Sexually Transmitted Diseases

The incidence, prevalence, and variety of sexually transmitted diseases have increased remarkably in recent years. These include the five classic venereal diseases (gonorrhea, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale), together with urethritis, vaginitis, hepatitis, genital herpes virus, and acquired immunodeficiency syndrome (AIDS). Serious consequences of these diseases have also increased: spontaneous abortions, ectopic pregnancies, pelvic inflammatory disease, infertility, cervical carcinoma, and death. Additionally, 60% of patients who have one sexually transmitted disease have been shown to have another. In light of these facts, examination and treatment of all sexual partners are strongly recommended.

NONGONOCOCCAL URETHRITIS

Chlamydia trachomatis is believed to be the most common cause of nonspecific urethritis in males (followed by Ureaplasma urealyticum, Mycoplasma hominis, and Trichomonas vaginalis). It has a prolonged incubation of 5 to 21 days and produces a watery or mucoid, whitish discharge with or without dysuria.

Reiter’s Syndrome

Reiter’s syndrome is a rare complication of nongonococcal urethritis caused by C. trachomatis, which presents with arthritis, conjunctivitis, balanitis circinata, or keratodermia blennorrhagia.

GONORRHEA

Gonorrhea is caused by a Gram-negative intracellular diplococcus, Neisseria gonorrhoeae. It has a short incubation of 2 to 8 days and most often produces a purulent, yellowish, urethral discharge with dysuria. (Up to 45% of males with gonococcal urethritis will also be infected with C. trachomatis.) Complications of gonorrhea in males include epididymitis, prostatitis, seminal vesiculitis, and urethral strictures.

Diagnosis

Diagnosis is based on a history of sexual contact, a purulent discharge with dysuria, and a positive Gram’s stain (intracellular Gram-negative diplococci within polymorphonuclear leukocytes) and/or culture. The specimen for culture and Gram’s stain must be carefully taken from within the urethra using a calcium alginate urethrogenital swab (Calgiswab) at least 1 hour after the patient last voided. A modified Thayer-Martin culture medium should be directly inoculated followed by prompt incubation. After culture inoculation, the swab should be rolled onto a clean microscope slide that is then air dried, heat fixed, and Gram stained. The presence of intracellular Gram-negative diplococci makes the diagnosis. Routine urine cultures should also be obtained.

SYPHILIS

The spirochete, Treponema pallidum, is the causative pathogen in syphilis. It usually gains entrance through the intact skin or mucous membranes of the penis. Syphilis has been called the “great imitator” because of its varied manifestations as it progresses through defined stages.

Primary syphilis is characterized by the chancre, a painless, shallow ulcer with indurated borders that appears 10 to 30 days following infection. It is generally solitary and lasts for 1 to 5 weeks.

Secondary syphilis is characterized by highly infectious macular papular or papulosquamous skin eruptions involving the palms and soles, the oral cavity, and the anogenital areas with generalized adenopathy.

Latent syphilis is without signs or symptoms of the disease; however, the spirochete has persisted in the body and has invaded all organs, most characteristically the cardiovascular and central nervous systems (e.g., tabes dorsalis). The patient remains potentially infectious for approximately the first two years of the disease.