DOC MY FATHER HAS DEMENTIA
Alzheimer's disease is a disease in which brain tissue degenerates. In Alzheimer's disease there is a severe and progressive decline in mental function. It is the most common cause of dementia (a general term for the loss of memory and other intellectual abilities serious enough to interfere with daily life).
The cause is as yet unknown but there are several different factors which may contribute to its development.
Aging is one important risk factor.
The illness mostly affects people over the age of 65.
A family history of Alzheimer's disease is another risk factor.
Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells.Plaques build up between nerve cells. Tangles form inside dying cells.Most scientists believe they somehow block communication among nerve cells and disrupt activities that cells need to survive.
Forgetfulness is often one of the earliest symptoms (Patients may forget dates, names of common objects and familiar people)
Confusion(Disorientation in time and place) ,
Trouble with organizing
Misplacing things,
Difficulty in expressing thoughts,
Difficulty performing familiar tasks
Difficulty understanding others
Poor or decreased judgment
Wandering and getting lost in familiar places
Changes in mood and behaviour (They may become easily agitated or depressed)
Changes in personality
In the early stage, forgetfulness is quite common in old people. As more symptoms appear, a doctor should be consulted for a full assessment and to confirm the diagnosis. Referral to a geriatrician may then be necessary for assessement and advice on management.
At the present moment there is no cure for Alzheimer's disease but there are many ways to reduce the problematic nature of the symptoms.
These including having
a fixed routine daily,
making the home and surroundings safe and familiar, and
using memory aids like diaries and calendars.
There are now drugs available to help delay or prevent symptoms from becoming worse:
One group of drugs helps improve the ability to think, understand, and remember.
Another group of drugs is also to help with behavioural problems associated with Alzheimer's disease, such as aggressiveness, agitation, depression, and anxiety.
Caring for a patient with dementia can be frustrating and stressful. It gets worse as the disease progresses.
There are now support groups and organisations which can help caregivers.
Tuesday, November 30, 2010
Monday, November 29, 2010
A Family Doctor's Tale - CEREBRAL PALSY
DOC I HAVE CEREBRAL PALSY
Cerebral palsy refers to a group of disorders characterized by loss of motor functions or any other nerve functions that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don't worsen over time.
Even though cerebral palsy affects muscle movement, it isn't caused by problems in the muscles or nerves. These disorders are caused by brain damage that occurs during foetal development or near the time of birth.
The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later.
Cerebral Palsy is mainly caused by brain damage that occurs during foetal development.
A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life:
1. brain infections such as bacterial meningitis or viral encephalitis
2. head injury from a motor vehicle accident, a fall, or child abuse.
It is not an inherited disease.
Symptoms of cerebral palsy are:
The early signs of cerebral palsy usually appear before a child reaches 3 years of age. Babies with Cerebral Palsy are usually slow to reach developmental milestones.
Abilities like learning to roll over, sit, crawl, smile or walk are not well developed.
The motor abilities will often seem unusual and strange.
The most common are:
1.lack of muscle coordination when performing voluntary movements (ataxia);
2.stiff or tight muscles and exaggerated reflexes (spasticity);
3.walking with one foot or leg dragging;
4.walking on the toes,
5.crouched gait, or a "scissored" gait:
6.muscle tone that is either too stiff or too floppy.
The symptoms of Cerebral Palsy vary from just mild clumsiness to extensive uncontrolled muscle spasticity.
Many with cerebral palsy have other disabilities :
1.seizures,
2.an inability to see, hear, speak or learn as others do,
3.psychological or behavioral problems.
Not everyone with Cerebral Palsy is retarded. Some are of average intelligence.
While some people with Cerebral Palsy have learning disabilities many others do not.
There are four types of Cerebral Palsy:
1.Spastic Cerebral Palsy, the most common type, is a disorder in which certain muscles are stiff and weak.
2.Athetoid (dyskinetic, hypotonic, dystonia) Cerebral Palsy where involuntary movements are present.
3.Ataxic Cerebral Palsy occurs when the Cerebellum has been damaged, thus causing lack of coordination and jerky movements. This form of Cerebral Palsy have staggered or fragmented movements often involving tremors or exaggerated posturing (athetosis) and bizarre twisting motions.
4.Mixed Cerebral Palsy is when two or more types of cerebral palsy are present in the same person.
Cerebral Palsy is a lifelong condition that cannot be cured.
The treatment is aimed at maintaining or improving the quality of life, providing the sufferer with tools to enjoy a near-normal life.
There are basically three types of treatment for Cerebral Palsy:
1.Surgery can be used to correct muscle contractures - removal of tight contractures that inhibits proper movement of the limbs.
2.Drugs such as clonazepam, baclofen and dantrolene are sometimes used to control muscle spasticity. Anticholinergic medications can help to control abnormal movements.
Alcohol or botulinum toxin type A (Botox) injections into muscle may be used to reduce spasticity for a short time so health care providers can work to lengthen a muscle.
3.Adjunctive therapies include
a.Physiotherapy, the most common treatment for cerebral palsy, consists of special exercises designed to increase and improve the range of movement and strength of the muscle groups, is aimed at strengthening and stretching muscles and preventing spasticity as well as increasing muscle control.
b.Occupational therapy is designed to help the child develop the fine motor skills needed to function day-to-day at home and school.
c.Speech therapy will also help the child develop communication skills.
Cerebral palsy doesn't always cause profound disabilities.
A child with severe cerebral palsy might be unable to walk and need extensive, lifelong care.
Another with mild cerebral palsy might be only slightly awkward and require no special assistance.
Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.
Cerebral palsy refers to a group of disorders characterized by loss of motor functions or any other nerve functions that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don't worsen over time.
Even though cerebral palsy affects muscle movement, it isn't caused by problems in the muscles or nerves. These disorders are caused by brain damage that occurs during foetal development or near the time of birth.
The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later.
Cerebral Palsy is mainly caused by brain damage that occurs during foetal development.
A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life:
1. brain infections such as bacterial meningitis or viral encephalitis
2. head injury from a motor vehicle accident, a fall, or child abuse.
It is not an inherited disease.
Symptoms of cerebral palsy are:
The early signs of cerebral palsy usually appear before a child reaches 3 years of age. Babies with Cerebral Palsy are usually slow to reach developmental milestones.
Abilities like learning to roll over, sit, crawl, smile or walk are not well developed.
The motor abilities will often seem unusual and strange.
The most common are:
1.lack of muscle coordination when performing voluntary movements (ataxia);
2.stiff or tight muscles and exaggerated reflexes (spasticity);
3.walking with one foot or leg dragging;
4.walking on the toes,
5.crouched gait, or a "scissored" gait:
6.muscle tone that is either too stiff or too floppy.
The symptoms of Cerebral Palsy vary from just mild clumsiness to extensive uncontrolled muscle spasticity.
Many with cerebral palsy have other disabilities :
1.seizures,
2.an inability to see, hear, speak or learn as others do,
3.psychological or behavioral problems.
Not everyone with Cerebral Palsy is retarded. Some are of average intelligence.
While some people with Cerebral Palsy have learning disabilities many others do not.
There are four types of Cerebral Palsy:
1.Spastic Cerebral Palsy, the most common type, is a disorder in which certain muscles are stiff and weak.
2.Athetoid (dyskinetic, hypotonic, dystonia) Cerebral Palsy where involuntary movements are present.
3.Ataxic Cerebral Palsy occurs when the Cerebellum has been damaged, thus causing lack of coordination and jerky movements. This form of Cerebral Palsy have staggered or fragmented movements often involving tremors or exaggerated posturing (athetosis) and bizarre twisting motions.
4.Mixed Cerebral Palsy is when two or more types of cerebral palsy are present in the same person.
Cerebral Palsy is a lifelong condition that cannot be cured.
The treatment is aimed at maintaining or improving the quality of life, providing the sufferer with tools to enjoy a near-normal life.
There are basically three types of treatment for Cerebral Palsy:
1.Surgery can be used to correct muscle contractures - removal of tight contractures that inhibits proper movement of the limbs.
2.Drugs such as clonazepam, baclofen and dantrolene are sometimes used to control muscle spasticity. Anticholinergic medications can help to control abnormal movements.
Alcohol or botulinum toxin type A (Botox) injections into muscle may be used to reduce spasticity for a short time so health care providers can work to lengthen a muscle.
3.Adjunctive therapies include
a.Physiotherapy, the most common treatment for cerebral palsy, consists of special exercises designed to increase and improve the range of movement and strength of the muscle groups, is aimed at strengthening and stretching muscles and preventing spasticity as well as increasing muscle control.
b.Occupational therapy is designed to help the child develop the fine motor skills needed to function day-to-day at home and school.
c.Speech therapy will also help the child develop communication skills.
Cerebral palsy doesn't always cause profound disabilities.
A child with severe cerebral palsy might be unable to walk and need extensive, lifelong care.
Another with mild cerebral palsy might be only slightly awkward and require no special assistance.
Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.
Sunday, November 28, 2010
DOC I HAVE CEREBRAL ANEURYSM
A cerebral aneurysm is an abnormal ballooning of a section of a blood vessel in the brain.
Cerebral aneurysms occur when there is a weakened area in the wall of a blood vessel in the brain.
1.They may occur as a congenital (before birth) defect or may develop later in life.
About 5% of the population has some form of aneurysm in the brain.
2.Trauma and infection, which can injure the blood vessel wall, can cause such aneurysms.
Symptoms are:
Cerebral aneurysm usually cause no symptoms until they rupture and cause bleeding into the brain.
Often, an aneurysm is found when a CT scan or MRI is performed for another reason. If the unruptured swollen aneurysm presses on the brain , it can cause the following symptoms:
1.Headaches
2.Eye pain
3.Neck pain
4.Double vision
5.Loss of vision
Symptoms of an aneurysm that have ruptured are:
1.Sudden occurrence of a severe headache (often described as "worst headache of my life")
2.Headaches with nausea or vomiting
3.Stiff neck
4.Muscle weakness, difficulty moving any part of the body
5.Numbness or decreased sensation in any part of the body
6.Vision changes like blurring of vision,double vision
7.Eyelid drooping
8.Confusion,
9. Sudden onset of irritability, impulsivity, or poor temper control
10.Slow, sluggish movement
11.Speech impairment
12.Seizures
A ruptured aneurysm is a medical emergency.
The following tests may be used to diagnose cerebral aneurysm:
1.CT scan of the head can identify bleeding and usually locate the aneurysm.
2.MRI of the head may be an alternative to a CT scan but may be as good at showing bleeding in the brain.
3.Cerebral angiography or spiral CT scan angiography of the head is used to pinpoint the location and size of the aneurysm.
4.cerebrospinal fluid examination via a spinal tap may confirm bleeding.
5.EEG (electroencephalogram) should be performed if there are seizures.
Treatment of cerebral aneurysm is important because symptoms often do not appear until bleeding of a cerebral aneurysm occurs.
A ruptured cerebral aneurysm is an emergency condition.
The goal of treatment is to prevent further bleeding.
Lowering of blood pressure can decrease the risk of further bleeding.
Neurosurgery is the primary treatment for cerebral aneurysm.
The base of the aneurysm is closed off with clamps or sutures.
Special coils or stents can be placed into the aneurysm through the arteries to prevent rupture.
A blood clot then forms in the aneurysm and prevents further bleeding. This is considered a less invasive approach than brain surgery. It is regarded as the best form of treatment.
If surgery is not feasible because of the location or size of the aneurysm or the condition of the person, medical treatment is:
1.restricting activity (often complete bedrest is advised),
2.treating symptoms such as headache,
3.controlling blood pressure, and
4.prescribing of antiseizure medications.
After the aneurysm is repaired, prevention of stroke due to blood vessel spasm is necessary. This may include intravenous fluids, certain medications, and controlling the blood pressure.
The prognosis depends on the severity of the condition.
Ruptured cerebral aneurysms are often serious.
In severe cases, about 25% of people die within 1 day, and another 25% die within about 3 months. Of those who survive, more than half will have some sort of permanent disability.
In small leaks of ruptured cerebral aneurysm, early treatment of the condition can be very effective with little loss of neurological deficit.
Unruptured aneurysms can be treated very effectively before causing problems.
The decision to repair an unruptured cerebral aneurysm is based on the size and location of the aneurysm, and the patient's age and general health.
Complications of cerebral aneurysm are :
1.Subarachnoid hemorrhage
2.Stroke
3.Seizures, epilepsy
4.Paralysis of any part of the body
5.Permanent loss of sensation of any part of the face or body
6.Other neurologic deficits (such as vision changes, loss of
speech ability, cognitive decline)
Prevention of cerebral aneurysm :
There is no known way to prevent the formation of a cerebral aneurysm because most of them are congenital.
If sudden or severe headache occurs, particularly if you also have nausea, vomiting, seizures, or any other neurological symptoms, early admission to hospital and appropriate investigation can detect an unruptured aneurym or one which has just started to bleed.
Treatment can be initiated and prognosis is good.
A cerebral aneurysm is an abnormal ballooning of a section of a blood vessel in the brain.
Cerebral aneurysms occur when there is a weakened area in the wall of a blood vessel in the brain.
1.They may occur as a congenital (before birth) defect or may develop later in life.
About 5% of the population has some form of aneurysm in the brain.
2.Trauma and infection, which can injure the blood vessel wall, can cause such aneurysms.
Symptoms are:
Cerebral aneurysm usually cause no symptoms until they rupture and cause bleeding into the brain.
Often, an aneurysm is found when a CT scan or MRI is performed for another reason. If the unruptured swollen aneurysm presses on the brain , it can cause the following symptoms:
1.Headaches
2.Eye pain
3.Neck pain
4.Double vision
5.Loss of vision
Symptoms of an aneurysm that have ruptured are:
1.Sudden occurrence of a severe headache (often described as "worst headache of my life")
2.Headaches with nausea or vomiting
3.Stiff neck
4.Muscle weakness, difficulty moving any part of the body
5.Numbness or decreased sensation in any part of the body
6.Vision changes like blurring of vision,double vision
7.Eyelid drooping
8.Confusion,
9. Sudden onset of irritability, impulsivity, or poor temper control
10.Slow, sluggish movement
11.Speech impairment
12.Seizures
A ruptured aneurysm is a medical emergency.
The following tests may be used to diagnose cerebral aneurysm:
1.CT scan of the head can identify bleeding and usually locate the aneurysm.
2.MRI of the head may be an alternative to a CT scan but may be as good at showing bleeding in the brain.
3.Cerebral angiography or spiral CT scan angiography of the head is used to pinpoint the location and size of the aneurysm.
4.cerebrospinal fluid examination via a spinal tap may confirm bleeding.
5.EEG (electroencephalogram) should be performed if there are seizures.
Treatment of cerebral aneurysm is important because symptoms often do not appear until bleeding of a cerebral aneurysm occurs.
A ruptured cerebral aneurysm is an emergency condition.
The goal of treatment is to prevent further bleeding.
Lowering of blood pressure can decrease the risk of further bleeding.
Neurosurgery is the primary treatment for cerebral aneurysm.
The base of the aneurysm is closed off with clamps or sutures.
Special coils or stents can be placed into the aneurysm through the arteries to prevent rupture.
A blood clot then forms in the aneurysm and prevents further bleeding. This is considered a less invasive approach than brain surgery. It is regarded as the best form of treatment.
If surgery is not feasible because of the location or size of the aneurysm or the condition of the person, medical treatment is:
1.restricting activity (often complete bedrest is advised),
2.treating symptoms such as headache,
3.controlling blood pressure, and
4.prescribing of antiseizure medications.
After the aneurysm is repaired, prevention of stroke due to blood vessel spasm is necessary. This may include intravenous fluids, certain medications, and controlling the blood pressure.
The prognosis depends on the severity of the condition.
Ruptured cerebral aneurysms are often serious.
In severe cases, about 25% of people die within 1 day, and another 25% die within about 3 months. Of those who survive, more than half will have some sort of permanent disability.
In small leaks of ruptured cerebral aneurysm, early treatment of the condition can be very effective with little loss of neurological deficit.
Unruptured aneurysms can be treated very effectively before causing problems.
The decision to repair an unruptured cerebral aneurysm is based on the size and location of the aneurysm, and the patient's age and general health.
Complications of cerebral aneurysm are :
1.Subarachnoid hemorrhage
2.Stroke
3.Seizures, epilepsy
4.Paralysis of any part of the body
5.Permanent loss of sensation of any part of the face or body
6.Other neurologic deficits (such as vision changes, loss of
speech ability, cognitive decline)
Prevention of cerebral aneurysm :
There is no known way to prevent the formation of a cerebral aneurysm because most of them are congenital.
If sudden or severe headache occurs, particularly if you also have nausea, vomiting, seizures, or any other neurological symptoms, early admission to hospital and appropriate investigation can detect an unruptured aneurym or one which has just started to bleed.
Treatment can be initiated and prognosis is good.
Friday, November 26, 2010
A Family Doctor's Tale - HEPATITIS A
DOC I HAVE HEPATITIS A
Hepatitis A is a acute inflammatory infection of the liver which is caused by the hepatitis A virus(HAV).
The virus is excreted in faeces and transmitted through contaminated food and water. Eating shellfish, cockle shells, prawns or crabs taken from sewage-contaminated water is a common means of contracting hepatitis A. It can also be acquired by close contact with individuals infected with the virus.
HAV causes the liver to become enlarged, inflamed and tender resulting in all the symptoms of hepatitis. There is no chronic (long-term) infection.
A person is infectious for 2-3 weeks before he or she experiences symptoms:
1.fever and joint pains
2.jaundice
3.fatigue
4.loss of appetite
5.nausea and vomiting
6.abdominal pain
7.pale coloured stools and dark urine
8.itchy skin due to irritation by the bilirubin.
During the first week of the illness he feels very sick and weak.
As the condition improves, the patient generally feels better after the first week but may requires to rest at home for 6 weeks to avoid damage to the liver.
A blood test is the best way to diagnose hepatitis A. His hepatitis antigens are raised at the early stage but as his condition improves the antibodies become positive.
His liver function tests are also done to assess the damage to the liver. Usually the seum bilirubin is high, liver enzymes or tramsaminase, alkaline phosphatase are raised in the acute stage of illness. As the condition improves, these tests gradually returned to normal.
There are no medicines for treatment of Hepatitis A except for symptomatic treatment of symptoms.
1.Rest in bed
2.multivitamins especially vitamin B to improve
the function of the liver
3.Lots of fluids
4.carbohydrate diet
5.Anti-itch creams and lotions to stop itch
Recovery is usual with rare cases going on to cirrhosis of the liver.
Hepatitis A vaccination is the best protection.
It is usually given in 2 doses within 1 year.
Immune globulin can be given for short-term protection. It is given before and within 2 weeks after coming in contact with hepatitis A virus. The vaccine is recommended for travellers travelling to developing countries and people with chronic liver disease.
Always practice good food hygiene.
Avoid food like seafood which may be contaminated by unhygienic water.
Always wash your hands with soap and water after using the toilet, before preparing and eating food.
Recovery is usual within 6 weeks.
Hepatitis A is a acute inflammatory infection of the liver which is caused by the hepatitis A virus(HAV).
The virus is excreted in faeces and transmitted through contaminated food and water. Eating shellfish, cockle shells, prawns or crabs taken from sewage-contaminated water is a common means of contracting hepatitis A. It can also be acquired by close contact with individuals infected with the virus.
HAV causes the liver to become enlarged, inflamed and tender resulting in all the symptoms of hepatitis. There is no chronic (long-term) infection.
A person is infectious for 2-3 weeks before he or she experiences symptoms:
1.fever and joint pains
2.jaundice
3.fatigue
4.loss of appetite
5.nausea and vomiting
6.abdominal pain
7.pale coloured stools and dark urine
8.itchy skin due to irritation by the bilirubin.
During the first week of the illness he feels very sick and weak.
As the condition improves, the patient generally feels better after the first week but may requires to rest at home for 6 weeks to avoid damage to the liver.
A blood test is the best way to diagnose hepatitis A. His hepatitis antigens are raised at the early stage but as his condition improves the antibodies become positive.
His liver function tests are also done to assess the damage to the liver. Usually the seum bilirubin is high, liver enzymes or tramsaminase, alkaline phosphatase are raised in the acute stage of illness. As the condition improves, these tests gradually returned to normal.
There are no medicines for treatment of Hepatitis A except for symptomatic treatment of symptoms.
1.Rest in bed
2.multivitamins especially vitamin B to improve
the function of the liver
3.Lots of fluids
4.carbohydrate diet
5.Anti-itch creams and lotions to stop itch
Recovery is usual with rare cases going on to cirrhosis of the liver.
Hepatitis A vaccination is the best protection.
It is usually given in 2 doses within 1 year.
Immune globulin can be given for short-term protection. It is given before and within 2 weeks after coming in contact with hepatitis A virus. The vaccine is recommended for travellers travelling to developing countries and people with chronic liver disease.
Always practice good food hygiene.
Avoid food like seafood which may be contaminated by unhygienic water.
Always wash your hands with soap and water after using the toilet, before preparing and eating food.
Recovery is usual within 6 weeks.
Thursday, November 25, 2010
A Family Doctor's Tale - BALANITIS
DOC I HAVE BALANITIS
Balanitis is an infection of the glans and prepuce of the penis.
It can occur because of:
1. Sexually transmitted bacterial diseases such as gonorrhea, chlamydia, candidiasis.
2. Viral diseases like genital herpes
3. Parasitic infection such as trichomoniasis
4..drug allergy and eruptions
5.Contact dermatitis, psoriasis, lichen planus, seborrheic dermatitis
6.collagen disease (Reiter's syndrome)
7.phimosis
Diagnosis is by:
1. Itchiness of the glans and prepuce with scratch marks
2. Pain and burning sensation on passing urine
3. Subpreputial(below prepuce) discharge 2-3 after intercourse in venereal disease
4. Oedema of prepuce
5. Ulceration of the glans
6. Blisters or rashes in genital herpes
7. enlarged inguinal lymph nodes
Physical examination.
Blood tests for venereal disease and glucose
Urine for sugar and leucocytes
Treatment is by:
1.Antibiotic
2.Personal and sexual hygiene
3.Treat underlying cause.
4. circumcision
Prognosis is good.
Balanitis is an infection of the glans and prepuce of the penis.
It can occur because of:
1. Sexually transmitted bacterial diseases such as gonorrhea, chlamydia, candidiasis.
2. Viral diseases like genital herpes
3. Parasitic infection such as trichomoniasis
4..drug allergy and eruptions
5.Contact dermatitis, psoriasis, lichen planus, seborrheic dermatitis
6.collagen disease (Reiter's syndrome)
7.phimosis
Diagnosis is by:
1. Itchiness of the glans and prepuce with scratch marks
2. Pain and burning sensation on passing urine
3. Subpreputial(below prepuce) discharge 2-3 after intercourse in venereal disease
4. Oedema of prepuce
5. Ulceration of the glans
6. Blisters or rashes in genital herpes
7. enlarged inguinal lymph nodes
Physical examination.
Blood tests for venereal disease and glucose
Urine for sugar and leucocytes
Treatment is by:
1.Antibiotic
2.Personal and sexual hygiene
3.Treat underlying cause.
4. circumcision
Prognosis is good.
Wednesday, November 24, 2010
A Family Doctor's Tale - SALPINGITIS
DOC I HAVE SALPINGITIS
Salpingitis is an acute or chronic infection of the fallopian tubes in females.
Acute Salpingitis is usually caused by the following:
Infections:
1.sexually transmitted disease like gonorrhea,trichomonas and chlamydia.
2.tuberculosis salpingitis is rare
3.Infection may follow childbirth or abortion
Mechanical irritants:
intrauterine device may cause acute or chronic Salpingitis
Persons who has Acute Salpingitis has the following
Symptoms:
1.severe lower abdominal pain
2.purulent vaginal discharge
3.painful or frequency of urination
4.fever
Signs:
1.tenderness in either lower abdominal quadrant
2.discharge can be seen in female vagina
3.vaginal examination - lateral movement of cervix causes pain
- palpation of the fallopian tubes may be very painful
4.swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.
Acute Salpingitis may progress to chronic Salpingitis:
1. tubal infection with abscess formation(pyosalphinx) or cyst formation(hydrosalphinx)
2. Pelvic abscess
3. Ovarian infection
4.Infertility due to tube blockage
5. Peritonitis may occur with rupture of cyst and abscess
1.Approprate Antibiotics for infections especially after uterine bacterial culture
2.Bedrest
3.Surgery may be necessary in cases not responding to antibiotics.
Drainage of the abscess may be done and infected tube resected if necessary
Prognosis is usually good with current antibiotics and medication.
Sexual partner may need to be treated.
Recurrence is quite common.
Infertility may result in blocked or scarred fallopian tubes
Salpingitis is an acute or chronic infection of the fallopian tubes in females.
Acute Salpingitis is usually caused by the following:
Infections:
1.sexually transmitted disease like gonorrhea,trichomonas and chlamydia.
2.tuberculosis salpingitis is rare
3.Infection may follow childbirth or abortion
Mechanical irritants:
intrauterine device may cause acute or chronic Salpingitis
Persons who has Acute Salpingitis has the following
Symptoms:
1.severe lower abdominal pain
2.purulent vaginal discharge
3.painful or frequency of urination
4.fever
Signs:
1.tenderness in either lower abdominal quadrant
2.discharge can be seen in female vagina
3.vaginal examination - lateral movement of cervix causes pain
- palpation of the fallopian tubes may be very painful
4.swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.
Acute Salpingitis may progress to chronic Salpingitis:
1. tubal infection with abscess formation(pyosalphinx) or cyst formation(hydrosalphinx)
2. Pelvic abscess
3. Ovarian infection
4.Infertility due to tube blockage
5. Peritonitis may occur with rupture of cyst and abscess
1.Approprate Antibiotics for infections especially after uterine bacterial culture
2.Bedrest
3.Surgery may be necessary in cases not responding to antibiotics.
Drainage of the abscess may be done and infected tube resected if necessary
Prognosis is usually good with current antibiotics and medication.
Sexual partner may need to be treated.
Recurrence is quite common.
Infertility may result in blocked or scarred fallopian tubes
Tuesday, November 23, 2010
A Family Doctor's Tale - CERVICITIS
DOC I HAVE CERVICITIS
Cervicitis is non-specific infection of the cervix.
It is most common on the posterior cervix but may be anterior or concentric.
1.Congeital cervical erosions or cervicitis can occur in virgins.
2.sexually active females
3.dilatation in labour or during abortion
There are
1.Simple:
Erosion surface is smooth
2.Paippilary:
Erosion surface is rough
3.Follicular:
Erosion surface is cystic
Bacterial infections:
1.Gonorrhea
2.Chlamydia
3.staphylococcus aureus
4.Streptococcus
5.Mycobacterium tuberculosis.
6.E.coli
Viral infections:
1.Genital herpes
2..Human Papilloma Virus
Other causes:
1.Cervical cap
2.Device to support the uterus (pessary)
3.Diaphragm
4.allergy to spermicides
5.Exposure to a chemical
danger
1.Pelvic inflammatory disease
2.Urethritis and cystitis
3.rarely malignant changes in cervix
4.inguinal lymphadenitis
5.Cervical cancer
1.Mucopurulent vaginal discharge (Gray, white, or yellow color) with odor
2.Blood in the vaginal discharge
a.After intercourse
b.After menopause
c.Between periods
3.Urinary infection symptoms - frequency and pain
3.hematuria (blood in the urine)
4.Pelvic pain
5.Backache
6.Painful sexual intercourse
7.Pain in the vagina
8.Pressure or heaviness in the pelvis
Signs:
1.reddened area of cervix
2.erosion of cervical wall
3.Vaginal surface of cervix may be affected
4.pus discharge from the cervix
5.Swelling (inflammation) of the walls of the vagina
6.Vaginal examination with Pap's smear of cervical cells
7.Cervical swab for culture and sensitivity to antibiotics
8.Blood tests( white cell count , blood culture, chlamydia, gonorrhea)
Acute Cervicitis
1. Antibiotics is given according to the sensitivity of bacteria in the culture.
2.Pelvic pain and backache may be treated with paracetamol
3.Local application of sulphonamide,tetracycline or other antibiotic cream
4.Cauterisation of the affected cervical area
5.Cryosurgery
6.Cone biopsy if necessary.
7.Hormonal therapy (especially in postmenopausal women)
8.Laser therapy
Prognosis with appropriate treatment and antibiotics is generally good.
Recurrence is common.
Cervicitis may last for months to years.
Cervicitis may lead to pain with intercourse (dyspareunia).
Avoid sexual intercourse with multiple partners.
Use condoms during sexual intercourse.
Vaccination against human papilloma virus
Avoid chemical irritants such as douches and deodorant tampons.
Avoid using spermicidal contraceptives
Make sure that any foreign objects that you insert into your vagina is clean or sterile.
Cervicitis is non-specific infection of the cervix.
It is most common on the posterior cervix but may be anterior or concentric.
1.Congeital cervical erosions or cervicitis can occur in virgins.
2.sexually active females
3.dilatation in labour or during abortion
There are
1.Simple:
Erosion surface is smooth
2.Paippilary:
Erosion surface is rough
3.Follicular:
Erosion surface is cystic
Bacterial infections:
1.Gonorrhea
2.Chlamydia
3.staphylococcus aureus
4.Streptococcus
5.Mycobacterium tuberculosis.
6.E.coli
Viral infections:
1.Genital herpes
2..Human Papilloma Virus
Other causes:
1.Cervical cap
2.Device to support the uterus (pessary)
3.Diaphragm
4.allergy to spermicides
5.Exposure to a chemical
danger
1.Pelvic inflammatory disease
2.Urethritis and cystitis
3.rarely malignant changes in cervix
4.inguinal lymphadenitis
5.Cervical cancer
1.Mucopurulent vaginal discharge (Gray, white, or yellow color) with odor
2.Blood in the vaginal discharge
a.After intercourse
b.After menopause
c.Between periods
3.Urinary infection symptoms - frequency and pain
3.hematuria (blood in the urine)
4.Pelvic pain
5.Backache
6.Painful sexual intercourse
7.Pain in the vagina
8.Pressure or heaviness in the pelvis
Signs:
1.reddened area of cervix
2.erosion of cervical wall
3.Vaginal surface of cervix may be affected
4.pus discharge from the cervix
5.Swelling (inflammation) of the walls of the vagina
6.Vaginal examination with Pap's smear of cervical cells
7.Cervical swab for culture and sensitivity to antibiotics
8.Blood tests( white cell count , blood culture, chlamydia, gonorrhea)
Acute Cervicitis
1. Antibiotics is given according to the sensitivity of bacteria in the culture.
2.Pelvic pain and backache may be treated with paracetamol
3.Local application of sulphonamide,tetracycline or other antibiotic cream
4.Cauterisation of the affected cervical area
5.Cryosurgery
6.Cone biopsy if necessary.
7.Hormonal therapy (especially in postmenopausal women)
8.Laser therapy
Prognosis with appropriate treatment and antibiotics is generally good.
Recurrence is common.
Cervicitis may last for months to years.
Cervicitis may lead to pain with intercourse (dyspareunia).
Avoid sexual intercourse with multiple partners.
Use condoms during sexual intercourse.
Vaccination against human papilloma virus
Avoid chemical irritants such as douches and deodorant tampons.
Avoid using spermicidal contraceptives
Make sure that any foreign objects that you insert into your vagina is clean or sterile.
Monday, November 22, 2010
A Family Doctor's Tale - PELVIC INFLAMMATORY DISEASE
DOC I HAVE PELVIC INFLAMMATORY DISEASE
Pelvic inflammatory disease (PID) is a general term used to describe inflammatory disorders of the upper female genital tract, such as infection of the uterus, fallopian tubes, ovaries and tissues around the reproductive organs.
It is the result of infection from some sexually transmitted diseases especially chlamydia and gonorrhea. The fallopian tubes and tissues in and near the uterus and ovaries are the most frequent organs damaged.
Sexually active women in their childbearing years are most likely to get PID. Women under age 25 are more likely to develop PID than those older than 25. The cervix of young women is not fully matured, and therefore more prone to be infected by STD.
Vaginal douching in women changes the vaginal bacteria flora in harmful ways, and can also force bacteria into the upper reproductive organs from the vagina.
Women with an intrauterine device (IUD) inserted has an increased risk of PID compared with women using other contraceptives or no contraceptive at all.
Symptoms of PID can vary widely.
Women whose PID is caused by chlamydial infection may have mild symptoms or no symptoms at all even as serious damage is being done to her reproductive organs. Most cases of PID are not detected about two thirds of the time.
Common symptoms of PID are
1.lower abdominal pain
2.fever,
3.unusual vaginal discharge with a foul odor,
4.painful intercourse,
5.painful urination,
6.irregular menstrual bleeding, and
7.pain in the right upper abdomen (rare).
Prompt and appropriate treatment can help prevent complications of PID. Without treatment, PID can cause
1. permanent damage to the female reproductive organs. Infection-causing bacteria can invade the fallopian tubes, damaging the lining of the tubes causing blockage of the fallopian tubes and preventing sperm from fertilising an egg.
2.Infertility also occur when the fallopian tubes are partially blocked or even slightly damaged as therm may find it difficult to reach the egg.
3.ectopic pregnancy may occur when the fertilized egg remains in the partially blocked fallopian tube and begins to grow. As it grows, an ectopic pregnancy can cause rupture of the fallopian tube resulting abdominal pain, internal bleeding, and death.
4.chronic pelvic pain that lasts for months or even years due to the inflammation, damage to the pelvic organs, and contraction of the scarred tissues.
5.endometrosis are blood clots in the pelvic region which occurs due to inflammation of the pelvis and can also cause pain during menses.
Because the symptoms are often subtle and mild, most cases of PID go undetected.
Diagnosis is usually based on clinical findings:
1.lower abdominal pain
2.abnormal vaginal or cervical discharge,r
3.evidence of gonorrheal or chlamydial infection.
4. pelvic ultrasound is a helpful procedure for diagnosing PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess is present.
5.laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end (laparoscope) is inserted through a small incision in the lower abdomen. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed.
PID can be cured with several types of antibiotics. A health care provider will determine and prescribe the best therapy. However, antibiotic treatment does not reverse any damage that has already occurred to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is critical that she seek care immediately. Prompt antibiotic treatment can prevent severe damage to reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.
Because of the difficulty in identifying organisms infecting the internal reproductive organs and because more than one organism may be responsible for an episode of PID, PID is usually treated with at least two antibiotics that are effective against a wide range of infectious agents. These antibiotics can be given by mouth or by injection. The symptoms may go away before the infection is cured. Even if symptoms go away, the woman should finish taking all of the prescribed medicine. This will help prevent the infection from returning. Women being treated for PID should be re-evaluated by their health care provider two to three days after starting treatment to be sure the antibiotics are working to cure the infection. In addition, a woman's sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.
Hospitalization to treat PID may be recommended if the woman (1) is severely ill (e.g., nausea, vomiting, and high fever); (2) is pregnant; (3) does not respond to or cannot take oral medication and needs intravenous antibiotics; or (4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess). If symptoms continue or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.
STD (mainly untreated Chlamydia or gonorrhea) is the main preventable cause of PID. Women can protect themselves from PID by taking action to prevent STDs or by getting early treatment if they do get an STD.
The surest way to avoid transmission of STDs is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of chlamydia and gonorrhea.
Pelvic inflammatory disease (PID) is a general term used to describe inflammatory disorders of the upper female genital tract, such as infection of the uterus, fallopian tubes, ovaries and tissues around the reproductive organs.
It is the result of infection from some sexually transmitted diseases especially chlamydia and gonorrhea. The fallopian tubes and tissues in and near the uterus and ovaries are the most frequent organs damaged.
Sexually active women in their childbearing years are most likely to get PID. Women under age 25 are more likely to develop PID than those older than 25. The cervix of young women is not fully matured, and therefore more prone to be infected by STD.
Vaginal douching in women changes the vaginal bacteria flora in harmful ways, and can also force bacteria into the upper reproductive organs from the vagina.
Women with an intrauterine device (IUD) inserted has an increased risk of PID compared with women using other contraceptives or no contraceptive at all.
Symptoms of PID can vary widely.
Women whose PID is caused by chlamydial infection may have mild symptoms or no symptoms at all even as serious damage is being done to her reproductive organs. Most cases of PID are not detected about two thirds of the time.
Common symptoms of PID are
1.lower abdominal pain
2.fever,
3.unusual vaginal discharge with a foul odor,
4.painful intercourse,
5.painful urination,
6.irregular menstrual bleeding, and
7.pain in the right upper abdomen (rare).
Prompt and appropriate treatment can help prevent complications of PID. Without treatment, PID can cause
1. permanent damage to the female reproductive organs. Infection-causing bacteria can invade the fallopian tubes, damaging the lining of the tubes causing blockage of the fallopian tubes and preventing sperm from fertilising an egg.
2.Infertility also occur when the fallopian tubes are partially blocked or even slightly damaged as therm may find it difficult to reach the egg.
3.ectopic pregnancy may occur when the fertilized egg remains in the partially blocked fallopian tube and begins to grow. As it grows, an ectopic pregnancy can cause rupture of the fallopian tube resulting abdominal pain, internal bleeding, and death.
4.chronic pelvic pain that lasts for months or even years due to the inflammation, damage to the pelvic organs, and contraction of the scarred tissues.
5.endometrosis are blood clots in the pelvic region which occurs due to inflammation of the pelvis and can also cause pain during menses.
Because the symptoms are often subtle and mild, most cases of PID go undetected.
Diagnosis is usually based on clinical findings:
1.lower abdominal pain
2.abnormal vaginal or cervical discharge,r
3.evidence of gonorrheal or chlamydial infection.
4. pelvic ultrasound is a helpful procedure for diagnosing PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess is present.
5.laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end (laparoscope) is inserted through a small incision in the lower abdomen. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed.
PID can be cured with several types of antibiotics. A health care provider will determine and prescribe the best therapy. However, antibiotic treatment does not reverse any damage that has already occurred to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is critical that she seek care immediately. Prompt antibiotic treatment can prevent severe damage to reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.
Because of the difficulty in identifying organisms infecting the internal reproductive organs and because more than one organism may be responsible for an episode of PID, PID is usually treated with at least two antibiotics that are effective against a wide range of infectious agents. These antibiotics can be given by mouth or by injection. The symptoms may go away before the infection is cured. Even if symptoms go away, the woman should finish taking all of the prescribed medicine. This will help prevent the infection from returning. Women being treated for PID should be re-evaluated by their health care provider two to three days after starting treatment to be sure the antibiotics are working to cure the infection. In addition, a woman's sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.
Hospitalization to treat PID may be recommended if the woman (1) is severely ill (e.g., nausea, vomiting, and high fever); (2) is pregnant; (3) does not respond to or cannot take oral medication and needs intravenous antibiotics; or (4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess). If symptoms continue or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.
STD (mainly untreated Chlamydia or gonorrhea) is the main preventable cause of PID. Women can protect themselves from PID by taking action to prevent STDs or by getting early treatment if they do get an STD.
The surest way to avoid transmission of STDs is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of chlamydia and gonorrhea.
Sunday, November 21, 2010
A Family Doctor's Tale - HEPATITIS C
DOC I HAVE HEPATITIS C
Hepatitis B is a serious inflammatory liver disease caused by a virus which is called hepatitis C virus (HCV).
Hepatitis C virus infection is one of the most common chronic bloodborne infection.
Persons at risk for infection are:
1. injection-drug users
2. blood transfusions or solid organ transplant recipients before July 1992
3. on long-term dialysis
4. sexual exposure to infected HCV carriers(rare)
Persons who has been newly infected with HCV usually are asymptomatic or have a mild clinical illness:
mild fever and bodyaches
slight jaundice
nausea
enlarged liver
A person exposed to Hepatitis C infection can detect HCV RNA in blood within 1-3 weeks.
The time from exposure to antibody to HCV seroconversion(or Anti-HCV) is 8-9 weeks.
Therefore diagnosis can usually be confirmed by :
1.the presence of Anti-HCV in 98% of infected persons within 6 months of exposure.
2.Reverse transcriptase polymerase chain reaction to detect HCV RNA
Chronic HCV infection occurs in 70% of HCV-infected persons.
Two thirds of these have evidence of active liver disease but may not be aware of their infection because they are not clinically ill.
Infected HCV carriers can transmit the illness to others and develop chronic liver diseases for years after infection.
There is no cure for HCV infections.
Persons found to be anti-HCV positive should be evaluated for presence of active infection, presence or development of CLD, and for possible treatment.
Combination therapy with interferon and ribavirin may help in treatment of patients with chronic hepatitis C.
No vaccine for hepatitis C is available.
Immune globulin is not effective in preventing HCV infection after exposure.
Primary prevention reduces or eliminates HCV transmission.
Secondary prevention activities reduce liver and other chronic diseases in HCV-infected persons by identifying them and providing appropriate medical management and antiviral therapy.
Persons who test positive for anti-HCV (see Diagnosis and Treatment) should be provided information regarding
1) how to protect their liver from further harm by avoiding alcohol and taking any new medicines (including OTC and herbals)
2) how to prevent transmission to others
a) not donate blood, body organs, other tissue, or semen;
b) not share any personal items that might have blood on them (e.g., toothbrushes and razors); c) cover cuts and sores on the skin to keep from spreading infectious blood or secretions
3) the need for medical evaluation including assessment of liver function tests, assessment for severity of liver disease and possible treatment, and determination of the need for hepatitis A and B.
HCV-positive women do not need to avoid pregnancy or breastfeeding.
Hepatitis B is a serious inflammatory liver disease caused by a virus which is called hepatitis C virus (HCV).
Hepatitis C virus infection is one of the most common chronic bloodborne infection.
Persons at risk for infection are:
1. injection-drug users
2. blood transfusions or solid organ transplant recipients before July 1992
3. on long-term dialysis
4. sexual exposure to infected HCV carriers(rare)
Persons who has been newly infected with HCV usually are asymptomatic or have a mild clinical illness:
mild fever and bodyaches
slight jaundice
nausea
enlarged liver
A person exposed to Hepatitis C infection can detect HCV RNA in blood within 1-3 weeks.
The time from exposure to antibody to HCV seroconversion(or Anti-HCV) is 8-9 weeks.
Therefore diagnosis can usually be confirmed by :
1.the presence of Anti-HCV in 98% of infected persons within 6 months of exposure.
2.Reverse transcriptase polymerase chain reaction to detect HCV RNA
Chronic HCV infection occurs in 70% of HCV-infected persons.
Two thirds of these have evidence of active liver disease but may not be aware of their infection because they are not clinically ill.
Infected HCV carriers can transmit the illness to others and develop chronic liver diseases for years after infection.
There is no cure for HCV infections.
Persons found to be anti-HCV positive should be evaluated for presence of active infection, presence or development of CLD, and for possible treatment.
Combination therapy with interferon and ribavirin may help in treatment of patients with chronic hepatitis C.
No vaccine for hepatitis C is available.
Immune globulin is not effective in preventing HCV infection after exposure.
Primary prevention reduces or eliminates HCV transmission.
Secondary prevention activities reduce liver and other chronic diseases in HCV-infected persons by identifying them and providing appropriate medical management and antiviral therapy.
Persons who test positive for anti-HCV (see Diagnosis and Treatment) should be provided information regarding
1) how to protect their liver from further harm by avoiding alcohol and taking any new medicines (including OTC and herbals)
2) how to prevent transmission to others
a) not donate blood, body organs, other tissue, or semen;
b) not share any personal items that might have blood on them (e.g., toothbrushes and razors); c) cover cuts and sores on the skin to keep from spreading infectious blood or secretions
3) the need for medical evaluation including assessment of liver function tests, assessment for severity of liver disease and possible treatment, and determination of the need for hepatitis A and B.
HCV-positive women do not need to avoid pregnancy or breastfeeding.
Saturday, November 20, 2010
A Family Doctor's Tale - GONORRHEA
DOC I HAVE GONORRHEA
Gonorrhea is a sexually transmitted disease caused by the gram negative bacteria Neisseria gonorrhoeae.
Gonorrhea is a very common infectious disease, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix, uterus and fallopian tubes in women, and in the urethra in women and men.
The bacterium can also grow in the mouth, throat, eyes, and anus.
Gonorrhea is spread by infected people through contact with the penis, vagina, mouth, or anus.
There is no life long immunity after tratment with Gonorrhea.
A person who has been treated for gonorrhea may get infected again if there is sexual contact with a person infected with gonorrhea.
Gonorrhea can also be spread from mother to baby during delivery.
People who are at risk for gonorrhea are:
Any sexually active person can be infected with gonorrhea if their partner has the disease.
Symptoms of gonorrhea
A high percentage of men with gonorrhea do not have any symptoms at all.
Some men have some symptoms that appear two to five days after infection.
Symptoms include
1.a burning sensation when urinating, or a white, yellow, or green discharge from the penis.
2. painful or swollen testicles.
In women the symptoms of gonorrhea are often mild.
Most women who are infected have no symptoms.
The initial symptoms in women include
1.a painful or burning sensation when urinating,
2.increased vaginal discharge,
3.vaginal bleeding between periods.
4.lower abdominal pain due to salpingitis(infected fallopian tubes)
Women with gonorrhea are at risk of developing serious complications from the infection.
Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements.
Most of the time rectal infection do not cause symptoms.
Infections in the throat may cause a sore throat.
Usually there are no symptoms.
A pregnant woman with gonorrhea may give the infection to her baby as the baby passes through the birth canal during delivery.
This can cause blindness, joint infection, or a life-threatening blood infection in the baby.
Treatment of gonorrhea should be started as soon as it is detected in pregnant women.
Diagnosis is by:
There are several laboratory tests available to diagnose gonorrhea:
1. a swab may be taken from cervix, urethra, rectum, or throat for testing
2. A direct Gram smear test of a sample from a urethra or a cervix allows the doctor in the clinic to see the gonorrhea bacterium under a microscope.
3. blood test can also detect the presence of gonorrhea in the blood stream
Treatment for gonorrhea is:
There are several antibiotics(penicillin, tetracyclines, spectinomycin) which can successfully cure gonorrhea in adolescents and adults.
Drug-resistant strains of gonorrhea are increasing in many areas of the world and successful treatment of gonorrhea is becoming more difficult.
Sometimes people with gonorrhea also have chlamydia.
Antibiotics for both infections are usually given together.
Persons with gonorrhea should be tested for other STDs.
It is advisable to take all of the medication prescribed to cure gonorrhea.
People who have had gonorrhea and have been treated can get the disease a second time if they have sexual contact with persons infected with gonorrhea.
Complications of gonorrhea are:
Untreated gonorrhea can cause serious and permanent complications in both women and men.
In women, gonorrhea is a common cause of pelvic inflammatory disease (PID).
Women with PID may not have symptoms.
Symptoms when present can be very severe and can include abdominal pain and fever.
PID can cause internal abscesses in the pelvis which can give rise to long-lasting, chronic pelvic pain.
PID can damage the fallopian tubes enough to cause infertility and the risk of ectopic pregnancy.
Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube, sometimes in the abdomen.
In men gonorrhea can cause epididymitis, a painful infection of the testicles that can lead to infertility if left untreated.
Prostatits(infection of prostate), seminal vesiculitis and chronic urethral infection may be associated with fever and lead to urethral strictures causing difficulty in passing urine.
People with gonorrhea are more likely to contract HIV the virus that causes AIDS.
Gonorrhea can spread to the blood, joints or eyes(uveitis).
Blood infection or septicemia can be life threatening.
Prevention of gonorrhea is by:
The best way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse.
He or she should be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea.
Any genital symptoms such as discharge or burning sensation during urination or unusual sore or rash should be a signal to stop having sex.
A person who has been diagnosed and treated for gonorrhea should notify all recent sex partners so they can also be treated.
In this way there is less risk that the sexual partners will develop serious complications from gonorrhea.
It will also reduce the person's risk of becoming re-infected.
The person and all of his or her sex partners must avoid sex until they have completed their treatment for gonorrhea.
Gonorrhea is a sexually transmitted disease caused by the gram negative bacteria Neisseria gonorrhoeae.
Gonorrhea is a very common infectious disease, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix, uterus and fallopian tubes in women, and in the urethra in women and men.
The bacterium can also grow in the mouth, throat, eyes, and anus.
Gonorrhea is spread by infected people through contact with the penis, vagina, mouth, or anus.
There is no life long immunity after tratment with Gonorrhea.
A person who has been treated for gonorrhea may get infected again if there is sexual contact with a person infected with gonorrhea.
Gonorrhea can also be spread from mother to baby during delivery.
People who are at risk for gonorrhea are:
Any sexually active person can be infected with gonorrhea if their partner has the disease.
Symptoms of gonorrhea
A high percentage of men with gonorrhea do not have any symptoms at all.
Some men have some symptoms that appear two to five days after infection.
Symptoms include
1.a burning sensation when urinating, or a white, yellow, or green discharge from the penis.
2. painful or swollen testicles.
In women the symptoms of gonorrhea are often mild.
Most women who are infected have no symptoms.
The initial symptoms in women include
1.a painful or burning sensation when urinating,
2.increased vaginal discharge,
3.vaginal bleeding between periods.
4.lower abdominal pain due to salpingitis(infected fallopian tubes)
Women with gonorrhea are at risk of developing serious complications from the infection.
Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements.
Most of the time rectal infection do not cause symptoms.
Infections in the throat may cause a sore throat.
Usually there are no symptoms.
A pregnant woman with gonorrhea may give the infection to her baby as the baby passes through the birth canal during delivery.
This can cause blindness, joint infection, or a life-threatening blood infection in the baby.
Treatment of gonorrhea should be started as soon as it is detected in pregnant women.
Diagnosis is by:
There are several laboratory tests available to diagnose gonorrhea:
1. a swab may be taken from cervix, urethra, rectum, or throat for testing
2. A direct Gram smear test of a sample from a urethra or a cervix allows the doctor in the clinic to see the gonorrhea bacterium under a microscope.
3. blood test can also detect the presence of gonorrhea in the blood stream
Treatment for gonorrhea is:
There are several antibiotics(penicillin, tetracyclines, spectinomycin) which can successfully cure gonorrhea in adolescents and adults.
Drug-resistant strains of gonorrhea are increasing in many areas of the world and successful treatment of gonorrhea is becoming more difficult.
Sometimes people with gonorrhea also have chlamydia.
Antibiotics for both infections are usually given together.
Persons with gonorrhea should be tested for other STDs.
It is advisable to take all of the medication prescribed to cure gonorrhea.
People who have had gonorrhea and have been treated can get the disease a second time if they have sexual contact with persons infected with gonorrhea.
Complications of gonorrhea are:
Untreated gonorrhea can cause serious and permanent complications in both women and men.
In women, gonorrhea is a common cause of pelvic inflammatory disease (PID).
Women with PID may not have symptoms.
Symptoms when present can be very severe and can include abdominal pain and fever.
PID can cause internal abscesses in the pelvis which can give rise to long-lasting, chronic pelvic pain.
PID can damage the fallopian tubes enough to cause infertility and the risk of ectopic pregnancy.
Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube, sometimes in the abdomen.
In men gonorrhea can cause epididymitis, a painful infection of the testicles that can lead to infertility if left untreated.
Prostatits(infection of prostate), seminal vesiculitis and chronic urethral infection may be associated with fever and lead to urethral strictures causing difficulty in passing urine.
People with gonorrhea are more likely to contract HIV the virus that causes AIDS.
Gonorrhea can spread to the blood, joints or eyes(uveitis).
Blood infection or septicemia can be life threatening.
Prevention of gonorrhea is by:
The best way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse.
He or she should be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea.
Any genital symptoms such as discharge or burning sensation during urination or unusual sore or rash should be a signal to stop having sex.
A person who has been diagnosed and treated for gonorrhea should notify all recent sex partners so they can also be treated.
In this way there is less risk that the sexual partners will develop serious complications from gonorrhea.
It will also reduce the person's risk of becoming re-infected.
The person and all of his or her sex partners must avoid sex until they have completed their treatment for gonorrhea.
Friday, November 19, 2010
A Family Doctor's Tale - BACTERIA VAGINOSIS
DOC I HAVE BACTERIAL VAGINOSIS
Bacterial Vaginosis (BV) is a condition in women where the normal balance of lactobacillus bacteria in the vagina is disrupted and replaced by an overgrowth of high concentrations of anaerobic bacteria (e.g., Prevotella sp. , Mobiluncus sp.), G. vaginalis, and Mycoplasma hominis. The condition is characterised by vaginal discharge, odor, pain and itching.
Bacterial Vaginosis is the most common vaginal infection in women after puberty.
BV is associated with an imbalance in the lactobacillus bacteria in a woman's vagina. The cause of this imbalance is not known.
Some possible causes of this imbalnce are:
1.Having multiple sex partners or a new sex partner
2.Vaginal Douching which alter the pH and bacterial flora of vagina
3.Using an intrauterine device for preventing pregnancy.
Women that have never had sexual intercourse are rarely affected.
Women with typical Bacterial Vaginosis symptoms have:
1.an abnormal vaginal discharge with an unpleasant fish-like odor especially after intercourse.The discharge is usually greyish,semiadherent, homogeneous. Sometimes it can be thin,cream to green in colour and frothy.
2.burning sensation during urination
3.itching around the outside of the vagina,
More than 50% women with BV report no symptoms at all.
In most cases, there are no complications.
Some serious complications from BV include:
1.pelvic inflammatory disease (PID) especially after surgery like hysterectomy
2.endometritis,
3.increased susceptibility to other STDs, such as chlamydia, gonorrhea and HIV.
4.increased risk for some complications of pregnancy such as ectopic pregnancy and premature births.
1.vagina examination for homogeneous, thin, white discharge that smoothly coats the vaginal walls;
2.laboratory tests on a sample of vaginal fluid:
a.presence of clue cells on microscopic examination;
b.pH of vaginal fluid >4.5;
c.fishy odor of vaginal discharge before or after addition of 1% KOH (the whiff test).
d.Gram stain is used to detect the relative concentration of lactobacilli (long Gram-positive rods), Gram-negative and Gram-variable rods and cocci ( G. vaginalis, Prevotella, Porphyromonas, and peptostreptococci), and curved Gram-negative rods (Mobiluncus) characteristic of BV.
All women suspected of BV should be treated to avoid such complications as Pelvic Inflammatory Disease.
Treatment is especially important for pregnant women. All pregnant women who have symptoms of BV should be checked and treated.
BV is treatable with antibiotics :
metronidazole 500 mg orally twice a day for 7 days
OR
Metronidazole gel, 0.75%,5 g intravaginally, once a day for 5 days
OR
Clindamycin 300 mg orally twice a day for 7 days
OR
Clindamycin cream, 2%,5 g intravaginally at bedtime for 7 days
Either can be used with non-pregnant or pregnant women, but the recommended dosages differ.
Patients treated with metronidazole should be advised to avoid consuming alcohol for 24 hours.
BV can recur after treatment.
Since BV is seldom found in women who have never had intercourse.
and is associated with having a new sex partner or having multiple sex partners, prevention measures are aimed at sexual transmission:
Abstain from sex
Do not have multiple sex partners.
Do not use vaginal douche.
Take all of the medicine prescribed for treatment of BV even if there are no more symptoms.
Bacterial Vaginosis (BV) is a condition in women where the normal balance of lactobacillus bacteria in the vagina is disrupted and replaced by an overgrowth of high concentrations of anaerobic bacteria (e.g., Prevotella sp. , Mobiluncus sp.), G. vaginalis, and Mycoplasma hominis. The condition is characterised by vaginal discharge, odor, pain and itching.
Bacterial Vaginosis is the most common vaginal infection in women after puberty.
BV is associated with an imbalance in the lactobacillus bacteria in a woman's vagina. The cause of this imbalance is not known.
Some possible causes of this imbalnce are:
1.Having multiple sex partners or a new sex partner
2.Vaginal Douching which alter the pH and bacterial flora of vagina
3.Using an intrauterine device for preventing pregnancy.
Women that have never had sexual intercourse are rarely affected.
Women with typical Bacterial Vaginosis symptoms have:
1.an abnormal vaginal discharge with an unpleasant fish-like odor especially after intercourse.The discharge is usually greyish,semiadherent, homogeneous. Sometimes it can be thin,cream to green in colour and frothy.
2.burning sensation during urination
3.itching around the outside of the vagina,
More than 50% women with BV report no symptoms at all.
In most cases, there are no complications.
Some serious complications from BV include:
1.pelvic inflammatory disease (PID) especially after surgery like hysterectomy
2.endometritis,
3.increased susceptibility to other STDs, such as chlamydia, gonorrhea and HIV.
4.increased risk for some complications of pregnancy such as ectopic pregnancy and premature births.
1.vagina examination for homogeneous, thin, white discharge that smoothly coats the vaginal walls;
2.laboratory tests on a sample of vaginal fluid:
a.presence of clue cells on microscopic examination;
b.pH of vaginal fluid >4.5;
c.fishy odor of vaginal discharge before or after addition of 1% KOH (the whiff test).
d.Gram stain is used to detect the relative concentration of lactobacilli (long Gram-positive rods), Gram-negative and Gram-variable rods and cocci ( G. vaginalis, Prevotella, Porphyromonas, and peptostreptococci), and curved Gram-negative rods (Mobiluncus) characteristic of BV.
All women suspected of BV should be treated to avoid such complications as Pelvic Inflammatory Disease.
Treatment is especially important for pregnant women. All pregnant women who have symptoms of BV should be checked and treated.
BV is treatable with antibiotics :
metronidazole 500 mg orally twice a day for 7 days
OR
Metronidazole gel, 0.75%,5 g intravaginally, once a day for 5 days
OR
Clindamycin 300 mg orally twice a day for 7 days
OR
Clindamycin cream, 2%,5 g intravaginally at bedtime for 7 days
Either can be used with non-pregnant or pregnant women, but the recommended dosages differ.
Patients treated with metronidazole should be advised to avoid consuming alcohol for 24 hours.
BV can recur after treatment.
Since BV is seldom found in women who have never had intercourse.
and is associated with having a new sex partner or having multiple sex partners, prevention measures are aimed at sexual transmission:
Abstain from sex
Do not have multiple sex partners.
Do not use vaginal douche.
Take all of the medicine prescribed for treatment of BV even if there are no more symptoms.
Wednesday, November 17, 2010
A Family Doctor's Tale - GENITAL HERPES
DOC I HAVE GENITAL HERPES
Genital herpes is a sexually transmitted disease caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2).
Most genital herpes is caused by HSV-2.
Incubation peroid is 14 days to several weeks.
Most infected patients do not show any signs or symptoms from Genital herpes infection.
In the male, small blisters occur on the penis glans and on the both the scrotums. If the urethra is involved. there may be discharge and pain on urination.
In the female, there may be one or more blisters on or around the genitals or rectum. The blisters normally break, leaving painful ulcers which may take two to four weeks to heal.
Typically, recurrence of the blisters may appear weeks or months after the first and is usually less severe and shorter than the first outbreak.The infection can stay in the body indefinitely with the number of outbreaks decreasing over a period of years.
Genital herpes is usaully a sexually transmitted disease.
Genital HSV-2 infection is more common in women (25%) than in men (20%).
This may be due to male-to-female transmissions.
HSV-1 and HSV-2 viruses are found in and released from the blisters and ulcers that the viruses cause.
They also are released between outbreaks from skin that does not appear to be broken or to have a sore.
Transmission can therefore occur from an infected partner who does not have a visible sore and may not know that he or she is infected.
HSV-1 can also cause genital herpes.
It however causes more infections of the mouth and lips, so-called "cold sores."
HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection.
Genital HSV-1 outbreaks does not recur as often as genital HSV-2 outbreaks.
The signs and symptoms of HSV-2 infection can vary greatly. Doctors can diagnose genital herpes by examination if the outbreak is typical, and by taking a sample from the sore(s) and testing it in a laboratory. HSV infections can be difficult to diagnose between outbreaks.
The best way to confirm the presence of Genital herpes is to do a blood test for HSV1 and HSV2. The results however may not 100% accurate.
Most people infected with genital herpes do not know of their infection.
Once the virus is transmitted, an outbreak usually occurs within two weeks and the sores typically heal within two to four weeks. During the primary episode, signs and symptoms may include a second crop of sores and sometimes fever and swollen glands. Most individuals with HSV-2 infection may never have sores, or they may have very mild signs that they do not even notice.
Most people diagnosed with a first episode of genital herpes can expect to have several symptomatic recurrences within a year. Usually these recurrences decrease in frequency.
There is no treatment that can cure herpes, but antiviral medications like aycloclir can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners.
The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Genital ulcer diseases can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes only when the infected area or site of potential exposure is protected. Since a condom may not cover all infected areas, even correct and consistent use of latex condoms cannot guarantee protection from genital herpes.
Persons with herpes should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected. Sex partners can seek testing to determine if they are infected with HSV. A positive HSV-2 blood test most likely indicates a genital herpes infection.
Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress in people who know they are infected.
In addition, genital HSV can cause potentially fatal infections in babies. It is important that women avoid contracting herpes during pregnancy because a first episode during pregnancy causes a greater risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed. Fortunately, infection of a baby from a woman with herpes infection is rare.
Herpes may play a role in the spread of HIV, the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious.
Genital herpes is a sexually transmitted disease caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2).
Most genital herpes is caused by HSV-2.
Incubation peroid is 14 days to several weeks.
Most infected patients do not show any signs or symptoms from Genital herpes infection.
In the male, small blisters occur on the penis glans and on the both the scrotums. If the urethra is involved. there may be discharge and pain on urination.
In the female, there may be one or more blisters on or around the genitals or rectum. The blisters normally break, leaving painful ulcers which may take two to four weeks to heal.
Typically, recurrence of the blisters may appear weeks or months after the first and is usually less severe and shorter than the first outbreak.The infection can stay in the body indefinitely with the number of outbreaks decreasing over a period of years.
Genital herpes is usaully a sexually transmitted disease.
Genital HSV-2 infection is more common in women (25%) than in men (20%).
This may be due to male-to-female transmissions.
HSV-1 and HSV-2 viruses are found in and released from the blisters and ulcers that the viruses cause.
They also are released between outbreaks from skin that does not appear to be broken or to have a sore.
Transmission can therefore occur from an infected partner who does not have a visible sore and may not know that he or she is infected.
HSV-1 can also cause genital herpes.
It however causes more infections of the mouth and lips, so-called "cold sores."
HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection.
Genital HSV-1 outbreaks does not recur as often as genital HSV-2 outbreaks.
The signs and symptoms of HSV-2 infection can vary greatly. Doctors can diagnose genital herpes by examination if the outbreak is typical, and by taking a sample from the sore(s) and testing it in a laboratory. HSV infections can be difficult to diagnose between outbreaks.
The best way to confirm the presence of Genital herpes is to do a blood test for HSV1 and HSV2. The results however may not 100% accurate.
Most people infected with genital herpes do not know of their infection.
Once the virus is transmitted, an outbreak usually occurs within two weeks and the sores typically heal within two to four weeks. During the primary episode, signs and symptoms may include a second crop of sores and sometimes fever and swollen glands. Most individuals with HSV-2 infection may never have sores, or they may have very mild signs that they do not even notice.
Most people diagnosed with a first episode of genital herpes can expect to have several symptomatic recurrences within a year. Usually these recurrences decrease in frequency.
There is no treatment that can cure herpes, but antiviral medications like aycloclir can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners.
The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Genital ulcer diseases can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes only when the infected area or site of potential exposure is protected. Since a condom may not cover all infected areas, even correct and consistent use of latex condoms cannot guarantee protection from genital herpes.
Persons with herpes should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected. Sex partners can seek testing to determine if they are infected with HSV. A positive HSV-2 blood test most likely indicates a genital herpes infection.
Genital herpes can cause recurrent painful genital sores in many adults, and herpes infection can be severe in people with suppressed immune systems. Regardless of severity of symptoms, genital herpes frequently causes psychological distress in people who know they are infected.
In addition, genital HSV can cause potentially fatal infections in babies. It is important that women avoid contracting herpes during pregnancy because a first episode during pregnancy causes a greater risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed. Fortunately, infection of a baby from a woman with herpes infection is rare.
Herpes may play a role in the spread of HIV, the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious.
Tuesday, November 16, 2010
A Family Doctor's Tale - SYPHILIS
DOC I HAVE SYPHILIS
Syphilis is not common nowadays especially in developed countries with good health care.
It may still be present in Africa and other less developed countries with poor health care facilities and medications. I have not seen a single case in the family clinic although there were a few cases seen during my student and hospital work days.
Syphilis is a infectious sexually transmitted disease caused by the bacterium Treponema pallidum.
It can be acute, subacute or chronic depending on the stage.
Syphilis is passed from a infected person through direct contact with a infected sore which occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. The bacteria can penetrate through normal mucous membrane and minor abrasions of the epithelium.
Transmission of the organism usually occurs during sexual contact.
Pregnant women with the disease can pass it to the babies they are carrying.
The signs and symptoms of syphilis may occur in four stages:
Primary
These signs may occur from 10 to 90 days after exposure:
1.A small, firm, painless sore (chancre) appears on the body where the syphilis enter the body, usually the genitals, rectum, tongue or lips. A single chancre is typical, but there may be multiple sores.
2.Enlarged lymph nodes in your groin.
The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.
Secondary
The signs and symptoms of secondary syphilis may begin two to 10 weeks after the chancre appears, and may include:
1.Rash marked by red or reddish-brown sores over any area of the body epecially the palms and soles. The rash usually does not cause itching.
2.Fever
3.Fatigue and a vague feeling of discomfort
4.swollen lymph glands,
5.sore throat,
6.weight loss,
7.Soreness and aching
The signs and symptoms of secondary syphilis will resolve with or without treatment.
Without treatment, the infection will progress to the latent and late stages of disease.
Latent
A period called latent syphilis in which no symptoms are present may follow the secondary stage. Signs and symptoms may not appear or the disease may progress to the tertiary stage.
Tertiary
Without treatment, syphilis bacteria may spread, leading to serious internal organ damage including the brain, nerves, eyes, heart, blood vessels, liver, bones,joints and finally death years after the original infection.
1.Neurological problems. These may include stroke; infection and inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis); poor muscle coordination; numbness; paralysis; deafness or visual problems; personality changes; and dementia.
2.Cardiovascular problems. These may include bulging (aneurysm) and inflammation of the aorta and of other blood vessels. Syphilis may also cause valvular heart disease, such as aortic valve insufficiency.
Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated.
The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth or of giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of disease. Untreated babies may become developmentally delayed, have seizures, or die.
Diagnosis is by:
1. dark-field microscope: examining material from a chancre using this microscope.
If syphilis bacteria are present in the sore, they will show up when observed through the microscope.
2.A blood test for syphilis antibodies is accurate, safe, and inexpensive. A low level of antibodies will stay in the blood for months or years even after the disease has been successfully treated.
Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.
Syphilis is easy to cure in its early stages.
Treatment with intramuscular injection of penicillin can kill the organism that causes syphilis.
If you're allergic to penicillin, other antibiotics such as erythromycin will kill the syphilis bacterium.
Treatment however will not repair damage already done.
Left untreated, the disease can lead to serious complications or death.
Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.
Even if you were treated for syphilis during your pregnancy, your newborn child should receive antibiotic treatment.
To make sure you're responding to the usual dosage of penicillin, your doctor likely will want you to have periodic blood tests.Blood test may remain positive up to 18 months even after successful treatment of syphilis.
Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.
The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to
1.abstain from sexual contact or
2.in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
3.Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior.
4.Correct and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or site of potential exposure is protected.
5.Complications from syphilis such as neurosyphilis are rare because of better diagnosis and treatment
Syphilis is not common nowadays especially in developed countries with good health care.
It may still be present in Africa and other less developed countries with poor health care facilities and medications. I have not seen a single case in the family clinic although there were a few cases seen during my student and hospital work days.
Syphilis is a infectious sexually transmitted disease caused by the bacterium Treponema pallidum.
It can be acute, subacute or chronic depending on the stage.
Syphilis is passed from a infected person through direct contact with a infected sore which occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. The bacteria can penetrate through normal mucous membrane and minor abrasions of the epithelium.
Transmission of the organism usually occurs during sexual contact.
Pregnant women with the disease can pass it to the babies they are carrying.
The signs and symptoms of syphilis may occur in four stages:
Primary
These signs may occur from 10 to 90 days after exposure:
1.A small, firm, painless sore (chancre) appears on the body where the syphilis enter the body, usually the genitals, rectum, tongue or lips. A single chancre is typical, but there may be multiple sores.
2.Enlarged lymph nodes in your groin.
The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.
Secondary
The signs and symptoms of secondary syphilis may begin two to 10 weeks after the chancre appears, and may include:
1.Rash marked by red or reddish-brown sores over any area of the body epecially the palms and soles. The rash usually does not cause itching.
2.Fever
3.Fatigue and a vague feeling of discomfort
4.swollen lymph glands,
5.sore throat,
6.weight loss,
7.Soreness and aching
The signs and symptoms of secondary syphilis will resolve with or without treatment.
Without treatment, the infection will progress to the latent and late stages of disease.
Latent
A period called latent syphilis in which no symptoms are present may follow the secondary stage. Signs and symptoms may not appear or the disease may progress to the tertiary stage.
Tertiary
Without treatment, syphilis bacteria may spread, leading to serious internal organ damage including the brain, nerves, eyes, heart, blood vessels, liver, bones,joints and finally death years after the original infection.
1.Neurological problems. These may include stroke; infection and inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis); poor muscle coordination; numbness; paralysis; deafness or visual problems; personality changes; and dementia.
2.Cardiovascular problems. These may include bulging (aneurysm) and inflammation of the aorta and of other blood vessels. Syphilis may also cause valvular heart disease, such as aortic valve insufficiency.
Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated.
The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth or of giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of disease. Untreated babies may become developmentally delayed, have seizures, or die.
Diagnosis is by:
1. dark-field microscope: examining material from a chancre using this microscope.
If syphilis bacteria are present in the sore, they will show up when observed through the microscope.
2.A blood test for syphilis antibodies is accurate, safe, and inexpensive. A low level of antibodies will stay in the blood for months or years even after the disease has been successfully treated.
Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.
Syphilis is easy to cure in its early stages.
Treatment with intramuscular injection of penicillin can kill the organism that causes syphilis.
If you're allergic to penicillin, other antibiotics such as erythromycin will kill the syphilis bacterium.
Treatment however will not repair damage already done.
Left untreated, the disease can lead to serious complications or death.
Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.
Even if you were treated for syphilis during your pregnancy, your newborn child should receive antibiotic treatment.
To make sure you're responding to the usual dosage of penicillin, your doctor likely will want you to have periodic blood tests.Blood test may remain positive up to 18 months even after successful treatment of syphilis.
Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.
The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to
1.abstain from sexual contact or
2.in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
3.Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior.
4.Correct and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or site of potential exposure is protected.
5.Complications from syphilis such as neurosyphilis are rare because of better diagnosis and treatment
Monday, November 15, 2010
A Family Doctor's Tale - TRICHOMONIASIS
DOC I HAVE TRICHOMONIASIS
Trichomoniasis is a sexually transmitted disease which are common in women presenting with painful urination and green
vaginal discharge . Men may present with painful urination.
The trichomonas is a protozoa which is easily treated with Flagyl or metronidazole.
Trichomoniasis is a common curable sexually transmitted disease caused by the single-celled protozoan parasite, Trichomonas vaginalis.
The parasite is sexually transmitted through penis-to-vagina intercourse with an infected partner.
The vagina is the most common site of infection in women.
In men the urethra is the most common site of infection.
Women can contract the disease from infected men or women.
Men usually contract it only from infected women.
Most men with trichomoniasis are symptomless.
Some men may temporarily have an irritation inside the penis, mild discharge, or slight burning after urination or ejaculation.
Women have symptoms of infection which consists of a frothy, yellow-green vaginal discharge with a strong fishy smell.
There may be discomfort during intercourse and urination and irritation and itching of the female genital area.
Cystitis and urethritis can also occur with increased frequency and pain during urination.
Rarely lower abdominal pain can occur.
Pregnant women with trichomoniasis may have babies who are born early or with low birth weight.
A physical examination and laboratory test is needed to diagnose trichomoniasis. The parasite is harder to detect in men than in women. In women, a pelvic examination can reveal small red ulcerations on the vaginal wall or cervix. A Pap smear may sometimes show the presence of the trichomonas protozoa.
Trichomoniasis can usually be cured with the prescription drug, metronidazole, given by mouth in a single dose.It is important for the patient to avoid alcohol with metronidazole and abstain form sex until they and their sex partners complete their treatment and have no symptoms.
Once treated the infection can be cured. It is important therefore that both partners should be treated at the same time to eliminate the parasite.
Metronidazole can be used to treat pregnant women.
Having trichomoniasis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.
The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact.
A long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected is important.
Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of trichomoniasis.
A person diagnosed with trichomoniasis (or any other STD) should receive treatment and should notify all recent sex partners so that they can be treated. This reduces the risk that the sex partners will develop complications from trichomoniasis and reduces the risk that the person with trichomoniasis will become re-infected.
Sex should be stopped until the person with trichomoniasis and all of his or her recent partners complete treatment for trichomoniasis and have no symptoms.
There is no vaccine for Trichomoniasis.
Trichomoniasis is a sexually transmitted disease which are common in women presenting with painful urination and green
vaginal discharge . Men may present with painful urination.
The trichomonas is a protozoa which is easily treated with Flagyl or metronidazole.
Trichomoniasis is a common curable sexually transmitted disease caused by the single-celled protozoan parasite, Trichomonas vaginalis.
The parasite is sexually transmitted through penis-to-vagina intercourse with an infected partner.
The vagina is the most common site of infection in women.
In men the urethra is the most common site of infection.
Women can contract the disease from infected men or women.
Men usually contract it only from infected women.
Most men with trichomoniasis are symptomless.
Some men may temporarily have an irritation inside the penis, mild discharge, or slight burning after urination or ejaculation.
Women have symptoms of infection which consists of a frothy, yellow-green vaginal discharge with a strong fishy smell.
There may be discomfort during intercourse and urination and irritation and itching of the female genital area.
Cystitis and urethritis can also occur with increased frequency and pain during urination.
Rarely lower abdominal pain can occur.
Pregnant women with trichomoniasis may have babies who are born early or with low birth weight.
A physical examination and laboratory test is needed to diagnose trichomoniasis. The parasite is harder to detect in men than in women. In women, a pelvic examination can reveal small red ulcerations on the vaginal wall or cervix. A Pap smear may sometimes show the presence of the trichomonas protozoa.
Trichomoniasis can usually be cured with the prescription drug, metronidazole, given by mouth in a single dose.It is important for the patient to avoid alcohol with metronidazole and abstain form sex until they and their sex partners complete their treatment and have no symptoms.
Once treated the infection can be cured. It is important therefore that both partners should be treated at the same time to eliminate the parasite.
Metronidazole can be used to treat pregnant women.
Having trichomoniasis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.
The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact.
A long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected is important.
Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of trichomoniasis.
A person diagnosed with trichomoniasis (or any other STD) should receive treatment and should notify all recent sex partners so that they can be treated. This reduces the risk that the sex partners will develop complications from trichomoniasis and reduces the risk that the person with trichomoniasis will become re-infected.
Sex should be stopped until the person with trichomoniasis and all of his or her recent partners complete treatment for trichomoniasis and have no symptoms.
There is no vaccine for Trichomoniasis.
Sunday, November 14, 2010
A Family Doctor's Tale - ERECTILE DYSFUNCTION
DOC MY PENIS CANNOT ERECT
Erectile dysfunction is a rare problem seen in the family clinic in the 1970 -1990. Most men do not want to talk about the problem at that time. The treatment at that time for one of my patient who has partial transverse paralysis of the lower half of his body was the painful injection of medicine into his penis to harden it before sexual intercourse. With the introduction of Viagra and other ED medicine like Cialis and Levitra, men do ask their family doctor about the usage of these medicines and their side effects. Since then you will have at least 4 or 5 patients asking for these medicines every month.
Erectile dysfunction is defined by the WHO as "the consistent or recurrent inability of a man to attain and/or maintain a penile erection of the penis sufficient for sexual performance"
The WHO sponsored Consultation recommend" a minimum of three months of erectile difficulty qualified for a diagnosis of Erectile Dysfunction."
The incidence of ED is unknown:
ED is currently under diagnosed and under treated.
More than 50% of all men 40-70 years old are likely to experience it.
Erectile dysfunction can be due to:
1.Medical causes
2.Lifestyle causes
3.Psychosocial causes
4.or a combination of these.
Medical causes:
1.Vascular disease-is the most common cause of ED.
atherosclerosis(hardening of the arteries)
high blood pressure
high cholesterol
heart disease
stroke
All these conditions affects the blood flow in and out of the penis.
2.Diabetes-
can cause nerve damage and damage to the blood vessel to the penis resulting in two thirds patients developing ED
3.Nerve disease-
such as spinal cord disease, nerve degeneration from diabetes and alcohol can reduce the sensitivity of the nerves to the penis
4.Hormonal problems-
low levels of testosterone(male hormone) can cause ED
5.Surgery-
any surgery of rectum,colon or prostate cancer and radiation therapy in the genital area may damage nerves and blood vessels to the penis.
6.Trauma-
spinal cord injury and pelvic fractures damages the nerves and blood vessels to the penis.
7.Side effects of medications (e.g. certain high blood pressure medications, antidepressants,tranquillizers) may reduce the blood flow to the penis
8. Urinary infections and a disease called Peyronie's Disease(causing scar tissue in the penis) can cause ED.
Lifestyle causes:
1.Alcohol -
heavy drinking reduces the ability to have a strong erection. long term excessive drinking damage nerves and blood vessels to the penis.
2.Smoking-
The incidence of ED in smokers are higher than in non smoker because the toxic chemicals in the cigarettes can damage nerves and blood vessels to the penis.
3.Substance abuse such as heroin etc can cause damage to the nerves and blood vessels to the penis.
4. Sedentary lifestyle-
Lack of exercise may lead to ED due to poor blood circulation
Pycho-social Causes:
1. Performance anxiety -nervousness and worry about poor sexual performance
2. Stress due to any cause
3. Depression
4. Relationship Problems- marital problems and tensions may affect sexual relationship
5. fatigue.
Diagnosis is by:
1.medical history especially about diabetes, hypertension, medications, alcohol , drug abuse, smoking.
2.medical examination including genitals and prostate
3. Blood tests of testosterone, cholesterol, sugar and PSA( in males above 50)
Successful treatment of erectile dysfunction includes:
1. Lifestyle modifications:
exercising
dieting
quitting smoking
reducing alcohol/drug abuse
counseling to manage anxiety/stress/marital problems
2.treatment of underlying medical conditions such as diabetes
3.change of medications
4.medication for treatment of ED.
Medications:
There are now oral medications available to treat erectile dysfunction.
They belong to a group of drugs known as phosphodiesterase inhibitors e.g. Viagra, Cialis, Levitra.
There is no instant erections when taken but with physical and psychological stimulation erections do occur.
Most of the men who has taken the drugs have had improvements in their erectile functions regardless of the cause of the ED.
Certain patients with heart problems or a history of stroke are advised against taking medications belonging to this group.
6.Other treatments for erectile dysfunction
a.Penile Injection therapy- medication which increases the blood flow in the penis is injected into the penis to cause erection before sexual activity
b.Intrautrethral therapy -pellets of medications which increases blood flow is inserted into the urethra which is the tube from the bladder to the outside.
c.Vacuum therapy :
This procedure holds the blood in the penis using a ring at the base of the penis
d:surgery for blocked blood vessels
e.penile implants -these are inserted into the penis and inflated when there is a desire for sexual intercourse. This surgery is offered when all other options failed.
Erectile dysfunction can cause a lot of stress on one’s marital relationship.
Communication and honesty with the spouse is important in ED so that she understands the problem and that she is not the cause of the problem.
In recent years, more men are becoming aware of the treatment of erectile dysfunction and are seeking help.
Erectile dysfunction is a rare problem seen in the family clinic in the 1970 -1990. Most men do not want to talk about the problem at that time. The treatment at that time for one of my patient who has partial transverse paralysis of the lower half of his body was the painful injection of medicine into his penis to harden it before sexual intercourse. With the introduction of Viagra and other ED medicine like Cialis and Levitra, men do ask their family doctor about the usage of these medicines and their side effects. Since then you will have at least 4 or 5 patients asking for these medicines every month.
Erectile dysfunction is defined by the WHO as "the consistent or recurrent inability of a man to attain and/or maintain a penile erection of the penis sufficient for sexual performance"
The WHO sponsored Consultation recommend" a minimum of three months of erectile difficulty qualified for a diagnosis of Erectile Dysfunction."
The incidence of ED is unknown:
ED is currently under diagnosed and under treated.
More than 50% of all men 40-70 years old are likely to experience it.
Erectile dysfunction can be due to:
1.Medical causes
2.Lifestyle causes
3.Psychosocial causes
4.or a combination of these.
Medical causes:
1.Vascular disease-is the most common cause of ED.
atherosclerosis(hardening of the arteries)
high blood pressure
high cholesterol
heart disease
stroke
All these conditions affects the blood flow in and out of the penis.
2.Diabetes-
can cause nerve damage and damage to the blood vessel to the penis resulting in two thirds patients developing ED
3.Nerve disease-
such as spinal cord disease, nerve degeneration from diabetes and alcohol can reduce the sensitivity of the nerves to the penis
4.Hormonal problems-
low levels of testosterone(male hormone) can cause ED
5.Surgery-
any surgery of rectum,colon or prostate cancer and radiation therapy in the genital area may damage nerves and blood vessels to the penis.
6.Trauma-
spinal cord injury and pelvic fractures damages the nerves and blood vessels to the penis.
7.Side effects of medications (e.g. certain high blood pressure medications, antidepressants,tranquillizers) may reduce the blood flow to the penis
8. Urinary infections and a disease called Peyronie's Disease(causing scar tissue in the penis) can cause ED.
Lifestyle causes:
1.Alcohol -
heavy drinking reduces the ability to have a strong erection. long term excessive drinking damage nerves and blood vessels to the penis.
2.Smoking-
The incidence of ED in smokers are higher than in non smoker because the toxic chemicals in the cigarettes can damage nerves and blood vessels to the penis.
3.Substance abuse such as heroin etc can cause damage to the nerves and blood vessels to the penis.
4. Sedentary lifestyle-
Lack of exercise may lead to ED due to poor blood circulation
Pycho-social Causes:
1. Performance anxiety -nervousness and worry about poor sexual performance
2. Stress due to any cause
3. Depression
4. Relationship Problems- marital problems and tensions may affect sexual relationship
5. fatigue.
Diagnosis is by:
1.medical history especially about diabetes, hypertension, medications, alcohol , drug abuse, smoking.
2.medical examination including genitals and prostate
3. Blood tests of testosterone, cholesterol, sugar and PSA( in males above 50)
Successful treatment of erectile dysfunction includes:
1. Lifestyle modifications:
exercising
dieting
quitting smoking
reducing alcohol/drug abuse
counseling to manage anxiety/stress/marital problems
2.treatment of underlying medical conditions such as diabetes
3.change of medications
4.medication for treatment of ED.
Medications:
There are now oral medications available to treat erectile dysfunction.
They belong to a group of drugs known as phosphodiesterase inhibitors e.g. Viagra, Cialis, Levitra.
There is no instant erections when taken but with physical and psychological stimulation erections do occur.
Most of the men who has taken the drugs have had improvements in their erectile functions regardless of the cause of the ED.
Certain patients with heart problems or a history of stroke are advised against taking medications belonging to this group.
6.Other treatments for erectile dysfunction
a.Penile Injection therapy- medication which increases the blood flow in the penis is injected into the penis to cause erection before sexual activity
b.Intrautrethral therapy -pellets of medications which increases blood flow is inserted into the urethra which is the tube from the bladder to the outside.
c.Vacuum therapy :
This procedure holds the blood in the penis using a ring at the base of the penis
d:surgery for blocked blood vessels
e.penile implants -these are inserted into the penis and inflated when there is a desire for sexual intercourse. This surgery is offered when all other options failed.
Erectile dysfunction can cause a lot of stress on one’s marital relationship.
Communication and honesty with the spouse is important in ED so that she understands the problem and that she is not the cause of the problem.
In recent years, more men are becoming aware of the treatment of erectile dysfunction and are seeking help.
Saturday, November 13, 2010
A Family Doctor's Tale - TESTICULAR TORSION
DOC I HAVE TESTICULAR TORSION
Testicular torsion is a rare condition which occurs in strenuous physical exercise which happened to one of my patients who suddenly found a sudden pain in the right testis. when I saw him he was in severe pain and his right testis was very tender and swollen. I referred him to hospital after giving him a pain killer.
He was operated on immediately after the ultrasound showed the presence of abnormal testis. Happily he was well after the operation.
Testicular torsion is the twisting of the testis on its cord either spontaneously or following strenuous activity.
It is a medical emergency as gangrene of testis may occur.
Testicular torsion is caused by
1.incomplete fixation of the epididymis to the testis
2.inadequate attachment of the mesorchium.(testicular body)
3.loose ligaments holding the testis to its cord .
Because of the loose attachment sudden movement of the testis on its cord may cause the testis to be twisted resulting sudden reduction of blood flow to the testis leading to gangrene of the testis.
Symptoms :
1.Severe pain in the testis
2.nausea and vomiting
3.fever
Signs:
1.scrotal swelling and edema
2.tenderness of the testis on palpation
3.redness and inflammation of the scrotal pouch
4.enlarged scrotal pouch
5.Ultrasound examination can detect the obvious torsion
Complications may be:
Damage to the testis with gangrene formation
The only treatment is surgical treatment to untangle the torsion and fasten the testis tightly to its attachment..
Removal of the testis (orchidectomy) may be necessary if there is gangrene.
The prognosis is usually excellent if treated early.
Gangrenous testis must be removed.
Testicular torsion is a rare condition which occurs in strenuous physical exercise which happened to one of my patients who suddenly found a sudden pain in the right testis. when I saw him he was in severe pain and his right testis was very tender and swollen. I referred him to hospital after giving him a pain killer.
He was operated on immediately after the ultrasound showed the presence of abnormal testis. Happily he was well after the operation.
Testicular torsion is the twisting of the testis on its cord either spontaneously or following strenuous activity.
It is a medical emergency as gangrene of testis may occur.
Testicular torsion is caused by
1.incomplete fixation of the epididymis to the testis
2.inadequate attachment of the mesorchium.(testicular body)
3.loose ligaments holding the testis to its cord .
Because of the loose attachment sudden movement of the testis on its cord may cause the testis to be twisted resulting sudden reduction of blood flow to the testis leading to gangrene of the testis.
Symptoms :
1.Severe pain in the testis
2.nausea and vomiting
3.fever
Signs:
1.scrotal swelling and edema
2.tenderness of the testis on palpation
3.redness and inflammation of the scrotal pouch
4.enlarged scrotal pouch
5.Ultrasound examination can detect the obvious torsion
Complications may be:
Damage to the testis with gangrene formation
The only treatment is surgical treatment to untangle the torsion and fasten the testis tightly to its attachment..
Removal of the testis (orchidectomy) may be necessary if there is gangrene.
The prognosis is usually excellent if treated early.
Gangrenous testis must be removed.
Friday, November 12, 2010
A Family Doctor's Tale - EPIDIDYMITIS OR ORCHITIS
DOC I HAVE EPIDIDYMITIS OR ORCHITIS
Epididymitis and orchitis are common infection in children especially after mumps infection and injuries to the testicular region. They also occur in adults after contacting sexually transmitted diseases. There is pain and swelling in the testes.
Epididymitis and orchitis is acute bacterial or viral infection of the epididymis and testis.
The epididymis is the small organ on top of the testis.
The illness usually occurs in:
1.childhood, usually related to mumps infection
2.sexually active males
3.Epididymitis is more common than Orchitis
Bacterial infections:
1.Gonorrhea
2.Chlamydia
3.staphylococcus aureus
4.Streptococcus
5.Mycobacterium tuberculosis.
6.E.coli
Viral infections:
1.mumps in childhood
2.measles
Complications are:
1.Orchitis or infection of the testis following epididymitis
2.Abscess formation of the epididymis
3.Gangrene of the testis if blood flow is affected.
4.Inguinal lymphadenitis
Symptoms
1.Pain in scrotum
2.Ejaculation of blood
3.hematuria (blood in the urine)
4.Fever
Signs:
1.Scrotal swelling of testis or epididymis
2.Induration of scrotum wall
3.Tenderness of epididymis
4.Tenderness of the testis if orchitis is present
5.Mid stream urine for culture
6.Ultrasound of the testis and epididymis shows inflammation and enlargement of the testis and epididymis
Treatment of Acute Epididymitis and Orchitis
1. Antibiotics may be commenced if fever is high or the culture showed bacterial infections.
2.Fever and pain may be treated with paracetamol
3.Scrotal support helps to relieve the painful swollen testis
4.Ice packs for scrotum
5.Bed rest and Fluids
6.Surgical drainage if there is abscess formation.
Prognosis with appropriate treatment and antibiotics is generally good.
There is a risk of sterility and decreased male hormone production if treatment is inadequate.
Epididymitis and orchitis are common infection in children especially after mumps infection and injuries to the testicular region. They also occur in adults after contacting sexually transmitted diseases. There is pain and swelling in the testes.
Epididymitis and orchitis is acute bacterial or viral infection of the epididymis and testis.
The epididymis is the small organ on top of the testis.
The illness usually occurs in:
1.childhood, usually related to mumps infection
2.sexually active males
3.Epididymitis is more common than Orchitis
Bacterial infections:
1.Gonorrhea
2.Chlamydia
3.staphylococcus aureus
4.Streptococcus
5.Mycobacterium tuberculosis.
6.E.coli
Viral infections:
1.mumps in childhood
2.measles
Complications are:
1.Orchitis or infection of the testis following epididymitis
2.Abscess formation of the epididymis
3.Gangrene of the testis if blood flow is affected.
4.Inguinal lymphadenitis
Symptoms
1.Pain in scrotum
2.Ejaculation of blood
3.hematuria (blood in the urine)
4.Fever
Signs:
1.Scrotal swelling of testis or epididymis
2.Induration of scrotum wall
3.Tenderness of epididymis
4.Tenderness of the testis if orchitis is present
5.Mid stream urine for culture
6.Ultrasound of the testis and epididymis shows inflammation and enlargement of the testis and epididymis
Treatment of Acute Epididymitis and Orchitis
1. Antibiotics may be commenced if fever is high or the culture showed bacterial infections.
2.Fever and pain may be treated with paracetamol
3.Scrotal support helps to relieve the painful swollen testis
4.Ice packs for scrotum
5.Bed rest and Fluids
6.Surgical drainage if there is abscess formation.
Prognosis with appropriate treatment and antibiotics is generally good.
There is a risk of sterility and decreased male hormone production if treatment is inadequate.
Thursday, November 11, 2010
A Family Doctor's Tale - PROSTATITIS
DOC I HAVE PROSTATITIS
Prostatitis is an acute or chronic infection of the prostate gland.
Prostatitis is usually caused by the following:
1.enteric Gram negative organism from intestinal or bladder infection
2.tuberculosis occasionally
Persons who has Acute Prostatitis has the following symptoms:
1.frequency of urination and nocturia
2.urgency of urination
3.hematuria(blood in urine)
4.low back pain
5.perineal pain
6.slow initiation of urine
Signs:
Tenderness on palpation of the prostate per rectum
Diagnosis can usually be made by :
1.History of frequency of urination, painful urination
2.Tenderness on palpation of the prostate per rectum
3. Culture of the expressed prostatic fluid by prostatic massage
4.Urine and prostatic fluid culture will determine the micro-organism involved and the antibiotic most appropriate for it.
Infections from the prostate can lead to infections of the bladder and up to the kidney.
Treatment is by:
Analgesic medicine
Antibiotics for infections especially after urine and prostatic fluid bacterial culture
Lots of fluids
Prognosis is usually good with medication.
Recurrence is quite common.
Prostatitis is an acute or chronic infection of the prostate gland.
Prostatitis is usually caused by the following:
1.enteric Gram negative organism from intestinal or bladder infection
2.tuberculosis occasionally
Persons who has Acute Prostatitis has the following symptoms:
1.frequency of urination and nocturia
2.urgency of urination
3.hematuria(blood in urine)
4.low back pain
5.perineal pain
6.slow initiation of urine
Signs:
Tenderness on palpation of the prostate per rectum
Diagnosis can usually be made by :
1.History of frequency of urination, painful urination
2.Tenderness on palpation of the prostate per rectum
3. Culture of the expressed prostatic fluid by prostatic massage
4.Urine and prostatic fluid culture will determine the micro-organism involved and the antibiotic most appropriate for it.
Infections from the prostate can lead to infections of the bladder and up to the kidney.
Treatment is by:
Analgesic medicine
Antibiotics for infections especially after urine and prostatic fluid bacterial culture
Lots of fluids
Prognosis is usually good with medication.
Recurrence is quite common.
Wednesday, November 10, 2010
A Family Doctor's Tale - ACNE ROSACEA
DOC I HAVE ACNE ROSACEA
Acne Rosacea is red rashes which typically occur in patients above the 45 years and more in females. It has been related to menopause and never occur in children. The rashes typically appear on the cheeks and are easily treated with antibiotics and anti- acne creams. There is no cure for Acne Rosacea.
Acne Rosacea is a chronic inflammatory disease of the skin which typically redness of the cheeks with maculopapular rashes.
Acne Rosacea occurs more in females than in males.
It is also more common in the middle ages.
It is rare in children
The cause of Acne Rosacea is unknown.
Some possible causes are:
1.menopause with flushing of the face due to hormonal causes
2.Excessive sebum production in the sebaceous glands
3.stress aggravate the condition
4.Alcohol and certain foods(seafood with its high histamine content, spicy food) can cause flushing
Onset is sudden or gradual.
They may last weeks or months and be recurrent.
Frequently they become chronic.
The typical rash of Acne Rosacea is well-defined :
1.red (rosy cheek)
2.small blood vessel seen in rashes
3.hypertrophic sebaceous glands without blockage of ducts
4.papules.
5.Typically on forehead, cheeks, nose, chin or center of face
6.Associated seborrheic dermatitis of the scalp(dandruff)and eyelids(blepharitis)
7.Eye lesions may include:
tearing of eyes
photophobia (fear of bright light)
visual disturbances
corneal infections
conjunctivitis
All types of Acne Rosacea can affect a person’s quality of life. 1.Appearance
2.Blood vessel on nose
3.papular rashes on the face
Treatment depends on the severity and type of Acne Rosacea.
1. mild cases may not require any treatment
2.Avoid food that can cause flushing such as alcohol, spicy foods, hot drinks
3.Avoid stress and tension
Treatments:
1.Topical Medicines include:
sulphur containing creams and shampoo to dry the oil from the skin
2.Systemic antibiotics like tetracycline or erythromycin
3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A, radiation)
4.Avoid corticosteroids which usually make the condition worse
5.Surgical treatment of rhinnophyma and laser treatment of dilated blood vessels
At the present moment there is no known cure for Acne Rosacea.
Medicines have been able to reduce the severity of inflammation and improve the quality of life.
Treatment is good with prolonged antibiotic therapy.
Lifelong treatment may be necessary to control signs and symptoms.
Acne Rosacea is red rashes which typically occur in patients above the 45 years and more in females. It has been related to menopause and never occur in children. The rashes typically appear on the cheeks and are easily treated with antibiotics and anti- acne creams. There is no cure for Acne Rosacea.
Acne Rosacea is a chronic inflammatory disease of the skin which typically redness of the cheeks with maculopapular rashes.
Acne Rosacea occurs more in females than in males.
It is also more common in the middle ages.
It is rare in children
The cause of Acne Rosacea is unknown.
Some possible causes are:
1.menopause with flushing of the face due to hormonal causes
2.Excessive sebum production in the sebaceous glands
3.stress aggravate the condition
4.Alcohol and certain foods(seafood with its high histamine content, spicy food) can cause flushing
Onset is sudden or gradual.
They may last weeks or months and be recurrent.
Frequently they become chronic.
The typical rash of Acne Rosacea is well-defined :
1.red (rosy cheek)
2.small blood vessel seen in rashes
3.hypertrophic sebaceous glands without blockage of ducts
4.papules.
5.Typically on forehead, cheeks, nose, chin or center of face
6.Associated seborrheic dermatitis of the scalp(dandruff)and eyelids(blepharitis)
7.Eye lesions may include:
tearing of eyes
photophobia (fear of bright light)
visual disturbances
corneal infections
conjunctivitis
All types of Acne Rosacea can affect a person’s quality of life. 1.Appearance
2.Blood vessel on nose
3.papular rashes on the face
Treatment depends on the severity and type of Acne Rosacea.
1. mild cases may not require any treatment
2.Avoid food that can cause flushing such as alcohol, spicy foods, hot drinks
3.Avoid stress and tension
Treatments:
1.Topical Medicines include:
sulphur containing creams and shampoo to dry the oil from the skin
2.Systemic antibiotics like tetracycline or erythromycin
3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A, radiation)
4.Avoid corticosteroids which usually make the condition worse
5.Surgical treatment of rhinnophyma and laser treatment of dilated blood vessels
At the present moment there is no known cure for Acne Rosacea.
Medicines have been able to reduce the severity of inflammation and improve the quality of life.
Treatment is good with prolonged antibiotic therapy.
Lifelong treatment may be necessary to control signs and symptoms.
Tuesday, November 9, 2010
A Family Doctor's Tale - PITYRIASIS ROSEA
DOC I HAVE PITYRIASIS ROSEA
Pityriasis Rosea is a common skin rash which starts as a herald patch on one part of the body before the onset of various patches of rashes elsewhere. It can be a bit frightening for a patient to see suddenly so new patches of rashes appearing.
But the condition itself is mild and heals by itself.
Many patients are unnecessary worried about the condition.
Pityriasis Rosea is a common non contagious disease which appears as numerous patches of red rash on the trunk of the body.
All ages and both sex are affected but occurs more between 10 - 35 years of age.
The cause is unknown but a viral infection is suspected to cause it.
Symptoms:
1.A single red large patch of rashes or herald patch usually occur 1-20 days on the body before the onset of numerous small patches.
2.sore throat may occur before the onset of rashes
3.Numerous Large patches of red oval-shaped rash on the body may occur on the chest, back and neck.
4. As the rashes subside on the body, they may spread to the groin and extremities like the legs and arms
5.Rashes can be extremely itchy
6.breathlessness
7.low-grade fever
8.headache
9.nausea
10.fatigue.
Diagnosis is by:
1.Symptoms and signs of typical herald patch followed by other patches of rashes
2.Skin scraping for microscopic examination.
Complications are:
1.Fungal infection
2.bacterial infection
Treatment:
1.No treatment may be necessary as the illness is self limiting
2.Itch may be controlled with antihistamines
3.Corticosteroid (oral or cream) may help reduce severe itching and inflammation
4. Soap should be avoided.
5.Moisturizer is better because of the dry skin
6.UV therapy sometimes help
7.Antibiotics may be given if there is secondary infection.
Prognosis of Pityriasis Rosea is :
Generally excellent but may recur.
Preventive measures are:
1.Good skin hygiene
2.Healthy lifestyle with balanced diet and adequate sleep.
3.Proper skin care of the body.
Pityriasis Rosea is a common skin rash which starts as a herald patch on one part of the body before the onset of various patches of rashes elsewhere. It can be a bit frightening for a patient to see suddenly so new patches of rashes appearing.
But the condition itself is mild and heals by itself.
Many patients are unnecessary worried about the condition.
Pityriasis Rosea is a common non contagious disease which appears as numerous patches of red rash on the trunk of the body.
All ages and both sex are affected but occurs more between 10 - 35 years of age.
The cause is unknown but a viral infection is suspected to cause it.
Symptoms:
1.A single red large patch of rashes or herald patch usually occur 1-20 days on the body before the onset of numerous small patches.
2.sore throat may occur before the onset of rashes
3.Numerous Large patches of red oval-shaped rash on the body may occur on the chest, back and neck.
4. As the rashes subside on the body, they may spread to the groin and extremities like the legs and arms
5.Rashes can be extremely itchy
6.breathlessness
7.low-grade fever
8.headache
9.nausea
10.fatigue.
Diagnosis is by:
1.Symptoms and signs of typical herald patch followed by other patches of rashes
2.Skin scraping for microscopic examination.
Complications are:
1.Fungal infection
2.bacterial infection
Treatment:
1.No treatment may be necessary as the illness is self limiting
2.Itch may be controlled with antihistamines
3.Corticosteroid (oral or cream) may help reduce severe itching and inflammation
4. Soap should be avoided.
5.Moisturizer is better because of the dry skin
6.UV therapy sometimes help
7.Antibiotics may be given if there is secondary infection.
Prognosis of Pityriasis Rosea is :
Generally excellent but may recur.
Preventive measures are:
1.Good skin hygiene
2.Healthy lifestyle with balanced diet and adequate sleep.
3.Proper skin care of the body.
Monday, November 8, 2010
A Family Doctor's Tale - MILIARIA
DOC I HAVE PRICKLY HEAT
Prickly heat or miliaria is common in the tropical climate because of the heat and humidity. They appear as itchy red rashes all over the body especially the back and groins and armpits. All National Service army boys in Singapore are given prickly heat powder which eases the discomfort of the rashes and cools the skin of the body down. Frequent showers and thorough drying of the skin after a shower will help prevent this condition.
Prickly Heat(also known as miliaria) is a common non contagious disease which appears as acute itchy red rash on the body due to retained sweat.
People of all ages are affected but it is more common in children and infants due to their underdeveloped sweat glands.
It is more common in hot and humid conditions.
There are several types of Miliaria:
I.Miliaria crystallina-
minute superficial vesicular lesions that normally do not cause any symptoms
2.Miliaria rubra -
deeper layer inflammatory lesions causing the typical appearance of redness (hence rubra) and larger blister-like lesions.
There is intense itching with a lack of sweating to affected areas.
This is the most common form of prickly heat.
3.Miliaria profunda-
the most severe form of miliaria due to the rapid spread and severe burning sensations.
The obstruction is deep in the structure of the sweat gland resulting in the sweat to leak between the superficial and deep layers of the skin.
The rash occurs within hours of an activity provoking sweating and disappear within hours when the stimulus for the sweating is removed.
The risk of heat exhaustion is higher.
The cause is the result of the keratin or dead skin cells or bacteria such as Staphylococcus epidermidis of the skin blocking the sweat ducts.
The occluded sweat ducts ruptures when sweating occur and the sweat form an intraepidermal vesicle which leads to irritation(prickly sensation) and itchiness.
Secondary infection may occurs from invasion of staphalococcus.
Symptoms:
1.Occurs in humid hot weather
2.Small red papulovesicular rashes
3.Occurs on the face, neck, under the breasts, trunk, under the scrotum, skin folds, behind knee and antecubital fossa.
4.Usually very itchy
5.Rash usually presents with prickly sensation hence the name Prickly Heat Rash
1.Symptoms and signs of small rashes occuring in hot humid condition with itchiness and prickly sensation
2.Skin scraping for microscopic examination.
Complications are:
1.Fungal infection
2.bacterial infection
Treatment is by:
A. Cool Environment
1. air-conditioned environment
2. avoid heat and sweat-inducing activities
3. avoid occlusive clothing,
4. take frequent cool showers.
B. Medicines:
1. topical antibacterials may reduce the symptoms in miliaria rubra
2. anti-itch preparations such as calamine or menthol preparations
3. topical steroid creams,
4. Avoid oil based preparations because they increase blockage to the sweat glands.
5. Oral Antibiotics may be given if there is secondary infection.
6. Oral antihistamines may be given if itch is troublesome.
7. Vitamin C or A in high dosages have not been found to be effective
Prognosis is:
Generally good to excellent but may recur.
Environmental factors like humidity and heat should be avoided.
Prevention is by:
1.Good skin hygiene
2.Healthy lifestyle with balanced diet and adequate sleep.
3.Wear light clothing
4.Reduce sweating (use air conditioner)
5.Frequent showers should help
6.Avoid heat and humidity.
Prickly heat or miliaria is common in the tropical climate because of the heat and humidity. They appear as itchy red rashes all over the body especially the back and groins and armpits. All National Service army boys in Singapore are given prickly heat powder which eases the discomfort of the rashes and cools the skin of the body down. Frequent showers and thorough drying of the skin after a shower will help prevent this condition.
Prickly Heat(also known as miliaria) is a common non contagious disease which appears as acute itchy red rash on the body due to retained sweat.
People of all ages are affected but it is more common in children and infants due to their underdeveloped sweat glands.
It is more common in hot and humid conditions.
There are several types of Miliaria:
I.Miliaria crystallina-
minute superficial vesicular lesions that normally do not cause any symptoms
2.Miliaria rubra -
deeper layer inflammatory lesions causing the typical appearance of redness (hence rubra) and larger blister-like lesions.
There is intense itching with a lack of sweating to affected areas.
This is the most common form of prickly heat.
3.Miliaria profunda-
the most severe form of miliaria due to the rapid spread and severe burning sensations.
The obstruction is deep in the structure of the sweat gland resulting in the sweat to leak between the superficial and deep layers of the skin.
The rash occurs within hours of an activity provoking sweating and disappear within hours when the stimulus for the sweating is removed.
The risk of heat exhaustion is higher.
The cause is the result of the keratin or dead skin cells or bacteria such as Staphylococcus epidermidis of the skin blocking the sweat ducts.
The occluded sweat ducts ruptures when sweating occur and the sweat form an intraepidermal vesicle which leads to irritation(prickly sensation) and itchiness.
Secondary infection may occurs from invasion of staphalococcus.
Symptoms:
1.Occurs in humid hot weather
2.Small red papulovesicular rashes
3.Occurs on the face, neck, under the breasts, trunk, under the scrotum, skin folds, behind knee and antecubital fossa.
4.Usually very itchy
5.Rash usually presents with prickly sensation hence the name Prickly Heat Rash
1.Symptoms and signs of small rashes occuring in hot humid condition with itchiness and prickly sensation
2.Skin scraping for microscopic examination.
Complications are:
1.Fungal infection
2.bacterial infection
Treatment is by:
A. Cool Environment
1. air-conditioned environment
2. avoid heat and sweat-inducing activities
3. avoid occlusive clothing,
4. take frequent cool showers.
B. Medicines:
1. topical antibacterials may reduce the symptoms in miliaria rubra
2. anti-itch preparations such as calamine or menthol preparations
3. topical steroid creams,
4. Avoid oil based preparations because they increase blockage to the sweat glands.
5. Oral Antibiotics may be given if there is secondary infection.
6. Oral antihistamines may be given if itch is troublesome.
7. Vitamin C or A in high dosages have not been found to be effective
Prognosis is:
Generally good to excellent but may recur.
Environmental factors like humidity and heat should be avoided.
Prevention is by:
1.Good skin hygiene
2.Healthy lifestyle with balanced diet and adequate sleep.
3.Wear light clothing
4.Reduce sweating (use air conditioner)
5.Frequent showers should help
6.Avoid heat and humidity.
Sunday, November 7, 2010
A Family Doctor's Tale - FOLLICULITIS
DOC I HAVE FOLLICULITIS
Folliculitis is like small pimples except that they are not caused excess sebum secretions but the infection of the skin hair follicle. Small little red swollen rashes are present at the root of the hair and can be painful. Normally they are not serious and treatment with antibiotics and antibiotic cream is very effective.
Folliculitis is a bacterial infection of the skin hair follicle.
People of all ages are affected .
It is more common in diabetes and people with low immune system.
1.The cause is infection of bacteria such as Staphylococcus aureus.
2.Poor skin hygiene
3.Skin damaged by eczema and dermatitis
4.Nasal transport of Staphylococcus aureus.
5.May complicate diabetes and low immune system patients like leukemia.
Symptoms:
1.Occurs at root of a hair follicle
2.superficial pustule or nodule
3.May become chronic at beard area.
4.May be painful
Diagnosis is by:
1.pustule at root of hair.
2.Skin scraping for microscopic examination, culture and sensitivity.
3.Blood count.
Complications are:
1.Fungal infection
2.Furuncle or carbuncle which are bigger and deeper areas of infection.
Treatment is by:
A. Skin hygiene
1. clean skin with antiseptic.
2. avoid scratching the skin
3. avoid plaster and poultices
4. cover with gauze after skin injury
B. Medicines:
1. topical antibacterials such as bacitracin, neomycin, gentamycin, tetracycline creams
2. Oral Antibiotics may be given if necessary.
3. Complicated conditions such as carbuncles may require surgical debridement.
Generally good to excellent but may recur.
Prompt treatment is important to prevent complication
Prevention is by:
1.Good skin hygiene
2.Healthy lifestyle with balanced diet and adequate sleep.
3.Avoid scratching of skin
4.Use clean razors for shaving
5.Avoid plasters and poultices.
Folliculitis is like small pimples except that they are not caused excess sebum secretions but the infection of the skin hair follicle. Small little red swollen rashes are present at the root of the hair and can be painful. Normally they are not serious and treatment with antibiotics and antibiotic cream is very effective.
Folliculitis is a bacterial infection of the skin hair follicle.
People of all ages are affected .
It is more common in diabetes and people with low immune system.
1.The cause is infection of bacteria such as Staphylococcus aureus.
2.Poor skin hygiene
3.Skin damaged by eczema and dermatitis
4.Nasal transport of Staphylococcus aureus.
5.May complicate diabetes and low immune system patients like leukemia.
Symptoms:
1.Occurs at root of a hair follicle
2.superficial pustule or nodule
3.May become chronic at beard area.
4.May be painful
Diagnosis is by:
1.pustule at root of hair.
2.Skin scraping for microscopic examination, culture and sensitivity.
3.Blood count.
Complications are:
1.Fungal infection
2.Furuncle or carbuncle which are bigger and deeper areas of infection.
Treatment is by:
A. Skin hygiene
1. clean skin with antiseptic.
2. avoid scratching the skin
3. avoid plaster and poultices
4. cover with gauze after skin injury
B. Medicines:
1. topical antibacterials such as bacitracin, neomycin, gentamycin, tetracycline creams
2. Oral Antibiotics may be given if necessary.
3. Complicated conditions such as carbuncles may require surgical debridement.
Generally good to excellent but may recur.
Prompt treatment is important to prevent complication
Prevention is by:
1.Good skin hygiene
2.Healthy lifestyle with balanced diet and adequate sleep.
3.Avoid scratching of skin
4.Use clean razors for shaving
5.Avoid plasters and poultices.
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