* This is a sexually transmitted disease caused by the bacteria Neisseria gonorrhoeae.
* Urethritis (males)-initially: burning on urination, clear or milky penile discharge, then 2-3 days later, a pain in the urethra (tube where urine goes out), followed by a yellow, creamy penile discharge. In addition, the prostate gland and epididiymis (tubes above testicles) may become painful and inflamed. * Proctitis-this is a rectal infection that has anal discharge. Most common in male homosexuals. * Throat infections-sometimes occur via oral sex * Cervicitis (women)-infection inside the vagina at the opening of the uterus. Vaginal discharge may or may not be present. Urinary symptoms often occur. Infection may spread to the tubes (pelvic inflammatory disease), which causes severe pelvic pain, leading to scarring in the tubes. The infection may also spread to the rectum. * Disseminated disease-sometimes the gonorrhea may spread to the rest of the body, causing diffuse joint pain/stiffness, fever, and diffuse rash. Very rarely, meningitis can occur. * Conjunctivitis-an infection and inflammation in the eye. It occurs in adults when a person with gonorrhea rubs their eyes after touching infected body fluids.
* Discharges from the urethra (males) and cervix (females) slides/smears may be done. * DNA probes of urethral or cervical discharge is the most common test
* Uncomplicated: * Ceftriaxone 250mg-one injection only * Ciprofloxacin by mouth, but some bacteria are resistant * Spectomycin injection is an alternative injection for penicillin-allergic individuals * Pelvic inflammatory disease: * Cefoxitin, Cefotetan, Clindamycin+Gentamicin, Cefoxitin + oral Doxycycline * Also: Chlamydia infections often co-exist at the same time with gonorrheal infections and should be treated as well (Doxycycline or Azithromycin commonly used).
If you suspect this condition
Both you and your partner need to be treated. Untreated, infections may lead to more chronic and severe infections. In addition, this infection can cause scarring in the tubes of females, which may result in infertility.
* Chlamydia trachomatis infection is very common among young adults and teenagers. However, many people do not know that they have chlamydia, because although they are infected they may not have any symptoms. About 75% of infected women and half of infected men exhibit no symptoms. * Chlamydia trachomatis is an atypical bacterium that causes two different general forms of sexually transmitted diseases. The first type is an urethritis/cerviticis (infections in the urinary tract of males or in the cervix of the uterus in females). The second type is called lymphogranuloma venereum that begins as an ulcer (in the genital area).
* Sexually transmitted
* Urethritis-male * Burning with urination * Discharge from penis * Cervicitis-female * May have no symptoms * Thick, malodorous vaginal discharge (white to yellow) * Bleeding between menstrual periods * Lower abdominal or pelvic pain * Lymphogranuloma venereum-male * Blister lesion/ulcer in genital area (may not be noticed) * Swollen glands in the groin-may have multiple * Multiple draining areas in the groin * Lymphogranuloma venereum--female * Discharge (bloody puss) from rectum * Anal pain * Rectal pain after a bowel movement * Constipation
* DNA probe (swabs) of the cervix * Culture not usually done because expensive * IgM immunofluorescence (blood test)
* Erythromycin * Doxycycline * Azithromycin * Sexual partner(s) need to be treated
* Chlamydia infections often scar the fallopian tubes (tubes that carry eggs from ovaries to uterus), a leading cause of infertility in the United States. It is important that individuals and their sexual partners be treated promptly.
Also known as Primary syphilis, secondary syphilis, or the great imitator
Description Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. The infection is usually transmitted person to person through minor cuts in the skin or mucous membranes (genitals or mouth) during sexual intercourse. Syphilis has three stages: Primary, Secondary, and Tertiary.
* Primary Syphilis: * Genital ulcer-usually painless with firm, indented borders * Swollen lymph glands in the groin * Secondary Syphilis: * A rash is usually composed of red lesions that can either be small or large. The rash is also present on the palms and soles of the feet (only a few conditions have a rash in these places) * Condylomata Lata-sweeping skin lesions in the moist areas of skin and mucous membranes * Silvery ulcer patches on the mucous membranes (mouth or vagina) * Diffuse lymph node swelling in the body * Yellow skin or eyes (occasionally) * Low-grade fever * Lack of energy * Loss of appetite * Joint and muscle aches * Headaches * Neck stiffness (rare-a sign of meningitis) * Eye inflammation
* VDRL or RPR are screening tests * FTA-ABS (antibody test for syphilis) confirms the diagnosis * Microscopic exam-dark field microscopy techniques show Treponema pallidum from material that has been aspirated from lesions of the affected regional lymph nodes
* Gonorrhea * Chlamydia * Chancroid * Herpes * HIV
* Penicillin by injection is the treatment of choice * Alternatives include Tetracycline, Doxycycline, or Azithromycin * There is no need for local treatment of lesions * Jarisch-Hersheimer reaction, the sudden killing of the Treponema pallidum bacteria that results in the release toxic products, may occur. This causes fever and a worsening of the current symptoms. * Treatment should not be stopped unless the symptoms are severe. Antipyretics (fever reducing medications such as Tylenol or aspirin) and corticosteroids can be used to prevent or modify this reaction. * The Jarisch-Hersheimer reaction generally resolves itself in 24 hours.
* Safe sex practices. Abstinence is ideal until the syphilis is properly treated. * Condoms are only effective in the covered areas * Exposed parts should be washed with soap and water after sex (both males and females) if couples do not refrain from engaging in sexual relations. * Persons exposed to syphilis in the preceding 3 months should be treated for presumed syphilis, as blood tests may initially be negative.
Also know as Condyloma, Venereal warts, Condylomata acuminate
Description Genital warts are a type of venereal diseases caused by human papilloma virus. This virus has many subtypes and some of them cause warts on skin and genital mucosa including anus. Cervical cancer of uterus is also related with infection with some specific subtypes.
* Single or clustered flesh colored growings on the genitals or anal area * Tiny, flat, and soft mass in the beginning * Sometimes cauliflower-like looks when grown up * Usually no symptoms but it may cause itching, tenderness, abnormal vaginal bleeding in women
How the Diagnosis Is Made
* Inspection(genital examination) * Biopsy * Colposcopy * Pap smear
* Sex with infected partners * Multiple sexual parters or unknown sex parters * Smoking * Vitamin deficiency * Decreased immunity due to medications or medical conditions such as AIDS
* Application of caustic agents * Surgical excision * Ablation with laser * Cryotherapy * Alpha-Interferon injections
* Bleeding * Secondary infection with bacteria or fungi * Obstruction with the birth canal when masses of warts become too large
* Sometimes spontaneous healing may happen * Recurrence is common with treatment
* Avoid sexual contact with multiple parters or unknown persons * Using condom may offer some protection from transmission but not always cover against infection
This is a sexually transmitted disease caused by the bacteria Haemophilus ducreyi. It often occurs simultaneously with other sexually transmitted diseases, such as herpes, syphilis, and HIV infection.
* Sexual transmission * Contact with lesion by medical personnel
* Pus-filled blister initially * Lesion then rupture and become ulcerated * Multiple lesions then form, often joining together * Women may have the disease with lesions * Swollen lymph glands * Lymph glands may burst * Fever, chills, and malaise * Inflammation of the head of the penis * Inflammation of the clitoris * Foreskin of penis becomes narrowed
* Culture on a special petri dish
* Syphilis * Herpes
* Antibiotics-many work well: * Azithromycin-single dose by mouth * Ceftriaxone (Rocephin)-single dose injection * Augmentin * Erythromycin * Ciprofloxacin
Description Scabies is an infection caused by the mite Sarcoptes scabiei. Infections occur when newly fertilized female mites are transferred from person-to-person through close contact. Crowded, unclean conditions and sexually promiscuity increase the risk of contracting scabies. Medical personnel are also at increased risk of infection.
* Sever itching of the infected area * Blisters or scabbed blisters in runs or burrows on finger webs, the heel of palms, and wrist creases * Small red raised lesions on the penis shaft
* Scrapings of lesion are viewed under a microscope. The presence of mites, ova (eggs), or feces confirms the diagnosis. * Burrow ink test involves ink being placed on the burrow and then scraped. The mite, ova, and feces can be seen under the microscope.
* Bedding and clothing should be cleaned and set aside for 48 hours. * A one-time application of Permethrin 5% cream for 8 to 12 hours is recommended. This regimen is safe and effective. * Lindane cream is more toxic than Permethrin and may pose dangerous side effects in children due to potential neurotoxicity. * Benzyl benzoate lotion may also be applied * Corticosteroids may be used for dermatitis (skin inflammation) that are caused by scabies.
* This is an infection in the vagina that occurs because there is an imbalance between "good", normal vaginal bacteria (i.e., Lactobacillus), and so-called "bad bacteria" (an overgrowth of the bacteria Gardnerella vaginalis, Bacteroides, Mycoplasma Hominis, and Mobiluncus). * It is most common in women of childbearing age, those with IUD's, those who douche, and those with multiple sexual partners. It is also seen in sexually inactive women. The cause is unknown, but it is thought to stem from the loss of a normal balance of vagina flora. Symptoms
* Vaginal discharge with a bad/fishy odor-thin, milky-white or gray discharge * Vaginal irritation or itching is sometimes present * Redness outside the vagina * There may be burning during urination * There may be no symptoms at all * There may be an increased chance of developing pelvic inflammatory disease (PID), or an increased risk for other sexually transmitted diseases. * Women with bacterial vaginosis who are HIV positive may have a higher chance of transmitting the virus to their sexual partners (as well as being infected by a HIV positive partner) than women without bacterial vaginosis.
* Flagyl (Metronidazole) by mouth * Clindamycin by mouth * Clindamycin vaginal cream * Metronidazole gel vaginally * Use protection (condoms) at all times * Do not douche
MISC Pregnancy Concerns
* Pregnant women with symptomatic bacterial vaginosis or a history of pre-term (premature) labor should probably be treated. In patients that have no symptoms and no history of pre-term labor, treatment of bacterial vaginosis does not seem to be needed, with no increase in the risk of pre-term labor.
* Hepatitis refers to an inflammation of the liver. Hepatitis B is a specific type of hepatitis caused by the hepatitis B virus, which is usually transmitted by blood products, or sexually. Hepatitis B can cause an acute infection or a chronic (persistent) one.
* Homosexual behavior * Intravenous drug abuse * Medical professionals * Hemodialysis workers * Infants of mothers with hepatitis B
First phase (lasts 2-3 weeks): * Fatigue * Not "feeling well" * Loss of appetite * Nasal discharge * Sore throat * Skin rashes * Joint pain * Fever or chills * Nausea/vomiting * Abdominal pain * Diarrhea or constipation
Second (Icteric) phase (occurs 5-10 days after first phase): * Yellow skin or eyes * Usually other symptoms improve * Third (convalescent) phase: * Continued steady improvement * Chronic persistent hepatitis: * May have none * Fatigue * Loss of appetite * Chronic active hepatitis: * May have none * Fatigue * Yellow skin or eyes may be present
Diagnosis * Skin-yellow skin or eyes * Liver tenderness * Spleen tenderness * Elevated AST, ALT, and total bilirubin * Hepatitis B antibody testing to confirm diagnosis * Acute: positive HBsAg, HbeAg, Anti-HBc IgM * Chronic persistent: positive HBsAg, positive Anti-Hbe IgG * Chronic active hepatitis: positive HBsAg, Anti HBc IgG (& low levels IgM), HbeAg * Liver biopsy to diagnose chronic forms
* Infection with delta agent. This is a secondary agent on top of the infection with hepatitis B. It can make the infection much more severe. Diagnosis is made by checking for anti-HDV in the blood. * Hepatocellular (liver) cancer-patients who have been infected with hepatitis B are at much higher risk of developing liver cancer * Liver cirrhosis
* Acute hepatitis: * Avoid Tylenol and alcoholic beverages. Bed rest as needed. No medical treatment. * Chronic active hepatitis: * Alpha-Interferon * Lamivudine
* Hepatitis B vaccine: * Hepatitis B vaccine now exists and is routinely given during childhood immunizations. It is also given to high-risk adults, e.g., medical professionals. * Hepatitis B immune globulin immunization for pregnant mothers * Universal blood precautions * Condoms may reduce or eliminate the chances of contracting hepatitis B from sexual relations.
Description This is an infestation of tiny, parasitic insects (singular louse) that attack the skin of the scalp, trunk, and pubic areas. Lice infestation is transmitted person-to-person and via intimate objects that tend to be shared (brushes, combs, towels, hats, etc.). Lice are 3-4 mm long, making them barely visible to the naked eye. Body lice are usually found in the seams of underclothing, and generally go to the body only to feed. Hair and pubic lice are located in these areas.
* Head louse * Body louse * Pubic louse ("crabs")
* Poor hygiene * Overcrowded living conditions * School children may pass to each other * Sexual transmission
* Intense itching * Raw skin from scratching * Nits (tiny "willow buds") of lice eggs in hair
Diagnosis From appearance of nits or lice found
Complications Trench fever, relapsing fever, and typhus are all diseases that may be transmitted by lice.
* Scabies * Seborrheic dermatitis * Eczema
* Lindane lotion (scabies) * Permerthrin 1% cream * Petrolatum for eyelid involvement * Special combs with tightly meshed teeth are available for mechanical removal of lice from hair.
Herpes is a disease caused by the Herpe svirus. Genital herpes is predominantly caused by Herpes virus 2, but Herpes virus 1 (which usually manifests as cold sores on the lips) may cause it as well. Herpes virus 2 is sexually transmitted. It can also infect fetuses and cause fetal abnormalities. Neonatals are often infected at birth when passing through the vaginal canal. The first outbreak of Herpes tends to be the worst. Once one has been infected, they tend to suffer recurring outbreaks on a regular basis (for example twice a year), with subsequent occurrences generally lessening in severity.
* Small grouped blisters * Blisters eventually crust * Burning/stinging
* Multiple tests can be done to confirm: * Tzanck smear * Viral cultures * ELISA * Immunofluorescence tests
* Birth defects * Baby infected during delivery * Encephalitis-infection of the brain * Herpetic Whitlow-infection spreads to fingers of health care workers who touch the lesions
* Chancroid * Syphilis * Pyoderma
* Acyclovir ointment * Oral medications * Acyclovir * Famvir * Valtrex * Low dose oral Acyclovir is used to prevent recurrent attacks in individuals who get multiple outbreaks.
* Avoid sexual contact during an active outbreak. Unfortunately, sometimes those with Herpes will have the virus without symptoms. Condoms also offer some protection from transmission, depending on the location of the outbreak.
ALSO KNOWN AS: Acquired Immune Deficiency Syndrome or HIV infection
DESCRIPTION: AIDS is caused by infection with the human immunodeficiency virus HIV-1. The HIV virus infects cells in the body that fight infection. The primary cell infected is the CD4 lymphocyte, but it infects other infection-fighting cells as well. This causes immune system impairment and difficulty fighting infection. Because the immune system has a role in cancer prevention, there is also an increase in certain cancers. To be HIV positive means that one is infected with the HIV virus. To be given the diagnosis of AIDS, one must be infected with HIV, which means that the HIV infection has compromised the immune system to
the extent that an AIDS-defining illness (one of multiple illnesses) has occurred. Before current "triple therapy" was developed, nearly all those who were HIV positive went on to develop AIDS. Now it is not the case. But, not all persons respond to "triple therapy" and a proportion still goes on to develop AIDS.
SYMPTOMS: * HIV syndrome occurs 3 to 6 weeks after infection and includes :
* Symptoms of any opportunistic illness (i.e., bacteria, fungi, protozoa, and viruses) * Some may not develop any symptoms for years after exposure. * Candidiasis (white patches in mouth) * Pneumocystis carinii (lung infection characterized by dry cough and shortness of breath) * Atypical mycobacterium * Toxoplasmosis (infection in brain with confusion) Progressive multifocal leukoencephalopathy (causes dementia) * Herpes simplex (causes ulcers that persist over 1 month) * Lymphoma (enlarged glands) * Kaposi's sarcoma (purple skin lesions) * Diarrheas -- cryptosporidosis and isoporiasis * Recurrent pneumonias * Tuberculosis (cough) * HIV encephalopathy (dementia) * HIV wasting syndrome * Cytomegalovirus infection /blindness * Cryptococcosis (especially meningitis) * Disseminated coccidiomycosis (fungal infection found in Southwest United States, typically affects lungs, but in HIV may go into spinal fluid and cause meningitis) * AIDS wasting (weight loss) syndrome * Depression and social/family isolation * Neuropathies * Pain
* HIV can be found in many types of bodily secretions (i.e., semen, urine, tears, saliva, blood, breast milk, spinal fluid, vaginal secretions). However, the risk of transmission is highest through semen and sexual activities. * Anal sex -- highest transmission rate * Heterosexual sex, homosexuals, bisexual males who engage in unprotected sex * Intravenous drug abusers who share needles * Oral Sex -- lower, but risk still present * Blood and blood product transfusions between 1977-1985 (now rare, because blood products are carefully screened) * Contaminated needle stick as in healthcare professionals (1:300 risk) * Children born to mothers with HIV infection * Not spread through casual contact such as touching, hugging, or sharing toilet seats * Not transmitted by insect bites such as mosquitoes * No documented cases of HIV infection from saliva or tears; however, if there is an open sore on the skin or mouth, the risk increases.
HOW THE DIAGNOSIS IS MADE
* Examination: * May be normal * Signs & symptoms of AIDS-defining illnesses (see below) * Laboratory Findings:
1. HIV antibody test -- the HIV virus multiplies in the body for weeks or months before the body responds by making antibodies to it, at which time the HIV test is considered positive. Decreased CD4 lymphocyte (also known as T-helper cells) count (the lower the count the more likely to develop infections and illness) 2. Symptoms begin to occur with CD4 count falling below 350/ml 3. Anemia 4. Polyclonal hypergammaglobulenimia 5. High cholesterol 6. Skin antigen testing fails to react to typical antigens
* The goal of treatment is to keep CD4 count above 200/ml, prevent/control opportunistic infections, and improve the quality of life. * Anti-retroviral drugs (Highly Active Anti Retroviral Therapy or HAART) -- these interfere with the HIV virus' ability to replicate. Some common ones are listed below: * Nucleoside analogs
* Triple therapy -- it has been found that combining two nucleoside analogue drugs with one protease inhibitor can substantially reduce the viral burden, infection rate, and death rate in HIV infection.
* Post-exposure prophylaxis (e.g., after a needle stick)
1. AZT probably beneficial 2. AZT plus other antiretroviral drugs probably will be shown to be more effective.
* Before the more effective "triple therapy" was developed, various regimens were recommended to prevent specific infections. For example, Trimethoprim- Sulfamethoxazole for Pneumocystitis carinii included various regimens that are now reserved for those who fail to respond or are intolerant of "triple therapy."
1. Abstinence 2. Safe sex (use of condoms and oral barriers) 3. HIV testing prior to a relationship 4. Stop intravenous drug abuse, sharing of dirty needles, and other high-risk behaviors. 5. Healthy lifestyle and join support groups if at risk