Medical Weblog

Treatment of these infections is directed at the underlying cause. For proctitis caused by bacterial infection with gonorrhea and chlamydia, the treatment is ceftriaxone and doxycycline. Treatment is usually started before the culture results return from the laboratory and is based on what is seen on examination. The treatments for chlamydia, gonorrhea, herpes, LGV, and syphilis are described in the respective sections in this part of the book.

The treatments for the bacterial causes of enteritis, such as salmonella and shigella and Campylobacter infections, are antibiotics. Giardia infections are usually treated with metronidazole.

Sexual contacts must be examined and treated. For some organisms that cause enteritis, such as giardia and shigella, evaluation of nonsexual household contacts(parents, spouses, children, and siblings) is also recommended, since these infections are fairly easy to transmit nonsexually as well, especially through improper food handling.

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Cultures performed on the mother at delivery, or even the polymerase chain reaction test,will usually take at least several days to show up positive if virus is present, and tests to detect shedding that are performed several days before delivery do not reveal anything about shedding at the time of delivery. The only benefit of performing these tests at delivery is to help guide therapy should the infant become ill; that is, a positive test for herpes may help diagnose the infant’s symptoms as being caused by herpes, and treatment may be started more quickly. A test may show up as positive even before a baby becomes symptomatic, and in that situation herpes medication should be started for the baby right away. Even though the presence of virus on the mother’s test doesn’t necessarily mean that the baby has been infected, it is probably better to be safe. Symptoms indicating that the infant may be infected include lack of appetite, skin lesions like blisters, fever, and sluggishness. These symptoms may take up to a month to develop in an infected infant.

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Fewer than 1 percent of people who are infected with HPV develop symptoms. For those who do, the visible symptom is the external genital wart or warts, which look like the warts one might have on the hand: they are usually flesh colored or a little bit darker, and they are harder than the surrounding tissue. They can be raised or flat. The raised warts tend to have a cauliflowerlike appearance when looked at closely or with a hand-held lens. Warts may occur singly or in groups, often of varying size, and they may grow together to form larger warts. They do not hurt unless scratched or picked at, in which case they can become irritated. In about 20 percent of people they itch, and in 20 percent of people, they disappear on their own. They may remain the same size for some time, or they may continue to enlarge.

It can be difficult to know whether or not these “bumps” are warts, because the genital skin is somewhat irregular in appearance in most men and women anyway. Bumps can be a normal part of the genital anatomy—pearly penile papules in men, sebaceous cysts in men and women, or hymen remnants for women. An experienced health care provider can help determine whether the bumps are simply normal anatomy, are caused by HPV infection, or are due to another infection, such as molluscum contagiosum.

Warts can occur anywhere in the anal and genital area, as high up as the lower abdomen and as low down as the upper thighs. A man may have warts in the urethral opening, where they may or may not be noticed. Symptoms include urethral bleeding or discharge, or a change in the stream of urine, although generally warts in the urethra do not cause symptoms.

Women may have warts on the soft surfaces of the inner labia and vagina and on the cervix. Warts on the inner labia and vagina may be raised or flat. Warts on the cervix are usually flat. Internal warts may not be noticed by the woman and may only be revealed upon examination by a health care provider.

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That everyone should avoid having sex with an infected partner sounds obvious, but it is not always. People who are infected with STDs may or may not know it. It’s highly unlikely that someone who has never had sex (oral, genital, or anal) will be infected with a sexually transmitted infection (except, rarely, by being infected through a blood transfusion or health care accident, or by his or her mother at birth.

But anyone who has had sexual relations may possibly have a sexually transmitted infection, even if he or she is completely symptom free.

If your partner has used condoms or other barrier methods during every sexual contact with other partners, it is less likely that he or she has acquired an infection, but this also is not guaranteed. Certain infections, such as herpes or genital warts, may spread even with condom use. Being tested for all of the sexually transmitted infections before becoming sexually active is the only way to know for sure. If you are not certain that your partner is not having sexual contact with other partners, then it is wise to continue to practice safer sex to protect yourself.

If your partner has any symptoms, or if you notice anything about your partner’s body that worries you, such as rashes or sores or discharge, it’s best to delay having sex until the symptoms have been evaluated by a health care provider. Inspecting your partner’s genitals before you become intimate can help you detect potential problems, including things that your partner hasn’t noticed or realized could be a problem. This examination doesn’t have to be done in a scientific way. During fore-play, if there is adequate lighting available, you can usually briefly examine your partner without being obvious about it.

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For years, doctors have been looking for a man’s version of the Pap smear—an early-warning cancer detector that spots a tumor long before it is clinically evident. In this area, no development has been more promising, or controversial, than die PSA test. Recently, you may have heard a lot, good and bad, about this test. The PSA test is not new. In years past, however, its purpose was limited; it functioned mainly as a means of monitoring already-diagnosed prostate cancer and as an indicator of tumor volume. Could its use be expanded? Could it detect cancer that had not yet been diagnosed? The answer, doctors found several years ago, was yes—elevated levels of PSA can indeed point to the presence of cancer. In 1992, the American Cancer Society recommended annual PSA tests for all men over age 50, and over age 40 for men at higher risk (particularly, African-American men and men with prostate cancer in the family.

However, PSA (prostate-specific antigen) is not a magic wand, pointing with resolute certainty toward prostate cancer—and that’s the problem. Even doctors aren’t exactly sure how best to use the test, and how to make sense of the information it provides.

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