extremities. About one-half of the infections oc-
cur without an obvious rash.
Congenital rubella causes defects of the
developing fetus of pregnant women with rubella.
Approximately 25 percent of infants born to
women with rubella during the first trimester of
pregnancy are affected.
Rubella occurs worldwide and is endemic
almost everywhere except in remote isolated com-
munities. This disease occurs most often in the
winter and spring. It is a disease of childhood in
unvaccinated populations and of adolescents and
adults in populations where children are
The infectious agent is the rubella virus. The
reservoir is man. Rubella is transmitted when
discharges from infected persons. When suscep-
tible persons live under crowded conditions, e.g.,
military recruits, all susceptible unimmunized per-
sons will probably be infected if the virus is
The average incubation period is about 18
days. Rubella is communicable from about a week
prior to the appearance of a rash until about 4
days after the appearance.
There is no specific medical treatment for
Preventive measures are primarily concerned
with the immunization of susceptible persons. Im-
munization with one dose of live attenuated
rubella virus vaccine produces a long-lasting im-
munity in about 95 percent of all susceptible per-
sons. It is recommended that all children receive
a vaccine of combined rubella/measles at about
15 months of age. Emphasis should also be placed
on immunizing susceptible adolescent and adult
females, because rubella continues to occur in
women of childbearing age. However, pregnant
women should not be vaccinated.
In hospitals or institutions, when a patient is
suspected of having rubella, isolation in a private
room is recommended. Every attempt should be
made to prevent exposing nonimmune pregnant
women to rubella. Children should be kept home
from school and adults should not go to work for
7 days after the onset of a rash.
Sexually Transmitted Diseases
Sexually transmitted diseases (STDs) are
among the most common communicable diseases.
Because of embarrassment or lack of education,
a great many cases go unreported and untreated.
Changes in sexual behavior, and the fact that
many people are asymptomatic carriers, have
added to the problems of control.
A hospital corpsman will havre the responsi-
bility of recognizing cases of sexually transmitted
disease in the sickcall environment, initiating
laboratory procedures to confirm the diagnosis,
and educating personnel in recognizing the signs
of sexually transmitted disease and the best way
to avoid infection.
This section will deal with the most common
types of sexually transmitted diseases: gonorrhea,
nongonnococcal urethritis, syphilis, and genital
herpes. There are many other less common sex-
ually transmitted diseases that are not covered
here. Current medical journals and books are a
good source of information, in addition to cur-
rent Naval texts and Instructions.
Each STD case should be interviewed by a
contact interviewer trained by preventive medicine
personnel. Information gained from the inter-
viewer should be recorded on the Venereal Disease
Epidemiologic Report Form, CDC Form
9.2936A, and be forwarded to the appropriate
agency. The Interviewer s Aid for VD Contact In-
vestigation, NAVMED P-5036, contains guidance
for conducting interviews. NAVMEDCOMNOTE
6222 series contains specific treatment re-
quirements for sexually transmitted diseases.
Chlamydial Genital Infections
This infection causes urethritis in males and
cervicitis in females. Clinically, in males the
urethritis produces an opaque discharge of scanty
or moderate quantity and urethral burning or itch-
ing on urination. Asymptomatic infections occur
in 1 to 10 percent of sexually active men. In
females, clinical symptoms similar to gonorrhea
include inflammation and infection of the uterine
cervix. Complications are infections of tube/
ovaries with risk of infertility. Diagnosis of
nongonnococcal urethritis or cervicitis is usually
based on the failure to denlonstrate Neisseriu
gonorrhoeae on culture.
The infectious agent is Chlamidia trachomatis.
The reservoir is man. The incubation period is 5
to 10 days or longer. Chlamydial genital in fee-
tions are transmitted through sexual contact. The
period of communicability is unknown. The
specific treatment is tetracycline, doxycycline, or
erythromycin, as directed by medical officer,
Preventive measures concerning health and sex
education for this infection are the same for all
sexually transmitted diseases. Emphasis sould be