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This paper shows how Lex Veneris was structured around a consensual agreement between the GP, the patient and the authorities involved. Responsibility for this legislation was shared by the National Board of Medicine, the Contagious Diseases Officer and the country's local GPs. Most cases caused no problems, with the patient consenting to provide information concerning their partner and agreeing to follow the recommended medical treatment. Nevertheless, the paper could also conclude that the legislation was put into practice with a certain degree of arbitrariness. This arbitrariness clearly created voids where certain patients did not fit in, such as patients who did not understand the importance of complying with the instructions given by their GP or simply did not want to. These patients were then followed up. Moreover, a larger proportion of women reported as sources of infection or medical treatment dissenters in Stockholm were taken in for examination and compulsory medical care. A smaller proportion of the men were subjected to compulsory medical examination and care. The paper also looked at those who failed to comply with doctors' orders. Who ignored the GPs and decided to choose for themselves? The qualitative material stored with the Lex Veneris ledgers in the Swedish archives provides a wide-ranging picture. This paper has used some of this information to shed light on how the legislation was put into practice. The qualitative material reveals the most about the cases in which the police and local health boards were involved in trying to bring dissenters back into medical care. The police searched for numerous young men and women. Families, former lovers and employers were often questioned in order to find the recalcitrant. This work was given high priority status by the police and was painstakingly carried out, with the police locating most patients within a couple of days. It is obvious that Swedish society tried hard and committed itself to rooting out these diseases. Extensive, costly legislation was put into place in 1919 and remained unchanged until 1966. Swedish physicians stood by the idea that compulsory contact tracing and mandatory medical treatment was the way to get to grips with venereal diseases. Lex Veneris was part and parcel of the creation of a social citizenship. This citizenship came at a high price for those who chose or happened to find themselves on the on the wrong side of the law.

The incidence of Chlamydia trachomatis infections in Sweden is increasing. The primary health care encounters many of the patients with C trachomatis infections. The aim of this study was firstly to examine if the primary health care met the requirements of the Swedish STD legislation and secondly to find out why the testing was done. A total of 44 case-books of patients tested positive for C trachomatis in Orebro county were studied. Contact tracing was ignored in a fourth of the patients identified as contacts. In four cases partners received treatment without testing. Not even half of the patients were examined after treatment as required. Symptoms were the most common reason for testing. Dysuria was the predominant symptom. Almost half of all the cases in women but none in men were diagnosed by screening or voluntary testing in asymptomatic patients. In to many cases the primary health care did not meet the requirements of the STD Act. This must improve. Generous testing of asymptomatic women is supported by this study. Chlamydia trachomatis infection should be considered in patients with cystitis. Voluntary testing in men should be encouraged.

Since 1989 the reporting of chlamydia infections is regulated by the Contagious Diseases Act, which stipulates that a physician who detects chlamydia is obliged to trace the patient's sexual partner(s). Up to 1994 the annual decrease in the number of chlamydia cases was 20 percent, which did not meet the goal stipulated by the County Council. A questionnaire study was carried out concerning diagnosis, treatment and public health intervention in chlamydia patients seen by general and private practitioners. While the clinical management was seen to adhere to the recommendations of the National Board of Health, adequate tracing of sexual contacts was not carried out in 20-45 per cent of the cases. In a major urban area, such as the County of Stockholm, referral of all chlamydia cases to specialist clinics could possibly improve not only the care of the patients but also the success rate in reaching their sex partners.

Four different types of contact tracing for partners of Chlamydia trachomatis infected patients were compared with respect to reinfections during two 15-month periods in 1979/80 and in 1983/84. Between the two study periods a gradual improvement in contact tracing occurred. No reduction in overall reinfections was observed in the second period, reinfections occurring within 12 weeks were similar in the two periods. Treatment of the regular partner (by giving the woman a prescription for her partner) without examination or further partner follow-up resulted in few reinfections. A system of partner referral without verification that partners actually appeared for examination resulted in significantly more reinfections by the regular partner than a system with non-mandatory verification: 60 of 997 women (6%) compared with 6 of 645 (1%). The addition of C. trachomatis infection to the existing STD legislation resulted in fewer identified partners refusing examination than previously, one of 254 men (0.4%) compared with 40 of 223 (18%) before legal inclusion.