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Reproductive Assignment - Group D
Submitted by Carol, Kristy, Marla and Meg
Ms. T. does not know which partner she got chlamydia from and wonders
if it could be her current partner. He has complained on and off of some
urethral irritation with occasional clear discharge. What could his
symptoms be due to?
Sexually
Transmitted
Infection
Chlamydia
(Bacterial)
Genital Herpes
(Viral)
Signs and
Symptoms:
Signs and Symptoms:
Male
Female


A vaginal discharge
A burning
sensation when
urinating (dysuria)
 Pain in the lower
abdomen,
sometimes with
fever and chills
 Pain during sex
(dyspareunia)
 Vaginal bleeding
between periods or
after intercourse
(Health Canada, 2006).


Sores inside or
near the vagina,
the cervix, on the
external genitals,
near the anus or
on the thighs or
buttocks
Tender lumps in
the groin
(lymphadenopathy
)


A discharge from the penis
A burning sensation when
urinating (dysuria)
 Burning or itching at the
urethra
 Pain and/or swelling in the
testicles and/or prostate
(Health Canada, 2006)


Sores on the penis,
testicles, anus or on the thighs
or buttocks
Tender lumps in the groin
(lymphadenopathy)
(Health Canada, 2006).

(Health Canada, 2006).
Gonorrhea
(Bacterial)


A burning
sensation when
urinating (dysuria)
A vaginal discharge
that is yellow or



Burning or pain when voiding at
the urethra (dysuria)
Purulent discharge from
the urethra
Painful or swollen testicles
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occasionally bloody
Mild or no
symptoms
 Infections in the
throat cause few
symptoms.
(Health Canada, 2006)

Human
Papillomavirus
(HPV) (Viral)
Syphilis
(Bacterial)

May have warts on
the vulva, cervix,
thigh, anus, and
rectum or in the
vagina or urethra
(Health Canada,
2006).
First Signs
 Painless ulcers to
labia majora or
minora, vaginal
canal, thigh, anus
and /or rectum
These signs and
symptoms may disappear
without treatment.
(Health Canada, 2006).
Secondary Signs:
 patchy hair loss
 a rash on the soles
of the feet, the
palms of the hands
or elsewhere on
the body
 fever; swollen
glands and muscle
and joint pain
(Health Canada,
2006).
Lymphogranuloma
Venereum
(LGV) (Bacterial)
flu-like symptoms,
including:
 low-grade fever
 chills
 fatigue
 muscle and joint
aches
(orchitis)
Symptoms of rectal infection include:
 Discharge
 Anal itching
 Soreness
 Bleeding
 May have painful bowel
movements
(Health Canada, 2006).

May have warts on the penis,
scrotum, thigh, anus, rectum or
in the urethra (Health Canada,
2006).
First Signs
 Painless ulcers to penis,
scrotum, thigh, anus, rectum
and/or in the urethra
These signs and symptoms may
disappear without treatment (Health
Canada, 2006).
 Men will typically notice a
chancre present on penis
(Berkow, Beers, & Fletcher,
1997)
Secondary Signs:
 patchy hair loss
 a rash on the soles of the feet,
the palms of the hands or else
where on the body
 fever; swollen glands and
muscle and joint pain (Health
Canada, 2006).
flu-like symptoms, including:
 low-grade fever
 chills
 fatigue
 muscle and joint aches.
If infected by anal sex, may have
discharge of blood or pus from anus
and may experience constipation
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Lymph nodes may
become swollen in your
groin (lymphadenopathy),
lesions of anal or neck
region (Health Canada,
2006).
Genital
Candidiasis
(Fungal)

Trichomoniasis
(Parasitic)

Mycoplasma
Genitalium
(Bacterial)
(Health Canada, 2006).
Genital itching or
burning.
May or may not
have "cottage
cheese-like"
vaginal
discharge.(Berkow,
Beers, & Fletcher,
1997)


Frothy, yellowgreen vaginal
discharge with a
strong odor.
 Discomfort during
intercourse and
voiding.
 May have irritation
and itching in
genital area.
In rare cases
 lower abdominal
pain (Center of
Disease Control
and Prevention,
2007).






Asymptomatic
Vaginal itching
Burning on voiding
(dysuria)
Pain during
intercourse
(About.com,
2008).






Asymptomatic
May have urethral pain after
voiding or intercourse
May notice a clear to white
discharge from penis. (Berkow,
Beers, & Fletcher, 1997)
Asymptomatic (Berkow, Beers,
& Fletcher, 1997, pp.1032)
May have temporarily irritation
along cavernous urethra
Mild discharge
Slight burning after voiding or
ejaculation (Center of Disease
Control and Prevention, 2007).
Asymptomatic
Urethral discharge Burning on
urination (dysuria)
Pain and swelling of the joints (arthritis)
(About.com, 2008).
Sexually transmitted infections (STIs)
are infections that are contracted
during oral, anal, or vaginal sex
between sexual partners (Health
Canada, 2006). Individuals may not
realize that they have been exposed to
a STI because there are few initials
signs or symptoms of infection. By the
time these signs or symptom are seen
the individual may have exposed
several other sexual partners to the
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STI (Health Canada, 2006). These
infections can be either viral, bacterial,
fungal, parasitic or protozoan (Health
Canada, 2006). In the table below are
the most common STIs and their signs
and symptoms for both female and
male.
Chlamydia
Chlamydia trachomatis (CT) or chlamydia as it is commonly known is a prevalent
gram-negative sexually transmitted infection. Youth and young adults, particularly
those under 20 years of age, who are sexually active are disproportionately
represented of the reported cases of chlamydia in Canada (Public Health Agency of
Canada, 2007; Morgan, 2006). It is a leading cause of nongonococcal
urethritis (Anti-infective Review Panel, 2005). Symptoms of chlamydia in males, as
per the table above, include urethral discharge, urethritis, urethral itch, dysuria,
testicular pain, conjunctivitis, and proctitis or they may also be asymptomatic
(Public Health Agency of Canada, 2007). Symptoms most reported in females, as
per the table above, include dysuria, cervicitis, proctitis, lower abdominal pain,
dyspareunia, conjunctivitis and abnormal vaginal bleeding but often they are
asymptomatic (Public Health Agency of Canada, 2007). Chlamydia is often
responsible for pelvic inflammatory disease (PID) (Morgan, 2006).
Research has also found that "79 out of 1025 women (7.8%) were infertile because
of post-salpingitic tubal occlusion" after contracting Chlamydia (BBC News,
2005). Chlamydia can also cause infertility in males by decreasing the
concentration and motility of sperm. Also chlamydia seems to cause defects in the
DNA of the sperm (BBC News, 2007).
Ms. T's partner's symptoms could be due to several forms of sexually transmitted
infections (STIs). Very likely based on the urethral irritation and clear urethral
discharge, the organism responsible for Ms. T's partner's symptoms is chlamydia. It
is present in 25% - 60% of men with nongonoccocus urethritis (NGU) (Morgan,
2006). Clinically, chlamydia cannot be differentiated from gonococcus.
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Although the age of Ms. T's partner is unknown, presumably he is older than the
usual 20 year olds who represent the age group most often infected with
chlamydia. This would by no means rule it out though as the cause. Chlamydia
is common among heterosexuals, those who have multiple and new partners and
those who have a history of gonnococcus (Morgan, 2006).
Other Possible Causes of Symptoms
Other possible causative organisms for Ms. T's partner's symptoms may be herpes
simplex virus, mycoplasma genitalium or ureaplasma urealyticum (Public Health
Agency of Canada, 2007). Given the urethral discharge described by Ms. T's
partner, it is unlikely, although possible, that he may also have epididymitis, which
is usually caused by chlamydia or gonoccocus (Public Health Agency of Canada,
2007). Since the primary symptom of epididymitis is pain, and there was no
mention of this as a symptom in the case study, this condition is most unlikely
(Morgan & McCance, 2006).
Ms. T's partner should have a culture of his penile discharge as well as an urine
culture to identify the causative organism(s). If these swabs are negative for
chlamydia or trichomoniasis then mycoplasma is most likely the cause.
Mycolplasma is the most common organism in non-chlamydial and nongonoccocal
urethritis in men (About.com, 2008).
Urethritis can also occur without the presence of infection. These symptoms of
urethral irritation and clear discharge, also fit with a male who has post-traumatic
urethritis, seen in men who require frequent catheterization (especially with a latex
catheter) (Elrod & Plewa, 2007). Chronic urethritis can lead to urethral strictures.
Compare and contrast three types of precocious puberty.
Precocious puberty is defined as "sexual maturation before 6 in black girls or age 7
in white girls, and before age 9 in boys" (Morgan & McCance, 2006, p, 773).
Kaplowitz (2007) defines the term slightly differently but agrees that basically
precocious puberty refers to children who demonstrate hormonal and physical signs
of puberty at an earlier age than that considered normal.
Three types of precocious puberty are:
1) Isosexual puberty - this describes a form that is dependent or independent of
gonadotropin-releasing hormone (GnRH). In true isosexual puberty it is dependent
upon GnRH and "occurs when the hypothalmic-pituitary-gonadal axis is working
normally but prematurely" (Morgan & McCance, 2006, p. 773). This axis basically
describes a feedback mechanism that involves follicle stimulating hormone (FSH)
and leutinizing hormone (LH), which is further described in an article by Feinberg,
Bromer, and Catherino (2005).
2) Heterosexual precocious puberty describes conditions whereby "children develop
some secondary sex characteristics of the opposite sex" (Morgan & McCance, 2006,
p. 773).
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3) Incomplete precocious puberty describes a condition whereby children develop
only partial yet appropriate secondary sex characteristics. This type is often present
in children who are obese (Morgan & McCance, 2006).
References:
About.com. (2008, March). Sexually transmitted diseases: What are the symptoms
of mycoplasma genitalium? Retrieved June 9, 2008 from
http://std.about.com/od/symptomsfaq/f/mycosymfaq.htm
Anti-infective Review Panel. (2005, 10th Anniversary Ed). Anti-infective guidelines
for community-acquired infections. Toronto, ON: MUMS Guidelines
Clearinghouse.
BBC News. (2005, October, 16). Chlamydia and infertility. Retrieved June 9, 2008
from http://news.bbc.co.uk/1/hi/programmes/panorama/4347858.stm
BBC News. (2007, October, 15). Chlamydia damages male fertility. Retrieved June
9, 2008 from http://news.bbc.co.uk/2/hi/health/7044602.stm
Berkow, R., Beers, M. H., & Fletcher, A.J. (Eds.). (1997). Sexually transmitted
diseases. The Merck manual of medical information: Home edition. (pp.
1025-1035). New York, NY: Pocket Books.
Center of Disease Control and Prevention. (2007, December). Sexually transmitted
diseases: Trichomoniasis - CDC Fact Sheet. Retrieved June 9, 2008 from
http://www.cdc.gov/STD/Trichomonas/STDFact-Trichomoniasis.htm#WhatIs
Elrod, W & Plewa, M. (2007). Urethritis, Male. emedicine. Accessed online June 8,
2008 from WebMed. http://www.emedicine.com/emerg/topic623.htm
Feinberg, E.C., Bromer, J.G., & Catherino, W.H. (2005, March). The evolution of in
vitro fertilization: Integration of pharmacology, technology and clinical care.
Journal of Pharmacology And Experimental Therapeutics. Retrieved on June
7, 2008 from http://jpet.aspetjournals.org/cgi/content/full/313/3/935
Health Canada. (2006, May 19). Sexually transmitted infections (STI): Diseases
and conditions. Retrieved June 9, 2008 from
http://www.hc-sc.gc.ca/dc- ma/sti-its/index-eng.php
Kaplowitz, P. B. (2007, September 28). Precocious puberty. Emedicine from
WebMD. Retrieved June 6, 2008 from
http://www.emedicine.com/ped/TOPIC1882.HTM
Morgan, K. (2006). Sexually transmitted infections. In K. L. McCance & S. E.
Huether (Eds.), Pathophysiology: The biologic basis for disease in adults and
children (5th ed., pp. 863-891). St. Louis, MI: Elsevier Mosby.
Morgan, K., & McCance, K.L. (2006). Alterations of the reproductive system. In
K. L. McCance & S. E. Huether (Eds.), Pathophysiology: The biologic basis for
disease in adults and children (5th ed., pp. 771-8861). St. Louis, MI: Elsevier
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Mosby.
Public Health Agency of Canada. (2007, October). Canadian guidelines on sexually
transmitted infections, Chlamydia, 2006 Edition. Retrieved on June 6, 2008
from http://www.phac-aspc.gc.ca/std-mts/sti_2006/pdf/05sti2006b_e.pdf
Public Health Agency of Canada. (2007, October). Canadian guidelines on sexually
transmitted infections, Epididymitis, 2006 Edition. Retrieved on June 9, 2008
from http://www.phac-aspc.gc.ca/std-mts/sti_2006/pdf/04sti2006b_e.pdf
Public Health Agency of Canada. (2007, October). Canadian guidelines on sexually
transmitted infections, Urethritis, 2006 Edition. Retrieved on June 6, 2008
from http://www.phac-aspc.gc.ca/std-mts/sti_2006/pdf/04sti2006g_e.pdf
Salt Lake Regional Medical Center. (2006). Urethritis - chronic. In A.D.A.M. health
library. Retrieved June 8, 2008
http://www.saltlakeregional.com/adam/Health%20Illustrated%20Encyclope
dia/1/001277/