Get your mind out of the gutter. The world's oldest ER doc is happily married. I am aware of ER workers who "fraternize" with each other. I hear the rumors and see the verbal foreplay. Today's topic concerns conditions and diseases of human sexual organs that present to the ER.
Torsion. The word means twisting. For the ER doc torsion is a true emergency involving the gonads. Ovaries and testicles can tort or twist, so that the blood supply to these precious organs is compromised. Missing this diagnosis means a dead gonad and a likely malpractice suit. The male version is usually obvious. A painful testicle is self-evident. High suspicion, a quick exam and ultrasound while waiting for the urologist to arrive, is the ER doc's task. Ovarian torsion is a lot more difficult. Deep in the pelvis, the pain of ovarian torsion can mimic any number of gastrointestinal and gynecological diseases. As usual, the ER doc must always consider the vascular disaster for any presenting complaint. In any female who hasn't had a total hysterectomy, ovarian torsion must be in the differential diagnosis.
STD's, sexually transmitted diseases, include an alphabet soup of infectious agents. LGV, HPV, HIV, HSV, GC, Hep B, Hep C all may transmitted via sexual contact. The list also includes other bacterial infections such as chancroid, syphilis, chlamydia. Even single cell animals such as amoeba and trichomonads can cause STD's. Sores, drips, swellings, pain, fever; are you getting in the mood? The most common STD's are relatively easy to diagnose and treat. Gonorhea, chlamydia and syphilis can be disgnosed with swabs or blood tests, and are treated with highly effective antibiotic therapy. Untreated they can progress to cause infertility and serious systemic diseases.
The many viruses that are sexually transmitted are more insidious and can lead to long term illnesses and delayed consequences. Herpes is a prime example. As a young and naive ER doc, I believed that the 2 types of herpes, HSV 1 and 2 were separated by the waist line. HSV 1 is universal. Every human has had a primary infection as a child and recurrent outbreaks as "cold sores" or "fever blisters" throughout one's life. HSV 2 was the alleged STD; only found below the equator. Human sexual behavior has made this geographic distinction moot. Either virus can be found at any of the sexual portals. Pain, blisters, and a life of recurrences are the legacy of HSV infections.
HPV has been in the news lately because of a recently released vaccine for young women. HPV, human papilloma virus has been linked to both venereal warts (condylomata) and cervical cancer. I recently treated a patient who had a rare cancer of the mouth and throat that was definitively linked to HPV. Young people who don't consider oral sex as risky should be cautioned. All STD's can be transmitted via orogenital contact.
Sex, drugs and rock and roll; STD's to follow. The use of needles for heroin, cocaine and other drugs is often tied to the professional sex trade. Trading sex for drugs, or earning money to purchase drugs is well documented. HIV and hepatitis B and C are easily transmitted by shared needles and then by sexual contact. HIV is treatable but not curable. The treatment is difficult, requiring expensive drugs, that must taken for life. Hepatitis B can be prevented by a vaccine and usually is self-limited. Hepatitis C has a treatment that is expensive, unpleasant and has a high failure rate. Having hep C will often lead to cirrhosis, liver failure and liver cancer sometimes decades after initial exposure.
Sexual assault is the most difficult of the diseases and conditions of the sexual organs that the ER doc must treat. Trauma, infections, possible pregnancy, and the maiming of the patient's psyche, all must be managed. The cases must also be documented and specimens obtained for forensic assessments by law enforcement agencies. Compassion, a non-judgemental attitude, and simple human decency are a professional and moral obligation.
If you are a parent, I would encourage you to share this blog with your teen or even tween child. Knowledge is power. Abstinence is an unrealistic policy. Humans are designed to reproduce the species.
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