Sketchy information for some of the tropical African countries comes from a paper by Dr. Guthe dated 1961, and gives curves for gonorrhea and syphilis that begin in 1946 or later and end in 1957 or 1959. In the careful language of the report, the pattern for this region is described as "somewhat different" from that of most other countries:

A curious inference can be drawn from the most recent statistics which is contrary to widespread belief: the rising incidence of VD in the United States does not seem to be more marked among the younger age groups than the others. An increasing incidence of VD among teenagers in Sweden was shown by a Swedish study in which careful mapping of annual case rates of gonorrhea by age group from 1916 to 1959 resulted in roughly but acceptably parallel curves for all groups, with similar peaks and valleys, except for the age group 15 19, in which a rise unmistakably greater than that in the other age groups appeared after World War II.

Official United States statistics for fiscal 1969 showed the highest incidence of both gonorrhea and early syphilis in the most populous areas, especially the big cities, and in the southern states. For primary and secondary syphilis the states and territories showing the highest levels were the entire east west belt of southern states except California (the only one somewhat below the average), plus New York, Maryland, and Illinois.

The first thing to look at is the trend of VD in US and elsewhere in so far as we can make it out. Our information on this score is all recent. Mortality statistics began to be published in the United States only in 1900, and included deaths from syphilis. Figures for illness as well as for death were published earlier for members of the U.S. Army as well as for military groups in other countries; but reporting of syphilis as illness in the civilian population of the United States began consistently only after Surgeon General Parran's campaign was under way, in the year 1940 41. So our first national figures for syphilis and other venereal diseases are hardly thirty years old as I write.

All reported disease statistics are subject to error, but VD statistics suffer more than others. People with reportable diseases do not always reach a doctor pr a clinic, or may go undiagnosed or mis-diagnosed. There is both under-reporting (cases missed) and over reporting (mistaken diagnoses).

A few years after the end of World War II we seemed to be in a position to solve the VD problem once and for all. On top of all we had before, there was penicillin inspiring a growing confidence that it would wipe out both syphilis and gonorrhea; and there were all sorts of new and encouraging bits of technology, among which the TPI test promised to do away with the nagging false positive blood test problem in syphilis.

A World Health Organization study from Copenhagen in 1969 found the highest proportion of resistant gonococci in 1967 1968 in Thailand, Taiwan, Vietnam, and Hong Kong. Other reports had noticed a high rate of failure in treatment in South Korea, as well as in Japan and on the west coast of the United States.

There is reason to believe that our troubles in treating gonorrhea are due at least partly to negligence and delay: we might have scotched it if we had acted more quickly. Now it looks as though syphilis, in which we have faced pretty much the same set of problems except penicillin resistance, is capable of following gonorrhea into the same predicament.

Beginning in 1962 Pierre Collart and his group at the Fournier Institute in Paris stirred up a small hornets' nest not many people seem to have been interested at the time they announced that active spirochetes may persist in the tissues after apparently satisfactory treatment of late syphilis.

We need to anticipate a little at this point to recognize that immunity in syphilis, such as it is, develops very slowly. The details must wait for our examination of the possibility of making a vaccine. Slow development means that when syphilis is completely cured in its early stages there is no immunity at all.