Dr Bolster's Notes of the Month

Sexually Transmitted Diseases

Sexually transmitted diseases are epidemic in the United States today. They cause everything from a little rash, infertility, major infection and illness, incurable hepatitis and AIDS to cancer and death. Their costs are usually astronomical, both financially, and socially! Most of these maladies are often accompanied with emotional problems that need medical attention also.

How can they be avoided? The answer is actually so simple, I am almost embarrassed to say. The answer is monogamy! If you five times a day with just one person all your life, and that person only has sex with you and you alone, you will never get a sexually transmitted disease. Sexually transmitted diseases can only come from other bodies with which you have had some sort of contact. Please note, I did not say unprotected sexual penetration. It can be transmitted on the hands, by the mouth and even by just touching body parts together. No, sexually transmitted disease cannot be contacted on the toilet seat except maybe bugs and lice. All the others live on warm bodies and die soon after the leave the body. Yes, you can find the AIDS virus, and other bacteria on counters and toilets, etc but, it has not been shown that those organisms are viable in the transmission of disease to another individual. They are transmitted by body and body fluid contact.

Lets look at these one by one:
Gonorrhea: This is a bacteria that has been around forever. It has been called "the clap" or "a drip." It causes a discharge of pus from the male genitalia and burning when he s. It usually begins about twenty-four to forty-eight hours after the contact. Initially, in women it begins more mildly around a week later. It can turn into a roaring infection of the inner female reproductive tract causing a condition known as pelvic inflammatory disease. For the most part it is easily treated with penicillin. Unfortunately, there have been a few strains out of the orient that are not susceptible to penicillin. As a matter of fact there may even be a few that we do not have a good antibiotic to treat it with. In some men, they can get a systemic disease where they get the bacteria in their joints causing a serious arthritis. That usually requires hospitalization for IV antibiotics. With oral contact, gonorrhea can also cause a sore throat. Among those who practice sodomy, a rectal infection can occur. This can be a rather severe illness.

Chlamydia: Chlamydia is the leading cause of infertility in young women today. In men, it causes a milder and more prolonged illness similar to gonorrhea with the drip and burning upon urination. In women, it causes very little symptoms initially. Because there so few symptoms initially, it finds its way into the inner organs quite consistently. There it causes a slow inflammatory process that causes scarring and adhesions of the lower abdominal contents including the female organs, the bladder and sometimes even the bowels. I have often seen this manifest itself as ill-defined cramps and abdominal pain that goes on and on. Unfortunately, each time this disease occurs, more scarring of the female organs occur causing infertility. It is estimated that after four pelvic chlamydial infections, complete infertility is almost certain. In men, an untreated infection can settle in the testicles. That infection really hurts! It is called epididymitis. Before it was routinely treated prophylactically, it often caused blindness in newborns. We have some good antibiotics to treat chlamydia. The problem is getting people to get treated before they give it to someone else or it causes more serious problems.

Syphilis: The granddaddy of the STD’s. It begins as "primary syphilis" as a painless open sore, a chancre (pronounced "shanker"), on the genitalia about a half an inch to an inch in diameter. By the time you see the chancre, the bacteria has gone throughout the whole . condary syphilis starts as a rash about three months after the initial contact. It causes large lymph nodes, generally feeling lousy and various aches and pains. About a third of the untreated individuals will progress on to have late phase syphilis about twenty years later. This affects the aorta and the brain. Fortunately, all phases of syphilis are treatable with penicillin if detected early enough.

Trichomonas is a little bigger than bacteria. It is a parasite. It causes nothing in men. In women, it causes a vaginal irritation and a foul odor. It too is easily treated with a medicine that gives you a metallic taste sensation for a week.

These are the major bacteria that cause sexually transmitted diseases. There are a few others but far less common than those I have listed. Now lets talk about the viruses. This list seems to get longer every year. The worst thing about these sexually transmitted viruses is that these "VIRUSES ARE FOREVER!" Any virus you contact can recur.

Herpes: About a week after one has sex with someone that has an active herpes disease, the new lesions will appear. A very uncomfortable burning or tingling in the skin where they will appear precedes the lesions The lesion is characterized by an inch circle of small blisters. The virus enters the body and resides on the on a nerve. It reactivates from that site about three or four times a year as the burning and the blisters. These blisters are teeming with the virus. Generally speaking, there are no major medical consequences of herpes. They are, however, very hard to explain to your spouse. They are only acquired by contact.

Human Papilloma Virus: Here is an interesting one. It is easily transferred by contact. It does not have to be coital contact. It never goes away. In some victims it seems to do nothing" these are the carriers. In others it causes these ugly growths on their genitalia. In pregnant women, they grow to incredible proportions. I have seen them as large as cauliflower. But far worse than that, in women, it causes cervical cancer. That’s right, Cervical Cancer s a sexually transmitted disease! We are not totally sure it is the only causative agent of cervical cancer but we are sure it does.

Hepatitis B: Hepatitis B, Hepatitis C and the virus that causes AIDS are all caused by "Body fluid to blood contact." A portion of these are caused by sharing needles in drug addicted individuals. The greatest number of cases are sexually transmitted. They were made rampant in the 70’s and 80’s by the frequent encounters in the community. In men these viruses are transmitted by either sharing a needle or by sodomy. Sodomy is rectal sex. It is fairly difficult for men to acquire these viruses via "normal" relations with a woman. The exception to this is if the man should have a sore or lesion like a syphilis chancre on his genitalia and has sex with an infected woman. He can easily contact the disease by exposure of that open lesion to her secretions. For women, it is a different story. They can acquire it from an infected male during regular coital sex. There are a few cases where the virus enters an otherwise "innocent" individual via a needle stick, or an unscreened blood transfusion. These are the exception these days. A last group of "innocent" victims are the unborn of AIDS infected women.

Summer is here and pool time is upon us. The kids are out of school and if they are lucky, they are in and out of the pool two or three times a day. Not everyone has a pool in their backyard or their neighbor's backyard but they still go to the municipal pool or summer camp or on the family vacation. The important point to realize is that getting into the pool or the river or the water slide or wherever puts one at risk of developing Swimmers Ear. The medical term for Swimmer's Ear is "otitis externa." It is a common problem that can be relieved with good medical attention. Swimmer's Ear hurts! If it happens to you or someone you love, take heart, it is treatable. Please bring that sore ear into the office before it gets so swollen that it is hard to get the medicine all the way into the ear canal.

How can you prevent Swimmer's Ear? For the most part, it is fairly preventable. The obvious way is to be sure that you are swimming in clean water. That water quality is not always so easy to determine. The next way is to clean your ears after each swimming session. I tell patients that after they are finished swimming, they need to clean their ears with hydrogen peroxide. If that is not available, at least use clean tap water. After this rinse, be sure the water is removed from your ear canal. That is best achieved by pulling a tissue up at the center and twisting it into a kind of spiral tissue stick that then is inserted into the ear canal in a spiral twisting motion. As it enters the ear canal, it collects the water and softens. Unlike the famous Q-tips, a sprig of soft tissue paper cannot do damage to the ear canal. Sometimes, when there is a good deal of liquid in the ear, it may be necessary to use a second dry piece of tissue. The only caution of this procedure is to be sure that you do not use so flimsy a tissue that it is going to tear off and get lodged in the canal. That could accumulate bio-debris and promote infection.

Otitis Externa is an infection that requires antibiotic treatment. Bacteria known as Pseudomonas or staphylococci usually cause the infection. Sometimes some a fungus can complicate this infection. The eardrops prescribed usually cover both bacteria and fungus. If you or someone you love have an ear pain, it is likely an infection. Please do not let these go. The longer an infection lasts in the ear canal, the more swelling occurs. If the canal is too swollen, we have a hard time getting the medications in.