Lab 15 Clinicals

Sexually transmitted disease

a disease that is spread by sexual contact. In most developed countries of the world, such as those of Western Europe, Japan, Australia, and New Zealand, the incidence of STDs has declined markedly during the past 25 years. In the United States, by contrast, STDs have been rising to near‐epidemic proportions; they currently affect more than 65 million people. AIDS and hepatitis B, which are sexually transmitted diseases that also may be contracted in other ways, Chlamydia (kla‐MID‐ē‐a) is a sexually transmitted disease caused by the bacterium Chlamydia trachomatis (chlamy‐=cloak) (Figure A). This unusual bacterium cannot reproduce outside body cells; it "cloaks" itself inside cells, where it divides. At present, chlamydia is the most prevalent sexually transmitted disease in the United States. In most cases, the initial infection is asymptomatic and thus difficult to recognize clinically. In males, urethritis is the principal result, causing a clear discharge, burning on urination, frequent urination, and painful urination. Without treatment, the epididymides may also become inflamed, leading to sterility. In 70 percent of females with chlamydia, symptoms are absent, but chlamydia is the leading cause of pelvic inflammatory disease. Moreover, the uterine tubes may also become inflamed, which increases the risk of ectopic pregnancy (implantation of a fertilized ovum outside the uterus) and infertility due to the formation of scar tissue in the tubes. Trichomoniasis (trik′‐ō‐mō‐NĪ ‐a‐sis) is a very common STD and is considered the most curable. It is caused by he protozoan Trichomonas vaginalis, which is a normal inhabitant of the vagina in females and urethra in males (Figure B). Most infected people do not have any signs or symptoms. When symptoms are present, they include itching, burning, genital soreness, discomfort with urination, and an unusually smelling discharge in females. Males experience itching or irritations in the penis, burning after urination of ejaculation, or some discharge. Trichomoniasis can increase the risk of infection with other STD's such as HIV and gonorrhea. Gonorrhea (gon‐ō‐RĒ‐a) (Figure C) or "the clap" is caused by the bacterium Neisseria gonorrhoeae. In the United States, 1-2 million new cases of gonorrhea appear each year, mostly among individuals aged 15-29 years. Discharges from infected mucous membranes are the source of transmission of the bacteria either during sexual contact or during the passage of a newborn through the birth canal. The infection site can be in the mouth and throat after oral-genital contact, in the vagina and penis after genital intercourse, or in the rectum after recto-genital contact. Males usually experience urethritis with profuse pus drainage and painful urination. The prostate and epididymis may also become infected. In females, infection typically occurs in the vagina, often with a discharge of pus. Both infected males and females may harbor the disease without any symptoms, however, until it has progressed to a more advanced stage; about 5-10 percent of males and 50 percent of females are asymptomatic. In females, the infection and consequent inflammation can proceed from the vagina into the uterus, uterine tubes, and pelvic cavity. An estimated 50,000 to 80,000 women in the United States are made infertile by gonorrhea every year as a result of scar tissue formation that closes the uterine tubes. If bacteria in the birth canal are transmitted to the eyes of a newborn, blindness can result. Administration of a 1 percent silver nitrate solution in the infant's eyes prevents infection. Syphilis, caused by the bacterium Treponema pallidum (trep‐ō‐NĒ‐ma PAL‐i‐dum) (Figure D), is transmitted through sexual contact or exchange of blood, or through the placenta to a fetus. The disease progresses through several stages. During the primary stage, the chief sign is a painless open sore, called a chancre (SHANG‐ker), at the point of contact. The chancre heals within 1 to 5 weeks. From 6 to 24 weeks later, signs and symptoms such as a skin rash, fever, and aches in the joints and muscles usher in the secondary stage, which is systemic—the infection spreads to all major body systems. When signs of organ degeneration appear, the disease is said to be in the tertiary stage. If the nervous system is involved, the tertiary stage is called neurosyphilis. As motor areas become extensively damaged, victims may be unable to control urine and bowel movements. Eventually they may become bedridden and unable even to feed themselves. In addition, damage to the cerebral cortex produces memory loss and personality changes that range from irritability to hallucinations Genital herpes is an incurable STD. Type II herpes simplex virus (HSV‐2) causes genital infections (Figure E), producing painful blisters on the prepuce, glans penis, and penile shaft in males and on the vulva or sometimes high up in the vagina in females. The blisters disappear and reappear in most patients, but the virus itself remains in the body. A related virus, type I herpes simplex virus (HSV‐1), causes cold sores on the mouth and lips and is not considered a sexually transmitted disease. Infected individuals typically experience recurrences of symptoms several times a year. Warts are an infectious disease caused by viruses. Human papillomavirus (HPV) causes genital warts, which can be transmitted sexually (Figure F). Nearly one million people a year develop genital warts in the United States. Patients with a history of genital warts may be at increased risk for cancers of the cervix, vagina, anus, vulva, and penis. There is no cure for genital warts. A vaccine (Gardasil®) against certain types of HPV that cause cervical cancer and genital warts is available and recommended for 11‐ and 12‐year‐old girls and boys.

PMS (premenstrual syndrome)

Cyclical disorder of severe physical and emotional distress. It appears during the postovulatory phase of the female reproductive cycle and dramatically disappears when menstruation begins. The signs and symptoms may include edema, weight gain, breast swelling and tenderness, abdominal distension, backache, joint pain, constipation, skin eruptions, fatigue and lethargy, greater need for sleep, depression or anxiety, irritability, mood swings, headache, poor coordination and clumsiness, and/or cravings for sweet or salty food. The cause is unknown

Orchitis

Inflammation of the testes, for example, as a result of the mumps virus or a bacterial infection.

Fibroids

Noncancerous tumors in the myometrium of the uterus composed of muscular and fibrous tissue. Their growth appears to be related to high levels of estrogens. They do not occur before puberty and usually stop growing after menopause. Symptoms include abnormal menstrual bleeding, and pain or pressure in the pelvic area.

Dysmenorrhea

Pain associated with menstruation; the term is usually reserved to describe menstrual symptoms that are severe enough to prevent a woman from functioning normally for one or more days each month.

Prostate cancer

Prostate cancer is the leading cause of death from cancer in men in the United States, having surpassed lung cancer in 1991. Each year it is diagnosed in almost 200,000 U.S. men and causes nearly 40,000 deaths. The amount of PSA (prostate‐specific antigen), which is produced only by prostate epithelial cells, increases with enlargement of the prostate (circled area in Figure B showing enlarged prostate narrowing the prostatic urethra) and may indicate infection, benign enlargement, or prostate cancer. A blood test can measure the level of PSA in the blood. Males over the age of 40 should have an annual examination of the prostate gland. In a digital rectal exam, a physician palpates the gland through the rectum with the fingers (digits). Many physicians also recommend an annual PSA test for males over age 50. Treatment for prostate cancer may involve surgery, cryotherapy, radiation, hormonal therapy, and chemotherapy. Because many prostate cancers grow very slowly, some urologists recommend "watchful waiting" before treating small tumors in men over age 70.

Salpingectomy

Removal of a uterine (fallopian) tube.

Oophorectomy

Removal of the ovaries.

Cryptorchidism

The condition in which the testes do not descend into the scrotum is called cryptorchidism (krip‐TOR‐ki‐dizm; crypt‐=hidden; orchid=testis). It occurs in about 3 percent of full‐term infants and about 30 percent of premature infants. Untreated bilateral cryptorchidism causes sterility due to the higher temperature of the pelvic cavity. The chance of testicular cancer is 30 to 50 times greater in cryptorchid testes, possibly due to abnormal division of germ cells caused by the higher temperature of the pelvic cavity. The testes of about 80 percent of boys with cryptorchidism will descend spontaneously during the first year of life. When the testes remain undescended, the condition can be corrected surgically, ideally before 18 months of age.

Erectile dysfunction

The consistent inability of an adult male to ejaculate or to attain or hold an erection long enough for sexual intercourse; previously termed impotence. Many cases are caused by insufficient release of nitric oxide (NO), which relaxes the smooth muscle of the penile arterioles and erectile tissue. Other causes include diabetes mellitus, physical abnormalities of the penis, systemic disorders such as syphilis, vascular disturbances, neurological disorders, surgery, testosterone deficiency, and drugs. Psychological factors include anxiety or depression, fear of causing pregnancy, fear of sexually transmitted diseases, religious inhibitions, and emotional immaturity

Fibrocystic disease

The most common cause of breast lumps in females, one or more cysts (fluid-filled sacs) and thickenings of alveoli develop. Occurs mainly in females between the ages of 30 and 50, and is probably due to a relative excess of estrogens or a deficiency of progesterone in the postovulatory (luteal) phase of the reproductive cycle. Usually causes one or both breasts to become lumpy, swollen, and tender a week or so before menstruation begins.

Colposcopy

Visual inspection of the vagina and cervix of the uterus using a culposcope, an instrument that has a magnifying lens (between 5 and 50 X) and a light

Endometriosis

characterized by the growth of endometrial tissue outside the uterus. The tissue enters the pelvic cavity via the open uterine tubes and may be found in any of several sites—on the ovaries, the rectouterine pouch, the outer surface of the uterus, the sigmoid colon, pelvic and abdominal lymph nodes, the cervix, the abdominal wall, the kidneys, and the urinary bladder. Endometrial tissue responds to hormonal fluctuations, whether it is inside or outside the uterus. With each reproductive cycle, the tissue proliferates and then breaks down and bleeds. When this occurs outside the uterus, it can cause inflammation, pain, scarring, and infertility. Symptoms include premenstrual pain or unusually severe menstrual pain

Radical mastectomy

involves removal of the affected breast along with the underlying pectoral muscles and the axillary lymph nodes. (Lymph nodes are removed because metastasis of cancerous cells usually occurs through lymphatic or blood vessels.)

Priapism

refers to a persistent and usually painful erection of the penis that does not involve sexual desire or excitement. The condition may last up to several hours and is accompanied by pain and tenderness. It results from abnormalities of blood vessels and nerves, usually in response to medication used to produce erections in males who otherwise cannot attain them. Other causes include a spinal cord disorder, leukemia, sickle‐cell disease, or a pelvic tumor.

Pelvic inflammatory disease

A collective term for any extensive bacterial infection of the pelvic organs, especially the uterus, uterine tubes, or ovaries, which is characterized by pelvic soreness, lower back pain, abdominal pain, and urethritis.

Hydrocele

A collection of serous fluid in the cavity of the tunica vaginalis. It may be caused by injury to the testes or inflammation of the epididymis. Usually, no treatment is required.

Hypospadias

A common congenital abnormality in which the urethral opening is displaced. In males, the displaced opening may be on the underside of the penis, at the penoscrotal junction, between the scrotal folds, or in the perineum; in females, the urethra opens into the vagina. The problem can be corrected surgically.

Endocervical curettage

A procedure in which the cervix is dilated and the endometrium of the uterus is scraped with a spoon-shaped instrument called a curette; commonly called a D and C (dilation and curettage).

Smegma

A secretion found chiefly around the external genitalia and especially under the foreskin of the male, consisting principally of desquamated epithelial cells.

PMDD (premenstrual dysphoric disorder)

A severe syndrome in which PMS-like signs and symptoms do not resolve after the onset of menstruation. May be caused by abnormal responses to normal levels of ovarian hormones.

Circumcision

A surgical procedure in which part of or the entire prepuce is removed. It is usually performed just after delivery, several days after birth, and is done for cultural, religious, or (more rarely) medical reasons. Although most health-care professionals find no medical justification for the procedure, some feel that it has benefits, such as a lower risk of urinary tract infections, protection against penile cancer, and possibly a lower risk for sexually transmitted diseases

Prostatitis

Because the prostate surrounds part of the urethra, any infection, enlargement, or tumor can obstruct the flow of urine. Acute and chronic infections of the prostate are common in postpubescent males, often in association with inflammation of the urethra. Symptoms may include fever, chills, urinary frequency, frequent urination at night, difficulty in urinating, burning or painful urination, low back pain, joint and muscle pain, blood in the urine, or painful ejaculation. However, often there are no symptoms. Antibiotics are used to treat most cases that result from a bacterial infection. In acute prostatitis, the prostate becomes swollen and tender. Chronic prostatitis (pros′‐ta‐TĪ‐tis) is one of the most common chronic infections in men of the middle and later years. On examination, the prostate feels enlarged, soft, and very tender, and its surface outline is irregula

Testicular cancer

Cancer of the testes, the most common cancer in males between the ages of 20 and 35. More than 95 percent of cases arise from spermatogenic cells within the seminiferous tubules. An early sign is a mass in the testis, often associated with a sensation of testicular heaviness or a dull ache in the lower abdomen; pain usually does not occur

Mammography

The most effective technique for detecting tumors less than 1 cm (0.4 in.) in diameter is mammography (mam‐OG‐ra‐fē; graphy=to record), a type of radiography using very sensitive x‐ray film. The image of the breast, called a mammogram (see Table 1.3), is best obtained by compressing the breasts, one at a time, using flat plates

Vascetomy

a surgical cutting and tying of the vas deferens to prevent the passage of sperm, consequently preventing pregnancy; male sterilization.

Cervical cancer

carcinoma of the cervix of the uterus, starts with cervical dysplasia (dis‐PLĀ‐sē‐a), a change in the shape, growth, and number of cervical cells. The cells may either return to normal or progress to cancer. In most cases, cervical cancer may be detected in its earliest stages by a Pap test (see Clinical Connection in Section 3.4). Some evidence links cervical cancer to the virus that causes genital warts, human papillomavirus (HPV). Increased risk is associated with having a large number of sexual partners, having first intercourse at a young age, and smoking cigarettes.

Breast cancer

is the development of a malignant tumor within the breast. At this point we will concentrate on how breast cancer may spread to other parts of the body via the lymphatic system.

Uterine prolapse

may result from weakening of supporting ligaments and pelvic musculature associated with age or disease, traumatic vaginal delivery, chronic straining from coughing or difficult bowel movements, or pelvic tumors. The prolapse may be characterized as first degree (mild), in which the cervix remains within the vagina; second degree (marked), in which the cervix protrudes through the vagina to the exterior; or third degree (complete), in which the entire uterus is outside the vagina. Depending on the degree of prolapse, treatment may involve pelvic exercises, dieting if a patient is overweight, a stool softener to minimize straining during defecation, pessary therapy (placement of a rubber device around the uterine cervix that helps prop up the uterus), or surgery.