b. Although some sexually transmitted disease is acquired through sexual
exposure with casual acquaintances and "pickups", most cases are contracted by
continued contact with a regular sexual partner. The importance of promiscuity cannot
be overemphasized, however, since two noninfected persons cannot possibly transmit
disease to one another. At least a third person must always be involved.
c. Prostitutes are a minor source of sexually transmitted disease in the US;
however, they are always a potential source of infection. Their constant repeated
contacts make it virtually impossible for them to remain free of infection indefinitely. It is
possible for a man to acquire infection from a prostitute infected only a few minutes
before.
8-4.
GONORRHEA
a. General. Gonorrhea accounts for the majority of sexually transmitted disease
among military personnel; it is caused by a bacterium, Neisseria gonorrhoea, also
known as the gonococcus. The incubation period is from 2 to 14 days, with an average
of 3 to 5 days. The symptoms are a yellow discharge from the penis in the male (may
be only mucoid at first) and from the vernix and/or urethra in the female, with burning
and urinary frequency. In the female, the infection may not be noticeable. The
discharge may be prolonged without treatment or with improper treatment. Diagnosis is
made by microscopic examinations of smears and cultures. Untreated or improperly
treated gonorrhea may result in severe complications involving other parts of the body.
Arthritis and sterility may occur. In rare instances, heart disease or septicemia
complicates the disease and may end fatally. The disease is infectious as long as
gonococci are harbored in the prostate, cervical, or other genital glands.
b. Treatment. All patients to be treated for gonorrhea should have a serologic
test for syphilis (STS) prior to receiving specific treatment for gonorrhea and a repeat
STS monthly for 3 months following such treatment. Patients should be cautioned to
report to a medical officer promptly if lesions suspicious of primary or secondary syphilis
develop. Treatment of male patients with typical clinical symptoms of gonorrhea need
not be delayed until laboratory confirmation of the diagnosis is obtained; however,
several unstained films of the discharge should be prepared before treatment for later
study. In females, cultures of the urethral or cervical discharge should also be made. A
case of uncomplicated gonorrheal urethritis should be treated on a duty status as an
outpatient. Individuals with complications should be hospitalized immediately and
treatment stated.
c. Penicillinase-Producing Neisseria Gonorrhoea. Penicillinase-producing
Neisseria Gonorrhoea (PPNG), an increasing number of gonococcal infections are
resistant to the standard treatment of penicillin. These infections do not respond to
treatment with penicillin and require treatment with other antibiotics. PPNG is a serious
problem because it complicates the course of treatment and limits the number of drugs
available to control gonorrhea. One factor that led to the development of PPNG was the
use of oral antibiotic prophylaxis (no sweat pills) for prevention of gonorrhea.
MD0008
8-4