According to WHO, Every day there is new 1 million getting sexually transmitted disease (STD) around the world, that is huge statistically, look like it’s a global endemic.
In spite of that most STD can be easily treated there is a lot of complication that make ignoring it very harmful.
Chlamydia and Neisseria, both are bacteria contain other subdivision and both can cause variety of disease but we will talk specifically about Chlamydia trachomatis and Neisseria gonorrhea (gonococcus), last tow cause's popular STD.
They are like bad boys in neighborhood always walk together and disturbing everyone around at least once in their life.
There is high rate of co-infection, that's means if you get one it is likely to get the other too in same setting So every doctor knows that if he find any one of this nasty twins he should treat the patient for both empirically.
Background and presentation
Gonorrhea
Male and female can be affected, it can be asymptomatic but usually presented with urethral discharge (liquid leaking from penis) and testicular pain in male and vaginal discharge bleeding or pelvic pain in female. It is transmitted through sexual contact This includes oral, anal, and vaginal sex, it can also transemmited from mother to newborn during delivery . It takes about 1 to 2 week after sexual contact for symptom to appear.
Chlamydia
As same as gonorrhea C trachomatis infection transmitted sexually by anal\oral\vaginal sex, it can be asymptomatic affects male & female, the cervix, urethra, uterus and epididymis. Can be presented like gonorrhea clinically with urethral\vaginal discharge, scrotal pain in male and pelvic pain in female. Unlike Gonorrhea, Chlamydia incubation period range from 1 to 3 weeks It is the most common cause of infertility in women so as we will see later many guideline worldwide recommend regular screening for women of childbearing age.
Complication
complication by both
Epididymitis: inflammation in testicles structures that store sperm for maturation, it present with testicular pain in male and can cause infertility.
Pelvic inflammatory disease(PID) : rare but can cause many complication in female. it is infection of upper female reproductive system like uterus, ovaries and Fallopian tubes, present with pelvic pain, vaginal discharge, pain with sex and UTI symptom like burning with urination.
it can cause Fitz-Hugh-Curtis syndrome, a rare complication of PID, inflammation of live capsule, presented with abdominal pain and tenderness.
It can also lead to ectopic pregnancy even if treated, ectopic means out, in this condition embryo attached to wrong place because of adhesion due to previous PID fromChlamedia infection, usually such a pregnancy is dangerous for mother and should be terminated.
Disseminated gonococcal infection : serious gonorrhea complication, sign and symptom can vary from generalize fatigue, skin rash and joint pain with or without urethral\vaginal discharge, more severe form it can present by septic arthritis, in late it can cause gonococcal meningitis (infection of brain meanings) , pericarditis (affect pericardium with cover the heart) , and endocarditis (affect heart it self) .
The problem with this complication that first it can present without any urethra\vaginal discharge, the second is blood culture usually negative.
Diagnosis
Sample should be taking for gram-stain and culture for gonococcus but polimerase chain reaction (PCR) is easy and wildly used now, for Chlamedia nucleic acid amplification testing (NAAT) is the most sensitive test so it is the first choice for many health institution. That been said doctors do not hesitate to treat empirically when this lab tests not available or patient refuse to do them.
Treatment
source
Gonorrhea
Simple uncomplicated infection can be treated with
Ceftriaxon 250mg intramuscular single dose
Chlamydia
Simple uncomplicated infection can be treated with
Azithromycing 1 mg per oral single dose
or Doxycyclin 100 mg per oral every 12 hour for 7 days
For uncomplicated infection both required
Ceftriaxon 250mg intramuscular single dose
and Azithromycing 1 mg per oral single dose
Sexual assault : prophylaxis for STD
Ceftriaxone 250mg intramuscular single dose
Azithromycing 1 mg per oral single dose
Metronidazol 2 g per oral single dose
Prognosis & treating partner
In both Gonorrhea & Chlamydia infection prognosis is excellent when diagnosed and treated early with right Antibiotic, well that is for now but resistant to antibiotic is being more difficult to manage with organism mutation to fight antibiotics.
Treating sexual partner is mandatory after confirmation of the diagnosis in a patient, in our local policy we won't test or ask for partner names or any personal information we just request from the patient to offer any sexual partner in last 60 days treatment, simply it is one pill for Chlamydia and one injection for Gonorrhea. Usually we are not treating partner for both disease, only the confirmed one.
Infectious disease like STD can be reduced dramatically just by behavioral modification like using condom although it is simple solution you will be surprised when you see some statistic and how public ignore it like anything; they are simply inviting STD by unprotected intercourse.
Patient story
21 years old young man from wealthy family presented to us with fever & ointt knee pain for more than 4 weeks, his father accompanied him during ER time, there is nothing significant in history and on examination he was toxic, febrile and hypertensive, investigation indicate that he has sever infection so medical specialist admitted him to ICU (intensive care unite) as Sepsis, we started septic screening as usual searching for focus of infection (chest x ray, blood culture, urine analysis and culture,, etc).
After admission to ICU while am doing inpatient assessment to make sure nothing missed he started to open up, he was shy from his father actually the condition started with urethral discharge after multiple unprotected sexual relationship with many partner he thought it was simple urinary tract infection (UTI) from his sexual intercourses and toke wrong Antibiotic any way urethral discharge stopped but fever continue and his condition getting worse also he have scrotal pain and tenderness. It was strange for me that he knows it is sexual transmuted and he knows that he would tell us to manage him probably but he prefer to not upset his father in spite of risk on his health, if this patient admitted to ward while his father accompanied him he won't tell anything.
After that history the most likely diagnosis was clear disseminated gonococcus infection. proper antibiotic started he improved and shifted to ward, there he start to search in Google about his recent infection he was concern about his fertility after infection and ask about complication like anything. during his 8 day admission, 4 days in ICU he was reassessing his behavior, praying most of the time, it was obvious that something changed in him, he walk out from critical condition as different person, more mature and responsible i hope.
Remember
Walking in the path not like knowing the path
now you know, i hope you avoid walking in it, enjoy as much as you can but please protect your self.
Links
www.uptodate.com/contents/treatment-of-uncomplicated-gonococcal-infections
www.uptodate.com/contents/treatment-of-chlamydia-trachomatis-infection
CDC: Sexually Transmitted Diseases Treatment Guidelines, 2015
emedicine.medscape.com/article/218059-workup
emedicine.medscape.com/article/214823-workup