SEXUALLY TRANSMITTED GASTROINTESTINAL DISORDERS – CLINICAL FEATURES AND MANAGEMENT
The symptoms of proctitis will vary depending on the cause and may
include anorectal pain, pruritis, mucopurulent or bloody discharge, tenesmus and, in severe cases, constipation. Many anorectal infections are asymptomatic. Erythema, oedema, exudate or tenderness on palpation may be noted on examination. N gonorrhoeae, С trachomatis and HSV are common causes of proctitis. Proctitis may be due to chemicals in lubricants, enemas, and shampoos resulting from direct or allergic contact reactions.
Primary rectal lesions may occur in syphilis, HPV, donovanosis or lymphogranuloma venereum. G lamblia is the predominant sexually transmitted cause of enteritis. Shigella and Campylobacter species and E histolytica may cause colitis or entercolitis.
It is important to be alert to the possibility of sexually transmitted gastrointestinal disease. Clinical assessment should include inquiry about anal coitus and other sexual practices and examination of the anorectal area.
Investigation of proctitis should include swabbing of inflamed areas for microscopy and culture with selective media . Biopsy may be necessary to establish the diagnosis and to exclude malignancy.
Treatment will depend on the cause. Treatment of asymptomatic E histolytica is usually not indicated.
Amoebiasis may involve the cervix, vagina, penis, perineum or anus. Anogenital amoebiasis may be transmitted by sexual intercourse. In tropical areas, amoebiasis should be included in the differential diagnosis of genital ulcer, balanitis and genital and perianal neoplasms. Investigations should include smears or biopsy of the lesion. In third world countries, trial of therapy may be appropriate.
Amoebiasis can be treated with metronidazole (e.g. 2 g orally in one dose daily for 3 days followed by diloxanide furoate 500 mg 3 times a day for 10 days.)
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Filed under Men's Health-Erectile Dysfunction | Comment (0)GENITAL HERPES – MANAGEMENT
At present, no cure is available. Treatment is largely symptomatic and consists of sedatives and analgaesics. Acyclovir (Zovirax), an antiviral agent, can shorten the clinical course of the primary lesion and may benefit patients with frequent severe recurrences. Indications for acyclovir are:
treatment of moderate or severe first episodes of genital herpes (200 mg 5 times daily — each 4 hours while awake — for 10 days);
suppressive treatment for patients with moderate to severe recurrent genital herpes (more than 10 attacks per year with microbiological confirmation) (200 mg 2 to 4 times per day);
treatment of acute lesions in immunosuppressed patients (5 mg/kg by slow IV infusion every 8 hours for 5 days);
suppressive treatment an in immunosuppressed patient with recurrent HSV;
treatment of neonatal infection; and
treatment of ophthalmic infections where idoxuridine proved ineffective (ophthalmic ointment).
Because genital herpes is recurrent and untreatable, patients with HSV are likely to be depressed. Patients and their partners can be assisted by counselling and support. Sexual abstinence should be practised while lesions are active. Patients can be taught to recognise the prodrome and minor symptoms which may indicate recurrence of infectivity. Condoms offer some protection.
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Filed under Men's Health-Erectile Dysfunction | Comment (0)SYPHILIS – LATENT SYPHILIS; LATE SYPHILIS
Positive serology in a patient without symptoms or signs of disease is referred to as latent syphilis and is the commonest presentation of syphilis in Australia today. Possibly because of the widespread use of antibiotics, the infection often proceeds to the latent stage without a recognised primary or secondary stage. An attempt should be made to determine the duration of latency (by asking about previous syphilis serology at the time of blood transfusion, STD or pregnancy, by identifying the occurrence of a primary lesion etc.) because specific treatments for early and late latent syphilis are different
Tertiary manifestations of syphilis may be ‘benign’ with development of gummas (granulomatous lesions) in almost any organ, or more serious with cardiovascular or central nervous system involvement. Benign gummatous disease is rare but cardiovascular disease and neurosyphilis occasionally occur. Careful management and follow up of patients with early or latent disease is essential to prevent late sequelae.
Late syphilis should be excluded in any patient with aortic incompetence or dilatation of the ascending arch of the aorta. Syphilis should be excluded as the cause of dementia, personality change, multifocal neurological disorders, nerve deafness, pupillary abnormalities, retinal disease or uveitis.
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Filed under Men's Health-Erectile Dysfunction | Comment (0)PELVIC INFLAMMATORY DISEASE – MANAGEMENT
Hospitalisation will be necessary if the patient is severely ill or if an
abdominal emergency such as acute appendicitis or ectopic pregnancy has not been excluded. Other indications for hospital treatment include pregnancy, inability to tolerate oral medication, expected poor compliance with oral therapy, failed outpatient management or suspected pelvic abscess. Patients who are prepubertal or adolescent are at risk of severe complications and should be admitted.
Various antibiotic regimens are used depending on the clinical situation.
Therapy should be commenced as soon as possible and not delayed until investigations are complete. Treatment should be selected according to the most probable infecting organism and the severity of symptoms. Hospitalised patients may require intravenous chemotherapy which can be replaced by oral treatment following clinical improvement. Antimicrobial therapy should be continued for at least ten days. Bed rest and sexual abstinence are of benefit during therapy. If an IUCD is present it should be removed following commencement of antibiotics.
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Filed under Men's Health-Erectile Dysfunction | Comment (0)GENERAL STD CONTROL
The major elements of STD control, in addition to effective management of
individual patients, are:
expertise; education; expeditious contact tracing; and, evaluation of epidemiological data.
Expertise
Health authorities in each State and Territory conduct STD centres and clinics to provide an expert service. The centres and clinics generally offer free treatment for patients and provide health workers for contact tracing. They should have access to specialist services such as a gynaecologist, colposcopist, dermatologist and clinical psychologist.
Education concerning STDs should be targeted at:
health care workers (medical students, medical practitioners, nurses, Aboriginal health workers);
high risk individuals (homosexual and bisexual men, prostitutes, intravenous drug users);
school students particularly at secondary level; parents; the general public; and patients and their contacts. Health authorities in States and Territories provide publications on aspects of AIDS and other STDs which may be useful to supplement or reinforce counselling.
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