Gonorrhoea control programme in Athens, 1974-98.

Introduction A prominent theme today is the influence of dynamically changing demographic and so-ciocultural forces on the spread of sexual transmitted diseases (STDs). In most indus-trialised countries the incidence of classic STDs such as gonorrhoea has been declining rapidly among the educated middle and upper classes. The aim of this study was to evaluate a gonorrhoea case finding programme which took place in Athens from 1974 to 1998 (25 years). Patients and methods The study was approved by the Greek ethics committee. The gonorrhoea case finding and treatment programme took place between 9 am and 12 noon on 6 days per week between 1 January 1974 and 31 December 1998. People were recruited for examination in " A Syngros " Hospital, Athens, then taken to the same hospital for further investigation and treatment. DIAGNOSTIC TESTS Direct microscopy and culture were the mainstay of gonorrhoea diagnosis. Samples could be Gram stained and examined by light microscopy to yield a diagnosis within 5 minutes. Accuracy varied with the site sampled and the experience of the microscopist. If there was a strong likelihood of infection and if presumptive treatment had not been given, a second or even third set of cultures performed on subsequent occasions maxim-ised detection. 3 Isolation of gonococci was also improved by the parallel use of selective and non-selective media. In practice, acceptable results were active with moderately selective media. Carbohydrate utilisation tests or newer methods such as co-agglutination and chromogenic enzyme substrates were used. TREATMENT Patients were interviewed, informed of potential side eVects, and asked to sign a form allowing treatment. Penicillin cured more than 90% of all gonorrhoea infections. By the late 1980s, penicillin therapy for gonorrhoea was no longer recommended because of widespread gonococcus resistance. Instead, another relatively inexpensive drug, such as tetracycline, ciprofloxacin, ofloxacin, cefriax-one, or quinolones, became widespread in Greece. Because clinical series have historically documented co-infection with Chlamy-dia trachomatis in patients with gonorrhoea—as high as 20%—routinely co-treating for chlamydia in all cases of gonor-rhoea has been an important public health measure for chlamydia control. Consequently , either azithromycin or doxycycline should be given. Results Figure 1 shows new gonorrhoea cases for each year between 1974 and 1998 in men and women. During this programme 1 643 823 subjects were examined, of whom 858 879 (52.2%) were males and 784 944 (47.8%) were females. Among positive cases 9834 (98.6%) were males and only 143 (1.43%) …