Two Depressing Infectious Disease Anecdotes

Over at denialism blog, PalMD has two posts which, to me anyway, are related. The first has describes how sexually transmitted diseases (STDs) are actually treated with antibiotics:

After hours, we see walk-ins, and that’s where the STD fun really begins. For whatever reason, I see STDs daily at the walk-in clinic, but almost never in my private practice. Most commonly, we see only one partner, and, at least in my state, treatment of the absent partner is prohibited. Basically, we only get one shot at folks, and we don’t have access to rapid tests. So what do we do? We order a lot of “party packs”—ceftriaxone and azithromycin, to treat gonorrhea and chlamydia. My residents will often ask, “why don’t we wait for the test results?”, and my answer is, “you will probably never see them again, and when you try their phone, it will be disconnected. Treat ’em while you got ’em.” We can give this treatment on site, and it cures most cases of gonorrhea and chlamydia. We also offer testing for HIV, syphilis, and other STDs, and try to get the patients to come back for general health care, but many of these patients are young, and disappear until their next bout of discharge. We often see patients who return re-infected because their partner wasn’t treated.

This is a great way to evolve antibiotic resistant STDs. PalMD isn’t at fault here, but, instead, a healthcare ‘system’ that discourages a consistent relationship with a medical practitioner (I would be interested in knowing roughly what percentage lack healthcare). The second post has to do with urinary tract infections:

A few years back, a medication called “phenazopyridine” became more widely available as an over-the-counter drug. It is marketed to treat the symptoms of UTIs. It turns urine and other body fluids bright orange. This medication is useful for reducing the symptoms of UTIs, but does not cure them. The FDA does mandate certain labeling for the OTC preparations, but I can tell you from experience, the subtlety of this distinction is, well, subtle. Fortunately, you don’t have to rely on my experience. Someone bothered to study the question. Most patients do not realize the difference between treating the symptoms and treating the disease. This leads to delay of treatment, and the infection can become more serious. To add insult to injury, phenazopyridine’s orange pigment interferes with the most common tests we use to diagnose UTIs.

The longer one has a UTI, the more likely you are to give it to someone else. By ‘give it to someone else’, I mean that there’s an increased chance that a family member (or pet) will harbor the disease-causing strain asymptomatically–meaning that the patient can be reinfected. It’s like having an STD, but without getting to have any sex….

This entry was posted in Antibiotics, E. coli, Evolution, Microbiology, Public Health. Bookmark the permalink.

3 Responses to Two Depressing Infectious Disease Anecdotes

  1. Tony P says:

    Oh I understand the difference between palliative and actual treatment.
    But you’re right, people don’t have relationships with their doctors because of several reasons. Many don’t have insurance which precludes a regular relationship with your doctor though I see change happening in that area.
    A group of M.D.’s in Rhode Island got sick of the insurance company games and offered a plan. It was $300 up front then $25 a month and you were guaranteed two regular visits per year, plus any emergency visits. So for $600 a year you get basic medical care.
    Even I have negotiated with my doctor and I give him 10% more than my former insurance carrier used to pay him per visit. He’s happy because there’s no paperwork hassle.

  2. PalMD says:

    Interesting points. As far as the microbiology of UTIs, in normals who are not living in nursing homes or in hospitals, the ecology is pretty predictable, and resistance of typical organisms hasn’t been a huge issue yet (although in some areas for some organisms it has been). Most UTI’s are caused by gut flora, so unless your bladder is catheterized, your gut commensals determine your UTI organism. Most UTIs cannot be passed, but as you said, gut commensals can probably be influenced by who you live with.
    Chlamydia and gonorrhea do very well with single dose therapy. Resistance is more problematic with longer courses of therapy, as non-compliance leads to intermittent exposure of the pathogen to the antibiotic.
    A good health care system with good access helps tremendously. Unfortunately, young people, who make up a large number of STD cases, often don’t have regular docs, and, at least around here, people are without insurance.

  3. mirc says:


Comments are closed.