Public Health: VD Detectives

PUBLIC HEALTH

Venereal disease in the U.S. is in creasing at a runaway rate, especially in the high school and college age brackets. Of the two principal diseases, gonorrhea is more “catching,” and therefore far more common, with 300,000 new cases reported annually, as against 20,000 for syphilis. The U.S. Public Health Service believes that the true figures, withheld because of embarrassment or ignorance, are closer to 1,200,000 and 300,000. The problem is not the cure; though some strains of both the syphilis and gonorrhea germs are resistant to penicillin, there is still no venereal disease that cannot be cured in its early stages by antibiotics. The trouble lies in finding VD victims, finding the person who infected them, and finding the contacts to whom they have passed on the disease. To this end, doctors and nurses have been pressed into serving as VD detectives.

One of the most efficient detective squads is in Boston; it is made up of 50 female “field epidemiologists” and directed by Dr. Nicholas Fiumara, head of the Massachusetts health department’s communicable diseases division. Like any good chief of detectives, Dr. Fiumara has analyzed his problem statistically. Only about 3% of Massachusetts’ cases result from contact with prostitutes since, as Dr. Fiumara says, “even streetwalkers take pretty good care of themselves.” Homosexual males account for 12%, and heterosexual free love for 85%. The highest incidence of gonorrhea is in the 20-to-24 age range, with teen-agers second. Most of these are 15 to 19, but some are only 13, and a few not yet in their teens.

Double Standard. To track down cases and contacts, Dr. Fiumara’s investigators pose as social workers, saleswomen, poll takers or long-lost relatives. They arrange interviews in law offices, public libraries, department stores and cocktail lounges. “VD certainly shows no class prejudice,” says one nurse-detective. “I go to a fair share of houses with maids and chauffeurs. Parents in the upper and middle classes get hysterical when I tell them that one of them, or their child, has been named as a contact. And there’s a double standard: fathers get apoplectic if they hear that a daughter may be infected, but can’t hide something like jubilance if it’s a son—the attitude of ‘I didn’t know Junior had it in him.’ ” This same nurse found a middle-class suburban girl in her teens, a gonorrhea victim, who gave her the names of 14 different contacts she had had in the previous three months.

One of the nurses was given the name of a homosexual VD carrier. (This type of case is difficult because of the promiscuity involved; whereas adult heterosexuals average four recent contacts and teen-agers six, homosexuals average up to twelve.) Posing as a poll taker, she talked her way into his Back Bay apartment. When she gave him the bad news, he gagged, ran to the bathroom and vomited. When he emerged, he fainted dead away. “Luckily,” says the nurse, “he fainted right next to his well-stocked bar, so I just reached over and poured a bit of brandy into him.” Restored, he named his contacts. Another homosexual who went voluntarily to the clinic took his gonorrhea diagnosis more realistically and returned a couple of days later with all 14 (twelve white, two Negroes) of his contacts. All tested positive.

Loyal to Jim? With its many colleges and universities, Boston has a higher-than-average share of young adults in its population. The disease detectives rate the schools not on the basis of academic excellence but on sexual activity as revealed by VD. On this scale, Harvard is tops, and M.I.T. is lowest.

One college senior (not a Harvard man) had the common complaint with an odd twist. He contracted gonorrhea four times last winter, though he insisted that he had only one girl friend. How had either of them caught gonorrhea? Probably, Dr. Fiumara speculated, at a marijuana bash that developed into a love-in. “I think I was always having relations with my girl friend,” the student replied, “but I can’t be sure—you get a bit fogged up.” Said the girl: “Even at the parties, I always stay loyal to Jim—I think.” Because the two did not have simultaneous treatment, the epidemiologists call theirs a case of “pingpong gonorrhea,”—each partner getting cured, then reinfected by the other in turn.