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Patients, except pregnant females, who are sensitive to penicillin can be treated with spectinomycin (see below), tetracyclines or trimethoprim/sulphamethoxazole. Pregnant patients should be treated with erythromycin.

Penicillin resistant infection (first line treatment where PPNG is endemic) Adults:

Ceftriaxone 250 mg intramuscularly in a single dose OR

Spectinomycin 2 g intramuscularly in a single dose. (Spectinomycin should not be used in pregnancy)

Children:

Spectinomycin 40 mg/kg intramuscularly in a single dose.

Complicated infections (PID, septic arthritis, septicaemia etc.)

Complicated infections such as PID, prostatitis or epididymitis, arthritis, ophthalmic lesions, disseminated infection, meningitis, endocarditis, myocarditis or pericarditis require multiple dose therapy. Hospitalisation and specialist referral is usually indicated. These patients often require intravenous chemotherapy which is replaced by oral treatment on clinical improvement. Duration of treatment will be at least 7 days extended to at least 14 days for meningitis and at least a month for endocarditis.
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Uncomplicated genital, anal or pharyngeal infections

Single dose regimens cure most cases of uncomplicated gonorrhoea. Treatment for chlamydia may also be given particularly if local experience is that postgonococcal urethritis is common. Sexual abstinence is of benefit during therapy. Admission to hospital is usually indicated for children with gonorrhoea. Pharyngeal infections are less responsive to treatment than genital infections.

Penicillin susceptible infection (first line treatment where PPNG is uncommon)

Adults:

Amoxycillin 3 g given with 1 g probenecid as a single oral dose for anogenital infections and as a daily dose for 3 days for oropharyngeal infection or Aqueous procaine penicillin G 3 g intramuscularly (1.5 g at 2 sites) with probenecid 1 g orally as a single dose.

Children:

Amoxycillin 50 mg/kg given with probenecid 25 mg/kg as a single oral dose or Aqueous procaine penicillin G 100,000 units/kg intramuscularly with probenecid 25 mg/kg orally as a single dose.
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It helps to do a bit of research, like finding some books about sexual technique and reading them for ideas. It is then helpful to read some of it with your partner and talk about the sorts of things you might both like to try. Simple things like having sex in different places in the house or at different times of the day can be enough to break some old habits. A change of scenery, like a weekend away together can give you the time and the relaxation you might be missing at home.

Some people find that erotic or instructional videos give them a few ideas too. These are now widely available at local video stores. If you are going to check some of them out it helps to have an open mind and a sense of humor, because a poor quality video can be as erotic and tasteful as a pile of last night’s dirty dishes.

Technique can’t substitute for real passion and sexual chemistry. Sex can become boring because you no longer find your partner sexually attractive. This is a difficult one to fix. The reality is that passion and chemistry are not always forever, but if the sexual feelings have just gone into hibernation because there are resentments and dissatisfaction with the rest of the relationship, then counselling is worth a try.

For some people the non-sexual aspects of their relationship are enough to outweigh the sexual, so sexuality is not such a high priority.

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There’s an old saying that you have to work at marriage. Now while that’s definitely true, it helps if you start off with the right raw materials: some interests in common, compatible goals in life, an ability to compromise and adapt, an ability to listen, compatible beliefs about childraising and financial management, mutual respect, and that indeterminate ‘chemistry’. While you don’t have to have a full house, it helps if you have a few of the cards in your hand.

The more you see of relationships the clearer it becomes that chance plays a major role in their success. When you consider the changes we go through as we get older, it’s a wonder that any two people who had compatible goals and needs in their twenties are still on the same wavelength at sixty or seventy. People would need to change in the same direction as they get older to continue to fulfil each other’s needs.

Add to this the well established fact that respective sexual peaks of men and women happen in totally separate decades of life, then you start to suspect there really might be something to this theory about the Creator with a wry sense of humor. But let’s take a look at this ‘well established fact’.

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The issue of longterm relationships is a highly complex one, and deserves the volumes written about it in its own right. But without a doubt, making the decision to enter into a longterm relationship makes you confront your attitudes to sexuality and partnerships not only in terms of passion, but also in terms of practicality.

Contrary to popular folklore, it is virtually impossible to tell how long it is going to last in the early stages of any relationship. It would help to have a crystal ball because some relationships that seem ‘made to measure’ fall apart at the seams, while others that seem doomed can blossom into the ‘love of a lifetime’. Obviously factors outside the relationship have an impact on how long it lasts too, like financial pressure, work commitments, family expectations, and cultural and religious differences.

Some people in a longterm relationship didn’t make the decision at all. It just happened. There you are one day, thinking how well you get along with your partner, and you realize you have been getting along well and happily making compromises for some time. Nevertheless, at some stage you will face a turning pont in the relationship that will make you confront your feelings about sexuality. That might be at a time when you make the decision to give up other partners, to stop using condoms, to live together, to marry or to have children — decisions that will shape the rest of your life.

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If you’re lucky you will get symptoms like an unusual discharge from the vagina or penis; painful intercourse; sores, lumps, blisters or rashes on the genitals; burning or stinging when you pass urine and so on.

If you’re a little less lucky you won’t have symptoms but your partner will and they will tell you about it so that you can both be checked out and treated. One of the ways we can minimize the damage and prevent an STD spreading is a procedure known as ‘contact tracing’. This is where a person who finds out they have a sexually transmissible disease makes sure that any possible recent sexual contacts are notified that they are at risk and should be checked out or treated. ‘He was six foot two, blond and had a great smile’ is going to make it hard to identify a casual encounter, but you get the point.

Those who are even less lucky will not have a clue until it’s too late. Unfortunately with some infections, like chlamydia, a lot of people will fall into this last category. You can look and feel completely healthy and still have an STD. Because of this, it pays to have what we in the business call ‘a high index of suspicion’. If you think there is a possibility that you have been in contact with an infected person, or you have had unprotected intercourse with a new partner, it’s worth getting a checkup just to be sure.

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It is often said that there is no such thing as totally safe sex (except masturbation on your own) and that the campaigns to increase condom usage fail to take into account that condoms can break in action. They even changed the expression ‘safe sex’ to the more accurate ‘safer sex’. It’s true that sex education is still in a process of evolution and we need to know where the misunderstandings are so that the information can be adjusted to account for them. Moreover, it is becoming more and more obvious that safer sex instructions need to be detailed enough so that there can be no room for error. It is not enough to say ‘use a condom’ without making it clear that putting it on at the last minute, just in time to catch the ejaculated semen, may be too late. Many people don’t realize that you needn’t actually ejaculate to pass on an infection. In particular syphilis, genital herpes and warts just need skin to skin contact, so for protection the condom needs to be put on before there is any genital contact at all.

It also helps to know things like how to put a condom on and take it off again correctly, that you need to keep squeezing the teat, at the end until the condom is rolled right down to the base of the penis, and that using a water-based lubricant helps to prevent the condom from breaking.

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One new product called the Femidom or female condom recently went on sale in Switzerland to a mixed reception. It consists of a firm outer ring with a loose bag attached, a bit like the windsocks you see at an airfield. The bag is inserted up into the vagina, and the firm ring remains on the outside, protecting the vulva. Some people said it was like having sex with a kitchen tidy bag. Others preferred the fact that they didn’t have to interrupt intercourse to put it in. Women with older male partners say that the female condom has an advantage for them because it is loose fitting, and the older man is less likely to lose his erection than with a regular condom. The added advantage of the female condom is that it gives increased protection against sexually transmitted diseases of the vulva. Actually, the same product is used as an anal condom to protect male homosexuals from STDs during anal intercourse.

Newer ‘morning after’ pills, male contraceptive pills, pregnancy vaccines and hormone implants are all on the horizon as researchers try to meet the needs of people in different situations.

Whatever contraception you decide is best for you, now or in the future, making a choice means confronting your attitudes and behaviors about sex, and getting in touch with the sexual attitudes of your partner.

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There is no such thing as the perfect contraceptive, so the best you can hope for is a fair compromise. Negotiating contraceptive options, like negotiating safer sex, takes some communication skills and a degree of self-confidence. That means knowing what your needs are, and what is non-negotiable for you. As an example, there is no point in a man deciding that the best alternative for him is for his partner to have an IUD inserted if she has no intention whatsoever of letting one anywhere near her.

There are some people who just can’t seem to find a contraceptive option that suits them. So the search for more alternatives continues, and the contraceptive options in the future will need to take into account more than reliability and safety. There is absolutely no point in a company expending enormous amounts of money and resources on a product that nobody wants to use, so the first step will always be to ask how this method fits into a person’s sex life.

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One issue that crops up from time to time is the question of the rights of the biological father when it comes to a decision about abortion. This is a difficult and emotive issue for anyone who finds themselves with an unplanned pregnancy, and many women think it’s better to avoid a confrontation altogether by acting on their decision without consulting the partner at all. This is particularly true of pregnancies that result from an extramarital affair or a relationship that is not likely to be longterm.

In other cases it depends very much on the relationship between the partners, and how much each person’s life is likely to change as a result of the decision. Far beyond the issue of who gets the morning sickness, the backache and the labor pains are the longer term questions: Who will have the responsibility for childcare? Who will cope with the reduced income? Who will have to compromise their career plans? As a rule of thumb, the right of each partner to make the decision will be reflected in the answers to these questions.

It’s not just your own contraceptive choices that force you to face your attitudes to sex. People say children grow up so fast that you turn around one day and they are adults, but it’s not until you witness your own child’s development at point-blank range that you realize the truth of this. The issue of a young person becoming sexually active can be a very confronting experience for a parent.

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