STD Handbook for Men
英語版 (English version) STD Handbook for Men
施設名
Editorial cooperation by Dr. Ichiro Itoda (Shirakaba Clinic)
資 料 ViiV Healthcare K.K. 請求先 AKASAKA INTERCITY AIR 1-8-1 Akasaka, Minato-ku, Tokyo FAX 03-4231-5983 禁 無断転載・複写 英語版
D1110 018 6 - P1811N 改訂年月2018年11月 ヴィーブヘルスケア株式会社 Introduction What are This handbook includes information (aIong with pictures) about the characteristic symptoms of commonly What are STDs? occurring sexually transmitted diseases (STDs) in men. The purpose of this STDs? handbook is to provide information about STDs are diseases that are mainly transmitted through what to do if someone contracts an STD. This handbook should be especially sexual contact. In some cases, the affected patient may useful to those who suspect that they not develop any symptom and may unknowingly transmit might have an STD or to those who are the disease to others. Any sexually active person can interested in gaining more knowledge contract an STD, and people can simultaneously about STDs. Introduction contract more than one STD. However, most STDs can Please note that the information Introduction 2 be managed by early examination and treatment. provided in this book serves only as a reference and that different patients may What are STDs? 3 have different symptoms. Even if 2 Types of STDs 4 patients have the same STD, one patient Association between 1. Syphilis 4 may not develop any symptom, while the acquired immune other may develop severe symptoms. If 2. Chlamydia infection 6 you have certain symptoms that are 3. Gonorrhea 7 deficiency syndrome worrying you, use this handbook as a 4. Ambiasis 8 reference, and visit a clinic for a proper (AIDS) and STDs 5. Herpes simplex 9 examination. You can nd a list of Acquired immune de ciency syndrome (AIDS) is institutions where patients can receive 6. Acute hepatitis A 10 a type of STD. The causal agent of AIDS—the consultation, regardless of their 7. Acute hepatitis B 11 human immunode ciency virus (HIV)—is not a sexuality, at the end of this handbook. 8. Hepatitis C 12 highly contagious virus. However, when a 9. Genital warts 13 person contracts an STD, it becomes easier for This handbook includes colored 10. Crab lice 14 the HIV to enter the body through the in amed photographs showing areas with 11. Scabies 15 genitals of the affected person. If you have contracted an STD, we recommend you to get lesions in actual patients who agreed 12. HIV infection 16 tested for other STDs, including HIV infection. to cooperate. Please be forewarned INDEX by symptoms 17 Please look at the website “HIV Map” for that these pictures are very Do you have any of these symptoms? grotesque. Find out the “Possible STD” on the basis of information on places where you can get tested the symptoms for HIV infection. TIPs for a better consultation 18 Stop worrying and go to the doctor!
02 Introduction What are STDs? 03 Symptoms Disease Syphilis 1 Syphilis symptoms manifest in 4 stages. Infectivity is strongest in the primary stage and decreases as the disease progresses from the Syphilis is a systemic disease caused by Treponema secondary to the tertiary stage. In some cases, symptoms do not develop even after infection.
Primary Genitals Anal Oral stage Syphilis is characterized by the development of painless, non-itchy The routes of infection Incubation period (3 weeks–3 months.) sores (diameter, 0.3 cm–3 cm). In most cases, only a single sore develops, but multiple sores can Direct contact of the genitals 3 weeks. develop in some cases. Vaginal intercourse Gradually, the sore starts to dent from its center (chancre). Anal intercourse Oral intercourse The sore disappears in about a month. * The risk of infection can be reduced by using condoms. The lymph nodes of the neck and/or the groin get inflamed.
Secondary Palms/Soles of the feet Body stage Secondary-stage syphilis also manifests as red rash on the palms,
(3 months–3 years.) soles of the feet, and the entire body (scarlet rash). The rashes disappear within 6 months, without leaving any trace. In some cases, the lymph nodes of the neck get inflamed.
Latent Infection with Treponema leads to inflammation in the body. syphilis
(3 years–10 years.)
Tertiary In some cases, lesions develop in the heart and/or the brain. syphilis
(10 years and on.)
The primary syphilis lesion is known as a chancre. Which department should I consult?
Internal Dermatology Urology Venereology medicine When can I have Method of examination sex again? BIood examination.
Treatment Rash from secondary syphilis (soles of the feet) Patients receive oral antibiotics for a Patients can have sex once the treatment is completed and period of 2–4 weeks (treatment sores on the genitals and rashes varies with variation in the stage of on the body completely the disease). disappear. Rash of secondary syphilis (palms)
04 Introduction of the disease syphilis Introduction of the disease syphilis 05 Chlamydia infection Disease2 Gonorrhea Disease3 Infection with Chlamydia causes disorders such as urethritis. Gonorrhea is caused by bacteria called Gonococcus and is characterized by urethritis.
Routes of infection Incubation period Routes of infection Incubation period
Direct contact of the genitals 1-4 weeks. Direct contact of the genitals 2 days-1 week. Vaginal intercourse Vaginal intercourse Anal intercourse Oral intercourse Anal intercourse Oral intercourse * The risk of infection can be reduced by using * The risk of infection can be reduced by using condoms. condoms.
Symptoms Which department should I consult? Symptoms Which department should I consult? Internal Internal Urology Venereology Urology Venereology medicine Urethra medicine In many cases, the affected person may White or yellow pus is discharged from the not develop any symptom. urethra. Method of examination Method of examination Urethra The patients may experience severe pain in Urinalysis and/or examination of the pus. The affected patients may experience a Urinalysis. the urethra while urinating. sense of discomfort (like itch or pain) in the Typically, the symptoms of gonorrhea are urethra (pathway of the urine) while Treatment more severe than those of Chlamydia Treatment urinating. infection, but in some rare cases, patients Patients receive drip infusions, or injections. Patients receive oral antibiotics for a do not develop symptoms. In addition, some patients may discharge period of 1-10 days. transparent pus from the urethra, while Others some may not. In some cases, the infection can occur in Others In some cases, the patient may also be affected In some cases, Chlamydia infection can be the throat (pain or discomfort in the throat). by Chlamydia infection; therefore, it is detected by a yellow stain on the white Detection of Chlamydia infection is In addition, infection with Gonococcus recommended that the patient be simultaneously underwear. difficult if the infection spreads to the causes epididymitis (fever, severe pain, and examined for both disorders. throat or rectum. Chlamydia infection is inflammation in one of the testicles). If the throat, rectum, and/or epididymis are treated in a manner similar to urethritis. Chlamydia infection may cause epididymitis In some cases, the affected by gonorrhea, the patient should be administered treatment similar to that (inflammation or pain in one of the testicles) infection may occur administered for urethritis. in some patients. in the rectum to the In some cases, the infection can occur in rectum (deep inside the throat and/or the rectum (there may be When can I have the anus). no particular symptoms). sex again? When can I start having sex again?
Patients can have sex once Patients can have sex the symptoms are resolved and once treatment is completed treatment is completed. Patients with gonorrhea may develop urethritis. and pus discharge stops.
06 Introduction of the disease Chlamydia infection Introduction of the disease Gonorrhea 07 Amebiasis Disease4 Herpes simplex Disease5 Amebiasis is characterized by the inflammation of Infection with the herpes simplex virus causes painful the large intestine or Liver Abscesses. blisters in the mouth and/or in the genitals.
Routes of infection Incubation period The routes of infection are as follows Incubation period Licking the anus Inflammation of the large intestine Direct contact of the genitals 6–8 days. Licking the finger or genital comes in contact 2–6 weeks. Vaginal intercourse with the anus Liver Abscesses Anal intercourse Oral intercourse within 5 months. Kissing Others * The risk of infection can be reduced by using Symptoms condoms. There are physicians who do not Inflammation of the large intestine (colitis) suspect of amebic dysentery, so if you Diarrhea and loose stool (sometimes mixed with have doubts, please ask your physician Which department should I consult? blood) lasting for over 2 weeks. for an examination. Symptoms Internal Pain in the Iower abdomen. If you are reluctant in telling the doctor Dermatology Urology Venereology Tenesmus (the need to evacuate the bowels, which that you had sexual intercourse, you In some cases, the affected individual may not medicine results in an incomplete passage of fecal matter can tell the physician that you visited develop any symptom. or no bowel movement at all). Southeast Asia (Thailand, Indonesia, Around the lips Penis/Pubic region Anus Method of examination etc.) within the past 6 months instead. The disease may become severe if it is not treated Several painful blisters are formed. appropriately. Blood examination. Rub a cotton swab against one of Liver (hepatic abscess): A mass of pus may Treatment accumulate in the liver (liver or hepatic abscess). Fever. the blisters.
are detected in the feces. Blisters caused by herpes simplex (broken blisters) 08 Introduction of the disease Amebic dysentery Introduction of the disease Herpes simplex 09 Acute hepatitis A Disease6 Acute hepatitis B Disease7 Infection with the hepatitis A virus causes Infection with the hepatitis B virus causes inflammation of the liver. inflammation of the liver.
Routes of infection The period of incubation Routes of infection Incubation period
Licking the anus 1 month. Vaginal intercourse 2–3 months. Licking the finger or genital that comes in Anal intercourse contact with the anus * The risk of infection can be reduced by using The disease is highly contagious and can be condoms. transmitted by having close contact with an infected person Symptoms Others In addition to being present in the blood Symptoms Others Whole body of the infected person, the hepatitis B Hepatitis A can be prevented by Lassitude. virus is present in the semen, saliva, and vaccination (regimen, 3 subcutaneous The whites of the eyes turn yellow (Jaundice). feces in small amounts; therefore, there is Whole body a possibility of transmission even through injections; the 2nd and 3rd injections The skin turns yellow (Jaundice). Fever. oral sex or deep kissing. should be received at intervals of 1 The urine becomes dark, and the color of Lassitude. and 6 months after the 1st injection. Hepatitis B can be prevented by the feces becomes light. vaccination (regimen, 3 subcutaneous, or The whites of the eyes turn yellow (Jaundice). Vaccination for hepatitis A is not covered by insurance; the cost of the intramuscular injections; the 2nd and 3rd The skin turns yellow (Jaundice). vaccines is about 6,000 –10,000 yen Patients recover from hepatitis B in 3–4 injections should be received at intervals The urine becomes dark, whereas that of the per injection, but the cost varies in months. of 1 and 6 months after the 1st injection. feces becomes light. different institutions). In rare cases, the disease may become Vaccination for hepatitis B is not covered Please visit the section “vaccination severe or progress to chronic hepatitis B. by insurance. The cost of each injection facilities” on the website of the is approximately 4,000–6,000 yen but The patient recovers from hepatitis A within the cost varies in different institutions). 1–2 months. Ministry of Health, Labour, and Which department should I consult? Welfare Quarantine Station Please visit the section “vaccination It does not progress to the chronic stage. facilities” on the website of the Ministry of (http://www.forth.go.jp/). The list of Internal GI internal Health, Labour, and Welfare Quarantine STD examination facilities where medicine medicine Which department should I consult? patients can receive these vaccines Station (http://www.forth.go.jp/). The list of STD examination facilities where is provided at the end of this Method of examination Internal GI internal handbook. patients can receive these vaccines is medicine medicine Blood examination. provided at the end of this handbook. Treatment Method of examination When can I start having sex again? Keeping quiet in bed. Patients receive drip infusion or oral antiviral Blood examination. treatment, if necessaly. In some cases, hospitalization is necessary. When can I start having sex again? Treatment Infectiveness will Keeping quiet in bed. Patients receive drip disappear 1 week after Usually, the infectiveness disappears 3 months infusion or oral medication, if necessary. In its onset. after the onset of the disease, but this must some cases, hospitalization is necessary. be comfirmed through blood examination.
10 Introduction of the disease Acute hepatitis A Introduction of the disease Acute hepatitis B 11 Hepatitis C Disease8 Genital warts Disease9 The hepatitis C virus causes inflammation of the liver. Infection with the human papillomavirus causes small warts to appear on the genitalia and the surrounding regions. Routes of infection Incubation period Anal sex Acute hepatitis Routes of infection Incubation period Fisting of or by multiple partners 2–14 weeks. Contact with an infected person 3-4 months. * Particularly when the anus is bleeding or damaged, Liver cirrhosis, liver cancer Vaginal intercourse ＊1 ＊1 sex with multiple partners, sex while using 10–30 years. Anal intercourse drugs, or after douching. * The risk of infection can be reduced * Using a condom can reduce the risk of infection. by using condoms.
Symptoms Treatment Symptoms Patients receive antiviral medication. In many cases, the affected Acute hepatitis In some cases, hospitalization is patients may not develop any No symptoms in almost all cases. necessary. Genital warts Genital warts that formed around the anus symptom. on the glandis Treatment Liver cirrhosis, liver cancer Others The genitals and its surroundings The anus and surroundings The treatment varies depending on the region Several painless warts also appear. in which the warts have developed and the 60–80% of people progress to chronic hepatitis The hepatitis C virus is mainly found extent of infection. C not knowing infected, and then on to liver in the blood or semen of infected Most affected patients can be treated at cirrhosis (where the cells in the liver die) or people, so you may get infected if you The disease is transmitted by contact; therefore, an out-patient clinics. liver cancer. have sex when you are bleeding or individual may develop warts on the anus without Treatment by surgical removal share needles. having anal sex. Warts are dissected under anesthesia by using There is no vaccine to prevent In some cases, warts develop deep inside the anus. a special apparatus. There is a risk of infection in you have sex without a hepatitis C. Warts can also be removed using liquid condom when the anus is bleeding. You can become infected again even nitrogen without using anesthesia. Treatment by medication You will not notice any symptoms. You should get after your hepatitis C has been cured. Which department should I consult? The risk of becoming infected with Patients are required to apply the prescribed tested if this sounds familiar. medication before going to bed and to wash hepatitis C is higher if you are already Dermatology Urology Proctology Venereology it away in the morning (application regimen, Which department should I consult? infected with other STDs. once every other day for several weeks). If you do not want to tell your doctor * The disease has a high rate of recurrence, and Internal GI internal that you have had risky sex, you can therefore, continued treatment is necessary. Method of examination * In case in which warts develop deep inside the anus, medicine medicine simply say that a close friend or the patient should be hospitalized for surgical relative is infected with hepatitis C. Genital warts are detected by inspection. removal of the warts. Method of examination * Usually, it is impossible to detect infection with the human papillomavirus. Others ＊2 Blood examination. When can I start having sex again? When can I start having Lumps that develop sex again? on the corona glandis (pearly penile papules) at equal Treatment will reduce the risk of infection, Genital warts infectivity is intervals are harmless but there is no need to stop having sex life-long; however, treatment as long as you use a condom and both you and not indications of and your partner avoid coming into contact reduces the risk of genital warts. with each other’s blood or semen. transmission. Pearly penile papules (Normal) 12 Introduction of the disease hepatitis C Introduction of the disease Genital Warts (Condyloma acuminatum) 13 Crab lice Disease10 Scabies Disease11 Crab lice infest the pubic hair and suck blood from Itch mites burrow inside the skin causing itching throughout the body. the area, thereby causing itching in the area. Routes of infection Incubation period
Routes of infection Incubation period Close contact or sleeping alongside an infected person 1 month.
Contact with the pubic hair of an infected person 1 month. Symptoms Treatment Treatment for insect disinfestation Itching worsens at night. Symptoms Method of examination Patients can be treated by a applying a topical Arms, legs body Examine the pubic hair properly medication on the entire body for several days. and look for eggs or insects. Small red rashes. Patients receive an oral anthelminthic agent Pubic hair or area with body hair In some cases, it can be detected on the (to be taken only once, but to be taken Penis/scrotum and their Itchy skin. basis of the formation of reddish black more than once after a week, if necessary). surrounding regions Treatment to stop the itch In some cases, patients develop small dots (crab lice feces) that appear on the Small swollen rashes Patients receive an oral anti-itch agent. rashes appear in the hairline. underwear of the affected individual. An itch mite is approximately 0.3 mm in size and is not visible Treatment to the naked eye. Others Which department should I consult? Patients should apply sumithrin® L Which department should I consult? Method of examination Itch mites are susceptible to dryness and die shampoo or sumithrin® powder as per shortly after being separated from the human The patients should first examine their pubic hair Scabies is detected by inspection. the instructions provided by the body (they live longer if the climate is humid for eggs or insects; patients can treat the infection Dermatology Scabies is detected by scraping manufacturer. and warm). by applying sumithrin (will be discussed below). the skin. Patients can also shave off the The patient’s bedding and clothes should not be In the following cases, please consult Dermatology pubic hair. shared until the patient recovers completely. a dermatologist. The frequency and method of washing the If you do not find any eggs or insects. Others clothes of the affected person can be the same If symptoms such as itching persist for as usual. Crab lice die 48 h after they are 1 week after application of sumithrin. Itch mites do not die even after bathing(however, separated from the human body. If you develop rashes after using sumithrin. the infection is not transmitted by bathing in the The frequency and method of washing If the rashes grow or spread or if pus same tub). develops. the clothes and bedding of the affected individual can be the same as usual. Crab lice do not die even after bathing (however, the infection is not Body of a crab louse (magnified) transmitted by bathing in the same tub). * The actual size of a crab louse is approximately 1–2 mm. Small rashes develop around the wrist.
When can I start having When can I start having sex again? sex again?
Egg laid by a crab louse on When the itch pubic hair (magnified) disappears and no eggs or When treatment is completed * The actual size of the egg and the itch disappears. is approximately 0.5 mm crab lice are observed. Swollen rashes that developed around the anus
14 Introduction of the disease Crab lice infection Introduction of the disease Scabies 15 HIV Infection Disease12 INDEX by symptoms Do you have any of these symptoms? Find out the “Possible STD” from the symptoms. Infection with the human immunodeficiency virus (HIV) gradually reduces the resistance of the body to diseases, thereby causing Discharge of pus Gonorrhea Page 7 If there is a lot of pus and pain, it is highly from the penis Chlamydia Page 6 possible that you may have gonorrhea. In cases of Chlamydia infection, only a small various infectious diseases (opportunistic infections). amount of pus is discharged from the penis, and the pain is mild. In rare cases, urethritis is caused by infection Routes of infection Incubation period with bacteria other than those that cause Chlamydia infection or gonorrhea. Vaginal intercourse Anal intercourse Within 10 years. Gonorrhea Page 7 Pain: gonorrhea, herpes simplex. Oral intercourse Discomfort in the penis while Chlamydia Page 6 Discomfort, itching or mild pain: Chlamydia (especially when oral ejaculation is involved) urinating Herpes simplex Page 9 infection. * The risk of infection can be reduced by using condoms.
A spot developed Syphilis Page 4 Pain: herpes simplex. on the penis, Genital warts Page 13 Itching: crab lice infection or scabies. anus, or scrotum Herpes simplex Page 9 No itching or pain: syphilis or genital warts. Which department should I consult? Crab lice Page 14 Symptoms Scabies Page 15 Internal medicine Itch around the Crab lice Page 14 Most of the times it is tinea cruris (jock itch). Whole body pubic region Scabies Page 15 If eggs or insects are detected in the pubic hair, the patient may have crab lice infection. Acute symptoms: some people experience Method of examination Scabies is characterized by itching and rash on flu-like symptoms at 3–6 weeks after other parts of the body besides the pubic region infection. BIood examination. (arms, legs, etc.); the itch worsens at night. Swelling of the Syphilis Page 4 Usually, the patient does not experience pain. Acquired immune deficiency syndrome Treatment lymph nodes in the Herpes simplex Page 9 (AIDS): If untreated, the person develops Oral administration of anti-HIV neck and the groin opportunistic infections such as pneumonia agent. and/or encephalitis within 10 years after the If patients develop an opportunistic Rashes on the Syphilis Page 4 If there is pain: Herpes simplex (around the lips, anus, infection. infection, this infection will be treated. skin Herpes simplex Page 9 penis, scrotum and the area surrounding regions). Scabies Page 15 If there is itching: Scabies (penis, scrotum, arms and legs, fingers, etc.). Others No itching or pain: Syphilis (palms, soles of the feet, Incidences of other STDs increase body). susceptibility to HIV infection. Experience diarrhea Amebiasis Page 8 In case of a liver abscess, patients may develop for more than 2 weeks fever and experience pain in the right abdominal region.
Chlamydia Page 6 When can I start having Inflammation of Usually, patients experience pain in only one testicle. The virus remains infectious the testicles Gonorrhea Page 7 If the patient has fever and experiences severe sex again? pain, the patient may have gonorrhea. throughout a patient’s life. Consult a doctor (urologist) as soon as possible. However, the risk of infection can be reduced by using condoms. * The contents of this page are only general indications, and symptoms may vary among individuals. If you notice abnormal signs and symptoms, visit a doctor as soon as possible.
16 Introduction of the disease HIV Infection INDEX by symptoms 17 Inform the doctor about any other treatment that 4 you are undergoing or about other medications TIPs that you are taking for treatment of other diseases. for a better consultation Stop worrying and go to the doctor! Some medications cannot be taken together. Therefore, make a note of the medications that Expressing your doubts and fears is not you are taking and inform the doctor about them. as difficult as you think. Try to recollect the diseases that you have had before, since even if you have been successfully treated for a disease such as syphilis, it may be detected again through a blood examination.
You do not necessarily have to 5 discuss your sexuality with the doctor.
Even if you do not tell the doctor about your sexuality, the doctor will try to make a diagnosis Do not be shy of doctors and determine a treatment plan taking into 1 consideration all different kinds of situations. If there is possibility of amebic dysentery, inform Doctors are professionals and are adept at the doctor if you have visited Southeast Asia extracting information from patients for making (Thailand, Malaysia, etc.) recently (in the past 6 a diagnosis. It is hard to talk about STDs with a months). friend, but you can ask for advice to a doctor. If the physician asks you about your sexuality, Doctors do not view an STD as a special answer honestly since the information may be disease; they view an STD as they would view necessary for diagnosing the disease. any other disease such as common cold.
Try to recollect when you may have Telephone the hospital in advance to contracted the STD due to through 6 confirm the points given below. Photo sources 2 having sex.
Knowledge about the incubation period Whether there is a need to make an appointment Formerly Director of Urology at the Japanese Red Cross is important for the diagnosis of an STD. Whether the hospital provides treatment on the basis Medical Center, former Director of the Tokyo Metropolitan It may not be necessary to discuss the of health insurance (If you have symptoms, you can Minami-shinjuku Testing and Counseling Office sexual activity in detail, but try to use insurance for the examination/treatment of STDs) Dr. Hiroyuki Kojima remember details in case you are asked. P4 Syphilis, P7 Gonorrhea, P9 Herpes simplex, Carry your health insurance card to P13 Genital warts(＊1), P14 Crab lice 7 the appointment. A patient should know the type of symptoms, their Director, Shirakaba Clinic 3 locations, and duration since the first appearance of the symptoms before the consultation If you have symptoms, visit the clinic Dr. Ichiro Itoda 8 as soon as possible. Since one may feel pressured and not (P13 Genital warts(＊2)) remember correctly during the consultation. An STD, like any other disease, is easier to treat The consultation will proceed smoothly if if diagnosed at an early stage. Therefore, to Head of Dermatology, Tokyo Medical University you try to recollect the information or write prevent unnecessary anxiety, undergo a medical it down before consultation. examination before the symptoms worsen. Dr. Ryoji Tsuboi (P15 Scabies)
18 TIPs for a better consultation 19