GENITOURINARY DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 301

orontheuterine cervix,wheretheyarenoteasily seen.Sometimes primarychancres never
appear, or they go unnoticed, particularly when hidden in a location such as the vagina.
The secondary stage of syphilis is characterized by the appearance of a skin rash about
six weeks after the primary lesion. However, many individuals do not manifest this stage
of the disease. The appearance of this rash is highly variable, although it does not produce
blisters, and it usually has a wide distribution, including the palms of the hands, soles of
the feet, and mucous membranes of the mouth. The rash does not itch, and infected indi-
viduals usually have no other significant symptoms. It usually lasts from a few days to a
few weeks.
In its third or tertiary stage, syphilis can produce fatal cardiac disease or disabling brain
disease. However, tertiary syphilis takes years to develop and can be prevented by appro-
priate antibiotic therapy.
A precise diagnosis of syphilis requires laboratory facilities not widely available in de-
velopingcountries.Treatmentinthewildernessshouldbebasedonahistoryofsexualcon-
tactandthepresenceofaprimarychancreorthesecondaryskinrash.Theinfectionismost
contagious during the primary and secondary stages.
The preferred treatment for all stages of syphilis is penicillin. Benzathine penicillin G
should be administered for primary or secondary disease. Alternatively, single daily intra-
muscular injections of procaine penicillin G may be given. Individuals allergic to penicil-
lin can be treated with erythromycin or tetracycline, but follow-up care should be obtained
from a physician after a wilderness outing to ensure the infection has been totally eradic-
ated.
Gonorrhea
Gonorrhea is a common, widespread infection that in males is usually limited to the
lowergenitaltract,principallytheurethra.Infectionatthissiteisassociatedwithapurulent
discharge, but the diagnostic feature is pain, often severe pain, with voiding. Residual in-
fection may persist, particularly in the prostate, or the infection may spread to other parts
of the body.
In females, gonorrhea is a much more insidious infection. Of infected women, 75 per-
cent have no initial symptoms at all. The infection must be diagnosed by bacterial cultures
taken from the vagina or uterine cervix. Treatment must be based on a history of sexual
contact with an infected individual when laboratory facilities for a definitive diagnosis are
not available.
Gonorrhea is also a much more threatening disorder in females. Spread of the infection
to other organs is much more common. Extension to the Fallopian tubes produces painful
infectionswithsymptomssimilartothoseofappendicitis(“Salpingitis,” Chapter20:Acute
Abdominal Pain ) . Permanent sterility often results. Spread to one or more joints can pro-