placed on the use of condoms for promiscuous sexual contacts.
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 Genitourinary Tract
The symptoms, severity, and ease of recognition of the bacterial disease gonorrhea are different 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. Asymptomatic 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 male homosexuals.
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 infertility 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 incubation 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 48 hours.
Specific treatment for gonorrhea is under the supervision of a medical officer and includes various combinations of procaine penicillin G, ampicillin, amoxicillin, and tetracycline. 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 cephalosporin derivatives.
Preventive measures are important. They include (1) providing general health and sex education to military personnel; (2) encouraging comprehensive diagnostic and treatment protocols; and (3) establishing case-finding programs, including interviews of patients and tracing of contacts.
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. Investigation of contacts should include interviews of patients and location and treatment of contacts. Trained interviewers should be used when possible, especially with uncooperative patients. Immunization is not available.
Herpes Simplex
Two etiologic agents, herpes simplex virus (HSV) types 1 and 2, usually produce distinct clinical symptoms, depending on the portal of entry. HSV type 2 usually produces genital herpes; HSV type 2 principally occurs in adults and is sexually 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 active genital herpes infection gives a great risk of serious infection to the newborn, HSV type 2 infection 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 infective for 7 to 12 days. Each recurrent disease is infective from 4 to 7 days. Episodic reactivation of genital herpes occurs repeatedly in the great majority 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 practices; (2) encouraging the use of a condom in random 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