reproductive morbidity

Number 1 Post: RW

Trichomonas is the most common non-viral sexually transmitted infection in the world.  It is an important source of reproductive morbidity and thus is a public health problem.  However, it is not a reportable disease and surveillance is not generally done.  Most person infected with trichomonas are asymptomatic.  The treatment of choice for women has been metronidazole, for decades, and a single dose has been the first line of defense. (Kissinger, 2015).

Pathogen and Proliferation

Trichomonas vaginalis, a parasitic protozoan, is a etiologic agent of trichomoniasis.  It is a flagellated protozoan possessing five flagella.  Although cell division has been extensively described through the use of microscopy, the life cycle of trichomonas is poorly understood.  Like many other protozoan parasites, it is known to exit only as a trophozoite and lacks a cystic stage.  Trichomonas is a primitive eukaryotic organism.  Although similar to many other eukaryotes it differs in its energy metabolism and shows remarkable similarity to primitive anerobic bacteria. (Petrin et al., 2018).  Trichomonas is a protozoan parasite that tends to destroy epithelial cells and induce pathogenesis. (Lin et al., 2015).

Male partner treatment

The CDC recommends male partners be treated with a single dose of 2g of metronidazole orally.  Concurrent treatment of all sex partners is vital for preventing reinfections.  Current partners should be referred for presumptive therapy.  Partners also should be advised to abstain from intercourse until they and their sex partners have been treated and any symptoms have resolved. (2021).

Metronidazole is a small molecule the enters trichomonas via passive diffusion.  The drug itself is inactive, but anaerobic reduction results in the formation of a cytotoxic nitro radical anion.  The nitro radial is then hypothesized to bind transiently to DNA, disrupting or breaking the strands and leading to cell death.  The action is a short-lived reaction rather than irreversible binding of the drug to DNA. (Cudmore et al., 2004).

Chlamydia

Chlamydia is a sexually transmitted infectious disease caused by the bacterium Chlamydia trachomatis.  It is the most commonly reported bacterial infection, Globally, it is the most common sexually transmitted infection.  It causes an ocular infection called “trachoma”, which is the leading infections cause of blindness worldwide.  In females, the cervix is the site that is most commonly infected. Chlamydial infections in women, especially if untreated, increase the risk of infertility and ectopic pregnancy.  In men, infection with chlamydia can lead to urethritis, epididymitis, prostatitis, proctitis, or reactive arthritis. (Mohseni et al., 2021).

 

 

Number 2 post: PG

A 16-year-old male presents with delayed pubertal signs and social immaturity. His lab values show low testosterone. He was administered GnRH, and no LH was produced. HCG was administered, which restored testosterone to normal levels.

1. Discuss male hypogonadism
2. Explain hormone administration
3. Is there a problem with the hypothalamus? Why or why not?

 

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Male hypogonadism is a testosterone deficiency in men (Dlugasch & Story, 2021). According to Butanis et al. (2017), male hypogonadism results from testosterone or sperm levels in the testes not reaching the proper levels due to disruption of the hypothalamic-pituitary-testicular (HPT) axis. Male hypogonadism causes include congenital, tumors, disease, drug-related, acquired cases, or chronic illness (Salonia et al., 2019). Furthermore, a research study found metabolic syndrome as a causative factor to hypogonadism (Lawrence et al., 2017). In this document, male hypogonadism explored; primary plus secondary are explained; hormone administration explored, and is there a problem with the hypothalamus? Why or why not?

The hypothalamus releases Gonadotropin-releasing hormone (GnRH) in normal physiology (Salonia et al., 2019). Also, in response to GnRH, the anterior pituitary secretes follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Additionally, Sertoli and Leydig cells in the testis are stimulated to produce sperm and testosterone by FSH and LH. Typically, the above occurs in normal physiology. However, problems could arise due to factors that can contribute to hypogonadism. As mentioned earlier, there are two types of hypogonadism: primary and secondary. Primary hypogonadism stems from an inherent defect within the testes (Salonia et al., 2019). Therefore, low or absent testosterone levels are accompanied by high gonadotropin levels in the condition (Salonia et al., 2019).

Additionally, spermatogenesis is often severely impaired and may not respond to hormonal treatment (Salonia et al., 2019). Secondary hypogonadism (also known as central hypogonadism or hypogonadotropic hypogonadism) results from hypothalamic or pituitary dysfunction (Salonia et al., 2019). The biochemical characteristics of this condition are low or inappropriately normal gonadotropin levels and low total testosterone levels (Salonia et, 2019). Moreover, spermatogenesis is impaired, but treatment usually improves it (Salonia et ., 2019).

Clinicians should perform tests to determine if the condition is primary or secondary and treat accordingly (Lawrence et al., 2017). Also, patient education and management guidelines are vital during treatment. For example, Salonia et al. (2019) informed testosterone therapy for congenital cases of hypogonadism is lifelong, and management of acquired care depends on whether the condition can be managed or if the state is permanent. Treatment may consist of replacing testosterone to raise the level in the blood and assist in countering the symptoms of male hypogonadism (Salonia et al., 2019). Treatment, for instance of testosterone, comes in various forms, such as injectables, esters, gels, nasal gels, or oral (Salonia et al. 2019). Also, Salonia et al. (2019) mentioned treatment of males less than ten should be treated with caution due to bone age and that high doses could cause premature epiphyseal closure.

According to Mayo Clinic (2022), in male hypogonadism, one could be born with a congenital condition or develop later in life. As mentioned above, the primary problem is with the testes (Mayo clinic, 2022). However, this type of hypogonadism in secondary could indicate a problem in the hypothalamus or the pituitary gland (Mayo clinic, 2022). Moreover, The hypothalamus produces gonadotropin-releasing hormones, which cause the pituitary to produce follicle-stimulating hormones and luteinizing hormones (Mayo clinic, 2022). In addition, luteinizing hormones stimulate testosterone production in the testes (Mayo clinic, 2022).

In closing, hypogonadism is a testosterone deficiency in males, and supplemental steroids may aid in relieving symptoms of this disorder and raise the blood level of the hormone. The problem of hypogonadism may lie with the testes or central (in the brain) like the hypothalamus or pituitary gland. As professionals in health care, monitoring steroid use, client education, and client, plus steroid guidelines are vital in managing the disorder.