SEXUALLY TRANSMITTED DISEASES STDs volume one

Sexually transmitted diseases: these are diseases contracted during sexual intercourse.
They are so numerous that they make a broad topic;  hence we shall discuss them in segments.

Today,  we shall be discussing about two examples of STDs Gonorrhea and  Chlamydia infections .
I decided to take these two today,  to enable us understand their almost insignificant etiological/pathological differences and not confuse them again.

The similarity of these diseasesI has lead mostly to their wrong diagnosis in most hospitals and  pharmacies and in turn plunge a lot of persons into the sequels of their poor management.

Gonorrhoea

This is a common human sexually transmitted infection caused by the bacterium Neisseria gonorrhoea.
It has an incubation period (time between infection and disease manifestation) of 2 to 14 days.
It is characterized by some specific symptoms as found below:

In Man
It causes burning sensation during urination (urethritis) and discharges of a whitish and viscous fluid from the penis.

In woman
It is mostly asymptomatic but sometimes presents vaginal dischrage and pelvic pain.

During oral sex
Persons are exposed to "gonorrhea of the throat" when performing oral sex on an infected partner,  usually male. This throat gonorrhea may be asymptomatic but at times,  presents sore throat.

Untreated/poorly treated gonorrhea may precipitate the following complications:

1. Skin lesions

2. Joint infection (pain and swelling of the joint)

3. Endocarditis of the heart (when it settles on heart valves)

4. Meningitis (when it settles in the spinal column)

5. In women, it may cause Pelvic inflammatory disease (infection of the womb,  fallopian tube and ovaries)  and making pregnancy impossible.

6. In man, it may cause epididymitis(noticed by pain in the scrotum) and this may result to infertility

7. Can be transmitted from infected mother,  to child during childbirth,  and in such it causes conjunctivitis.

Gonorrhea can be 'easily' treated if diagnosed on time, and such diagnosis requires some laboratory investigations ( NAATs, culture), which must be carried out on noticing any of the above listed symptoms.

Treatment of detected gonorrhea includes the use of
Ceftriaxone and other third generation cephalosporin.

Chlamydia infection:

This is another std commonly found in human,  caused by the bacterium Chlamydia trachomatis (this specie of chlamydia is found only in human and as an intracellular bacterium).

Modes of transmission includes:

1.  Sexual intercourse (Vaginal, Anal and Oral sex)

2. From infected mother to child,  during childbirth

The symptoms of this disease includes:

In man

• It causes urethritis (painful urination but not always as found with gonorrhea)

• White non-viscous discharge from the penis (watery, as against in gonorrhea where the discharge is sticky like pus) which is also lighter in colour than in gonorrhea.

• Swollen or tender testes

• fever

In Woman

This infection is mostly asymptotic in women,  but sometimes present the following symptoms:

• vaginal bleeding between periods

• Pain in the abdomen (stomach region)

• Painful sexual intercourse

• vaginal discharg

• Fever

• Painful urination

• Urge to urinate more frequently than usual.

Poorly treated/untreated chlamydia infection may lead to the following complications:

In Women

• Pelvic Inflammatory disease (PID) which affects her fertility

• ectopic pregnancy secondary to PID

• Spontaneous abortion in pregnancy

• Premature birth

When transmitted to the newborn,  it causes:

• Pneumonia

• gonococcal ophthalmia (cause of blindnes)

In man

Chronic Epididymitis which may result to abscess formation and testicular infarction (death of the testicles)  and in turn, Infertility and hypogonadism.

This specie of CHLAMYDIA also causes:

1. Trachoma (eye disease) a significant cause of blindness. 
NB Trachoma can be spread from eye to eye by fingers, shared towels or cloths,  coughing,  sneezing,  and eye-seeking flies.

2. Reactive arthritis (Reiter's syndrome)  which is more in men.

Chlamydia infection can be confirmed by some laboratory investigations which are mostly of NAAT type (Nucleic Acid Amplification Tests).

When diagnosed, uncomplicated chlamydia infection can easily be treated using antibiotics which includes:
Azithromycin,  doxycycline,  erythromycin,  or ofloxacin.

ADVICE

1. Adults are advised to always undergo screening tests for chlamydia and gonorrhea whenever they notice changes

2. In the course of ensuring total eradication of these diseases in any patient, any of it is detected, Patient-Delivered Partner Therapy is recommended,  whereby prescription/medication is provided for the patient's sex partner without the partner going for examination.

3. Adults are most advised to stick to one sex partner (whose health status they must know), 

4. Where (3) is not very possible,  disease-protection mechanisms must be employed,  which includes the use of condoms

5. During treatment of gonorrhea,  it is pertinent to include azithromycin or doxicycline,  as chlamydia may occur alongside gonorrhea.

6. Patients diagnosed,  are advised to cease sexual intercourse until they finish their antibiotics regimen.

7. Going for check up after three months of treatment is important,  to ensure there is no chances of relapse (recrudescence or recurrence)

Thanks.

Pharm. Chuka Amukamara (Bpharm, PharmD)
Faculty of Pharmacy
University of Benin.

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