Volume 92 Number 3
Editorial correspondence
equally effective but is certainly one of the most effective drugs currently available for severe hypertension. Alan Sinaiko, M.D. Bernard L. Mirkin, Ph.D., M.D. Division of Clinical Pharmacology Departments of Pediatrics and Pharmacology University of Minnesota Medical School Minneapolis, MN 55455
REFERENCES 1. Koch-Weser J: Vasodilatation for vasospastic hypertension, N Engl J Med 289:213, 1972. 2. Boerth RC: Effect of propranolol in the treatment of hypertension in children, Pediatr Res 10:328, 1976. 3. Mirkin BL, and Sinaiko AR: Clinical pharmacology and therapeutic utilization of antihypertensive agents in children, in New MI, and Levine, LS, editors: Juvenile hypertension, New York, 1977, Raven Press, pp 195-217. Lew EA: High blood pressure, other risk factors and longevity: The insurance viewpoint, Am J Med 55:281, 1973. Kannel WB: Role of blood pressure in cardiovascular morbidity and mortality, Prog Cardiovasc Dis 17:5, 1974.
Screeningfor gonorrhea To the Editor: The article by Hein, Marks, and Cohen 1 in the April issue of Tn~ JOURNALcomes to conclusions that I feel are unsupported by present epidemiologic knowledge. The study was performed on what can only be considered a biased sample of inner city youth, let alone, urban youth. There is nothing to show that detainees in a youth center are typical of, let alone representative of, all inner city youth. They are certainly not representative of all urban youth. Gonorrhea has a known incubation period. We are not told whether the youth examined here had been held past the 2- to 5(occasionally 9) day incubation period before testing. If not, it may well be that many of the "asymptomatic" individuals were incubating what would have become symptomatic gonorrhea had they not been detained. My experience with patients having gonorrhea, similar to that of other public health clinicians, is that many of our clients, treated and cured (as far as can be determined with present technology), return in several weeks to months with another episode of disease. The purpose of screening is supposedly to identify illness, either to prevent disease in the carrier or to prevent spread to others. Problems with screening include identification of those to be screened, getting them to accept screening examinations, and then getting them to take treatment offered. Screening women at risk of gonorrhea has been conducted and analyzed for several years in clinics other than venereal disease (VD) clinics and in private physicians' officesY It has not been found to have a yield significant enough to use regularly for all women. The present epidemic of gonorrhea demonstrates the failure of
5 11
present programs? There is a need for better health and sex education among those most at risk. These youth need to understand that contraceptive pills and intrauterine uterine devices are not VD prophylactics. They need to understand the value of condoms. Their intrinsic value systems are such that treatment is presently simpler than prevention. With such attitudes recruitment for screening programs, among those most at risk, is hardly likely to be beneficial. I would suggest that more physicians who give health care to youth need to develop skills in counseling on sexual behavior and VD prevention. C. M. G. Buttery, M.D., M.P.H. Associate Professor Department of Fami@ Practice Eastern Virginia Medical School PO Box 1980 Norfolk, VA 23501
REFERENCES 1. Hein K, Marks A, and Cohen MI: Asymptomatie gonorrhea: Prevalence in a population of urban adolescents, J PEDIATR 90:634, 1977. 2. Results of Screening for Gonorrhea: US, 12 months ending June 30, 1975, "Morbidity and Mortality Weekly" Vol. 24, No. 41. 3. Gonorrhea and Early Syphilis Cases: US 1976, "Morbidity and Mortality Weekly Report," Vol. 26, No. 1.
To the Editor: We appreciate Dr. Buttery's comments re~arding the difficulties encountered in screening for gonorrhea in adolescent patients. The health professional may not be able to reach large numbers of sexually active adolescents unless medical facilities are located in areas where numerous teen-agers congregate. Youth detention centers are one such setting, but college campuses, teen-age clinics, adolescent recreation programs, and secondary school health services are other examples. The need for screening adolescents in a given setting can only be determined by knowing the prevalence of gonorrhea in that group. Our report emphasizes the amount of asymptomafic gonorrhea in a group of inner-city youths. We conclude with the statement that the report deals with prevalence, and a more precise incidence is yet to be determined. Since recurrence of gonorrhea is common, especially if sexual practice includes multiple partners, the optimal frequency of screening for Neisseria gonorrhoeae of a particular individual might best be based on the individual's personal sexual history. Based on sexual histories obtained from our patients, in virtually all cases, cultures were obtained beyond the incubation period of two to five days. We would conclude then that this represents asymptomatic gonorrhea. We view the current problem of gonorrhea among adolescents as a major one, albeit not universal to all teen-agers. The detained tcen-ager is clearly not representative of anyone except himself but one must be aware that some 20,000 American teen-
Editorial correspondence
equally effective but is certainly one of the most effective drugs currently available for severe hypertension. Alan Sinaiko, M.D. Bernard L. Mirkin, Ph.D., M.D. Division of Clinical Pharmacology Departments of Pediatrics and Pharmacology University of Minnesota Medical School Minneapolis, MN 55455
REFERENCES 1. Koch-Weser J: Vasodilatation for vasospastic hypertension, N Engl J Med 289:213, 1972. 2. Boerth RC: Effect of propranolol in the treatment of hypertension in children, Pediatr Res 10:328, 1976. 3. Mirkin BL, and Sinaiko AR: Clinical pharmacology and therapeutic utilization of antihypertensive agents in children, in New MI, and Levine, LS, editors: Juvenile hypertension, New York, 1977, Raven Press, pp 195-217. Lew EA: High blood pressure, other risk factors and longevity: The insurance viewpoint, Am J Med 55:281, 1973. Kannel WB: Role of blood pressure in cardiovascular morbidity and mortality, Prog Cardiovasc Dis 17:5, 1974.
Screeningfor gonorrhea To the Editor: The article by Hein, Marks, and Cohen 1 in the April issue of Tn~ JOURNALcomes to conclusions that I feel are unsupported by present epidemiologic knowledge. The study was performed on what can only be considered a biased sample of inner city youth, let alone, urban youth. There is nothing to show that detainees in a youth center are typical of, let alone representative of, all inner city youth. They are certainly not representative of all urban youth. Gonorrhea has a known incubation period. We are not told whether the youth examined here had been held past the 2- to 5(occasionally 9) day incubation period before testing. If not, it may well be that many of the "asymptomatic" individuals were incubating what would have become symptomatic gonorrhea had they not been detained. My experience with patients having gonorrhea, similar to that of other public health clinicians, is that many of our clients, treated and cured (as far as can be determined with present technology), return in several weeks to months with another episode of disease. The purpose of screening is supposedly to identify illness, either to prevent disease in the carrier or to prevent spread to others. Problems with screening include identification of those to be screened, getting them to accept screening examinations, and then getting them to take treatment offered. Screening women at risk of gonorrhea has been conducted and analyzed for several years in clinics other than venereal disease (VD) clinics and in private physicians' officesY It has not been found to have a yield significant enough to use regularly for all women. The present epidemic of gonorrhea demonstrates the failure of
5 11
present programs? There is a need for better health and sex education among those most at risk. These youth need to understand that contraceptive pills and intrauterine uterine devices are not VD prophylactics. They need to understand the value of condoms. Their intrinsic value systems are such that treatment is presently simpler than prevention. With such attitudes recruitment for screening programs, among those most at risk, is hardly likely to be beneficial. I would suggest that more physicians who give health care to youth need to develop skills in counseling on sexual behavior and VD prevention. C. M. G. Buttery, M.D., M.P.H. Associate Professor Department of Fami@ Practice Eastern Virginia Medical School PO Box 1980 Norfolk, VA 23501
REFERENCES 1. Hein K, Marks A, and Cohen MI: Asymptomatie gonorrhea: Prevalence in a population of urban adolescents, J PEDIATR 90:634, 1977. 2. Results of Screening for Gonorrhea: US, 12 months ending June 30, 1975, "Morbidity and Mortality Weekly" Vol. 24, No. 41. 3. Gonorrhea and Early Syphilis Cases: US 1976, "Morbidity and Mortality Weekly Report," Vol. 26, No. 1.
To the Editor: We appreciate Dr. Buttery's comments re~arding the difficulties encountered in screening for gonorrhea in adolescent patients. The health professional may not be able to reach large numbers of sexually active adolescents unless medical facilities are located in areas where numerous teen-agers congregate. Youth detention centers are one such setting, but college campuses, teen-age clinics, adolescent recreation programs, and secondary school health services are other examples. The need for screening adolescents in a given setting can only be determined by knowing the prevalence of gonorrhea in that group. Our report emphasizes the amount of asymptomafic gonorrhea in a group of inner-city youths. We conclude with the statement that the report deals with prevalence, and a more precise incidence is yet to be determined. Since recurrence of gonorrhea is common, especially if sexual practice includes multiple partners, the optimal frequency of screening for Neisseria gonorrhoeae of a particular individual might best be based on the individual's personal sexual history. Based on sexual histories obtained from our patients, in virtually all cases, cultures were obtained beyond the incubation period of two to five days. We would conclude then that this represents asymptomatic gonorrhea. We view the current problem of gonorrhea among adolescents as a major one, albeit not universal to all teen-agers. The detained tcen-ager is clearly not representative of anyone except himself but one must be aware that some 20,000 American teen-
