Causes:
Genital warts are caused by the HPV virus. Although there are more than 75 strains
of the virus, 2 strains (HPV 6 and HPV 11) are responsible for 90 percent of the
cases of genital warts. Approximately 8 more strains can cause genital warts and
ALSO have a higher potential for causing cancer. Strains HPV 16, 18, 31 and 45
together account for 80 percent of cervical and genital cancers.
Approximately 2 out of 3 of the people who have sexual contact with a person
infected with the HPV virus ALSO become infected with the HPV virus.
"The viral particles are able to penetrate the skin and mucosal surfaces through
microscopic abrasions in the genital area, which occur during sexual activity. Once
cells are invaded by HPV, a latency (quiet) period of months to years may occur."
The latency period just means the HPV virus is in an incubation period. Having sex
with a partner whose HPV infection is in the incubation period still leaves you
vulnerable to becoming infected yourself. In other words, just because one can't
see the genital warts, doesn't mean they are not there. The incubation period can
last from 3 months to 2 years.
Common warts (that usually appear on the hands) are caused by different strains of
the HPV virus and are not the same as genital warts.
Symptoms:
Genital warts are generally painless, but are a nuisance due to their location, size
and itching/irritation.
When genital warts grow from their incubation period, they often start out as small,
gray, pink, red or white swellings in the genital area. The often begin as single
lesions approximately 1 to 2 mm in size, but if left untreated, can rapidly grow in
clusters which when form together, can be large and appear similar to a cauliflower
head.
Besides itching, genital warts can cause pain during intercourse and in some cases,
bleeding.
• Lesions are visibly enhanced with the application of a chemical called acetic
acid solution which causes them to become white for about 5 to 10 minutes.
• A pap test for women can detect changes to the cervix which may occur as a
result of the HPV virus.
• Magnification, also called colposcopy, may be used to see lesions that are not
visible to the eye.
• Pelvic examination for women.
Treatment
Genital warts can be removed, however the HPV virus that causes genital warts can
not be cured. The virus continues to live inside your skin and may cause the warts
to return. Genital warts may need to be removed more than once.
• Cryotherapy: A process that uses liquid nitrogen to "freeze off" the warts.
• Loop electrosurgical excision procedure (LEEP) involves a sharp instrument,
shaped like a loop, which is passed underneath the wart and then used to cut
it out from the skin.
• Laser treatment to physically destroy the lesion.
• Electric current to physically destroy the lesions.
Besides physical removal, your doctor may prescribe certain topical medications
that are applied to the skin to treat the virus. As outlined by eMedicineHealth, these
include:
Prevention
Since no treatment for genital warts is 100 percent effective, prevention should be
a top concern whether you are infected with the HPV virus or not.
Condoms do not offer iron-clad protection against genital warts since the infected
spot may not be covered by a condom."Skin near the warts and around the
genitals, anus, and other areas can pass the virus from one person to the next.
Therefore, male and female condoms cannot fully protect you...Nonetheless,
condoms should still be used. They reduce your chances of getting or spreading
STDs."
Abstinence and monogamous sex with partner not infected with the HPV virus is the
best method for prevention.
A new vaccine known as Gardasil offers protection from the most dangerous types
of HPV. The Food and Drug Administration (FDA) approved the vaccine in June
2006. The national Advisory Committee on Immunization Practices recommends
routine vaccination for girls age 11 and 12, as well as girls and women ages 13 to
26 if they haven't received the vaccine already. The vaccine is most effective if
given to girls before they become sexually active.
Complications
In worst cases, the HPV virus can lead to cancer of the cervix. Some experts
believe that HPV is responsible for 90 percent of all cases of cervical cancer. (5)
Certain types of the HPV strains have been associated with cancer of the vulva, anal
cancer, rectal cancer and cancer of the penis.
• Difficulty urinating
• Warts on the vaginal wall may reduce the vagina's ability to stretch
• Transmission of the virus to the baby, to include the baby's throat. Surgery
may be needed to prevent airway obstruction.
Reference: http://www.cdc.gov/std/HPV/STDFact-HPV.htm
www.wikipedia.com
Chlamydia
C. trachomatis is naturally found living only inside human cells. Chlamydia can be
transmitted during vaginal, anal, or oral sex, and can be passed from an infected
mother to her baby during vaginal childbirth. Between half and three-quarters of all
women who have a chlamydia infection of the neck of the womb (cervicitis) have no
symptoms and do not know that they are infected. In men, infection of the urethra
(urethritis) is usually symptomatic, causing a white discharge from the penis with
or without pain on urinating (dysuria). Occasionally, the conditions spreads to the
upper genital tract in women (causing pelvic inflammatory disease) or to the
epididymis in men (causing epididymitis). If untreated, chlamydial infections can
cause serious reproductive and other health problems with both short-term and
long-term consequences. Chlamydia is easily treated with antibiotics.
Related conditions
Genital disease
Chlamydia is known as the "Silent Epidemic" because in women, it may not cause
any symptoms in 75% of cases, and can linger for months or years before being
discovered. Symptoms that may occur include: unusual vaginal bleeding or
discharge, pain in the abdomen, painful sexual intercourse (dyspareunia), fever,
painful urination or the urge to urinate more frequently than usual (urinary
urgency)
Male patients may develop a white, cloudy or watery discharge (shown) from the
tip of the penis.
Eye disease
Rheumatological conditions
Chlamydia may also cause reactive arthritis - the triad of arthritis, conjunctivitis
and urethritis (inflammation of the urethra) - especially in young men. About
15,000 men develop reactive arthritis due to chlamydia infection each year in the
U.S., and about 5,000 are permanently affected by it. It can occur in both sexes,
though is more common in men.
Perinatal infections
As many as half of all infants born to mothers with chlamydia will be born with the
disease. Chlamydia can affect infants by causing spontaneous abortion; premature
birth; conjunctivitis, which may lead to blindness; and pneumonia. Conjunctivitis
due to chlamydia typically occurs one week after birth (compare with chemical
causes (within hours) or gonorrhea (2-5 days)).
Other conditions
Diagnosis
Screening
For sexually active women who are not pregnant, screening is recommended in
those under 25 and others at risk of infection. Risk factors include a history of
chlamydial or other sexually transmitted infection, new or multiple sexual partners,
inconsistent condom use.[15] For pregnant women, guidelines vary: screening
women with age or other risk factors is recommended by the U.S. Preventive
Services Task Force (USPSTF) (which recommends screening women under 25) and
the American Academy of Family Physicians (which recommends screening women
aged 25 or younger). The American College of Obstetricians and Gynecologists
recommends screening all at risk, while the Centers for Disease Control and
Prevention recommend universal screening of pregnant women. The USPSTF
acknowledges that in some communities there may be other risk factors for
infection, such as ethnicity. Evidence-based recommendations for screening
initiation, intervals and termination are currently not possible. There is no universal
agreement on screening men for chlamydia.
Laboratory detection
The diagnosis of genital chlamydial infections evolved rapidly from the 1990s
through 2006. Nucleic acid amplification tests (NAAT), such as polymerase chain
reaction (PCR), transcription mediated amplification (TMA), and the DNA strand
displacement amplification (SDA) now are the mainstays. NAAT for chlamydia may
be performed on swab specimens collected from the cervix (women) or urethra
(men), on self-collected vaginal swabs, or on voided urine. Urine and self-collected
swab testing facilitates the performance of screening tests in settings where genital
examination is impractical. At present, the NAATs have regulatory approval only for
testing urogenital specimens, although rapidly evolving research indicates that they
may give reliable results on rectal specimens.
Treatment
Chlamydia trachomatis inclusion bodies (brown) in a McCoy cell culture.
• Ciprofloxacin 500 milligrams twice daily for 3 days. (Although this is not an
approved method of treatment.)
β-lactams are not suitable drugs for the treatment of chlamydia. While they have
the ability to halt growth of the organism (i.e. are microbistatic), these antibiotics
do not eliminate the bacteria. Once treatment is stopped, the bacteria will begin to
grow once more. (See below for Persistence.)
Areas of research
Pathophysiology
For Chlamydia's life cycle, see Chlamydia (bacterium)
Chlamydiae have the ability to establish long-term associations with host cells.
When an infected host cell is starved for various nutrients such as amino acids (e.g.
tryptophan), iron, or vitamins, this has a negative consequence for Chlamydiae
since the organism is dependent on the host cell for these nutrients. Long-term
cohort studies indicate that approximately 50% of those infected clear within a
year, 80% within two years, and 90% within three years.
The starved chlamydiae enter a persistent growth state wherein they stop cell
division and become morphologically aberrant by increasing in size. Persistent
organisms remain viable as they are capable of returning to a normal growth state
once conditions in the host cell improve.
There is much debate as to whether persistence has in vivo relevance. Many believe
that persistent chlamydiae are the cause of chronic chlamydial diseases. Some
antibiotics such as β-lactams can also induce a persistent-like growth state, which
can contribute to the chronicity of chlamydial diseases.
Reference:
wikipedia.org/wiki/Chlamydia
Trichomoniasis
Symptoms
Symptoms include:
Most men with trichomoniasis do not have signs or symptoms; however, some men
may temporarily have an irritation inside the penis, mild discharge, or slight
burning after urination or ejaculation.
Some women have signs or symptoms of infection which include a frothy, yellow-
green vaginal discharge with a strong odor. The infection also may cause discomfort
during intercourse and urination, as well as irritation and itching of the female
genital area. In rare cases, lower abdominal pain can occur. Symptoms usually
appear in women within 5 to 28 days of exposure.
Diagnosis
Complications
Research has shown a link between trichomoniasis and two serious sequelæ. Data
suggest that:
Pregnant women with trichomoniasis may have babies who are born early or with a
low birth weight (under 5 pounds).
The Centers for Disease Control and Prevention (CDC) recommends that women
with trichomoniasis who have symptoms should be treated, but women without
symptoms do not necessarily need to be treated.
During the first 3 months of pregnancy, many experts feel that women shouldn't
take metronidazole (Flagyl®) because it may hurt the baby. However, most doctors
feel that metronidazole can be given safely after the end of the first trimester.
The American Social Health Association estimates trichomoniasis affects 7.4 million
previously unaffected Americans each year and is the most frequently presenting
new infection of the common sexually transmitted diseases.[3]
Use of male condoms may help prevent the spread of trichomoniasis, although
careful studies have never been done that focus on how to prevent this infection.
Refraining from sharing swimsuits or towels may also help as trichomonads survive
for up to 45 minutes outside of the body.
Sex partner(s) should be treated at the same time you are being treated to
increase the cure rate and reduce the possibility of further transmission or
reinfection. Sexual intercourse should be avoided during treatment until symptoms
have gone away and until partners have been treated. Ideally, it is best to avoid sex
for 1 week after treatment with a single dose of metronidazole. Male partners may
not have symptoms but still need treatment.
People who are infected with HIV receive the same treatment for trich as those who
are HIV-negative.
Reference:
en.wikipedia.org/wiki/Trichomoniasis
SYPHILIS
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 is passed from person-to-person through direct contact with a syphilis sore
(called a chancre). Chancres mainly occur on the external genitals, vagina, anus, or
rectum, but may also occur on the lips and in the mouth. Transmission of syphilis
occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass
it on to their babies.
Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs,
bath tubs, shared clothing, or eating utensils.
The first symptoms of syphilis can appear from 10-90 days (average 21 days). The
first stage is marked by the appearance of a chancre that is usually firm, round,
small, and painless. The chancre lasts 1-5 weeks and heals on its own. The second
stage of syphilis begins when one or more areas of the skin develops a non-itching
rash. Rashes can appear as rough, "copper penny" spots on the palms of the hands
and bottom of the feet; a prickly heat rash, small blotches or scales all over the
body; a bad case of old acne; moist warts in the groin area; white patches in the
mouth; sunken dark circles the size of a nickel or dime; or as pus-filled eruptions
like chicken pox. Rashes can last 2-6 weeks and, like the chancre, heal on their
own. During the first and second stages of syphilis, an infected person can easily
pass the disease to their sex partners.
The latent (hidden) stage of syphilis begins when the secondary symptoms
disappear. If the infected person has not received treatment, he/she still has
syphilis even though there are no symptoms. Syphilis remains in the body and
begins to damage the internal organs including the brain, nerves, eyes, heart, blood
vessels, liver, bones, and joints.
An infected pregnant woman has about a 40% chance of having a stillbirth
(syphilitic stillbirth) or delivering a baby who dies shortly after birth. A baby born to
a mother with either untreated syphilis or syphilis treated after the 34th week of
pregnancy has a 40%-70% chance of being infected with syphilis (congenital
syphilis). The baby may be born without symptoms, but will develop them within a
few weeks, if not treated immediately. Some infected babies are born with very
serious health problems including skin sores, a very runny nose which is sometimes
bloody (and infectious), white patches in the mouth, inflamed arm and leg bones, a
swollen liver, anemia, jaundice, or a small head. Untreated babies may become
retarded or have seizures. About 12% of infected newborns will die because of the
disease.
Bicillin, a type of penicillin (G benzathine), will cure a person who has had
syphilis for <1 year. More doses are needed to cure someone who has had it longer.
A baby born with the disease needs daily penicillin treatment for 10 days. There are
no home remedies or over-the-counter drugs that cure syphilis. Washing the
genitals, urinating, or douching after sex does not prevent syphilis. Any unusual
discharge, sore, or rash -especially in the groin area - should be a signal to stop
having sex and to see a doctor immediately.
Alternative names
The name "syphilis" was coined by the Italian physician and poet Girolamo
Fracastoro in his epic noted poem, written in Latin, entitled 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").
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 present
among invading armies or sea crews, due to the high incidence of unprotected
sexual contact with prostitutes. It was also called "Great pox" in the 16th century 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" (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".
The Columbian Exchange theory holds that syphilis was a New World disease
brought back by Columbus and Martin Alonso Pinzon. Supporters of the Columbian
theory find syphilis lesions on pre-contact Native Americans and cite documentary
evidence linking crewmen of Columbus's voyages to the Naples outbreak of 1494. A
recent study of the genes of venereal syphilis and related bacteria has supported
this theory, by locating an intermediate disease between yaws and syphilis in
Guyana, South America.
Historian Alfred Crosby suggests both theories are correct in a combination theory.
Crosby's argument is built on the similarities of the species of bacteria which cause
yaws and syphilis. The bacterium that causes syphilis belongs to the same
phylogenetic family as the bacteria which cause yaws and several other diseases.
Despite a tradition of assigning yaws's homeland to sub-Saharan Africa, Crosby
notes that there is no unequivocal evidence of any related disease being present in
pre-Columbian Europe, Africa, or Asia, while there is indisputable evidence of
syphilis' presence in the pre-Columbian Americas. Conceding this point, Crosby
writes, "It is not impossible that the organisms causing treponematosis arrived from
America in the 1490s...and evolved into both venereal and non-venereal syphilis
and yaws."
Syphilis infection
Primary syphilis is typically acquired via direct sexual contact with the infectious
lesions of a person with syphilis.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. Rarely, there may be multiple
lesions present although typically 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 can not be contracted through toilet seats, daily activities, hot tubs, or
sharing eating utensils or clothing.
Secondary syphilis
Latent syphilis
Tertiary syphilis
Tertiary syphilis usually occurs 1-10 years after the initial infection, though 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.
Neurosyphilis
• Asymptomatic neurosyphilis
• Meningovascular syphilis
• General paresis
• 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.
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.
Reference: www.wikipedia.com
http://www.cdc.gov/std/stats/syphilis.htm
Human immunodeficiency virus (HIV)
Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-
ejaculate, or breast milk. Within these bodily fluids, HIV is present as both free
virus particles and virus within infected immune cells. The four major routes of
transmission are unprotected sexual intercourse, contaminated needles, breast
milk, and transmission from an infected mother to her baby at birth (Vertical
transmission). Screening of blood products for HIV has largely eliminated
transmission through blood transfusions or infected blood products in the developed
world.
HIV infection in humans is now pandemic. As of January 2006, the Joint United
Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization
(WHO) estimate that AIDS has killed more than 25 million people since it was first
recognized on December 1, 1981. It is estimated that about 0.6 percent of the
world's population is infected with HIV. In 2005 alone, AIDS claimed an estimated
2.4–3.3 million lives, of which more than 570,000 were children. A third of these
deaths are occurring in sub-Saharan Africa, retarding economic growth and
increasing poverty. According to current estimates, HIV is set to infect 90 million
people in Africa, resulting in a minimum estimate of 18 million orphans.
Antiretroviral treatment reduces both the mortality and the morbidity of HIV
infection, but routine access to antiretroviral medication is not available in all
countries.
HIV primarily infects vital cells in the human immune system such as helper T cells
(specifically CD4+ T cells), macrophages, and dendritic cells. HIV infection leads to
low levels of CD4+ T cells through three main mechanisms: firstly, direct viral
killing of infected cells; secondly, increased rates of apoptosis in infected cells; and
thirdly, killing of infected CD4+ T cells by CD8 cytotoxic lymphocytes that recognize
infected cells. When CD4+ T cell numbers decline below a critical level, cell-
mediated immunity is lost, and the body becomes progressively more susceptible to
opportunistic infections.
Eventually most HIV-infected individuals develop AIDS. These individuals mostly die
from opportunistic infections or malignancies associated with the progressive failure
of the immune system. Without treatment, about 9 out of every 10 persons with
HIV will progress to AIDS after 10-15 years. Many progress much sooner.
Treatment with anti-retrovirals increases the life expectancy of people infected with
HIV. Even after HIV has progressed to diagnosable AIDS, the average survival time
with antiretroviral therapy (as of 2005) is estimated to be more than 5 years.
Without antiretroviral therapy, death normally occurs within a year. It is hoped that
current and future treatments may allow HIV-infected individuals to achieve a life
expectancy approaching that of the general public.
Classification
There are two strains of HIV known to exist: HIV-1 and HIV-2. HIV-1 is the virus
that was initially discovered and termed LAV. It is more virulent, relatively easily
transmitted, and is the cause of the majority of HIV infections globally. HIV-2 is less
transmittable and is largely confined to West Africa.
History
Two species of HIV infect humans: HIV-1 and HIV-2. Both species of the virus are
believed to have originated in West-Central Africa and jumped species (zoonosis)
from a non-human primate to humans. HIV-1 is thought to have originated in
southern Cameroon after jumping from wild chimpanzees (Pan troglodytes
troglodytes) to humans during the twentieth century. It evolved from a Simian
Immunodeficiency Virus (SIVcpz)[20] HIV-2, on the other hand, may have
originated from the Sooty Mangabey (Cercocebus atys), an Old World monkey of
Guinea-Bissau, Gabon, and Cameroon.
New World Monkeys are an interesting exception to the transmission of HIV. Their
immunity is believed to be caused by retrotransposition of the Cyclophilin gene into
an intron of TRIM5. The result is fusion gene that provides the owl monkey with
resistance to HIV-1 infection.
Transmission
Three main transmission routes for HIV have been identified. HIV-2 is transmitted
much less frequently by the mother-to-child and sexual route than HIV-1.
Sexual
The majority of HIV infections are acquired through unprotected sexual relations.
Sexual transmission can occur when infected sexual secretions of one partner come
into contact with the genital, oral, or rectal mucous membranes of another. In high-
income countries, the risk of female-to-male transmission is 0.04% per act and
male-to-female transmission is 0.08% per act. For various reasons, these rates are
4 to 10 times higher in low-income countries.
The correct and consistent use of latex condoms reduces the risk of sexual
transmission of HIV by about 85%. However, spermicide may actually increase the
male to female transmission rate due to inflammation of the vagina.
In general if infected blood comes into contact with any open wound, HIV may be
transmitted. This transmission route can account for infections in intravenous drug
users, hemophiliacs and recipients of blood transfusions (though most transfusions
are checked for HIV in the developed world) and blood products. It is also of
concern for persons receiving medical care in regions where there is prevalent
substandard hygiene in the use of injection equipment, such as the reuse of needles
in Third World countries. Health care workers such as nurses, laboratory workers,
and doctors have also been infected, although this occurs more rarely. People who
give and receive tattoos, piercings, and scarification procedures can also be at risk
of infection.
Since transmission of HIV by blood became known medical personnel are required
to protect themselves from contact with blood by the use of Universal precautions.
Mother-to-child
The transmission of the virus from the mother to the child can occur in utero during
pregnancy and intrapartum at childbirth. In the absence of treatment, the
transmission rate between the mother and child is around 25 percent. However,
where combination antiretroviral drug treatment and Cesarian section are available,
this risk can be reduced to as low as one percent.
Breast feeding also presents a risk of infection for the baby.
Other routes
HIV has been found at low concentrations in the saliva, tears and urine of infected
individuals, but there are no recorded cases of infection by these secretions and the
potential risk of transmission is negligible.
Multiple infections
Unlike some other viruses, infection with HIV does not provide immunity against
additional infections, particularly in the case of more genetically distant viruses.
Both inter- and intra-clade multiple infections have been reported, and even
associated with more rapid disease progression. Multiple infections are divided into
two categories depending on the timing of the acquisition of the second strain.
Coinfection refers to two strains that appear to have been acquired at the same
time (or too close to distinguish). Reinfection (or superinfection) is infection with a
second strain at a measurable time after the first. Both forms of dual infection have
been reported for HIV in both acute and chronic infection around the world.
Diagram of HIV
HIV is different in structure from other retroviruses. It is roughly spherical with a
diameter of about 120 nm, around 60 times smaller than a red blood cell, yet large
for a virus. It is composed of two copies of positive single-stranded RNA that codes
for the virus's nine genes enclosed by a conical capsid composed of 2,000 copies of
the viral protein p24. The single-stranded RNA is tightly bound to nucleocapsid
proteins, p7 and enzymes needed for the development of the virion such as reverse
transcriptase, proteases, ribonuclease and integrase. A matrix composed of the
viral protein p17 surrounds the capsid ensuring the integrity of the virion
particle.This is, in turn, surrounded by the viral envelope which is composed of two
layers of fatty molecules called phospholipids taken from the membrane of a human
cell when a newly formed virus particle buds from the cell. Embedded in the viral
envelope are proteins from the host cell and about 70 copies of a complex HIV
protein that protrudes through the surface of the virus particle.This protein, known
as Env, consists of a cap made of three molecules called glycoprotein (gp) 120, and
a stem consisting of three gp41 molecules that anchor the structure into the viral
envelope. This glycoprotein complex enables the virus to attach to and fuse with
target cells to initiate the infectious cycle. Both these surface proteins, especially
gp120, have been considered as targets of future treatments or vaccines against
HIV.
HIV test
Many HIV-positive people are unaware that they are infected with the virus. For
example, less than 1% of the sexually active urban population in Africa have been
tested and this proportion is even lower in rural populations. Furthermore, only
0.5% of pregnant women attending urban health facilities are counselled, tested or
receive their test results. Again, this proportion is even lower in rural health
facilities. Since donors may therefore be unaware of their infection, donor blood and
blood products used in medicine and medical research are routinely screened for
HIV.
Treatment
See also Antiretroviral drug
The timing for starting HIV treatment is still debated. There is no question that
treatment should be started before the patient's CD4 count falls below 200, and
most national guidelines say to start treatment once the CD4 count falls below 350;
but there is some evidence from cohort studies that treatment should be started
before the CD4 count falls below 350. In those countries where CD4 counts are not
available, patients with WHO stage III or IV disease should be offered treatment.
Anti-retroviral drugs are expensive, and the majority of the world's infected
individuals do not have access to medications and treatments for HIV and AIDS.
Research to improve current treatments includes decreasing side effects of current
drugs, further simplifying drug regimens to improve adherence, and determining
the best sequence of regimens to manage drug resistance. Unfortunately, only a
vaccine is thought to be able to halt the pandemic. This is because a vaccine would
cost less, thus being affordable for developing countries, and would not require
daily treatment. However, after over 20 years of research, HIV-1 remains a difficult
target for a vaccine.
Treatments in development
Promising new treatments include Cre recombinase and the enzyme Tre
recombinase, both of which are able to remove HIV from an infected cell. These
enzymes promise a treatment in which a patient's stem cells are extracted, cured,
and reinjected to promulgate the enzyme into the body. The carried enzyme then
finds and removes the virus.
Media reports in 2008 and a publication in the New England Journal of Medicine in
2009, described the anecdotal case of an HIV-positive patient of a Berlin doctor,
Gero Hütter. The patient, who had both acute myelogenous leukemia (AML) and
HIV had been "functionally cured" of his HIV following a bone marrow transplant for
AML. The bone marrow donor had been selected to have a CCR5-Δ32 mutation.
After 600 days without antiretroviral drug treatment, no HIV was detectable in the
patient's blood, bone marrow or bowel (although it is likely to be present in other
tissues). The patient himself was heterozygous for CCR5-Δ32. Following
transplantation, his peripheral CD4+ T-cells were homozygous for CCR5-Δ32. The
macrophages in his bowel, which continued to express wildtype CCR5 (because
they hadn't been replaced yet from bone marrow precursors), also had no
detectable virus.
The mortality risk associated with bone marrow transplants is thought to
contraindicate the use of this experimental treatment for HIV-positive individuals
without leukemia or lymphoma. Resistance to CCR5 inhibition may be less
important if CXCR4 strains of HIV emerge (these use CXCR4 rather than CCR5 as a
coreceptor, from which they become independent), though before the treatment
Hütter's patient carried the CXCR4 virus at low levels. People without CCR5 appear
to be more sensitive to some infections such as West Nile virus.
Symptoms
Note: At the time of diagnosis with HIV, many people have not experienced any
symptoms.
Acute HIV infection can appear like infectious mononucleosis, flu, or other viral
illnesses.
• Decreased appetite
• Fatigue
• Fever
• Headache
• Malaise
• Swollen lymph glands
• Muscle stiffness or aching
• Rash
• Sore throat
• Ulcers of the mouth and esophagus
Expectations (prognosis)
HIV is a long-term medical condition that can be treated but not yet cured. There
are effective means of preventing complications and delaying (but not preventing)
progression to AIDS. At the present time, not all cases of HIV have progressed to
AIDS, but time has shown that the vast majority do.
Complications
• AIDS (acquired immune deficiency syndrome)
• Autoimmune diseases
• Cancers, typically Kaposi's sarcoma and lymphomas
• Opportunistic infections (unlikely to occur in early stages of HIV disease)
• Bacillary angiomatosis
• Candidiasis
• Cryptosporidium or other protozoal enterocolitis
• Cytomegalovirus infection
• Pneumocystis carinii pneumonia
• Mycobacterium avium complex (MAC)
• Progressive multifocal leukoencephalopathy
• Salmonella infection of the bloodstream
• Toxoplasmosis
• Tuberculosis
Reference: www.wikipedia.com
www.aids.com
Herpes simplex virus 1 and 2 (HSV-1 and HSV-2) are two species of the
herpes virus family, Herpesviridae, which cause infections in humans. Eight
members of herpes virus infect humans to cause a variety of illnesses including cold
sores, chickenpox or varicella, shingles or herpes zoster (VZV), cytomegalovirus
(CMV), and various cancers, and can cause brain inflammation (encephalitis). All
viruses in the herpes family produce life-long infections.
They are also called Human Herpes Virus 1 and 2 (HHV-1 and HHV-2) and are
neurotropic and neuroinvasive viruses; they enter and hide in the human nervous
system, accounting for their durability in the human body. HSV-1 is commonly
associated with herpes outbreaks of the face known as cold sores or fever blisters,
whereas HSV-2 is more often associated with genital herpes.
Herpes is contagious if the carrier is producing and shedding the virus. This is
especially likely during an outbreak but possible at other times. There is no cure
yet, but there are treatments which reduce the likelihood of viral shedding.
Transmission
HSV is transmitted during close contact with an infected person who is shedding
virus from the skin, in saliva or in secretions from the genitals. This horizontal
transmission of the virus is more likely to occur when sores are present, although
viral shedding, and therefore transmission, does occur in the absence of visible
sores. In addition, vertical transmission of HSV may occur between mother and
child during childbirth, which can be fatal to the infant. The immature immune
system of the child is unable to defend against the virus and even if treated, the
infection can result in inflammation of the brain (encephalitis) that may cause brain
damage. Transmission occurs when the infant passes through the birth canal, but
the risk of infection is reduced if there are no symptoms or exposed blisters during
delivery. The first outbreak after exposure to HSV is commonly more severe than
future outbreaks, as the body has not had a chance to produce antibodies; this first
outbreak carries a low (~1%) risk of developing aseptic meningitis.
HSV-1
• Small, painful blisters filled with fluid around the lips or edge of the mouth
• Tingling or burning around the mouth or nose (often a few days before
blisters appear)
• Fever
• Sore throat
• Swollen lymph nodes in neck
HSV-2
• Small red blisters or open sores on genitals or inner thighs; in women, often
occur inside the vagina
• May be painful or not
• In women, vaginal discharge
• Fever, muscle aches
• Headache Painful urination
• Swollen lymph glands in the groin
Causes:
HSV-1 is transmitted through saliva. Kissing, using the same eating utensils,
sharing personal items (such as a razor), and receiving oral sex from someone who
has HSV-1 can cause you to contract the virus.
Both herpes viruses can be contagious even if the infected person does not have
active symptoms or visible blisters.
Also, a mother can pass the infection to her baby during vaginal birth, especially if
there are active blisters around the vagina at the time of delivery.
Risk Factors:
Everyone is at risk for oral herpes from HSV-1. In fact, studies suggest that by
adolescence 62% of Americans are infected with HSV-1 and by the time people are
in their 40s, 90% have been infected.
Genital herpes
All sexually active people are at risk for genital herpes. Having multiple sexual
partners puts you at even greater risk. Women have a greater risk of being infected
after sex with an unprotected partner than men do. Estimates of how many
Americans are infected range from 20% to 30%.
Other factors
People with weakened immune systems, such as people with HIV/AIDS or those
who take immunosuppressant drugs to treat an autoimmune disease or because of
organ transplant, are at increased risk for severe cases of herpes.
Diagnosis:
In many instances, your doctor is able to make the diagnosis of herpes from
examining you and no tests are required. If your doctor is not 100% certain,
however, then he or she make take a sample from the blisters to test for the virus.
Finally, there is a blood test that may be helpful for making a diagnosis, especially if
your doctor suspects herpes but you don't have an active infection.
Preventive Care:
HSV-1
HSV-2
• Avoid having sex if you or your partner has an outbreak (active infection) of
herpes. Herpes outbreaks are not always obvious and your partner may be
contagious without you knowing it. Anyone involved in an ongoing sexual
relationship with a partner infected with HSV-2 should get counseling from a
healthcare practitioner on how to best keep yourself safe.
• Avoid touching the sores
• Use or have your partner use a latex condom (even when sores are not
visible)
• Limit the number of sex partners
Treatment Approach:
Herpes cannot be cured, so the goals of treatment are to reduce the number of
outbreaks and to lessen symptoms when you do have an outbreak.
Antiviral medications for genital herpes can reduce outbreaks and help speed
recovery when an outbreak does occur. They can also lessen the chances of
spreading the virus.
Coping with the emotional and social aspects of having genital herpes is part of
treatment. Relaxation techniques and support groups can help.
Lifestyle
For cold sores, applying either heat or cold to blisters may help relieve pain. Try ice
or warm compresses.
For genital herpes, wear cotton underwear and avoid tight fitting clothes as they
can restrict air circulation and slow the healing of lesions.
Be sure to tell your partner or potential partner that you have herpes.
Medications
Antiviral medicines — may help shorten the duration of a herpes outbreak and
suppress recurring outbreaks. For genital herpes, there are two types of therapy:
episodic and suppressive. With episodic therapy, you take medication at the first
sign of an outbreak and for several days to shorten the duration or prevent a full
outbreak. With suppressive therapy, you may take medication daily to keep
outbreaks from occurring. Antiviral medications include:
• Acyclovir (Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)
Topical medications (for oral herpes) — include the antiviral cream Penciclovir
(Denavir) and an over-the-counter cream, docosanol (Abreva).
Because supplements may have side effects or interact with medications, they
should be taken only under the supervision of a knowledgeable healthcare provider.
• Lysine (1 to 3 g per day) — Although not all studies agree, several studies
suggest that lysine may help reduce the number of recurring outbreaks of
cold sores and possibly genital herpes. Most of the studies have involved
people with cold sores or with both cold sores and genital herpes. A few
studies also suggest that lysine may help shorten the duration of an
outbreak. The evidence is somewhat stronger for cold sores: the research to
date is not entirely conclusive, lysine supplements have been used to help
treat or prevent mouth and genital lesions caused by herpes. Taking lysine
supplements or increasing lysine in your diet (from foods like fish, chicken,
eggs, and potatoes) may speed recovery time and reduce the chance of
recurrent breakouts of the herpes infection. If you have high cholesterol,
heart disease, or high triglycerides (type of fatty material in the blood,
generally measured when you have your cholesterol checked), it is best, at
this point, not to use lysine because animal studies suggest that this
supplement may raise cholesterol and triglyceride levels.
• Propolis — A resin made by bees, propolis is loaded with flavonoids
(antioxidants that help fight infection and boost immune function). Test tube
studies show it can stop HSV-1 and HSV-2 from reproducing. One small
study of people with genital herpes compared an ointment made from
propolis to Zovirax ointment. People using propolis saw the lesions heal
faster than those using topical Zovirax. More studies are needed to say for
sure whether propolis works.
• Zinc — In test tubes, zinc is effective against HSV-1 and HSV-2. In one small
study in people, those who applied zinc oxide cream to cold sores saw them
heal faster than those who applied a placebo cream.
Other Considerations:
Pregnancy
Special Populations
Newborns – herpes infections contracted during delivery from the mother can lead
to meningitis, herpes infection in the blood, chronic skin infection, and may even be
fatal.
You are more likely to have severe, frequent outbreaks and to experience
complications from herpes if your immune system is suppressed from:
• HIV or AIDS
• Chemotherapy for cancer
• Long-term use of high doses of corticosteroids
• Medications that intentionally suppress the immune system
Warnings and Precautions
If you are diagnosed with genital herpes, you should be tested for other sexually
transmitted diseases such as chlamydia and gonorrhea.
Herpes is a chronic, recurrent infection. The initial symptoms usually appear within
1 to 3 weeks of exposure to the virus and last 7 to 10 days (for cold sores) or 7 to
14 days (for genital lesions). Usually the number of outbreaks is greatest in the first
year and higher for HSV-2 genital lesions than HSV-1 cold sores. Each year after
that, the number of outbreaks usually goes down and they become less severe. But
you can never completely get rid of the virus.
• Herpetic keratitis – herpes infection of the eye leading to scaring within the
cornea and possible blindness
• Persistent herpes infection, without lesion-free periods
• Herpes infection in the esophagus
• Herpes infection of the liver which can lead to cirrhosis (liver failure)
• Encephalitis and/or meningitis (serious brain infections)
• Lung infection
• Eczema herpetiform – widespread herpes across the skin
Reference: www.wikipedia.com
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