figure-probably an underestimate-is impressive in terms of both dollars and cents and human suffering.The problem of non-recognition and the reluctance of physicians to report gonorrhea have been long-standing concerns to public health officers charged with responsibility for the control of this and other venereal diseases. Following the onset of the penicillin era, many primary care physicians became less sensitive to the potential seriousness of gonorrhea in the adult and even less inclined to report the cases they treated. Possibly this trend was accentuated by the fact that the majority of the cases they saw were uncomplicated and the patients themselves assumed that cure was an easy matter. By the very nature of the symptomatology, patients seriously ill with complications of gonococcal infection-such as arthritis, endocarditis, meningitis, the Fitz-Hugh-Curtis syndrome, or one of the many other manifestations of disseminated disease-seek care in the emergency rooms of hospitals or from specialist physicians. Here again, once Neisseria gonorrhoeae has been identified as the underlying culprit, reporting the disease and tracing the contacts may be ignored.There are no effective vaccines currently available against the venereal diseases. Hence accurate, complete reporting and diagnosis, adequate treatment, follow-up of cases, and the tracing of contacts are the pivotal components of a public health program to fulfill mandated responsibilities for their control and prevention. In this context the findings reported from the state of Washington are distressing. Whether identified in the private or public sector of the health care system, timely information on incidence and prevalence is essential to the development and execution of control measures and the monitoring of their effectiveness. Effective care for the patient with urethritis and the prevention of disease transmission require as definitive a diagnosis as possible prior to treatment, the use of appropriate medication in fully therapeutic doses, and post-treatment follow-up. Penicillinase producing N. gonorrheoae (PPNG) are identified primarily through post-treatment follow-up with test-of-cure culture.Effective contact tracing for control and prevention depends upon as high a level of reporting as possible. The discovery that a significant number of asymptomatic men are infected and may be transmitting disease to others was made only because male contacts of infected women were traced and brought to examination.7 8 Handsfield, in a recent study, found that as many as 40 per cent of the male contacts of women with pelvic inflammatory disease were bacteriologically positive, albeit asymptomatic, and reinfecting their partners.9
