It's sexually transmitted and It's gonorrhea!

A 45 year old lady has been coming to the clinic with the complaint of recurrent foul-smelling vaginal discharge since a year ago and was seen by various doctors who treated her for vaginal candidiasis (fungal infection). She was quite distressed by the time I saw her as the condition never seemed to go away. She admitted going to both government and private doctors and found no relief despite being given antibiotics as well.

I decided to engage her by asking about her family life including her sexual history. Yes, she is married with four children and now working as a housekeeping staff in one of the local hotels and no, the husband is most of the time outstation and comes home only every now and then and that rings a bell for me. I decided to take a high vaginal swab and test for sexually-transmitted disease (STD) organisms like gonorrhea, chlamydia and trichomoniasis and there the result before me " intracellular diplococci, morphologically similar to Neisseria gonorrhea", there you are, the source of her malady. She was promptly given an intramuscular injection of an antibiotic most suitable to treat the disease.

I informed her to tell her husband to come to the clinic for a similar treatment as required under infectious disease protocol. She told me her husband was still outstation and she appeared reluctant to come with him for an STD counselling. Anyway, I advised her to get her husband treated as some gonorrhea cases in men have no symptoms. I also carefully suggested to her that this kind of condition normally thrives in cases of having multiple sex partners so it is wise to avoid such a situation. As a health personnel, we have to educate our patient on the nature of the disease and its transmission.

Usually in a busy practice local doctors  would hardly ask patients for a sensitive history, preferring to shoot in the dark by treating the commonest condition in a woman with vaginal discharge that is candidiasis, a fungal infection. The tragedy is  when every time she comes in she sees a different doctor and so the history of treatment is not really scrutinised. Often the same therapy is repeated as in this poor woman's case.

Today she comes for review six week-post treatment and reported that her condition has cleared for the first time in months! A disease needs to be correctly diagnosed and given the right treatment to be cured. I am relieved for her.