Venereal disease is a major problem for homosexuals. The following was written especially for the REVIEW by a medical specialist with wide experience in venereal disease control work.

Venereal

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Disease

in the HOMOSEXUAL

In the past few years, there has been a significant increase in the amount of venereal diseases, gonorrhea and syphilis, reported by most health jurisdictions in the United States. An increasing number of these jurisdictions have become aware that a significant proportion of this increased VD caseload is a result of homosexual activity-which is probably more of an apparent, than a real phenomenon.

Venereal diseases are transmitted through close intimate contact. By this, we mean the close approximation of mucous membrane surfaces, (most prominently the genitals, mouth and rectum) of one individual with another or the deposit of body secretions on such mucous membrane surfaces. The sex act meets these criteria readily. Physical and psychologic factors contribute to make the VD problem in the male homosexual infinitely greater than in the female and our discussion is limited to the former for these reasons. This should suggest methods of sexual gratification where the transmission of VD matiachine REVIEW

is minimized, i.e. manual stimulation, and I hope it allays fears of VD contracted from towels, drinking glasses, bed linen, etc.

The condom is used to prevent conception although it is sold for the prevention of disease, and when properly used it can produce this result. The homosexual, not concerned with contraception, has a limited motivation in using the condom, with an associated reduction in its use as a disease preventing device. In addition, he may not use the condom because of decreased erotic stimulation resulting from its improper use (it should be lubricated on the inside prior to putting it on). Immediate post-coital urination plus soap and water washing of the external organs would reduce VD.

If one is concerned with possible venereal infections, competent medical examinations are indicated. It should be stressed that the "blood test" is for syphilis only and tells us nothing about gonorrhea or the three other less common venereal diseases. In the very early stages of the disease, it will be negative. (Frequently, a person may suspect a syphilis infection because of an ulcer at the site of some sexual activity and arranges for a blood test; being reassured by a negative result. If that ulcer was the lesion of primary syphilis, the blood test would be negative.)

The initial symptom of gonorrhea is a discharge. In the narrow confines of the penis it is obvious and the infected person knows something is the matter. The same discharge in larger anatomic areas, such as the female genito-uninary tract or rectum, is easily overlooked in the early stages. Symptoms here frequently are those of complications, i.e. abscesses. Therefore, a proper VD examination is more than taking of laboratory specimens, but requires some type of physical examination with the examining physician being advised of possible VD problems so special attention may be given to areas he may not otherwise examine, i.e., the anus.

The homosexual should find a medical setting possessing sufficient competence and where he can discuss his problem with some feeling of security. All too frequently, he excludes health department VD clinics thinking 1 that they would not be aware of his special needs, nor be in a position to handle it with confidence. In general, VD clinics seeing a large number of patients, including homosexuals, have something special to offer. By law in California, and probably in most states, records of VD clinics are the most confidentail of all medical records-public or private. As with most health problems, early diagnosis in addition to preventing development of late complications, guarantees ready and easy treatment. In the area of communicable diseases, the sooner a person is made non-infectious, the less hazard he is to others in the community. It is also important to remember that the large majority of early syphilis and some forms of gonorrhea are hidden. Therefore, a person should have VD checkups based on activity rather than on symptoms.