Prevention and treatment of gonorrhea and genital warts: A guide to men's health.

Gonorrhea

Gonorrhea is an inflammatory disease of the mucous membranes of the urogenital tract caused by Neisseria gonorrhoeae. It is currently the most prevalent sexually transmitted disease worldwide. Neisseria gonorrhoeae are oval or kidney-shaped, arranged in pairs, and are generally found in the cytoplasm of white blood cells in infected individuals. It is primarily transmitted through direct sexual contact, but can also be transmitted indirectly through contaminated instruments, clothing, or utensils. Infection during pregnancy can lead to premature rupture of membranes, resulting in intra-amniotic infection, causing fetal growth retardation, miscarriage, premature birth, and neonatal sepsis. During childbirth, it can be transmitted to the fetus through the birth canal, causing neonatal gonococcal conjunctivitis. Postpartum, the mother is prone to endometritis and postpartum sepsis, posing significant risks to both mother and child. Additionally, due to different sexual practices, gonococcal infections of the anus, rectum, and pharynx can occur. Humans are the only natural host for Neisseria gonorrhoeae, which primarily invades mucous membranes and causes inflammatory reactions. The skin tissue is composed of stratified squamous epithelium, which offers some resistance to gonococci. The urethra in men and women, as well as the cervix, is composed of simple columnar epithelium, making it susceptible to invasion by gonococci. The infection can spread along the mucosal surface, causing widespread congestion, edema, and discharge. Symptoms may include urinary frequency, dysuria, and terminal hematuria. Urethral or cervical discharge is initially thin and serous, later becoming purulent. When gonococci enter the urethral glands or crypts, the openings of the ducts and crypts become blocked, preventing the discharge from overflowing and forming cysts. These bacteria hidden in the glands are the main foci of infection for chronic gonorrhea. If the infection in female patients is not controlled in time, it can ascend to the uterine cavity and fallopian tubes, causing acute endometritis, acute salpingitis, pelvic inflammatory disease, etc. During infection repair, the mucosa, submucosal glands and surrounding tissues are replaced by connective tissue, which can lead to fibrosis, resulting in adhesions or scar formation, causing partial or complete obstruction of the fallopian tubes, and eventually hydrosalpinx, infertility, ectopic pregnancy, pelvic adhesions, etc.

【Drug Therapy】

(1) Gonococcal urethritis or cervicitis:

① Procaine penicillin 4.8 million units, intramuscularly injected in two portions into both buttocks, plus probenecid 1 g, taken orally once.

② Amoxicillin 3 g, probenecid 1 g, taken orally once. Also, doxycycline 0.1 g, orally twice daily for 7 days. ③ If resistant to penicillin, spectinomycin 2-4 g can be administered intramuscularly once; or norfloxacin 0.8 g orally once; or ofloxacin 0.4-0.6 g orally in 1-2 divided doses; or cefotaxime sodium 1 g intramuscularly once; or ceftriaxone 0.25 g intramuscularly once. While using any of the above medications, doxycycline 0.1 g should be continued twice daily for 7 days.

(2) Gonococcal conjunctivitis:

① Spectinomycin 2 g intramuscularly, twice daily for 5 days.

② Cefotaxime sodium 1 g intramuscularly, twice daily for 5 days.

③ Ceftriaxone 1 g intramuscularly once for 5 days.

④ Penicillin 10 million units intravenously, once daily for 5 days. During the above treatments, the eyes should be rinsed with saline solution every hour. After rinsing, apply 0.5% erythromycin eye ointment, 1% tetracycline eye ointment, or 1% silver nitrate solution.

(3) Gonococcal pharyngitis:

① Compound sulfamethoxazole, 3 tablets orally each time, 3 times a day, for 7 consecutive days.

② Norfloxacin 0.8g, orally once.

③ Ceftriaxone 0.25g, intramuscular injection once.

(4) Gonococcal proctitis:

① Spectinomycin 2g, intramuscular injection once.

② Norfloxacin 0.8g, orally once.

③ Ceftriaxone 0.25g, intramuscular injection once. Once diagnosed, this disease should be treated immediately. Treatment must adhere to the principles of adequate dosage, timely administration, and regular medication to prevent it from becoming chronic. Simultaneously, the spouse and those in contact with the infected individual must be examined and treated to prevent mutual transmission. Utensils should be sterilized and kept separate from those of other family members.

Penicillin is the first-line treatment for this disease. Combining it with oral probenecid can improve efficacy. Because probenecid is primarily secreted and excreted through the renal tubules, it competes with penicillin and cephalosporins for secretion pathways, reducing drug excretion from the kidneys and protein binding in the plasma, thus enhancing and prolonging the effect of penicillin.

Gentle Condyloma Acuminata

Gentle condyloma acuminata, also known as genital warts, is also a sexually transmitted disease. This disease is caused by the human papillomavirus (HPV) and is mainly transmitted through sexual intercourse. It can also be transmitted through other close contact routes, such as swimming pools, bathtubs, and public toilet seats. Studies show that approximately 65% ​​of people who have sexual contact with someone suffering from genital warts will become infected. Genital warts are more common in young adults, which is related to changes in sexual behavior and sexual hygiene. There is a close relationship between genital warts and malignant tumors; they can coexist with vulvar cancer and cervical cancer. Human papillomavirus (HPV) is one of the smallest deoxyribonucleic acid viruses. Previously, it was believed that all skin warts were caused by the same type of HPV, but it was later discovered that flat warts and common warts, which are common in children and adolescents, do not become cancerous, while genital warts, which are more common in adults, are prone to becoming cancerous. In recent years, at least 28 types of HPV have been identified, of which HPV type 6 is the most commonly associated with genital warts.

Gentle wart lesions mostly occur on the external genitalia and perianal area in both men and women. In men, the common sites are the coronal sulcus of the penis and around the anus; in women, they occur in the moist areas at the junction of the skin and mucous membranes of the vulva, perineum, and perianal area, and may also involve damage to the vaginal wall and surrounding tissues. Keeping the vulva clean and dry is important. Patients should avoid directly touching the affected area with their hands to prevent the lesions from spreading.

This disease corresponds to the categories of itching and pruritus in Traditional Chinese Medicine. It is caused by damp-heat descending to the skin and mucous membranes, disrupting the balance of Qi and blood, weakening the pores, and being further aggravated by pathogenic factors. The dampness and toxins accumulate in the skin of the genitals and anus, leading to this condition. Treatment should focus on clearing heat, eliminating dampness, detoxifying, and resolving stasis.