What is this Condition?

A chronic sexually transmitted disease, syphilis begins in the mucous membranes and quickly becomes systemic, spreading to nearby lymph nodes and the bloodstream. This disease, when untreated, is characterized by progressive stages: primary, secondary, latent, and late (formerly called tertiary).

About 34,000 cases of primary and secondary syphilis are reported each year in the United States. Incidence is highest among urban populations, especially in people between ages 15 and 39, drug users, and those infected with HIV Untreated syphilis leads to crippling or death, but the prognosis is excellent with early treatment.

What Causes it?

Infection by the organism Treponema pallidum causes syphilis. The disease spreads primarily through sexual contact during the primary, secondary, and early latent stages of infection. An infected mother can pass the disease to her fetus.

What are its Symptoms?

Primary syphilis develops after an incubation period of about 3 weeks. Initially, one or more chancres (small, fluid-filled lesions) erupt on the genitalia; others may erupt on the anus, fingers, lips, tongue, nipples, tonsils, or eyelids. Usually painless, these chancres start as pimples and then erode; they have hardened, raised edges and clear bases. Chancres typically disappear after 3 to 6 weeks, even when untreated. They’re usually associated with lymph node disease on one or both sides of the body. In women, chancres may be overlooked because they often develop internally, on the cervix or vaginal wall.

Secondary syphilis is marked by development of symmetrical lesions on mucous membranes and skin and general lymphadenopathy, which may develop within a few days or up to 8 weeks after the first chancres appear. The rash of secondary syphilis varies in appearance. Lesions are of uniform size, well defined, and generalized. Macules often erupt between rolls of fat on the trunk and on the arms, palms, soles, face, and scalp. In warm, moist areas (perineum, scrotum, vulva, between rolls of fat), the lesions enlarge and erode, producing highly contagious pink or grayish white lesions.

Mild constitutional symptoms, which appear during the secondary stage, may include headache, malaise, lack of appetite, weight loss, nausea, vomiting, sore throat, and possibly a mild fever. Hair loss may occur, with or without treatment, and is usually temporary. Nails become brittle and pitted.

Latent syphilis lacks clinical symptoms but is detected in a serologic test for syphilis. Because infectious lesions may reappear when the infection is less than 4 years old, early latent syphilis is considered contagious. About two-thirds of people are symptom-free in the latent stage and remain so until death. The rest develop characteristic late-stage symptoms.

Late syphilis is the final destructive but noninfectious stage of the disease. It has three subtypes, any or all of which may affect the person: late benign syphilis, cardiovascular syphilis, and neurosyphilis. Late benign syphilis produces lesions 1 to 10 years after infection. They may appear on the skin, bones, mucous membranes, upper respiratory tract, liver, or stomach. In severe cases, late benign syphilis results in destruction of bones or organs, which eventually causes death.

How is it Diagnosed?

Microscopic identification of T. pallidum from a lesion confirms the diagnosis. Other tests may identifY this organism in tissue, eye fluid, cerebrospinal fluid, tracheobronchial secretions, and discharges from lesions.

Additional procedures may include the Venereal Disease Research Laboratory (VDRL) slide test, the rapid plasma reagin test, and cerebrospinal fluid analysis.

How is it Treated?

The treatment of choice is penicillin by intramuscular injection. Persons who are allergic to penicillin may be treated with Achromycin or Vibramycin by mouth for 15 days for early syphilis or for 30 days for late infections. Pregnant women should not be given Achromycin.

What can a Person with Syphilis do?

• Be sure to complete the entire course of drug therapy, even after symptoms subside.

• Arrange for testing after 3,6, 12, and 24 months to detect possible relapse. If you’ve been treated for latent or late syphilis, have blood tests every 6 month for 2 years.

• Inform sexual partners of your infection so they can receive treatment.

• Get tested for HIV.

What is this Condition?

Impotence refers to a man’s inability to reach or maintain erection of the penis sufficient to complete intercourse. It’s called primary impotence if he has never achieved a sufficient erection or secondary impotence if he has successfully completed intercourse in the past despite present inability. Secondary impotence is more common and less serious than primary impotence.

In response to stress, a man may have situational impotence, a temporary condition. About half of adult men probably experience temporary periods of impotence, which aren’t considered dysfunctional.

Impotence affects all age-groups but becomes more common with advancing age. The prognosis depends on the severity and duration of impotence and on the underlying cause.

What Causes it?

Emotional and mental factors account for at least half of all cases of impotence; physical factors account for the rest. In some men, all of these factors coexist, so it’s hard to isolate the main cause.

Emotional and mental causes fall into two main categories. Personal sexual anxieties generally involve guilt, fear, depression, or feelings of inadequacy resulting from previous traumatic sexual experience, rejection by parents or peers, exaggerated religious orthodoxy, incest, or homosexual experiences. Interpersonal sexual anxieties reflect a disturbed sexual relationship and may stem from differences in sexual preferences between partners, lack of communication, ignorance of sexual function, or nonsexual personal conflicts.

Physical causes of impotence include chronic diseases, such as heart and lung disease, diabetes, MS, or kidney failure; spinal cord injury; complications of surgery; drug or alcohol use; and genital or central nervous system defects.

What are its Symptoms?

The man with partial impotence can’t achieve a full erection. The man with intermittent impotence sometimes is potent with the same partner. The man with selective impotence is potent only with certain women.

Some men become impotent suddenly; others, gradually. If the underlying cause isn’t physical, the man may still be able to achieve an erection through masturbation.

When impotence stems from emotional or mental factors, the man may experience anxiety, sweating, and palpitations, or he may lose interest in sex. He may also suffer extreme depression (this may cause the impotence or result from it).

How is it Diagnosed?

Typically, the health care professional takes a detailed sexual history to help distinguish between physical and nonphysical factors that may be causing impotence. The health care provider also must rule out other disorders, such as diabetes and problems involving the blood vessels, nervous system, or urinary and genital structures.

How is it Treated?

Sex therapy, which should include both partners, may cure impotence stemming from emotional or mental factors. This type of therapy usually includes exercises that restrict the couple’s sexual activity while encouraging foreplay. It also includes improving verbal communication skills, eliminating unreasonable guilt, and reevaluating attitudes toward sex and sexual roles.

When impotence results from physical factors, treatment aims to reverse the underlying cause, if possible. If it can’t be reversed, psychological counseling may help the couple deal realistically with their situation and explore alternatives for sexual expression. Some men who are physically impotent may benefit from penile implants.

What is this Condition?

Premature ejaculation refers to a man’s inability to control his ejaculatory reflex during sexual intercourse, resulting in persistently early ejaculation. This common sexual disorder affects men in all age­groups.

What Causes it?

Premature ejaculation may result from anxiety and is often linked to previous sexual experiences. Other psychological factors may include ambivalence toward or unconscious hatred of women, a negative sexual relationship in which the man unconsciously denies his partner sexual fulfillment, and guilty feelings about sex.

Premature ejaculation can also occur in emotionally healthy men with stable, positive relationships. Rarely, it may be linked to an underlying neurologic disorder, such as multiple sclerosis, or to an inflammatory process such as prostatitis.

What are its Symptoms?

The man with this disorder may be unable to prolong foreplay, or he may be able to prolong foreplay but ejaculates as soon as penetration occurs. Some men may exhibit signs of severe inadequacy or self­doubt in addition to general anxiety and guilt. With other men, the complaint lies solely with the sexual partner, who may believe that the male is indifferent to her sexual needs.

How is it Diagnosed?

The physical exam and lab test results are usually normal because most men with this complaint are quite healthy. However, a detailed sexual history can be valuable in making a diagnosis. A history of adequate ejaculatory control without evidence of psychological problems suggests an organic cause.

How is it Treated?

Masters and Johnson have developed a highly successful, intensive program that combines insight therapy, behavioral techniques, and experiential sessions involving both sexual partners. The program designed to help the man focus on the sensations of an impending orgasm, continues for 2 weeks or longer and typically includes:

• mutual physical exam, which increases the couple’s awareness of anatomy and physiology while reducing shameful feelings about sexual parts of the body

• sensate focus exercises, which allow each partner to caress the other’s body, without intercourse, and to focus on the pleasurable sensations of touch

• Semans squeeze technique, which helps the man gain control of ejaculatory tension by having the woman squeeze his penis every few minutes during a touching exercise that is designed to delay ejaculation.

Another method, called the stop-and-start technique, involves intercourse with pelvic thrusting by the woman, who is in the superior position. She continues thrusting until orgasmic sensations start, then stops and restarts to help her partner control ejaculation. Eventually, the couple is allowed to achieve orgasm.

What can a Man with Premature Ejaculation do?

• Be aware that this is a common disorder that does not reflect on your masculinity.

• Be aware that the condition is reversible