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World Health Orsanization Manila REGIONAL OFFICE FOR THE WESTERN PACIFIC of the World Health Orsanization Manila REPORT ON THE SECOND REGIONAL SEMINAR ON VENEREAL DISEASE CONTROL MANILA. PHILIPPINES, 3 - 12 DECEMBER 1968 ., REGIONAL OFfiCE fOR THE WESTERN PACIFIC OF THE WORLD HEALTH ORGANIZATION MANILA ~PORl' ON rrHE SECOND REGIONAL SEMlNAR ON VENEREAL DISEASE CONTROL - Manila. Philippines 3 to 12 Decemher, 1968 WPRO 0144 SECOND RlOOIONAL SEMINAR ON VENEREAL DISEASE CONTBOL Sponsored by the WORLD HEALTH ORGANIZATION RIDIONAL OFFICE FOR THE WESTERN PACIFIC Manila, Philippines 3 to 12 December 1968 FINAL REPORT NOT FOR SALE PRINTED AND DISTRIBUTED by the REGIONAL OFFICE FOR THE WESTERN PACIFIC of the World Health Organization Manila, Philippines August 1969 CONTENTS PREFACE ~ 1. INTRODUCTION: THE CHANGING ENVIRONMENT •••••••••••••••••••••••• 1 2. NATURE AND ~ OF THE PBOBLEM .............................. 2 3. DIAGNOSIS OF VENEREAL DISEASES ....................•..••......•• 6 4.. TREA'D-mNT OF VENEREAL DlSEAS:e:f> ................................................................ .. 11 5.. VENEREAL DISEASE CONTROL .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 17 6. BEHAVIOURAL PA'1"1'ERNS, HEALTH ElXJCATION AND ATTITUDES ........... 33 7 .. roruRE (J(]IJ!I.()OK .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 35 8. SUMMARY AND RECOMMENDATIONS ............•..................•.... 35 9.. RE:P'ERmlCES .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4:5 ANNEX I LIST OF ~UIPMENT AND SUPPLIFS FOR VDRL TEST (see 3 .. 1.2" .. ( 6) ) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 66 ANNEX II LIST OF EQUIPMENT AND SUPPLIFS FOR FTA TEST (see 3.1.2(c)) ...................................................................... 67 ANNEX III SUGGESTED FORM FOR USE BY CLINICS/DOCTORS WHEN SENDING SERUM SPECIMENS TO A LABORATORY FOR EXAMIN­ ATION FOR SYPHILIS (OR OTHER TREPONEMATOSES), AND SUGGESTED REPORTING FORM FROM THE LABORATORY (see 3.1.2(c» .................................... 68 ANNEX N NOTE ON PRESERVATION AND TRANSPORT OF SERA IN LIQUID NITROGEN AT 15<)0C TO 1960C (see 3.1. 2( e) ) . 70 ANNEX V SUGGESTED SCHEOOLES FOR THE TREATMENT OF SYPHILIS (see 4.1.1) ....................................... 17 ANNEX VI SUGGESTED SCHEOOLES FOR THE TREATMENT OF GONORRHOEA IN AREAS OF HIGH RESISTANCE (see 4.2. 4) . 78 tI ANNEX VII SUGGESTED TREATMENT OF SOME lMPORT.AN.r SEXUALLY TRANSMITTED DISEASES OTHER THAN SYPHILIS AND GONORRHOEA (see 4.3) • • • . • • .. .. • .. • • . .. .. .. .. .. 81 r .. I - 2 - .. ANNEX VIII FORM OF CONrACT SLIP USED IN THE UNITED KINGOOM (see 5.3.1(b» ...... ... .............. .... ......... 80 ,. ANNEX IX MECHANISM OF BUILD-UP OF RESISTANCE OF THE GONOCOCCUS TO ANTIBIO'rICS IN THE WESTERN PACIFIC RF.(}ION • • • • • • • • • • . • • . • • • • • • • . • • • • • . • • • • • • • • • • • . • • • 87 ANNEX X INTERNATIONAL ASPECTS OF VENEREAL DISEASE AND TREPONEMATOSES CONTROL ••..••...•••.•....•..•..••.. 90 TABLE I TRENDS IN THE PREY' ALENCE OF EARLY SYPHILIS IN REPORTING CLINICS OF SOME COUNTRIES OF THE WESTERN PACIFIC REGION OF WHO 1960-19b7 (see 2.1.2) ......................... "............. 50 TABLE II SEROPOSrrIV'ITY FOR SYPHILIS IN PROSTITUTES 19b7 . (see 2.2.2) ....................... "............... 51 TABLE III SEPOSrrIV'ITY FOR SYPHILIS IN MIXED GROUPS (see 2.2.2) ....................................... 52 TABLE IV' RESULTS OF SERUM TESTING BY REAGIN TESTS ON EXPECTANT MOTHERS IN SOME COUNTRIES OF THE WESTERN PACIFIC REGION OF WHO (see 2.2.2) •••••.••• 5} TABLE V REAGIN SERUM TEST RESULTS IN KOREA COMPAREID WITH THOSE OF REITER PROTEIN COMPLEMENT-FIXATION REACTION (see 2.2.2) • • • • • • • • • • • • • • • • . • • • • . • • • • • . • • 54 TABLE VI TRENDS IN THE PREY' ALENCE OF GONORRHOEA IN REPORTING CLINICS OF SOME COUNTRIBS OF THE WESTERN PACIFIC REGION OF WHO (see 2.}.1) ••••••••••••••••• 55 TABLE VII ANTIBIO'rICS USED IN THE TBEATMENr OF GONORRHOEA (see 4.2.1) .............. , . .. 56 TABLE VIII SENSrrlVrrIES OF 4, MIXED STRAINS OF GONOCOCCI FROM THAILAND, HONG KONG, TAIWAN AND VIET-NAM EXAMINE:D 1967-1968 AT THE WHO NEISSERIA CENTRE COPENHAGEN (see 4.2.2.6) •••.•••••.•.••••••. 57 TABLE IX SERUM LEVELS IN UNITS/ML FOLLOWING 5 MmA UNITS OF BENZYL PENIClLLIN WITH AND WITHOUT 1.0 GM PROBENECID (PROBENECID GIVEN HALF AN HOUR BEFORE INJOOTION, see 4.2.4) •••••••••••.•••..•••••.•.•.•• 58 TABLE X GONORRHoEA IN PROSTITUTES - 19b7 (see 5. b. 2 ) • • • • • • 59 - 3 - ~ ~ FIG I PENICILLm SENSITIVITIES OF MIXED AND UN- .,. SELECTED STRAINS OF GO~OCCI IN THE FAR EAST AND m LONDON26, 2 , 71 (see 4.2.2 b) 61 FIG II SERUM LEVELS FOLLOWING 2.4 MOOA UNITS OF PROCAINE PENICILLIN m EIGHT SUBJEC~8, 75 (see 4.2.3) ................................. 62 FIGS IIa &I IIIb SERUM LEVELS OF PENICILLIN (u/mJ.) AFTER 2-8 HOORS FOLLOWING 5 MOOA UNITS OF BEN.zn. PENICILLm WITH AND WITHOUT PROBENECID HALF AN HOUR BEFORE mrECTION (see 4.2.3) ....................... 63 FIG IV BUILD-UP OF RESISTANCE OF THE GONOCOCCUS TO ANTIBIOTICS (see Annex IX) ............... 64 .. Pm'ACE The Second WHO Regional Seminar on Venereal Disease Control took place at the WHO Regia1al Office, Manila, PhilippineS, fran 3 to 12 December 1968. It was opened by Dr. F.J. Dy, Regional Director, who, in welcaaing participants, pointed out that the First Seminar which had been held in Tokyo in 1958, had provided an inventory of information concerning the ex­ tent of the problems of the venereal diseases and the services to deal with them in countries of the Region. A decade had now elapsed and because of the many striking cbaDges which had since occurred, it was time~ that a second Seminar be convened to appraise developments. '!'he meetinf.was attended by 19 participants from 15 countries*, four WHO consultants ,eight local obaervers***, and four members of the WHO secretariat**** • 'l'here was simultaneous translation into English and French of the discussions throughout the Seminar. Dr. G.V. Balbin (Philippines) was elected Chairman; Dr. Dang-Van CUong (Viet-Bam) Vice Chairman; Coronel R. Guiraud (New Caledonia) French Rapporteur; and Dr. F. Jepson (New Zealand) English Rapporteur. Professor E. Aujaleu served as Director of the Seminar and Dr. R.R. Willcox (Uni:ted Kingdan) as Overall Rapporteur. TIlis report has taken into account the Country Reports of partiCipants, both written and verbal, the dai~ notes made by the English and French rapporteurs, the papers presented at the meeting, the background material prOY'ided to the Seminar and 1n:formation obtained in different countries during the pl"e-Seminar viSits of the WHO consultants. *Dr. I.P. Wilson (Australia); Dr. A. Tarutia (Papua and New Guinea); Dr. Kuang-Yu-Fan (China-Taiwan); Dr. Shun-An Chang (China-Taipei City); lobe. M.C. Duprat (French Polynesia); Dr. N. Sanerive (Fiji); Dr. Wong Kwok-on (Hong Kong); Dr. M. Ashizawa (Japan); Dr. Bak. Chin Chung (Korea); Coronel Robert Guiraud (New Caledonia); Dr. F.L. Jepson (New Zealand); Dr. G.V. Balbin, Dr. P.A. Santos (Philippines); Dr. Koh Kim Yam (Singapore); Dr. T. Ishoda (Trust Territory o:f the Pacific Islands); Dr. Dang-Van-CUong, Dr. Huynh-Duc-Tinh and Dr. Ngu;yen-Duc-BaDh (Viet-Ifam) and Dr. L.F. Tautasi (Western Samoa). **:Professor E. Aujaleu (France); Dr. H. Ita. Nielsen (Denmark); Dr. T.V. Tiglao (Philippines) and Dr. R.R. Willcox (United Kingdom). ***Dr. D.Q. Geaga; Dr. L. Ibarra; Dr. S. Santos; Dr. A. Zalamaa; Dr. L. Arabit; Dr. I. de Jesus; and Dr. L. Vira;y (Philippines) and A.E. teager (UNICEF Representative, Manila). .. ****Dr. T. Guthe, Chief vm Section, WHO, Geneva; Dr. C.H. Yen (Opera­ tional Officer) and Dr. B. Vel.1m1rOY'ic, Regional. Advisers on COlllDl1lnicable Diseases, Western PaCific Region, and Dr. T. Oyama of WHO Communicable Disease Advisory Team, WPR • • 1. INTROOOCTICN THE CHANGmG ENVDlCNMENT The Western Pacific Region of WHO is vast, stretching from .the Arctic to the Antarctic and inclUding a number of countries on the land mass of Asia, a sUbcontinent in the Southl and a myriad of scattered large,. smaller and even minute islands and atolls in the China Sea and Pacific Ocean. Within the Region in spite of war and military mobilization, politioal readjustments and alignments, a considerable economic advanoe­ ment - the early fruits of which are already olearly visible • i8 occurring. Although there is still poverty in many areas expanding building programmes and higher living standards both bear witness to this situation. Since the 1958 Sem1nar66 there has been an acceleration in oommunica­ tion between countries by the introduction of the jet aircraft, trade has expanded and the shipping lanes are today filled with faster and bigger vessels. More Asians than before are visiting Europe and the Western Hemisphere while, in reverse, cultural, business and tourist traffic are inoreasing year by year. There have also been widespread civil and military migrations from one country to another both within and from outside the Region. Venereal disease problems arising in one country are thus no longer confined to that area28. All of this has been acoompanied by increasing urbaniz ation and industrialization both in previous~ developed and in developing areas, J' while riSing birth rates, some of which have been slowed down by familY planning programmes,
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