Dr. Emmanuel L. Sta. Cruz

May be silently and innocently acquired

    Sexually Transmitted Disease (STD) or Venereal Disease (VD) has been a dreaded social disease because the word VD connotes having Genital Infection that is acquired through sexual contact with a prostitute. Thus, patients are afraid or embarassed to be diagnosed or treated with STD/VD. This has created a social stigma to its diagnosis.

    Traditionally, Genitourinary Infection is classified as Venereal and Non-Venereal Disease. The more common VD organisms are Gonorrhea and Chlamydia. While the so-called non-VD organisms are skin bacteria such as Staphylococcus Aureus, Epidermidis and Saprophyticcus; the intestinal bacteria such as the Coliforms: E. coli, Acetinobacter, Enterobacter, Klebsiella, Proteus; Yeast (Fungus); Ureaplasma and Mycoplasma species. We also have Trichomonas and Gardnerella vaginalis which can be acquired from contaminated water.

    Although the WHO had renamed STD as a Sexually Transmitted Infection (STI) and the term VD now is viewed as outdated as the more common VD-causing organisms had been found to be transmissible also through non-sexual means, these so called VD organisms like Gonorrhea and Chlamydia continue to be labelled as Venereal organisms. So many patients avoid the specific test to diagnose them and many physicians likewise do not do these tests routinely due to the reluctance of patients because of the misconception that the so-called VD organisms can only be acquired from a prostitute, while others are in a state of denial. Thus, Chlamydia has become a silent epidemic affecting unsuspecting men, women and children because it rarely shows symptoms. The WHO estimate on the incidence of Chlamydia infection between ages 15 and 49 was 101 million new cases for year 2005. 

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I. What Sexually Transmitted Infection (STI) is Really All About

 

    In reality, if we have to classify which organisms are transmissible through sexual contact with a prostitute, then this list would include all organisms (i.e., the so-called Venereal and Non-Venereal organisms alike). Skin bacteria such as Staphylococcus and the Coliforms (intestinal bacteria) such as E. coli, Klebsiella and others are as virulent as Chlamydia or Gonorrhea when it comes from a prostitute because they are potentially exposed to different antibiotics. Who can say then that a so-called Non-Venereal organism, when found on a decent woman, did not come from a prostitute when these organisms are common to all women. 

    On the other hand, how would we know that the so-called VD organisms, especially Chlamydia which customarily does not produce symptoms, came from a prostitute and not from a decent woman when these organisms are also transmissible through non-sexual means and are found even in children. 

    Even among boyfriends and girlfriends in a monogamous relationship, they may never be certain of the various potential organisms their partner has acquired from previous sexual relationships. All it takes is one indiscretion from one partner in a chain of relationships among decent men and women to cause Venereal organisms to be passed on to unsuspecting men and women. One sexual contact could be like having contacts with all the sexual partners your partner has had a relationship with. So in reality, many men may be harboring dormant organisms in their Prostate Glands that causes STI as well as in the Cervix of women. Therefore, we should stop labeling organisms as Venereal and Non-Venereal and just classify them all as Genitourinary Tract Infection (GUTI) as these organisms are common among men and women.  

    On the other hand, if a decent woman can have various organisms, how much more for a prostitute. Yet, some men would still risk having unprotected sexual contact with a high risk woman hoping that they are lucky enough to find a prostitute without an infection. Although using condoms may reduce the chance of getting STI from sexual contact, studies have shown that despite condom use, a man still has a 40% chance of contracting an STI. Kissing and Oral Sex are other ways of getting STI/GUTI which are not known to most men and women. 

    While in men who had a history of STI, even years or decades back, who were already previously treated but without Prostate Massage, there is a likelihood that these STI organisms were left inside the thousands of individual glands of their Prostate because, although antibiotics could eradicate the organism in the urinary tract and bladder, antibiotics do not readily enter the glands of the Prostate without thrice weekly Prostate Massage. These surviving organisms may not produce symptoms, although they may be slowly destroying these glands one after the other, just like termites eating up their Prostates. 

 

 

II. A Comprehensive Diagnostic Test for STI/GUTI

 

1. GRAM STAIN: is an important screening test for STI/GUTI and a suitable indicator of the gravity of infection. Although Gram Stain is in no way diagnostic, it acts as a good monitoring guide on when to stop medications.

2. URINALYSIS: is an unreliable basis for lower urinary infection.

3. WET MOUNT: is good for Trichomonas.

4. DIRECT FLUORESCENCE ANTIBODY: is the most reliable test for Chlamydial Infection compared to PCR. 

5. CULTURES: are diagnostic. It identifies the organisms involved and also tells us the appropriate medications to eradicate them. But there are several specific culture media for each group of organisms such as Staph/Strep, the Coliforms (E. coli, Klebsiella, etc.), Gardnerella and Trichomonas vaginalis, Neisseria species like Gonorrhea and the atypical bacteria (Ureaplasma and Mycoplasmas). 

6. BLOOD TESTS for Hepatitis, HIV and Syphilis may be necessary for individuals with an exposure to a high risk sexual contact.

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III. Key Points in the Treatment of STI/GUTI

 

    1. The first step is to do a comprehensive diagnostic test for STI/GUTI on both partners so the physician can assess the magnitude of the problem and choose the best antibiotic that can eradicate the most number of organisms involved.

 

    2. The antibiotic treatment for men should be combined with thrice weekly Prostate Massage to drain out the infected Prostate fluid thereby allowing antibiotics to enter these glands as new fluid refills them after the Prostate Massage. Otherwise, "there is an inherent failure of the antibiotics to penetrate the Prostate" (Stamey & Meares) without a Prostate Massage. This should be done week after week, until there is proof of a cure (not just by disappearance of symptoms) whereby the WBC count is back to normal and the repeat Cultures and DFA test are negative. Otherwise, an inadequately treated infection in men could lead to Prostatitis and its complications such as recurrent UTI, Erectile Dysfunction, Infertility, Pain Syndrome, Enlarged Prostate, Elevated PSA and eventually Prostate Cancer. Based on my experience, it would be very unlikely for any STI in men to resolve without the help of Prostate Massage.

 

    3. If warranted, both partners should be treated together by one primary physician thereby using the same medications to avoid reinfection or the "ping-pong" effect. As it is, STI/GUTI is already a complex problem with serious consequences. There cannot be two captains of a ship. Varying opinions could further make treatment more complicated. The failure of a partner's treatment is the failure of the other.

    

    In women, an inadequately treated STI/GUTI could lead to recurrent UTI, Chronic Cervicitis, Infertility, blockage of the Fallopian tubes and, among others, Cervical Cancer.

    Decent men and women may be silently and innocently haboring various organisms that cause STI/GUTI because the comprehensive tests to diagnose them are not routinely done nor is it readily available in medical institutions. 

    STI/GUTI is not healthy. Diagnose and treat it before it is too late.