Gonorrhoea and the iceberg phenomenon.

For years the problem of gonorrhea has been compared to the configuration of an iceberg, with the reported cases representing only the tip. U.S. Public Health Officials estimated that only 1 in 5 cases ever came to their attention. They further believed that the kinds of people with unreported venereal disease were quite different from those who were reported. The typical gonorrhea patient was shown to be an unmarried Negro male between the ages of 18 and 25. He worked as an unskilled laborer, and less than a high school education, and lived in an urban area. Common sense dictated that most unreported gonorrhea patients were also male, were high school or college students, white, suburban, and middle class. However, a series of studies conducted in Georgia, North Carolina, and abroad, plus an analysis of the private physician attitude study data gathered from physicians in selected areas of the U.S., indicates that this is not the case. People with unreported cases of gonorrhea generally share the same characteristics as to age, sex, race, job, education, and income status as those with reported cases. A possible exception is the number of females with unreported cases who come from the lowest social class and live in urban ghettos. Unless new evidence is presented, public health officials will concentrate their control efforts on residents of the black ghettos and will be more concerned with inner-city doctors serving the lowest social classes. All women, however, should be tested for gonorrhea as a routine part of a gynecological exam.