A physician or other person, except persons who merely practice the religious tenets of their church without pretending a knowledge of medicine or surgery, provided, however, that sanitary laws, rules, and regulations are complied with, who knows or has reason to believe that a person whom he or she treats or prescribes for, or to whom he or she sells patent or proprietary medicine purporting to cure or alleviate the symptoms of gonorrhea or syphilis, has one of these diseases, shall immediately report the name, nationality, race, marital state, address, age, and sex of such person, and, if obtainable, the date and source of contracting the same, to the Commissioner on forms furnished for that purpose. Such persons so reported shall submit to regular treatment prescribed by a physician until discharged by the physician. A person who willfully refuses to regularly submit to prescribed treatment shall be reported at once to the State's Attorney for immediate prosecution. Such willful refusal shall be punishable by a fine of not more than $100.00 or three months' imprisonment, or both.