As recently as the 1960s the term venereal disease (named for Venus, the goddess of love) referred to five well- known diseases. Syphilis and gonorrhea were the most prevalent. These diseases were reasonably well understood from a medical perspective.
The rise of STDs
With the 1970s, however, came a sexual revolution. Venereal disease (VD) became known as sexually-transmitted disease (STD). STD was thought to be a term less judgmental and more to the point. Fortunately, with the sexual revolution came the knowledge revolution.
Grouped under the term STD are those infections that people used to talk about under their breaths. We used to think of VD as a disease that is picked up by soldiers in foreign countries or by virginal youngsters using public toilet teats. Today, due to increased sexual activity and variations of sexual technique, STDs are in the public eye to a much greater extent than in the past. People now understand that these diseases are caused by sexual contact and not contaminated toilet seats.
It will not be a shock to most of you to hear that STD is on the rise in this country. The U.S. Public Health Service estimates that there are two million new cases of gonorrhea; 1 500,000 new cases of genital warts; 100,000 new cases of syphilis; and 400,000 to 500,000 new cases of genital herpes each year. Each of these figures is expected to increase dramatically in the next decade.
Media coverage of genital herpes in the last year or so may become responsible for generating a positive effect on the STD statistics. While this new awareness will not cause a decrease in the statistical numbers, the widespread fear of genital herpes may at least be a slowing force in the growth of the numbers. An August 1982 article in TIME magazine reported that: “Those remarkable numbers are altering sexual rites in America, changing courtship patterns, sending thousands of sufferers spinning into months of depression and self-exile and delivering a numbing blow to the one night stand. The herpes counterrevolution may be ushering a reluctant, grudging chastity back into fashion.”
The difficulty in controlling STDs stems from the age-old feelings of embarrassment people feel when they contract a disease and their unwillingness to identify their sexual partners. Since most of those partners also require treatment, matters only get worse. Society as a w ole pays the price for general lack of communication and cooperation. Until genital herpes rose to its existing heights of infamy, syphilis and gonorrhea were the two best-known STDs. We will take a brief look at several of these other sexually transmitted diseases to help you better understand our target disease. Some STDs can be cured with a single visit to the physician and others, as we have already seen, may lie dormant for years without the slightest symptom. It is important you get at least a broad overview of these other diseases.
Sixteenth and seventeenth century Europe was ravaged by epidemics of syphilis. The English called it “the French disease” and the French called it “Neopolitan disease.” It was thought at that time to have been brought , from the New World by Columbus’ crew. Americans also called syphilis “the pox” and “the scab.”
Although it is no longer the wholesale killer it once was, it can still be very dangerous. Once detected it is an easily treated disease, however. Like herpes, it can inhabit the body for years without showing symptoms. When the symptoms of advanced syphilis finally do appear they can be quite serious.
Syphilis is caused by the bacterium Treponema pallidum. It can affect any tissue or vascular organ in the body and can be passed from mother to fetus (congenital syphilis). In acquired syphilis (syphilis contracted through sexual contact) the bacteria enters the body through the mucous membranes or abrasions of the skin, much the same way herpes virus does. Also like herpes virus, it does not grow on artificial media and cannot survive for long outside the human body. Infection is usually transmitted by sexual contact, including orogenital and anorectal sex.
Syphilis has four distinct stages: primary, secondary, latent and late or tertiary. During the primary stage a lesion or chancre generally appears within four weeks of infection. This lesion will heal in four to eight weeks if untreated. At the site of inoculation, it develops as a red, pimple-like sore that soon becomes a painless ulcer. The base of the chancre is hard. The sore does not bleed on abrasion but gives off a clear serum containing the bacterium. It is usually single, but may be multiple. The lymph nodes of the area become enlarged but normally remain painless. Primary chancres may occur on the penis, anus, and rectum in men, and the cervix, vulva, and perineum in women. Chancres may also be found in the mouth, on the tonsils, or on the fingers.
In the secondary stage of syphilis, rashes usually appear within six to 12 weeks after inoculation, and are most noticeable after three to four months. These lesions may disappear in a matter of days or may persist for several months. Mild, flu-like symptoms may accompany this stage. Syphilitic skin rashes may imitate a variety of dermatologic conditions. (You can tell from the symptoms of syphilis that it may have traits in common with herpes. This is why it is suggested that you see a physician, even for something you may believe to be an easy diagnosis.)
The third stage of syphilis, the latent stage, may last for a few years or for the rest of the patient’s life. The patient at this point will appear normal. About one-third of these patients will develop tertiary syphilis.
Tertiary syphilis can take many different courses in its destruction of the body. It can affect the eyes, skin, brain, heart, nerves and many other parts of the body. Some of the tertiary symptoms will not appear for 25 years after the initial infection.
There are a host of diagnostic tests for syphilis. Different tests are used for different stages. Early stages can usually be diagnosed with a microscope study and blood tests. Treatment is easy if the disease is caught early. Penicillin is the drug of choice. Penicillin will not be effective for herpes virus, so it is important to be diagnosed by your health professional and not by your roommate, friend or relative.
Gonorrhea, also known as “the clap,” “the drip,” and “the gleet,” is caused by a bacteria called Neisseria gonorrhea. It is spread by sexual contact. Gonorrhea is an infectious disease of the lining of the urethra (the passageway for urine coming from the bladder), cervix, vagina and rectum; and may also involve other areas of the body. Women are frequently symptomless carriers of the organisms for weeks or months and are often only identified through sexual contact tracing. Another symptomless carrier is the homosexual male when the bacteria are found in the mouth or rectum. There has been an increase of involvement of the urethras of both heterosexual and homosexual males in recent years.
In men there is a two-day to two-week incubation period. The onset usually consists of tingling or itching in the urethra. This is followed by a discharge which may be yellow-green in color. As the disease spreads up the urethra, urination may become painful.
In women, symptoms usually begin within one to three weeks of infection. Symptoms are generally mild but may occasionally be severe.
Rectal gonorrhea is common in either sex. It is usually symptomless, but there maybe some discomfort in the anal area. There may be a rectal discharge as well.
No blood test is available for gonorrhea. An accurate diagnosis consists of obtaining material (via a cotton-tipped swab) from appropriate locations and then looking at it under a microscope. This allows rapid identification in most men.
Women are not so fortunate. This inspection under the microscope (called a gram-stain smear) is only about 50% to 60% reliable in women. A culture is performed on patients suspected of having gonorrhea who show negative gram stain smear. This is done because of the unreliability of the gram-stain smear. As with herpes, virus cultures must be taken when symptoms are present.
Because these diagnostic techniques were sometimes inconvenient and the disease easy to treat, past practice often involved treating suspicious symptoms (painful urination and milky discharge) with penicillin. This approach has been modified by some. The emergence of penicillin-resistant strains of gonorrhea has resulted in the use of tetracycline drugs as initial therapy. This is because they are effective against the disease.
Post Gonococcal Non-Specific Urethritis
A common complication of gonorrhea in men is post gonococcal non-specific urethritis. In simple terms, this means that the discharge returns after a week or so. This may be due to the presence of other organisms which were simultaneously acquired with gonorrhea. These organisms may have longer incubation periods and may not respond to penicillin.
Tetracycline becomes the drug of choice in these cases as well. Patients should, as with other STDs, abstain from sexual activity until a cure is confirmed. Men are advised not to squeeze the penis in search for urethral discharges.
Most of the economic, physical, and emotional burden of gonorrhea is borne by women and their offspring. About 10% to 20% of women with gonococcal infection will suffer from salpingitis (also known II inflammation of the fallopian tubes) and PID (pelvic inflammatory disease). The term pelvic inflammatory disease is used by some to include infection of the cervix (cervicitis), uterus (endometritis) or ovaries (oophoritis). It is incorrect to use the term as a catch-all for pelvic pain of unknown origin.
Salpingitis occurs predominantly in women under age 25 who are sexually active. It is the result of infection transmitted most commonly by intercourse, less often by childbirth or abortion. Patients with intrauterine devices are thought to be more vulnerable. The principal causative agent is Neisseria gonorrhea, the same bacteria responsible for gonorrhea.
Symptoms include severe lower abdominal pain, vomiting and high fever. Discharge from the cervix is common. Diagnosis consists of gram-stain and culture. A patient may have a recent intrauterine device insertion, childbirth or abortion. Because any of these raise a red flag for the diagnosing physician, a history is important.
Treatment should not be delayed. If gone unchecked the disease may cause infertility. Treatment consists of penicillin or tetracycline. The physician must have a truthful history as with other diseases. Examination and treatment of sexual contacts should be done. Some contacts may be found to have non symptomatic nongonococcal urethritis. Failure to treat male sexual partners is a major cause of recurrent gonococcal salpingitis.
Nongonococcal urethritis (NGU), while being the most popular term, is also known as nonspecific urethritis (NSU) and medically as nonspecific sexually transmitted infection (NSI). We will call it NGU since that seems to be the most commonly used term. NGU is a common sexually transmitted disease in the U.S. today. Some feel it is even more prevalent than gonorrhea. It is caused most frequently by the bacterium Chlamydia trachomatis. The name NGU derives from the common situation in which an obvious infection of the urethra is not caused by gonorrhea.
Distinguishing between gonorrhea and something other than gonorrhea is important in determining treatment. Gonorrhea is usually treated with penicillin but NGU is treated with an antibiotic other than penicillin, normally tetracycline. NGU is more or less discovered as a result of “not finding” gonorrhea. Although Chlamydia trachomatis is known to be responsible for about half of the NGU cases, it is easier to begin treatment with an antibiotic which is known to work in most cases of NGU. This will save the patient time and money. NGU is not so much a new disease as it is an entity becoming recognized in cases when gonorrhea is not identified or when penicillin treatment for gonorrhea fails.
Trichomoniasis is caused by a protozoan, Trichomonas vaginalis. Trichomoniasis is almost always sexually acquired. The infection may be asymptomatic and thus go unrecognized. More commonly, it produces a vaginitis (inflammation of the vagina) characterized by a copious, greenish-yellow, frothy vaginal discharge with an unpleasant odor. Males are usually asymptomatic.
Sometimes a routine Pap test will indicate the presence of Trichomonas. Microscopic examination can also be used to view these protozoa. It is treated with the drug metronidazole given orally.
Pubic lice, otherwise known as “the crabs,” are usually transmitted sexually but may also be passed along on towels, bedding and clothing. This pest is capable of making its way through a college dorm because it is relatively easy to transmit. The pubic louse is a tiny parasite that thrives in pubic hair, infesting the hair near the anus and genitals.
The lice are tiny and not easily seen. They lay eggs which attach to the base of the hair. A sign of infestation is a scattering of minute dark brown specks (excretion from the louse) on undergarments where they come in contact with the anus and genitals. They can be rapidly cured with a shampoo, lotion or cream, called Kwell. Prolonged use of these products should be avoided as they can cause genital dermatitis. Sources of infestation such as hats, combs, clothing and bedding should be decontaminated by was being in very hot water or dry cleaning. Recurrence is common.
Scabies is readily transmitted, often through an entire household, by skin-to-skin contact with an infected individual. It is sometimes called the “itch mite” and can also be acquired sexually. Similar to lice, it is spread by clothing or bedding. Scabies will exist for only two to three days when away from human skin, hence, clothes worn prior to three days before treatment would not have living mites and would be safe to wear. Scabies is caused by a tiny mite which lives on and around the genitals. The female mite burrows beneath the skin to lay her eggs. The symptoms, itchy lumps and tacks on the skin, become noticeable after four to six weeks’ incubation. They can occur between the fingers, on the buttocks, armpits and wrists as well as the genitals. Treatment is the same as for pubic lice.
Genital warts (Condylomata acuminata) are caused by a virus and are usually transmitted sexually. They can also spread as the result of poor hygiene.‘ The incubation period is from one to six months. They occur most commonly on warm, moist surfaces of the genitals, in or near the anus and rectum in homosexual males, and less frequently on the bladder, urethral mucosa, and/or the ureters.
Genital warts normally appear as soft, moist, small, pink or red swellings that grow rapidly. Several of them may be found in the same area, often producing a cauliflower appearance. Diagnosis is usually a matter of identifying the warts by appearance. Such diagnosis should, however, be carried out by a physician because human papillomavirus (HPV) has in instances been found in Condylomata acuminata. Researchers suspect a connection between HPV and genital carcinogenesis so, therefore, HPV should be clinically ruled out?
Genital warts are treated by careful application of an anti-wart agent of 20-25% podophyllin resin in ethanol or benzoin in weekly applications. Particular attention must be paid to following exact instructions of the prescribing physician. Genital warts may also be removed by electro- surgery or freezing technique utilizing applications of liquid nitrogen every two to three weeks until lesions are gone.3
If you suspect you have an STD by recognizing any of the symptoms listed (sores, lumps, abnormal discharges or persistent irritations), it is most important that you see your physician. It can be dangerous, even life-threatening, to wait for the problem to go away on its own. That is just what some of these diseases will lull you into doing. The symptoms disappear, but the infection is very much alive within your body.