DEAR DR. DONOHUE: I am a 30-year-old man who developed a discharge from the penis. Next my knees began to hurt. At this point, I knew I needed a doctor. After the doctor had examined me and did some blood tests, he informed me I have Reiter’s syndrome. This is something I never heard of. What is it? – N.W.

ANSWER: Reiter’s (pronounced “writers”) syndrome features three seemingly unrelated symptoms. One is a genital discharge – a urethritis. The urethra is the tube that empties the bladder to the outside world. Arthritis and eye inflammation are Reiter’s other two components. All three need not be present to make the diagnosis.

The genital discharge makes a person think of gonorrhea, but this discharge might or might not cause pain when urinating. Gonorrhea almost always does so.

About four weeks after the urethritis, joints can begin to give trouble. The most commonly affected ones are the knees, ankles and feet.

Eye inflammation is a later manifestation. When it is part of the picture, it is best to involve an eye doctor as a member of the treatment team.

The cause of Reiter’s syndrome is believed to be a previous infection. One implicated germ is the chlamydia germ, often transmitted through sexual relations.

Another implicated germ is the salmonella germ – not sexually transmitted. It produces a digestive-tract infection. Other germs are on the suspect list.

A peculiar aspect is the finding of a body protein, HLA-B27, in a blood test. It indicates a special genetic makeup that predisposes people to develop this syndrome.

Antibiotics are often part of treatment. When arthritis is present, anti-inflammatory drugs such as Indocin are prescribed. The eye doctor can generally take care of eye inflammation with eyedrops.

DEAR DR. DONOHUE: I have a co-worker who has missed many workdays because of chronic fatigue syndrome. She has a hard time explaining it to me, but it piques my interest because I have many of its symptoms. Can you throw a little light on this for me? – G.B.

ANSWER: A constellation of signs and symptoms establishes the diagnosis of chronic fatigue syndrome. There is no test that confirms it.

The most prominent symptom is profound fatigue that persists for six or more months. Of the following seven signs, four must be present to put the diagnosis on firm ground. Those signs are: impaired memory or concentration; sore throat; swollen lymph nodes; muscle pain; joint pain; headaches; and sleep that does not refresh.

Doctors test for other illnesses where fatigue is a major symptom to exclude the possibility that they might be the cause.

The pamphlet on chronic fatigue is a summation of the current knowledge and treatment of this mysterious affliction. Readers can obtain a copy by writing: Dr. Donohue – No. 304, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: How can I treat an ingrown toenail without having to see a doctor? – B.N.

ANSWER: Soak the affected foot in Burow’s solution for 15 minutes. Burow’s solution is aluminum acetate, and you can get it from your local drugstore without any trouble.

After the soak, gently pry the corner of the nail free from the adjacent skin in which it is embedded. Don’t use any sharp instrument to do this. You can usually do it with your fingernail.

Pack the underside of the now-freed nail edge with cotton that has been soaked in alcohol and leave it until you soak your foot again the next day. Then pack it again. This routine must be a daily chore for one week.

If, after a week, you have not made progress, then you have to see a doctor, whether you like the idea or not.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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