Physician's Notebooks 8 - http://physiciansnotebook.blogspot.com - See Homepage
All STD Chapters Update 28 Aug. 2021
Other chaps: 17. Gono and NSU, 18. Syphilis, warts et al. - scroll down)Sexual Transmitted Disease (STD)
16. Introduction to STD
STD is HIV/AIDS, syphilis, genital herpes, gonorrhea and nonspecific urethritis (NSU), genital wart (condyloma acuminata), and cervicitis with pre-cancer lesion. It was called venereal disease (VD). Today it includes some diseases not solely gotten by sexual contact. Virus hepatitis is sexually connected because transmitted by body fluid or product or by needle contaminated with it; but it is also transmitted by fecal-oral and blood transfusion. The HIV is transmitted by all body fluids including breast milk. Main risk factor for STD is your sex partner. In the sex transmission, the more partners per unit time the greater risk. The mutually monogamous, single-partner, strictly hetero lifestyle is safest. When the partners have previously been strangers, it is best that both test for HIV, syphilis and the various virus hepatitis antigens, and get a urinalysis, a urethral smear (for male) and cervical & Pap smear (for female) before sexual contact.
This has been brought about by the advent of HIV/AIDS. Previously, one could just meet a partner and not run a risk of dying badly of HIV or having to live a ruinous HIV long life.
Ideally both partners in a proposed monogamous relationship should vow not to show sexual possessiveness or jealousy in return for honesty of each partner telling the other of outside relationship shortly after the sexual contact. In the situation of a usually monogamous partner having sex with an outside person, a condom should be used every time. Hygiene before each sex contact should include shower or hot bath with particular attention to soap and tolerable hot water cleaning of sexual orifices. (Where bath or shower may not be available or practical just before having sex, using alcohol wipes to clean a partner's asshole and vulva or penis is OK for quick hygiene) Also antiseptic mouthwash, and inspection of body and, in particular, genitals and mouth and lips for any possible pimple or ulcer. (If such found, diagnose and cure before any sexual contact)
17. Gonorrhea and Non-Specific Urethritis (NSU)
Say you, a man, had sex without condom a few days ago? Peeing, you get a feeling between scald and pain in penis then notice discharge that comes out your penis tip without squeezing and yellow-stains your pants.
The above gives diagnosis of gonorrhea and ought to send you, Mr. Man, to infectious disease specialist or urologist at University-HMO (In USA; in other country, big hospital clinic).
Gonorrhea in women affects peeing and may have vaginal discharge. Any cystitis or vaginal discharge should prompt Did I have coitus without condom last 10 days? If Yes, get yourself to infectious disease specialist or gynecologist and be checked for STD.
Women are more at risk because of Pelvic Inflammatory Disease.
I emphasize self-diagnosis by symptom, sign and history because, in women, speed in treatment is crucial to prevent complication. Once you suspect gonorrhea, seek top medical care to confirm diagnosis by smear, culture & sensitivity, and start effective sensitivity antibiotic.
Gonorrhea also can infect the cocksucker (mouth to penis oral sex), causing sore throat; or, after getting penis up asshole, it can cause pain in rectum or irritated feeling there. Medical check for gonorrhea includes throat and rectal culture in addition to urethral and cervical cultures & sensi’s. A complete negative testing, plus other STD tests of yourself and prospective partner should be part of a ticket to mutually monogamous sex relationship in USA today.
The gonococcus is easily killed by heat and immune defense, with a little help from good hygiene. In case of new, untested partner, correct condom use is a must. Sitting in hot bath for 15 minutes after sex has stopped or prevented early gonorrhea infection but is not to be depended on.
NSU, or Non Specific Urethritis: Quite a few men after an attack of gonorrhea (or even without it) get a condition where they are constantly fearful they have STD urethritis. They note small, watery discharge, which they produce by squeezing and milking penis too frequently. They test often but it is usually inconclusive or shows Chlamydia bacteria or a diagnosis of prostatitis is made and antibiotic treatment given with poor result. The NSU burns out after several years. Undoubtedly this is a trashcan diagnosis category of non-gonorrhea urethritis (NGU) that includes some low-grade infection and much neurosis from sexual guilt and minor health paranoia in obsessive types.
The best you can do for self, Mr. Man, if you are so afflicted, is get one good STD check by an experienced infectious disease specialist at top HMO clinic. This is to assure you are not rotting away with a sexual disease. (Or if you are, to diagnose and cure it.) If it does not show important infection, adjust to life with the NSU. Try practicing monogamy with one monogamous partner whose tests also check out negative; or, if no partner, satisfy self by masturbation. In your mind, counter the paranoid thought by thinking, I have NSU but so what! It won’t harm me except by further worrying and I am not going to bother any further about it as long as I practice the present safe sex with good loyal partner or with my hand. What happens afterward is that one day you wake up and remember Oh yes, once I had NSU! In other words tincture of time combines with good sexual hygiene and after a good ruling out of STD will cure most NSU.
18. Syphilis, Wart & Ulcer
Syphilis is an STD spirillum infection that presents as single, firm-feeling shallow skin ulcer or as mucous membrane ulcer (hard chancre in mouth or rectum) at point of contact with another person, typically on shaft of penis or inside vagina. An examining doctor or a sex partner who masturbates others may get it on a finger. It is important to make accurate diagnosis when the chancre appears and not to mistake it for herpes ulcer or insect bite.
Syphilis has 3 stages: The ulcer appears in the early weeks after contact, first as pimple then breaking down to ulcer, and after 6 to 10 weeks disappearing as if healed, even without treatment; then, the secondary stage several months later as flu-like illness with highly infectious rash on body and in mouth, and it too disappears without treatment as if healed; and, lastly, the tertiary stage 10 – 50 years later, which may express as insanity or spinal cord sensory syndrome or a deadly heart valve and main artery disease. Thus, the importance of diagnosing syphilis at the time of the ulcer, treating it correctly and testing for cure!
Syphilis has 3 stages: The ulcer appears in the early weeks after contact, first as pimple then breaking down to ulcer, and after 6 to 10 weeks disappearing as if healed, even without treatment; then, the secondary stage several months later as flu-like illness with highly infectious rash on body and in mouth, and it too disappears without treatment as if healed; and, lastly, the tertiary stage 10 – 50 years later, which may express as insanity or spinal cord sensory syndrome or a deadly heart valve and main artery disease. Thus, the importance of diagnosing syphilis at the time of the ulcer, treating it correctly and testing for cure!
Prevention: As much as reasonable, inspect your potential sex partner’s mouth and lips, and penis or sexual openings before kissing or starting sex. Be highly observant for pimple, ulcer and raw skin that your genitals or lips or tongue may touch, and call a halt to the sex if you spot one. A good way of doing this, and at same time reducing infectiousness if you miss it, is for you and potential partner to bathe and clean each other before the sex. Also make it a habit to inspect your genital area and mouth and lips under good light. A worker in prostitution should get regular (monthly or weekly depending on frequency of business) STD medical examination. The worker should always put a condom on her client from the start.
I have not mentioned blood test for syphilis because it turns positive too late for early diagnosis. But it is useful and indispensable in not allowing later syphilis to slip by. Once the blood test turns positive, it may have been passed to hundreds if one is a prostitute. When you consult a physician, blood testing should always be done.
Risk factors are as for all STDs – the more partners the higher risk. Promiscuity is key risk, and the least-to-zero risk is being faithful to a similarly faithful monogamous mate, ideally a virgin when you start. If not a proven virgin, prevention starts with ruling-out syphilis (and all other STDs) by physical and microscopic examination and blood testing negative. In USA. and Japan (my experiences) consulting an infectious disease M.D. in University-HMO/Clinic is best.
Herpes and lesser known STD Ulcer
Genital herpes differs in that the 1st attack shows many chickenpox-like (tiny central blister and red periphery), painful pimples on or around penis or on or also in vulva-vagina. Also tender, swollen, local lymph glands (in the groin when infection of genitals) and low fever with malaise. Herpes comes and goes in repeated attack where lesions go through stage of acute pimple to small painful ulcer and healing and disappearing after 10 days. Eventually herpes burns out as immunity develops. Its significance is in pregnancy (because of transmission to fetus and newborn) and to person with weak immunity (AIDS, elderly or genetic) in whom it can become generalized and infect brain. (Since year 2000, herpes anti-viral medications, acyclovir and others, are being used; check with your specialist.) The usual sex hygiene with consistent condom use will help prevent herpes. Infection from herpes can be tested for by direct smear and culture as well as blood test, all of which should be part of general STD check before establishing monogamous relationship.
Genital herpes differs in that the 1st attack shows many chickenpox-like (tiny central blister and red periphery), painful pimples on or around penis or on or also in vulva-vagina. Also tender, swollen, local lymph glands (in the groin when infection of genitals) and low fever with malaise. Herpes comes and goes in repeated attack where lesions go through stage of acute pimple to small painful ulcer and healing and disappearing after 10 days. Eventually herpes burns out as immunity develops. Its significance is in pregnancy (because of transmission to fetus and newborn) and to person with weak immunity (AIDS, elderly or genetic) in whom it can become generalized and infect brain. (Since year 2000, herpes anti-viral medications, acyclovir and others, are being used; check with your specialist.) The usual sex hygiene with consistent condom use will help prevent herpes. Infection from herpes can be tested for by direct smear and culture as well as blood test, all of which should be part of general STD check before establishing monogamous relationship.
Lesser known STDs cause an ulcer looking like syphilis. They can only be diagnosed by STD specialist.
Sexual Warts
Sexual Wart termed condyloma acuminatum (plural, acuminata) is not infrequently seen on penis, anus and vulva and in vagina and rectum in person who has sex with promiscuous partner and who along with partner practices poor sexual hygiene before and after sex. It is best treated in STD clinic by chemical, electric, or laser burning, or liquid nitrogen freezing in a series of visits until all lesions are destroyed. It is best to stop having sex with whomever gave you the warts because it may ping-pong back to you after cure from the infectious, promiscuous person. Do not have sex with anyone while you see the warts. A virus that causes sexual warts also causes cancer of the cervix over a 10- to 20-year course, so – You women out there – get it treated well and best of all avoid it by good choice of partner, by limiting to a responsible monogamous relationship and by always doing a good pre- and post-sex hygiene. (When a famous woman dies of cervical cancer, e.g., Eva Peron, Gertrude Lawrence, you can bet and win she got it from too much, multi-partner un-condomed sex!)
End . To read on next now, click 8.19 Stop HIV/AIDS
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