Sexually Transmitted Diseases (STD): Chlamydia and Gonorrhea

A 45 year old man sees his doctor complaining of a weak urine stream. The urethra (urine tube in the penis) seems to bulge under his penis about halfway down the penis. He feels a lot of pressure. This is a sign of a scar in the urethra, probably from a past STD.

After proving there is no active infection, he is sent to the urologist who looks inside his urethra with a scope and some anesthetic lubricant, of course, and finds the narrowing, but no tumors or growths. The urologist then uses more of the same lubricant to pass larger and larger solid rubber rods into the penis to the point that the narrowing is now dilated to the normal size. Now the urine can flow freely without being obstructed. He needs to repeat this procedure twice over the next year and is then without further problems.

Why does this man have this problem? It is probably from an undiagnosed and untreated Chalmydia or Gonorrhea infection. For men, many of these infections do not have the classic sign of pain in the testicles or a drip in the underwear. In fact, about 1/3 of men have no symptoms when they have the infection. Women have more of these infections that do not bother them until they find they cannot have children, due to the narrowing of the tube that brings the egg to the uterus. Sometimes the infection in women requires hospitalization with intravenous antibiotics. The sperm can also meet the egg in the tube on the other side of the narrowing resulting in a growing embryo in the tube that causes severe pain and needs surgery to remove it. But usually the infection is without symptoms, other than being unable to have children—this is a common cause of infertility in women.

In men with symptoms, they usually have a drip or discharge, burning on urination, an itch inside their penis, or needing to urinate more frequently then normal.

We would all like our world to be without these diseases, but that is not the case. In general, as germs evolve with humans, they tend to cause less and less symptoms so they can be passed along and live rather than die with treatment or death of the human host. This is a common pattern: at first the germ is very deadly, but some evolve to be less deadly and then even over hundreds of years evolve to have very little symptoms on some of those they infect. Remember, the purpose of a living thing is to have offspring, and the more the better. Of course we think our purpose is to make life better for those around us and those after us, but we must have children or else humanity would end on the earth. So like HIV, much of the time the Chlamydia or Gonorrhea is passed to others without the person knowing he or she has it until months or years later.

So, if you have unprotected sex with multiple partners or with one partner whom you are not sure is monogamous, then get an STD check regularly. Some recommend every 3 months for bathhouse enthusiasts, and yearly for those who are mostly monogamous. But if you went wild one weekend, feel free to get a checkup within a week or so.

In our HIV clinics we usually check any of the three places that can have these 2 germs and the patient says they have had sex there: penis or vagina, rectum, and throat. It is very common for a positive test to come back when the person felt perfectly normal.

Of course I am always promoting condoms, but, I’ve heard rumors that some of you don’t follow our advice so I must speak to you–you. You know who you are.

I have seen a few cases of painful rectums from these germs also and a swab is helpful to find the germ. But, if your provider is using a swab in the penis, then you should insist on the urine test—the first tablespoon of urine coming out is enough. This contains the “washout” of the urethra, where the germs are. The rest of the urine is from the bladder, where the germs are not.

Physicians are told to treat first, and confirm the diagnosis later with STDs since they are so hard to eliminate from the population. The test results come back a few days later. Since we cannot tell if you have Gonorrhea (treated with a shot) or Chlamydia (treated with a pill) we usually give you both.

The treatment for Gonorrhea is usually an injection and for Chlamydia is a pill. Not finishing your pills can cause resistance in the germ and you pass it to others. These germs have become resistant to multiple antibiotics over the years but so far this is not a problem.

Chlamydia is the most common STD in the United States, attacking about 4 million/year and about 90 million worldwide. Besides the problems above, it can attack the testicles and cause much pain, and in women it can attack the liver.

If you have a suspected STD, the medical provider must notify the public health department of your name, address, etc. They then contact you to find out what you know about your sexual contacts. Some of this information is passed on to a caller, who then call these contacts and says something to the effect, “We called to let you know that someone said you were a sexual contact of theirs and that person now has Chlamydia. I don’t know the person’s name or when they had contact with you, but I do recommend you go to your provider and get checked. If you don’t have a provider, here are some free places to get checked. Even if you feel nothing and seem perfectly healthy, you can have an STD. Please get checked.” This is the way they respect your privacy as much as possible, but also try to control this disease. I have seen some sore throats due to Gonorrhea and it is treated the same way after sending a swab to the laboratory. Chlamydia does not cause sore throats.