Hospital Corpsman Sickcall Screener's Handbook
BUMEDINST 6550:9A
Naval Hospital Great Lakes
1999

1. Gonorrhea: One of the most common and easily spread of all STD’s caused by the gonococcus bacteria. Usually infecting the urethra, cervix, occasionally the rectum, throat, or eyes. The incubation period is from 2 to 14 days. Warning: Venereal diseases in women often have no symptoms.

   S: Tingling sensation or burning with urination; purulent discharge or "drip" from the penis, the urethral meatus may be red and edematous or itch; frequency and urgency of urination may be present.
   O: A mucopurulent (mucus and pus) urethral discharge. Gram stain of discharge is positive for gram negative diplococci occurring both intracellularly and extracellularly (both inside and outside of the WBC’s)
   A: Gonorrhea Note: Confirmed by positive culture of urine and discharge from urethra. May co-exist with epididmitis or prostatis.
   P: Ceftriaxone: 250mg IM (for the GC) and Doxycycline 100mg BID for 10 days (for NGU).

   Note: Generally patients are treated for Chlamydial infection at the same time because of the hand in hand relationship of the two STD’s. 2. 5% of men are asymptomatic with the danger of developing G.C. arthritis. It may even spread through the blood to any joint, tendons, meninges, and endocardium.

2. Non-Gonococcal Urethritis (NGU): Infection of the urethra or cervix by chlamydia. Incubation is 1 to 3 weeks.

   S: Mild dysuria with frequency, a thin mucopurulent discharge that is worse in the A.M., irritation to the meatus.
   O: Discharge with gram stain negative for gonorrhea, showing large numbers of WBCs but no organisms noted. Chlamydia test is positive.
   A: Non-Gonorrheal Urethritis
   P: Doxycycline 100mg BID for 10 days or
   Erythromycin 500mg QID for 10 days or
   Tetracycline 500mg QID for 10 days
   Increase fluid intake, avoid alcoholic beverages. Recurrent NGU due to lack of compliance with medication or re-infection.

3. Syphilis: Caused by the spiral/corkscrew shaped bacteria called treponema pallidium. The disease begins locally but rapidly invades the body affecting any tissue or organ via the blood and lymph systems. Untreated may lead to death.

   S: Stages of Syphillis and Associated Symptoms:

   1. Primary Syphillis: Starts with a painless sore/chancre on the sex organs, anus, fingers, lips or tongue from 10 to 30 days after contact. This heals spontaneously. Note: The spirochete can also be identified when a sample scraped from the chancre is examined under a darkfield microscope. If untreated the next stage develops.
      Secondary Syphillis: A flulike illness may develop 6 to 12 weeks after the chancre, a generalized non-pruritic rash which may affect the palms and soles. Aches, sore throat, hair loss, and enlarged lymph nodes may be present. This also resolves without treatment.

   2. Latent (Hidden) Syphillis: No physical signs-may last from months to a lifetime.

   3. Late (Tertiary) Syphillis: Develops 3 to 4 years or more later with tumors of the skin, bones, liver, aortic insufficiency, aneurysms, CNS disorders with widespread damage leading to dementia or psychosis.,

   O: Positive darkfield examination. Positive VDRL and RPR. Positive FTA-ABS test (fluorescent treponemal antibody absorption).
   A: Syphilis
   P: If less than a year: Penicillin G benzathene 2.4 MU IM, or
   Tetracycline 500mg QID for 14 days.
   If more than a year: Penicillin G benzathene 2.4 MU IM 3 times at 7 day intervals.
   

4. Genital Herpes: Caused by the Herpes Simplex Type II virus, this disease is chronic and recurring with no cure. Active reinfection of the genital area is dangerous to the delivering mother and her baby. A caesarian delivery may be required to protect the baby from the life threatening complications of herpes.

   S: Painful, small blisters, on the penis, genital area, groin, rectum. May be preceded by a tingling or burning sensation.
   O: Vesicular lesions on an erythematous base, fever, lymphadenopathy, and dysuria. Positive Tzank Smear or positive culture.
   A: Genital Herpes
   P: No sexual intercourse until blisters or sores are healed over!
   Warm compression several times a day may relieve inflammation and pain.
   If initial infection: Acyclovir (Zovirax) 200mg 5 times a day for 7 to 10 days.
   If recurrent: At first sign of herpes begin Acyclovir 200mg 5 times a day for 5 days
   

5. Venereal Warts (Condylomata Acuminata):

   S: and O: Warts appear as firm papules found on the head, foreskin, or shaft of the penis, on the scrotum or rectum and in the urethra, 1 to 3 months after contact. At times the warts look like cauliflower or are flat. They are caused by the human papillonma virus (HPV) and are non-tender.
   A: Condyloma
   P:

   1. Podophyllin applied to the wart only, wash off in 4 to 6 hours. (absorbed by the wart, destroying it from the inside out)

   2. Cryotherapy: freezes the wart with liquid nitrogen

   3. Electrosurgery: burns them off with electrical heat
      

6. Molluscum Contagioscum: Caused by a poxvirus that infects epidermal cells. The lesions are small, dome-shaped papules that are not often umbilicated. When in doubt, the diagnosis may be confirmed by expressing the cheesy core and smearing it onto a glass slide. A Wright’s stain of this material will show the typical oval molluscom bodies.

   S: Small, non-tender bumps on the genitals or groin.
   O: Small smooth umbilicated papules
   A: Molluscum Contagiosum
   P: Cryotherapy or Curettage (may be scraped off with minimal discomfort and bleeding)

7. HIV and AIDS: The human immunodeficiency virus is harmful to the immune system. It results in the body’s inability to fight infection. A person who is infected may show no signs of infection but is able to transmit the virus to others through sexual contact, contaminated blood and through needle sharing. The HIV test is used to detect antibodies to HIV in the blood.

   Symptoms Associated with HIV:

   1. Recurrent fever and "night sweats"

   2. Rapid weight loss for no apparent reason.

   3. Swollen lymph glands

   4. Fungal infection causing whitish spots or coating of the tongue or throat.

   5. Constant tiredness

   6. Diminished appetite or diarrhea

PREVENTION: Practice safe sex, use a condom, do not abuse IV drugs and as medical staff use precautions with all body fluids.