Sexually Transmitted Diseases in Men (STDs)

Sexually Transmitted Diseases in Men
(STDs)



Sexually transmitted diseases (STDs) are infections that are transmitted during any type of sexual exposure, including intercourse (vaginal or anal), oral sex, and the sharing of sexual devices, such as vibrators. In the professional medical arena, STDs are referred to as STIs (sexually transmitted infections). This terminology is used because many infections are frequently temporary. Some STDs are infections that are transmitted by persistent and close skin-to-skin contact, including during sexual intimacy. Although treatment exists for many STDs, others currently are usually incurable, such as HIV, HPV, hepatitis B and C, and HHV-8. Furthermore, many infections can be present in, and be spread by, patients who do not have symptoms.

The most effective way to prevent the spread of STDs is abstinence. Alternatively, the diligent use of latex barriers, such as condoms, during vaginal or anal intercourse and oral-genital contact helps decrease the spread of many of these infections. Still, there is no guarantee that transmission will not occur. In fact, preventing the spread of STDs also depends upon appropriate counseling of at-risk individuals and the early diagnosis and treatment of those infected.

In this article, the STDs in men have been organized into three major categories: (1) STDs that are associated with genital lesions; (2) STDs that are associated with urethritis (inflammation of the urethra, the canal through which urine flows out); and (3) systemic STDs (involving various organ systems of the body). Note, however, that some of the diseases that are listed as being associated with genital lesions (for example, syphilis) or with urethritis (for example, gonorrhea) can also have systemic involvement.

Diseases Associated With Genital Lesions

Chancroid

What is chancroid?

Chancroid is a bacterial infection with the bacteria Hemophilus ducreyi. The infection initialy manifests in a sexually exposed area of the skin. The infection typically appears on the penis but also occasionally occurs in the anal or mouth area. Chancroid starts out as a tender bump that emerges 3 to 10 days (the incubation period) after the sexual exposure. The bump then erupts into an ulcer (an open sore), which is usually painful. Often, there is an associated tenderness of the glands (lymph nodes), for example, in the groin of patients with penile bumps or ulcers. Chancroid is a relatively rare cause of genital lesions in the U.S., but is much more common in many developing countries.

How is chancroid diagnosed?

The diagnosis of chancroid is usually made by a culture of the ulcer to identify the causative bacteria. A clinical diagnosis (which is made from the medical history and physical examination) can be made if the patient has one or more painful ulcers and there is no evidence for an alternative diagnosis such as syphilis or herpes. The clinical diagnosis justifies the treatment of chancroid even if cultures are not available. Incidentally, the word chancroid means resembling a "chancre," which is the medical term for the painless genital ulcer that is seen in syphilis. Chancroid is also sometimes called "soft chancre" to distinguish it from the chancre of syphilis, which feels hard to the touch.

How is chancroid treated?

Chancroid is almost always cured with a single oral dose of 1 gram of azithromycin (Zithromax) or a single injection of ceftriaxone (Rocephin). Alternative medications are ciprofloxacin (Cipro), 500 mg taken twice per day by mouth for three days, or erythromycin, 500 mg taken four times per day by mouth for 7 days. Whichever treatment is used, the ulcers should improve within 7 days. If no improvement is seen after treatment, the patient should be reevaluated for other causes of the ulcers. HIV-infected individuals are at an increased risk of failing treatment for chancroid. They should therefore be followed especially closely to assure that the treatment has worked. In addition, someone diagnosed with chancroid should be tested for other sexually transmitted diseases (such as chlamydia and gonorrhea), because more than one infection can be present at the same time.

What should a person do if exposed to someone with chancroid?

A health care practitioner should evaluate anyone who has had sexual contact with a person with chancroid. Whether or not the exposed individual has an ulcer, they should be treated if they were exposed to their partner's ulcer. Likewise, if they had contact within 10 days of the onset of their partner's ulcer, they should be treated even if their partner's ulcer was not present at the time of the exposure.