Chapter Fourteen: Sexually Transmitted Diseases: Overview, Gonorrhea, Syphilis, Non-gonococcal Urethritis

Chapter Fourteen Sexually Transmitted Diseases

What are sexually transmitted diseases?

Sexually transmitted diseases (STDs) are a group of infectious diseases primarily transmitted through sexual contact. These diseases can also be transmitted through similar sexual behaviors, indirect contact, and bloodstream transmission. Due to changes in sexual lifestyles, the modes of sexual transmission have become more diverse, including not only traditional male-female sexual intercourse but also all acts of contact between the sexual organs and mucous membranes of opposite or same sexes, such as oral sex, anal sex, and genital licking. These diseases not only cause lesions on the sexual organs but can also invade the lymph nodes and mucous membranes associated with the sexual organs through the lymphatic system, and even spread throughout the body via the bloodstream to affect important tissues and organs. Traditional Chinese medicine refers to these diseases as "venereal diseases" or "syphilis."

How many types of sexually transmitted diseases are there in my country?

Previously, the category of sexually transmitted diseases (STDs) only included five types: syphilis, gonorrhea, chancroid, lymphogranuloma venereum, and granuloma inguinale. However, due to changes in sexual activity, the World Health Organization, based on the increasing number of sexually transmitted diseases, expanded the scope of this category to more than 20 diseases in the early 1970s. These included genital warts, genital herpes, HIV/AIDS, non-gonococcal urethritis, trichomoniasis, candidal vaginitis, pubic lice, bacterial vaginosis, and even scabies, hepatitis, and tinea cruris, all collectively referred to as the new generation of STDs. Given my country's national conditions, it is not currently appropriate to directly include all 20+ internationally recognized STDs in the STD category. For example, hepatitis, scabies, and tinea cruris are not primarily transmitted through sexual contact in my country, so they must be treated separately.

Common sexually transmitted diseases (STDs) in my country include: gonorrhea, genital warts, non-gonococcal urethritis (cervicitis), syphilis, genital herpes, AIDS, chancroid, lymphogranuloma venereum, genital candidiasis, trichomoniasis, bacterial vaginosis, pubic lice, and scabies. However, the "Regulations on the Prevention and Control of STDs" promulgated by the Ministry of Health of China on August 12, 1991, only includes the first eight STDs under legal management; the latter few are not primarily transmitted sexually and therefore are not included.

How are sexually transmitted diseases in men mainly transmitted?

(1) Sexual transmission: Sexual intercourse is the main mode of transmission, that is, direct contact between the penis and vagina. Oral sex, anal sex and kissing can also transmit the virus.

(2) Indirect contact transmission: through contaminated clothing and utensils, such as through bath tubs and shared towels.

(3) Transmission through blood and blood products: Syphilis and HIV can be transmitted through this route, such as sharing needles when using drugs, or accidentally receiving blood or blood products from an infected person.

(4) Occupational transmission: Syphilis can be transmitted to midwives who are not wearing rubber gloves during childbirth. AIDS can also be transmitted by medical staff who accidentally prick their skin with needles or scalpels contaminated with the HIV virus, or by dentists who accidentally injure their skin while performing dental procedures on AIDS patients.

What is unsafe sexual behavior?

Unsafe sexual behavior, literally meaning unclean sexual contact, stems from the historical perception that sexually transmitted diseases (STDs) were filthy, hence the term "unsafe sexual behavior." The term "unsafe" has three layers of meaning: first, genital filth with purulent discharge or other infections, indicating the presence of pathogens that can be transmitted; second, unclean practices such as anal sex, oral sex, and promiscuity; and third, unsafe sexual practices such as prostitution, group sex, and gang rape.

Can men still contract sexually transmitted diseases while using condoms during intercourse?

Even with condoms, unprotected sex does not guarantee that men will not contract sexually transmitted infections (STIs). While condoms can indeed prevent STIs and reduce infection rates, they are not 100% safe.

Condoms provide a physical barrier to prevent direct contact with a sexual partner's bodily fluids or blood, effectively reducing the risk of various sexually transmitted infections (STIs). However, the effectiveness of condoms against different STIs varies. Data indicates that condoms offer relatively little protection against genital herpes; prolonged sexual intercourse can allow the virus to penetrate the condom. During intercourse, the condom is constantly stretched, and its structure is damaged, providing an opportunity for the virus to pass through and cause infection. Furthermore, improper or inconsistent condom use can significantly reduce its preventative effect. Clinically, many STI patients report contracting STIs despite using condoms; upon further questioning, it turns out they used them inconsistently, sometimes without, sometimes they slipped or broke, and sometimes they only used them before ejaculation. These incorrect practices all increase the risk of infection.

Condoms only protect a portion of the male genitalia (primarily the penis). During sexual intercourse, women produce a large amount of vaginal secretions, which can flow to areas not protected by the condom due to friction between the genitals. If not cleaned promptly after intercourse, this can lead to sexually transmitted infections.

Furthermore, some sexually transmitted disease (STI) pathogens can be expelled from lesions other than the penis and vagina. For example, the chancre that transmits syphilis can appear on other parts of the body, and genital warts and genital herpes can be transmitted through autoinoculation or appear in the mouth. Therefore, while condoms offer protection, they also have limitations. Healthcare professionals need to educate patients that while condoms are not 100% foolproof, their use can effectively prevent STIs, especially HIV/AIDS. They should also explain and demonstrate the correct usage and precautions, and inform patients how and where to obtain or purchase condoms.

What should be noted when treating male sexually transmitted diseases?

(1) First, a thorough physical examination should be conducted at a regular hospital to clarify the diagnosis, identify any possible concurrent infections, and gain a comprehensive understanding of the condition. After contracting one sexually transmitted infection (STI), patients should be aware of the possibility of co-infection with other STIs, so a comprehensive examination is necessary.

(2) Medication should be used in accordance with the doctor’s treatment plan, with sufficient dosage, regular treatment and full course of treatment. Do not take medication when you are sick, double the dosage or take it for a long time; or reduce the dosage or course of treatment on your own because you are afraid of the side effects of the medication.

(3) Select sensitive drugs and avoid the abuse of antibiotics. For patients who are able to undergo examination, it is best to perform pathogen culture and drug sensitivity testing, which will help to select effective drugs and avoid long-term or repeated switching of antibiotics.

(4) Obtain a detailed allergy history and avoid using medications that may cause allergies. All medications have various adverse reactions, the most common being drug allergies. Severe drug allergies often lead to delayed treatment or even death. For example, penicillin is the most effective drug for treating syphilis, but many people are allergic to it. Therefore, it is essential to carefully inquire about allergies and perform a penicillin skin test during treatment. Furthermore, patients allergic to penicillin should be aware of cross-allergies; for instance, when treating gonorrhea, patients allergic to penicillin should ideally avoid cephalosporin antibiotics.

(5) The patient's spouse or sexual partner should be examined and treated at the same time, and sexual intercourse should be avoided during treatment. This is a basic principle of treating sexually transmitted diseases and one of the main measures to prevent recurrence of sexually transmitted diseases.

(6) During treatment, disinfect underwear, towels, etc., and keep the vulva and genitals clean. Patients with sexually transmitted diseases should use their own sanitary products and avoid sharing them with others to prevent transmission. Many patients with sexually transmitted diseases don't know how to dispose of their underwear, either throwing it away or repeatedly washing it with disinfectant. In reality, the pathogens causing sexually transmitted diseases have very poor survival ability outside the human body. The simplest way to treat them is to scald them with boiling water and then expose them to sunlight for 3-5 days.

(7) Pay attention to rest, strengthen nutrition, eat less spicy food, and do not drink alcohol.

(8) All medications must be used rationally under the guidance of a specialist doctor in a regular hospital.

What is gonorrhea?

Gonorrhea is one of the most common sexually transmitted diseases. It is a purulent inflammatory disease of the male urogenital system caused by Neisseria gonorrhoeae (commonly known as gonococci), primarily transmitted through sexual intercourse. In my country, it currently ranks first among sexually transmitted diseases in terms of incidence. Clinically, it directly infects the male urethra, causing increased urinary frequency, urgency, urethral pain, and purulent urethral discharge; it can also infect the rectum, perianal area, conjunctiva, and pharynx. Gonococci can also spread hematogenously, causing bacteremia, arthritis, endocarditis, meningitis, hepatitis, and even infertility and blindness. Due to the emergence of drug-resistant strains, prevention and control of this disease have become extremely difficult, making it one of the most harmful sexually transmitted diseases.

How to prevent gonorrhea in men

(1) Conduct sex education and strictly prohibit prostitution;

(2) Encouraging the use of condoms can reduce the incidence of gonococcal infection and also has a certain preventive effect against Chlamydia trachomatis and other sexually transmitted pathogens.

(3) Sexual partners should be treated at the same time. Prophylactic use of antibiotics can reduce the risk of infection in people who have sexual contact with gonococcal patients.

(4) Pay attention to personal hygiene and disinfection isolation. Patients should not share a bed or bath with family members or children (especially girls). They should also not share bath towels or hand towels.

(5) Implement the system of administering antibiotic eye drops to newborns to prevent gonococcal ophthalmia.

What is syphilis?

Syphilis, caused by Treponema pallidum, is a chronic, classic sexually transmitted disease that can affect almost all organs of the body, producing a wide variety of symptoms and signs. Early symptoms primarily involve the skin and mucous membranes, while later stages can cause lesions in multiple organs and tissues, including the bones, eyes, cardiovascular system, and central nervous system. This disease is known as a "mimicry master," mimicking the characteristics of many diseases, making its manifestations extremely complex. On the other hand, syphilis can also remain latent for many years without any symptoms. Syphilis is mainly transmitted through sexual intercourse, but it can also be transmitted to the next generation through the placenta, resulting in congenital syphilis. In traditional Chinese medicine, it is called "milk sores," "cancer sores," or "venereal disease." In old China, brothels were rampant, and according to statistics, the incidence of syphilis in some areas reached as high as 40%. After the founding of the People's Republic of China, during the large-scale treatment of syphilis in the 1950s, various traditional Chinese medicine therapies and integrated traditional Chinese and Western medicine treatments were widely used, contributing significantly to the near-complete eradication of syphilis in my country within a short period. In the early 1960s, the Chinese government announced that syphilis had been basically eradicated in my country, which caused a great stir worldwide. In recent years, syphilis has shown a resurgence. Especially since the 1980s, the spread of syphilis has accelerated, and some doctors lack knowledge about the disease, often leading to misdiagnosis and delayed treatment. Furthermore, some patients often self-diagnose, making syphilis appear as a mysterious and difficult-to-treat disease. In fact, syphilis diagnosis and treatment are not difficult; as long as its basic principles are understood, early detection and treatment are possible.

How is syphilis primarily transmitted in men?

The main routes of transmission for syphilis in men are as follows:

(1) Sexual contact: Sexual contact is the main route of transmission for this disease. Treponema pallidum is transmitted through intact mucous membranes or abraded skin. Untreated patients are most infectious within the first year after infection; as the disease progresses, infectivity decreases; by the fourth year after infection, there is generally no infectivity through sexual contact.

(2) Blood transmission: Syphilis patients, latent syphilis, and occult syphilis serum are all infectious and can be transmitted to others through blood transfusions and sharing needles. However, Treponema pallidum syphilis dies after 3 days at 4°C in a blood bank, so blood that has been refrigerated in a blood bank refrigerator for more than 3 days is not infectious.

(3) Other: A few people can be infected through routes other than sexual contact, such as kissing; they can also be infected by contact with the daily necessities of patients with infectious lesions, such as clothing, towels, razors, tableware, cigarette holders, toilets, etc.

What is nongonococcal urethritis?

As its name suggests, this disease is a type of urethritis that resembles gonorrhea but is not gonorrhea. It is also one of the common sexually transmitted diseases. Common symptoms include frequent urination, urgency, painful urination, and urethral discharge. It can occur alone or simultaneously with gonococcal urethritis, and it plays a significant role in sexually transmitted diseases, being widespread globally. Reports indicate that $2 billion is spent annually in the United States to treat this disease, demonstrating its widespread prevalence. In the early 1980s, the incidence rate in my country was not high, but it experienced a sharp upward trend after the 1990s.

Clinically, co-infection with gonorrhea and non-gonococcal urethritis is common. Therefore, some women develop urethritis and urethral discharge 3-5 days after extramarital sexual contact. The symptoms disappear after anti-gonorrhea treatment, but reappear after 2-3 weeks, leading to the misconception of a relapse. In reality, it is a flare-up of non-gonococcal urethritis after its incubation period. Therefore, all gonorrhea patients should routinely undergo testing for non-gonococcal pathogens to avoid missed diagnosis and delayed treatment.

What are the pathogens of nongonococcal urethritis?

The main pathogens causing non-gonococcal urethritis are Chlamydia trachomatis and Mycoplasma. These two microorganisms are between bacteria and viruses in size. In addition, these two microorganisms can cause trachoma and pneumonia. Different subtypes can cause different diseases. Chlamydia trachomatis causes a variety of diseases, such as trachoma and lymphogranuloma venereum. Chlamydia trachomatis can be divided into 18 serotypes, and different serotypes can cause different diseases. Subtypes A, B, Ba, and C cause trachoma, while serotypes D to K cause this disease. Mycoplasma is a pathogen even smaller than Chlamydia and, in addition to causing infections of the urogenital system, can also cause pneumonia.

Chlamydia trachomatis is the most common pathogen causing non-gonococcal urethritis. According to the U.S. Centers for Disease Control and Prevention, 25% to 55% of cases are caused by Chlamydia trachomatis, 20% to 40% by Ureaplasma urealyticum, and 2% to 5% by Trichomonas vaginalis, Candida albicans, Mycoplasma genitalium, adenovirus, etc. Herpes simplex is occasionally also a cause of this disease. The pathogens of the remaining cases are currently unknown.

Other bacteria such as Mycobacterium tuberculosis, Staphylococcus aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa can also cause urethritis, but they are generally not transmitted through sexual contact, so urethritis caused by these bacteria does not fall under the category of sexually transmitted diseases.

How is nongonococcal urethritis transmitted in men?

In adults, Chlamydia trachomatis and Mycoplasma infections are primarily transmitted sexually. In children, however, infection mainly occurs through indirect contact, often due to their parents or caregivers being infected. In adults, indirect contact primarily involves sharing toiletries with infected individuals or using unsterilized towels or bath towels in bathhouses.