commands and program managers must develop local programs to meet this need.
In the past, educational efforts to control STD used the “fear approach” by illustrating gross malignancies and lesions of latent cases, while lightly passing over the early symptoms that, if recognized, encourage personnel to present themselves for early diagnosis and treatment. That type of educational approach, along with a policy of a disciplinary approach with resultant quarantine or other punitive measures, caused personnel to conceal their infection or to resort to self-treatment. The best approach to STD education is one that is straightforward, factual, and nonmoralistic, but which at the same time does not condone promiscuity by implication. Abstinence shall be emphasized as the only sure method of prevention. Condoms should be made available to prevent infections but it should be pointed out that condoms are not foolproof. It should be stressed that no punitive measures will be taken against people who contract one of these infections if they voluntarily report for treatment, regardless of the time lapse. Isolation or restriction is ordinarily not medically justified and is usually counterproductive.
Contact Interviewing
Contact interviewing is a confidential conversation between the interviewer and an infected patient. Its purpose is to elicit information that will make it possible to find and bring to treatment everyone with whom the patient was sexually intimate during the critical period. This period is the time during which the infected patient could have acquired and/or transmitted the infection.
Contact interviews should be performed by qualified personnel who have attended a formal course in interviewing techniques under the auspices of a federal medical service. Activities requiring qualified interviewers may contact area EPMUs for availability of such courses. At least one individual in the Medical Department of each command should be qualified to conduct contact tracing. Therefore, it behooves all senior hospital corpsmen to be familiar with the basic techniques involved.
During the interview, three areas of information should be explored in detail. The first is concerned with general information about the patient’s social environment; the second with getting a medical history of previous sexually transmitted diseases; and the third with a history of sexual behavior and the people involved. For epidemiological purposes the interviewer will be concerned with two periods of time: a critical period and an interviewing period. The critical period is always determined individually for each patient and is based on the duration of symptoms and the maximum incubation period for the particular stage of the disease.
The MDR responsible for contact interviewing is the single most important individual in the total STD control program, since epidemiological success or failure is in his or her hands. To be most effective, the MDR must maintain an open mind concerning the patient’s sexual behavior. The interviewer’s personal moral standards and convictions must not be expressed, implied, or conveyed in any manner to the patient. The goal of the interview is to obtain the names of all the patient’s contacts within the critical period of infection. Any and all information obtained in the interview is confidential communication and must remain so.
There are no hard and fast rules for conducting an interview. Each interview must be tailored to the individual patient. What works in obtaining results with one patient may alienate the next patient and result in poor information. Full step-by-step procedures and methods for conducting interviews are contained in Interviewer’s Aid for VD Contact Investigation, NAVMED P-5036. The interviewing techniques described in NAVMED P-5036 are by no means the only approach to the contact interview, but are methods that have proven successful for many interviewers. Common sense, sound judgment, and maturity are as important to the interviewer’s success as are training and knowledge. Since patients probably cannot remember all the epidemiological information they are asked to furnish on their sexual contacts during short interview, they should be interviewed again later for additional information.
The contact interviewer is required to complete and distribute the STD contact reports. The Venereal Disease Epidemiologic Report,