Saturday, 11 February 2017



Of the many infections that occur in the body, Infections of the genitalia and urinary tract are most disconcerting and annoying to the body and mind, simply because of the sexual nature of the body parts involved and it's deep and evolutionary impression in the mind.
   Because genitalia and urinary tract are so closely placed and related in both females and males, most infections involve both the urinary tract and the genitalia and hence I have grouped them together as Genitourinary Infections (GUI).

  Though males can have genitourinary infections(GUI) as well as females, both differ qualitatively and quantitatively to each other.

  In males many genitourinary infections (GUI) are likely to be sexually transmitted disease (STD) like syphilis, gonorrhea, AIDS, chancroid etc. Mostly it’s the male who transfer such infections to the female. Other genitourinary infections(GUI) in males are similar to those in females though less common  and can be treated similarly.

   In males, urine is expelled through the urethra, which is a narrow canal passing through the penis  and collection of urine takes place in the urinary bladder and that too temporarily, except in elderly males with Benign prostatic hypertrophy (BPH), in which case urine stays in the bladder longer and hence genitourinary infections (GUI) is more common in such cases.

   In females though there is no danger of of BPH but the urethra is much shorter and stays inside the vagina, and hence while micturating,  the urine gets in touch with the inner walls of this vagina, and can stay there for long periods of time, and give rise to media for the growth of bacteria, which multiply fast to infect the urethra, vagina and external genitalia and can go higher to infect the cervix and uterus  and even fallopian tubes causing lower abdominal pain, problems in micturition, general malaise and irritability, which can increase frequency of micturition.
     This is the reason genitourinary infections (GUI) is more common in females.

  Another common cause of genitourinary(GUI) infections in females is the use of tamponades  during menstruation. In many cases, the females use cotton & cloth which is used in many cycles after washing. Blood, especially menstrual blood, is a very good medium for the growth of bacteria. The bacteria can infect and grow on these cloths in as less as 12 to 24 hours.
 Before going into the treatment of genitourinary infections (GUI), I am going to give important preventive steps, particularly in females.

  The females are advised to shave off their pubic hairs as it facilitates washing after micturition and prevents urine from getting entangled in the pubic hairs which may extend around the vagina and external genitalia.

   Next comes the micturition habits. Females should go to Toilets where water is available. Also the Mesopotamian version of toilet, where one sits with bottom clear of the toilet, is preferable as it permits easy washing of vagina after micturition.

The female should take a mug or bottle of water in one hand, part apart the vaginal lips with other hand (clean or washed before micturition ) and pour water inside which will wash away all urine sticking to the inside walls of vagina and external genitalia and hopefully bacteria as well and reduce the bacterial count as well as make vagina less favorable for the growth of bacteria, by decreasing their concentration to less than the threshold necessary to cause infection.
The other very important preventive method in females is that tamponades used during menstruation should always be disposable and should be changed at least every day. Reusable cotton &/ cloth tamponades should never be used. In some susceptible females, the tamponades can even be changed twice or thrice daily.

  Another preventive method, particularly when male and female are living apart is to examine each other’s genitalia before proceeding with sexual intercourse. Any abnormal discharge, smell, ulcer or lesion noticed should mean that  such a person has genitourinary infection (GUI), which should be treated before commencing sexual intercourse again.

   Females should prophylactically take the following treatment every 3 or 6 months and can get their male partner the same treatment.

Injection Tetanus Toxoid 0.5ml intramuscular
Tablet Ciprofloxacin 500 mg twice daily after food
(in females 250mg if weight less than 45 kg)
Tablet Metronidazole 400 mg twice daily after food
Tablet Chlorpheniramine maleate 4mg twice daily
(cause sedation and drowsiness, don’t drive)
Cap Flucanazole 150 mg at bed time

                                                                                X 3days

In addition a parentral (intravenous or intramuscular) antibiotic like Injection Ceftriaxone 1 gram or Injection Benzathine penicillin 2.5 million units (after hypersensitivity test ) or Injection Cefuroxime 1 gram or Injection Ampicillin 1 gram should be taken.

Those not able to tolerate Ciprofloxacin can take Capsule Amoxycillin 500 mg twice daily for three days.

The same prophylactic treatment I have described can be curative in almost all genitourinary infections (GUI) and can be taken in present infections.

  In present infections make sure that both sexual partners take treatment at the same time to prevent reinfection from the partner.

   COPYRIGHT  Tanvir Nebuchadnezar
   All rights Tanvir Nebuchadnezar

Wednesday, 24 August 2016

Sunday, 10 April 2016




Bacterial Antimicrobial Resistance (BAR) or Antibiotic Resistance (AR) is the phenomenon of inefficiency of a drug against bacteria in similar therapeutic doses, for which it was effective some time back. In short, the drug fails to kill bacteria against which it was lethal or at least inhibitory previously.

Before taking the discussion of BAR or AR further, we have to realise that bacteria are the oldest living organisms and date back to 3.5 billion years. We must also realise that bacteria are the template and provided the genetic material for the evolution of unicellular animals and plants and later multicellular animals and plants.

The bacteria have and still survive in all kinds of environment possible in the last 3.5 billion years on planet Earth. Their call and genetic material is labile and can transform according to the environment it is exposed to.

Also we must appreciate that human body is the best environment for a bacteria to live in. That is why there are more bacteria in human body than there are cells. But most bacteria are harmless, some symbiotic and some pathogenic, which are kept in check by the immune system of the body.

When the body need help to fight harmful bacteria, antibiotics are prescribed by a Doctor to overcome them. Mostly they are successful but sometimes the bacteria modifies itself and prevents the antibiotic from killing it. This bacteria is now said to be resistant to this antibiotic and this phenomenon is called Bacterial Antimicrobial Resistance (BAR) or Antibiotic Resistance (AR). 

The bacteria can acquire resistance in several ways like spontaneous mutations, gene transfer from another bacteria or virus, slow genetic change because of environmental pressure etc. Whatever way bacteria acquires this change, it is able to prevent the concerned antibiotic to kill it, at least majority of bacteria in the colony are not killed.

Thus, bacteria are designed by evolution to survive and to change and survive. We cannot totally eliminate them from the body and nor is it desirable.

Also we can never completely stop bacteria from developing antibiotic resistance because it is bacterial nature. All we can do is to ensure that the balance of power remains in our favour and we are able to destroy harmful bacteria causing diseases in our body most of the time.
But even such favourable balance of power has become difficult in today’s world.

I will examine the most important factors for this adverse shift in balance of power and ways to bring it back in our favour.

>>> As I have given earlier, human body is the best medium for bacteria to survive and grow, including that for pathogenic bacteria. Thus, more the human population grows, more bacteria come in this world. More bacteria means a greater mathematical possibility of acquiring resistance and than passing it to other bacteria.
      Places like India, China, Africa, South-East Asia, and South America, where human turnover is very fast are the ideal breeding grounds for Antibiotic Resistance (AR). And these areas are the hotbed of Antibiotic Resistance as borne out by various WHO reports.
     Added to the population pressure in the above areas is the high population density, insanitary hygienic conditions, poor waste disposal and you have ideal conditions for the development of Antibiotic Resistance and its spread too.

>>> The other significant factor in the development of antibiotic resistance is the amount of exposure the population gets to antibiotics and the circulating bloodstream antibiotic amount in a given period of time, in a given population. High levels of both lead to constant exposure of bacteria to these antibiotics and as per their nature, they modify themselves to develop resistance against these antibiotics.

>>> Another important factor is the prevalence of bacterial infectious diseases, particularly chronic bacterial diseases like Tuberculosis, Leprosy, Chronic and repeated Upper Respiratory Tract Infections (URTI), Chronic Lower Respiratory Tract Infections (LRTI), Chronic and repeated Gastroenteritis etc. All these diseases require antibiotic treatment of more than one week, with some like Tuberculosis and Leprosy requiring many months of antibiotic treatment.
      This prolonged exposure to antibiotics result in changes in bacteria, leading to resistance.

^^^Now, if we examine all above factors, a infectious disease prevalence (both acute and chronic bacterial infections) of 10% or more will be accompanied by very high drug resistance. Such is the case in India and Africa.

^^^A infectious bacterial disease prevalence (Total number of bacterial cases divided by the total population and multiplied by 100) of between 5% and less than 10% will be accompanied by high drug resistance. Such is the case in South East Asia, China and South America.

^^^A infectious bacterial disease prevalence (IBDP) of less than 5% but more than 1% will be accompanied by moderate drug resistance. Such is the case in North America and Western Europe.

^^^A infectious bacterial disease prevalence (IBDP) of less than 1% will be accompanied by low drug resistance. Such is the case in Eastern Europe, Northern Europe (Scandinavia), Russia and Israel. 

Now, having understood the basic causes of antibiotic resistance, I will focus on ways to decrease antibiotic resistance and tilt the balance of power in our favour.

<<< Decreasing population growth by proper family planning methods like Sterilisation operations etc. This is most important in India, Bangladesh, South East Asia, Africa and South America.

<<< Judicious use of antibiotics which should be available only on the prescription of a MSMS (Mesopotamian System of Medicine and Surgery) (Allopathy) Doctor.

<<< Antibiotic sensitivity test should be made available and compulsory in all hospitals and clinics where an antibiotic is prescribed. In far flung areas, use of mobile vans can be done.

<<< Safe disposal of expired or damaged antibiotics in incinerators, so that they do not enter the environment like water or soil.

<<< Judicious use of antibiotics in animals. Growth stimulants instead of antibiotics should be used for their growth.

<<< Constant R & D (Research and Development) to develop newer antibiotics. 50% tax concession should be given for newer antibiotics during their patent period.

<<< Strong patent and copyright laws especially in India and China to prevent new antibiotics reaching the market from being copied.

We probably cannot outlive bacteria but with above measures we can control them.