection may spread to the
posterior urethra and produce epididymitis, or it
may be limited to the anterior urethra. Asymp-
tomatic carriage may occur. Rectal infections may
be asymptomatic or may cause itching, painful
spasms with a desire to evacuate the bowel, and
an anal discharge. Rectal infection is common in
In females, an initial urethritis or cervicitis,
so mild it may pass unnoticed, occurs a few days
after an infecting exposure. There is a risk of in-
fertility from infection of the tubes and ovaries.
In both males and females, pharyngeal and
anal infections are due to direct sexual contact.
Conjunctivitis in adults is rare. Deaths may occur
with endocarditis. Arthritis from systemic spread
may cause permanent joint damage if antibiotic
therapy is delayed.
The infectious agent is the bacterium Neisseria
gonorrhoeae. Man is the only reservoir. The in-
cubation period normally ranges from 2 to 7 days.
The period of communicability may range from
days to months in untreated cases, especially in
asymptomatic individuals. Effective antibiotic
therapy normally stops communicability in 24 to
Specific treatment for gonorrhea is under the
supervision of a medical officer and includes
various combinations of procaine penicillin G,
Penicillinase-producing Neisseria gonorrhoeae
(PPNG) and chromosomally mediated penicillin-
resistant (B-lactamasenegative) are new forms of
gonorrhea that are resistant to penicillin; these are
usually treated with spectinomycin or cepha-
Preventive measures are important. They in-
clude (1) providing general health and sex educa-
tion to military personnel; (2) encouraging
comprehensive diagnostic and treatment pro-
tocols; and (3) establishing case-finding programs,
including interviews of patients and tracing of
Management of patients, contacts, and the
nearby environment includes several principles.
No isolation is required. Patients should avoid
sexual contact until post-treatment cultures are
negative for gonococci. Avoid previous untreated
sexual partners to prevent reinfection. Investiga-
tion of contacts should include interviews of pa-
tients and location and treatment of contacts.
Trained interviewers should be used when possi-
ble, especially with uncooperative patients. Im-
munization is not available.
Two etiologic agents, herpes simplex virus
(HSV) types 1 and 2, usually produce distinct
clinical symptoms, depending on the portal of en-
try. HSV type 2 usually produces genital herpes;
HSV type 2 principally occurs in adults and is sex-
ually transmitted. In women, the most common
sites of the primary lesions are the cervix and
vulva; recurrent disease usually involves the vulva,
perineal skin, legs, and buttocks. In men, lesions
affect the penis or pubic areas and, in male
homosexuals, the anus and rectum. Other genital
or perineal sites and the mouth may be involved.
Vaginal delivery of pregnant women with an ac-
tive genital herpes infection gives a great risk of
serious infection to the newborn, HSV type 2 in-
fection in adult women is a possible risk factor
associated with cervical cancer.
Herpes simplex occurs worldwide. HSV type
2 infection usually begins with sexual activity and
is rare before adolescence.
The reservoir is man. The incubation period
is from 2 to 12 days. The transmission of HSV
type 2 to nonimmune adults is usually through
sexual contact. Primary genital lesions are infec-
tive for 7 to 12 days. Each recurrent disease is in-
fective from 4 to 7 days. Episodic reactivation of
genital herpes occurs repeatedly in the great ma-
jority of patients for many subsequent years.
Specific treatment for genital herpes is with the
new topical and oral drug Acyclovir; this should
be prescribed only by a medical officer.
Preventive measures include (1) the education
of personnel on appropriate sexual hygiene prac-
tices; (2) encouraging the use of a condom in ran-
dom sexual practice, to decrease the risk of
infection when the health of the sex partner is
unknown; and (3) the wearing of gloves by health