The most remarkable change in patterns of health during the last century has been the largely successful conquest of infectious disease. Less than one hundred years ago diphtheria, tuberculosis, pneumonia, typhoid, and dysentery constituted this nation's greatest health threats; epidemics could devastate a city or town with tragic speed. In 1918 an outbreak of Spanish influenza claimed more victims than did combat in World War I. 1day these diseases are largely under control if not virtually unknown. Although there is considerable debate about the reasons for the decline of these infections -- some credit medical advances while others have stressed a rising standard of living, better nutrition, and natural changes in the host-parasite relationship -- there is no doubt that we have much less to fear from infectious disease than we did even a generation ago. 2
Yet, strikingly, venereal diseases are inadequately controlled, if controlled at all. Given the power of the contemporary media, it seems impossible to be unaware of the current problem. Herpes, a viral infection that is often transmitted sexually, is according to most reports epidemic, affecting perhaps as many as 20 million Americans. With no effective treatments available, it threatens to become endemic. Even more ominous is the new disease known as Acquired Immune Deficiency Syndrome (AIDS). Found primarily among homosexual males, in most cases this disease poses a lethal threat. Again, there is no known effective treatment. Yet even syphilis and gonorrhea, diseases for which cures have been developed, remain in dramatically high proportions. Gonorrhea constitutes the most prevalent bacterial infection on earth, with over one hundred million cases occurring annually; more than two million of which occur in the United States. 3 Why, if we have been successful in fighting infectious disease in this century, have we been unable to deal effectively with venereal disease?
To answer this question, we must examine venereal disease not only as a biological entity, but as a disease that has engaged certain attitudes and values; beliefs about its causes and consequences that in turn affect responses to the problem. A society's response to those who are ill, its employment of medical discoveries and resources, is closely related to its most basic assumptions and