Up-to-date manual on S.T.D.

Press, 28 December 1985, Page 14

Up-to-date manual on S.T.D.

Herpes, A.1.D.5., and Other Sexually Transmitted Diseases. By Derek Llewellyn-Jones. Faber/Penguin, 1985. 150 pp. Index. $9.50 (paperback). (Reviewed by W. M. Platts) Books on the sexually transmitted diseases (S.TJD.) have become fashionable. This is a particularly good one, free of medical jargon and fully covering the still widening field. There are over 40 pen and wash illustrations and several useful incidence graphs. There is also an interesting short chapter on V.D. in history. After a chapter of questions and answers the author discusses our failure to control the S.T.D. which have become epidemic world wide, especially in the emerging countries. He argues that morality has lost its power to influence the situation, and believes the only way is to remove the age-old stigma of the S.T.D. by regarding them as an ordinary infectious disease — to be discussed openly. Although this has happened to some extent, they are unlikely ever to become a breakfast conversation piece because of man’s natural pudency and the unique significance of the appearance of an S.T.D. in a sexual relationship. Marked stigma still exists in the minds of our medical administrators,

and is the principal reason for the !>rimitive state of our S.T.D. clinics which see about half the country’s total cases) compared with any other hospital outpatient service. In Britain the elimination of the dreaded word “venereal,” by firstly changing the name of clinics from V.D. to S.T.D., and now the specialty from venereology to genito-urinary medicine, has improved its status in the eyes of both the medical hierarchy and the public. Control measures advocated are diligent contact tracing in all the S.T.D., not only in the case of the statutory venereal diseases, gonorrhoea and syphilis, as happens at present. This would involve several trained contact tracers in every city. Locally we have only one, greatly overworked. Compulsory notification of cases, absent in Britain and New Zealand, as being distasteful and inefficient, is also recommended. Dr LLewellyn-Jones is a liberal who believes that education in “sexuality, its delights and consequences” should begin in primary school. He admits education may not lower the S.T.D. figures however. For individual protection, the much despised condom now enjoying a minor sales boom because of A.1.D.5., is recommended.

For those with numbers of partners, regular medical checks (once a month? once a week?) are advised. In practice, such patients often fail to turn up. The chapters on the individual diseases contain a few errors. Figures given for trichomaniasis incidence are too high, and those for recurrent herpes far too low. The illustrations of the various diseases are unhelpful, all looking alike. Only three pages are devoted to the ostensibly principal subject, A.1.D.5., the scenario of which is still unfolding, and on which the best sources of information are the daily press and letters to the “Lancet.” The key measure in slowing spread now that transfusion blood and blood products are being rendered safe, is the reduction by promiscuous homosexuals of the number of thensexual partners (to “one or two”). There is evidence that, to some extent, this is already happening. However, the public panic is such that complete anonymity of all A.I.D.S. test results is proving essential. Over all, this is the most up-to-date manual on the S.T.D. available, and despite its small errors, is full of accurate information and is recommended both for medical and general reading.