Sexually Transmitted Diseases

Moles, Warts & Skin Tags Removal

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. 

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