By Tedler D. Depaynos, MD
It was quite some time when we had patients suffering from Sexually Transmitted Diseases. We were reminded once again of the cases we encountered when a neighbor colleague over a cup of coffee was recalling a young foreign male student who suddenly appeared recently in his clinic suffering from painful urination or dysuria. The patient volunteered that it was 4 days ago when together with some of his countrymates during a drinking spree somewhere in Metro-Manila he had a sexual contact with one of the “entertainers”. He was much worried that he might “infect” his Filipina girlfriend and who might leave him and all their plans disappearing into thin air.
This is the common history we usually got from our male patients – 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. In other cases which are not treated early, complications may occur and the testicles may enlarge and become tender. Upon examination 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.
There are many types of Sexually Transmitted Diseases (STD) but the one due to Neisseria Gonorrhoeae bacteria is sometimes called simply as G.C. and those due to other bacteria are called Non-Gonococcal Urethritis or non-G.C. From our old textbooks, the G.C. bacteria were originally described by a certain Neisser in the 18th century as anaerobes and diplococcal. Gonorrhea allegedly comes from a Greek word meaning “flow of seed” because “probably the pus was mistaken to be the semen carrying the sperms”.
The STD manifestations maybe similar and although G.C. could be confirmed by Gram Staining and by culture in the laboratory. Most of the time they are diagnosed clinically. After the usual adequate G.C. treatment and there are still the signs and symptoms, either the G.C. bacteria is resistant or the patient has Non-G.C. Urethritis.
It may be that we no longer have the number of patients like before but with the similar experience of our colleagues, the incidence of the disease apparently has decreased. Probably our local bars and pubs no longer employ dubious “entertainers” or perhaps our local Health Centers are stricter in requiring medical certificates from them.
G.C. manifestations in females are usually not significant except sometimes for an 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 peritoneal cavity. With time the fallopian tubes may close causing sterility. Hence, in the cases we experienced earlier we always advised strictly that the partners of our patients should be treated likewise.
I could recall a lawyer wife of a patient who once visited me unannounced asking why her husband consulted me showing the receipt of the medicines I prescribed which her husband bought. Despite the denials of her husband she had strong suspicions and she also insisted that she should also be treated. I was placed in a very tight position and it was good I was quite familiar with the husband so that eventually everything went fine.
The treatment of early G.C. 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 of abstinence while under treatment or until full recovery is assured. **
