Full Answer Section

• Medications: Some diuretics or sedatives can worsen OAB symptoms.
• Bladder abnormalities: Bladder stones or tumors can irritate the bladder.
• Incomplete bladder emptying: If the bladder doesn’t empty fully, there’s less capacity for new urine, leading to frequent urges. This can be caused by BPH in men or prolapse in women.
• Urinary tract infections (UTIs): UTIs can cause OAB-like symptoms.
• Caffeine and alcohol: These can act as bladder irritants and diuretics, increasing urine production and urgency.
• Aging: While not a normal part of aging, OAB becomes more common with age due to changes in bladder muscle and nerve function.
• Obesity: Excess weight can put pressure on the bladder.
• Chronic constipation: Can put pressure on the bladder and nerves.

Symptoms: The hallmark symptoms of OAB are:

• Urgency: A sudden, strong, often overwhelming need to urinate that’s difficult to postpone.
• Urgency Incontinence: Involuntary leakage of urine immediately following a strong urge to urinate. (Not everyone with OAB experiences incontinence).
• Frequency: Urinating too often, typically eight or more times in 24 hours.
• Nocturia: Waking up two or more times during the night to urinate.

Treatment: Treatment for OAB typically starts with conservative approaches and may progress to medications or more invasive therapies if needed.

1. Behavioral Therapies (First-line and often very effective):

   • Bladder Training: Gradually increasing the time between bathroom visits to train the bladder to hold more urine.
   • Pelvic Floor Muscle Exercises (Kegel exercises): Strengthening the pelvic floor muscles can help suppress urgency and prevent leakage.
   • Fluid Management: Drinking adequate fluids, but avoiding excessive intake and limiting fluids before bed.
   • Dietary Modifications: Avoiding bladder irritants like caffeine, alcohol, artificial sweeteners, citrus, and spicy foods.
   • Weight Management: Losing weight if overweight or obese.
   • Managing Constipation: Increasing fiber intake.
   • Timed Voiding: Urinating on a set schedule, regardless of urge.
   • Biofeedback: Using sensors to help patients learn to control bladder muscles.

2. Medications:

   • Anticholinergics/Antimuscarinics: These drugs relax the bladder muscle, reducing involuntary contractions.
     • Examples: Oxybutynin (Ditropan), Tolterodine (Detrol), Solifenacin (Vesicare), Fesoterodine (Toviaz), Trospium.
     • Common side effects include dry mouth and constipation.
   • Beta-3 Agonists: These drugs relax the bladder muscle by a different mechanism than anticholinergics and have fewer side effects like dry mouth.
     • Examples: Mirabegron (Myrbetriq), Vibegron (Gemtesa).
   • Vaginal Estrogen (for postmenopausal women): Can help strengthen tissues in the urethra and vagina, improving bladder control.

3. Advanced Therapies (for severe cases unresponsive to other treatments):

   • Botulinum Toxin A (Botox) Injections: Small doses injected into the bladder muscle can relax it, increasing bladder capacity and reducing urgency. Effects typically last 6-9 months.
   • Sacral Neuromodulation (InterStim, Axonics): A small device is surgically implanted to stimulate the sacral nerves that control bladder function, normalizing bladder activity.
   • Percutaneous Tibial Nerve Stimulation (PTNS): A less invasive form of neuromodulation where a thin needle is inserted near the ankle to stimulate the tibial nerve, which connects to nerves controlling the bladder. This is typically done in a series of office visits.

4. Treatment Options and Recommendations for Different STIs

It’s crucial to remember that all sexual partners must be treated simultaneously to prevent reinfection. Abstinence from sexual activity is recommended until all partners have completed treatment and symptoms have resolved. Retesting after treatment is often recommended to confirm cure, especially for gonorrhea and syphilis.

a) Chlamydia (Chlamydia trachomatis)

• Description: A common bacterial STI that often has no symptoms. If left untreated, it can lead to serious complications like pelvic inflammatory disease (PID) in women (causing chronic pain, infertility, and ectopic pregnancy) and epididymitis in men (causing pain, swelling, and potential infertility).
• Treatment Options: Chlamydia is curable with antibiotics.
  • Preferred Regimen (Non-pregnant adults):
    • Doxycycline: 100 mg orally twice daily for 7 days. (This is increasingly the preferred treatment due to emerging resistance to azithromycin.)
  • Alternative Regimen (especially if adherence is a concern, or for pregnant women):
    • Azithromycin: 1 gram orally in a single dose.
  • Pregnancy: Azithromycin or Amoxicillin are generally preferred.
• Recommendations:
  • Treat all sexual partners from the past 60 days (or longest-term partner if that’s longer).
  • Abstain from sexual activity for 7 days after all partners have completed treatment and symptoms have resolved.
  • Test for reinfection 3 months after treatment, especially for women, due to high rates of re-exposure.
  • Screening is recommended for sexually active women under 25 annually, and for older women and men with risk factors.

b) Gonorrhea (Neisseria gonorrhoeae)

• Description: A common bacterial STI that can affect the genitals, rectum, and throat. Like chlamydia, it often has no symptoms. Untreated gonorrhea can lead to PID, infertility, epididymitis, and disseminated gonococcal infection (DGI), which can affect joints, skin, and heart.
• Treatment Options: Gonorrhea is treated with antibiotics, but drug resistance is a growing concern.
  • Preferred Regimen (Uncomplicated urogenital, anorectal, and pharyngeal gonorrhea):
    • Ceftriaxone: 500 mg (1 gram for individuals weighing 150 kg or more) intramuscularly (IM) in a single dose.
  • For co-infection with Chlamydia (which is common): It is often recommended to add Doxycycline 100 mg orally twice daily for 7 days in addition to ceftriaxone, unless chlamydia has been ruled out.
  • For Ceftriaxone allergy: Gentamicin 240 mg IM as a single dose PLUS Azithromycin 1 gram orally as a single dose.
• Recommendations:
  • Treat all sexual partners from the past 60 days.
  • Abstain from sexual activity for 7 days after treatment is completed and symptoms have resolved.
  • Test for reinfection 3 months after treatment, especially for pharyngeal or rectal infections, and if symptoms persist.
  • Due to increasing antibiotic resistance, follow current CDC or WHO guidelines closely, as recommendations can change.
  • Dual therapy (ceftriaxone plus a second agent) is often used to combat resistance and cover potential co-infections with Chlamydia.

c) Syphilis (Treponema pallidum)

• Description: A bacterial STI that progresses through distinct stages (primary, secondary, latent, and tertiary) if untreated. It can cause serious long-term complications affecting the heart, brain, nerves, and other organs, and can be transmitted from mother to child during pregnancy (congenital syphilis).
• Treatment Options: Syphilis is curable with penicillin. The treatment regimen depends on the stage of the infection.
  • Primary, Secondary, or Early Latent Syphilis (infection for ≤ 1 year):
    • Benzathine Penicillin G: 2.4 million units intramuscularly (IM) in a single dose. (This is the preferred and only recommended treatment for pregnant individuals).
  • Late Latent Syphilis (infection for > 1 year or unknown duration) or Tertiary Syphilis:
    • Benzathine Penicillin G: 2.4 million units IM once a week for 3 consecutive weeks (total 3 doses).
  • Neurosyphilis (syphilis affecting the brain or spinal cord):
    • Requires intravenous (IV) penicillin for 10-14 days, often in a hospital setting.
  • Penicillin Allergy: For patients with a true penicillin allergy, desensitization to penicillin may be recommended, especially for pregnant women or those with neurosyphilis, as penicillin is the most effective drug. Alternatives like doxycycline or ceftriaxone may be used for non-pregnant patients with early syphilis, but require careful monitoring.
• Recommendations:
  • Treat all sexual partners from the past 90 days (for primary/secondary syphilis) or longer depending on the stage.
  • Abstain from sexual activity until all sores have healed and treatment is completed.
  • Follow-up blood tests: Regular blood tests (e.g., RPR or VDRL titers) are crucial to confirm treatment success. The frequency and duration of follow-up depend on the stage of syphilis.
  • HIV testing: All individuals diagnosed with syphilis should be offered HIV testing, as co-infection is common.
  • Jarisch-Herxheimer reaction: Patients may experience a short-term fever, chills, headache, and muscle aches after the first dose of penicillin. This is a common, temporary immune reaction and not an allergic reaction.