By Tedler D. Depaynos, MD
The male patient came to the hospital two weeks ago because of difficulty of urination or dysuria. The MDs who saw him were suspicious of a Sexually Transmitted Disease or STD but because the patient was adamant in denying any contact, he was treated for a simple Urinary Tract Infection or UTI.
He faithfully took the prescribed medicines but he felt his left “orchid” enlarging and getting painful. Because of the severity of the pain and the non-relief of his dysuria, he rushed himself to the same hospital and even pleaded to be admitted quickly.
Despite his persistent denials, the MDs treated him for STD with complications.
Uncomplicated STD is simple to treat but with complications, it would take a longer time and higher dosage to treat. In general STD does not respond to the antibiotics given for UTI.
There are many types of STD but the one due to Neisseria Gonorrhea bacteria is sometimes called GC and those due to other bacteria are called Non-Gonococcal Urethritis or non-GC. From our old textbooks, the GC bacteria were originally described by a certain Neisser in the 18th century as anaerobes and diplococcal. Gonorrhea allegedly comes from a Greek word that means “flow of seed” because “probably the pus was mistaken to be the semen carrying the sperm”.
The STD manifestations maybe similar and although GC could be confirmed by Gram Staining and by culture in the laboratory, most of the time they are diagnosed clinically just like in this patient. For most MDs, while treating GC, antibiotics for the non-GC are also given. This is what was done to the patient.
The common history we usually got from our male patients is a history of sexual contact and after 3-5 days, dysuria. In other cases they manifest a “morning drip” which is actually the pus accumulated during the night exiting thru the penis in the morning sometimes just staining their underwear. It is not manifested during day time because the pus is washed or admixed with the urine. With complications, the testicles may enlarge and become tender and the epididymis which is the tract draining the testicles of sperm or even the prostate which provides the liquid where the sperm swims may also be infected and become tender. This is practically what happened to the patient.
GC manifestations in females are usually not-significant except sometimes through increase of vaginal discharge. Complications may also occur so that the bacteria may enter the endo-cervical area causing infection of the uterus or even the fallopian tubes causing “salphingitis”. In rare cases it may be mistaken as “acute appendicitis” especially if the pus spills into the right peritoneal cavity. With time the fallopian tubes may close causing sterility. Fortunately, with this patient he is no longer cohabiting with his wife for as a rule, partners of patients must also be treated.
The treatment of early GC may be simple. Usually it is just a single injection or sometimes divided into 2 and injected in both buttocks. Because of severe pain some practitioners add local anesthesia to the formula to lessen it. Oral antibiotics are then prescribed usually taken for at least 10 days to take care of the non-gonoccocal bacteria. For chronic or resistant cases treatment may be more complicated so that it is better that more experienced MDs on infectious diseases should be consulted. They are advised of course abstinence while under treatment or until full recovery is assured.
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