Venereal Disease Program
An Agency to Serve the Public
Next, the exhibit explores how CDC became an agency to serve the public through the “Great Society” program started by President Lyndon B. Johnson. For this program, Congress passed legislation that fought against poverty; protected civil rights; and aimed to improve education, health, and mass transit.
This legislation reflected an expanding belief in social progress – essentially building a greater society in the U.S. In this social context, CDC expanded its public health programs in the 1960s and early 1970s. While surveillance of infectious diseases was still central to CDC’s work, disease prevention was also emphasized. By 1970, the agency’s work included chronic disease prevention, environmental health, injury control, and workplace safety.
Building an Agency: Venereal Disease Control
In 1957, the Public Health Serviceexternal icon, CDC’s parent agency, transferred its Venereal Disease Division to CDC. Venereal disease, or VD, is the older term for what now is referred to as sexually transmitted diseases, or STDs.
While CDC currently studies many STDs, during the 1950s and 1960s the primary focus was on syphilis and gonorrhea. Each of the two diseases is caused by a different bacterium and is spread through sexual contact.
Public Health Advisors
Tasked with stopping the spread of STDs in the U.S., CDC created a new role: the Public Health Advisor, or PHA. PHAs were a corps of college graduates with liberal arts backgrounds who were assigned to state health departments to help organize programs for disease prevention and control. Their jobs were to work in communities to determine which people had venereal diseases, and to encourage those who tested positive for VDs to seek treatment. Once PHAs identified a case of VD, they would ask that person if they would be willing to share information about their sexual and close social contacts. The PHAs would then speak to the contacts to see if they would be willing to get tested for VDs as well. This method of using a confirmed case of a disease’s contacts to find other cases of a disease was called “contact epidemiology.” To this day, CDC frequently uses contact epidemiology to track the spread of diseases, but it is now sometimes referred to as contact tracing.
Shown here is a 1950s contact tracing chart that demonstrates how syphilis spreads in a community. The chart includes people without syphilis, those with unknown disease status, those receiving preventative treatment, and those who do have syphilis. The chart also shows if individuals have a sexual relationship or a close social relationship. Contact tracing charts like these were one of the epidemiological tools the PHAs used to track the health of people in their assigned communities and remain a useful tool for CDC.
Pictured here are Sheppard Tubes, which were used by PHAs to collect blood samples to then test for venereal diseases. Sheppard tubes are glass tubes approximately one-half inch in diameter and four inches in length. The tubes were vacuum packed, helping draw blood into the tube from the patient’s vein once the needle was inserted. The tubes allowed for quick blood sample collection by PHAs.
Public Health Service Syphilis Study at Tuskegee
In 1932, 399 African American men in Tuskegee, Alabama were enrolled in a Public Health Service study on the long-term effects of untreated syphilis. At that time, there was no cure for syphilis, though many ineffective and often harmful treatments, such as arsenic, were used. In the 1940s penicillin was discovered, and by the 1950s it was widely accepted by the medical community as the quickest and most effective treatment for syphilis. The men in the study were not made aware of the availability of penicillin as treatment, however, and the study continued and was transferred to CDC along with the PHS VD Unit in 1957.
The study was intended to last only six months but continued into the 1970s. In 1968, Peter Buxton, a PHS Officer, raised questions about the study. After several years of questioning by Mr. Buxton, several news articles were published, leading to a Senate investigation headed by Sen. Edward Kennedy. It was this investigation that forced the study’s end in 1972. CDC and the Department of Health and Human Services (HHS)external icon acknowledged the study as unethical, ended it, and compensated study survivors for medical care and burial expenses.
Shown above is a letter that then-CDC Director Dr. David J. Sencer wrote to the survivors of the Tuskegee Study explaining that they would receive medical care for the rest of their lives. Also on display is one of the benefits cards that was distributed, which reads, “To Serve Those Who Served,” as well as a photograph of President Clinton with the survivors at the White House, where on May 16th, 1997, he officially apologized to the last living participants. Out of this tragedy came the Belmont Reportexternal icon, a comprehensive document that created new standards of research to protect participants from unethical practices.
Take a closer look:
- What is syphilis and how does it spread? Learn more about syphilis and the bacterium that causes the disease, Treponema pallidum.
- View a close-up image of Treponema pallidum under a microscope and grimace at symptoms of syphilis symptoms on a human hand.
- Learn more about gonorrhea and the bacterium that causes it, Neisseria gonorrhoeae.
- Explore CDC’s STD resources covering prevention initiatives, surveillance, treatment, training programs, and so much more.
- Did you know human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S.? Learn more in this CDC Museum Public Health Academy Teen Newsletter.
From the source:
- Curious how Treponema pallidum, the bacterium that causes syphilis causes such a complex disease? Check out this CDC webinar covering just that.
- Meet Brandy Maddoxexternal icon, Health Scientist in the Division of Sexually Transmitted Disease Prevention at CDC.
- Hear from a CDC expert about her path to public health and her work in adolescent sexual health at CDC in the CDC Museum Public Health Academy Teen Newsletter: September 2020 – Healthy Schools Zoom.
- Keep up with the latest STD updates from CDC on Twitter and Facebook.
- Did you know that there is a vaccine to protect against some strains of HPV that cause cancer? Learn more from the cervical cancer survivor in this videoexternal icon.
- Listen to CDC experts talk about their paths to public health and their work with human papillomavirus (HPV), the most common sexually transmitted infection in the United States in the CDC Museum Public Health Academy Teen Newsletter: January 2021 – HPV Zoomexternal icon.
Then and now:
- Learn more about incidence, prevalence, and cost of STIs over time in the U.S. in this fact sheetpdf icon.
- Read about CDC’s successful STD prevention effortspdf icon in Kansas and Washington.
- View a timeline of the Tuskegee Study and learn how this study informed ethical data collection and changed research practices for good.
- Explore the history of traveling and sexually transmitted diseases in this EID issue.
- Learn about the rise of antibiotic-resistant gonorrhea and CDC measures to combat antibiotic resistance across the U.S.
- Contemplate the impact of the Tuskegee Study on affected familiesexternal icon.
- Read about nurse Eunice Riversexternal icon, the nurse who worked on the Tuskegee Study.
Give it a try:
- How much do you know about gonorrhea? Explore prevention tips, a close-up view of Neisseria gonorrhoeae, and key facts with CDC’s Disease of the Week gonorrhea feature, then try your hand at a short quiz.
- Explore the origins of contact epidemiology with these coloring sheets:
- A Public Health Advisor (PHA) conducts a contract tracing investigation pdf icon[561 KB, 1 Page]
- A Public Health Advisor (PHA) dons gear to conduct contact tracing in the community pdf icon[445 KB, 1 Page]
- A patient shows symptoms to a PHA in order to be diagnosed and treated pdf icon[192 KB, 1 Page]
- How does contract tracing work? Find CDC contact tracing guidance and resources.
- 3D print a model of a portion of human papillomavirus through the National Institutes of Health 3D Print Exchangeexternal icon.
- Looking to expand your knowledge on STDs? Check out these continuing education resources.
- Know your status. Find a testing site near you.
- Take a deep dive into human papillomavirus (HPV), the most common sexually transmitted infection in the United States in the CDC Museum Public Health Academy Teen Newsletter: January 2021 – HPV.