Sexually Transmitted Diseases (STDs)

HIV and AIDS are the most feared of all the sexually transmitted diseases and generally the first to come to mind. The other STDs are more prevalent, though. In order to prevent any STD it is important to know how they are spread, the common symptoms and how they are treated. STDs affect women and men of all races, backgrounds and economic levels. About 2/3 of these infections are diagnosed in people under the age of 25.

The incidence of STDs is rising. People are likely to have more sexual partners throughout their lifetime than in the past, which increases the risk of STDs. Young people are becoming sexually active earlier, they're getting married later and divorce is more common.

Many STDs have no symptoms, especially in women. These infections can still be spread to sexual partners. Health problems caused by sexually transmitted diseases tend to be more severe for women than men. Some STDs, especially chlamydia and gonorrhea, can spread from the vagina to the uterus and fallopian tubes causing PID- pelvic inflammatory disease. The scarring left by PID can lead to infertility or ectopic pregnancies (a pregnancy outside the uterus which if not terminated early can lead to death.) HPV can cause cervical cancer and other cancers of the genitals. Undiagnosed STDs can be passed from mother to baby before and during delivery. Some infections are easily cured while others can lead to permanent impairment or death.

To prevent STDs:

• Arm yourself with information. Learn to recognize the symptoms in yourself or partner.
• Do not have sex if you or your partner have symptoms of an STD and have not seen a health professional.
• Ask your partner about exposure to STDs.
• Use condoms correctly and consistently.
• Have regular checkups for STDs, even in the absence of symptoms.
• There is a vaccine available for Hepatitis B.

You may be at high risk for sexually transmitted diseases if:

• You have had more than one sexual partner in your lifetime.
• You know or suspect your partner has had sex with other partners.
• You have shared IV drug needles, or have had sex with someone who has.
• You received blood between 1978 and March of 1985 or have had sex with someone who has.
• you have had sexual contact with a hemophiliac.
• You have had an STD in the past.

If you think you are at risk for a sexually transmitted disease - get tested. Any information you share with your healthcare professional is confidential. When diagnosed early almost all STDs can be treated effectively if not cured. It is important to always finish all the treatment prescribed.

Click on link below to go to appropriate category:

• Chlamydia
• Gonorrhea
• Genital Herpes
• Syphilis
• Hepatitis
• Molluscum Contagiosum
• Pubic Lice/Crabs
• Venereal Warts
• HIV/AIDS

Chlamydia

Chlamydia is one of the most common sexually transmitted infections in the US, affecting 3-5 million women and men a year. It has been referred to as a "silent epidemic" because the infection has no symptoms in 2/3 of all infected women and half of the infected men. 46% of females with chlamydia are between the ages of 15 and 19 years. Women between the ages of 20 to 24 represent about 33%.

The bacteria that cause chlamydia in the US, chlamydia trachomatis, can infect the mucous membranes in the penis, vagina, cervix, anus, urethra or eye. Chlamydia can be a serious health threat for women. In women, the infection generally begins on the cervix. Untreated the infection can spread to the fallopian tubes or ovaries causing PID (pelvic inflammatory disease.) PID can result in sterility by scarring and blocking the fallopian tubes. In men, chlamydia can cause epididymitis if it spreads from the urethra to the testicles. Untreated, epididymitis can cause sterility in men.

Symptoms

Unfortunately, chlamydia often has no symptoms. When there are symptoms, they may begin in as few as five to ten days following exposure.

Symptoms for women may include:

• bleeding between periods
• vaginal bleeding after intercourse
• abdominal pain
• painful intercourse
• low grade fever
• painful urination
• cervical inflammation
• abnormal vaginal discharge
• mucopurulent cervicitis (MPC) - a yellowish discharge from the cervix that may have a foul odor.

Untreated chlamydia can lead to pelvic inflammatory disease. The symptoms of PID include:

• lower abdominal pain
• fever
• vomiting
• abnormal mucus discharge
• longer and/or heavier periods
• increased cramping with periods
• pain during intercourse
• fatigue, weakness

In men the symptoms are similar to the symptoms for gonorrhea. They may appear early in the day and be mild so men may not take them seriously. The symptoms may include:

• pus, watery or milky discharge from the penis
• pain or burning with urination
• redness and swelling in the testicles

In men and women, chlamydia affecting the rectum can cause itching, bleeding, mucus discharge and diarrhea. Touching the eye with infectious secretions can cause an eye infection characterized by redness, itching and a discharge.

Diagnosis

In women chlamydia is diagnosed through examination of the cervix and cervical discharge. A lab culture of cells taken from the cervix, urethra, penis or anus can be sent to the laboratory.

A pap test cannot diagnose chlamydia, but it may indicate that a chlamydia test would be appropriate.

Treatment

Chlamydia is a treatable infection if treated promptly and appropriately. Both partners must be treated at the same time. Chlamydia is treated with antibiotics - most commonly those of the tetracycline or erythromycin families.

When being treated for chlamydia, remember:

• Take all the prescribed medication. Symptoms may go away before all the bacteria are eradicated from your body.
• Make sure your partner is treated at the same time you are so you don't re-infect each other.
• Make a follow-up visit for a "test of cure" to be sure the bacteria are gone before resuming sexual intercourse.
• Don't share your medicine with anyone.

Affects of Chlamydia on Pregnancy

20-50% of children born to women with chlamydia will be infected. The infants may develop ear infections, eye infections that can lead to blindness, and pneumonia. Ear and respiratory infections in infants caused by chlamydia are harder to treat than chlamydia infections in adults.

Chlamydia infections may also cause heavy bleeding before delivery.

[return to top]

Gonorrhea

Gonorrhea is a curable sexually transmitted disease caused by the bacterium Neisseria gonorrhea. Gonorrhea is spread through sexual intercourse, whether it is vaginal, oral or anal. Gonorrhea can also be passed to a newborn during delivery.

As with chlamydia, gonorrhea is a leading cause of infertility. The most common site of initial infection in women is the cervix and the urethra. If left untreated, the infection can spread to the uterus and fallopian tubes resulting in PID (pelvic inflammatory disease.) PID causes scarring of the fallopian tubes, which may lead to infertility or ectopic pregnancy, in which a fertilized egg us implanted outside the uterus, most frequently in the fallopian tube. Ectopic pregnancy can be life threatening.

Symptoms

The symptoms of gonorrhea usually appear two days to three weeks after exposure to the infection. Unfortunately, you can be infected for months and never know it. Sometimes when symptoms do occur, they are mild.

Women may have:

• a vaginal discharge
• painful, burning sensation with urination
• lower abdominal pain and fever
• pain with intercourse

If the symptoms are ignored and the infection goes untreated, the bacteria can spread to the uterus, fallopian tubes and ovaries causing PID (pelvic inflammatory disease.) PID causes scarring that can lead to infertility or ectopic pregnancies.

Men may have:

• painful burning sensation with urination
• milky white to yellow discharge from the penis
• redness and swelling around the opening of the penis
• pain and swelling in the testicles

Diagnosis

Gonorrhea is diagnosed from a DNA test using swab specimens from the cervix, rectum, throat or urethra.

Treatment

The infection can be cured by antibiotics. It is important to complete all the medication, even if you have no symptoms or your symptoms go away. All partners must be treated at the same time, you should abstain from intercourse until both of you have finished the medication.

Pregnancy

Pregnant women with gonorrhea are at increased risk of premature delivery. Transmission to the infant during birth can cause severe eye infections.

[return to top]

Genital Herpes

Genital herpes is a contagious viral infection, most often acquired through sexual contact. The viruses that cause genital herpes are related to the group of viruses that include chicken pox and mononucleosis. HSV1 (Herpes Simplex Virus 1) most commonly causes sores around the mouth while HSV2 (Herpes Simplex Virus 2) is associated with sores on the genitals. Both viruses, though, can cause sores around the mouth or on the genitals.

It is estimated that 45 million Americans harbor the HSV virus; this is one of every four Americans. As many as 75% of the people infected with genital herpes may be asymptomatic. They can unknowingly pass the infection onto their sexual partners.

Herpes is passed through skin-to-skin contact with the affected area with someone who is infected, generally during sexual activity. HSV can be introduced to the genital area through oral sex. About 20% of the new outbreaks of genital herpes are the result of oral sex. The virus is spread rarely if ever, through contact with bath towels, toilet seats or hot tubs. The virus does not survive long outside the human body. Once the virus enters the genital area it camps out in the nerves at the base of the spine until it is stimulated to grow again.

The severity and length of herpes outbreaks varies from person to person. The outbreaks usually become less frequent over time.

Symptoms

The classic symptom of a genital herpes outbreak is a cluster of painful ulcers on the labia and/or buttocks. As many as 2/3 of all men and women infected with herpes never have any symptoms, or have mild symptoms that they mistake for a rash or mosquito bite. The remaining 1/3 are not so lucky.

About 2 to 10 days after the herpes virus enters the body, flu-like symptoms may appear. These include swollen glands, fever, chills, muscle aches, fatigue and nausea. Ulcers begin as small red bumps that advance to painful fluid filled blisters. These blisters rupture becoming ulcers that ooze and bleed. After 3-4 days scabs form and the ulcers heal without scarring. The first episode lasts from 2 to 3 weeks.

After the initial outbreak heals, the virus remains in the body, hiding in the nerves at the base of the spinal cord in an inactive state. Periodically it can travel through the nerves to the skin at or near the site of the original outbreak. On the skin the virus multiples and new sores erupt. The virus can also reactivate with no outward signs. At these times the virus can still shed and infect a sexual partner.

The recurrent episodes are generally milder than the initial outbreak and usually last about a week. Often there is a prodrome, or warning symptoms, signaling an outbreak is on the way. Prodromal symptoms include a tingling sensation or itching at the site of infection, pain in the buttocks or down a leg. Sometimes only the prodrome appears, no visible sores erupt or the blisters are very small and barely visible. At other times the red spots develop into open sores that crust over then go away.

Some people may recognize only one to two outbreaks in their lifetime; others may have several outbreaks a year. The number and pattern of outbreaks usually change over time. Researchers do not yet understand why some people have many outbreaks, or why others have so few. They do not yet know what makes the virus reactivate. It is thought the reoccurrences can be brought on by physical or emotional stress, menstruation or immunosuppression.

Diagnosis

The most common methods used to diagnose genital herpes are a viral culture and a test for viral DNA. For either test a swab of fluid is taken from an active lesion. The tests must be performed before the ulcers scab over. A negative test result does not necessarily mean that herpes is not present. If the lesion appears clinically to be genital herpes, caution should be taken as though the test was positive. If another outbreak occurs, the ulcers should be tested at the earliest sign.

There are blood tests available to test for the presence of HSV-1 and HSV-2 antibodies. Because the body in response to infection makes antibodies, the blood test may not be positive until several weeks after exposure. The blood test is also not site specific, therefore especially in the case of HSV-1, the test may be picking up cold sores.

Treatment

Although there is no cure for herpes, there are several prescription medications that can lessen the severity of the symptoms and decrease the length of the outbreak. The medications interfere with the ability of the virus to reproduce itself. The medications work best if taken at the first sign of an outbreak during the prodrome.

People with recurrent infections (6 or more per year), or who will be delivering a baby soon, may want to take the medication daily to help prevent outbreaks.

Any time there is an active herpes outbreak it is important to follow a few simple rules to help speed healing and to help prevent transferring the infection to other sites on the body (self inoculation) or to other people.

• Keep the area clean and dry to prevent a secondary infection. A portable blow dryer can be used to dry the area after showering or a bath. Panties with a cotton crotch should be worn to allow air to circulate.
• Avoid touching the sores, wash your hands after any contact with the sores.
• Avoid sexual contact from the time the symptoms first are recognized until the sores are completely healed.

Herpes in Pregnancy

All women who are pregnant should tell their healthcare provider if she or her partner has a history of herpes. During pregnancy the initial or recurrent infections can be more severe.

Babies born to women during an HSV outbreak may become infected. Most infants who are infected came into contact with the virus as they passed through the birth canal. Infection with the herpes virus can cause serious skin infections, damage to the nervous system, blindness, mental retardation or death.

The risk to the newborn is the highest if this is the mother's primary outbreak. Usually if there are no active sores at the time of labor the baby can be delivered vaginally. If there is an active infection a Cesarean section may be recommended.

Medication such as acyclovir may be given during the last month of pregnancy to prevent an outbreak close to delivery.

[return to top]

Syphilis

Syphilis is a sexually transmitted disease caused by a small spiral-shaped bacteria call Treponema pallidum. Where syphilis once caused devastating epidemics, it now can be easily diagnosed by a blood test and effectively treated with antibiotics. Syphilis occurs in stages. The disease is more easily spread in some stages than in others.

Syphilis is spread through sexual or skin-to-skin contact with someone who is in an infectious stage where the symptoms are present. Syphilis spreads through open sores or rashes containing bacteria that can penetrate the mucous membranes of the genitals, mouth or anus. The bacterium is very fragile, the infection is almost always spread by sexual contact.

Symptoms

Once the bacteria enter the body, the disease may progress through four stages depending on when the treatment is initiated. Left untreated, syphilis can cause blindness, insanity, paralysis, heart disease or death. Symptoms can appear within 10 to 90 days following exposure. The symptoms of syphilis are divided into four stages.

1) Primary Stage

The first sign of syphilis is usually a painless ulcer called a chancre. The chancre may look like a pimple, blister or an open sore. The chancre makes its appearance usually at or near the place where the bacteria entered the body. The chancre may occur inside the body where it will go unnoticed. Only about 10% of the women who develop chancres notice them. The disease is highly contagious during this stage. With or without treatment, the sore will heal (usually within 1 to 5 weeks) but the bacteria within the body will continue to increase and spread. About 1/3 of the people infected will progress to chronic stages.

2) Secondary Syphilis

About 2 weeks to 6 months after the chancre is gone a rash appears consisting of brown sores about the size of a penny. The rash is almost always on the palms of the hands and soles of the feet, but could also appear on other parts of the body. At this stage any physical contact, sexual or nonsexual, with the broken skin of the infected person may spread the disease. The rash usually heals within several weeks to months. Other symptoms that may occur include mild fever, fatigue, headaches, sore throat, swollen lymph glands, loss of appetite, hair loss, muscle, and joint or bone pain. The symptoms tend to be mild, may come and go over the next one to two years and will disappear without treatment.

3) Latent Stage

During this stage the disease is not contagious and there are no symptoms. This stage may last many years. Many people who are not treated will have no further evidence of the disease. Approximately 1/3 of those who have secondary syphilis will go on to develop tertiary syphilis.

4) Tertiary Syphilis

During this stage the bacteria will cause damage to the heart, eyes, brain, nervous system, bones, joints or almost every other part of the body. There can be symptoms such as slurred speech, paralysis, insanity or senility. If left untreated tertiary syphilis can cause death. This stage can last for years, even decades. This is not an infectious stage.

Neurosyphilis

The syphilis bacteria frequently invade the nervous system during the early stages of syphilis. Approximately 3% to 7% of untreated persons with syphilis will develop neurosyphilis during the early stages of syphilis. Symptoms may include headache, stiff neck and fever due to the inflammation of the lining of the brain. Some people develop seizures. If the blood vessels are affected, symptoms of a stroke may develop with numbness, weakness or visual complaints. The time from infection to developing neurosyphilis can be as long as 20 years. The course of neurosyphilis and the treatment may be different with patients with HIV infection.

Diagnosis

There are three ways to diagnose syphilis. 1) A doctor's recognition of the signs and symptoms, 2) microscopic identification of the syphilis bacteria collected from a surface scraping of an ulcer or chancre or 3) blood tests (the most common way to diagnose syphilis.) A blood test may show a false negative test for up to 3 months after infection. There may be a false positive test result in people with an autoimmune disorder (such as Lupus.)

Treatment

Syphilis is usually treated with penicillin given by injection. There are other antibiotics that can be used in patients who are allergic to penicillin. The disease usually becomes non-infectious 24 hours after beginning therapy. Because some people don't respond to the usual dose of penicillin it is important to have follow up blood tests. Those with neurosyphilis may need to be tested for up to two years following treatment.

Antibiotics can cure syphilis in all stages, but in tertiary syphilis damage already done to organs of the body cannot be reversed.

Effects of Syphilis in Pregnant Women

Syphilis crosses the placenta to the fetus after 16-18 weeks gestation. About 1/4 of affected pregnancies result in stillbirth or neonatal death.

Some infants with congenital syphilis display symptoms at birth, but most will develop symptoms between 2 weeks and 3 months later. The symptoms may include: skin sores, rashes, fever, weakened or hoarse crying sounds, swollen liver and spleen, jaundice (yellow skin and whites of the eyes), anemia and birth defects. If the infant is not treated early, blindness, brain damage and problems with growth and development may appear. As the children grow older and become teenagers they may develop late-stage syphilis including damage to their bones, teeth, eyes, ears and brain.

[return to top]

Hepatitis

Hepatitis is an inflammation of the liver. Viruses or other factors, including alcohol abuse, certain medications and trauma, can cause it. Some cases of hepatitis are not a serious threat to health, but the disease can become chronic and can lead to liver failure and death.

There are four major types of viral hepatitis:

• Hepatitis A - the infection caused by the hepatitis A virus is usually mild and does not become chronic. The virus is most commonly spread by food and water contamination, although it can be passed through sexual practices involving oral-anal contact.
• Hepatitis B - the infection caused by the hepatitis B virus (HBV) is most often passed to a sexual partner during sexual intercourse, especially during anal sex. HBV can also be passed through contact with infected blood (such as with shared needles or a needle stick with contaminated blood.) or from a mother to her newborn. The infection may be mild or severe acute or chronic.
• Non-A, Non-B - this infection is primarily caused by the Hepatitis C virus (HCV). The infection is usually mild, but is more likely than HBV to lead to chronic liver disease. With new blood donor screening tests, the likelihood of being infected with HCV has diminished. It is now most often contacted through shared needles or an accidental needle stick in a health care setting. Although it can be spread sexually, it is much less likely.
• Hepatitis E - this is another type of non-A, non-B hepatitis. The virus is usually found in areas with poor sanitation. It has not been found in the US and is not spread through sexual contact.
• Delta Hepatitis - the hepatitis D virus (HDV) only produces disease when HBV is present. Most cases have occurred in people who are frequently exposed to blood or blood products (hemophiliacs) or among drug users sharing contaminated needles.

Transmission

HBV, HCV and HDV are spread in the following ways:

1. Through sexual intercourse with a contaminated person without the use of a condom.
2. Sharing contaminated needles among users of injected street drugs.
3. Needle stick accidents in a health care setting.
4. Mother to child transmission of HBV during birth.
5. Transfusions of blood or blood products. Until recently blood transfusions were the most frequent cause of hepatitis C. Blood banks in the US now routinely screen donated blood for HBV and HCV. Tests for HBV also screen out HDV. Now the risk of acquiring hepatitis through a blood transfusion is very low.
6. Personal contact with an infected person. HBV, HCV and HDV can be spread to a household member if they come into contact with virus-infected blood or body fluids - usually through cuts and scrapes, semen (sexual intercourse without a condom) or by sharing personal items such as razor or toothbrush.

Symptoms

40% of those who have been infected with viral hepatitis have no symptoms. When symptoms are present they can range from mild to severe. The most common early symptoms are mild fever, headache, muscle aches, fatigue, loss of appetite, nausea, vomiting or diarrhea. Later symptoms may include dark and foamy urine and pale feces, abdominal pain, and jaundice (yellowing of the skin and the whites of the eyes.

Some patients with a more severe form of hepatitis B may develop short-term arthritis like symptoms. Many of those with HBV only develop flu-like symptoms. Very severe HBV is rare but can be life-threatening. Early signs, including personality changes and agitated behavior, require immediate medical attention.

Some people who are infected with HBV or HCV but have no symptoms become chronic carriers. There are an estimated 1.5 million HBV carriers in the US (300 million carriers worldwide.) About 90% of the babies infected at birth with HBV become chronic carriers. At least ½ of all HCV carriers, whether or not they had symptoms, go on to develop chronic liver disease.

Diagnosis

Several blood tests can detect HBV, HCV or HDV even before symptoms develop. A number of blood tests can also be performed to determine how well the liver is functioning.

Treatment

Bed rest, a healthy diet and no alcoholic beverages is generally the recommendation for treating the acute symptoms of viral hepatitis. Because it is a virus, not a bacteria, antibiotics will not cure viral hepatitis.

Interferon alpha may be used to treat chronic HBV and HCV. Interferon alpha is a genetically engineered form of a naturally occurring protein. The drug improves liver function and may decrease symptoms, although interferon alpha has its own side effects (headache, fever and flu-like symptoms.) Some patients don't respond to the drug, while with others the benefits decrease over time.

Pregnancy

HBV can be transmitted during childbirth. It is recommended that pregnant women receive a blood test to see if they are a chronic carrier of HBV. If a woman tests positive for HBV, the baby can receive hepatitis B immune globulin and a vaccination for HBV immediately after birth. Immune globulin offers temporary protection and the vaccine provides a longer lasting immunity.

[return to top]

Molluscum Contagiosum

Molluscum contagiosum is a benign viral infection of the skin. It most often affects young children who pass it to each other through saliva. In adults the virus is sexually transmitted and the lesions are usually on the genitals, lower abdomen, buttocks or inner thighs. The rash caused by molluscum contagiosum causes painless wart-like bumps. Molluscum is caused by a poxvirus. The rash usually develops 2 to 7 weeks after exposure. Molluscum is spread by direct contact with infected skin and can be spread to self or other people.

Symptoms

Molluscum causes normal skin to grow into bumps. There is no pain or discharge associated with the bumps unless they are accidentally cut.

Diagnosis

Diagnosis is made by observation by an experienced practitioner.

Treatment

Molluscum is treated by destroying the infected skin. The lesions can be destroyed using liquid nitrogen, a laser or by burning them off with an acid solution.

[return to top]

Pubic Lice, Crabs

Pediculosis is a tiny crab-like parasite that is usually found in the pubic hair of infected men and women and occasionally in the hair of the chest, armpits, eyelashes and eyebrows. The more common names are pubic lice or crabs. The lice survive on human blood. Usually the parasites are spread through sexual contact, although in a few cases they have been picked up through contact with infected bedding or clothing.

Symptoms

The main symptom is severe itching in the genital or other affected area. Scratching can transfer the lice to uninfected parts of the body.

Diagnosis

Diagnosis is easy because the lice are visible to the naked eye. They are the size of the head of a pin, oval and grayish, but appear reddish-brown when full of blood from their host. The nits, or tiny white eggs, are also visible clinging to the base of the pubic hair.

Treatment

Lotions and shampoos that kill pubic lice are available both over the counter and by prescription. Pregnant women should not use the over the counter products and should call their health care provider for advice. None of the drugs should be used in or around the eyes. An ophthalmic petroleum jelly should be used for lice in the eyebrows. All persons who also may be infected due to intimate contact should be treated. All clothing and bedding should be dry-cleaned or washed in very hot water (125 degrees F), dried at a high setting and ironed to rid them of any lice or nits. Pubic lice die within 24 hours of being separated from the body while the eggs may live up to six days.

[return to top]

Human Papilloma Virus and Condyloma (Venereal Warts)

HPV, or Human Papilloma Virus, may well be the STD of the new millennium. The virus has been studied for a relatively short time but already 80 different genotypes have been identified in the US. Approximately 20 to 30 are known to infect the genital area. Even though the viruses are not a reportable disease, it is believed that 60% of sexually active adults are infected with one or more types of the virus with an estimated 5.5 million new cases a year.

The virus was named "Papilloma virus" because they are known to cause warts, or papillomas. The strains of HPV that cause warts on the hands and feet are different from the strains that cause genital warts. Not all the viruses, though, cause warts. Sometimes the virus lives on the skin without showing any symptoms. Many people with HPV are not aware they are infected. There are strains of HPV that can cause cancers of the vulva or cervix in women, the penis in men or the anus in men and women.

The HPV types that are responsible for genital infections have been divided between "low risk" and "high risk" types, depending upon whether the virus type is associated with genital cancer.

HPV is usually transmitted by sexual contact. The time period between the exposure to the virus and any manifestation of symptoms is unknown. It can be anywhere from several weeks to years making it difficult to know exactly when a person is infected.

Condoms can help avoidance with the virus, but do not prevent it. The only parts of the genitals protected are those covered with latex.

Symptoms

The HPV types that are associated with genital infection are divided into two types - low risk and high risk, depending upon whether they are associated with genital cancers. Low risk HPV is usually associated with genital warts (also known as condyloma accuminata or venereal warts.) Genital warts are small pink or red bumps on the vulva, vagina, cervix penis shaft, urinary opening or anus. Generally they are painless, but there may be burning or bleeding when irritated. Genital warts tend to occur in clusters. They may grow into a cauliflower-like growth.

High risk HPV has been linked to various cancers in both women and men. Nearly all cases of cervical cancer are caused by a high risk HPV virus. These infections can not be seen with the naked eye.

Diagnosis

The diagnosis of genital warts is usually made by a healthcare professional who simply looks at the area. If there is a question the wart may be removed and sent to a pathologist at a lab for diagnosis.

Often HPV infection may first be suspected after an abnormal pap smear. On the basis of the abnormal pap, a colposcopy may be recommended. During this exam, a health care professional will apply acetic acid to the cervix to help identify HPV infection otherwise invisible to the eye. The solution causes "aceto-white patches" which are especially visible with the use of a colposcope. A colposcope is an instrument that looks like binoculars on a stand that is used to inspect the infected area under magnification. A biopsy may be taken to aid in the diagnosis.

There is a test available to detect the HPV DNA. The swab is taken of the vagina or cervix and sent to a laboratory. The test only indicates whether the virus is being shed at the place and during the time the test is performed. A negative test does not necessarily mean exposure to the virus has not taken place. The result of the DNA test indicates whether the viral DNA detected is low risk type or high risk.

Treatment

As with other viruses, there is no cure for HPV. Genital warts may come and go on their own, or may persist despite aggressive treatment. Treatment of genital warts is easiest when the warts are small and few in numbers.

None of the treatments discussed below will guarantee that the warts won't return and all treatments cause a local irritation. The goal with treatment of genital warts is to remove visible warts and annoying symptoms.

Treatments that are applied by a health care professional include:

• TCA (trichloracetic acid) is a chemical painted on the surface of the wart to destroy it. The acid may cause some localized burning as it dries. It takes weekly treatments for a number of weeks to get rid of the warts - they should turn white, shrink and disappear.
• Podophyllin is another chemical that can be painted on condyloma. It also causes burning as it dries and should be washed off with soap and water 4 to 6 hours after application.
• Other methods used to treat genital warts are cryotherapy (freezing the warts off) and laser therapy (burning the warts off with a beam of light).

There are a few new products that have been introduced that can treat the warts at home:

• Podofilox (Condylox) solution or gel can be applied at home twice a day for 3 days, followed by 4 days of no therapy. This regiment can be repeated up to four times.
• Imiquimod (Aldara) stimulates the immune system to target the warts. The cream is applied three times a week for up to 16 weeks.

Pregnancy

Genital warts can cause problems during pregnancy. Sometimes they enlarge, causing difficulty with urination. Warts on the wall of the vagina can cause obstruction with delivery.

There are safe ways to treat genital warts during pregnancy.

[return to top]

HIV and AIDS

AIDS (acquired immunodeficiency syndrome) is the most severe form of HIV (human immunodeficiency virus.) AIDS was first reported in 1981 and is now a worldwide epidemic. HIV progressively destroys the cells of the immune system thereby damaging the body's ability to fight off viruses, bacteria and fungus that cause disease. Opportunistic infections develop such as pneumonia, meningitis and certain types of cancers. The microbes causing the infections generally wouldn't cause illness in a healthy person; but for a person with a weakened immune system the infections can be life threatening.

An estimated 900,000 Americans are living with HIV currently. During the last ten years HIV infection among women has dramatically increased. In 1992 women made up 13 % of people with AIDS, in 1998 20% of the people living with AIDS were women. AIDS is the third leading cause of death for women in the US ages 25 to 44. In African-American women in this age group AIDS is the number one cause of death.

HIV is transmitted through the blood, semen or vaginal secretions of an infected person. HIV is usually spread by sexual contact with an infected person. It can also spread through sharing contaminated needles or syringes among drug users. Untreated women can pass the infection to their children during pregnancy, birth or through their breast milk.

Although HIV has been found in the saliva of infected people, but no evidence exists that the virus is passed through saliva. Saliva appears to have natural compounds that inhibit the infectiousness of HIV. Researchers have found no evidence that HIV is spread through urine, feces, sweat or tears. HIV is not passed through casual contact, through insect bites or stings.

The risk of acquiring HIV from an infected health care worker is extremely low. World wide there have been only two cases documented of an HIV-positive surgeon transmitting the virus to a patient.

Having another sexually transmitted disease such as herpes, gonorrhea, chlamydia or syphilis appears to make a person more susceptible to acquiring the virus through unprotected sex with an infected person.

Symptoms

Many people don't develop symptoms when they are first infected with HIV. Some people, though, develop a flu-like illness within a month or two of exposure to the virus. The symptoms - fever, malaise and enlarged lymph nodes - usually disappear within a week to a month and are commonly mistaken for other viral illnesses. People are very infectious during this period.

It can be a decade or more from the time the virus enters the body to when more severe symptoms appear. During this asymptomatic period, the virus is actively multiplying, infecting and killing cells of the immune system. The virus disables or destroys the T4 cells (or CD4+T cells), which are the immune system's key infection fighters.

AS the immune system deteriorates, complications begin to surface. One of the first symptoms to appear in many people are swollen glands, or enlarged lymph nodes, that remain swollen for longer than three months. Other symptoms that may begin to appear include fatigue, weight loss, frequent fevers and sweats, frequent yeast infections (vaginal and oral), persistent skin rashes or flaky skin, PID (pelvic inflammatory disease) that doesn't respond to medication or short term memory loss. Some people develop severe herpes sores in the mouth, genitals or anus.

Symptoms of AIDS

The most advanced stage of HIV infection is known as AIDS. In 1993 the CDC revised the definition of AIDS, to include all HIV infected people who have fewer than 200 T4 cells (healthy adults usually have 1,000 or more.) The definition also includes 25 conditions, mostly opportunistic infections, that affect people with advanced HIV disease. Opportunistic infections develop when the immune system can no longer fight off certain bacteria, viruses and other microbes. The infections can cause such symptoms as coughing, shortness of breath, seizures, mental confusion and forgetfulness, severe and persistent diarrhea, fever, vision loss, severe headaches, weight loss, extreme fatigue, nausea, vomiting, lack of coordination, coma, abdominal cramps, or difficult or painful swallowing.

People with AIDS are particularly prone to various cancers caused by viruses - Karposi's sarcoma, cervical cancer and lymphomas. These cancers are harder to treat and usually are more aggressive in people with AIDS.

Diagnosis

The first tests for HIV antibodies were developed to screen donated blood, then were expanded to test people at risk for HIV infection. There are two standard tests for HIV. The Enzyme Immunosorbent Assay (EIA) detects the antibodies that are produced in response to HIV infection. The western Blot test is a more specific test that can differentiate between HIV antibodies and other antibodies that can react to the EIA. If the EIA test result is positive, it will be repeated using the same blood sample. If that test is also positive then a Western Blot test will be performed on the same blood sample.

HIV antibodies usually do not reach detectable levels until one to three months following infection. It can take as long as 6 months to have enough antibodies created in large enough quantities to show up in standard blood tests.

People who think they have been exposed to HIV should be tested for HIV as soon as they are likely to have developed antibodies. Early testing allows treatment to begin at a time when they are most able to combat HIV and prevent opportunistic infections.

Treatment

The treatment for HIV has been rapidly evolving. The earlier HIV is detected the sooner treatment can be started. If initiated soon after the infection with the HIV virus, the initial viral surge can be decreased. The drugs can delay the gradual weakening of the immune system. The treatment may also reduce the chance of spreading the disease to a partner. The treatments not only decrease the amount of virus in the blood, but also in the bodily fluids.

The first group of drugs used to treat HIV infection are called nucleoside analog reverse transcriptase inhibitors (NRTIs). They work by interrupting an early stage of virus replication. The most well known of these drugs is AZT. These drugs may slow the spread of HIV in the body and delay the onset of opportunistic infections. These medications, though, do not prevent the spread of HIV to others. Non-nucleoside reverse transcriptase inhibitors (NNRTIs), the second group of drugs, also target the enzyme, but work in a different way. The third group of drugs, protease inhibitors, interrupt the virus from making copies of itself once it has entered a cell.

The drugs used do have side effects that can be serious. AZT can cause a decrease in red or white blood cells in the blood, especially in the later stages of the disease. The protease inhibitors can cause nausea, diarrhea and other GI symptoms. There can also be an abnormal distribution of body fat, especially paunches or bumps.

In 1996 a new test was introduced to monitor how well the body is responding to treatment. The viral load test measures the amount of HIV in the blood in terms of "copies per milliliter." A high normal load indicates the person is progressing towards AIDS, while a low viral load indicates the immune system is keeping the infection in check.

Pregnancy

Women can transmit the HIV virus to their babies during pregnancy, birth or through breastfeeding. One fourth to one third of all untreated women will pass the infection on to their babies. If the drug AZT is taken during pregnancy the risk of passing the virus to the child is reduced by two thirds. If AZT is used along with delivering the baby by cesarean section the infection rate is dropped to 1%. Women infected with the HIV virus should not breastfeed their babies.

[ return to top ]

meet our physicians  ::   our locations  ::   obstetric topics  ::   gynecologic topics
contact us  ::   make an appointment  ::   hospitals  ::   insurance and billing
our mission statement  ::   what's new  ::   homepage

design by matschca design, inc.
© Mt. Auburn Obstetrics and Gynecologic Associates, Inc.