Blockage of uterine tubes, often the consequence of pelvic inflammatory disease.
Anatomical problems, eg. Retroversion of the uterus.
Endocrine factors, any abnormalities of the glands and hormones governing the menstrual cycle can interfere with, for example, ovulation or the uterine cycle.
Low body weight. Endometriosis.
Inflammation of the glands and prepuce may be caused by a specific or non specific infection. In non specific infections , or balanitis , lack of reproal hygiene is an important predisposing factor,especially if phimosis is present, i.e the orifice in the foreskin is too small to allow for its normal retraction.if the infection becomes chronic there may be fibrosis of the foreskin , which increases the phimosis
Benign tumours
Most breast Tumours are benign .fibroadenomas are the commonest type and occur any time after puberty ,incidence peaks in the third decade .some are cystic and some solid and they usually occur in women nearing the menopause .They may originate from secretory cells .
Malignant Tumours
Most common types of Tumours are usually painless lumps found in the upper outer quadrant of the breast.there is considerable fibrosis around the Tumour that may cause retraction of the nipple and necrosis and ulceration of the overlying skin . It is increasingly common between 35 and 70 yrs .early spread beyond the breast is via lymph to the axillary and internal mammary nodes.local invasion involves the pectoral muscles and the pleura .blood spread metastases may occur later in many organs and bones , especially lumbar and thoracic vertebrae .the causes of breast cancer are not known , but an important predisposing factor appears to be high oestrogen exposure .women with an early menarche , a late menopause , and no pregnancies have a higher than normal risk because they experience more menstrual cycles in their life times and each monthly proliferative phase of the cycle . A genetic component is also likely with close relatives of cancer sufferers having a significantly elevated risk of developing the disease .one precent of all breast cancer occur in men
1)INFECTION OF PENIS:inflammation of glans and prepuce may be caused by a specific or non-specific infection in non-specific infection ,or balanitis,lack of personal hygiene is an important predisposing factor,especially PHIMOSIS is present ,i.e,the orifice in the foreskin(prepuse) is too small to allow for its normal retraction .if the infection becomes chronic there may be fibrosis of the foreskin,which increases the phimosis2)INFECTION OF URETHRA :gonococcal urethrites is the most common specific infection .non-specific infection may be spread from the bladder(cystitis).or be introduced dyring catherisation,cystosscopy or surgery.both types may spread throughout the system to the prostate,seminal vesicles,epididymis and testes.if infection becomes chronic,fibrosis may causes urethral structure or obstrucation,leading to retention of urine3)INFECTION OF TESTES A)ORCHITIS :(inflammation of the testis):this is more commonly caused by mumps viruses,blood dorne from the parotid glands.acute inflammationwith oedema occurs about 1 week after apperance of parotid swelling the infection is ussually unilateral but,if bilateral,severe damage to germinal epithelium of the seminiferous tubules may result in sterilityB)UNDESENDED TESTIS(CRYPTORCHIDISM)during embronic life the testes develop with the abdominal cavity,but desends into the scrotum prior to birth .if they fail to do this and the condition is not corected ,infertilty is like to follow and the risk of testicular cancer is increased.C)HYDROCELE:this is the most common from of scrotal swelling and is accumulation of serous fluid in the tunica vaginalis.the onset may be acute and painfull or chronic,it may be congenital or be secondary to another disorder of the testis or epididymis
1)PELVIC INFLAMATORY DISEASES(PID) this infection may be specific or non-specific .it usually begins as vulvovaginitis,including the vulvar glands,then it may spread to the cervix,uterus,uterine tube and spread is most common when microbes are present in the vagina before a surgical procedure,child birth or absorption,especially if some of produtcs of conception2)VULVAR DYSTROPHIESA)ATROPHIC DYSTROPHY:this is thining of vulvar epithelium and the formation of fibrous tissues occuring after the menopause due to oestrogen withdrawal.it predisposes to infection,especially in debilated women and to malignant epithelium neoplasiaDISORDERS OF UTERINE TUBE AND OVARIESA)ACUTE SALPINGITES:salpingitis is inflammation of the uterine tubes & is usually due to infection spreading from the uterus,and only occasionally from the peritoneal cavity.the out come may be 1)uneventful recovery.2)chronic inflammation leading to fibrous tubal.obstrucation & infertility.3)pus formation(pyosalpinx)FEMALE INFERTILITYmay be due to 1)blocakage of uterine tube,often the consequence of pelvic inflammatory diseases.2)anatomical problems,e.g,retroversion(tiliting backwards)of the uterus3)endocrine factors,any abnormalities of glands & hormones governing the menstural cycle can interfere.for example ovulation or the uterine cycle.4)endo metriosis.5)low body weight or severve malnourishment.DISORDERS OF THE BREAST1)MASTITIS(inflamation of breast) A)ACUTE NON-SUPPURATIVE MASTITISthis occurs during lactation and is associated with painful congenstion & oedema of the breast B)ACUTE SUPPURATIVE(PYOGENIC) MASTITISthe microbes enter through a nipple abrasion caused by the infant sucking.the most common causative microbes the STAPHYLOCOCCUS AUREUS and STREPTOCOCCUS PYOGENES usually acquired by infants which in hospital.the infection spreads along,the mammary ducts of alobe causing localised swelling & redness.if it does not resolve it can become chronic and an abseen may form.
What is a sexually transmitted disease (STD)?
An STD is an illness that is spread through sexual contact.
How can sexually transmitted diseases be avoided?
* The less sexual partners a person has, the lower the risk of infection.
* Most sexually transmitted diseases can be avoided to a large extent by practicing safe sex (eg using condoms).
* Most sexually transmitted diseases can be cured if they are diagnosed and treated in their early stages.
The most common diseases and their symptoms are described below.
Chlamydia
Chlamydia is the most common and fastest spreading sexually transmitted disease in the UK. It stems from a bacterium, Chlamydia trachomatis.
Women diagnosed with Chlamydia can also infect their newborn infant during delivery. Symptoms usually appear approximately 7 to 21 days after infection and differ for men, women and children.
Symptoms in men:
* inflammation of the urethra (the bladder duct within the penis)
* stinging feeling when passing water
* clear discharge from penis and possible itchiness around the opening
* pain or tenderness in the testicles.
Symptoms in women:
* stinging feeling when passing water
* unusual vaginal discharge
* pain caused by pelvic inflammation (pelvic inflammatory disease)
* pain during intercourse
* in some cases, bleeding between periods.
Symptoms in infants:
* inflammation of the eye (conjunctivitis) at birth
* problems breathing
* premature birth
* in rarer instances, pneumonia.
One of the most common ways of testing for Chlamydia is for the GP to collect a cell sample from the infected area (cervix or penis) with a cotton swab. This is then sent to a laboratory for evaluation. In the absence of a firm diagnosis, you may be referred to a specialist genitourinary clinic for further testing. Treatment consists of antibiotics, and should also be given to the patient’s partner. A further swab is recommended once treatment has ended to check whether the infection has cleared. For more information, read the factsheet on chlamydia.
Gonorrhoea
Gonorrhoea is caused by Neisseria gonorrhoeae, a bacteria that grows and multiplies quickly in moist, warm areas of the body such as the cervix, urethra, mouth, or rectum. In women, the cervix is the most common site of infection. However, the disease can also spread to the uterus (womb) and fallopian tubes, causing pelvic inflammatory disease leading to infertility. Gonorrhoea is most commonly spread during genital contact, but can also be passed from the genitals of one partner to the throat of the other during oral sex. Gonorrhoea of the rectum can occur in people who practice anal intercourse. In pregnant women, gonorrhoea can be passed from an infected woman to her newborn infant during delivery if left untreated.
The early symptoms of gonorrhoea are often mild, and many women who are infected have no visible symptoms of the disease. If symptoms of gonorrhoea develop, they usually appear within 2 to 10 days after sexual contact with an infected partner, although a small percentage of patients may be infected for several months without showing symptoms.
Symptoms in women include:
* painful, burning sensation when urinating
* yellowish or bloody discharge from the vagina
* bleeding between periods
* abdominal pain.
Men are more likely to show symptoms than women. Some of the symptoms in men include:
* burning sensation during urination
* yellowish-white discharge from the penis.
Other symptoms affecting the rectal area include itching, discharge and sometimes painful bowel movements.
A diagnosis is made through detection of bacteria in samples taken from the urethra, cervix, throat or rectum. The condition is treated with antibiotics, and treatment should also be given to the patient’s partner. As with Chlamydia, further testing is recommended once treatment has ended to check whether the infection has cleared.
Herpes genitalis (genital herpes)
Gential herpes is a highly contagious viral condition caused by the herpes simplex virus (HSV). It principally infects the skin and mucous membranes of the genitals and rectum, but can also appear in areas such as the mouth. It is transmitted primarily through physical and sexual contact. During birth, the presence of herpes simplex virus on the genitalia or in the birth canal is a threat to the infant. Infection in the newborn infant can lead to herpetic meningitis, herpetic viremia (herpes virus particles present in the blood) and chronic skin infection.
The symptoms of herpes simplex virus usually occur a week after infection, but sometimes take longer to appear. Initially, the skin becomes reddened and multiple small blisters filled with a clear, straw-coloured fluid appear. Prior to the presence of blisters, the infected individual may also experience increased skin sensitivity, tingling, burning or pain at the site where blisters will appear. Later, the blisters burst leaving shallow, painful ulcers which eventually scab and heal over a period of 7 to 14 days.
The outbreak may be accompanied by other symptoms such as:
* swelling and tenderness of the lymph nodes in the groin area.
* in women, vaginal discharge and painful urination.
* in men, a possibility of painful urination if the lesion is near the opening of the urethra.
* fever.
In most cases, a description of the condition and the appearance of the blisters will be enough to make a diagnosis. The GP may also advise referral to a specialist genitourinary medicine (GUM) clinic for confirmation of the diagnosis.
There is no cure for the herpes simplex virus; once infected, patients will remain a carrier for the rest of their lives. Some remedies, however, can reduce the duration of the eruption. In addition, by being more aware of the initial symptoms of recurrence (skin sensitivity and tingling), timely treatment with medication such as aciclovir (Zovirax tablets/suspension) will often abort the outbreak of blisters.
The best way to avoid transmission is to avoid direct contact with an open lesion. People with herpes simplex virus should avoid sexual contact when active lesions are present.
Although the symptoms of genital herpes may not be present, it is important for those infected to inform their partner that they have the disease. This will encourage both parties to use barrier protection (condoms) to prevent the spread of the illness. Using condoms and not sharing towels are good ways of reducing the chance of infection in the first place.
HIV and AIDS
AIDS is a potentially lethal sexually transmitted disease and is caused by the HIV virus. HIV invades and destroys the immune system, which protects the body from infection. This means that a person who carries the HIV virus is prone to many different illnesses and may die from diseases that are harmless to healthy people.
AIDS is still most widespread south of the Sahara in Africa, Asia, and the Caribbean islands, and is more common among homosexual and bisexual men. However, in more developed countries the disease is becoming more frequent among heterosexuals, especially young people. In the UK, new cases of HIV are now more prevalent among heterosexuals.
Intravenous drug users and people with many different partners are particularly at risk from HIV. The virus is found in bodily fluids such as blood, sperm and vaginal secretions, and can pass through little scratches that may occur during sexual intercourse.
Although they vary considerably, the symptoms include:
* fever
* diarrhoea
* sweating at night
* loss of weight
* swollen glands
* general discomfort.
The diagnosis is made when the HIV antibody is found in the blood. The test is not usually positive until 6 to 12 weeks after infection.
There is no cure for HIV and AIDS, but the earlier the diagnosis is made, the easier it is for the doctors to help. Today, efficient treatments exist that increase quality of life and prolong life itself. Anyone who is infected with HIV should only have safe sex using barrier protection and inform all previous partners about their infection. For more information, read the factsheet on AIDS and HIV.
Genital warts
Warts, or condylomata acuminata, are caused by the human papilloma virus (HPV). Up to nine months can pass from the time of infection to the actual development of warts. In women, human papilloma virus can lead to changes in the cervix and to the development of cervical cancer. Therefore, it is important that this condition is diagnosed and treated.
The symptoms are raised, rough, wart-like growths that may occur singly or in clusters. In men, they are usually found around the head of the penis and tend to be drier. In women, they appear most often around the vaginal opening and may spread to the rectal area. It is also possible for the virus to appear on or near the cervix as whitish, flat-like lesions, usually only detectable through close visual examination of the cervix (colposcopy). In both men and women, lesions may also be present in the mouth and throat. In general, symptoms can intensify if the immune system is weakened, or during pregnancy or if the person has diabetes. The warts are very contagious so safe sex is advisable.
A diagnosis is made when a characteristic lesion is visible. By swabbing the skin with 5 per cent acetic acid, ‘invisible’ warts will emerge as white-coloured patches. A GP can treat the warts by freezing and swabbing, but if this does not help the patient may be referred to a genitourinary specialist who can offer more specialised treatment. However, it is important to note that treatment does not always offer a complete cure.
Syphilis
Syphilis is a dangerous and life-threatening bacterial disease. After infection, the bacteria is transported through the body via the bloodstream and adversely affects vital organs such as the heart, brain, nervous system and spine.
The symptoms are divided into three stages.
Up to 12 weeks after the time of infection:
* one or more red lesions will develop on the penis, labia (lips of the vagina), anus and sometimes on the mouth and lips. These lesions disappear after a week.
Up to six months after the time of infection:
* a red rash appears on the chest, back, arms, legs, hands and soles of the feet
* high fever
* sore throat
* muscular fatigue
* general feeling of discomfort.
Anyone experiencing these symptoms should contact their doctor immediately.
If the illness is not treated by the second stage, it will disappear for a while. However, the disease can lie dormant in the body and return up to 20 years later. At this more advanced stage the symptoms will be:
* heart failure
* paralysis
* insanity
* possible death.
The diagnosis is made through the detection of the micro-organism or the detection of antibodies in the blood. In its early stages, syphilis can easily be treated with antibiotics.
How to avoid sexually transmitted diseases (STDs)
Avoid high-risk behaviours and practise safe sex.
* Though not necessarily practical or desirable, abstinence is the only way to completely prevent STDs.
* Avoid sex with many different partners.
* Always use condoms.
