Venereal Problems in a Developing Country

Abstract

Venereal disease is a main public health problem and it was recently placed on the priority list in Uganda. Mulago Hospital in Kampala was found as a venereal disease (VD) clinic at the beginning of the century by Sir Alber Cook. In 1972 about 32000 new patients were seen in these clinics. During the 1st year of the reestablished clinic paramedical staff were trained to diagnose and treat venereal diseases. All patients with genital sores are examined by darkground microscopy for Treponema pallidum. The staff are also trained in contact tracing. The treatment is provided in the clinic by nursing staff and strict guidelines for treatment of the various venereal and paravenereal diseases are enforced. The main problem in any VD campaign is that of convincing women to come for early examination and treatment as symptoms of acute gonorrhea are so mild in females they are usually unaware of the possibility of being infected. Another problem concerning women patients is that the microscopical demonstration of gonococci is often insufficient. Culturing of gonococci is essential in diagnosing gonorrhea in females. Since 1972 a central laboratory for this purpose has been established at Mulago Hospital. When in full operation this laboratory should be able to examine 400-500 specimens a day and can offer its services to other hospitals and to the southern part of Uganda. Diagnosis of syphilis in women is also more difficult. About 75% of men with syphilis are diagnosed in the primary stage of the disease. In contrast 75% of the females attending the VD clinic are initially diagnosed in the secondary stage of the infection. The importance of careful contact is obvious. A high proportion of false positive tests have been demonstrated in serological testing for syphilis. Many false negative reactions can occur even in secondary syphilis. The introduction of a general VD law in Uganda cannot be recommended at this time. A special legislation for prostitutes has proved to be quite useless in other countries. A single dose treatment with a very high cure rate is of special importance for clinics treating many thousand cases of gonorrhea each year. Gonococci have gradually developed increasing resistance to treatment with penicillin but full resistance to penicillin has never been demonstrated. In contrast to Neisseria gonorrhoeae Treponema pallidum is just as sensitive to penicillin as it was when the treatment of syphilis under this drug was introduced in 1943. Chancroid is a common disease in Uganda and the diagnosis is made purely on the clinical aspect of the genital sores and the presence of enlarged lymph nodes in the groin. Lymphogranuloma venereum was not very common in the clinic and granuloma inguinale was not diagnosed in the VD clinic.