No matter how often or how loud the alarums are sounded, no matter the warnings, the articles, the films, the lectures: that body of ills known as the sexually transmitted disease (STD) is going to remain the stuff of the shocked whisper.
Because no matter how sexually free we may think we are, the thought of having one of those, you know, STDs -- well, how does it feel to you?
Would you frankly take your symptoms to your family doctor? And, even if you did, would he be one of so many doctors out there who wouldn't want to "insult" their patients by asking probing questions about certain symptoms?
It is very much too bad. And not just because some of the peskier varieties -- pubic lice (crabs) or scabies, for example -- are relatively easily disposed of.
Even the venerable venereal diseases -- gonorrhea and syphilis -- are beginning to be outrun by a horde of new sexually-transmitted ailments. They range from the merely noisome to those which can effectively sterilize or even kill, or cause a variety of ills in newborn infants, including blindness or death. Most, although not all, are preventable, even curable.
But knowing about them, identifying them early and approaching the problem without fear or embarassment, can certainly ameliorate the long-term effects of even the worst STDs, and perhaps even interrupt the cycle of transmission.
Maria Corsaro, a longtime researcher, clinician and writer on STD, has co-authored with journalist Carole Korzeniowsky a useful handbook simply called "STD, A Commonsense Guide," ($9.95, St. Martin's Press).
It is a candid, no-nonsense guide to symptoms, recommended treatments and tips for prevention. As a public-health VD investigator in the early '70s, Corsaro was appalled to find scores of children with one or more of the 20-plus identified disorders connected with sexual activity and countless men and women who either did not care, or didn't know, what the consequences -- or even the symptoms -- might be.
The STDs are increasingly moving out of the cities, knowing no socio-economic barrier, no respector of wealth, race or sexual preference.
Maria Corsaro is part of a growing group of public-health workers determined to turn the whisper into a clamor, before what is already a national epidemic becomes a national catastrophe.
Among the STD problems are some unique to homosexual men. Physicians have found hepatitis, amoebic disorders, even typhoid fever, which had been sexually transmitted, according to a recent article in Medical World News. Corsaro, in the guidebook, urges that such techniques as STD screening in bath houses be intensified and expanded.
Several of the newly recognized STDs stand out -- because of their widespread nature and their potential for disaster:
Genital herpes virus: This cousin of the cold sore has been the STD most difficult to control because of the nature of the virus. (A relative also causes chicken pox and shingles.)
It huddles in the body's nerve cells and never really goes away.
Its symptoms are painful genital blisters which may recur monthly. In women it has been linked to an increased incidence of cervical cancer and may cause blindness, encephalitis, or worse in infants infected when delivered vaginally while the mother has an active case.
Some promising research on antiviral agents hints that a generally available cure is imminent. Meanwhile, perhaps half a million Americans are infected each year, adding to the bank of several million -- maybe, some suggest, as many as 20 million sufferers.
Corsaro advises: "Do not use ointments on the sores. This can spread the infection. Drying agents like alcohol may help. Keep the area clean and dry. Use a barrier contraceptive." Finally, women with herpes should have PAP tests once, even twice a year because of the possible link to cervical cancer.
The American Social Health Association (ASHA), in Palo Alto, Calif disseminates information on all STDs, has formed a special support system for herpes sufferers. the lack of a cure and, until recently, the lack of much accurate information has made it a source of panic as well as shame and discomfort. And to top it off, outbreaks appear to be linked to stress.
Information on ASHA's two-dozen or so "HELP" chapters (with around 25,000 members) may be obtained by writing "HELP, P.O. Box 100, Palo Alto, Calif. 94302."
Chlamydia: A microorganism associated with the eye disease, trachoma, and now indicated in almost half of all cases of non-gonorrheal inflammation of the urethra. So-called NGU is believed to be twice as prevalent as gonorrhea on college campuses, where even the latter is considered epidemic. The typical male victim of NGU, says Corsaro, is "young, unmarried, heterosexual, white and from a middle or higher socio-economic group." Symptoms are a burning sensation while urinating and a discharge.
The organism can cause eye diseases in everybody, and women are at risk for pelvic inflammatory disease which can cause life-threatening systemic infection. The organism can cause possibly fatal pneumonia in newborn infants.
Chlamydia can be treated, but there are two problems: Women mostly have no symptoms in the early stages, so they must rely on the male partner for even suspicion of its presence. Also, it is difficult to culture and there is no widely available test for its presence. It responds to some antibiotics and can be cleared up in a matter of weeks, says Corsaro, once it has been diagnosed.