Sexually Transmitted Disease (STD)

Sexually transmitted diseases (aka venereal diseases) are diseases which are or can be transmitted by sexual intercourse (or in many cases also by non-intercourse sexual behaviors..). Traditionally, the five STDs have been syphilis, gonorrhea, chancroid, lymphogranuloma venereum, and granuloma inguinale. Today, it is recognized that there are many such diseases, including nonspecific urethritis, trichomoniasis, chlamydia, genital candidiasis, genital and anorectal herpes, genital warts, vulvovaginitis, proctitis, scabies, pubic lice, HIV infection, salmonellosis, giardiasis, amebiasis, shigellosis, campylobacteriosis, hepatitis A, hepatitis B, and cytomegalovirus. Since there is a strong correlation between papillomavirus infection and cervical cancer, some are beginning to consider cervical cancer as an STD as well.

Gonorrhea is one of the traditional STDs. It is caused by Neisseria gonorrhoeae, a gram-negative kidney-shaped diplococcus. The incubation period is 2 to 14 days in men. Symptoms in men include painful urination, a purulent urethral discharge, and frequent and urgent urination. In women, the incubation period is 7 to 21 days. Many gonorrheal infections are asymptomatic in women. If symptoms are present, they include frequent painful urination, and vaginal discharge. Oropharyngeal and rectal infections are commonly asymptomatic, though sometimes perianal irritation and discharge or sore throat with redness and exudate may be present. If gonorrhea is not treated, disseminated gonococcal infection (infection enters the bloodstream and is transmitted throughout the body) and gonococcal arthritis (infection in a joint) may occur. Sterility can result in both men and women. Recommended treatment is an injection of 250 mg Rocephin (ceftriaxone), followed by a 7-day course of 100 mg doxycycline twice daily.

Chlamydia is one of the most prevalent STDs, often found in combination with gonorrhea. It is caused by Chlamydia trachomatis, and is often lumped together with Ureaplasma urealyticum under nonspecific urethritis. Incubation period in men is 7 to 28 days. Symptoms are usually fairly mild, with slight discomfort on urination and a discharge which can range from clear to purulent. Infections in women are generally asymptomatic. Chlamydial infections can cause sterility in both men and women. Treatment usually consists of 100 mg doxycycline twice daily for 7 days.

Syphilis is probably the most famous traditional STD. It is caused by the spirochete Treponema pallidum. The incubation period can range from 1 to 13 weeks, with the most common being 3-4 weeks.
The primary lesion is a chancre, a painless ulcer at the site of inoculation. It usually heals within 4-8 weeks, and is often overlooked.
Secondary syphilis is characterized by skin rashes, sometimes accompanied by fever, aching, malaise, nausea and fatigue; meningitis can also occur. Lesions on the mucous membranes are extremely contagious. This period can last up to 2 years.
The latent stage of syphilis can last for several years or indefinitely. In this stage the patient is not contagious and appears normal.
Tertiary syphilis can manifest as tissue, organ or bone lesions that destroy portions of whatever tissue they appear in, as cardiovascular syphilis causing heart damage, or as neurosyphilis. Neurosyphilis can manifest as paralytic problems, seizures, dementia, or tabes dorsalis.
Penicillin G is the treatment of choice for all stages of syphilis, with dosages increasing depending on stage and severity.

Trichomoniasis is a STD caused by Trichomonas vaginalis, a flagellated protozoan (REALLY cool, you can see them swimming around under the microscope!). In women, symptoms include a frothy purulent discharge, perineal irritation and painful urination as well as pain during intercourse. In men, trichomoniasis is generally asymptomatic, although some frothy purulent discharge and urethral irritation may occur. Flagyl (metronidazole) is the treatment of choice; women receive one dose of 2 gm, men a 7-day course of 500 mg twice daily.

Candidiasis is an overgrowth of the normal skin organism Candida albicans. It may or may not be transmitted sexually. In women, symptoms include severe vulvar irritation (can you say "just rip it off, it would hurt and burn less") and a thick, curdy, cottage-cheese discharge. In men, symptoms, if present at all, are usually mild irritation of the glans and possible slight urethral discharge. Candidiasis may be triggered by contraceptive or antibiotic use. Treatment consists of either topical or oral antifungal agents (there are a multitude, so they will not be listed here).

Genital herpes is an infection by herpes simplex virus Type 2 (usually; Type 1 also occurs, but uncommonly). Incubation period is 4-7 days after exposure, and the virus permanently remains in the nerve roots, from which it reappears to cause recurrent episodes. The first indication of a herpes outbreak is itching and soreness, followed by a patch of redness on the skin or mucous membranes. Lesions consist of small groups of blisters which break open to form small ulcers. These crust over and heal within about 10 days. Malaise, fever and painful urination may also be present. There is no cure, but Zovirax (acyclovir) helps to decrease the symptoms and help control outbreaks.

Genital warts are caused by the human papillomavirus (HPV). Their incubation period is usually 1 to 6 months. They tend to be soft, skin-colored papules which can grow rapidly and take on a cauliflower-like appearance ( I personally have seen one man with perianal condylomata so extensive that they hindered defecation, and a pregnant woman whose vulvar condylomata were so big that a nurse had to lift them out of the way during delivery..). They can be removed through electrocauterization, laser treatment, cryotherapy (freezing with liquid nitrogen), or surgical removal. Podophyllin or trichloroacetic acid can be applied topically, but are not very effective. Interferon alpha or beta has been used, but has not been studied extensively as of yet. Women with HPV infections must be followed closely due to the association of cervical cancer with HPV infection.

Ok, any more STDs you feel I should include, /msg me.. :-)

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