Blog About Health & Medicine

Whether or not the organisms that cause proctocolitis, proctitis, and enteritis are acquired sexually, the symptoms are usually those of a gastrointestinal illness. How much time elapses between initial infection and the appearance of symptoms depends on which infection is present. Although abdominal pain and rectal discharge are common, the specific symptoms depend on which area of the gastrointestinal tract is involved.

The symptoms of proctitis include pain in the anal area, a mucous discharge from the anal area, constipation, and feeling an urgent need to have a bowel movement without being able to do so, despite straining. Blood may be noticed in the stool or when wiping after a bowel movement. If the proctitis is caused by herpes or syphilis, then lesions may be present. Infections such as chlamydia and gonorrhea usually produce far fewer symptoms in men when they are present in the rectum than when they are present in the urethra.

The symptoms of proctocolitis are generally the same as for proctitis, with the addition of diarrhea and abdominal pain. Less often, proctitis and proctocolitis are symptom free.

The symptoms of enteritis include diarrhea and cramping or pain in the abdominal area, often in the lower left abdomen. Nausea and bloating often accompany these symptoms. The diarrhea may be bloody, depending on which organism has caused the infection, and there may also be a mucous rectal discharge. Other possible symptoms include fever, chills, and malaise (a generalized sense of not feeling well). Significant weight loss can result if food is not absorbed well because of inflammation in the bowel.

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A woman who is infected with herpes before pregnancy has antibodies in her bloodstream, which are the body’s immune response to infection and offer protection against new herpes infection. These antibodies (and the immunity they convey) are transmitted to the fetus in the womb, so there is a low risk of the fetus becoming infected in the womb if the mother had herpes before she became pregnant. The greatest risk of infection in this situation occurs during delivery, when the newborn may be exposed to a large quantity of virus, especially if the woman is experiencing an outbreak. If a woman with herpes is having an outbreak at the time of delivery, then a cesarean section is recommended to prevent the passage of the baby through the infected birth canal. (Rarely, babies born by cesarean section are nevertheless infected with HSy probably because they were infected in the womb or during premature rupture of the membranes.) If the mother is not having an outbreak, there is a very small chance (0.35-1.4%) that she will be shedding virus through the birth canal at delivery; if she is shedding, there is a small chance (probably less than 1%) that the child will become infected. So, for women who have herpes and who give birth vaginally the overall risk is less than 1 percent that the baby will become infected.

The decision whether or not to perform a cesarean section is an individual one, and it must be discussed with one’s health care provider. Cesarean sections are not routinely performed on all pregnant women with herpes, since this procedure is not in itself without risk, and the risk of transmission to the baby when there is not an outbreak is very low. A woman who knows she has herpes can prepare for this decision well in advance.

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For both men and women, antifungal medications provide dependable treatment for yeast infections. Men usually have success with over-the-counter creams applied to the affected area twice a day for two weeks. Treatment with antifungal medication is recommended only for a woman with symptoms, and then only for a woman who has been diagnosed with yeast infection in the past and is certain that yeast is again the cause of her symptoms. For women, there is no reason to treat yeast colonization if it is not causing symptoms.

Many antifungal creams are available without a prescription, and most of them are well tolerated, except for the rare allergic reaction. Since all over-the-counter creams are equally effective (they cure infection 80-90 percent of the time), using the least expensive cream seems to make sense. Butoconazole, clotrimazole, miconazole, and tioconazole are some of the most frequently used medications; they are applied at night, some as a single dose, some for three days, and some for a week.

Women can use either creams, which are inserted into the vagina with an applicator packaged with the cream, or vaginal suppositories, which are pills that are inserted into the vagina. When using a cream, for best results the medication should be rubbed on the vulva (the outside of the genitals) as well as inserted into the vagina. For women with a history of difficult, recurrent yeast infections, the longer, seven-day course is a better option from the start. Some women experience irritation from the frequent use of the treatments themselves, and in this case an alternative treatment (see the next paragraph) should be used. Because the creams are oil based, they may weaken latex condoms and diaphragms.

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Having said that, it’s important to repeat that every STD is different and can be transmitted in different ways.

This is important for couples who know that one of them has an STD, or who suspect that an STD may have been transmitted from one of them to the other. It will help explain how they can protect themselves or how transmission may have taken place.

Finally, unprotected sex is not unsafe for a couple who are mutually faithful, have tested negative for all of the STDs, and are beyond any waiting periods that are necessary for a positive test for infection to show up, as long as neither of them has other risk factors for infection (such as a recent exposure to infected material by a health care worker, or intravenous drug use).

Before turning to the more general guidelines, I list the practices that we know are absolutely unsafe if you are having sex with a partner whose status for infections you don’t know:

— Receiving vaginal sex without a condom

— Giving vaginal sex without a condom

— Giving oral sex without a condom or barrier

— Receiving oral sex without a condom or barrier

— Receiving anal intercourse without a condom

— Giving anal intercourse without a condom

— Oral-anal contact (rimming) without a barrier

— Contact with your partner’s blood

The following practices are possibly unsafe and should be avoided with a partner whose status for infections you don’t know:

— Hand contact with your partner’s genital or anal area without a glove

— Sharing sex toys without cleaning them or using a new condom on the toy

In the following list of possibly safe, or safer, practices, the first five are unsafe if the condom or barrier breaks. Even with the condom intact, some STDs, such as herpes, may be transmitted. In the first three examples, condoms or barriers must be used for the entire contact, since pre-ejaculate (the small amount of fluid released prior to ejaculation) can transmit infection. Wet kissing is possibly safe if neither person has bleeding gums or other open sores in the mouth.

—Anal intercourse (giving or receiving) with a condom —Vaginal intercourse (giving or receiving) with a condom

— Oral sex with a condom or barrier

— Oral-anal contact with a barrier

— Sharing sex toys with a barrier —Wet (French) kissing

Finally, practices that we know are safe are the following:

— Masturbation in each other’s presence (touching your genitals, nor your partner’s)

— Sensual massage

— Dry kissing

— Hugging

— Fantasizing together

— Rubbing clothed bodies together (without genital to genital contact)

— Bathing together (without contact with a potentially infected area of a partner)

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One reason so many cases of prostate cancer are not caught early is obvious: Too many men don’t get regular physicals that include a digital rectal examination (DRE), the first step in diagnosis, when a doctor feels for a knot, lump, or anything abnormal that might be a tumor. (In men with cancer, the doctor uses the rectal exam to learn as much as possible about the cancer—does it encompass part of one lobe, one entire lobe, or both lobes of the prostate? Has the cancer spread outside the prostate, into the pelvic side wall or the seminal vesicles?)

But even for those who do get checked yearly, the digital rectal exam is not an ironclad guarantee that cancer will be found in time. As many as 40 percent of all prostate cancers begin their growth in an inopportune spot, at a point where a doctor’s finger simply can’t reach. Therefore, many patients have advanced disease by the time it is diagnosed with a digital rectal exam. Also, the digital rectal exam is only as good as the doctor performing it; it is a subjective test.

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