Study finds no blood clot risk with hormone patch
Friday, December 31, 2010
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By Amy Norton
NEW YORK (Reuters Health) - Women who treat menopause symptoms with hormone patches rather than pills may not have an increased risk of blood clots in the legs or lungs -- even when they have a history of such clots, a new study suggests.
The findings, published in the journal Menopause, add to evidence that skin patches can be a safer alternative to pills for women who want to treat their bothersome menopause symptoms with hormone replacement therapy (HRT).
The number of women using HRT plummeted in 2002 after a large U.S. clinical trial found that women on estrogen-plus-progesterone pills had higher risks of blood clots, heart attack, stroke and breast cancer than placebo users did.
Up to that point, HRT had been prescribed to prevent heart disease and osteoporosis. Experts now advise against that.
However, hormone therapy remains the most effective way to ease menopausal hot flashes, so some women with severe symptoms still opt for it. Because of the risks, experts say women should use HRT at the lowest dose and for the shortest time possible.
There is growing evidence, though, that low-dose patches may not carry all the risks that pills do.
Some studies have found that, unlike pills, patches may not raise women's risk of a first-time venous thromboembolism (VTE), which refers to blood clots either in the leg veins or the lungs.
And a large UK study earlier this year found that women who used low-dose patches for hormone therapy had no greater risk of stroke than women not on HRT. Those on hormone pills or high-dose patches, however, did have a higher stroke risk than non-users.
Most strokes are caused by clots that disrupt blood flow to the brain.
For the new study, French researchers looked at hormone therapy and the risk of repeat VTEs among women who had already been treated for one.
Of the 1,023 women they followed, 103 started using hormone patches for menopausal symptoms after stopping their VTE treatment -- which usually involves several months on anti-clotting drugs. Another 10 women used oral HRT, and the rest did not use any hormone replacement.
Over an average of 6.5 years, 77 women -- or 1 percent per year -- suffered a repeat blood clot. For women using hormone patches, the risk was no greater than it was for women not on
HRT.
Of the 103 women who used the patches, six had a repeat blood clot. In contrast, two of the 10 who used hormone pills had a repeat clot. When the researchers weighed other factors, like the women's age and weight, those on pills showed a six-fold greater risk of a repeat blood clot than women who did not use hormone therapy.
The findings suggest that even for women at high risk of VTE, hormone patches may not further that risk, lead researcher Valerie Olie, of the French national research institute INSERM, told Reuters Health by e-mail.
Researchers think hormone patches may be less risky than pills because of the way they work. Unlike oral hormones, those delivered via skin patch bypass the liver, and may not boost clot-promoting proteins in the blood.
The current study, Olie said, is only the first to suggest that high-risk women who use hormone patches have no extra risk of repeat blood clots.
And the findings cannot tell women whether they should or shouldn't try hormone patches for severe menopause symptoms, according to Olie.
That, the researcher said, is a personal decision for women to make after talking with their doctor about the risks and benefits.
The study was partially funded by the French pharmaceutical company Pierre Fabre Sante. None of the researchers reports any financial conflicts of interest.
The guidance, from experts at the U.S. Centers for Disease Control and Prevention
THURSDAY, Jan. 27 (HealthDay News) -- U.S. health authorities on Thursday issued an "interim guidance" to help doctors and patients using Truvada, the once-a-day combination pill that was shown in November to help prevent the spread of HIV in high-risk individuals.
The guidance, from experts at the U.S. Centers for Disease Control and Prevention, stresses that only gay and bisexual men at high risk for contracting the virus -- the same population included in the study -- should use the pill.
When used as a preventive agent, the medication should only be given to men who are currently HIV-negative and only as part of a larger prevention plan that includes testing for other sexually transmitted diseases, counseling and using condoms faithfully.
"While we think this is really a very important new tool in HIV prevention, it has only been proven safe and effective with men who have sex with men, so at this point we don't feel we have the information to discuss its use for anyone other than [this group]," said Dr. Dawn Smith, lead author of the new guidance, which appears in the Jan. 28 issue of the CDC journal Morbidity and Mortality Weekly Report.
Even for highly sexually active gay and bisexual men, "it's not the first line of prevention," Smith said. "It's meant for men who are unable to successfully, consistently use standard methods of reducing their risk of acquiring HIV."
In essence, Truvada is "meant to function as a safety net in addition to those methods. So if a man can't use condoms consistently then maybe [Truvada] would be helpful while they improve condom use," Smith said.
Truvada is a combination of two anti-HIV drugs, emtricitabine (Emtriva) and tenofovir (Viread), included in a once-a-day pill. The pill is already available by prescription as a treatment for HIV infection.
A study published Nov. 25 in the New England Journal of Medicine found that it cut the risk of HIV infection by almost 44 percent in those at highest risk for contracting the virus, namely sexually active gay and bisexual men.
The risk reduction climbed to nearly 73 percent among study participants who took the pill 90 percent of the time, the researchers added.
Both the treatment and the control group in the study also received intensive counseling on safe sex practices and were given condoms (about 500,000 condoms were distributed throughout the course of the trial).
Men in the study reported having had an average of 18 sexual partners in the previous 12 weeks.
Another expert agreed, however, that Truvada is not meant to supplant the condom.
"There has always been a concern that people will see this as an either/or proposition [pill or condom] but it's clearly 'and,'" said Dr. Michael Horberg, director of HIV/AIDS at Kaiser Permanente Health Plan.
"A lot of organizations such as ours have strategized how best to interpret the study results and we totally agree with the considerations of the CDC," he said.
At the time the study was released, the CDC issued "immediate cautions" with similar but less specific recommendations.
This interim report includes more specific information, including getting tested and receiving safe-sex counseling every two to three months while on the medication.
The guidance is intended to fill a gap until formal U.S. Public Health Service guidelines are issued hopefully later this year, Smith said.
"We're working on the first draft of the formal guidelines but, because they involve other Health & Human Services agencies and a public comment process, we don't expect them until later this year," said Smith, who is a biomedical intervention implementation officer at the U.S. National Center for HIV/AIDS Prevention, part of the CDC.
One cloud in the silver lining: A year's worth of Truvada totals more than $10,000 a year, and that is the discounted rate. Generic versions are available in some countries (not the United States) for as low as $500 a year.
SOURCES: Dawn Smith, M.D., biomedical intervention implementation officer, National Center for HIV/AIDS Prevention, CDC; Michael Horberg, M.D., director, HIV/AIDS, Kaiser Permanente Health Plan; Jan. 28, 2011, Morbidity and Mortality Weekly Report
The guidance, from experts at the U.S. Centers for Disease Control and Prevention, stresses that only gay and bisexual men at high risk for contracting the virus -- the same population included in the study -- should use the pill.
When used as a preventive agent, the medication should only be given to men who are currently HIV-negative and only as part of a larger prevention plan that includes testing for other sexually transmitted diseases, counseling and using condoms faithfully.
"While we think this is really a very important new tool in HIV prevention, it has only been proven safe and effective with men who have sex with men, so at this point we don't feel we have the information to discuss its use for anyone other than [this group]," said Dr. Dawn Smith, lead author of the new guidance, which appears in the Jan. 28 issue of the CDC journal Morbidity and Mortality Weekly Report.
Even for highly sexually active gay and bisexual men, "it's not the first line of prevention," Smith said. "It's meant for men who are unable to successfully, consistently use standard methods of reducing their risk of acquiring HIV."
In essence, Truvada is "meant to function as a safety net in addition to those methods. So if a man can't use condoms consistently then maybe [Truvada] would be helpful while they improve condom use," Smith said.
Truvada is a combination of two anti-HIV drugs, emtricitabine (Emtriva) and tenofovir (Viread), included in a once-a-day pill. The pill is already available by prescription as a treatment for HIV infection.
A study published Nov. 25 in the New England Journal of Medicine found that it cut the risk of HIV infection by almost 44 percent in those at highest risk for contracting the virus, namely sexually active gay and bisexual men.
The risk reduction climbed to nearly 73 percent among study participants who took the pill 90 percent of the time, the researchers added.
Both the treatment and the control group in the study also received intensive counseling on safe sex practices and were given condoms (about 500,000 condoms were distributed throughout the course of the trial).
Men in the study reported having had an average of 18 sexual partners in the previous 12 weeks.
Another expert agreed, however, that Truvada is not meant to supplant the condom.
"There has always been a concern that people will see this as an either/or proposition [pill or condom] but it's clearly 'and,'" said Dr. Michael Horberg, director of HIV/AIDS at Kaiser Permanente Health Plan.
"A lot of organizations such as ours have strategized how best to interpret the study results and we totally agree with the considerations of the CDC," he said.
At the time the study was released, the CDC issued "immediate cautions" with similar but less specific recommendations.
This interim report includes more specific information, including getting tested and receiving safe-sex counseling every two to three months while on the medication.
The guidance is intended to fill a gap until formal U.S. Public Health Service guidelines are issued hopefully later this year, Smith said.
"We're working on the first draft of the formal guidelines but, because they involve other Health & Human Services agencies and a public comment process, we don't expect them until later this year," said Smith, who is a biomedical intervention implementation officer at the U.S. National Center for HIV/AIDS Prevention, part of the CDC.
One cloud in the silver lining: A year's worth of Truvada totals more than $10,000 a year, and that is the discounted rate. Generic versions are available in some countries (not the United States) for as low as $500 a year.
SOURCES: Dawn Smith, M.D., biomedical intervention implementation officer, National Center for HIV/AIDS Prevention, CDC; Michael Horberg, M.D., director, HIV/AIDS, Kaiser Permanente Health Plan; Jan. 28, 2011, Morbidity and Mortality Weekly Report
Sexually transmitted diseases
Definition
Sexually transmitted diseases (STDs) are infections generally acquired by sexual contact. The organisms that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids.
Some of these infections can also be transmitted nonsexually, such as from mother to infant during pregnancy or childbirth, or through blood transfusions or shared needles.
It's possible to contract sexually transmitted diseases from people who seem perfectly healthy — people who, in fact, aren't even aware of being infected. Many of the infections transmitted through sex cause no symptoms, which is one of the reasons experts prefer the term "sexually transmitted infections" to "sexually transmitted diseases." The symptoms of several sexually transmitted infections are also easy to mistake for those of other conditions, so the correct diagnosis may be delayed.
Symptoms
Sexually transmitted infections (STIs) have a wide range of signs and symptoms. That's why they may go unnoticed until complications occur or a partner is diagnosed. Signs and symptoms that might indicate an STI include:
Sores or bumps on the genitals or in the oral or rectal area
Painful or burning urination
Discharge from the penis
Vaginal discharge
Unusual vaginal bleeding
Sore, swollen lymph nodes, particularly in the groin but sometimes more widespread
Signs and symptoms may appear a few days to three months after exposure, depending on the organism. They may resolve in a few weeks, even without treatment, but progression with later complications — or recurrence — sometimes occurs.
When to see a doctor
See a doctor immediately if you are sexually active and you believe you've been exposed to an STI or you have signs and symptoms of an STI.
Make an appointment with a doctor for STI counseling and, if appropriate, for screening tests:
When you consider becoming sexually active, or when you're 21, whichever comes first
Before you start having sex with a new partner
Causes
Sexually transmitted infections can be caused by:
Bacteria (gonorrhea, syphilis, chlamydia)
Parasites (trichomoniasis)
Viruses (human papillomavirus, genital herpes, HIV)
Sexual activity plays a role in spreading many other infectious agents, although it's possible to be infected without sexual contact. Examples include the hepatitis A and B viruses, shigella, cryptosporidium and Giardia lamblia.
Risk factors
Anyone who is sexually active risks exposure to a sexually transmitted infection to some degree. Factors that may increase that risk include:
Having unprotected sex. Vaginal or anal penetration by an infected partner who is not wearing a latex condom transmits some diseases with particular efficiency. Without a condom, a man who has gonorrhea has a 70 to 80 percent chance of infecting his female partner in a single act of vaginal intercourse. Improper or inconsistent use of condoms can also increase your risk. Oral sex is less risky but may still transmit germs without a latex condom or dental dam.
Having multiple sex partners. The more people you have sex with, the greater your overall exposure. This is true for concurrent as well as consecutive partners. Each time you break up with one partner and move on to another, even if each relationship is monogamous, your STI risk is increased.
Having a history of one or more STIs. Being infected with one STI makes it much easier for another STI to take hold. If you're infected with herpes, syphilis, gonorrhea or chlamydia and you have unprotected sex with an HIV-positive partner, you're more likely to contract HIV. Also, it's possible to be reinfected by the same infected partner if he or she isn't treated along with you.
Abusing alcohol or using recreational drugs. Substance abuse can inhibit your judgment, making you more willing to participate in risky behaviors.
Injecting drugs. Needle sharing spreads many serious infections, including HIV and hepatitis B. If you acquire HIV by injecting drugs, you can transmit it sexually.
Being an adolescent female. In adolescent girls, the immature cervix is made up of constantly changing cells. These unstable cells make the adolescent female cervix more vulnerable to certain sexually transmitted organisms.
According to a surveillance report from the Centers for Disease Control and Prevention, sexually transmitted infections are more common among certain groups, such as young people, men who have sex with men and minority communities. The theory is that potential sex partners often belong to social networks made up of people of similar age, location and background. Within these overlapping networks, couples regularly form, split up and find new partners. If one STI is making its way through such a network, there's a good chance that others are, too.
Transmission from mother to infant
Certain STIs such as gonorrhea, chlamydia and syphilis can be passed from an infected mother to her child during pregnancy or delivery. STIs in infants can cause serious problems and may be fatal. All pregnant women should be screened for these infections and treated, if necessary.
Preparing for your appointment
Not many people feel comfortable sharing the details of their sexual experiences, but the doctor's office is one place where such information is essential to appropriate care.
What you can do
Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance.
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Make a list of all medications, as well as any vitamins or supplements, that you're taking.
Write down questions to ask your doctor.
Some basic questions to ask your doctor include:
What's the medical name of the infection or infections I have?
How, exactly, is it transmitted?
Will it keep me from having children?
If I get pregnant, could I give it to my baby?
Is it possible to catch this again?
Could I have caught this from someone I had sex with only once?
Could I give this to someone by having sex with that person just once?
How long have I had it?
Should I abstain from sexual activity while being treated?
Does my partner have to go to a doctor to be treated?
What to expect from your doctor
Giving your doctor a complete report of your symptoms and sexual history will help your doctor determine how to best care for you. Here are some of the things you may be asked:
Do you think you might have a sexually transmitted infection? If so, why?
Are you sexually active with men, women or both?
Do you currently have one sex partner or more than one?
How long have you been with your current partner or partners?
Have you ever injected yourself with drugs?
Have you ever had sex with someone who has injected drugs?
What do you do to protect yourself from STIs?
What do you do to prevent pregnancy?
Has a doctor or nurse ever told you that you have chlamydia, herpes, gonorrhea, syphilis or HIV?
Have you ever been treated for a genital discharge, genital sores, painful urination or an infection of your sex organs?
How many sex partners have you had in the past year?
How many people have you had sex with in the past two months?
When was your most recent sexual encounter?
Tests and diagnosis
If your sexual history and current signs and symptoms suggest that you have an STI, laboratory tests can identify the cause and detect coinfections you might also have contracted.
Blood tests. Blood tests can confirm the diagnosis of HIV or later stages of syphilis.
Urine samples. Some STIs can be confirmed with a urine sample.
Fluid samples. If you have active genital sores, testing fluid and samples from the sores may be done to diagnose the type of infection. Laboratory tests of material from a genital sore or discharge are used to diagnose the most common bacterial and some viral STIs at an early stage.
Screening
Testing for a disease in someone who doesn't have symptoms is called screening. Most of the time, STI screening is not a routine part of health care. But there are exceptions:
Everyone. The one STI screening test suggested for everyone ages 13 to 64 is a blood or saliva test for human immunodeficiency virus (HIV), the virus that causes AIDS. Most health care settings in the United States offer a rapid HIV test with same-day results.
Pregnant women. Screening for HIV, hepatitis B, chlamydia and syphilis generally takes place at the first prenatal visit for all pregnant women. Gonorrhea and hepatitis C screening tests are recommended at least once during pregnancy for women at high risk of these infections.
Women age 21 and older. The Pap test screens for cervical abnormalities, including inflammation, precancerous changes and cancer, which is caused by certain strains of human papillomavirus (HPV). Experts recommend that, starting at age 21, women should have a Pap test at least every three years. Some experts also advise that women who start having sex before age 21 should have a Pap test within three years of first intercourse.
Women under age 25 who are sexually active. All sexually active women under age 25 should be tested for chlamydia infection. The chlamydia test uses a sample of urine or vaginal fluid you can collect yourself. Some experts recommend repeating the chlamydia test three months after you've had a positive test and been treated. The second test is needed to confirm that the infection is cured, as reinfection by an untreated or undertreated partner is common. A bout of chlamydia doesn't protect you from future exposures. You can catch the infection again and again, so you should get retested if you have a new partner. Screening for gonorrhea is also recommended in sexually active women under age 25.
Men who have sex with men. Compared with other groups, men who have sex with men run a higher risk of acquiring STIs. Many public health groups recommend annual or more frequent STI screening for these men. Regular tests for HIV, syphilis, chlamydia and gonorrhea are particularly important. Evaluation for herpes and hepatitis B also may be recommended.
People with HIV. If you have HIV, it dramatically raises your risk of catching other STIs. Experts recommend frequent syphilis, gonorrhea, chlamydia and herpes tests for people with HIV. Women with HIV may develop aggressive cervical cancer, so they should have Pap tests twice a year to screen for HPV. Some experts also recommend regular HPV screening of HIV-infected men who risk anal cancer from HPV contracted anally.
Complications
Prompt treatment can help prevent the complications of some STIs. Since many people in the early stages of an STI experience no symptoms, screening for STIs is especially important in preventing complications.
Possible complications include:
Sores or bumps anywhere on the body
Recurrent genital sores
Generalized skin rash
Pain during intercourse
Scrotal pain, redness and swelling
Pelvic pain
Groin abscess
Eye inflammation
Arthritis
Pelvic inflammatory disease
Infertility
Cervical cancer
Other cancers, including HIV-associated lymphoma and HPV-associated rectal and anal cancers
Opportunistic infections occurring in advanced HIV
Maternal-fetal transmission, which causes severe birth defects
Treatments and drugs
STIs caused by bacteria are generally easy to treat. Viral infections can be managed but not always cured. If you're pregnant and have an STI, prompt treatment can prevent or reduce the risk of infection of your baby. Treatment usually consists of one of the following, depending on the infection.
Antibiotics. Antibiotics, often in a single dose, can cure many sexually transmitted bacterial and parasitic infections, including gonorrhea, syphilis, chlamydia and trichomoniasis. Typically, you'll be treated for gonorrhea and chlamydia at the same time because the two infections often appear together.
Once you start antibiotic treatment, it's crucial to follow through. If you don't think you'll be able to take medication as prescribed, tell your doctor. A shorter, simpler treatment regimen may be available. In addition, it's important to abstain from sex until you've completed treatment and any sores have healed.
Antiviral drugs. You'll have fewer herpes recurrences if you take daily suppressive therapy with a prescription antiviral drug, but you can still give your partner herpes at any time.
Antiviral drugs can keep HIV infection in check for many years, although the virus persists and can still be transmitted. The sooner you start treatment, the more effective it is. If you take anti-HIV medication for 28 days, starting as soon as you know you've been exposed, you may avoid becoming HIV-positive.
Partner notification and preventive treatment
If tests show that you have an STI, your sex partners — including your current partners and any other partners you've had over the last three months to one year — need to be informed so that they can get tested and treated if infected. Each state has different requirements but most mandate that certain STIs be reported to the local or state health department. Public health departments frequently employ trained disease intervention specialists, who can help with partner notification and treatment referrals.
Official, confidential partner notification effectively limits the spread of STIs, particularly syphilis and HIV. The practice also steers those at risk toward appropriate counseling and treatment. And since you can contract some STIs more than once, partner notification reduces your risk of getting reinfected.
Prevention
There are several ways to avoid or reduce your risk of sexually transmitted infections.
Abstain. The most effective way to avoid STIs is to abstain from sex.
Stay with one uninfected partner. Another reliable way of avoiding STIs is to stay in a long-term mutually monogamous relationship with a partner who isn't infected.
Get vaccinated. Getting vaccinated early, before sexual exposure, is also effective in preventing certain types of STIs. Vaccines are available to prevent two viral STIs that can cause cancer — human papillomavirus (HPV) and hepatitis B. The HPV vaccine is recommended for all girls between ages 9 and 26, and the hepatitis B vaccine is usually given to newborns.
Wait and verify. Avoid vaginal and anal intercourse with new partners until you have both been tested for STIs. Oral sex is less risky, but use a latex condom or dental dam to prevent direct contact between the oral and genital mucosa.
Use condoms consistently and correctly. Use a new latex condom for each sex act, whether oral, vaginal or anal. Never use an oil-based lubricant, such as petroleum jelly, with a latex condom. Keep in mind that nonbarrier forms of contraception, such as oral contraceptives or intrauterine devices, don't protect against STIs.
Don't drink alcohol excessively or use drugs. If you're under the influence, you're more likely to take sexual risks.
Avoid anonymous, casual sex. Don't look for sex partners online or in bars or other pickup places. Not knowing your sex partner well increases your risk of possible exposure to an STI.
Communicate. Before any serious sexual contact, communicate with your partner about practicing safer sex. Reach an explicit agreement about what activities will and won't be OK.
Teach your child. Becoming sexually active at a young age tends to increase a person's number of overall partners and, as a result, his or her risk of STIs. Biologically, young girls are more susceptible to infection. While you can't control your teen or preteen's actions, you can help your child understand the risks of sexual activity and that it's OK to wait to have sex.
Consider male circumcision. There's evidence that male circumcision can help reduce a man's risk of acquiring HIV from an infected woman (heterosexual transmission) by 50 to 60 percent. Male circumcision may also help prevent transmission of genital HPV and genital herpes.
Coping and support
It's traumatic to find out you have an STI. You might be angry if you feel you've been betrayed, or ashamed if there's a chance you infected others. At worst, an STI can cause chronic illness and death, even with the best care in the world. Between those extremes is a host of other potential losses — trust between partners, plans to have children, and joyful embrace of your sexuality and its expression.
Here's how you can cope:
Put blame on hold. Don't jump to the conclusion that your partner has been unfaithful to you. One (or both) of you may have been infected by a past partner.
Be candid with health care workers. Their job is not to judge you, but to stop STIs from spreading. Anything you tell them remains confidential.
Contact your health department. Although they may not have the staff and funds to offer comprehensive services, local health departments maintain STI programs that provide confidential testing, treatment and partner services.
Sexually transmitted diseases (STDs) are infections generally acquired by sexual contact. The organisms that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids.
Some of these infections can also be transmitted nonsexually, such as from mother to infant during pregnancy or childbirth, or through blood transfusions or shared needles.
It's possible to contract sexually transmitted diseases from people who seem perfectly healthy — people who, in fact, aren't even aware of being infected. Many of the infections transmitted through sex cause no symptoms, which is one of the reasons experts prefer the term "sexually transmitted infections" to "sexually transmitted diseases." The symptoms of several sexually transmitted infections are also easy to mistake for those of other conditions, so the correct diagnosis may be delayed.
Symptoms
Sexually transmitted infections (STIs) have a wide range of signs and symptoms. That's why they may go unnoticed until complications occur or a partner is diagnosed. Signs and symptoms that might indicate an STI include:
Sores or bumps on the genitals or in the oral or rectal area
Painful or burning urination
Discharge from the penis
Vaginal discharge
Unusual vaginal bleeding
Sore, swollen lymph nodes, particularly in the groin but sometimes more widespread
Signs and symptoms may appear a few days to three months after exposure, depending on the organism. They may resolve in a few weeks, even without treatment, but progression with later complications — or recurrence — sometimes occurs.
When to see a doctor
See a doctor immediately if you are sexually active and you believe you've been exposed to an STI or you have signs and symptoms of an STI.
Make an appointment with a doctor for STI counseling and, if appropriate, for screening tests:
When you consider becoming sexually active, or when you're 21, whichever comes first
Before you start having sex with a new partner
Causes
Sexually transmitted infections can be caused by:
Bacteria (gonorrhea, syphilis, chlamydia)
Parasites (trichomoniasis)
Viruses (human papillomavirus, genital herpes, HIV)
Sexual activity plays a role in spreading many other infectious agents, although it's possible to be infected without sexual contact. Examples include the hepatitis A and B viruses, shigella, cryptosporidium and Giardia lamblia.
Risk factors
Anyone who is sexually active risks exposure to a sexually transmitted infection to some degree. Factors that may increase that risk include:
Having unprotected sex. Vaginal or anal penetration by an infected partner who is not wearing a latex condom transmits some diseases with particular efficiency. Without a condom, a man who has gonorrhea has a 70 to 80 percent chance of infecting his female partner in a single act of vaginal intercourse. Improper or inconsistent use of condoms can also increase your risk. Oral sex is less risky but may still transmit germs without a latex condom or dental dam.
Having multiple sex partners. The more people you have sex with, the greater your overall exposure. This is true for concurrent as well as consecutive partners. Each time you break up with one partner and move on to another, even if each relationship is monogamous, your STI risk is increased.
Having a history of one or more STIs. Being infected with one STI makes it much easier for another STI to take hold. If you're infected with herpes, syphilis, gonorrhea or chlamydia and you have unprotected sex with an HIV-positive partner, you're more likely to contract HIV. Also, it's possible to be reinfected by the same infected partner if he or she isn't treated along with you.
Abusing alcohol or using recreational drugs. Substance abuse can inhibit your judgment, making you more willing to participate in risky behaviors.
Injecting drugs. Needle sharing spreads many serious infections, including HIV and hepatitis B. If you acquire HIV by injecting drugs, you can transmit it sexually.
Being an adolescent female. In adolescent girls, the immature cervix is made up of constantly changing cells. These unstable cells make the adolescent female cervix more vulnerable to certain sexually transmitted organisms.
According to a surveillance report from the Centers for Disease Control and Prevention, sexually transmitted infections are more common among certain groups, such as young people, men who have sex with men and minority communities. The theory is that potential sex partners often belong to social networks made up of people of similar age, location and background. Within these overlapping networks, couples regularly form, split up and find new partners. If one STI is making its way through such a network, there's a good chance that others are, too.
Transmission from mother to infant
Certain STIs such as gonorrhea, chlamydia and syphilis can be passed from an infected mother to her child during pregnancy or delivery. STIs in infants can cause serious problems and may be fatal. All pregnant women should be screened for these infections and treated, if necessary.
Preparing for your appointment
Not many people feel comfortable sharing the details of their sexual experiences, but the doctor's office is one place where such information is essential to appropriate care.
What you can do
Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance.
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Make a list of all medications, as well as any vitamins or supplements, that you're taking.
Write down questions to ask your doctor.
Some basic questions to ask your doctor include:
What's the medical name of the infection or infections I have?
How, exactly, is it transmitted?
Will it keep me from having children?
If I get pregnant, could I give it to my baby?
Is it possible to catch this again?
Could I have caught this from someone I had sex with only once?
Could I give this to someone by having sex with that person just once?
How long have I had it?
Should I abstain from sexual activity while being treated?
Does my partner have to go to a doctor to be treated?
What to expect from your doctor
Giving your doctor a complete report of your symptoms and sexual history will help your doctor determine how to best care for you. Here are some of the things you may be asked:
Do you think you might have a sexually transmitted infection? If so, why?
Are you sexually active with men, women or both?
Do you currently have one sex partner or more than one?
How long have you been with your current partner or partners?
Have you ever injected yourself with drugs?
Have you ever had sex with someone who has injected drugs?
What do you do to protect yourself from STIs?
What do you do to prevent pregnancy?
Has a doctor or nurse ever told you that you have chlamydia, herpes, gonorrhea, syphilis or HIV?
Have you ever been treated for a genital discharge, genital sores, painful urination or an infection of your sex organs?
How many sex partners have you had in the past year?
How many people have you had sex with in the past two months?
When was your most recent sexual encounter?
Tests and diagnosis
If your sexual history and current signs and symptoms suggest that you have an STI, laboratory tests can identify the cause and detect coinfections you might also have contracted.
Blood tests. Blood tests can confirm the diagnosis of HIV or later stages of syphilis.
Urine samples. Some STIs can be confirmed with a urine sample.
Fluid samples. If you have active genital sores, testing fluid and samples from the sores may be done to diagnose the type of infection. Laboratory tests of material from a genital sore or discharge are used to diagnose the most common bacterial and some viral STIs at an early stage.
Screening
Testing for a disease in someone who doesn't have symptoms is called screening. Most of the time, STI screening is not a routine part of health care. But there are exceptions:
Everyone. The one STI screening test suggested for everyone ages 13 to 64 is a blood or saliva test for human immunodeficiency virus (HIV), the virus that causes AIDS. Most health care settings in the United States offer a rapid HIV test with same-day results.
Pregnant women. Screening for HIV, hepatitis B, chlamydia and syphilis generally takes place at the first prenatal visit for all pregnant women. Gonorrhea and hepatitis C screening tests are recommended at least once during pregnancy for women at high risk of these infections.
Women age 21 and older. The Pap test screens for cervical abnormalities, including inflammation, precancerous changes and cancer, which is caused by certain strains of human papillomavirus (HPV). Experts recommend that, starting at age 21, women should have a Pap test at least every three years. Some experts also advise that women who start having sex before age 21 should have a Pap test within three years of first intercourse.
Women under age 25 who are sexually active. All sexually active women under age 25 should be tested for chlamydia infection. The chlamydia test uses a sample of urine or vaginal fluid you can collect yourself. Some experts recommend repeating the chlamydia test three months after you've had a positive test and been treated. The second test is needed to confirm that the infection is cured, as reinfection by an untreated or undertreated partner is common. A bout of chlamydia doesn't protect you from future exposures. You can catch the infection again and again, so you should get retested if you have a new partner. Screening for gonorrhea is also recommended in sexually active women under age 25.
Men who have sex with men. Compared with other groups, men who have sex with men run a higher risk of acquiring STIs. Many public health groups recommend annual or more frequent STI screening for these men. Regular tests for HIV, syphilis, chlamydia and gonorrhea are particularly important. Evaluation for herpes and hepatitis B also may be recommended.
People with HIV. If you have HIV, it dramatically raises your risk of catching other STIs. Experts recommend frequent syphilis, gonorrhea, chlamydia and herpes tests for people with HIV. Women with HIV may develop aggressive cervical cancer, so they should have Pap tests twice a year to screen for HPV. Some experts also recommend regular HPV screening of HIV-infected men who risk anal cancer from HPV contracted anally.
Complications
Prompt treatment can help prevent the complications of some STIs. Since many people in the early stages of an STI experience no symptoms, screening for STIs is especially important in preventing complications.
Possible complications include:
Sores or bumps anywhere on the body
Recurrent genital sores
Generalized skin rash
Pain during intercourse
Scrotal pain, redness and swelling
Pelvic pain
Groin abscess
Eye inflammation
Arthritis
Pelvic inflammatory disease
Infertility
Cervical cancer
Other cancers, including HIV-associated lymphoma and HPV-associated rectal and anal cancers
Opportunistic infections occurring in advanced HIV
Maternal-fetal transmission, which causes severe birth defects
Treatments and drugs
STIs caused by bacteria are generally easy to treat. Viral infections can be managed but not always cured. If you're pregnant and have an STI, prompt treatment can prevent or reduce the risk of infection of your baby. Treatment usually consists of one of the following, depending on the infection.
Antibiotics. Antibiotics, often in a single dose, can cure many sexually transmitted bacterial and parasitic infections, including gonorrhea, syphilis, chlamydia and trichomoniasis. Typically, you'll be treated for gonorrhea and chlamydia at the same time because the two infections often appear together.
Once you start antibiotic treatment, it's crucial to follow through. If you don't think you'll be able to take medication as prescribed, tell your doctor. A shorter, simpler treatment regimen may be available. In addition, it's important to abstain from sex until you've completed treatment and any sores have healed.
Antiviral drugs. You'll have fewer herpes recurrences if you take daily suppressive therapy with a prescription antiviral drug, but you can still give your partner herpes at any time.
Antiviral drugs can keep HIV infection in check for many years, although the virus persists and can still be transmitted. The sooner you start treatment, the more effective it is. If you take anti-HIV medication for 28 days, starting as soon as you know you've been exposed, you may avoid becoming HIV-positive.
Partner notification and preventive treatment
If tests show that you have an STI, your sex partners — including your current partners and any other partners you've had over the last three months to one year — need to be informed so that they can get tested and treated if infected. Each state has different requirements but most mandate that certain STIs be reported to the local or state health department. Public health departments frequently employ trained disease intervention specialists, who can help with partner notification and treatment referrals.
Official, confidential partner notification effectively limits the spread of STIs, particularly syphilis and HIV. The practice also steers those at risk toward appropriate counseling and treatment. And since you can contract some STIs more than once, partner notification reduces your risk of getting reinfected.
Prevention
There are several ways to avoid or reduce your risk of sexually transmitted infections.
Abstain. The most effective way to avoid STIs is to abstain from sex.
Stay with one uninfected partner. Another reliable way of avoiding STIs is to stay in a long-term mutually monogamous relationship with a partner who isn't infected.
Get vaccinated. Getting vaccinated early, before sexual exposure, is also effective in preventing certain types of STIs. Vaccines are available to prevent two viral STIs that can cause cancer — human papillomavirus (HPV) and hepatitis B. The HPV vaccine is recommended for all girls between ages 9 and 26, and the hepatitis B vaccine is usually given to newborns.
Wait and verify. Avoid vaginal and anal intercourse with new partners until you have both been tested for STIs. Oral sex is less risky, but use a latex condom or dental dam to prevent direct contact between the oral and genital mucosa.
Use condoms consistently and correctly. Use a new latex condom for each sex act, whether oral, vaginal or anal. Never use an oil-based lubricant, such as petroleum jelly, with a latex condom. Keep in mind that nonbarrier forms of contraception, such as oral contraceptives or intrauterine devices, don't protect against STIs.
Don't drink alcohol excessively or use drugs. If you're under the influence, you're more likely to take sexual risks.
Avoid anonymous, casual sex. Don't look for sex partners online or in bars or other pickup places. Not knowing your sex partner well increases your risk of possible exposure to an STI.
Communicate. Before any serious sexual contact, communicate with your partner about practicing safer sex. Reach an explicit agreement about what activities will and won't be OK.
Teach your child. Becoming sexually active at a young age tends to increase a person's number of overall partners and, as a result, his or her risk of STIs. Biologically, young girls are more susceptible to infection. While you can't control your teen or preteen's actions, you can help your child understand the risks of sexual activity and that it's OK to wait to have sex.
Consider male circumcision. There's evidence that male circumcision can help reduce a man's risk of acquiring HIV from an infected woman (heterosexual transmission) by 50 to 60 percent. Male circumcision may also help prevent transmission of genital HPV and genital herpes.
Coping and support
It's traumatic to find out you have an STI. You might be angry if you feel you've been betrayed, or ashamed if there's a chance you infected others. At worst, an STI can cause chronic illness and death, even with the best care in the world. Between those extremes is a host of other potential losses — trust between partners, plans to have children, and joyful embrace of your sexuality and its expression.
Here's how you can cope:
Put blame on hold. Don't jump to the conclusion that your partner has been unfaithful to you. One (or both) of you may have been infected by a past partner.
Be candid with health care workers. Their job is not to judge you, but to stop STIs from spreading. Anything you tell them remains confidential.
Contact your health department. Although they may not have the staff and funds to offer comprehensive services, local health departments maintain STI programs that provide confidential testing, treatment and partner services.
Top 10 Items You Should Have in Your Medicine Chest
Headache, upset stomach, sinus problems, menstrual pain, athlete's foot, dandruff, lip conditions, dry skin and the common cold -- chances are you've had one if not more than one of them. They're the most common, everyday health complaints, and while you may not be able to prevent them with a little at-home preparation, you can knock each of them out for the count and just maybe avoid a visit to your doctor. The secret? A well-stocked medicine chest.
First things first: You've got to take stock of what's in there already -- and then clean and restock it annually. Toss out old supplies and anything that's damaged (damaged container, unreadable or missing labels, broken or discolored pills) or past its expiration date. This is also the time to get your prescription and over-the-counter (OTC) medicines out of there, and not just because your guests might snoop. A "medicine" chest isn't actually for storing your medicines, however convoluted that may sound. The humidity in your bathroom isn't good for medicine, most of which can deteriorate quickly in moisture -- you may like a steamy shower, but your pills don't. Store them instead in a cool, dark and dry place in another room.
If medicine doesn't belong in a medicine chest, what does? We've compiled a list of the 10 essentials, from symptom relief to first aid, along with tips for homes with kids and pets.
First things first: You've got to take stock of what's in there already -- and then clean and restock it annually. Toss out old supplies and anything that's damaged (damaged container, unreadable or missing labels, broken or discolored pills) or past its expiration date. This is also the time to get your prescription and over-the-counter (OTC) medicines out of there, and not just because your guests might snoop. A "medicine" chest isn't actually for storing your medicines, however convoluted that may sound. The humidity in your bathroom isn't good for medicine, most of which can deteriorate quickly in moisture -- you may like a steamy shower, but your pills don't. Store them instead in a cool, dark and dry place in another room.
If medicine doesn't belong in a medicine chest, what does? We've compiled a list of the 10 essentials, from symptom relief to first aid, along with tips for homes with kids and pets.
ARC, AIDS-RELATED COMPLEX
ARC, AIDS-RELATED COMPLEX short for has been oluşmuştur.Türkçesi, AIDS related diseases and these diseases, AIDS disease are composed of the virus with the same type of virus causes olmaktadır.AIDS of asymptomatic periods after approximately 4-5 years, ongoing and chronic illnesses seen stage is. This disease on any of the captured person with AIDS with the same symptoms gösterebilir.Bunların some lymph nodes swelling, fatigue and rapid weight loss sayılabilir.Bu diseases, opportunistic infections, as tanımlanabilir.Fırsatçı infection, the body immune system weakness yararlanırlar.Fırsatçı infections, the most important Pneumystic carinii Pneumaonia (PCP), Kaposis sarcoma (KS), and is skin cancer. Immune suppression (Immunosupressed) or have compromised immune (Immunocompromised) persons who have weakened immune systems are the words to express the other terms are used. As a result, weakening the immune system of HIV and other diseases, the problem was caused by the same virus can cause death of patients with complex. The AIDS virus has caused the above mentioned diseases are one of the people caught the virus is activated even if the ill person edebilirler.Ancak continue a normal life, some may have mild symptoms. Çıkmayabilir.İlk five years until the middle to AIDS did not show any symptoms, even in times olmuştur.New York 29% of patients in the study of disease symptoms is also seen that within the first 4.5 years.
A condom as a method of birth control
A condom as a method of birth control or protection against sexually transmitted diseases are used as methods.
If you have sex with your partner a match, including sexually transmitted HIV, the virus does not carry any disease until you are sure that vaginal, oral or anal sex, always use at. You can also use it to provide birth control. Condom use before the expiration date of your check.
Even if you use other methods of birth control, condom use for disease prevention must. Of course, protection from sexually transmitted diseases is the cleanest way is to not have sex. Let us now come to our subject.
Proper condom use
If you follow the steps in the most efficient use of condoms.
* A new condom before each use combined.
* When removing the condom from the package, on a condom with your fingernails, your teeth, take care not to drill holes or other objects.
* Wear a condom on your penis just as soon as the erection.
* Keep the tip of the condom before inserting the condom and that the air inside the empty space left in the men get to hide your.
* If you're not circumcised condom before inserting your excess skin is pulled back.
* A condom is keeping the head, from the root to the tip of your penis-story portion is open.
* If you are using condoms for birth control purposes, your spouse spermatisid (a gel that kills sperm) to make sure that.
* If you are going to use petroleum jelly lubricant, oil, hand lotion, baby oil or fat in such products do not use any petroleum-based. Oil can weaken the condom. To do this task instead of using specific products produced here (Astroglide, KY Gel).
* Discharge from the penis after the condom by holding up your part of the lowest point to remove the (still do at your erection). Thus prevents loss of semen in a condom inside you.
* Always vaginal, oral or anal sex, condom use during the new.
* Wash your hands after using a condom.
Purchase and storage conditions
* U.S. property please be sure to use latex condoms (condoms produced ABDe has very strict security standards).
* From the latex condom (rubber), polyurethane, or are made from sheep intestines. Latex prevents sexually transmitted diseases, but made from sheep intestine condoms do not provide this protection.
* Use a condom in original packaging until you dry, cool place away from sunlight and keep. Certainly before the expiration date of a refer.
* To keep a condom in cold areas of particular attention here because the heat weakens latex and increases the likelihood of tearing the condom.
* Do not use a condom package is damaged.
If you have sex with your partner a match, including sexually transmitted HIV, the virus does not carry any disease until you are sure that vaginal, oral or anal sex, always use at. You can also use it to provide birth control. Condom use before the expiration date of your check.
Even if you use other methods of birth control, condom use for disease prevention must. Of course, protection from sexually transmitted diseases is the cleanest way is to not have sex. Let us now come to our subject.
Proper condom use
If you follow the steps in the most efficient use of condoms.
* A new condom before each use combined.
* When removing the condom from the package, on a condom with your fingernails, your teeth, take care not to drill holes or other objects.
* Wear a condom on your penis just as soon as the erection.
* Keep the tip of the condom before inserting the condom and that the air inside the empty space left in the men get to hide your.
* If you're not circumcised condom before inserting your excess skin is pulled back.
* A condom is keeping the head, from the root to the tip of your penis-story portion is open.
* If you are using condoms for birth control purposes, your spouse spermatisid (a gel that kills sperm) to make sure that.
* If you are going to use petroleum jelly lubricant, oil, hand lotion, baby oil or fat in such products do not use any petroleum-based. Oil can weaken the condom. To do this task instead of using specific products produced here (Astroglide, KY Gel).
* Discharge from the penis after the condom by holding up your part of the lowest point to remove the (still do at your erection). Thus prevents loss of semen in a condom inside you.
* Always vaginal, oral or anal sex, condom use during the new.
* Wash your hands after using a condom.
Purchase and storage conditions
* U.S. property please be sure to use latex condoms (condoms produced ABDe has very strict security standards).
* From the latex condom (rubber), polyurethane, or are made from sheep intestines. Latex prevents sexually transmitted diseases, but made from sheep intestine condoms do not provide this protection.
* Use a condom in original packaging until you dry, cool place away from sunlight and keep. Certainly before the expiration date of a refer.
* To keep a condom in cold areas of particular attention here because the heat weakens latex and increases the likelihood of tearing the condom.
* Do not use a condom package is damaged.
The United Nations World AIDS Day
The United Nations World AIDS Day events held under the leadership of the 18th When entering the year, this global health problem despite all the calls and the effort is still dark in the table.
UN Children's Fund (UNICEF), pregnant mothers, people living with HIV and drug treatment facilities necessary to attain the status of 600 thousand babies born each year with HIV, more than half of those born with the disease could be said to prevent.
24 years ago in a medical journal comes up as a mysterious disease, AIDS, almost everyone in the world today can affect their lives is creating a health crisis.
English başharfleriyle sendromuun alleviate immune deficiency called AIDS, HIV virus through blood or sexual contact is due July. HIV virus after receiving the emergence of the disease varies from person to person is. AIDS, the body's immune system to collapse and death can go up to open the door leads to various diseases.
TABLE pessimistic: 40 million people are TAS VIRUS
Gloomy statement on World AIDS day, among them children, including more than 40 million people carry the virus that cause disease. This year alone more than 3 million people died due to illness. 5 million new cases emerged.
Is spreading rapidly
AIDS, race, language, from the rich-poor diagnosis continues to spread. The number of HIV carriers and AIDS patients in the world of the African continent where two-thirds of the disease, who pay the heaviest price for the region will continue to be.
The UN organization fighting AIDS (UNAIDS) 2005 report, the percentage of women with HIV live in Afrikaans 77inin 3.2 million Africans infected this year and 2.4 million Africans died of AIDS. In the report, the Sahara of the world population live in areas under more than 10ndan 60an percent said that more than HIV. 13.5 million people living with HIV 17.5 million women in the report underlined that the African AIDS on the continent under the age of 5 as one of the most important cause of child deaths were recorded. According to the report, the country most of people living with HIV in South Africa at least 6.2 million people, ranking the first and Nijerya3, is in third place with 2 to 3.6 people.
India takes second place outside of africa.
Kenya, Uganda and Zimbabvee among adults seen in a decrease in the proportion of people infected in the report, in the central part of Africa, where infection levels are exceptionally high seyretmeyedevam said. Bostwana, Lesotho, Namibia and Swaziland in countries such as disease prevalence among pregnant women than 30an percent recorded in 1990 up to the peak of the disease, the number of infections on a regular basis is Ugandaa falls. However, in the report, not improve measures may not be warned that this development will continue.
UNAIDS and World Health Organization (WHO), this cycle of death and co-guided the development of measures to prevent drugs can be easily reached opinion is reported.
UN Children's Fund (UNICEF), pregnant mothers, people living with HIV and drug treatment facilities necessary to attain the status of 600 thousand babies born each year with HIV, more than half of those born with the disease could be said to prevent.
24 years ago in a medical journal comes up as a mysterious disease, AIDS, almost everyone in the world today can affect their lives is creating a health crisis.
English başharfleriyle sendromuun alleviate immune deficiency called AIDS, HIV virus through blood or sexual contact is due July. HIV virus after receiving the emergence of the disease varies from person to person is. AIDS, the body's immune system to collapse and death can go up to open the door leads to various diseases.
TABLE pessimistic: 40 million people are TAS VIRUS
Gloomy statement on World AIDS day, among them children, including more than 40 million people carry the virus that cause disease. This year alone more than 3 million people died due to illness. 5 million new cases emerged.
Is spreading rapidly
AIDS, race, language, from the rich-poor diagnosis continues to spread. The number of HIV carriers and AIDS patients in the world of the African continent where two-thirds of the disease, who pay the heaviest price for the region will continue to be.
The UN organization fighting AIDS (UNAIDS) 2005 report, the percentage of women with HIV live in Afrikaans 77inin 3.2 million Africans infected this year and 2.4 million Africans died of AIDS. In the report, the Sahara of the world population live in areas under more than 10ndan 60an percent said that more than HIV. 13.5 million people living with HIV 17.5 million women in the report underlined that the African AIDS on the continent under the age of 5 as one of the most important cause of child deaths were recorded. According to the report, the country most of people living with HIV in South Africa at least 6.2 million people, ranking the first and Nijerya3, is in third place with 2 to 3.6 people.
India takes second place outside of africa.
Kenya, Uganda and Zimbabvee among adults seen in a decrease in the proportion of people infected in the report, in the central part of Africa, where infection levels are exceptionally high seyretmeyedevam said. Bostwana, Lesotho, Namibia and Swaziland in countries such as disease prevalence among pregnant women than 30an percent recorded in 1990 up to the peak of the disease, the number of infections on a regular basis is Ugandaa falls. However, in the report, not improve measures may not be warned that this development will continue.
UNAIDS and World Health Organization (WHO), this cycle of death and co-guided the development of measures to prevent drugs can be easily reached opinion is reported.
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