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Sexually Transmitted Diseases - STDs



Gonorrhoea

In February 2002 the British Medical Association (BMA) Science Department and Board of Science and Education published a document called 'Sexually Transmitted Infections'.

This bacterium has an incubation period of two to seven days, but can also be of longer duration.  However, although symptoms can be manifest, there are often no symptoms which means the person can be contagious for months without their knowledge thus allowing long term damage to occur within the body, which in women could lead to Pelvic Inflammatory Disease and on to ectopic pregnancy or infertility.  The report also states that rectal infection can not only occur in women due to anal sex, the same as in men, but also by the infection spreading from the vagina.  There is no mention in the report of what physical external signs to look out for, only pain during urination and sometimes an obvious penile discharge in men, and sometimes fever, deep pelvic pain or pain on intercourse in women.  This would mean that this silent bacterium is passed directly into the body with no external signs, eg rash, swelling, blisters etc at all.

The report then says "Gonococcal infection can cause conjunctivitis in adults." with no explanation of how the eyes can become infected.  Is this due to external contact from the infected partner's sexual organs coming into contact with the eyes, or is it via hands touching infected sexual organs and then touching eyes, or is it via the bacterium in the body travelling within the body and contaminating the eyes internally, or is it through the air as one would 'catch a cold'?  This is very worrying.  Does gonococcal conjunctivitis differ in any way from 'ordinary' conjunctivitis?  Is the treatment the same?  Is it easy for a doctor to distinguish between the two?  What would be the short or long term effects to the eyes or the sight following infection?  Would an infected person visit a GUM clinic or their GP with this infection?  If a doctor saw this form of infection, would s/he automatically know that the patient has full gonorrhoea even if they had no other symptoms?  The report does explain how babies can get gonococcal conjunctivitis soon after birth by passing through the infected cervix of its mother.

There is no mention in the report of whether or not Gonorrhoea can be spread via oral sex, nor any mention of any symptoms around the mouth area.

The report goes on to say that "Gonorrhoea, if untreated, can lead to septicaemia.  Nowadays this is rare in developed countries.  Antibiotic treatment usually leads to a complete cure."  It fails to say what the symptoms of septicaemia (blood poisoning) are, nor does it mention what happens to those people in undeveloped or less developed (third world) countries who will probably get septicaemia due to them not being able to obtain antibiotics.  Antibiotics are not easily available in these countries.  The people may not have a national health service and would need to pay for the drugs, assuming they can even find a doctor to treat them and that the correct antibiotics are actually available.  These people would doubtless never experience a complete cure.

The report continues "There is increasing concern about the spread of resistance to routine treatments for gonorrhoea with 9.3 per cent of isolates showing some penicillin resistance in England and Wales.  Antibiotic-resistant cases of gonorrhoea can be more difficult to eradicate.  As a result, standard therapies do change."  If 9.3 per cent of those with gonorrhoea show penicillin resistance, does this mean that these people have had gonorrhoea more than once which is causing the resistance?  What studies have been carried out to ascertain the reason(s) for this resistance?  Who changes the standard therapies?  On what authorisation?  Are these changes 'across the board' or localised to the areas that have resistance?  How much does it cost the British taxpayer any time a change of standard therapy is carried out?  How is this information of a change disseminated to GPs, Pharmacies, GUM clinics etc?  Do these changes have any effect on other treatments that are given for other sexually transmitted diseases?  Who is recording and collating all this information?

Finally the report on gonorrhoea states "It is important to take a sexual history, particularly from the point of view of establishing where (in which country) the individual had sex or where their sexual partner was from, as infections acquired outside the UK are much more likely to be resistant to penicillin."  This shows the seriousness of gonorrhoea as this is the first time in the report that establishing the country of origin is mentioned.  The report fails to say which countries are more riskier than others.  It fails to mention what tests, if any, are carried out on anyone coming in from these countries.  It fails to mention whether it is males or females who are bringing the disease in.  In the light of many youngsters going abroad for holidays with the intention of 'having fun' the report fails to indicate if this is one of the main causes for the rise of gonorrhoea in this country.  If this is the case, what warnings are given to these youngsters before they travel abroad of the possibility of catching gonorrhoea or any of the many other diseases that can so easily be caught from a 'one night stand'?  Are condoms assumed to be the answer to preventing these diseases being caught, despite the fact that condoms have inherent holes that are bigger than most, if not all, sexually transmitted diseases?  Can these diseases then be spread via toilets in the airport or even on board the plane?  And why should these unnamed countries be more likely to have penicillin-resistant infections?  Could it be that so many youngsters pass through the country year after year, spreading the infections time after time, that gradually super-bug infections occur?  If it is third world countries that produce the risk, then this could be due to the fact that the local people catch the diseases initially from UK residents on holiday, but as they are unable to afford or obtain antibiotics themselves, then a stronger strain of the disease is produced that eventually gets passed back to a visitor who has gone on holiday for 'fun'.  Had the report said Spain, the Balearic Islands, Thailand or the Philippines then it would be assumed that sexual promiscuity was the reason for the visit and that obviously the dangers of contracting diseases would be great and that sex should be avoided.

If these unnamed countries have bacterium or viruses that are known to be more penicillin resistant then what is our country doing to encourage these nations in preventing the spread of diseases to our residents?  Are they screening UK visitors to their countries to prevent these diseases from entering?  Who pays for any or some or all of these tests?  If someone is found with a disease are they refused permission to enter or leave the UK (depending on whether they are travellers to or from the UK)?  How long does it take from when someone is tested to when the results are known?  What follow-up is carried out on anyone who has been found to have a disease?  Are the tests voluntary or enforced?


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