Venereal diseases sexually transmitted
Venereal disease (named after Venus, the goddess of love), more accurately called sexually transmitted diseases belong to a particular class of diseases defined by the mode of transmission (sexual contact or report). Other diseases of the genital tract are rather urology, gynecology, or psychiatry.
The most advanced companies are not yet able to defeat the strong ties they have established between sexuality and ethics, where the notion of "shameful disease" that taints venereal diseases and guilt. This state of mind, crystallized social and religious taboos, says public ignorance not only with respect to the anatomy or physiology of the reproductive system, but also against sexually transmitted diseases . Individual negligence resulting tempers thus the progress of therapy. It is therefore not surprising to see an increase in sexually transmitted diseases. In ignorance and unconsciousness medicine must oppose objective information and persuade the public that early treatment results in the vast majority of cases an immediate cure.
Sexually transmitted diseases (STDs) are very different. There are currently more than twenty. These diseases, including gonorrhea, are one of the most common causes of disability worldwide (WHO).
The term "gonorrhea" was coined with the word blenna (slime) and Reg radical (which implies the idea of rupture and flow extension). It appears for the first time in 1784 in the writings of Swediaur. Besides gonorrhea gonococcal due to a specific microbe, the gonococcus (described very clearly in 1879 by A. Neisser in pus from a urethral discharge and pus in the eye), there are non-gonococcal gonorrhea. These can be caused by parasites, fungi, various germs other than gonorrhea and even viruses.
Outside syphilis [cf. SYPHILIS], other M.S.T. are characterized by the formation of an ulceration disease and Nicolas Favre and chancroid. These last two are rarely encountered in Europe.
Moreover, M.S.T. due to some viruses: hepatitis B, genital warts, acquired immunodeficiency syndrome (AIDS), etc.., continue to grow at an alarming rate worldwide.
These diseases are transmitted during or during sex, such as scabies and pubic infestation and the anal region by Pediculosis pubis (crab louse). All concern both the man and the woman, and the child eventually (in utero or at birth). Neglected diseases are of concern for their late consequences: damage of the testis, salpingitis, infertility, cancer.
1. gonorrhea gonococcal:
Gonorrhea gonococcal oldest known venereal disease ("Any man with a flow of the penis thereby defiled," Leviticus, XV, 3), has since 1968 an upsurge amazing.
United States, the estimated annual number of cases between 2.5 million and 3 million. Gonorrhea in this country is the disease in adults is more common after the flu.
For several years in France, some 17,000 cases are reported annually, but industry surveys from INSERM would consider approximately 500,000 cases per year, as few medical practitioners report cases seen in private practice.
In developing countries, the estimate, which can only be approximate, remains high.
The gonococcus is often associated with other germs. We observe, moreover, increasingly antibiotic-resistant strains because of the widespread use of these and self-medication. This is why gonorrhea is therefore in many countries, regardless of political or economic organization, a major public health problem.
Incubation period:
Between the time of infection and the onset of clinical symptoms, there is a silent period, the incubation period.
In humans, it varies between two and six days (on average, three days), but if the patient has a congenital abnormality, a long foreskin, a short brake, this period may be longer or shorter or longer.
In women, it is theoretically between two and seven days, but the first symptoms are generally very discreet, it is often impossible to specify.
Although not all clinical signs, this period is contagious.
typical clinical aspects:
Gonorrhea presents itself very differently in men and women.
- male gonorrhea:
In men, gonorrhea is primarily localized to the urethra.
At the beginning of acute urethritis, the patient complained for a very variable (from a few hours to two days) itching at the meatus (tip of the penis), while seepage occurs, resulting in a slight cooking time urination, hence the popular name "clap" given to this disease. Very quickly, the secretion becomes more abundant. At this stage of the disease, microbiological examination of pus, after spreading on slides and simple staining with methylene blue, which detects gonococci two components reniform opposing "coffee bean" by their concave and surrounded a capsule separating from each other (cf. PHAGOCYTOSIS, photo). Immediate treatment resulted in over 96% of cases a permanent cure. However, if the patient is not treated, the urination becomes painful, while the urethra will be achieved and urine are then very cloudy.
In a few cases (less than 5%), urethritis appears as a small secretion little or no pain. This is called subacute immediately.
If proper treatment is not prescribed from the beginning, or in the case of offenders who did not follow the advice of hygiene or diet, or in the case of a particular strain of gonococci virulent complications may occur either at the genital organs located in the scrotum (testicles and epididymis) or at the prostate. There does exceptionally sclerosis channel (urethral stricture).
Despite treatment, urethritis sometimes persists and is prolonged due to the existence of a small space focus, at a gland located near the meatus or inside the urethra.
- female gonorrhea:
In women, gonorrhea is often silent in the beginning: it is said from the outset total because of multiple glandular local haunts. Exceptionally, the infection has an acute (acute gonococcal outbreak newlyweds). Most of the time, the woman sees him from his illness. Gonorrhea is the male partner who almost always seek to consult (or when we know that, unconsciousness or cowardice, few men prevent their partner, we understand why the diagnosis is made very late) .
The woman gives indeed much importance to the appearance of some burning when urination, genital discharge a few can cause irritation to mucosal vulvovaginal and difficulties at the time of reporting. This initial period is particularly insidious and dangerous because of its contagiousness. It is the systematic examination gynecological allow the identification of the gonococcus by culture on specific environment.
Sometimes, the woman begins to worry before the appearance of genital discharge larger pain in ovaries (pelvic inflammatory disease). The latter location seems more frequent. Recently, the United States, 33% of 27,300 salpingitis studied were due to gonorrhea. Gonococcal salpingitis represent approximately 15-20% of all cases of salpingitis (in four cases, there is at the same time tiny bacteria, chlamydia).
If gonorrhea is treated correctly, after local destruction of homes, the results are excellent. In contrast, in the absence of any diagnosis, it evolves extremely capricious manifests itself in the form of successive crops from small local shelters glandular (eg, from the Skene's glands in the region of the meatus) to Following a fatigue, sex prolonged childbirth.
- General complications:
Both in men than in women, the general complications are very rare when proper early treatment has been applied.
The ocular lost in our European countries, their severity once formidable because of the prophylactic method, which consists of instillation of a solution of silver nitrate 1% in each corner of the eye at birth . This eliminates purulent conjunctivitis of the newborn.
Articular manifestations, but often highly polymorphic localized at the knee (effusion) are now rare: 1 ‰ in patients not treated properly.
- Atypical gonorrhea:
Gonorrhea, such as syphilis, tends to present under new aspects.
The location of the gonococcus at the anorectal mucosa is more frequent, but it attracted little attention or ill. Most of the time, it appears as an extremely minimal suppuration. Since systematic reviews are conducted, the various statistics show that at least 8-10% of female cases of gonorrhea and 4-6% of male cases, there is a location anorectum.
United States, in some family planning centers, this location is found in 15-20% of women with gonorrhea. In France, at least 20% of gonorrhea cases are anorectal original homosexual (SIBOULET André, 1983).
The non-genital locations, in the tonsils, pharynx (after oral coitus) and also the skin, attract attention.
Finally, systematic reviews can detect very many "healthy carriers", that is to say, subjects with gonorrhea, but who have no clinical symptoms. This asymptomatic gonorrhea is particularly dangerous because of its contagiousness. Sweden (1982), 50% of women are asymptomatic. United States (1971), a survey conducted in thirty-six cities, including New York and Chicago, found that 11.1% of women attending antenatal clinics or those of family planning were infected with gonorrhea: in three cases four, he was asymptomatic gonorrhea. At the Institut Alfred-Fournier (Paris), André SIBOULET and colleagues detected by culture, in 10% of female partners of infected men gonococci in the urethra without any clinical signs irritation.
- Diagnosis:
Neisser gonococcus, Neisseria gonorrhoeae can be detected by staining methods and culture.
Humans, can be used in acute recent staining techniques (simple methylene blue staining, double staining Gram). But in doubtful cases in humans, and in all cases in women and children, only technical cultures (circles Thayer and Martin) allow an accurate diagnosis based on both biochemical criteria and immunology.
Both in men than in women, it is necessary to perform a systematic sampling at the level of the anal mucosa and throat, and always at the woman, the urethra.
Used successfully transport medium (Transgrow medium) that allows the doctor to take a sample or if the patient can not get to the lab.
Are now trying to make the diagnosis of gonorrhea by serological tests, which can be very useful in the diagnosis of asymptomatic, non-genital forms, or when complications.
- treatment:
The choice of treatment depends closely epidemiological factors, we prescribed a type of therapeutic efficacy extremely fast, the only way to break the chain of infection, where the practice of "treatments minute." These treatments include administration of antibiotics once either oral or parenteral (intramuscular injection) in either case, we obtain 96% good immediate results, provided to choose the antibiotic effective time.
Syphilis has been contracted at the same time as gonorrhea, we choose a treatment that does not mask incubating syphilis, or can be a real prophylactic treatment of syphilis (4 million units of penicillin-way delay, but this therapy is not without risk).
In all cases, the patient must undergo strict general rules:
- Follow the advice on hygiene and diet: abstention from alcohol (wine, beer, cider, appetizers), game, meat, spices, little coffee or tea; prohibition of any violent exercise (cycling, motorcycle).
- Wash hands thoroughly after each urination and do not rub your eyes change underwear every day; delete any report, protected or not.
- Above all, practice synchronized with the treatment, or the partners, and reports back after knowledge control tests.
- Before any treatment, do a blood test to screen for syphilis incubation examination must be renewed three weeks, then three months later. In case of treatment failure, we seek local home reinfection.
If treatment is instituted early and correct, gonorrhea heals very quickly without sequelae.
Finally, from the perspective of immunoprophylaxis, there is currently no vaccine available despite numerous research.
All suppurations urethrovaginal genital are not due to gonorrhea, and current developments in laboratory techniques to identify germs very diverse. Often, the clinical manifestations are quite similar to those described in gonorrhea.
Genital infections urethrovaginal plurimicrobiennes are increasingly observed and are poorly understood. These infections "mixed etiology" involve other germs to gonococci, where the risk of treatment failure during antibiotic treatment targeting a single germ.
It is therefore understandable interest is the repetition of laboratory tests, they lead indeed to specific treatments.
Urethro-genital trichomoniasis:
In 15-20% of cases, highlights parasites, particularly Trichomonas vaginalis, described in 1836 by Alfred Given. The incubation period is often difficult to define, is usually ten to twenty days in humans. This infestation often results in the couple of psycho-emotional complications. Current treatments are very effective synchronized.
Genital candidiasis urethrovaginal:
In 15-20% of cases, highlights fungi, including Candida albicans, highly pathogenic urogenital tract. Predisposing factors include "the pill" over two hundred women with urogenital infections with Candida albicans, D. Catterall (1970) noted that ninety-nine of them were on the pill. Treatment, often very disappointing, requires repeated treatments over time. It must be synchronized with the partner or partners.
Other genital infections urethrovaginal:
Mycoplasma infections are responsible for 20% of non-gonococcal urethritis. This is especially subacute. These germs without wall play a role in some cases of male infertility and pelvic inflammatory disease. They are especially sensitive to class antibiotics cyclins. The diagnosis is relatively easy from urine cultures.
Pyogenic infections (cocci, staphylococci, Enterobacteriaceae: Escherichia coli, anaerobic) are in fact due to opportunistic pathogens. Must be based on data sensitivity.
Infections urethrovaginal genital Chlamydia are identified in 30-60% of non-gonococcal urethritis, 60% of gonococcal urethritis post, 65% of female partners of men with 5 to 35% of men with gonococcal urethritis.
Centre O.M.S. on M.S.T. the Institut Alfred-Fournier, which are considered particularly these infections, the age at high risk in humans is between thirty-one and forty years (45.6% of cases) and women between twenty one and thirty-one (59.1% of cases).
It is the most common male and female genital infections in connection with tiny bacteria (not virus), Chlamydia, which have the characteristic of not being able to grow at the expense of a living host cell .
Since 1968, we individualized three species of Chlamydia:
- Chl. pneumoniae, which infects the upper respiratory tract.
- Chl. psittaci, widespread in the animal world. Healthy carriers are common.
- Chl. trachomatis, which can infect all mucous membranes: the urethra, causing urethritis usually subacute, vaginal and cervical, causing vulvovaginitis usually subacute, endocervical infections, conjunctival manifestation mild or severe (keratoconjunctivitis trachoma).
The clinical presentations are diverse.
In case of urethritis, the incubation period is often difficult to determine. In general, it is ten to sixty days, sometimes several weeks.
Chlamydia trachomatis plays a major role in male infertility, affecting the epididymis, it leads to female infertility by causing the ovaries and fallopian tubes, especially among young women, by determining:
- Firstly, acute salpingitis (for Henrion and Henry-Suchet, 40% of total salpingitis due to Chlamydia trachomatis);
- Secondly, silent salpingitis (interest laparoscopy) may be accompanied by even a peri-hepatitis.
Locations throat, anal, are not uncommon.
In 7% of cases can occur syndrome urethrovaginal-synovial connective Association (urethritis-conjunctivitis-articular manifestations), usually in young men.
The diagnosis is made primarily by culture and serology.
Penicillin is totally ineffective. We recommend cyclin or erythromycin. Treatments are long (fifteen to twenty days) and must be synchronized with the partner.
The M.S.T. now constitute a major public health problem studied What World Congress held in Puerto Rico in 1981 and in Paris in 1986, bringing to light many sharp danger. Two examples highlight the health impact of STDs
- Genital warts are either in the form of genital warts (rooster combs) or lesions almost invisible to the naked eye revealed after examination (condyloma plans). Highly contagious, they are caused by viruses: papilloma. Some of them may result in young women, under certain conditions, a precancerous condition of the cervix, so it is important to perform a cervical smear for cytological examination in any woman lifetime sexual unstable.
- Since 1980, the onset of infection with HIV has posed serious questions to the people and government. This virus causes the collapse of the immunity of the holder, where "opportunistic infections" and outbreaks tumor (Kaposi's sarcoma) treatments being implemented significantly delay the progression of the disease, but none is effective to prevent the fatal outcome.
Paradoxically, even when they receive effective therapy, sexually transmitted diseases do not disappear, on the contrary, it means a total failure of epidemiology in this area.
Regardless of age and social environment, ignorance and unconsciousness are staggering. A survey O.M.S.-I.N.S.E.R.M. showed, firstly, that 64% of men with gonorrhea have not seen fit to prevent their female partners, on the other hand, 13% of patients waited students from seven to ten days before viewing. Youth of sixteen, in 25% of cases, it took fifteen to thirty days prior to any consultation, this behavior is in part relate to the ignorance and imprecision of the incubation period.
In addition, 24% of patients report having students or technicians contracted gonorrhea during their vacation outside their country of origin (SIBOULET). This is also the case for 26% of Swedish students. The number of adolescents who have contracted the disease - because of the popularization of the pill - is increasing year by year, as well as contamination due to the passing friend, which illustrates the role of subclinical infections.
These remarks apply to all sexually transmitted diseases, encourage, therefore, in addition to the diagnostic effort necessary to reach an effective treatment, awareness among the sick men of his responsibility for his or its partners.
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