The teaching of the venereal diseases in medical schools

T

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Washington, D. C.

September-October 1970

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Provisional Agenda Item 16 CSP18/DT/2 EN t

27 August 1970

ORIGINAL: SPANISH

THE TEACHING OF THE VENEREAL DISEASES

IN MEDICAL SCHOOLS

Dr. Carlos J. Alarc_n

Head of the Department of Dermatology and

Svphilography of the Central University of Venezuela

Chief of the Division of Venereology of MSAS

CSPI8/DT/2 (Engo)

THE TEACHING OF THE VENEREAL DISEASES

IN MEDICAL SCHOOLS

I. General Considerations

As a result of the discovery of penicillin and of its subsequent use

on an extensive scale in the treatment of venereal diseases, especially

syph-ilis and gonorrhea, there was a substantial decline in the incidence of these

diseases. But it was not long before there was an upward swing which became

progressively more marked until the present situation, which is a cause for

concern throughout the world, was reached° This situation can be described,

without fear of contradiction, as an alarming on_ as these diseases now

undoubtedly present a serious public health problem at both local and

inter-national levels.

The unquestionable initial success of the penicillin treatment created

a false sense of victory and, as a result, medical schools and health services

in the majority of the countries of the world regarded the problem as solved.

For this reason, the systematic and compulsory teaching of venereolog¥

disap-peared from the curricula of most medical schools to a point where the little

that is still taught is incidental to the teaching of dermatology. The same

thing has happened to the clinics that were concerned with the treatment of

patients suffering from venereal diseases, most of which have ceased to exist

as separate services. In Latin America, only two countries (Mexico and

Venezuela) have maintained, as part of their central health organization,

units and divisions especially concerned with the technical supervision and

coordination of the fight against the venereal diseases at the national level.

In other countries, these activities have been absorbed by divisions or

sec-tions concerned generally with the epidemiology of communicable diseases.

Moreover, the venereal diseases have been regarded primarily as a problem of

control of prostitution and, as a result, epidemiological methods of

investi-gation of contacts and health education in venereal diseases have been

neglected. In short, the position today is that there are some countries

that do not have any effective national program to combat the venereal

diseases.

It is, therefore, not surprising that most of the students of medicine

of the past two decades who are now general practitioners, or engaged in

fields closely related to the venereal diseases, failed to receive sufficient

training to enable them to give proper treatment to patients with venereal

diseases of various types and at various stages. This is all the more a

matter of concern since today such patients do not usually go first to see

a specialist in dermatology or in the venereal diseases as they would have

in the thirties, forties and fifties, but rather seek the advice of a general

practitioner.

It is, accordingly, of vital importance that both the general

practi-tioner and the specialist, whichever it may be, should be conversant with the

CSPI8/DT/2 (Eng.) Page 2

We know that, with the appearance of the antibiotics, substantial changes

have occurred in the symptomatologv of syphilis to a point in which cases

arise that even specialists with extensive experience find hard to diagnose

clinically without the assistance of the two basic laboratory tests, i.e.,

the dark field test for Treponema pallidum and routine serological tests, or

in some cases, specialized tests of this kind.

The result of this almost complete ignorance of symptomatologv and of

a lack of awareness of the venereal diseases is that many cases of syphilis

at the contagious stage - both primary and secondary - pass unnoticed or

incorrectly diagnosed and treated, so that they pass on to the latent phases

and subsequently to the stage of serious and irreversible cardiovascular or

nervous complications, becoming chronic hospital cases and finally a charge

on the state.

Another consequence of this situation is that the magnitude of the

problem presented by the venereal diseases is not even partly known. The

fact that there is no system of classification or of uniform statistical data

hampers all efforts to plan any program for the control of these diseases.

We believe that if really effective programs to control these diseases

are to be launched, the teaching of venereology should be expanded, not only

at undergraduate but also at graduate levels. Particular reference should be

made here to the teaching of venereology in schools of public health, whether

they come under universities or directly under ministries of health, and also

to what should be incorporated in courses for other health professions and

related disciplines since this is a problem of equal concern to all.

II. Status of the Teaching of Venereology in Some

Latin American Countries

In order to obtain an overall picture of the present situation of the

teaching of venereal diseases in a number of medical schools in Latin American

countries, we turned on the one hand to the Department of Human Resources of

the Pan American Sanitary Bureau in Washington_ D. C. and on the other to a

group of distinguished professionals engaged in the academic field in a

num-ber of those countries.

The information provided by PASB relates to a relatively recent period

(1967-1968) and was obtained as part of a survey on the teaching of preventive

medicine undertaken by that Institution. In view of its importance, we attach

the table on the teaching of epidemiology of the venereal diseases as

fur-nished by PASB.

It is clear from this table that although practically three-quarters

of the schools included in the survey indicate that they provide instruction

in the epidemiology of the venereal diseases, the time actually given to this

subject is relatively very small, the average being less than three hours a

CSPI8/DT/2 (Eng.) Page 3

With regard to clinical instruction, data was obtained with respect

to 28 schools, generously provided by a large number of the specialists

con-sulted, to whom I would like to express my sincere thanks° We have tried to

summarize the data obtained in the second table, also included in this report.

This information only provides a partial indication of the present

situation as it covers a limited number of schools in relation to the total

number in existence. Nevertheless, it is clear that the instruction varies

from one country to another and probably from one school to another within

the same country. In other words, there is a lack of uniformity in the

approach to the teaching of this subject.

Moreover, the data received shows that such instruction has no separate

identity as in all the schools from which information was obtained it is

inci-dental to the teaching of dermatology. It is, therefore, not unreasonable to

assume that it is not a mandatory subject.

It is also to be noted that within the range of time devoted to clinical

instruction (in the final years of training) very few schools provide a

suf-ficient number of classroom hours to furnish each physician leaving medical

school with an adequate training.

It is also very interesting to observe how little importance, if any,

is attached to the venereal diseases as an integral part of graduate courses,

both in the area of general medicine and in such related fields as urology,

gynecology, obstetrics and pediatrics.

The above information leaves no room for doubt as to the current

defi-ciencies in the teaching of the venereal diseases in the Hemisphere and

the need to take urgent measures, consistent with the seriousness of the

problem, to remedy this situation.

III. Recommendations

From the foregoing, it is clear that what is needed is a joint effort

on the part of health authorities, medical educators and other interested

bodies to obtain proper recognition of the urgency of the health problem

pre-sented by the venereal diseases. In this, the education of the physician and

of other members of the health team has an important role to play. The

follow-ing recommendations are therefore made:

i. Medical schools, schools of public health and other similar

institu-tions in all the countries should include, in both their undergraduate and

graduate programs, mandatory instruction in the venereal diseases. Not only

the academic authorities directly concerned but also teachers of disciplines

related to venereology, such as dermatology, pediatrics, gynecology and

obstet-rics, urology, preventive medicine, etc., should be associated with efforts to

CSPI8/DT/2 (Eng.) Page 4

2. A minimum program of subjects relating to these diseases,

espe-cially syphilis and gonorrhea, should be introduced and should cover:

a) The problem of the venereal diseases in its local and

inter-national aspects.

b) The classification, clinical study, diagnosis and treatment of

the venereal diseases.

c) The control of venereal diseases, particularly with respect to

epidemiological methods, health education and serological surveys.

d) Laboratory techniques used in the diagnosis of the venereal

diseases.

e) The training and use of medical and paramedical personnel in

programs for the control of these diseases.

f) Advances in venereological research.

3. All official and private institutions in contact with the problem,

such as social security agencies, the medical services of the armed forces,

institutions for medical care, both public and private, etc. should be

encour-aged to take an interest in the teaching of venereologv and in research into

the venereal diseases.

4. Consideration should be given to the possibility of preparing an

adequately illustrated manual on the venereal diseases which would include

a full description of the proposed program and which should be issued in the

various languages used in the Hemisphere.

5. Steps should be taken to make use of international financial and

technical resources, to encourage effective programs to combat the venereal

diseases and, in particular, to promote the exchange of visits bv experts in

these diseases between medical schools in various countries.

6. International courses on the epidemiology of the venereal diseases

and on programs for their control should be held for professionals from

var-ious countries of the Region.

7. Committees should be formed in each country to plan and program

instruction in the venereal diseases at the level of medical schools. Such

instruction should embrace two major fields: one covering the microbiological

and epidemiological aspects of these diseases at the pre-clinical stage, and

the other the clinical and therapeutic aspects, and the administration of

programs, to be taken toward the end of medical training.

8. Annual meetings should be arranged to study and evaluate

educa-tional programs and should be attended by representatives of all the countries

of Latin America and of the agencies concerned with the control of the venereal

CSPI8/DT/2 (Eng.) Page 5

9. The various medical schools should be provided with the educational

materials essential to instruction, such as films, slides, et cetera.

i0. Training should be provided for members of other disciplines who

will participate in instruction in the venereal diseases in medical schools.

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