GENITOURINARY DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 300

for either disorder. Younger individuals should receive the currently recommended therapy
for gonorrhea, which changes frequently and is listed on the CDC website www.cdc.gov .
Persons with testicular torsion who cannot be evacuated right away need antibiotics to pre-
vent the establishment of an infection in the dead tissue of the testis.
Almost everyone with either of these disorders must be evacuated. Individuals with
testiculartorsionrequiresurgery,evenifitcannotbecarriedoutquicklyenoughtosavethe
testis. Individuals with epididymitis require rest and antibiotics. Two to three weeks may
be required for complete healing. Resumption of activity before all symptoms have com-
pletelyclearedfrequentlyreactivatesthedisease.However,epididymitishaslittletendency
to spread to other tissues and probably could be adequately treated in base camp in truly
remote circumstances.
SEXUALLY TRANSMITTED INFECTIONS
Of sexually transmitted infections (STIs or STDs), syphilis, gonorrhea, and herpes are the
most common. Hepatitis B is spread largely by sexual contact in developed nations but is
not considered an STD and is discussed in Chapter 19: Gastrointestinal Disorders . Human
immunodeficiency virus (HIV) also is spread by sexual contact. That infection and the ac-
quired immunodeficiency syndrome (AIDS) it produces are discussed in Chapter 22: In-
fections .
All STDs are spread by intimate personal contact. Infection from toilet seats or similar
sources essentially does not occur because the organisms cannot survive outside of the
body. At the present time the only dependable way to completely prevent such infections
is to avoid sexual contact with infected individuals. Condoms are helpful but do not com-
pletely prevent infection. Prophylactic antibiotic therapy has many disadvantages in addi-
tion to the significant risk of allergic reactions to the drugs.
Syphilis
Syphilis is produced by the spirochete Treponema pallidum . This infection has an in-
teresting history. It apparently originated in the Western Hemisphere, was transported to
Europebymembers ofColumbus' crew,andinanamazingly shorttime spreadall overthe
world.Thegreatvariationinitsclinicalfeatures,itslongduration,anditsabilitytoinvolve
any of the body's organs and mimic many other diseases has been particularly fascinating.
The discovery of penicillin therapy was a dramatic triumph.
Syphilitic infections have three stages. The primary stage is that of the chancre, a one-
quarter- to one-half-inch (6 to 13 mm) painless ulcer that appears at the site of inoculation.
Most chancres appear on the genitalia but are occasionally found on the mouth or lips or
the skin of other parts of the body. In women, chancres may be located within the vagina