Archive for March 27th, 2009

HOW IS SCABIES TRANSMITTED?

Transmission occurs through skin-to-skin contact with an infected person, either sexual or nonsexual, or through contact with bedding or clothing that has been in contact with an infected person. The infection is usually not transmitted through casual contact, for example in a workplace.

In adults, scabies is usually transmitted by sexual contact with an infected partner, but intercourse is not necessary to transmit scabies sexually. Children transmit scabies to one another through close physical contact. Multiple members of the same family frequently become infected, often through contact with the clothing or bedding of an infected person. Outbreaks sometimes occur in hospitals and nursing homes.

There is another type of scabies mite that can be transmitted from animals to humans, particularly from dogs. Outbreaks are not uncommon among entire families in which there is an infected dog. This scabies mite is different from the human scabies mite but can still cause infection in humans, as well as symptoms similar to those previously described. The human scabies mite does not infect animals, however, and the animal scabies mite cannot be transmitted from one person to another. The infection caused by the animal scabies mite resolves on its own without treatment.

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TESTING FOR HERPES: IMMUNODOT ASSAYS

The immunodot assay also looks for antibodies to a specific protein on the herpes virus. It has a sensitivity similar to that of the Western blot assay, and it will also correctly distinguish between HSV-1 and HSV-2. Like the Western blot assay, it is not 100 percent accurate, and it may take time—three weeks to six months after first infection—to show a positive result. Like the Western blot, this assay is useful for retesting a person whose culture was negative but whose symptoms strongly suggest herpes. If such a person notices another genital sore, he or she can either return to the health care provider as soon as possible for another culture or return in three to six months to have the blood test performed.

When genital sores or ulcers are present, other possible diagnoses must be considered. Syphilis, lymphogranuloma venereum, and chancroid are additional sexually transmitted diseases that can cause genital ulcers. In addition, certain medical conditions, such as the inflammatory bowel disorder called Crohn’s disease, can causegenital sores. The autoimmune disease Behcet’s syndrome can cause genital ulcers as well as oral ulcers and conjunctivitis.

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STD HPV IN PREGNANT WOMEN

Another way in which the virus can be transmitted is from mother to child. Infants can become infected in the womb (possibly through the amniotic fluid) or through contact with the virus at delivery. However, infection via these routes is very rare, especially given how common the virus is.

When a child is diagnosed with genital warts, it does not automatically mean that the child is a victim of sexual abuse, although this possibility must be investigated. Children can be infected at birth by mothers who are themselves carrying HPV, and, as already noted, the infection can take months or years to produce symptoms. Children can be infected through an inanimate object, such as a towel (which, as discussed previously, is possible but unlikely), or through close nonsexual contact with a family member who is infected. Each situation must be addressed individually.

If a mother has visible warts at delivery, she can pass the virus to her child, causing warts on the larynx (voice box) and occasionally on the eyes or genital area. Laryngeal warts are treatable, although this condition can be serious and recurrent in children. The virus can be passed on to the child even if there are no visible warts at delivery; given the large number of women infected with the virus, it is surprising how rarely this occurs. The virus can be passed to the fetus while in the womb, although this route of transmission is also thought to be very rare.

Having the HPV virus does not prevent a woman from becoming pregnant, nor does it increase her risk of a miscarriage or premature labor. However, the virus sometimes becomes more active during pregnancy. If extensive warts are present at delivery, a cesarean section may be recommended, especially if the warts are extensive enough to block the birth canal. This method of delivery may decrease the risk of HPV transmission to the child, although some babies born by cesarean section still develop warts on the larynx (possibly by transmission through the amniotic fluid in the womb). Therefore, a cesarean section is usually not recommended solely for the purpose of preventing transmission of the virus to the newborn. A better approach is to treat warts well before delivery so that they are not present during and cannot interfere with delivery.

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FOR SAFE OR SAFER SEX: AVOID HIGH-RISK BEHAVIORS AND HIGH-RISK PARTNERS

Several behaviors put people at highest risk for STDs, including having unprotected sex (especially with several partners), having unprotected sex with a prostitute, and sharing needles during injection drug use or body piercing and tattooing. A woman whose partner is bisexual may be at higher risk for becoming infected with a sexually transmitted infection if her male partner has had unprotected sex with male partners either while they are together or in the past. In addition to avoiding these behaviors yourself, you must choose your partners wisely, because not only are partners who engage in high-risk activity at risk for acquiring an infection themselves, they may infect any sexual partner they are with. A partner who has sex with other partners while you are together puts you at risk for sexually transmitted infections.

People who exchange sex for money or drugs, such as prostitutes, are at very high risk for transmitting STDs. Those who have sex with prostitutes have a high risk of acquiring infections. Any type of sexual contact—oral, anal, or genital—with a prostitute is high risk. If protection is used, then this risk is decreased, but condoms may break or leak, so there is still risk. Some people are under the erroneous assumption that receiving oral sex without a condom from a prostitute is safe. But if a person performs unprotected oral sex on many people, his or her throat can become a harbor for infection just like the genital or anal area.

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PROSTATE CANCER: PSA TEST CAN SAVE YOUR LIFE!

Why would anyone want to have a PSA test? Because it can save lives.

It’s true, many men out there do have prostate cancer that doesn’t do a whole lot, but just seems to percolate in the prostate without spreading. Are you one of those men? Are you willing to gamble, with your life, that you are? Or that you won’t live long enough for your prostate cancer to spread? Ideally, doctors would be able to tell the difference between harmless and aggressive tumors, and treat only the “bad” kind of cancer. However, as a Mayo Clinic urologist recently concluded: “Since we do not have the capability to reliably distinguish aggressive tumors from those that are clinically insignificant, one must assume that any prostate cancer identified in a man with a life expectancy of 10 years or more is potentially life-threatening, and should therefore be treated.” This doesn’t mean, as some would argue, that surgery—and particularly, unnecessary surgery—is the automatic next step; it isn’t, not by a long shot.

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