Sexually Transmitted Disorders or STD:
A group of contagious sexually related disorders results from infection
that is transmitted through sexual contact. These disorders include
gonorrhea,
chlamydial
infections, trichomoniasis,
genital herpes, genital warts,
syphilis,chancroid,
and AIDS.
Chlamydial
Infections: The most common sexually transmitted disorders
in the United States, the infecting agent is Chlamydia trachomatis,
a bacterium. Chlamydial infection include urethritis ( inflammation
of the urethra; - a passage through which urine is discharged from
the bladder to the exterior or the body) in men, and cervicitis ( inflammation
of the cervix ) in women, and lymphogranuloma venereum or LGV ( mark
by a primary transient ulcerative lesion of the genitals, cause by chlamydial
infec. ) for both male and female Because many of theses infections may
produce no symptoms until late in their development, sexual transmission
usually occurs unknowingly.
If left untreated, chlamydial infections can lead to other complications
such as acute epididymitis ( inflammation of the epididymis; the
ducts of which the spermatozoa are stored ), salpingitis (inflammation
of the uterine tube), Pelvic inflammatory disease, and even sterility.
In pregnant women, chlalmydial infections can an has been associated with
spontaneous abortion, premature delivery, and possibly neonatal death.
Children born of infected mothers may contract trachoma ( an contagious
disease progresses from a mild infection with tiny folicles on the eyelid
conjunctiva to invasion of the cornea, with scaring and contraction which
may result in blindness ), otitis media (ear infection ), and pneumonia
during passage through the birth canal.
Symptoms:
Varies with the specific type of infection.
LVG: the primary lesion is a painless vesicle or
non-indurated ulcer, 2 to 3 mm in diameter ( usually unnoticeable ). Develops
regional lymphadenopathy after 1 to 4 weeks
Inguinal lymph node swelling about 2 weeks later Systemic symptoms
include: myalgia, headache, fever, chills, backache, and weight loss
Proctitis: infection of the rectum may produce:
diarrhea, tenesmus ( ineffectual and painful straining at stool or in urinating
), prorates (itching ), bloody or mucoopurulent discharge (containing mucus
and or pus or both ), diffuse or discrete ulceration in the rectosigmoid
colon.
Cervicitis: cervical erosion, mucopurulent discharge,
pelvic pain or dyspareunia ( painful intercourse )
Endometritis or Salpingitis: Possible pain, abdomen tenderness,
cervix, uterus, and lymph nodes tenderness. vaginal discharge, and
or painful urination ( dysuria )
Urethral syndrome: dysuria, pyuria ( pus in
the urine ), and or urinary frequency
Epididymitis: Painful scrotal swelling and urethral
discharge
Prostatitis: may have low back pain, urinary frequency,
painful urination, nocturia ( voiding at night ), urethral discharge and
or painful ejaculation.
Urethritis: dysuria, erythema and tenderness of
the urethral meatus, urinary frequency, pruitus, or urethral discharge
Your doctor may take a culture sample and serologic tests, to determine
infection.
Treatment:
Antibiotic therapy 7 to 21 days Patients with LGV requires extended
treatment,.
* If you are infected with this and or other STD disorder;
please inform your sex partner or partners so they can get treated and
to prevent the spread of disease.
* Call your doctor if you have any of the above symptoms or if
you think that you may have been expose to STD.
Chancroid:
This venereal disease is also called soft chancre, it is marked
by painful genital ulcers and inguinal adenitis (inflammation ot the groin
gland). Although it occurs worldwide, ti is especially common in
tropical countries and affects males (more so with uncircumcised male)
more than females. Chancroidal lesions may heal spontaneously and
usually respond well to treatment if no secondary infections exist.
It is caused by a nonmotile, gram-negative streptobacillus called Hemophilus
ducreyi.
Symptoms:
After 3 to 5 day incubation period, a small papule appears at the site
of entry, usually the groin or inner thigh.
In the male - it may appear on the penis
In the female - it may appear on the vulva, vagina, or cervix
Occasionally this papule may erupt on the tongue, lip, breast, or navel
The papule or papules may rapidly ulcerates, becoming painful,
soft, with a bad odor (malodorous), it may bleed easily, and produces pus.
It is gray and shallow, with irregular edges, and measures up to 1'
in diameter.
Approximately 2 to 3 weeks, inguinal adenitis develops, creating suppurated,
inflamed nodes that may rupture into large ulcers.
May experience headache, and malaise,
During healing stage, phimosis ( constriction of the orifice of the
prepuce (foreskin of the penis) so that it cannot be drawn back over the
glans ) may develop.
Your doctor will want to take a gram stain smears of ulcer exudate,
and or do a blood agar cultures. Biopsy confirms the diagnosis but
is reserved for resistant cases or those in which cancer is suspected.
Dark - field examination and serologic testing rule out other venereal
disease, which cause similar ulcers such as, genital herpes, syphilis,
or LGV.
Treatment:
Co-trimoxazole, usually cures chancroid within 2 weeks. Sulfonamides,
erythromycin may be used to prevent detection of coexisting syphilis.
Aspiration of fluid - filled nodes helps prevent the infection from spreading.
* If you are diagnosis with chancroid, do not apply creams, lotions,
or oils on or near genitalia or on other lesion sites. Abstain from sexual
contact until healing is completed ( usually 2 weeks after medication treatment
) and wash the genitalia daily with soap and water.
* For uncircumcised males; retract the foreskin to thoroughly clean
the glans penis.
* Understanding the prevention of STD is essential.
Genital Herpes:
also known as simplex virus type 2 or venereal herpes.
This is one of the most common recurring acute, inflammatory infection
of the genitalia. It is caused by herpes simplex virus type 2.
prognosis varies according to the strength of his immune system, age, and
the infection site. Genital herpes is usually self limiting but may
cause painful local or systemic disease. Genital herpes can be severe,
with complications with high mortality rate, in such patients as those
with weaken immune system, neonates, and in those with disseminated (scattered)
disease.
Genital herpes is usually transmitted by sexual contact, and
may also be spread by contaminated toilet seat, towels, and bathtubs though
very rare. Pregnant women may transmit the infection to their neonates
during vaginal delivery, such transmitted infection may be localized such
as, the eyes, or disseminated and may be associated with CNS involvement.
Complications are rare and usually arise from extra genital
lesions. These include hepatic keratitis, which may lead to
blindness, and potentially fatal herpes simplex encephalitis.
Symptoms:
Fluid filled, painless vesicles appearing after a 3 to
7 day incubation period.
In women; they occur on the cervix (most common site) and possibly
on the labia, perianal skin, vulva, or vagina and leukorrhea. In the men;
the glans penis, foreskin, or penile shaft Extra genital lesions may occur
in the mouth or anus For both men and women; the vesicles will rapture
and develop into extensive, shallow, painful ulcers
Edema
Inguinal lymph nodes
Fever
Malaise
Dysuria
Your doctor may order lab work and or tissue culture
Treatment:
Medication to treat genital herpes such as Acyclovir (zovirax)
For those with suppress immune system or high risk patients, may need
to be hospitalize for treatment. For those with recurring outbreaks your
doctor may prescribe a suppressive therapy consisting of zovirax
200mg 3 to 5 times a day for 6 months
For all medication: Use as directed by your doctor
For pregnant women your doctor may do a cesarean section if cultures
are positive ad due date.
Avoid sexual intercourse during the active stage of this disease ( while
lesions are present ) Please inform your sexual partner if you are diagnosis
with any STD, so he/she can also be treated and to prevent the spread of
the disease.
Women who are infected: have a Pap smear about every 6 months.
* Good nutrition, adequate rest and stress reduction to help reduce
subsequent outbreaks.
* You may want to contact the Herpes Resource Center an American
Social Health Association group for support in your area.
Genital Warts:
Also known as condylomata acuminata or HPV (human papilloma virus),
these warts consist of papillomas with fibrous tissue overgrowth from the
dermis and thickened epithlial coverings ( characterize by soft wart like
growth on the genitals ) It is caused by the human papilloma virus (HPV),
which also cause common warts. Genital warts is usually transmitted through
sexual contact, but in children it may be transmitted with or without sexual
contact.
Symptoms:
After 1 to 6 month incubation period, genital warts develop on moist
surfaces
In males; appearing on the subpreputial sac, within the urethral meatus
and less commonly, on the penile shaft.
In females; it usually appears on the vulva and on vaginal and cervical
walls. Vaginal discharge. Abnormal bleeding ( usually after intercourse)
In both; papillomas spread to the perineum and perianal area.
Genital sores ( may start out as tiny red or pink swelling)
Genital lesions
Cauliflower like appearing on the genital and or on and around the anus
Itching
Treatment:
Treatment aims to eradicate associated genital infections.
The warts may resolves spontaneously. If not, topical drug therapy is
needed, medication such as; trichloroacetic acid, podopohyllum in tincture
of benzoin . (Podopohyllum is contraindicated in pregnancy) * With
all medications, use as prescribe by your doctor.
Warts larger than 1' (2.5cm) are usually removed by surgery, cryosurgery,
electrocautery or 5 - fluorouracil cream debridement.
* If using podophyllulm, wash it off after 4 to 6 hours with soap
and water after application.
Recommended use of condom during intercourse until healing is complete.
Protect the surrounding tissue with petrolatum before using trichloroacetic
acid
Regularly wash genitalia with soap and water.
Females: To prevent vaginal infection, ; avoid feminine hygiene
sprays, frequent douching, tight pants, nylon underwear, and or
panty hose. Pap smear should be taken every 6 months or as advised
by your doctor.
Gonorrhea:
Gonorrhea: This common venereal disease infects the genitourinary
tract (especially the urethra and cervix ) and may occasionally infect
the rectum, pharynx, and may even affect the eyes. Reinfection is
common, but after adequate treatment, the prognosis in both males and females
is excellent. Gonorrhea is prevalent in young unmarried adults
If Gonorrhea is left untreated, it can spread through the blood
to the joints, tendons, meninges, and endocardium. Children and adults
with gonorrhea can contract gonococcal conjunctivitis by touching their
eyes with contaminated hands. Children
born of infected mothers can contract gonococcal ophthalmia neonatorum
during passage through the birth canal. ( Routine instillation of 1% silver
nitrate or erythromycin in the eyes of all neonates immediately after birth
for prevention) Other possible results of untreated disease include
gonococcal septicemia ( more common in females than in males ), sterility,
corneal ulceration, blindness and arthritis.
Neisseria gonorrhoeae, is the organism known to cause gonorrhea.
Gonorrhea is transmitted almost exclusively through sexual contact with
an infected person.
Symptoms:
Most females remain asymptomatic, but inflammation and a greenish yellow
discharge from the cervix are the most common symptoms.
Males may be asymptomatic, but after a 3 to 6 day incubation period,
they may show signs of urethritis, including dysuria (painful urination),
purulent urethral discharge, and redness and swelling at the infection
site.
Symptoms varies according to the site involved:
* Urethra: dysuria, urinary frequency and incontinence,
purulent discharge, itching, red and edematous meatus
* Vulva: burning and pain caused by exudate from an adjacent
infected area, occasional itching
* Vagina: engorgement, redness, swelling, and profuse purulent
discharge (excessive pus like discharge). ( most common site in children
over age 1 )
* Pelvis: Severe lower abdominal and pelvic pain, muscle
rigidity, tenderness, and abdominal distention. As the infection
spreads may experience fever, nausea, vomiting, increase heart rate may
develop in patients with salpingitis or PID
* Liver: right upper quadrant pain in patients with perihepatitis
* Eyes: conjunctivitis (most common in men) with unilateral
conjunctival redness and swelling; and gonococcal ophthalmia neonatorum,
with lid edema, bilateral conjunctival infection and abundant purulent
discharge 2 to 3 days after birth.
Other possible signs and symptoms include pharyngitis, tonsillitis,
rectal burning, itching, and bloody mucopurulent discharge.
Your doctor may take a culture from the site of infection to diagnosis
infection. Gram stain showing gram negative diplococci supports the diagnosis,
and usually confirm gonorrhea in males.
Treatment:
For uncomplicated gonorrhea : Your doctor may order 1 g of probenecid
by mouth to block penicillin excretion from the body, followed in 30 minutes
by 4.8 million units of aqueous penicillin G procaine injected I.M. at
2 separate sites in a large muscle mass. If patients is allergic
to penicillin, your doctor may prescribe tetracycline by mouth or spectinomycin
I.M. Because many patients with gonorrhea may also have chlamydial
infection, tetracycline or doxycycline by mouth for 7 days may be prescribe.
Gonorrhea complicated by severe PID or septicemia requires I.V. antibiotic
therapy with doxycycline and cefoxitin for 4 to 6 days, followed by doxycycline
P.O. for an additional 10 to 14 days.
* To confirm that gonococcal infection has been cured, a follow
up cultures are necessary 4 to 7 days after treatment and again in 6 months
and or before delivery in pregnant women.
Syphilis:
Syphilis: This Chronic, infectious venereal disease begins in
the mucous membranes and rapidly becomes systemic, spreading to nearby
lymph nodes and the bloodstream. The infecting agent is the spirochete
Treponema pallidum. Syphilis spreads by sexual contact during the
primary, secondary and early latent stages of infection. For those
expecting mothers who has this disorder, it may be spread to the neonate
through the placenta.
Syphilis rank the third most prevalent reportable infectious
disease in the United States, and more common between the ages of 15 to
39. If left untreated syphilis leads to crippling or death.
Prognosis is excellent with early treatment.
Symptoms:
Clinical features vary with the stage of the disease:
Primary syphilis: Applies to a period of 3 weeks after contact.
Patients may develop chancres - small fluid filled lesion on the genitalia,
fingers, anus, lips, tongue, nipples, tonsils, or eyelids that eventually
erode and develop indurated ( becomes abnormally hard), raised edges and
clear bases. Regional lymphadenopathy may also occur (disease of
the lymph nodes)
Secondary syphilis: Applies to a period from a few days to 8 weeks
after the onset of initial chancres. Patients may exhibit a rash
which can be macular (a distinguishable by color, thickening , spot), it
can be papular ( a small circumscribed, solid, elevated lesion of the skin),
or it could be nodular (resembling nodules), and it can be symmetrical
mucocutaneous (pretaing to mucous membrane and skin) lesions. Macules commonly
erupt between rolls of fat on the trunk and, proximally on the arms, palms,
soles, face, and scalp. Condylomata lata may develop it drives in warm,
moist areas such as the perineum, scrotum, vulva, and between rolls of
fat, the lesions may be enlarge and erode, producing highly contagious,
pink or grayish white lesions. Watch for signs of general lymphadenopathy;
mild constitutional symptoms such as headache, malaise, anorexia, weight
loss, nausea, vomiting, and sore throat. Patient may have brittle and pitted
nails, possible a low grade fever, and may have hair loss (alopecia).
Latent syphilis: Characterized by an absence of symptoms
Late syphilis: This stage includes three subtypes; late
benign syphilis, cardiovascular syphilis, and neurosyphilis. Any
or all may be present during this stage.
* Late benign syphilis: the typical lesion is a gumma
- a chronic, superficial nodule or deep granulomatous (a tumor like mass)
lesion that is solitary, asymmetrical, painless, and abnormally hard
(indurated). Other symptoms may affect the liver, causing
epigastric pain, tenderness, enlarged spleen, and anemia; also the
patient may develop upper respiratory involvement with potential perforation
of the nasal septum or palate.
* Cardiovascular syphilis: The patient may develop aortitis
(inflammation
of the aortic), aortic regurgitation, or aortic aneurysm, or the patient
may experience no symptoms at all.
* Neurosyphilis: meningitis and widespread CNS (Central
nervous system) damage, symptoms includes, general paresis (slight or incomplete
paralysis ), personality changes, and arm and leg weakness.
Treatment:
Antibiotic therapy, treatment of choice is penicillin I.M. For early
syphilis, treatment may consist of a single injection of penicillin G benzathine
I.M. Syphilis of more than 1 year's duration should be treated with penicillin
G benzathine I.M. for 3 weeks.
Patient who is allergic to penicillin may be treated successfully with
tetracycline or erythromycin - 15 days for early syphilis; and 30 days
for late infections; usually by mouth 4 times a day.
* Important to complete the course of therapy even after symptoms
subside.
* Have a recheck scheduled appointment with your doctor after
3, 6, 12, and 24 months to detect a possible relapse.
* For patients who is treated for latent or late syphilis should
receive blood tests at 6 months intervals for 2 years.
* Please inform your sex partner of his infection so they can
receive treatment, and to prevent the spread of this disease.
Trichomoniasis: This protozoal
infection of the lower genitourinary tract affects about 15% of sexually
active females and 10% os sexually active males. The infecting agent
is Thrichomonas vaginalis. Most commonly spread by sexual contact,
trichomoniasis may also be spread by contaminated douche equipment or moist
washcloths, or if the mother is infected, via vaginal delivery. In
females, the condition may be acute or chronic. Recurrence of trichomoniasis
is minimized when sexual
partners are treated concurrently. Risk factors for infection
include bacterial overgrowth, pregnancy, exudative vaginal or cervical
lesions, frequent douching and
use of oral contraceptives.
Symptoms:
Usually patients experience no symptoms.
Acute infection may produce variable signs and symptoms; Women
may experience a vaginal discharge (gray or greenish yellow and possibly
profuse, frothy, and bad smell to it ( malodorous ), patient may experience
"strawberry spots" on the cervix, severe itching, redness, swelling, tenderness,
dyspareunia ( difficult or painful intercourse ), dysuria ( painful urination
) and urinary frequency. Females may also experience spotting after intercourse
( postcoital ), menorrhagia ( excessive menstruation ), or dysmenorrhea
( Painful menstruation ).
Men may develop transient mild to severe urethritis, dysuria, or urinary
frequency.
Treatment:
Metronidazole by mouth is given to both sexual partners, prognosis is
excellent.
Females, a mild douche with a vinegar and water solution may help acidify
vaginal pH, consult your doctor.
* do not douche before being examined for trichomoniasis, and
or pelvic exams.
For pregnant patient, your doctor may prescribe clotrimazole vaginal
tablets/cream at bedtime for 7 days. * As with all medication use as prescribe
by your doctor.
After treatment, both sexual partners need to have a follow up examination
by your doctor to check for residual signs of infection.
To prevent reinfection during treatment, abstain from intercourse, or
use condoms.
* Important - When using metronidazole treatment, abstain
from alcoholic beverages, because alcohol consumption may provoke a disulfiram
- type reaction ( confusion, headache, cramps, vomiting, and convulsions
). Using metronidazole may turn
urine dark brown.
