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DHAAT - MALE LEUCORRHOEA - AS SEEN IN MODERN PERSPECTIVE SPECIALLY IN UP AND BIHARI PATIENTS
OP Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
It is only in our country that male patients complain of "Dhaat". This word is used when a patient passes whitish sticky substance in the urine. Many of them differentiate it from passing semen in the urine.In scientific terms this should be accepted as a symptom of chronic prostatitis. Although, in 50% of patients no cause could be found, in the other 50% patients, infection was due to:
1. trichomonas infection
2. herpes simplex
3. chlamydia infection
In the beginning, I used to ask for microscopic and culture examination of the prostatic secretion obtained after prostatic massage. After asking for this test in more than a thousand patients, I have stopped this practice, because the reports always showed "occasional pus cells" and the culture was negative.
This is because all the above three organisms cannot be grown easily. In the last 2-3 years, I started asking for "blood tests" to confirm the diagnosis of chlamydia and herpes simplex. These tests are very costly. Also the interpretation of these tests by GPs will often go wrong. IgG anti-bodies of chlamydia and herpes simplex are often present in normal people. It is only the presence of IgM (herpes simplex) or IgA (chlamydia) antibodies that suggests the diagnosis.
Lately, instead of making the patient spend on these tests, I give a therapeutic test which costs almost the same.
1. To eradicate trichomonas infection, a course of metronidazole 200 mg three times a day for a week or 10 days to both husband and wife (or sexual partner) should be prescribed.
2. For eradicating chlamydia, doxicycline in a dose of 100 mg twice a day for 8-10 days should be given to both the partners. Recently one dose of azithromycin in the form of 4 tablets of 250 mg each is shown to be sufficient to eradicate chlamydia.
3. Finally, the treatment of herpes simplex - This could be eradicated by prescribing acyclovir (Ocuvir - cheap preparation) 200 mg five times a day for 5 days to both partners. The relapses seem to be so common in this infection that for a patient who can afford it, a maintenance dose of 400 mg twice a day could be given for as long as a year, to both, the patient and his sexual partner.
Recently, Ribavirin has appeared in the market and can be given in the dose of 200 mg four times a day for a week to eradicate herpes simplex. Even this course costs about Rs. 1500/- and the problem of relapse remains.
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