Sexually Transmitted Diseases in Men
Basic male genital tract drawing:A-Urethra ,B-Testicles,C-Scrotum,D-Epidydimis,E-Spermatic Cord,F-Prostate,
G-Seminal Vesicle X-Inguinal and femoral lymph nodes (groin lymph nodes)
Genital Herpes
(caused by Herpes Simplex I and II)
- Type I is becoming more prevalent cause of genital herpes(less severe & less frequent flare ups)
- Incubation is 2-7 days
- Multiple small blisters(pin head) —> turn to ulcers & may turn to larger ulcer
- Very Painful
- Mildly swollen inguinal lymph nodes
- May cause fever
- Diagnosis: swab (antigen/culture) or blood test (antibodies)
- Treatment: Antiviral
Syphilis-Chancre
(caused by Treponema Pallidum)
- 90,000 cases/year in USA
- Incubation is 10 to 90 days
- Starts as a bump that ulcerate
- Painless and hard to touch, has elevated border
- Lasts 3-6 weeks
- May cause swollen non tender inguinal lymph nodes
- Diagnosis: Blood test
- Treatment: Penicillin IM injection
Chancroid
(chancre like) caused by Haemophilus Ducreyi
- 2000 cases/year in USA
- Starts as a bump—>fills with pus—>ulcer
- Ulcer is soft and very Painful
- Causes swollen lymph nodes that turn to boils (drain pus)
- Diagnosis: Stain or culture of pus draining from ulcer or lymph nodes
- Treatment: Rocephin IM or Cipro orally
Lymphogranuloma Venereum
caused by Chlamydia Trachomatis
- 600-1000 case/year in USA
- Incubation is 5-21 days
- Painless bump that ulcerate
- May cause tender swollen boils like swollen matted lymph nodes that cause fistulas and sinus tracts complicated by ulcers and scarring
- May cause inflammation/infection in heart cover,joints,rectum,brain,meninges and eyes
- Diagnosis: Usually clinical
- Treatment: Doxycycline for 7 days
Granuloma Inguinale
caused by C.Granulomatis
50 cases / year in USA
- Causes large soft fleshy cauliflower like lesion
- Is not associated with swollen inguinal lymph nodes
- Chief importance is distinction from Syphilis and Chancroid
- Treatment: Topical podophyllin+- Cryosurgery or Laser resection
Urethritis
- Most common causes are Chlamydia , Gonorrhea and Mycoplasma Genitalium
- Trichomonas may cause urethritis but it is less common
- The usual symptoms are :burning on urination , urethral itching and discharge
- Diagnosis is made clinically if there is mucoid purulent discharge or by urine test /urethral swab
- Treatment is usually directed at the common causes (Chlamydia and Gonorrhea) with Rocephin injection and oral Zithromax
- Sex partner treatment is a must
- Testing for all other STDs causes is recommended
Epididymitis
- Most common causes in young sexually active men is Chlamydia and Gonorrhea
- Older patients may have non STD Epididymitis caused by colonic bacteria just like bladder infections
- Patient usually presents with one sided Epididymis swelling and pain
- The infection can spread to the testicle causing testicular infection or “Orchitis”
- May need scrotum ultrasound to rule out testicular torsion
- Treatment of STD Epididymitis is similar to Urethritis treatment
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