Category: STDs

Introduction

Gonorrhea is a sexually transmitted disease (STD). Neisseria gonorrhoeae is the causal agent of this venereal disease (CDC para. 1). Neisseria gonorrhoeae is a bacterium that thrives well in the urethra, uterus, oviduct, throat, and rectum due to the warm and moist environment characteristic of these areas. Other places where this bacterium can grow include the mouth, anus, and even the eyes. This is a very popular disease and everyone can contract it. A report by CDC indicates that over 700,000 people in the United States of America alone contract gonorrhea every year (CDC para. 2). This is alarming given the effects and complications of this disease. There is a dire need to deal with this disease effectively to reduce its prevalence in a quest to come up with a healthy nation. However, there are underlying issues that need clear understanding before stepping up campaigns to arrest this situation. What are these issues?

Prevalence

To deal with an issue successfully, it is important to establish its root cause and tackle it from the roots otherwise, it will keep on sprouting every other time. What are the predisposing factors of gonorrhea? According to Mayo Clinic staff, the common predisposing factors also known as risk factors of gonorrhea are; multiple sex partners, a new sex mate, younger age, and previous gonorrhea infection (para. 1). Gonorrhea predominantly spreads through sexual intercourse regardless of the type of sex. As long as there is contact with the penis, mouth, vagina, or anus without protection, infection is likely to occur. Regrettably, gonorrhea can pass from mother to child in the process of delivery (CDC, para. 3). Sexually active people are at great risk of contracting gonorrhea due to intense sexual activities, which unfortunately may involve multiple partners. How does someone know that he or she has contracted gonorrhea?

Causes

According to American Social Health Organization, men will develop symptoms within two to five days after infection while women do so ten days after infection (para. 4). However, most women remain asymptomatic with men developing full-blown symptoms. Symptoms differ depending on the part of the body where the bacterium is growing. In urethral infection, there is painful urination, inflammation of one testicle sometimes accompanied by pain, and pus-like discharge from the penis (Mayo Clinic staff para. 1). In women, there is increased discharge from the vagina, painful urination, vaginal hemorrhage between periods, and pelvic and abdominal pain. Gonorrhea also causes eye pain with increased sensitivity to light together with pus-like discharge from eyes (Mayo Clinic Staff para. 4). In throat infection, there are inflamed lymph nodes around the neck and sore throat. Nevertheless, as mentioned above most women are asymptomatic and even in cases where they develop symptoms, they are usually misidentified as bladder or vaginal infections.

Predisposing factors

Numerous complications arise because of gonorrheal infection and some have devastating effects in the end. Women suffer the wrath of this infection most because it is difficult to diagnose the infection. According to the National Institute of Allergy and Infectious Diseases, gonorrhea spreads to the oviduct and uterus causing pelvic inflammatory disease (PDI); a condition reported in over one million women in the United States of America yearly (para. 5). PDI causes internal abscesses that are difficult to cure. Moreover, this condition is a predisposing factor to infertility and ectopic pregnancy due to damaged fallopian tubes.

In men, gonorrhea causes infertility if left untreated for a long time. This results from inflammation of the epididymis causing a condition known as epididymitis. This is a treatable condition but if untreated for a long time it becomes complicated to treat (American Social Health Organization para.6). In other cases, the bacterium causing gonorrhea enters the bloodstream and grows in other places like joints. The possible symptoms here include joint pains and inflammations, fever, rash, stiffness, and skin sores (Mayo Clinic Staff para. 9). Recent research creates a strong link between gonorrhea and human immunodeficiency virus (HIV) infection. Gonorrhea weakens the immune system thus exposing an individual to possibilities of contracting HIV (CDC para. 7). Gonorrheal infection passed from mother to child causes blindness and severe blood infection coupled with joint pains.

To ascertain whether someone has gonorrhea, different laboratory tests are performed. Testing the urine can give sufficient information on whether someone is infected. The commonly used clinical test is the Gram test. Bacteria are either gram-positive or gram-negative and by carrying a test using a gram stain, the bacterium becomes visible under a microscope (CDC para. 9). Is there a conclusive treatment for gonorrhea?

Treatment

Well, according to the National Institute of Allergy and Infectious Diseases, gonorrhea is a curable disease (para. 1). Several antibiotics are available to treat and cure gonorrhea completely. However, it is advisable for anyone infected to seek medical attention as soon as possible to treat the disease at its early stages before developing complications. Unfortunately, due to the continued use of common antibiotics, a drug-resistant strain of this bacterium has emerged in the recent past. Additionally, people with gonorrhea have other sexually transmitted diseases like Chlamydia and this complicates further the issue of treatment. However, there is hope with current research indicating that a combination of different antibiotics could overcome this impediment.

Prevention

Nevertheless, prevention is better than cure and this adage resonates well with issues about gonorrhea. The indisputable way to avoid gonorrhea infection is to refrain from sexual intercourse or remain faithful to one sexual partner who has tested negative for gonorrhea. The big question here remains whether people can refrain from sexual intercourse with the current glorification of the same across borders. There is hope for those who cannot handle and control sexual desires. A latex condom used correctly prevents infection of most STDs including gonorrhea. It is advisable also to go for a gonorrhea test and pressurize sex mates to do the same. This will aid in cutting down transmission rates (Mayo Clinic Staff para. 12).

Conclusion

People should avoid having sexual intercourse with partners showing unusual symptoms. Even though some symptoms like skin rash may not necessarily signal gonorrhea infection, it is wise to take precautionary measures and visit a doctor for clarification (Mayo Clinic Staff para. 13). Regular gonorrhea screening tests are also mitigation factors because as discussed above women usually remain asymptomatic. These regular tests will identify the concealed cases of infection. Health agencies also play a major role in the fight against gonorrhea. They have to provide adequate and affordable healthcare services in a bid to overcome gonorrhea infections and transmission. There is a need to intensify education on STDs to equip young people with cognition on the dangers of engaging in premarital sex. Publicizing condom use may also help curb the transmission of the same even though this move is likely to face rejection from different quarters. People will always have different opinions but it is important to come up with a strategy to curb the spread of STDs especially gonorrhea.

Works Cited

American Social Health Association. “Gonorrhea”. 2000. Web.

Centers for Disease Control. “Gonorrhea”. Sexually Transmitted Diseases. 2008.

Mayo Clinic Staff. “Gonorrhea”. 2009.

National Institute of Allergy and Infectious Diseases. “Gonorrhea”. 2009. Web.

Herpes zoster is a viral infection that mainly affects the older people. Its symptoms are a painful skin rash often accompanied by blisters on one area of skin. The virus that causes this dermal condition is the same as that which causes chicken pox (varicella). The only difference is that chicken pox is mainly as a result of initial contact with the virus while zoster is more of a secondary effect. Chicken pox mainly affects children and young people and it is infectious. When it clears, the viruses do not leave the human body completely but instead remain latent and for some reasons these may reactivate causing zoster in the later years. In most cases the viruses resurface when the body’s immune system can no longer contain the virus replication (Eastern, J & Elston, M. n.d) available on http://emedicine.medscape.com/article/1132465-overview. Herpes zoster vaccine is a drug used to prevent Herpes Zoster outbreaks in adults aged 60 years and above. It is recommended for use in the United States targeting individuals who have a history of chickenpox. However, experts recommend that all persons over the age of 60 get the vaccine, provided their immunity has not been compromised as in the case of HIV/AIDS victims or cancer patients undergoing chemotherapy. Its use in immunocompromised persons may result in undesirable side effects (PMC 2008) available on http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2324151/. The vaccine is endorsed by the Food and Drug Administration. This vaccine is given subcutaneously and is a single dose. It should not be used in children (Center for Disease Control and Prevention n.d.)

The zoster virus is identical to varicella virus, the virus that causes chicken pox. The vaccine is also closely related to varivax, the vaccine against chicken pox. Its components are similar to those of varicella vaccine but has got a higher virus concentration. Herpes Zoster manifests as a dermal disorder setting itself apart from varicella by the clinical symptoms it exhibits. Persons who have had an earlier exposure to varicella are at a greater risk of developing herpes zoster than those with no exposure.

The vaccine is dispensed as Zostavax and is normally stored frozen in temperatures of about -50. It is only removed for reconstitution for injection a few minutes before administration. The reconstituted vaccine should be used within 30 minutes and any remainders discarded. This is owing to the fact that it comprises of live attenuated varicella virus, and must be kept alive for efficacy.

The study of the viral behavior of varicella zoster was carried out on human tissue implanted on the SCID-hu mouse. Infection of these skin implants formed the basis for study of the virus and hence the foundation of its attenuation. V-Oka is the strain of varicella- zoster virus used to generate the vaccine. To begin with its pathogenicity was analyzed against that of its parent, P-Oka, and two other strains of varicella-zoster virus; VZV-S (varicella-zoster virus Schenke) which is a clinical isolate strain with low-passage and VZV-Ellen, which is a standard strain used in the laboratory (American Society for Microbiology 1998) which can be found at (http://jvi.asm.org/content/72/2/965.full). All these strains of the virus replicated positively in tissue culture and only the low-passage strains were infective in skin. This was investigated by an analysis of the character of glycoprotein C in infection of the human skin. The analysis was carried out using gC negative mutants of V-Oka and VZV-Ellen.

Analysis of infectious virus yields and of human skin tissue implants for VZV DNA and viral protein synthesis revealed that only low passage strains were virulent in the human skin. Comparison of the infectivity of V-Oka and P-Oka revealed that V-Oka was generally weaker and it was eventually nullified by lack of glycoprotein C. This formed the basis for clinical attenuation of V-Oka, owing to the fact that it has reduced replication in skin and passage through tissue culture decreases the infectivity of VZV on the human skin. The efficacy of this vaccine was investigated in a study on a sample population in the US. The study was carried out on healthy persons aged 60 and above who had had an earlier infection of chicken pox or had lived in the United States for over 30 years. These people were given the herpes Zoster vaccine as a 0.5ml of live attenuated herpes virus as a single subcutaneous injection or a placebo. Follow up on the patients indicated that the severity and duration of the disease was reduced significantly in the vaccinated individuals as compared to previous data on the disease.

The side effects were more pronounced in the vaccinated group than in the group that was given a placebo.

Zostavax is contraindicated in pregnancy and breastfeeding though no conclusive study has been carried out to confirm if zostavax is secreted in milk. This is owing to the fact that the drug indications exempt children. People in the child bearing age are advised not to use this vaccine. It is also important to note that Zostavax is not used to treat zoster herpes. Neither is it used as a vaccine against chicken pox.

Herpes zoster vaccine can offer protection for about 4 years. Protection beyond four years is not confirmed. However, booster dosage is not recommended but this may change with advancement of studies (Public Health Agency of Canada 2010) http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-1/index-eng.php).

References

American Society for Microbiology 1998. Attenuation of the Vaccine Oka Strain of Varicella-Zoster Virus and Role of Glycoprotein C in Alphaherpesvirus Virulence Demonstrated in the SCID-hu Mouse. Web.

Eastern, J & Elston, M. n.d Herpes Zoster.Web.

Center for Disease Control and Prevention n.d. Herpes Zoster Vaccination for Healthcare Professionals. Web.

PMC 2008.Live, Attenuated varicella zoster vaccination for an immunocompromised patient. Web.

Public Health Agency of Canada 2010. Statement on the Recommended Use of Herpes Zoster Vaccine. Web.

Etiology and Pathophysiology

• Caused by gram-negative, aerobic diplococcus bacterium N gonorrhoeae.
• The gonococcal infection occurs with sexual contact or perinatally.
• Infection of the lower genital tract is the most frequent clinical presentation.
• Male urethritis and female endocervicitis are the primary manifestations.
• Additional symptoms include infection of pharynx, rectum, or urethra in females.

Gonorrhea is a sexually transmitted disease. It is spread through mucosal inoculation during vaginal, anal, or sexual contact. The bacterium is able to develop attached to sperm or vaginal fluids, allowing it to invade lower genital organs and progress to the upper structures. Symptoms can take 1 -14 days to appear. In males, it manifests in urethral discharge, itching, pain in the scrotum and during urination. Females may experience painful sexual intercourse and urination, swelling, discharge, and fever (Wong, 2017).

Incidence and Prevalence

• Second most reported notifiable disease in the United States.
• Latest CDC survey in 2016 indicates 468,514 annual cases.
• Increased rate over the last years to 145.8 cases per 100,000 population.
• 48.6% increase over the last ten years since the historic low in 2009 (Centers for Disease Control and Prevention, 2017).
• Community prevalence can lead to higher risk of acquisition and greater disease burden.

The disease prevalence has increased rapidly in the last decade, caused by sexual behavior and risk factors within communities. Risk factors can include racial discrimination, socioeconomic status, and access to healthcare. Furthermore, the disease has seen increased resistance to traditional antibiotic treatment, requiring dual therapy. Statistically, males are more frequently infected than females, with the highest rate occurring in the 20-24 age group.

Evaluation

• History should include past incidences and treatment of STDs.
• Known STD symptoms in partners, type of contraception, and menstrual cycle for females.
• Physical examination in females looks for mucopurulent discharge from vagina, urethra or cervix.
• Tenderness in cervix motion or friability as well as in the lower abdomen.
• Males have urethral discharge with the possibility of epididymitis or edema.
• Rectal symptoms include mucopurulent discharge or inflammation, with or without bleeding.

The above are typical signs of the gonorrhea infection. However, they may manifest uniquely in each patient. Furthermore, if the disease has disseminated to the upper reproductive tract, the site of the mucosal infection may not present any symptoms. Some patients may display additional signs of discharge from the eyes, fever, tenderness in the upper abdomen (Wong, 2017).

Differential Diagnosis

• Chlamydia infection – an STD with similar presentation, but a more common prevalence.
• Trichomonas – a less common STD demonstrating symptoms of vaginal discharge.
• Pelvic inflammatory disease – infection of reproductive organs caused by STDs.
• Candidal or bacterial vaginosis – caused by disruption of bacterial flora with symptoms of discharge or irritation.
• Urinary tract infection – a common infection with symptoms of dysuria and hematuria.

Many of these differential diagnoses, particularly STDs cannot be differentiated from gonorrhea without a diagnostic test. They present similar symptoms of discharge, irritation, and pain during urination. Chlamydia is particularly difficult to distinguish because the only difference between them is the disseminated infection in gonorrhea. That is a unique feature of gonorrhea as it infects the upper genital tract unlike the other diagnoses (Epocrates, n.d.).

Diagnostic Studies

• Laboratory testing to identify the gonorrhea bacterium.
• Urine test – identifies bacteria in the urethra.
• Gram stain test via swab from the infection site.
• Rare but radiography or ultrasonography can be used.
• Nucleic Acid Amplification Test (NAAT).

The most common diagnostic studies include culture tests via urine or swab. These are usually effective and low cost that can be used on a variety of testing sites. Imaging tests include chest radiography to visualize hemidiaphragm elevation in Fitz-Hugh-Curtis symptom. Ultrasonography or CT scan is used for women to investigate the possibility of pelvic inflammatory disease or to eliminate other causes such as ectopic pregnancy. The NAAT is more expensive, accurate, and sensitive, amplifying genetic sequences in the sample. These tests are helpful when mucosal swab or examination may be difficult (Centers for Disease Control and Prevention, 2013).

Treatment

• Most treatments are outpatient.
• Females may have a higher risk of complications requiring inpatient treatment.
• Females should conduct a pregnancy test to determine appropriate use of medications.
• Dual antibiotic treatment of ceftriaxone (250mg intramuscular) and azithromycin (1g).
• Single dose injectable cephalosporin or cefixime is safe but usually ineffective.

Like most STDs, gonorrhea is treated with antibiotics. However, the disease has a high resistance which is why a dual treatment is recommended. The dual therapy should be administered simultaneously. Furthermore, those infected with N gonorrhea are commonly infected with C trachomatis as well. Therefore, a dual therapy helps to eliminate any comorbidities as well. This type of approach is thought to be effective as well because of more convenient dosing and therefore, increased patient compliance (Wong, 2017).

Expected Outcome and Follow-Up

• According to the CDC guidelines, a test-of-cure is not necessary with recommended treatment.
• Monitoring should occur since treatment failure most often results from reinfection from sexual partners.
• CDC recommends reevaluation three months post-treatment.
• If possible, screening should occur within 12 months.
• Patients are recommended to follow-up with primary care physician to reduce the risk of infection.

Treatment outcomes are mostly positive with the dual therapy treatment. However, if any alternative regimens are used, a test-for-cure should occur within 14 days using NAAT or culture test. Some rare instances may result in complications or antibiotic resistance. The patient should maintain contact with their physician. Unfortunately, reinfection is a high probability for people with regular sexual partners (Wong, 2017). Therefore, patient education is a critical factor in producing positive outcomes and reducing infection rates.

Patient Education

• The patient should be taught the causes and symptoms of gonorrhea.
• Prevention strategies such as the use of condoms.
• Discussion of sexual partners and the infectious nature of STDs.
• Locations and methods for testing for STDs.
• Encourage to see a medical professional if symptoms appear.

Patient education of gonorrhea should focus on the disease as well as STDs in general since the individual may be at higher risk for such infections. It is critical for the patient to understand the transmission process that is influenced by sexual behavioral factors and choice of partners. Furthermore, preventive strategies such as using condoms are a critical aspect of patient education. Finally, the patient should be aware to see a physician and receive testing if there are symptoms or suspicion of gonorrhea or other STDs (Swygard, Seña, & Cohen, 2017).

Reference

Centers for Disease Control and Prevention. (2013). STD curriculum for clinical educators. Web.

Centers for Disease Control and Prevention. (2017). 2016 sexually transmitted diseases surveillance. Web.

Epocrates. (n.d.). Gonorrhea infection. Web.

Swygard H., Seña, A. C., & Cohen, M. S. (2017). Patienteducation: Gonorrhea (beyondthebasics). Web.

Wong, B. (2017). Gonorrhea. Web.

The Tuskegee Syphilis Study compelled the nation to reconsider and reinterpret human testing procedures, particularly those affecting minority communities. As a result, HEW formed a National Human Investigation Board, and legislation requiring the formation of Institutional Review Boards was approved. A class action suit brought on behalf of the survivors in the 1970s resulted in no new law and skirted the question of government liability for harm caused by such an experiment. Eventually, each survivor got a financial compensation of around $40,000.00 (Alsan et al., 2020). The Tuskegee Syphilis Study’s greatest lasting impact is its ramifications in the African American community, which have implications in light of the AIDS pandemic.

The study provided the groundwork for African Americans’ persistent skepticism of the medical establishment, particularly public health initiatives and immunizations. It fostered negative attitudes about the medical system and the federal government, as well as a disrespect for African American life. Despite community outreach efforts, there appears to be evidence that African Americans did not seek treatment for AIDS in the early 1980s due to skepticism of healthcare practitioners over the diagnosis, forecast, and treatments of AIDS. Government leaders and medical professionals must work to rid medicine of social contamination by removing any racial or moral prejudices about individuals or their ailments.

The Tuskegee Study, as a symbol of racism and medical malpractice, may never inspire the nation to action, but it may influence the way Americans approach sickness. Within the outpouring of rage and pain from those who oppose the experiment is a cry for government and medical experts to listen to the anxieties of people whose faith has been shattered, to address their concerns directly, and to recognize the relationship between public health and community trust (White, 2019). It thus demonstrates that social prejudices and institutional mistrust are deep-running societal problems that cannot be overridden without systemic structural work.

Reference List

Alsan, M., Wanamaker, M., & Hardeman, R. R. (2020). The Tuskegee study of untreated syphilis: A case study in peripheral trauma with implications for health professionals. Journal of general internal medicine, 35(1), 322-325., Web.

White, R. M. (2019). Driving Miss Evers’ boys to the historical Tuskegee study of untreated syphilis. Journal of the National Medical Association, 111(4), 371-382., Web.

Gonorrhea is a disease from a group of sexually transmitted infections. Gonorrhea in men is most acute and characterized by inflammatory lesions of the urethra. In addition, the symptoms are itching and burning sensation when urinating, cloudy urine, pelvic pain, and rubbing (Dombrowski, 2021). If the untreated infection spreads to the upper parts of the genitourinary system, the signs are joined by an increase in body temperature, difficulty in urination, and pain when defecating. In women, gonorrhea does not always have the typical symptoms and often occurs in subacute form. This is because there may be a mixed infection in the genital tract (Dombrowski, 2021).

Therefore, besides gonorrhea, smears detected trichomonads, ureaplasma, and other pathogenic flora. The most typical symptoms include vaginal discharge with an admixture of pus, reddening of the mucosa of the external genitalia, small sores on their surface, and lower abdominal pain.

It is significant to emphasize that without treatment in women, the infection can penetrate from the urethra through the uterine cavity and fallopian tubes to the abdominal cavity. This causes the development of pelvic inflammatory disease, leading to internal abscesses and persistent damage to the fallopian tubes and uterus (Dombrowski, 2021). Furthermore, terminal ileitis with peritonitis is an unusual extragenital manifestation of gonococcal infection.

If the inflammatory process becomes chronic, the menstrual cycle is disturbed in women, and the adhesion process in the pelvis develops. This can lead to infertility, ectopic pregnancy, miscarriages, and chronic pelvic pain syndrome. Hence, gonorrhea must be treated with antibiotics so that Jane does not suffer from infertility. However, the bacteria that cause gonorrhea quickly adapt to antibiotics (Dombrowski, 2021). Each time humans use a new class of antibiotics to treat this infection, the bacteria adapt and develop drug resistance.

Reference

Dombrowski, J. C. (2021). Chlamydia and gonorrhea. Annals of Internal Medicine, 174(10), 145-160. Web.