March 27th, 2009 admin
There is still debate about whether to initiate protease inhibitors as part of the first treatment regimen offered to a patient or to wait until after the initiation of the antiretrovirals and the start of disease progression, although most experts now recommend triple therapy from the start. In addition, there has been discussion about initiating these medications during the acute infection period and not waiting until several years later, when the virus eventually “outsmarts” the immune system and starts attacking it. Some experts are recommending an aggressive approach, with a combination of antiretrovirals and protease inhibitors given during the primary infection period and continuing for six months. Whether this approach becomes the standard of care for treatment will depend on its long-term effectiveness. Research is continuing in an effort to answer this question.
If a person experiences toxicity or intolerable side effects from the foregoing medication regimens, then an alternative regimen can be chosen. Unfortunately, many people experience side effects from these medications, and changes in medication or dose reductions are often needed.
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March 27th, 2009 admin
There are specific blood tests for hepatitis B. On the one hand, about 90 percent of people with acute hepatitis B infection show evidence of the infection on blood tests when they first visit their health care provider. On the other hand, early in the infection the blood tests may be negative in a person who is actually infected; later blood tests will show evidence of the infection in such a person. Ask your health care provider what your test results mean and whether or not you need additional tests to rule out infection.
The tests that are most helpful to diagnose hepatitis look for either the body s immune response to the virus (antibodies) or particles of the virus itself. The blood tests can distinguish among people who have been infected and have cleared the infection, people who have been infected and are carriers, and people who have been vaccinated—although follow-up tests may be necessary to make these distinctions. To determine the stage of infection, it may be necessary to perform a liver biopsy, which involves taking a piece of liver tissue from a person under anesthesia and examining the sample under a microscope.
Tests that measure how well the liver is working, called liver function tests or liver injury tests, are not an adequate screen for hepatitis B. Although results of these tests are often elevated in acute and chronic hepatitis, normal liver function tests cannot be interpreted as ruling out viral hepatitis infection.
When a person is found to be a carrier of hepatitis B, it is recommended that a blood test also be performed for hepatitis D, or delta hepatitis. This is an infection that can only occur in individuals who have hepatitis B infection, since the delta virus needs the hepatitis B virus to survive. Hepatitis D can be sexually transmitted but has a higher risk of transmission from blood exposure, such as through injection drug use or receiving transfusions with infected blood. (The blood supply has been screened for hepatitis D since the 1970s.) A person can be infected with hepatitis D at the same time that infection with hepatitis B occurs, or he or she can become superinfected with hepatitis D while a carrier for hepatitis B. In either situation, severe liver damage and death can result, or the person is likely to become a carrier for hepatitis D as well as B, which can hasten the progression of liver disease to cirrhosis. The diagnosis of hepatitis B and D, m both the acute and chronic forms, is reportable in most states to the health department.
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March 27th, 2009 admin
Most chlamydia infections don’t cause any symptoms! Half of men and three-quarters of women with chlamydia infections in the genital area are completely symptom free. Therefore, many people at risk for infection with chlamydia may mistakenly believe they don’t need to be tested. A person with chlamydia infection may remain symptom free for his or her entire life or may start to show symptoms weeks, months, or even years after infection.
A woman with chlamydia infection can have infection of the uterus and Fallopian tubes (pelvic inflammatory disease [PID]), of the cervix (mucopurulent cervicitis [MPC]), of the urethra (urethritis), around the liver (this is a complication of PID called Fitz-Hugh Curtis syndrome), or a combination of these. If she is going to develop symptoms, they will usually appear one to three weeks after infection. The symptoms include the following:
— discharge from the genital area
— burning with urination
— pelvic pain
— bleeding between periods or after sexual intercourse
(See the sections on pelvic inflammatory disease and mucopurulent cervicitis for a more thorough discussion of these syndromes.) About half the time, chlamydia infection that appears to be limited to the cervix is actually causing silent (symptom-free) infection in the uterus. For all women, the urethra is a potential site of infection with chlamydia; the only symptom may be burning with urination. This may be the only symptom in infected women who have had a hysterectomy.
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March 27th, 2009 admin
Talking with a partner about these issues before you become sexually active has been proven to help prevent infection with STDs, no matter what your age or sexual orientation. Study after study confirms that communicating with a partner increases the chance that steps will be taken to guard against STDs and unwanted pregnancy. However, poor communication with a partner increases the likelihood that you will contract a sexually transmitted infection.
As noted earlier, screening for sexually transmitted infections is the only way to know for sure whether or not a person has been infected. The goal of this chapter is to help prepare you to become a better communicator about sexual health. The chapter begins with a discussion about why it is so difficult to communicate and then suggests ways to make communication easier. In general, talking about sex is easier if you practice communication skills beforehand. If you have thought about what your partner may tell you, and what you would say in response, you will be better prepared for different situations that may arise. You can also learn from your past mistakes. If in the past things did not turn out exactly as you would have wanted, think about what you might do differently in the future and identify the communication patterns you want to change. You do not have to keep on making the same mistakes.
You owe it to yourself to be safe.
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March 27th, 2009 admin
Allergic reactions. Many women have allergic reactions or increased sensitivity to certain products used in safer sex practices, such as latex condoms and spermicide (nonoxynol-9). About one-third of people have allergic reactions, which can range from mild to severe, to spermicide or other lubricants. Allergic reactions most often occur immediately or shortly after intercourse and may consist of redness, itching, and breaks in the skin.
Bacterial vaginosis. Although bacterial vaginosis usually doesn’t cause significant irritation of the labia and vagina, sometimes there can be mild itching. More common is a white to gray discharge, which has a strong, fishy odor, usually most prominent after sex or during menstruation.
Herpes. Herpes outbreaks often itch, and in fact this may be the only sign that the virus has reactivated and is on the surface of the skin. There may be tingling, redness, a bump, or a break in the skin, such as a blister, ulcer, or slit. Lymph nodes in the groin may be swollen, and a person may also experience leg pain and flu-like symptoms.
Jock itch. Also caused by a fungus, but by a different fungus than Candida, this condition is very common in both men and women. It is caused by the fungus Tinea cruris and most commonly causes an itchy, scaly red rash on the genitals and the upper thighs.
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