SEXUALLY TRANSMITTED DISEASES
Gonococcal Urethritis (Gonorrhea)
The causative agent of gonococcal urethritis is Neisseria gonorrhoeae, a gram-negative diplococcus. Incubation (incubation period) usually ranges from 3-10 days, although the time required for symptoms (s) to develop may be as short as 12 hours or as long as 3 months. The most common cause of gonococcal urethritis is sexual intercourse. For a male, the risk of transmission as a result of a single relationship with an infected partner is approximately 20%, whereas the possibility of transmission from an infected male to a female is 80%. The higher the number of sexual intercourse with the carrier or sick partner, the higher the risk.
SEXUALLY TRANSMITTED DISEASES Symptoms and Findings:
Burning when urinating
Urethral discharge (The discharge is usually inflamed, yellow-brown in appearance, and very abundant)
Periurethritis, periurethral abscess
Prostatitis, prostate abscess, epididymitis, proctitis, and arthritis can be seen.
SEXUALLY TRANSMITTED DISEASES Treatment and Prevention:
Gonorrhea can be prevented by regular use of condoms and antibiotics after intercourse, intravaginal antiseptic, or antibiotics. Ceftriaxone, Spectinomycin Ciprofloxacin, Norfloxacin, Cefuroxime aksetil, Ceftizoksime, and Amoxicillin can be used in treatment. It is important to follow up with patients after treatment. 3.-7. If urethritis persists on the first day, the development of resistance, postgogococcal urethritis, or re-infection should be considered.
Nongonococcal Urethritis (NGU)
When N. gonorrhea cannot be demonstrated by culture or gram staining in the presence of urethritis, a diagnosis of non-gonococcal urethritis is made. The most important and dangerous agent is Chlamydia trachomatis. It can be shown in the urethra in 25-60% of men with NGU and 4-35% of men with gonorrhea. In 50% of chlamydial infections, there are no symptoms, but they are carriers. Ureaplasma urealyticum is the agent of NGU in 20-50% of patients. It is most common in 20-24 years of age. 50-75% of acute urethritis is nongonococcal. The incubation period is 7-35 days.
Urethral discharge, (discharge is usually small, thin, and mucoid in nature)
Dysuria (burning when urinating) and urethral (urinary tract) itching and stinging sensation.
Treatment and Prevention:
Tetracycline, doxycycline, or erythromycin can be used. Protection from NGU is limited to the use of condoms and vaginal spermicide as in gonorrhea. It is very important to treat the sexual partners of the patient together.
Syphilis (syphilis) is caused by spirochetes called Treponema pallidum. T. pallidum enters the body through the skin and mucous membranes, and a painless chancre (a wound that looks like a stapler) develops on the penis 2-4 weeks after sexual intercourse. Pain is not detected by pressing. If no treatment is given, the lesion will heal slowly on its own. The disease passes to the 2nd stage. Unilateral or bilateral, separate, painless lymphadenopathies (lymph node swelling) can be found in the inguinal region.
The material taken by scraping the base of the chancre is diagnosed by observing the spirochetes by performing a darkfield examination or by fluorescent antibody techniques. If the dark field examination cannot be performed, serological testing should be used. Serological tests can be negative even 1-3 weeks after the chancre appears.
Urological complications are rare and occur in the third stage of the disease. These include testicular gums and neurogenic bladder seen in neurosyphilis.
Penicillin G is given to patients with early syphilis. Doxycycline or tetracycline can be given to those who are allergic to penicillin.
Trichomonas Vaginalis causes the disease. Its incidence is 2%. It is most common in women and men between the ages of 15-40. It is transmitted by sexual intercourse and has been found in 60% of male partners of infected women and 67-100% of female partners of infected men. It is often asymptomatic in men.
Treatment and Prevention:
Condoms should be used until the treatment is successful. Metronidazole is given to the patient and their partner. Immediate response to treatment is obtained. It is very important to treat partners seriously.
Chancroid (Ulcus Molle)
It is formed by Haemophilus ducreyi. The papule seen a few days after sexual intercourse is the first symptom of chancroid. Then, single or multiple, dirty-looking, painful chancroid ulcers appear. Usually, they cause purulent discharge. Patients have fever, headache, and weakness. Untreated ulcers grow slowly, burst, and merge with others. Painful inguinal inflammation causes lymphatic obstruction, and genital lymphedema develops, and in advanced stage elephantiasis. In 50% of the patients, gram-negative coccobacilli are seen when examining the sample taken from the ulcer by gram staining. A biopsy is always diagnostic.
Azithromycin 1 g. single-dose, erythromycin 500 mg. 4 × 1 7 days, ceftriaxone 250 mg. a single dose can be used. It is appropriate to have an HIV test at the time of diagnosis and after 3 months. With proper treatment, the prognosis is very good.
Chlamydia Trachomatis is causative. Genital lesions, lymphadenitis, and rectal strictures can be seen. A papule or pustule appears 5-21 days after sexual contact. The genital lesion is small and often overlooked. The growth of C. trachomatis in culture is diagnostic.
With the rupture of the inguinal (groin) lymph nodes, draining sinuses are formed. Chronic inguinal inflammation can cause lymphatic obstruction and elephantiasis. Rectal stenosis is a late complication.
Doxycycline 100 mg. It is used for 2 × 1, 3 weeks.
It is caused by Calymmatobacterium granulomatis (Donovan bacillus) and the incubation period is 2-3 months.
A papule is the first sign. From this, a firm, indurative, painless ulcer raised from the surrounding skin, base erythematous, and hemorrhagic secretion are formed. The observation of Donovan bodies in a stained smear is diagnostic.
Tetracycline 500 mg. 4 × 1 or trimethoprim-sulfamethoxazole (160/800 mg. Tablet) 2 × 1 is applied until the lesions heal.