Although gonorrhea and syphilis are the most serious of the sexually transmitted diseases, there are a number of others that cause considerable discomfort or embarrassment. Venereal warts, for example, can be acutely painful. Pubic lice (crab lice) cause intensive itching.
Sexually transmitted diseases (venereal diseases) are infections that are contracted through intimate sexual contact. Once established, sexually transmitted diseases such as gonorrhea and syphilis can spread and cause extensive, serious physical damage. It is important to make a doctor's appointment immediately if you suspect that you have contracted--or have been exposed to--such an infection. If it is found that you have been infected, you should abstain from sexual contact until your doctor tells you that you are no longer contagious. You should also inform your sexual partners so that they can be examined and treated also, whether or not they have symptoms.
Gonorrhea
Gonorrhea is a bacterial infection, and an extremely contagious one. An estimated 2.5 million Americans contract this disease annually.
The symptoms of gonorrhea usually appear within one to three weeks after infection. In men, these symptoms include a white to yellow-green penile discharge, burning pain while urinating and deep, aching pain or pressure in the genitals. In women, there may be painful and frequent urination, deep, aching pain in the lower abdomen and, rarely, a vaginal discharge. Pharyngeal gonorrhea (in the mouth and throat) may produce a sore throat; rectal gonorrhea occasionally causes discomfort in the area around the anus and a slight discharge. However, in 10 to 20 percent of men and up to 80 percent of women, there are no perceived symptoms at all.
Untreated, gonorrhea commonly affects the urethra in men, making urination extremely painful and difficult; it may progress to chronic obstruction and infertility. In women, the disease can attack the fallopian tubes and other pelvic organs (pelvic inflammatory disease), causing pain, fever and, very likely, infertility. The risk of infertility increases with each infection: 75 percent of women who have had three infections involving the pelvic organs are infertile. In both sexes, untreated gonorrhea may result in arthritis, or in a generalized bacterial infection affecting the heart and nervous system. If a woman has active gonorrhea at the time of delivery, her baby may develop permanent blindness.
Fortunately, once it is diagnosed, gonorrhea can be treated quickly and effectively with antibiotics.
A diagnosis of gonorrhea can be made by a microscopic examination of the discharge or a cervical smear; or, more reliably, by a culture that takes two days to incubate. The culture should be repeated one week after treatment.
Syphilis
Syphilis is caused by an organism called a spirochete that is spread through sexual contact. About 20,000 cases a year are reported to United States health authorities, but it is highly probable that several thousands more are not reported.
The disease has three stages. First, skin ulcers (chancres), which are usually painless, appear in the genital area. The chancres may erupt anywhere from 10 to 90 days after infection. Men may see them on the penis, but in women they usually form inside the vagina and may easily be missed. These sores heal in a few weeks, leaving little or no scarring. Meanwhile, the spirochetes circulate in the bloodstream and, in a few weeks, produce the symptoms of the second stage of the disease: fever, swollen glands and reddish rash. these signs then also disappear, even without treatment, within 10 days to two weeks; the disease becomes latent and, within two years, no longer infectious. the third stage may develop without warning, years later. In this final stage, there is tissue damage in the brain and the nervous system, the heart, liver, bone and skin. In as many as one-third of untreated individuals, this damage may result in death.
If a woman infected with syphilis becomes pregnant, or contracts the disease during pregnancy, there is a high risk that her baby will be stillborn or suffer from severe birth defects.
Syphilis is most accurately diagnosed by a blood test. It can be treated successfully with penicillin or other antibiotics. Periodic tests should be done for two years after treatment to make certain that the disease is cured. As is the case with all sexually transmitted diseases, sexual partners should be informed immediately, and examined and treated.
Venereal Warts
Venereal warts (condylomata acuminata), cauliflower-like and red, are caused by a virus and are thought to be almost exclusively sexually transmitted. In women, they appear around the vagina and rectum, growing more rapidly where they come in contact with any vaginal discharge and being greatly aggravated by pregnancy. In men, they appear on the penis and rectal area.
A wart-removing compound may be prescribed, although it is not recommended for use during pregnancy since it can be harmful to the fetus. The compound should be used with care and applied only to the surface of the warts. About six hours after application, a sitz bath should be taken to remove any excess. Over-the-counter preparations should never be used; the genital tissues are too sensitive for such products. Occasionally it is necessary to remove venereal warts by electro-cauterization (burning) or by surgery.
Pubic Lice
Pubic lice (crab lice) are almost always transmitted sexually. The lice, which can be found attached to the pubic hair, are yellow-gray in color, becoming dark after they are engorged with blood.
An infestation of crab lice causes intense itching in the pubic area as a reaction to the parasites' bites. It can be readily cured with the application of a prescription cream, lotion or shampoo. To prevent re-infestation, the sexual partner(s) should also be treated, and clothes and linens washed.
Summing Up
Sexually transmitted diseases such as gonorrhea and syphilis are highly contagious infections. If you are sexually active--other than with a single partner who is also monogamous--you risk exposure to these diseases; the more partners, the greater the risk. Sensible precautions that may be taken include urinating and washing the genitals after intercourse, using condoms and spermicidal vaginal foams, jellies or creams, and being tested frequently for gonorrhea and syphilis if you have several sexual partners--or if your partner does.
If you suspect that you have a sexual infection do not hesitate to tell your partner(s) and to visit your doctor or a clinic immediately. Sexually transmitted diseases can be cured only with prescribed courses of drug therapy. Never attempt to treat these diseases yourself. Above all, do not let fear or embarrassment stand in the way of receiving medical care.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
