Genital tract infection

There are two main areas: sex spread infection, and then those that aren't sexually transmitted. Whilst the latter are more common, we've put the sex ones top because they tend to be more serious, and are more easily preventable.

Sexually transmitted infection

There are two keys to managing sexually transmitted infections: confidentiality, and contact tracing. This slightly contradicts, as you have to not tell anyone about the person's condition, whilst also telling lots of people about the person's condition. Thus, telling contacts is left to the patient, who is too scared to do it, and thus, the infection continues to spread...

Chlamydia

Chlamydia trachomatis is a small bacterium, and is the most common STD in the developed world! Around 5-10% of 20-30 year olds have it! There can be some inflammation or discharge, but often it is asymptomatic. The big problems is it can cause pelvic inflammatory disease, which can lead to infertility.

Treatment: tetracycline, erythromycin or azithromycin.

Gonorrhoea

This time its Neisseria gonorrhoeae, rearing its ugly head. It's particularily prevalent in the developing world. Again, its usually asymptomatic, but can cause some irritation and discharge. Again it causes PID, which you don't want.

Treatment: ceftriaxone, cefixime or spectinomycin.

Genital warts

These are caused by human papilloma virus, and again, are extremely common. The warts are usually multiple, and found on the vulva, in the vagina and on the cervix, where they can lead to cervical intraepithelial neoplasia. Interestingly though, the types of HPV that cause cervical cancer generally aren't the same as the wart ones. So having genital warts may not actually mean your chance of getting cancer gets any higher.

Genital herpes

Multiple small vesicles and ulcers around the entrance of the vagina, or on the penis. There can also be dysuria and local lymphadenopathy. In about 75% of cases, after the first episode, it recurs. Herpes simplex type 2 is the usual cause of herpes, although it sometimes can be type 1. Acyclovir is a treatment that reduces symptoms. Neonatal herpes has a high mortality and can be prevented.

Trichomonas

Trichomonas vaginalis is fairly rare. It has an offensive grey/green discharge with itching and pain during sex. It's pretty much like bacterial vaginosis but sexually transmitted.

Treatment: metronidazole.

Syphilis

Caused by Treponema pallidum, which I'm proud to say I've never heard of. Its rare in developing countries, but common in the developing world.

  • Primary - Basically, you get an ulcer at first.
  • Secondary - Then, a few weeks later, you get a rash, lots of genital warts, mouth ones too, and you feel awful.
  • Latent- The previous phase resolves on its own, and you forget you ever had it.
  • Tertiary - The virus hits anything, the liver, the heart, you get dementia, its pretty erratic

Treatment: im penicillin or oral doxycycline/azithromycin

HIV

This is a big problem in the third world, as you should have heard. It leads to AIDS, and is transfered in sexual contact, from mother to child, and through intravenous drug use. CIN is also more common in HIV infected women. Other genital infections, such as candidiasis are more common, due to the immuno-compromisation (I don't know if that is a word).

Hepatitis

Whilst not a true genital tract infection, it's an STI that enters the body through intercourse, or blood, as in HIV. You won't be surprised to hear that the key symptom is liver inflammation, or hepatic-itis. There are several types, each with different disease profiles, so it's probably best to read the pages on Hepatitis.

Other infections

Candidiasis

This is the commonest cause of vaginal infections. It's found in 20% of women! Being pregnant, having diabetes, and use of antibiotics are risk factors. Often there are no symptoms, but if there are you get a "cottage cheese" discharge, with pruritis. More common in immuno-compomised, so be aware.

Treatment: imidazoles and oral fluconazole

Bacterial vaginosis

This is when the normal bacteria in the vagina are overgrown by particular bugs. No one knows why it happens, but it still happens in about 12% of women. No itchyness, but a fishy smell, sometimes with a discharge. Can be a symptom of underlying PID.

Treatment: metronidazole

Foreign bodies

In children, a common cause of vaginal discharge is foreign bodies. In adults, you can get toxic shock syndrome from a retained tampon! This can lead to a toxic Staphlococcus aureus infection. Quite bad!