HUMAN PAPILLOMA VIRUS INFECTION (VENEREAL WARTS) – MANAGEMENT
Personal hygiene is important. Affected parts should be kept clean, cool and dry. In females, any associated vaginal discharge should be investigated and treated.
Warts on the skin may be treated by the direct application of podophyllin
(10 to 25% solution in spirit or other solvent). When first used, the podophyllin should be washed away after 2 to 4 hours; if tolerated by the patient, the duration of subsequent applications can be increased. The area surrounding the wart can be protected by applying petroleum jelly before podophyllin is applied. Podophyllin is neurotoxic and large areas should not be treated at one time. Podophyllin should be avoided during pregnancy and must not be applied to the cervix. Treatment can be repeated every 2 or 3 days if necessary. Cauterisation or cryosurgery can be used for small lesions, if necessary under general anaesthetic. Trichloroacetic acid can be used for small keratinised lesions. Larger warts may be excised surgically. Carbon dioxide laser surgery possibly offers the best treatment option for patients with extensive condylomas or condylomas which are resistant to simpler treatments.
Sexual partners of patients with HPV infection should be examined.
Patients and their partners should be counselled about the prevention of transmission of the virus, including the use of condoms.
Because of the association of carcinoma with cervical HPV infection,
annual cervical cytological examination is recommended. Colposcopy is advisable for women with abnormal cervical smears. Because of the possibility of concomitant syphilis, syphilis serology should be repeated after 3 to 6 months.
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GENITAL HERPES – CLINICAL MANIFESTATIONS
The incubation period is usually from 3 to 6 days but may be longer.
In males, primary lesions usually occur on the penile shaft, prepuce or glans or the anal region.
In females, primary lesions occur commonly on the labia, clitoris, introitus and vagina. The cervix is involved in at least 50% of cases. In about 25%, the cervix is the only site of lesions and these cases may be asymptomatic.
Lesions may occur in the mouth or throat following oral sex.
Lesions may occur on the fingers, buttocks, torso and the eyes as a result of autoinoculation. Transmission may also occur on fomites.
Lesions are usually preceded by a 12-24 hour prodromal period characterised by local hypersensitivity or discomfort.
Multiple vesicles appear. They are surrounded by an areola of erythema. After 24 to 72 hours, the vesicles rupture to form painful superficial ulcers. Lesions of varying age and size coexist. Symptoms persist for 1 to 3 weeks. In 75% of cases, regional lymph nodes are enlarged and tender for up to 6 weeks.
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SYPHILIS – DEFINITION
Syphilis is caused by Treponema pallidum, one of a group of closely related spirochaetes including Tpertenue,Tcarateum and Tpallidum var Bosnia which cause yaws, pinta and endemic syphilis respectively.
In Australia, syphilis usually presents either as a primary lesion or through the chance finding of positive syphilis serology. Practitioners should be alert to the various manifestations of secondary syphilis. Congenital syphilis is rare where there is general serological screening of antenatal patients. Tertiary, cardiovascular and central nervous syphilis are rarely seen. Notifications of syphilis have increased in the past decade. This is largely attributed to a high incidence in urban homosexual men.
The usual mode of transmission is sexual intercourse. Transplacental transmission to the foetus can occur. Tpallidum may be spread by blood contamination, for example by needlestick injuries or the sharing of needles by intravenous drug users or by direct contact with open lesions.
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REACTIVE ARTHRITIS AND REITER’S DISEASE
Aseptic arthritis associated with genital tract infection is the commonest cause of acute arthritis in young adults.
Reiter’s disease is a syndrome characterised by reactive arthropathy, eye involvement and urethritis. It usually follows infection with С trachomatis. It is IS times more common in men than in women and is manifested by urethritis with one or more extragenital immune complications such as arthritis of the knees, ankle, spine (notably a sacroiliitis), metatarsophalangeals, wrists, elbows or tarsals, plantar fasciitis, conjunctivitis or uveitis or skin involvement (circinate balanitis or keratoderma blenorrhagica). Symptoms may occur together or sequentially. The acute disease is usually self-limited and remits after a few months. Recurrence is common. About 10% of patients develop chronic disease. Cardiac conduction disturbance or aortic incompetence may develop after some years.
Reiter’s disease may be a rare complication of gonococcal urethritis. It may also complicate gastrointestinal infections particularly shigellosis, but also infections due to salmonella and yersinia.
Reiter’s disease is one of a group of reactive arthropathies including ankylosing spondylitis and psoriatic arthritis which are commonly associated with the HLA-B27 histocompatability antigen.
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EPIDEMIOLOGICAL TREATMENT; TREATMENT SHOULD BE SPECIFIC; COUNSELLING
The term ‘epidemiological treatment’ is applied to the treatment of the sexual partner of a person known to be infected with a pathogen associated with a high risk of infection and serious sequelae whether or not there is laboratory evidence of infection.
Although treatment is given to contacts without proof of infection in some situations, shotgun therapy and repeated antibiotic prescriptions should not displace proper clinical evaluation of genital infections. Appropriate laboratory investigation should be undertaken unless precluded by circumstances.
The patient should be counselled (see p. 10) about the natural history of the disease, sequelae and method of spread, the effectiveness and side effects of therapy and the need for follow-up. The need to investigate the sexual contacts of the patient must be stressed. Advice about reducing the risk of infection should be given.
*8/56/1*
EMOTION AND SEX 2
Harsh words, perhaps, but how does your partner feel about you? Have you asked her?
The extent to which a man can abandon himself to the joy of sex varies. It depends on the presence or absence of the inhibitions to sex he has acquired during childhood and adolescence. It depends on his acceptance or rejection of the sexual double standard. It depends on his ability to communicate with his partner. It depends on his partner’s sexual inhibitions, and on her ability to communicate with him.
In the final analysis it depends on how the couple perceive sexual pleasure, and on their knowledge that the degree of pleasure can be increased by communicating their needs to each other. Some people obtain great sexual pleasure from ‘fun sex’, that is a sexual encounter between two people who are urgently attracted to each other physically, but who have no deep emotional bond. Others reject this form of sexual pleasuring, claiming that unless the emotions are involved, sexual pleasure is inevitably diminished, and ‘fun sex’ can never equal ‘love sex’. Unfortunately, what some couples believe to be ‘love sex’ is sterile, in reality, and is associated with minimal surrender by one or both partners during the experience. Other couples enjoy group sex, either as a novelty or as a way of sexual life.
The variations of what produces sexual pleasure seem infinite, and until you find out what your partner wants and are comfortable in helping her realize those needs, you will not be a good lover.
If you are able to find out, by asking, what gives your partner the most sexual pleasure and are able to enjoy sharing the experience, you will become a better lover.
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WHAT WOMEN WHANTS FROM SEX?
The women who responded to Shere Hite’s invitation to tell their sexual experiences were, in general, disappointed by their lover’s sexual techniques, although they often loved the man deeply. The men seemed largely insensitive to the woman’s sexual needs, and often unwilling to experiment. They knew that a woman wanted ‘foreplay’ (by which they meant a cursory kiss, a brief fumbling with her breasts, and a perfunctory caress around her vulva) after which the man could get on with what he really wanted. That was to insert his penis into the woman’s vagina, thrust, and ejaculate. And after that? Well, a man feels contented and wants to sleep, which does not help the woman much. One woman wrote, ‘Most of the men I’ve slept with have had absolutely no idea of what I want and no interest in finding out.’ Another, ‘I find a lot of men care nothing about sex foreplay and are only interested in “getting it off”.’ Another, ‘I’ve only had sex with my husband … he always initiates it. We kiss and he plays with my breasts. He puts one hand down and sticks his finger into my vagina and moves it back and forth like a penis would go . . . When he’s ready … he sticks his penis into me and moves it back and forth until he finishes.’ Another, ‘Some men just feel, finger and fuck. Then come and light a cigarette.’
These comments are multiplied, with variations, in The Hite Report, and from them it seems that many American men are insensitive to a woman’s sexual needs, while most women are inarticulate in asking their lover to satisfy those needs. Sex is more than friction and fantasy! Sex means communication. Sex means mutual pleasuring. Sex means closeness and body contact.
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SEXUAL INTERCOURSE
Another change is in a man’s blood pressure. As sexual tension uses, so does the blood pressure, reaching the peak at orgasm. At the peak, the man’s blood pressure may be one and a half times as high as in his sexually unstimulated state.
They have found that the increased heart rate, the raised blood pressure, and the increased rate of breathing put an extra strain on the heart of a man who has had a heart attack, but it is not more than that caused by mild exertion. When a man who has had a heart attack is able to take mild exertion, such as walking up a flight of stairs, without any problems, he can enjoy sex without any anxiety.
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THE HUMAN SEXUAL RESPONSE – INDIVIDUAL RESPONDS
The excitement phase is explained by its name. The individual responds, sexually, to any stimulation which his (or her) brain interprets as a sexual invitation. The stimulus, in our culture, is usually visual or tactile, but may be, and often is, enhanced by smell or by sound. The stimulus must be of sufficient strength, or be reinforced by additional stimuli, to permit a sufficient increase in sexual desire to extend the phase into the second, or plateau, phase. The opposite can also happen. An advance by a man (or by a woman) may be rejected by the other, and unless the individual’s sexual desire is so heightened that he (or she) persists, the excitement phase will be terminated. On the other hand, an obvious response by the person approached, particularly if welcoming, will increase the intensity of the response and bring the individual more quickly into the plateau phase. In our culture, men, especially, are said to be stimulated erotically more by vision and women by touch; but this may not be true, as I have mentioned.
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WHAT SHOULD SEX EDUCATION PROVIDE FOR CHILDREN OF BOTH SEXES?
It should detail the physical, mental, and emotional changes which occur during puberty to girls and boys. This information must include descriptive knowledge of genital anatomy and its variations, and discussions to reduce anxiety about menstruation, masturbation, petting, wet dreams, and sexual arousal.
It should explain about conception, pregnancy, childbirth, and parenthood. It should also stress the obligations and responsibilities of the couple to each other and to their child.
It should provide clear information about sexually transmitted diseases.
It should encourage students to accept people whose sexual practices are discordant with their own.
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