Syphilis is a sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum subspecies pallidum. The route of transmission of syphilis is almost always through sexual contact, although there are examples of congenital syphilis via transmission from mother to child in utero.
The signs and symptoms of syphilis are numerous; before the advent of serological testing, precise diagnosis was very difficult. In fact, the disease was dubbed the "Great Imitator" because it was often confused with other diseases, particularly in its tertiary stage.
Syphilis can generally be treated with antibiotics, including penicillin. If left untreated, syphilis can damage the heart, aorta, brain, eyes, and bones. In some cases these effects can be fatal. In 1998, the complete genetic sequence of T. pallidum was published, which may aid understanding of the pathogenesis of syphilis.[1][2]
Contents[hide]
1 Alternative names
2 Signs and symptoms
2.1 Primary syphilis
2.2 Secondary syphilis
2.3 Latent syphilis
2.4 Tertiary syphilis
2.5 Neurosyphilis
3 Diagnosis
3.1 Other Treponematoses
4 Prevention
5 Treatment
5.1 Late latent and infections of unknown duration
5.2 Treatment of neurosyphilis
5.3 Alternative regimens
5.4 Jarisch-Herxheimer reaction
5.5 Tuskegee syphilis study
6 Epidemiology
7 History
7.1 Origins
7.2 European outbreak
7.3 History of treatments
7.4 History of diagnosis
7.5 Notable syphilis-infected people in history
8 Society and culture
8.1 Art
8.2 Classic and antique literature
8.3 Modern literature
8.4 Film, television and stage
9 Gallery
10 See also
11 References
12 External links
//
Alternative names
The name "syphilis" was coined by the Italian physician and poet Girolamo Fracastoro in his epic noted poem, written in Latin, titled Syphilis sive morbus gallicus (Latin for "Syphilis or The French Disease") in 1530. The protagonist of the poem is a shepherd named Syphilus (perhaps a variant spelling of Sipylus, a character in Ovid's Metamorphoses). Syphilus is presented as the first man to contract the disease, sent by the god Apollo as punishment for the defiance that Syphilus and his followers had shown him. From this character Fracastoro derived a new name for the disease, which he also used in his medical text De Contagionibus ("On Contagious Diseases").[3]
Until that time, as Fracastoro notes, syphilis had been called the "French disease" in Italy and Germany, and the "Italian disease" in France. In addition, the Dutch called it the "Spanish disease", the Russians called it the "Polish disease", the Turks called it the "Christian disease" or "Frank disease" (frengi) and the Tahitians called it the "British disease". These "national" names are due to the disease often being spread by foreign sailors and soldiers during their frequent, unprotected sexual contact with local prostitutes.
During the 16th century, it was called "great pox" in order to distinguish it from smallpox. In its early stages, the great pox produced a rash similar to smallpox (also known as variola). However, the name is misleading, as smallpox was a far more deadly disease. The terms "Lues"[4] (or Lues venerea, Latin for "venereal plague") and "Cupid's disease" have also been used to refer to syphilis. In Scotland, syphilis was referred to as the Grandgore. The ulcers suffered by British soldiers in Portugal were termed "The Black Lion".[5]
Signs and symptoms
Different manifestations occur depending on the stage of the disease:
Primary syphilis
PRIMARY CHANCRE OF SYPHILIS ON THE HAND
Primary chancre of syphilis at the site of infection on the penis
Primary syphilis is typically acquired via direct sexual contact with the infectious lesions of a person with syphilis.[6] Approximately 10–90 days after the initial exposure (average 21 days), a skin lesion appears at the point of contact, which is usually the genitalia, but can be anywhere on the body. This lesion, called a chancre, is a firm, painless skin ulceration localized at the point of initial exposure to the spirochete, often on the penis, vagina or rectum. In rare circumstances, there may be multiple lesions present, although it is typical that only one lesion is seen. The lesion may persist for 4 to 6 weeks and usually heals spontaneously. Local lymph node swelling can occur. During the initial incubation period, individuals are otherwise asymptomatic. As a result, many patients do not seek medical care immediately.
Syphilis cannot be contracted through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing.[7]
Typical presentation of secondary syphilis rash on the palms of the hands and usually also seen on soles of feet
SECONDARY SYPHILIS
Secondary syphilis occurs approximately 1–6 months (commonly 6 to 8 weeks) after the primary infection. There are many different manifestations of secondary disease. There may be a symmetrical reddish-pink non-itchy rash on the trunk and extremities.[8] The rash can involve the palms of the hands and the soles of the feet. In moist areas of the body (usually vulva or scrotum), the rash becomes flat, broad, whitish, wart-like lesions known as condyloma latum.) Mucous patches may also appear on the genitals or in the mouth. All of these lesions are infectious and harbor active treponeme organisms. A patient with syphilis is most contagious when he or she has secondary syphilis. Other symptoms common at this stage include fever, sore throat, malaise, weight loss, headache, meningismus, and enlarged lymph nodes. Rare manifestations include an acute meningitis that occurs in about 2% of patients, hepatitis, renal disease, hypertrophic gastritis, patchy proctitis, ulcerative colitis, rectosigmoid mass, arthritis, periostitis, optic neuritis, interstitial keratitis, iritis, and uveitis.
LATENT SYPHILIS
Latent syphilis is defined as having serologic proof of infection without signs or symptoms of disease.[6] Latent syphilis is further described as either early or late. Early latent syphilis is defined as having syphilis for two years or less from the time of initial infection without signs or symptoms of disease. Late latent syphilis is infection for greater than two years but without clinical evidence of disease. The distinction is important for both therapy and risk for transmission. In the real-world, the timing of infection is often not known and should be presumed to be late for the purpose of therapy. Early latent syphilis may be treated with a single intramuscular injection of a long-acting penicillin. Late latent syphilis, however, requires three weekly injections. For infectiousness, however, late latent syphilis is not considered as contagious as early latent syphilis. Fifty percent of those infected with latent syphilis will progress into late stage syphilis, 25% will stay in the latent stage, and 25% will make a full recovery.
TERTIARY SYPHILIS
Tertiary syphilis usually occurs 1–10 years after the initial infection, however in some cases it can take up to 50 years. This stage is characterized by the formation of gummas, which are soft, tumor-like balls of inflammation known as granulomas. The granulomas are chronic and represent an inability of the immune system to completely clear the organism. They may appear almost anywhere in the body including in the skeleton. The gummas produce a chronic inflammatory state in the body with mass-effects upon the local anatomy. Other characteristics of untreated tertiary syphilis include neuropathic joint disease, which is a degeneration of joint surfaces resulting from loss of sensation and fine position sense (proprioception). The more severe manifestations include neurosyphilis and cardiovascular syphilis. In a study of untreated syphilis, 10% of patients developed cardiovascular syphilis, 16% had gumma formation, and 7% had neurosyphilis.[9]
Neurological complications at this stage can be diverse. In some patients, manifestations include generalized paresis of the insane, which results in personality changes, changes in emotional affect, hyperactive reflexes, and Argyll-Robertson pupil. This is a diagnostic sign in which the small and irregular pupils constrict in response to focusing the eyes, but not to light. Tabes dorsalis, also known as locomotor ataxia, a disorder of the spinal cord, often results in a characteristic shuffling gait. See below for more information about neurosyphilis.
Cardiovascular complications include syphilitic aortitis, aortic aneurysm, aneurysm of sinus of Valsalva, and aortic regurgitation. Syphilis infects the ascending aorta causing aortic dilation and aortic regurgitation. This can be heard with a stethoscope as a heart murmur. Contraction of the tunica intima leads to a tree bark appearance that is wrinkly. The aortic valve dilation and subsequent insufficiency leads to diastolic regurgitation and causes massive hypertrophy of the left ventricle. The heart grows so large (over 1000 grams) that the heart is termed cor bovinum (cow's heart). The course can be insidious, and heart failure may be the presenting sign after years of disease. The infection can also occur in the coronary arteries and cause narrowing of the vessels. Syphilitic aortitis can cause de Musset's sign,[10] a characteristic bobbing of the head in synchrony with the heartbeat. The clinical course of these cardiovascular effects causes mediastinal encroachment and secondary respiratory difficulties (dyspnea), difficulty swallowing (dyphagia), and persistent cough because of pressure on the recurrent laryngeal nerve triggering the cough reflex. Pain can stem from erosion of the ribs or vertebrae. Also, the cor bovinum can lead to coronary ostia obstruction and ischemia. The aneurysm developed during the disease course may also rupture leading to massive intrathoracic hemorrhage and likely death, although the most likely cause of death is the heart failure resulting from aortic regurgitation.
Neurosyphilis
Neurosyphilis refers to a site of infection involving the central nervous system (CNS). Neurosyphilis may occur at any stage of syphilis. Before the advent of antibiotics, it was typically seen in 25-35% of patients with syphilis.
Neurosyphilis is now most common in patients with HIV infection. Reports of neurosyphilis in HIV-infected persons are similar to cases reported before the HIV pandemic. The precise extent and significance of neurologic involvement in HIV-infected patients with syphilis, reflected by either laboratory or clinical criteria, have not been well characterized. Furthermore, the alteration of host immunosuppression by antiretroviral therapy in recent years has further complicated such characterization.
Approximately 35% to 40% of persons with secondary syphilis have asymptomatic central nervous system (CNS) involvement, as demonstrated by any of these on cerebrospinal fluid (CSF) examination:
An abnormal leukocyte cell count, protein level, or glucose level
Demonstrated reactivity to Venereal Disease Research Laboratory (VDRL) antibody test
Commonly called Brain Syphilis, Neurosyphilis dementia is also a psychiatric diagnosis wherein a multitude of atypical anti-psychotic medications are used to help control the patient's irrational behaviors—with limited success. The term is used in traditional classifications of organic disorders of the brain.
There are four clinical types of neurosyphilis:
Asymptomatic neurosyphilis
Meningovascular syphilis
General paresis[11]
Tabes dorsalis
The late forms of neurosyphilis (tabes dorsalis and general paresis) are seen much less frequently since the advent of antibiotics. The most common manifestations today are asymptomatic or symptomatic meningitis. Acute syphilitic meningitis usually occurs within the first year of infection; 10% of cases are diagnosed at the time of the secondary rash. Patients present with headache, meningeal irritation, and cranial nerve abnormalities, especially the optic nerve, facial nerve, and the vestibulocochlear nerve. Rarely, it affects the spine instead of the brain, causing focal muscle weakness or sensory loss.
Meningovascular syphilis occurs a few months to 10 years (average, 7 years) after the primary syphilis infection. Meningovascular syphilis can be associated with prodromal symptoms lasting weeks to months before focal deficits are identifiable. Prodromal symptoms include unilateral numbness, paresthesias, upper or lower extremity weakness, headache, vertigo, insomnia, and psychiatric abnormalities such as personality changes. The focal deficits initially are intermittent or progress slowly over a few days. However, it can also present as an infectious arteritis and cause an ischemic stroke, an outcome more commonly seen in younger patients. Angiography may be able to demonstrate areas of narrowing in the blood vessels or total occlusion.
General paresis, otherwise known as general paresis of the insane, is a severe manifestation of neurosyphilis. It is a chronic dementia that ultimately results in death in as little as 2–3 years. In general, patients have progressive personality changes, memory loss, and poor judgment. In more rare instances, they can have psychosis, depression, or mania. Imaging of the brain usually shows atrophy.
Diagnosis
Poster for treatment of syphilis, showing a man and a woman bowing their heads in shame (ca. 1936).
It is only in the 20th century that effective tests and treatments for syphilis were developed. Microscopy of fluid from the primary or secondary lesion using darkfield illumination can diagnose treponemal disease with high accuracy. As there are other treponemes that may be confused with T. pallidum, care must be taken in evaluating with microscopy to correlate symptoms with the correct disease.
Star Wars themed parade float promoting syphilis testing at a 2005 parade in Seattle, Washington, United States.
Present-day syphilis screening tests, such as the Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests are cheap and fast but not completely specific, as many other conditions can cause a positive result. These tests are routinely used to screen blood donors. It can be noted that the spirochete that causes syphilis does not survive the conditions used to store blood, and the number of transfusion transmitted cases of syphilis is minuscule; but the test is used to identify donors that might have contracted HIV from high risk sexual activity. The requirement to test for syphilis has been challenged due to the vast improvements in HIV testing. False positives on the rapid tests can be seen in viral infections (Epstein-Barr, hepatitis, varicella, measles), lymphoma, tuberculosis, malaria, Chagas Disease, endocarditis, connective tissue disease, pregnancy, intravenous drug abuse, or contamination.[6] As a result, these two screening tests should always be followed up by a more specific treponemal test. Tests based on monoclonal antibodies and immunofluorescence, including Treponema pallidum hemagglutination assay (TPHA) and Fluorescent Treponemal Antibody Absorption (FTA-ABS) are more specific and more expensive. Unfortunately, false positives can still occur in related treponomal infections such as yaws and pinta. Tests based on enzyme-linked immunosorbent assays are also used to confirm the results of simpler screening tests for syphilis.
Neurosyphilis is diagnosed by finding high numbers of leukocytes in the CSF or abnormally high protein concentration in the setting of syphilis infection.[6] In addition, CSF should be tested with the VDRL test although some advocate using the FTA-ABS test to improve sensitivity. There is anecdotal evidence that the incidence of neurosyphilis is higher in HIV patients, and some have recommended that all HIV-positive patients with syphilis should have a lumbar puncture to look for asymptomatic neurosyphilis.[12]
Other Treponematoses
Treponematoses are diseases caused by species of the spirochete Treponema. In addition to Syphilis, this group includes:
Yaws is a tropical disease characterized by an infection of the skin, bones and joints; it is caused by Treponema pallidum subspecies pertenue.
Pinta - caused by Treponema pallidum subspecies carateum.
Bejel - caused by Treponema pallidum subspecies endemicum.
Prevention
While abstinence from any sexual activity is very effective at helping prevent syphilis, it should be noted that T. pallidum readily crosses intact mucosa and cut skin, including areas not covered by a condom. Proper and consistent use of a latex condom may be effective against the spread of syphilis through sexual contact, although this cannot be guaranteed due to the ease with which non-genital body parts can be infected.[13]
Individuals sexually exposed to a person with primary, secondary, or early latent syphilis within 90 days preceding the diagnosis should be assumed to be infected and treated for syphilis, even if they are currently seronegative. If the exposure was more than 90 days before the diagnosis, presumptive treatment is recommended if serologic testing is not immediately available or if follow-up is uncertain. Patients with syphilis of unknown duration and nontreponemal serologic titers ≥1:32 may be considered as having early syphilis for purposes of partner notification and presumptive treatment of sex partners. Long-term sex partners of patients with late syphilis should be evaluated clinically and serologically and treated appropriately. All patients with syphilis should be tested for HIV. Patient education is important, as well.
Treatment
APPLICATION OF MERCURY.
The first-choice treatment for all manifestations of syphilis remains penicillin in the form of penicillin G.[14] The effect of penicillin on syphilis was widely known before randomized clinical trials were used; as a result, treatment with penicillin is largely based on case series, expert opinion, and years of clinical experience. Parenteral penicillin G is the only therapy with documented effect during pregnancy. For early syphilis, one dose of penicillin is sufficient.
Non-pregnant individuals who have severe allergic reactions to penicillin (e.g., anaphylaxis) may be effectively treated with oral tetracycline or doxycycline; however, data to support this is limited. Ceftriaxone may be considered as an alternative therapy, although the optimal dose is not yet defined. However, cross-reactions in penicillin-allergic patients with cephalosporins such as ceftriaxone are possible. Azithromycin was suggested as an alternative. However, there have been reports of treatment failure due to resistance in some areas.[15] If compliance and follow-up cannot be ensured, the CDC recommends desensitization with penicillin followed by penicillin treatment. All pregnant women with syphilis should be desensitized and treated with penicillin. Follow-up includes clinical evaluation at 1 to 2 weeks followed by clinical and serologic evaluation at 3, 6, 9, 12, and 24 months after treatment.
Azithromycin has been used to treat syphilis in the past because of easy once-only dosing. However, in one study in San Francisco, azithromycin-resistance rates in syphilis, which were 0% in 2000, were 56% by 2004.[16]
Late latent and infections of unknown duration
Late latent syphilis is defined as latency for greater than one year. If CSF examination yields no evidence of neurosyphilis, then penicillin G is recommended in weekly doses for 3 weeks. If allergic, then tetracycline or doxycycline may also be used for this stage, but for 28 days instead of the normal 14. As with before, the data to support use of tetracycline and ceftriaxone are limited.
Treatment of neurosyphilis
For patients diagnosed with neurosyphilis including ocular or auditory syphilis with or without positive CSF results, aqueous crystalline penicillin G is the treatment of choice. The recommended regimen is intravenous treatment every 4 hours or continuously for 10–14 days. If intravenous administration is not possible, then procaine penicillin is an alternative (administered daily with probenecid for two weeks). Procaine injections are painful, however, and patient compliance may be difficult to ensure. To approximate the 21-day course of therapy for late latent disease and to address concerns about slowly dividing treponemes, most experts now recommend 3 weekly doses of benzathine penicillin G after the completion of a 14-day course of aqueous crystalline or aqueous procaine penicillin G for neurosyphilis. No oral antibiotic alternatives are recommended for the treatment of neurosyphilis. The only alternative that has been studied and shown to be effective is intramuscular ceftriaxone daily for 14 days.
Monday, June 13, 2011
HIV AIDS
Alternative regimens
Alternative regimens such as tetracyclines are not well studied in HIV infection and a careful follow-up is recommended. Tetra-cyclines are contraindicated in pregnancy.
HIV-infected patients with early syphilis may have a higher risk of neurological complications and a higher rate of treatment failure with currently recommended regimens. The magnitude of these risks, however, although not precisely defined, is probably small. Skin testing or desensitization is recommended in latent syphilis and neurosyphilis in other patients with HIV infection.
Jarisch-Herxheimer reaction
Before administering any treatment, clinicians should warn all patients about the possibility of a Jarisch-Herxheimer reaction, which occurs most often in secondary syphilis and with penicillin therapy, and may be more common in HIV-infected patients.[17] This reaction is characterized by fever, fatigue, and transient worsening of any mucocutaneous symptoms, and usually subsides within 24 hours. These symptoms can be alleviated with acetaminophen (paracetamol) and should not be mistaken for drug allergy. In addition, clinicians should inform HIV-infected patients that currently recommended regimens may be less effective for them than for patients without HIV infection and that close serologic follow-up is therefore essentia
HIV AIDS
HIV, is the virus that causes acquired immune deficiency syndrome (AIDS). The virus weakens a person's ability to fight infections and cancer. People with HIV are said to have AIDS when they develop certain infections or cancers or when their CD4 count is less than 200. CD4 count is determined by a blood test in a doctor's office.
Having HIV does not always mean that you have AIDS. It can take many years for people with the virus to develop AIDS. HIV and AIDS cannot be cured. Although people with AIDS will likely one day die from an AIDS-related illness, there are ways to help people stay healthy and live longer.
HOW DOES HIV AND AIDS CAUSE ILLNESS?
HIV attacks and destroys a type of white blood cell called a CD4 cell. This cell's main function is to fight disease. When a person's CD4 cell count gets low, they are more susceptible to illnesses.
WHAT IS AIDS?
AIDS is the final stage of HIV infection. When the immune system CD4 cells drop to a very low level, a person's ability to fight infection is lost. In addition, there are several conditions that occur in people with HIV infection with this degree of immune system failure—these are called AIDS defining illnesses.
HOW DO PEOPLE GET HIV?
A person gets HIV when an infected person's body fluids (blood, semen, fluids from the vagina or breast milk) enter his or her bloodstream. The virus can enter the blood through linings in the mouth, anus or sex organs (the penis and vagina), or through broken skin.
Both men and women can spread HIV. A person with HIV can feel okay and still give the virus to others. Pregnant women with HIV also can give the virus to their babies.
COMMON WAYS PEOPLE GET HIV:
Sharing a needle to take drugs
Having unprotected sex with an infected person
YOU CANNOT GET HIV FROM:
Touching or hugging someone who has HIV/AIDS
Public bathrooms or swimming pools
Sharing cups, utensils, or telephones with someone who has HIV/AIDS
Bug bites
WHO CAN GET HIV?
Anyone can get HIV if they engage in certain activities. You may have a higher risk of getting HIV if you:
Have unprotected sex. This means vaginal or anal intercourse without a condom or oral sex without a latex barrier with a person infected with HIV.
Share needles to inject drugs or steroids with an infected person. The disease can also be transmitted by dirty needles used to make a tattoo or in body piercing.
Receive a blood transfusion from an infected person. This is very unlikely in the U.S. and Western Europe, where all blood is tested for HIV infection.
Are born to a mother with HIV infection. A baby can also get HIV from the breast milk of an infected woman.
If you fall into any of the categories above, you should consider being tested for HIV.
Health care workers are at risk on the job and should take special precautions. Some health care workers have become infected after being stuck with needles containing HIV-infected blood or less frequently, after infected blood contact with an open cut or through splashes into the worker's eyes or inside their nose.
HOW CAN I KNOW IF I HAVE HIV?
The only way to know if you have HIV is to take an HIV test. Most tests looks for signs of HIV in your blood. A small sample of blood is taken from your arm. The blood is sent to a lab and tested for HIV. There are other tests available that check for HIV in the urine and oral fluid. The urine test is not very sensitive. There are currently two FDA approved oral fluid tests. They are OraSure and OraQuick Advance.
Because of the inaccurate results, the FDA has not approved any of the home-use HIV tests which allow people to interpret their tests in a few minutes at home. There is however a Home Access test approved which can be found at most drugstores. In this test blood from a finger prick is placed on a card and sent to a licensed laboratory. Consumers are given an identification number to use when phoning for results and have the opportunity to speak with a counselor if desired.
Clinics that do HIV tests keep your test results secret. Some clinics even perform HIV tests without ever taking your name (anonymous testing). You must go back to the clinic to get your results. A positive test means that you have HIV. A negative test means that no signs of HIV were found in your blood.
Before taking an HIV test:
Ask the clinic what privacy rules it follows
Think about how knowing you have HIV would change your life
Ask your doctor or nurse any questions you have about HIV, AIDS or the HIV test
WHO SHOULD BE TESTED?
Currently, it is recommended that people who engage in risky behaviors such as unprotected sex, needle-sharing—and all pregnant women be tested for HIV infection.
DOES HIV HAVE SYMPTOMS?
Some people get flu-like symptoms a month or two after they have been infected. These symptoms often go away within a week to a month. A person can have HIV for many years before feeling ill.
As the disease progresses, both women and men may experience yeast infections on the tongue (thrush), and women may develop severe vaginal yeast infections or pelvic inflammatory disease
WHAT ARE THE SYMPTOMS OF AIDS?
Signs that HIV is turning into AIDS include:
A fever that won't go away
Sweating while you sleep
Feeling tired all the time (not from stress or lack of sleep)
Feeling sick all the time
Losing weight
Swollen glands (neck, groin or underarms)
WHAT INFECTIONS DO PEOPLE WITH AIDS GET?
People with AIDS are extremely vulnerable to infection, called AIDS defining illnesses, and often exhibit the following conditions:
Kaposi's sarcoma, a skin tumor that looks like dark purple blotches
Mental changes and headaches due to fungal infections or tumors in the brain and spinal cord.
Shortness of breath and difficulty breathing due to infections of the lungs
Dementia
Severe malnutrition
Chronic diarrhea
HOW IS AIDS DIAGNOSED?
If a person with HIV infection has a CD4 count that drops below 200—or if certain infections appear (AIDS defining illnesses)—that person is considered to have AIDS.
HOW IS HIV TREATED?
We've come along way from the days when diagnosis with HIV equaled a death sentence. Today, there are a variety of treatments that, when used in combination can significantly slow down and in some cases stop altogether, the progression of HIV infection.
After HIV infection is confirmed, your doctor will start you on a drug regimen consisting of several drugs; combinations of different types of anti-HIV drugs sometimes are called HAART, for highly-active anti-retroviral therapy (HIV is a kind of virus called a retrovirus).
Unfortunately, taking HAART therapy isn't easy. These drugs must be taken at exactly the right time, every single day. If the drugs aren't taken appropriately, a range of side effects may occur, including: diarrhea, nausea, or abnormal distribution of body fat. And, the virus often mutates, or changes, making the treatments ineffective.
If your disease has progressed to AIDS, your treatment may also include drugs to combat and prevent certain infections.
HOW DO I KNOW IF MY HIV TREATMENTS ARE WORKING?
Your doctor can monitor how well your treatment is working by measuring the amount of HIV in your blood (also called the viral load.) The goal is to get the viral load so low with HAART treatment as to be undetectable.
HOW CAN I KEEP FROM GETTING HIV?
The best way to protect yourself is to avoid activities that put you at risk. There's no way to tell by looking at someone if he or she has HIV. Always protect yourself.
Use latex condoms (rubbers) whenever you have any type of sex (vaginal, anal, or oral).
Don't use condoms made from animal products.
Use water-based lubricants (lotion). Oil-based lubricants can weaken condoms.
Never share needles to take drugs.
Avoid getting drunk or high. People who are drunk or high may be less likely to protect themselves.
HOW CAN I PREVENT HIV FROM PROGRESSING TO AIDS?
You can help prolong your life by taking good care of yourself and insisting on good medical care from a doctor experienced at treating people with HIV infection. Also be consistent about taking your HIV medications as prescribed.
Alternative regimens such as tetracyclines are not well studied in HIV infection and a careful follow-up is recommended. Tetra-cyclines are contraindicated in pregnancy.
HIV-infected patients with early syphilis may have a higher risk of neurological complications and a higher rate of treatment failure with currently recommended regimens. The magnitude of these risks, however, although not precisely defined, is probably small. Skin testing or desensitization is recommended in latent syphilis and neurosyphilis in other patients with HIV infection.
Jarisch-Herxheimer reaction
Before administering any treatment, clinicians should warn all patients about the possibility of a Jarisch-Herxheimer reaction, which occurs most often in secondary syphilis and with penicillin therapy, and may be more common in HIV-infected patients.[17] This reaction is characterized by fever, fatigue, and transient worsening of any mucocutaneous symptoms, and usually subsides within 24 hours. These symptoms can be alleviated with acetaminophen (paracetamol) and should not be mistaken for drug allergy. In addition, clinicians should inform HIV-infected patients that currently recommended regimens may be less effective for them than for patients without HIV infection and that close serologic follow-up is therefore essentia
HIV AIDS
HIV, is the virus that causes acquired immune deficiency syndrome (AIDS). The virus weakens a person's ability to fight infections and cancer. People with HIV are said to have AIDS when they develop certain infections or cancers or when their CD4 count is less than 200. CD4 count is determined by a blood test in a doctor's office.
Having HIV does not always mean that you have AIDS. It can take many years for people with the virus to develop AIDS. HIV and AIDS cannot be cured. Although people with AIDS will likely one day die from an AIDS-related illness, there are ways to help people stay healthy and live longer.
HOW DOES HIV AND AIDS CAUSE ILLNESS?
HIV attacks and destroys a type of white blood cell called a CD4 cell. This cell's main function is to fight disease. When a person's CD4 cell count gets low, they are more susceptible to illnesses.
WHAT IS AIDS?
AIDS is the final stage of HIV infection. When the immune system CD4 cells drop to a very low level, a person's ability to fight infection is lost. In addition, there are several conditions that occur in people with HIV infection with this degree of immune system failure—these are called AIDS defining illnesses.
HOW DO PEOPLE GET HIV?
A person gets HIV when an infected person's body fluids (blood, semen, fluids from the vagina or breast milk) enter his or her bloodstream. The virus can enter the blood through linings in the mouth, anus or sex organs (the penis and vagina), or through broken skin.
Both men and women can spread HIV. A person with HIV can feel okay and still give the virus to others. Pregnant women with HIV also can give the virus to their babies.
COMMON WAYS PEOPLE GET HIV:
Sharing a needle to take drugs
Having unprotected sex with an infected person
YOU CANNOT GET HIV FROM:
Touching or hugging someone who has HIV/AIDS
Public bathrooms or swimming pools
Sharing cups, utensils, or telephones with someone who has HIV/AIDS
Bug bites
WHO CAN GET HIV?
Anyone can get HIV if they engage in certain activities. You may have a higher risk of getting HIV if you:
Have unprotected sex. This means vaginal or anal intercourse without a condom or oral sex without a latex barrier with a person infected with HIV.
Share needles to inject drugs or steroids with an infected person. The disease can also be transmitted by dirty needles used to make a tattoo or in body piercing.
Receive a blood transfusion from an infected person. This is very unlikely in the U.S. and Western Europe, where all blood is tested for HIV infection.
Are born to a mother with HIV infection. A baby can also get HIV from the breast milk of an infected woman.
If you fall into any of the categories above, you should consider being tested for HIV.
Health care workers are at risk on the job and should take special precautions. Some health care workers have become infected after being stuck with needles containing HIV-infected blood or less frequently, after infected blood contact with an open cut or through splashes into the worker's eyes or inside their nose.
HOW CAN I KNOW IF I HAVE HIV?
The only way to know if you have HIV is to take an HIV test. Most tests looks for signs of HIV in your blood. A small sample of blood is taken from your arm. The blood is sent to a lab and tested for HIV. There are other tests available that check for HIV in the urine and oral fluid. The urine test is not very sensitive. There are currently two FDA approved oral fluid tests. They are OraSure and OraQuick Advance.
Because of the inaccurate results, the FDA has not approved any of the home-use HIV tests which allow people to interpret their tests in a few minutes at home. There is however a Home Access test approved which can be found at most drugstores. In this test blood from a finger prick is placed on a card and sent to a licensed laboratory. Consumers are given an identification number to use when phoning for results and have the opportunity to speak with a counselor if desired.
Clinics that do HIV tests keep your test results secret. Some clinics even perform HIV tests without ever taking your name (anonymous testing). You must go back to the clinic to get your results. A positive test means that you have HIV. A negative test means that no signs of HIV were found in your blood.
Before taking an HIV test:
Ask the clinic what privacy rules it follows
Think about how knowing you have HIV would change your life
Ask your doctor or nurse any questions you have about HIV, AIDS or the HIV test
WHO SHOULD BE TESTED?
Currently, it is recommended that people who engage in risky behaviors such as unprotected sex, needle-sharing—and all pregnant women be tested for HIV infection.
DOES HIV HAVE SYMPTOMS?
Some people get flu-like symptoms a month or two after they have been infected. These symptoms often go away within a week to a month. A person can have HIV for many years before feeling ill.
As the disease progresses, both women and men may experience yeast infections on the tongue (thrush), and women may develop severe vaginal yeast infections or pelvic inflammatory disease
WHAT ARE THE SYMPTOMS OF AIDS?
Signs that HIV is turning into AIDS include:
A fever that won't go away
Sweating while you sleep
Feeling tired all the time (not from stress or lack of sleep)
Feeling sick all the time
Losing weight
Swollen glands (neck, groin or underarms)
WHAT INFECTIONS DO PEOPLE WITH AIDS GET?
People with AIDS are extremely vulnerable to infection, called AIDS defining illnesses, and often exhibit the following conditions:
Kaposi's sarcoma, a skin tumor that looks like dark purple blotches
Mental changes and headaches due to fungal infections or tumors in the brain and spinal cord.
Shortness of breath and difficulty breathing due to infections of the lungs
Dementia
Severe malnutrition
Chronic diarrhea
HOW IS AIDS DIAGNOSED?
If a person with HIV infection has a CD4 count that drops below 200—or if certain infections appear (AIDS defining illnesses)—that person is considered to have AIDS.
HOW IS HIV TREATED?
We've come along way from the days when diagnosis with HIV equaled a death sentence. Today, there are a variety of treatments that, when used in combination can significantly slow down and in some cases stop altogether, the progression of HIV infection.
After HIV infection is confirmed, your doctor will start you on a drug regimen consisting of several drugs; combinations of different types of anti-HIV drugs sometimes are called HAART, for highly-active anti-retroviral therapy (HIV is a kind of virus called a retrovirus).
Unfortunately, taking HAART therapy isn't easy. These drugs must be taken at exactly the right time, every single day. If the drugs aren't taken appropriately, a range of side effects may occur, including: diarrhea, nausea, or abnormal distribution of body fat. And, the virus often mutates, or changes, making the treatments ineffective.
If your disease has progressed to AIDS, your treatment may also include drugs to combat and prevent certain infections.
HOW DO I KNOW IF MY HIV TREATMENTS ARE WORKING?
Your doctor can monitor how well your treatment is working by measuring the amount of HIV in your blood (also called the viral load.) The goal is to get the viral load so low with HAART treatment as to be undetectable.
HOW CAN I KEEP FROM GETTING HIV?
The best way to protect yourself is to avoid activities that put you at risk. There's no way to tell by looking at someone if he or she has HIV. Always protect yourself.
Use latex condoms (rubbers) whenever you have any type of sex (vaginal, anal, or oral).
Don't use condoms made from animal products.
Use water-based lubricants (lotion). Oil-based lubricants can weaken condoms.
Never share needles to take drugs.
Avoid getting drunk or high. People who are drunk or high may be less likely to protect themselves.
HOW CAN I PREVENT HIV FROM PROGRESSING TO AIDS?
You can help prolong your life by taking good care of yourself and insisting on good medical care from a doctor experienced at treating people with HIV infection. Also be consistent about taking your HIV medications as prescribed.
GONORRHEA
Gonorrhea, also spelt gonorrhoea (and once known as the clap), is a sexually transmitted infection caused by the bacterium Neisseria gonorrheoae. It affects both men and women and can infect the cervix, urethra, rectum, anus and throat. Gonorrhea is one of the most common sexually transmitted diseases (STDs). Global gonorrhea statistics show that an estimated 62.35 million cases of gonorrhea occur each year, affecting more women than men. Gonorrhea is easily curable but if left untreated it can cause serious health problems such as pelvic inflammatory disease (PID), which can lead to abdominal pain and ectopic pregnancy in women. Untreated, gonorrhea can also lead to infertility, meningitis andsepticaemia.
GONORRHEA SYMPTOMS
Symptoms of gonorrhea infection may appear 1 to 14 days after exposure, although it is possible to be infected with gonorrhea and have no symptoms. Men are far more likely to notice symptoms as they are more apparent. It is estimated that nearly half of the women who become infected with gonorrhea experience no symptoms, or have non-specific symptoms such as a bladder infection.
Gonorrhea symptoms can include:
WOMEN
a change in vaginal discharge; it may appear in abundance, change to a yellow or greenish colour, and develop a strong smell.
a burning sensation or pain whilst passing urine.
irritation and/or discharge from the anus.
MEN
a white or yellow discharge from the penis.
a burning sensation or pain whilst passing urine.
irritation and/or discharge from the anus.
To see pictures of gonorrhea visit our STD pictures page.
HOW IS GONORRHEA PASSED ON?
Gonorrhea is passed on through penetrative sex, including:
vaginal sex.
anal sex.
oral sex :oral sex can either transmit gonorrhea from the genitals to the throat of the person giving the stimulation, or it can pass an infection from the throat to the genitals of the person receiving stimulation.
Less often it can be transmitted by:
a person using their mouth and tongue to lick or suck another person's anus.
a person putting fingers into the vagina, anus or mouth of someone infected with gonorrhea, then touching their own mouth, genitals or anus without washing their hands in between.
WHERE TO GO FOR HELP
If you have any symptoms or you are worried you may have been infected with gonorrhea, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can.
Some countries have specific sexual health clinics that can help you directly.
TESTS FOR GONORRHEA
To test for gonorrhea an examination of the genital area will be carried out by a doctor or nurse and samples will be taken, using a cotton wool swab or sponge, from any infected areas - the cervix, urethra, anus or throat. Women will also be given an internal pelvic examination, similar to a smear test. A sample of urine may be taken.
None of these tests are painful, but they may cause minor discomfort. If a person has had anal sex, it is important that they tell the doctor so that a swab can be taken from the rectum. They should also tell the doctor if they have had oral sex so swabs can be taken from the throat.
If a person suspects they have been exposed to gonorrhea, they can have a test as soon as they want to.
DIAGNOSIS AND TREATMENT
Samples taken during the examination will be sent to a laboratory to be tested for the bacterium Neisseria gonorrheae and will usually be available within a week. This may vary depending on which country the patient is in. Some sexual health clinics have rapid testing services to provide immediate results. In these clinics the doctor will check the sample for gonorrhea bacteria under a microscope to confirm an infection straight away.
Treatment is easy and essential. The patient will be given an antibiotic in tablet, liquid or injection form.
If the patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, it is very important that the doctor is informed as this may affect treatment options. Once a course of treatment is started it is important to complete it, even if symptoms diminish, to ensure the infection is cured.
The doctor or health advisor will discuss the gonorrhea infection and answer any questions. They will also want to know about any partners the patient has had sexual contact with as they will also be at risk of having gonorrhea and should be tested.
The patient should not have penetrative sex until they have returned to the clinic and it is confirmed that the infection is gone. The doctor or health adviser will inform the patient which sexual activities are safe.
Follow-up
Once the patient has completed the course of treatment for gonorrhea, they should return to the clinic or their doctor for a check-up.
Some types of gonorrhea are resistant to certain antibiotics. Further tests will be done to make sure that the infection has cleared. If it has not then different, usually stronger, antibiotics will be prescribed.
COMPLICATIONS
WOMEN
Gonorrhea can cause Pelvic Inflammatory Disease (PID), an inflammation of the fallopian tubes (the tubes along which an egg passes to get to the womb) which increases the future risk of ectopic pregnancy (a pregnancy outside the womb) or premature birth.
If a woman is pregnant and has gonorrhea when giving birth, the infection may be passed on to her child. The baby could be born with a gonoccocal eye infection, which must be treated with antibiotics as it can cause blindness. It is better for the woman to get treatment before giving birth.
MEN
Gonorrhea can cause painful inflammation of the testicles and the prostate gland, potentially leading to epididymitus, which can cause infertility.
Without treatment, a narrowing of the urethra or abscesses can develop after time. This causes considerable pain and problems whilst urinating.
Once gonorrhea has been successfully treated it will not come back unless the person becomes reinfected.
PREVENTION
Using latex or polyurethrane condoms during sex can reduce the chances of getting or passing on gonorrhea. Latex condoms are proven to be over 99% effective when used consistently and correctly.
Ways to further reduce the risk of gonorrhea transmission include regularly visiting a sexual health clinic for check ups, having fewer sexual partners, and ensuring that all partners have been checked for STDs.
GONORRHEA SYMPTOMS
Symptoms of gonorrhea infection may appear 1 to 14 days after exposure, although it is possible to be infected with gonorrhea and have no symptoms. Men are far more likely to notice symptoms as they are more apparent. It is estimated that nearly half of the women who become infected with gonorrhea experience no symptoms, or have non-specific symptoms such as a bladder infection.
Gonorrhea symptoms can include:
WOMEN
a change in vaginal discharge; it may appear in abundance, change to a yellow or greenish colour, and develop a strong smell.
a burning sensation or pain whilst passing urine.
irritation and/or discharge from the anus.
MEN
a white or yellow discharge from the penis.
a burning sensation or pain whilst passing urine.
irritation and/or discharge from the anus.
To see pictures of gonorrhea visit our STD pictures page.
HOW IS GONORRHEA PASSED ON?
Gonorrhea is passed on through penetrative sex, including:
vaginal sex.
anal sex.
oral sex :oral sex can either transmit gonorrhea from the genitals to the throat of the person giving the stimulation, or it can pass an infection from the throat to the genitals of the person receiving stimulation.
Less often it can be transmitted by:
a person using their mouth and tongue to lick or suck another person's anus.
a person putting fingers into the vagina, anus or mouth of someone infected with gonorrhea, then touching their own mouth, genitals or anus without washing their hands in between.
WHERE TO GO FOR HELP
If you have any symptoms or you are worried you may have been infected with gonorrhea, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can.
Some countries have specific sexual health clinics that can help you directly.
TESTS FOR GONORRHEA
To test for gonorrhea an examination of the genital area will be carried out by a doctor or nurse and samples will be taken, using a cotton wool swab or sponge, from any infected areas - the cervix, urethra, anus or throat. Women will also be given an internal pelvic examination, similar to a smear test. A sample of urine may be taken.
None of these tests are painful, but they may cause minor discomfort. If a person has had anal sex, it is important that they tell the doctor so that a swab can be taken from the rectum. They should also tell the doctor if they have had oral sex so swabs can be taken from the throat.
If a person suspects they have been exposed to gonorrhea, they can have a test as soon as they want to.
DIAGNOSIS AND TREATMENT
Samples taken during the examination will be sent to a laboratory to be tested for the bacterium Neisseria gonorrheae and will usually be available within a week. This may vary depending on which country the patient is in. Some sexual health clinics have rapid testing services to provide immediate results. In these clinics the doctor will check the sample for gonorrhea bacteria under a microscope to confirm an infection straight away.
Treatment is easy and essential. The patient will be given an antibiotic in tablet, liquid or injection form.
If the patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, it is very important that the doctor is informed as this may affect treatment options. Once a course of treatment is started it is important to complete it, even if symptoms diminish, to ensure the infection is cured.
The doctor or health advisor will discuss the gonorrhea infection and answer any questions. They will also want to know about any partners the patient has had sexual contact with as they will also be at risk of having gonorrhea and should be tested.
The patient should not have penetrative sex until they have returned to the clinic and it is confirmed that the infection is gone. The doctor or health adviser will inform the patient which sexual activities are safe.
Follow-up
Once the patient has completed the course of treatment for gonorrhea, they should return to the clinic or their doctor for a check-up.
Some types of gonorrhea are resistant to certain antibiotics. Further tests will be done to make sure that the infection has cleared. If it has not then different, usually stronger, antibiotics will be prescribed.
COMPLICATIONS
WOMEN
Gonorrhea can cause Pelvic Inflammatory Disease (PID), an inflammation of the fallopian tubes (the tubes along which an egg passes to get to the womb) which increases the future risk of ectopic pregnancy (a pregnancy outside the womb) or premature birth.
If a woman is pregnant and has gonorrhea when giving birth, the infection may be passed on to her child. The baby could be born with a gonoccocal eye infection, which must be treated with antibiotics as it can cause blindness. It is better for the woman to get treatment before giving birth.
MEN
Gonorrhea can cause painful inflammation of the testicles and the prostate gland, potentially leading to epididymitus, which can cause infertility.
Without treatment, a narrowing of the urethra or abscesses can develop after time. This causes considerable pain and problems whilst urinating.
Once gonorrhea has been successfully treated it will not come back unless the person becomes reinfected.
PREVENTION
Using latex or polyurethrane condoms during sex can reduce the chances of getting or passing on gonorrhea. Latex condoms are proven to be over 99% effective when used consistently and correctly.
Ways to further reduce the risk of gonorrhea transmission include regularly visiting a sexual health clinic for check ups, having fewer sexual partners, and ensuring that all partners have been checked for STDs.
CHLAMYDIA
Chlamydia is actually a group of different infections caused by different strains of the Chlamydia bacterium:
Chlamydia pneumonia causes a type of walking pneumonia
Chlamydia psittaci causes a type of pneumonia caused by birds
Chlamydia trachomatis causes various sexually transmitted diseases.
Chlamydia trachomatis is currently one of the most common and widespread bacterial STDs in the United States. It is estimated that more than 4 million people are infected each year. Rates of Chlamydia in the United States are highest in the West and Midwest, with Missouri having above average numbers.
As many as 1 in 10 adolescent girls tested for Chlamydia is infected.
Teenage girls have the highest rates of Chlamydia infection regardless of demographics or location:
15-19 year old girls 46% of infections
20-24 year old women 33% of infections
Chlamydia infection is widespread geographically and highly prevalent among these economically disadvantaged young women between 16 and 24 years old.
People infected with Chlamydia often have no symptoms therefore are often unaware they are infected and may not seek professional health care.
Approximately:
50% of men
75% of women
Chlamydial Infection
Chlamydial infection is a curable sexually transmitted disease (STD), which can be transmitted
during oral, vaginal, or anal sex with an infected partner, from a mother to her newborn baby during delivery.
When diagnosed, Chlamydia can be easily treated and cured. Untreated, Chlamydia can cause serious long and short term health problems in men and women as well as in newborn babies of infected mothers, including pelvic inflammatory disease (PID), which can cause:
Infertility
Tubal pregnancy (which can sometimes be fatal)
Chlamydia may also result in problems for the newborn such as:
neonatal conjunctivitis, pneumonia
SYMPTOMS
Asymptomatic
It is called Asymptomatic if there are no symptoms.
In the beginning Chlamydia may not make you feel anything so you may not even know you have it. It can just come and go.
Those who do notice that they have this infection will have certain symptoms for weeks or months, depending on the severity of the infection and whether treatment was undertaken early, or not at all. But, as it gets worse, you will begin to experience different symptoms
In Pre-puberty Girls
Vaginal discharge and odor (Vaginitis)
In Post-puberty Girls
Discharge (off-white) and odor which comes from the cervix being infected In Women
Chlamydia is often silent in women, with up to 90% of women asymptomatic. Women can carry the bacteria for months or even years without knowing it. This makes screening very import
Symptoms can start to occur within 3 weeks after getting the infection and include the following:
Constant lower abdominal pain
Mild, milky or yellow mucus-like vaginal discharge
Nausea and fever
Pain during urination
Pain during sexual intercourse
Spotting between periods
Chlamydia can also lead to:
Cervicitis which is inflammation of the cervix.
Salpingitis which is inflammation of the fallopian tubes
Ectopic Pregnancy
If a pregnant woman has Chlamydia trachomatis the risk of an Ectopic pregnancy is much higher. This is where the fetus does not grow in the womb but in the ectopic tubes.
Chlamydia can silently linger for months without symptoms and the infection may move inside the body if it is not treated, where it may cause:
Epidydimitis in men
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) causes:
infertility
chronic pain
even death
In men
Chlamydia causes something called NON-SPECIFIC URETHRITIS (NSU) which can produce symptoms such as:
Burning on urination (non-gonoccocal urethritis (NGU))
Groin pain and swelling (Epididymitis)
Irritation around opening of the penis
Mild, sticky, milky or mucus-like discharge from penis
Pain when urinating
Swollen testes (which if not treated can lead to infertility)
Testicular pain Symptoms may seem to "come and go"
In babies
1/4 of babies passing down the infected birth canal will get Chlamydia Pneumonia
1/2 of all babies born to infected women after delivery through the birth canal will develop Chlamydial Conjunctivitis (pink eye) a week after birth
In severe cases blindness may occur
The bacteria can be easily passed to the developing child within the uterus
The child may have respiratory diseases for a long time if not treated
Other conditions:
The infection can occur in the Pharynx (throat) from oral-genital contact
The infection can be spread to the eyes causing inflammation of the lining of the eye (pink eye)
In tropical climates, a particular strain of C. trachomatis causes an STD called Lymphogranuloma venereum (LGV) which can get into the skin through tiny cuts.
After months or years it can spread to other lymph nodes causing:
Genital problems
Pain
Proctitis (inflamed rectum)
Skin breakdown (ulceration)
Swelling
TRANSMISSION
The bacteria causing the infection is transmitted by direct person-to-person contact through:
Blood
Passing it to a baby during birth
Semen from the penis
Touching eyes when infected
Vaginal fluid
Risk Groups
Babies (from infected mothers)
Sexually active people, regardless of their sexual preference
Sexually active teenagers (about 45%)
DIAGNOSIS
If you have certain symptoms or feel differently to how you normally feel and have been with an infected person, go to a doctor for confirmation.
Chlamydial infection can be confused with Gonorrhea because the symptoms of both diseases are similar and in some situations they occur together.
Laboratory Tests
A sample of the patient's genital secretions is tested in a laboratory using one of a wide variety of quick and inexpensive laboratory tests
Culture
Growing the organism in specialized tissue culture is one of the most definitive tests.
These tests are:
Difficult to do
Expensive
Test results not available for 3-7 days
DNA amplification
A process called DNA amplification is used to detect the genes of the organisms in genital secretions (urine). This method does not require an invasive sample, pelvic examination or swabbing of the penis
These tests are:
Less expensive
More rapid
Performed during a routine checkup
Slightly less accurate
Results available within 24 hours
Amplicor Chlamydia Trachomatis Test
Recently, a new Chlamydia test became available called Amplicor Chlamydia Trachomatis Test, which is carried out using:
A sample of a man's urine
A swab from a woman's cervix or urethra
Results are available within 4 hours and not 3-7 days
PREVENTION
Due to lack of symptoms people who are infected with Chlamydia may unknowingly infect their sex partners.
If you are sexually active, you can lower your risk by following these guidelines:
Abstinence is the only way to be 100% sure of protection from Chlamydia and other sexually transmitted diseases
Drugs reduce your ability to make sensible decisions, such a:
becoming sexually intimate when drinking alcohol and/or taking drugs
Condoms or diaphragms should be used during sexual intercourse:
anal, oral, vaginal
Form a monogamous relationship
be tested before you have sex
both partners are faithful
Limit your number of sexual partners
risk increases as number of partners increases
Persons who have more than one sex partner, especially women under 25, should be tested regularly
Regular check-ups for STD's
do not wait for symptoms to appear
testing should be part of your regular examination
Recommendations
Annual screening of all sexually active females under 20 years of age
Pregnant women should be tested
Women with infection of the cervix should be tested
Screening of women over 20 with one or more risk factors for Chlamydia:
Diaphragm contraception
Lack of condom
Multiple sex partners
New sex partner
TREATMENT
Chlamydia can be in your body for a very long time unless treated with antibiotics. Usually this consists of a 7-10 day treatment program.
A number of antibiotics are used to treat Chlamydial infections including:
Amoxicillin
Azithromycin (one-day course)
Doxycycline (seven day course)
Erythromycin
Tetracycline (some people are allergic to the drug)
Ofloxacin
able to be used during pregnancy
Note
* Penicillin is not effective against Chlamydial infections
* The prescribed medication should be taken, even after symptoms disappear, until advised by your health practitioner
* All sexual partners of a person with Chlamydial infection need to be evaluated and treated to prevent re-infection
Screening and treatment of Chlamydia:
decreases the incidence of complications, such as Pelvic Inflammatory Disease (PID)
reduces the prevalence of lower genital tract infection
Pelvic Inflammatory Disease
If Chlamydia is untreated up to 40% of women with the infection will develop Pelvic Inflammatory Disease (PID), a serious infection of the reproductive organs.
As many as half of all cases of Pelvic Inflammatory Disease (PID) may be due to Chlamydial infection, often without symptoms, producing scarring of the fallopian tubes which can:
block the tubes and prevent fertilization occurring
interfere with the passage of the fertilized egg down into the uterus causing the egg to implant in the fallopian tube (ectopic or tubal pregnancy)
threaten the life of the mother and fetus
Pelvic Inflammatory Disease (PID) is the most common cause of pregnancy-related death among poor teenagers in the inner cites and rural areas
EFFECTS
Complications
When treated early, there are no long term consequences of Chlamydia. Serious complications can result however when left untreated.
In men
Long term complications may include:
Epididymitis - an inflammation of the testicles that can cause sterility
Prostatitis - an infection of the prostate gland
Reiter's Syndrome - an autoimmune, arthritis-like condition
Sterility
In women
Long term complication may include:
Pelvic Inflammatory Disease
an infection that spreads from the vagina and cervix to the the lining of the uterus and fallopian tubes and can lead to sterility
Perihepatitis
an infection around the liver
Reiter's Syndrome
an automimmune, arthritis-like condition
Sterility
Long term complication in infants may include:
Blindness
Ear infections
Eye infections
Pneumonia
Death
Effects of Chlamydia in Pregnancy & Newborns
Pregnancy
Of women with Pelvic inflammatory Disease caused by the Chlamydia infection, 9% will have a life-threatening tubal (ectopic pregnancy). Tubal pregnancy is the leading cause of first-trimester, pregnancy-related deaths in American women
Newborns
Chlamydia infection during pregnancy can result in Neonatal Conjunctivitis (eye infection) usually within the first ten days
Symptoms include:
eye discharge
swollen eyelids
Chlamydia infection during pregnancy can also result in Pneumonia, usually with 3-6 weeks
Symptoms include:
a progressively worsening cough
congestion
Both conditions can be treated successfully with antibiotics
Routine testing of pregnant women for Chlamydial infection is recommended because of the risks to newborn babies.
Chlamydia pneumonia causes a type of walking pneumonia
Chlamydia psittaci causes a type of pneumonia caused by birds
Chlamydia trachomatis causes various sexually transmitted diseases.
Chlamydia trachomatis is currently one of the most common and widespread bacterial STDs in the United States. It is estimated that more than 4 million people are infected each year. Rates of Chlamydia in the United States are highest in the West and Midwest, with Missouri having above average numbers.
As many as 1 in 10 adolescent girls tested for Chlamydia is infected.
Teenage girls have the highest rates of Chlamydia infection regardless of demographics or location:
15-19 year old girls 46% of infections
20-24 year old women 33% of infections
Chlamydia infection is widespread geographically and highly prevalent among these economically disadvantaged young women between 16 and 24 years old.
People infected with Chlamydia often have no symptoms therefore are often unaware they are infected and may not seek professional health care.
Approximately:
50% of men
75% of women
Chlamydial Infection
Chlamydial infection is a curable sexually transmitted disease (STD), which can be transmitted
during oral, vaginal, or anal sex with an infected partner, from a mother to her newborn baby during delivery.
When diagnosed, Chlamydia can be easily treated and cured. Untreated, Chlamydia can cause serious long and short term health problems in men and women as well as in newborn babies of infected mothers, including pelvic inflammatory disease (PID), which can cause:
Infertility
Tubal pregnancy (which can sometimes be fatal)
Chlamydia may also result in problems for the newborn such as:
neonatal conjunctivitis, pneumonia
SYMPTOMS
Asymptomatic
It is called Asymptomatic if there are no symptoms.
In the beginning Chlamydia may not make you feel anything so you may not even know you have it. It can just come and go.
Those who do notice that they have this infection will have certain symptoms for weeks or months, depending on the severity of the infection and whether treatment was undertaken early, or not at all. But, as it gets worse, you will begin to experience different symptoms
In Pre-puberty Girls
Vaginal discharge and odor (Vaginitis)
In Post-puberty Girls
Discharge (off-white) and odor which comes from the cervix being infected In Women
Chlamydia is often silent in women, with up to 90% of women asymptomatic. Women can carry the bacteria for months or even years without knowing it. This makes screening very import
Symptoms can start to occur within 3 weeks after getting the infection and include the following:
Constant lower abdominal pain
Mild, milky or yellow mucus-like vaginal discharge
Nausea and fever
Pain during urination
Pain during sexual intercourse
Spotting between periods
Chlamydia can also lead to:
Cervicitis which is inflammation of the cervix.
Salpingitis which is inflammation of the fallopian tubes
Ectopic Pregnancy
If a pregnant woman has Chlamydia trachomatis the risk of an Ectopic pregnancy is much higher. This is where the fetus does not grow in the womb but in the ectopic tubes.
Chlamydia can silently linger for months without symptoms and the infection may move inside the body if it is not treated, where it may cause:
Epidydimitis in men
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) causes:
infertility
chronic pain
even death
In men
Chlamydia causes something called NON-SPECIFIC URETHRITIS (NSU) which can produce symptoms such as:
Burning on urination (non-gonoccocal urethritis (NGU))
Groin pain and swelling (Epididymitis)
Irritation around opening of the penis
Mild, sticky, milky or mucus-like discharge from penis
Pain when urinating
Swollen testes (which if not treated can lead to infertility)
Testicular pain Symptoms may seem to "come and go"
In babies
1/4 of babies passing down the infected birth canal will get Chlamydia Pneumonia
1/2 of all babies born to infected women after delivery through the birth canal will develop Chlamydial Conjunctivitis (pink eye) a week after birth
In severe cases blindness may occur
The bacteria can be easily passed to the developing child within the uterus
The child may have respiratory diseases for a long time if not treated
Other conditions:
The infection can occur in the Pharynx (throat) from oral-genital contact
The infection can be spread to the eyes causing inflammation of the lining of the eye (pink eye)
In tropical climates, a particular strain of C. trachomatis causes an STD called Lymphogranuloma venereum (LGV) which can get into the skin through tiny cuts.
After months or years it can spread to other lymph nodes causing:
Genital problems
Pain
Proctitis (inflamed rectum)
Skin breakdown (ulceration)
Swelling
TRANSMISSION
The bacteria causing the infection is transmitted by direct person-to-person contact through:
Blood
Passing it to a baby during birth
Semen from the penis
Touching eyes when infected
Vaginal fluid
Risk Groups
Babies (from infected mothers)
Sexually active people, regardless of their sexual preference
Sexually active teenagers (about 45%)
DIAGNOSIS
If you have certain symptoms or feel differently to how you normally feel and have been with an infected person, go to a doctor for confirmation.
Chlamydial infection can be confused with Gonorrhea because the symptoms of both diseases are similar and in some situations they occur together.
Laboratory Tests
A sample of the patient's genital secretions is tested in a laboratory using one of a wide variety of quick and inexpensive laboratory tests
Culture
Growing the organism in specialized tissue culture is one of the most definitive tests.
These tests are:
Difficult to do
Expensive
Test results not available for 3-7 days
DNA amplification
A process called DNA amplification is used to detect the genes of the organisms in genital secretions (urine). This method does not require an invasive sample, pelvic examination or swabbing of the penis
These tests are:
Less expensive
More rapid
Performed during a routine checkup
Slightly less accurate
Results available within 24 hours
Amplicor Chlamydia Trachomatis Test
Recently, a new Chlamydia test became available called Amplicor Chlamydia Trachomatis Test, which is carried out using:
A sample of a man's urine
A swab from a woman's cervix or urethra
Results are available within 4 hours and not 3-7 days
PREVENTION
Due to lack of symptoms people who are infected with Chlamydia may unknowingly infect their sex partners.
If you are sexually active, you can lower your risk by following these guidelines:
Abstinence is the only way to be 100% sure of protection from Chlamydia and other sexually transmitted diseases
Drugs reduce your ability to make sensible decisions, such a:
becoming sexually intimate when drinking alcohol and/or taking drugs
Condoms or diaphragms should be used during sexual intercourse:
anal, oral, vaginal
Form a monogamous relationship
be tested before you have sex
both partners are faithful
Limit your number of sexual partners
risk increases as number of partners increases
Persons who have more than one sex partner, especially women under 25, should be tested regularly
Regular check-ups for STD's
do not wait for symptoms to appear
testing should be part of your regular examination
Recommendations
Annual screening of all sexually active females under 20 years of age
Pregnant women should be tested
Women with infection of the cervix should be tested
Screening of women over 20 with one or more risk factors for Chlamydia:
Diaphragm contraception
Lack of condom
Multiple sex partners
New sex partner
TREATMENT
Chlamydia can be in your body for a very long time unless treated with antibiotics. Usually this consists of a 7-10 day treatment program.
A number of antibiotics are used to treat Chlamydial infections including:
Amoxicillin
Azithromycin (one-day course)
Doxycycline (seven day course)
Erythromycin
Tetracycline (some people are allergic to the drug)
Ofloxacin
able to be used during pregnancy
Note
* Penicillin is not effective against Chlamydial infections
* The prescribed medication should be taken, even after symptoms disappear, until advised by your health practitioner
* All sexual partners of a person with Chlamydial infection need to be evaluated and treated to prevent re-infection
Screening and treatment of Chlamydia:
decreases the incidence of complications, such as Pelvic Inflammatory Disease (PID)
reduces the prevalence of lower genital tract infection
Pelvic Inflammatory Disease
If Chlamydia is untreated up to 40% of women with the infection will develop Pelvic Inflammatory Disease (PID), a serious infection of the reproductive organs.
As many as half of all cases of Pelvic Inflammatory Disease (PID) may be due to Chlamydial infection, often without symptoms, producing scarring of the fallopian tubes which can:
block the tubes and prevent fertilization occurring
interfere with the passage of the fertilized egg down into the uterus causing the egg to implant in the fallopian tube (ectopic or tubal pregnancy)
threaten the life of the mother and fetus
Pelvic Inflammatory Disease (PID) is the most common cause of pregnancy-related death among poor teenagers in the inner cites and rural areas
EFFECTS
Complications
When treated early, there are no long term consequences of Chlamydia. Serious complications can result however when left untreated.
In men
Long term complications may include:
Epididymitis - an inflammation of the testicles that can cause sterility
Prostatitis - an infection of the prostate gland
Reiter's Syndrome - an autoimmune, arthritis-like condition
Sterility
In women
Long term complication may include:
Pelvic Inflammatory Disease
an infection that spreads from the vagina and cervix to the the lining of the uterus and fallopian tubes and can lead to sterility
Perihepatitis
an infection around the liver
Reiter's Syndrome
an automimmune, arthritis-like condition
Sterility
Long term complication in infants may include:
Blindness
Ear infections
Eye infections
Pneumonia
Death
Effects of Chlamydia in Pregnancy & Newborns
Pregnancy
Of women with Pelvic inflammatory Disease caused by the Chlamydia infection, 9% will have a life-threatening tubal (ectopic pregnancy). Tubal pregnancy is the leading cause of first-trimester, pregnancy-related deaths in American women
Newborns
Chlamydia infection during pregnancy can result in Neonatal Conjunctivitis (eye infection) usually within the first ten days
Symptoms include:
eye discharge
swollen eyelids
Chlamydia infection during pregnancy can also result in Pneumonia, usually with 3-6 weeks
Symptoms include:
a progressively worsening cough
congestion
Both conditions can be treated successfully with antibiotics
Routine testing of pregnant women for Chlamydial infection is recommended because of the risks to newborn babies.
Saturday, June 11, 2011
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