I started this year off with Surgery as my opening rotation, and now I'm in Family Medicine. Very different ballgame. On Surgery, it was hernia, appendicitis, cholecystitis, lather, rinse, repeat. This week on Family Med it was chlamydia, balanitis, and yeast infections.
Not all genital infections or ailments are sexually transmitted. Balanitis, bacterial vaginosis, and yeast infections can occur in people who have never had sex (by any definition of the word). On the other hand, it is pretty much impossible for anyone to get syphilis, chlamydia, or gonorrhea without having had sexual contact with an infected partner. Incidentally, you can get infections not only in the genitals but also in the throat or rectum from any of these lovely organisms :) I wonder if all the kids wearing "chastity rings" know about that...
This week in clinic I saw two patients with concerns about STDs. The more interesting of the two was a middle-aged man arriving with symptoms suggestive of gonorrhea. He had been treated the previous year for the same infection. His boyfriend was also treated; he had passed it to my patient. My patient was visibly dismayed as I asked him about his symptoms. "I know what I have; I've had it before. Let me ask you this: is it possible that last year the antibiotics didn't work and I just now am getting sick again? I mean, that's possible, right?" His eyes were searching mine and begging for me to tell him that yes, it is possible, and no, your boyfriend's not cheating on you with the bus-boy at his restaurant. I hemmed and hawed a bit, trying to buy time while my mind scrambled for some explanation other than the obvious one that would explain this man's having gonorrhea for the second time in 6 months. I quickly concocted a reasonable-sounding explanation. "Well, sir, it's possible if you and your partner did not take your antibiotics at exactly the same time last year, and you were still sexually active with each other, you could have re-infected each other during that time period." I didn't know then that my reasoning was actually scientifically valid, but it certainly seemed logical to me at the time. (Please know that I always have an M.D. who comes into the room at the end of the visit to discuss diagnosis and treatment with the patient and also answer any of the questions the patient has.)
At any rate, my patient was tremendously relieved. I cautioned him to go home and have a long talk with his partner about the issue, and also to send his partner in for treatment since he was probably also infected.
That day I was a little bit Sex Talk with Sue, a little bit Dr. Phil (who I hate; I'm not linking to his website to give him more traffic. I'm sure everyone know who he is).
The CDC has an excellent section on their website about STDs. Check it out if you're feeling nervous.
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3 comments:
Do you mind if I pass this link to my buddies on the boards? Probably some docs in there...
Please link me! Just do me a favor and don't reveal and identifying info about me (last name, city, school). I'd like to keep it anonymous if that's even possible.
Oh dear..... I was stuck in a room with a couple in a domestic last week for over an hour last week, so I understand the Dr Phil bit (though I cannot stand the man). Hope the gono was cleared up by the antibiotics "this time".
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