>Hepatitis C

Hepatitis C

Hepatitis C, caused by Hepatitis C virus,like other forms of hepatitis, causes inflammation of the liver. The hepatitis C virus is transferred primarily through blood, and is more persistent than hepatitis A or B.

Hepatitis C virus

Transmission of hepatitis C:

The hepatitis C virus (HCV) can be spread in the following ways:

• By sharing drug-injecting equipment (needles, heating spoons, etc). This is the primary transmission route for HCV outside sub-Saharan Africa.
• By using non-sterilised equipment for tattooing, acupuncture or body piercing. This can be a problem in countries where tattooing or scarification is a traditional ritual practice.
• Through exposure to blood during unprotected sex with an infected person. Blood may be present because of genital sores, cuts or menstruation. Sexual transmission is an uncommon way of becoming infected with hepatitis C.
• Rarely, from an infected mother to her baby during childbirth. The risk may be greater if the mother is also infected with HIV.
• Through blood transfusion. In many developing countries blood is not screened (tested) for the hepatitis C virus. All blood for transfusion in the UK and USA is tested.
• By sharing equipment used to snort cocaine. Usually this is a rolled banknote, which can become contaminated with blood from a person’s nose.

Hepatitis C cannot be passed on by hugging, sneezing, coughing, sharing food or water, sharing cutlery, or casual contact.

Signs and symptoms of hepatitis C:

Many people do not have symptoms when they become infected with hepatitis C. Symptoms may emerge later, taking anywhere between 15 and 150 days to develop. Occasionally a person will not develop any symptoms and their immune system will successfully clear the virus without their knowledge. An infected person without symptoms can still act as a carrier and pass the virus on to others.

Symptoms may include:

• A short, mild, flu-like illness;
• nausea and vomiting;
• diarrhoea;
• loss of appetite;
• weight loss;
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
• itchy skin.

About 20% of individuals who become infected with HCV will clear the virus from their body within 6 months, though this does not mean they are immune from future infection with HCV.

The other 80% of people will develop chronic hepatitis C infection, during which the virus may cause mild symptoms or no symptoms at all. These people will however carry the hepatitis C virus for the rest of their lives and will remain infectious to others.

If a person lives with hepatitis C infection for a number of years then they may develop the following complications:

• chronic hepatitis
• liver cirrhosis
• liver cancer

If symptoms become severe then a person with hepatitis C may be admitted to hospital for monitoring and treatment.

The tests for hepatitis C:

Tests for the hepatitis C virus have only been available since 1989. A doctor can diagnose hepatitis C by carrying out blood tests that detect HCV antibodies in the blood.

What does a positive test result mean?

The first test searches for HCV antibodies in the patient’s blood. A positive result shows that the person has been exposed to the hepatitis C virus and their immune system has responded by producing antibodies.

This may mean that the patient is a carrier of the hepatitis C virus. Alternatively, the patient may have recently cleared an HCV infection and still have antibodies in their blood. Further tests will be conducted to find out whether the patient has a current infection.

A specialist will carry out a blood test that looks for the genetic material of the hepatitis C virus itself instead of the antibodies. This test will identify whether the virus is still present.

If the patient has successfully cleared the virus, this does not mean they are immune to reinfection.

What does a negative test result mean?

A negative result generally means the patient has never been infected with HCV. However, as the tests rely on the detection of antibodies to HCV, and the antibodies can take some months to develop, the doctor may advise the patient to take a repeat test if they believe they may have been recently exposed to the virus.

Treatment for hepatitis C:

To determine the extent to which the liver has been affected by hepatitis C, other tests may be carried out. These include liver function tests, which measure substances (specific proteins and enzymes) in the patient’s blood, showing how effectively the liver is working. A liver biopsy may also be carried out. A fine hollow needle is passed through the skin into the liver and a small sample is taken. The sample is then examined under a microscope to gauge the amount of liver damage (inflammation, scarring and cirrhosis).

Treatment combines the antiviral drugs interferon and ribavirin. Although treatment has improved in recent years, the success rates vary depending on which genotype the patient has and how long they have had hepatitis C.

The antiviral drugs may cause significant side effects that may be intolerable for some people. These include:

• headaches
• flu-like symptoms
• nausea
• tiredness
• body aches
• depression
• skin rashes

A patient will also require regular check-ups to monitor their progress. It is important to remember that if HCV treatment is effective and the infection is cleared, this does not mean the patient has future immunity to hepatitis C.

Follow-up:

If a patient has been diagnosed with hepatitis C infection, they will be advised to have regular blood tests and physical check-ups.

The infected person should limit the amount of alcohol they drink as alcohol puts strain on the liver. The doctor may also advise avoiding fatty foods and following a low-salt diet.

Prevention:

Currently, there is no vaccine for hepatitis C, but research is in progress. Like HIV, HCV can mutate easily, which makes vaccine development complicated. As no vaccine exists, all measures should be taken to prevent HCV transmission.

Injecting drug users should never share any needles, syringes or mixing spoons, as blood can be transferred between users.

Infection through penetrative sex does occur, although it is not common. If a person is infected with HCV, it is advisable for them to use a condom for penetrative sex to ensure they do not pass on the virus to their partners through any open genital cuts or sores.

People should avoid sharing toothbrushes, shaving equipment (especially razors), or anything else that may be contaminated with infected blood.

The doctor will advise the patient of any precautions necessary to avoid infecting others with the virus.

>Hepatitis B

Hepatitis B

Hepatitis B is caused by Hepatitis B virus and similar to hepatitis A in its symptoms, but is more likely to cause chronic long-term illness and permanent damage to the liver if not treated.

Hepatitis B virus

Transmission of hepatitis B:

The hepatitis B virus (HBV) is very common worldwide, with more than 350 million people infected. Those with long term HBV are at high risk of developing liver cirrhosis or liver cancer.

Hepatitis B is most frequently passed on through the exchange of bodily fluids with an infected person. HBV is estimated to be 50 to 100 times more infectious than HIV.

HBV can be spread in the following ways:

• By unprotected (without a condom) penetrative sex (when the penis enters the anus, vagina or mouth) with someone who is infectious. Also by sex that draws blood with someone who is infected.
• By sharing contaminated needles or other drug-injecting equipment.
• By using non-sterilised equipment for tattooing, acupuncture or body piercing.
• From an infected mother to her baby, most commonly during delivery. Immunisation of the baby at birth prevents the transmission of hepatitis B.
• Through a blood transfusion in a country where blood is not screened for blood-borne viruses such as HBV.

Hepatitis B cannot be spread through sneezing, coughing, hugging or coming in contact with the faeces of someone who is infected.

Signs and symptoms of hepatitis B:

Many people who become infected with HBV experience mild symptoms or no symptoms at all, but they may still carry the infectious virus and pass it on to others. When symptoms do appear they are similar to those of hepatitis A and may include:

• A short, mild, flu-like illness;
• nausea, vomiting and diarrhoea;
• loss of appetite;
• weight loss;
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
• itchy skin.

If symptoms become severe then a person with hepatitis B may be admitted to hospital.

Most adults infected with the hepatitis B virus fully recover and develop life-long immunity. Between 2% and 10% of individuals infected as adults will become chronic carriers, which means they will be infectious to others and can develop chronic liver damage. Infected children, especially newborn babies, are much more likely to become chronic carriers.

If a person lives with hepatitis B infection for a number of years then they may develop the following complications:

• chronic hepatitis
• liver cirrhosis
• liver cancer.

What does a positive test result mean?

A positive test result could indicate either of the following:

• A past infection. This means the patient has already been in contact with hepatitis B and their immune system has succeeded in fighting off the virus. The patient will then have a natural immunity to the virus.
• The patient is a carrier. This means the patient is carrying HBV and can pass it on to others. The person may not display any symptoms but could be at risk of developing chronic liver disease.

A doctor may perform a number of different types of test to distinguish between current and past infections, and to estimate how infectious a patient with a current infection may be.

What does a negative test result mean?

This result generally means the patient has never been infected with HBV and therefore has no natural immunity against the virus. If the person suspects they may have been recently exposed to HBV, the doctor may advise them to take a repeat test to confirm their negative status, and may also advise immunisation against hepatitis B.

Treatment for hepatitis B:

In most countries a patient with a positive test result will be referred to a specialist who will carry out further tests to determine the degree to which hepatitis B may be affecting the liver, and what may be the best treatment options. In these tests a small sample of liver tissue may need to be taken (a liver biopsy).

In the majority of patients with active HBV, symptoms will not be severe and treatment will not be required. The patient will be monitored and after a few months the patient’s immune system should fight off the virus, giving the patient natural immunity.

In around 5% of adults, 30-50% of young children (aged 1-4), and 90% of infants, HBV infection will become chronic. The virus is more deadly to the young and those that are infected at birth have a 25% chance of developing a life-threatening liver-related illness.

Antiviral medication is given as treatment to those with chronic symptoms to help prevent further liver damage. These medications may be injected or given in pill form. Examples are Interferon Alpha, Lamivudine and Baraclude. Treatment usually lasts 6 months, during which time the patient will be carefully monitored.

Regardless of whether the infection is producing symptoms or not, the patient will be advised to avoid alcohol, get plenty of rest and maintain a healthy diet.

Hepatitis B immunisation:

Three immunisation injections are given over a period of 3-6 months. A blood test is taken once the course of injections is completed to check they have worked. Immunity should last for at least 5 years.

Follow-up

A patient with an active infection will be advised to have regular blood tests and physical check-ups to monitor the virus, even if they are not receiving treatment. All carriers of HBV should expect to be referred to specialist services.

The doctor or nurse may advise the patient to avoid alcohol, fatty foods and follow a low-salt diet. They will also describe any precautions necessary to ensure the patient avoids infecting others with the virus, such as not sharing toothbrushes or shaving equipment.

It is important to use a condom for penetrative sex to prevent passing on the virus. Sexual partners of the patient should be tested and immunised against HBV (if not already infected).

>Hepatitis A

Hepatitis

'Hepatitis' refers to viral infections that cause inflammation of the liver. Hepatitis A, B and C are the most common types. Each have different causes and symptoms.

• Hepatitis A
• Hepatitis B
• Hepatitis C

Hepatitis A 

Hepatitis A is the most common of the seven known types of viral hepatitis. Infection with the hepatitis A virus leads to inflammation of the liver, but complications are rarely serious.

Hepatitis A virus

Transmission of hepatitis A:

The hepatitis A virus (HAV) is found in the faeces of someone infected with the virus. It only takes a tiny amount of faeces getting inside another person’s mouth to cause hepatitis A infection. Personal hygiene, such as careful hand washing, can minimise the risk of the virus being passed on.
HAV is a common infection in many parts of the world where sanitation and sewage infrastructure is poor. Often people become infected with HAV by eating or drinking contaminated food or water.
Hepatitis A is also classed as a sexually transmitted disease (STD) because it can be passed on sexually, particularly during activities such as anilingus (rimming). The washing of genital and anal areas before sex, and the use of condoms or dental dams can help to prevent this risk.
Hepatitis A can affect all age groups. Once a person is exposed to the virus it takes between 2 and 6 weeks to produce symptoms.

Signs and symptoms of hepatitis A:

It is possible to experience mild or no symptoms whatsoever, but even if this is the case the person’s faeces will still be infectious to others. Many people who become infected with HAV will have symptoms that include:

• A short, mild, flu-like illness;
• nausea, vomiting and diarrhoea;
• loss of appetite;
• weight loss;
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
• itchy skin;
• abdominal pain.

The infection usually clears in up to 2 months, but may occasionally recur or persist longer in some people. Once a person has been infected and their body has fought off the virus they are permanently immune. Occasionally symptoms may be severe and require monitoring in hospital.
There are rarely any complications with hepatitis A infection. Permanent damage to the liver is very unlikely, but in extremely rare cases the infection can be fatal, particularly in older people.

What does a positive test result mean?

HAV is tested for using a blood test. A positive test result means the patient has either had a past infection or is currently infected. The type of antibody detected in the test will indicate whether the infection is current or has been cleared. A patient who tests positive may be asked about recent contacts and sexual partners that may need to be tested too. A patient who has already had the infection and fought it off is naturally immune to HAV.

What does a negative test result mean?

A negative test result means the patient is not infected with Hepatitis A. If the patient is believed to be at high or ongoing risk of infection, a doctor may advise immunisation.

Treatment for hepatitis A:

There is no specific treatment for HAV and most people fight off the virus naturally, returning to full health within a couple of months. The doctor will advise avoiding alcohol and fatty foods as these can be hard for the liver to process and may exacerbate the inflammation.
Patients should get plenty of rest and eat a nutritious diet. They should also ensure they do not spread HAV by washing their hands after using the toilet and before preparing food. Patients with more severe symptoms may be monitored in hospital for a short period.

Hepatitis A immunisation

Hepatitis A immunisation is given in a series of injections. The first single injection in the arm gives protection for a year. The second booster injection at 6 to 12 months extends protection for up to 10 years.
The hepatitis A vaccine may be routinely recommended for young children living in areas with high incidence of hepatitis A, and anyone travelling to countries where hepatitis A is endemic. In addition, immunisation may be recommended for people whose sexual practices are likely to put them at risk.
Immunisation may also be recommended to prevent hepatitis A developing if a person suspects they have been exposed to the virus.

Follow-up

Someone who is infected with hepatitis A should limit the amount of alcohol they drink. Their doctor may also offer dietary advice.
The doctor will advise about any precautions necessary to avoid infecting others with the virus.

>AIDS (Acquired immuno deficiency syndrome)

AIDS Introduction

AIDS stands for: Acquired Immune Deficiency Syndrome

AIDS is a medical condition. A person is diagnosed with AIDS when their immune system is too weak to fight off infections.
Since AIDS was first identified in the early 1980s, an unprecedented number of people have been affected by the global AIDS epidemic. Today, there are an estimated 33.4 million people living with HIV and AIDS and each year around two million people die from AIDS related illnesses.

Causes of AIDS:

AIDS is caused by HIV.

HIV and Immune cells

HIV is a virus that gradually attacks immune system cells. As HIV progressively damages these cells, the body becomes more vulnerable to infections, which it will have difficulty in fighting off.  It is at the point of very advanced HIV infection that a person is said to have AIDS. It can be years before HIV has damaged the immune system enough for AIDS to develop.

Symptoms of AIDS:

A person is diagnosed with AIDS when they have developed an AIDS related condition or symptom, called an opportunistic infection, or an AIDS related cancer. The infections are called ‘opportunistic’ because they take advantage of the opportunity offered by a weakened immune system.
It is possible for someone to be diagnosed with AIDS even if they have not developed an opportunistic infection. AIDS can be diagnosed when the number of immune system cells (CD4 cells) in the blood of an HIV positive person drops below a certain level.

Is there a cure for AIDS?

Worryingly, many people think there is a 'cure' for AIDS - which makes them feel safer, and perhaps take risks that they otherwise wouldn’t. However, there is still no cure for AIDS. The only way to stay safe is to be aware of how HIV is transmitted and how to prevent HIV infection.

How many people have died from AIDS?

Since the first cases of AIDS were identified in 1981, more than 25 million people have died from AIDS. An estimated two million people died as a result of AIDS in 2008 alone.
Although there is no cure for AIDS, HIV infection can be prevented, and those living with HIV can take antiretroviral drugs to delay the onset of AIDS. However, in many countries across the world access to prevention and treatment services is limited. Global leaders have pledged to work towards universal access to HIV prevention and care, so that millions of deaths can be averted.

Treatment of AIDS:

 
A community health worker gives an HIV positive patient antiretroviral drugs, Kenya 

Antiretroviral treatment can prolong the time between HIV infection and the onset of AIDS. Modern combination therapy is highly effective and someone with HIV who is taking treatment could live for the rest of their life without developing AIDS.
An AIDS diagnosis does not necessarily equate to a death sentence. Many people can still benefit from starting antiretroviral therapy even once they have developed an AIDS defining illness. Better treatment and prevention for opportunistic infections have also helped to improve the quality and length of life for those diagnosed with AIDS.
Treating some opportunistic infections is easier than others. Infections such as herpes zoster and candidiasis of the mouth, throat or vagina, can be managed effectively in most environments. On the other hand, more complex infections such as toxoplasmosis, need advanced medical equipment and infrastructure, which are lacking in many resource-poor areas.
It is also important that treatment is provided for AIDS related pain, which is experienced by almost all people in the very advanced stages of HIV infection.

Why do people still develop AIDS today?

Even though antiretroviral treatment can prevent the onset of AIDS in a person living with HIV, many people are still diagnosed with AIDS today. There are four main reasons for this:

• In many resource-poor countries antiretroviral treatment is not widely available. Even in wealthier countries, such as America, many individuals are not covered by health insurance and cannot afford treatment. 
• Some people who became infected with HIV in the early years of the epidemic before combination therapy was available, have subsequently developed drug resistance and therefore have limited treatment options.
• Many people are never tested for HIV and only become aware they are infected with the virus once they have developed an AIDS related illness. These people are at a higher risk of mortality, as they tend to respond less well to treatment at this stage.
• Sometimes people taking treatment are unable to adhere to, or tolerate the side effects of drugs.

Caring for a person with AIDS:

In the later stages of AIDS, a person will need palliative care and emotional support. In many parts of the world, friends, family and AIDS organisations provide home based care. This is particularly the case in countries with high HIV prevalence and overstretched healthcare systems.
End of life care becomes necessary when a person has reached the very final stages of AIDS. At this stage, preparing for death and open discussion about whether a person is going to die often helps in addressing concerns and ensuring final wishes are followed.

The global AIDS epidemic

Around 2.7 million people became infected with HIV in 2008. Sub-Saharan Africa has been hardest hit by the epidemic; in 2008 over two-thirds of AIDS deaths were in this region.

 

Parc de l'espoir - AIDS Memorial Park in Montreal, Canada

The epidemic has had a devastating impact on societies, economies and infrastructures. In countries most severely affected, life expectancy has been reduced by as much as 20 years. Young adults in their productive years are the most at-risk population, so many countries have faced a slow-down in economic growth and an increase in household poverty. In Asia, HIV and AIDS causes a greater loss of productivity than any other disease. An adult’s most productive years are also their most reproductive and so many of the age group who have died from AIDS have left children behind. In sub-Saharan Africa the AIDS epidemic has orphaned nearly 12 million children.
In recent years, the response to the epidemic has been intensified; in the past ten years in low- and middle-income countries there has been a 6-fold increase in spending for HIV and AIDS. The number of people on antiretroviral treatment has increased, the annual number of AIDS deaths has declined, and the global percentage of people infected with HIV has stabilised.
However, recent achievements should not lead to complacent attitudes. In all parts of the world, people living with HIV still face AIDS related stigma and discrimination, and many people still cannot access sufficient HIV treatment and care. In America and some countries of Western and Central and Eastern Europe, infection rates are rising, indicating that HIV prevention is just as important now as it ever has been. Prevention efforts that have proved to be effective need to be scaled-up and treatment targets reached. Commitments from national governments right down to the community level need to be intensified and subsequently met, so that one day the world might see an end to the global AIDS epidemic.

>HIV(Human immuno deficiency virus)

Introduction of HIV

HIV and Immune cells

HIV stands for: Human Immunodeficiency Virus

HIV is a virus. Viruses such as HIV cannot grow or reproduce on their own, they need to infect the cells of a living organism in order to replicate (make new copies of themselves). The human immune system usually finds and kills viruses fairly quickly, but HIV attacks the immune system itself – the very thing that would normally get rid of a virus.

With around 2.7 million people becoming infected with HIV in 2008, there are now an estimated 33 million people around the world who are living with HIV, including millions who have developed AIDS.

The Structure of HIV:

In this computer generated image, the large object is a human CD4+ white blood cell, and the spots on its surface and the spiky blue objects in the foreground represent HIV particles. 

HIV virus structure

Outside of a human cell, HIV exists as roughly spherical particles (sometimes called virions). The surface of each particle is studded with lots of little spikes.
An HIV particle is around 100-150 billionths of a metre in diameter. That's about the same as:

• 0.1 microns
• 4 millionths of an inch
• one twentieth of the length of an E. coli bacterium
• one seventieth of the diameter of a human CD4+ white blood cell.

Unlike most bacteria, HIV particles are much too small to be seen through an ordinary microscope. However they can be seen clearly with an electron microscope.

HIV particles surround themselves with a coat of fatty material known as the viral envelope (or membrane). Projecting from this are around 72 little spikes, which are formed from the proteins gp120 and gp41. Just below the viral envelope is a layer called the matrix, which is made from the protein p17.

The proteins gp120 and gp41 together make up the spikes that project from HIV particles, while p17 forms the matrix and p24 forms the core.

The viral core (or capsid) is usually bullet-shaped and is made from the protein p24. Inside the core are three enzymes required for HIV replication called reverse transcriptase, integrase and protease. Also held within the core is HIV's genetic material, which consists of two identical strands of RNA.

Viral class of HIV:

HIV belongs to a special class of viruses called retroviruses. Within this class, HIV is placed in the subgroup of lentiviruses. Other lentiviruses include SIV, FIV, Visna and CAEV, which cause diseases in monkeys, cats, sheep and goats. Almost all organisms, including most viruses, store their genetic material on long strands of DNA. Retroviruses are the exception because their genes are composed of RNA (Ribonucleic Acid).

RNA has a very similar structure to DNA. However, small differences between the two molecules mean that HIV's replication process is a bit more complicated than that of most other viruses.

Number of genes of HIV:

HIV has just nine genes (compared to more than 500 genes in a bacterium, and around 20,000-25,000 in a human). Three of the HIV genes, called gag, pol and env, contain information needed to make structural proteins for new virus particles. The other six genes, known as tat, rev, nef, vif, vpr and vpu, code for proteins that control the ability of HIV to infect a cell, produce new copies of virus, or cause disease.

At either end of each strand of RNA is a sequence called the long terminal repeat, which helps to control HIV replication.

HIV life cycle:

Entry

HIV can only replicate (make new copies of itself) inside human cells. The process typically begins when a virus particle bumps into a cell that carries on its surface a special protein called CD4. The spikes on the surface of the virus particle stick to the CD4 and allow the viral envelope to fuse with the cell membrane. The contents of the HIV particle are then released into the cell, leaving the envelope behind.

Reverse Transcription and Integration

Once inside the cell, the HIV enzyme reverse transcriptase converts the viral RNA into DNA, which is compatible with human genetic material. This DNA is transported to the cell's nucleus, where it is spliced into the human DNA by the HIV enzyme integrase. Once integrated, the HIV DNA is known as provirus.

Transcription and Translation

HIV provirus may lie dormant within a cell for a long time. But when the cell becomes activated, it treats HIV genes in much the same way as human genes. First it converts them into messenger RNA (using human enzymes). Then the messenger RNA is transported outside the nucleus, and is used as a blueprint for producing new HIV proteins and enzymes.

Assembly, Budding and Maturation

 

This electron microscope photo shows newly formed HIV particles budding from a human cell.

Among the strands of messenger RNA produced by the cell are complete copies of HIV genetic material. These gather together with newly made HIV proteins and enzymes to form new viral particles, which are then released from the cell. The enzyme protease plays a vital role at this stage of the HIV life cycle by chopping up long strands of protein into smaller pieces, which are used to construct mature viral cores.

The newly matured HIV particles are ready to infect another cell and begin the replication process all over again. In this way the virus quickly spreads through the human body. And once a person is infected, they can pass HIV on to others in their bodily fluids.

Connection between HIV and AIDS:

HIV causes AIDS by damaging the immune system cells until the immune system can no longer fight off other infections that it would usually be able to prevent.

It takes around ten years on average for someone with HIV to develop AIDS. However, this average is based on the person with HIV having a reasonable diet, and someone who is malnourished may well progress from HIV to AIDS more rapidly.

Transmission of HIV:

HIV is found in the blood and the sexual fluids of an infected person, and in the breast milk of an infected woman. HIV transmission occurs when a sufficient quantity of these fluids get into someone else's bloodstream.

There are various ways a person can become infected with HIV:

• Unprotected sexual intercourse with an infected person: Sexual intercourse without a condom carries the risk of HIV infection.
• Contact with an infected person's blood: If sufficient blood from somebody who has HIV enters someone else's body, then HIV can be passed on in the blood.
• Use of infected blood products: Many people in the past have been infected with HIV by the use of blood transfusions and blood products which were contaminated with the virus. In much of the world this is no longer a significant risk, as blood donations are routinely tested for HIV.
• Injecting drugs: HIV can be passed on when injecting equipment that has been used by an infected person is then used by someone else. In many parts of the world, often because it is illegal to possess them, injecting equipment or works are shared.
• From mother to child: HIV can be transmitted from an infected woman to her baby during pregnancy, delivery and breastfeeding.

Certain groups of people, such as injecting drug users, sex workers, prisoners, and men who have sex with men have been particularly affected by HIV. However, HIV can infect anybody, and everyone needs to know how they can and can’t become infected with HIV.

HIV symptoms:

Some people experience a flu-like illness, develop a rash, or get swollen glands for a brief period soon after they become infected with HIV. However, although these are hiv symptoms they are also common symptoms of other less serious illnesses, and do not necessarily mean that a person has HIV.

Often people who are infected with HIV don’t have any symptoms at all. It is important to remember that a person who has HIV can pass on the virus immediately after becoming infected, even if they feel healthy. It’s not possible to tell just by looking if someone has been infected with HIV.

The only way to know for certain if someone is infected with HIV is for them to be tested.

Testing for HIV:

 

A sign promoting HIV testing in Livingstone, Zambia 

 

It is important for a person to get an HIV test if they think they may have been at risk of HIV infection.

There are various types of HIV test, but the most commonly used - the antibody or ELISA test - detects HIV antibodies in a person’s blood. It is necessary to wait at least 3 months after the last possible exposure before having an HIV antibody test, to be certain of an accurate result.

The prospect of receiving a positive test result (meaning that a person is infected with HIV) may be daunting, but learning that you are HIV positive is the first step to getting support and staying healthy. HIV testing is also very important for stopping the spread of HIV, as somebody who is aware of their HIV status can take steps to ensure they do not pass on the virus.

Treatment of HIV:

 

An HIV positive South African woman holding her antiretroviral drugs 

 

Antiretroviral drugs keep the levels of HIV in the body at a low level, so that the immune system is able to recover and work effectively. Antiretroviral drugs enable many HIV positive people to live long and healthy lives.

Starting antiretroviral treatment for HIV infection involves commitment – drugs have to be taken every day, and for the rest of a person’s life. Adhering to HIV treatment is important, particularly because not doing so increases the risk of drug resistance. Side effects to the HIV drugs can make adherence difficult, and are sometimes very severe. There are ways of reducing the impact of these side effects, but sometimes it is necessary to change to an alternative HIV treatment regime.

There are more than 20 antiretroviral drugs approved for the treatment of HIV infection in the US and Europe, as well as many new HIV drugs currently undergoing trials. Although treatment for HIV has become more widely available in recent years, access to antiretroviral treatment is limited in some parts of the world due to a lack of funding.

Prevention of HIV:

Despite considerable investment and research, there is currently no vaccine for HIV, and microbicides (designed to prevent HIV being passed on during sex) are still undergoing trials. However, there are other ways that people can protect themselves from HIV infection, which are the basis of HIV prevention efforts around the world.

Education about HIV and how it is spread is an essential part of HIV prevention. HIV education needs to be culturally appropriate and can take place in various settings, for example lessons at school, media campaigns, or peer education.

Preventing sexual transmission of HIV

 

HIV and AIDS education for Scouts in the Central African Republic 

 

If a person has sexual intercourse with someone who has HIV they can become infected. ‘Safer sex’ refers to things that a person can do to minimise their risk of HIV infection during sexual intercourse; most importantly, using condoms consistently and correctly.

A person can be certain that they are protected against HIV infection by choosing not to have sex at all, or by only doing things that do not involve any blood or sexual fluid from one person getting into another person's body. This kind of sexual activity is the only thing that can be considered ‘safe sex’.

Effective sex education is important for providing young people with the knowledge and skills to protect themselves from sexual transmission of HIV. Comprehensive sex education should develop skills and attitudes that encourage healthy sexual relationships, as well as provide detailed information about how to practise ‘safer sex’.

Preventing transmission of HIV through blood

A person can protect him or herself against HIV infection by ensuring that HIV infected blood does not enter their body.

Injecting drug users who share injecting equipment or works are at risk of HIV infection. Needle exchange programmes can help to prevent HIV transmission among drug users by providing clean needles and disposing of used ones.

Health care workers can be exposed to HIV infected blood while at work. The most effective way to limit their risk of HIV infection is to use universal precautions with every patient, for example washing hands and wearing protective barriers (gloves, aprons, goggles). In the event that a healthcare worker is exposed to potentially HIV infected blood at work, PEP (Post exposure prophylaxis) is recommended as an HIV prevention measure.

Preventing mother to child transmission of HIV

Mother to child transmission of HIV can be prevented by using antiretroviral drugs, which reduce the chances of a child becoming infected with HIV from around 25% to less than 2%. Once a child is born, safer infant feeding practices can also greatly reduce the risk of HIV being passed on from mother to child.

For these precautions to be taken, an HIV positive mother must firstly be aware of her status. This is why HIV testing in pregnancy is a crucial prevention measure.

The full story of HIV and AIDS

HIV is only half the story…

What happens when HIV develops into AIDS? Why are approximately 2 million people dying from AIDS each year? What are the effects of the global AIDS epidemic?

Learn about AIDS and get the full story.

>Anthrax

Introduction of Anthrax

Microscopic picture of anthrax

Anthrax is described in the early literature of the Greeks, Romans, and Hindus. The fifth plague, described in the book of Genesis, may be among the earliest descriptions of anthrax.

Anthrax is caused by exposure to the spores of the bacteria Bacillus anthracis that become entrenched in the host body and produce lethal poisons. It is primarily a disease of grazing animals such as cattle, sheep, goats, and horses. Pigs are more resistant, as are dogs and cats. Birds usually are naturally resistant to anthrax. Buzzards and vultures are naturally resistant to anthrax but may transmit the spores on their talons and beaks.

The bacteria that cause anthrax are able to go into a dormant phase, in which they form spores. Spores can exist in the environment for decades. Under the right conditions, the dormant spores can germinate and multiply.

If terrorists were to use the anthrax spores, they would most likely want to disperse it into the air for mass effect. As was seen in October 2001, terrorists could also deliver anthrax by other means, such as placing spores in letters or packages to be opened and inhaled and handled by unsuspecting recipients.People of any age may be affected. Most cases are mild and go away with treatment. Anthrax, however, can be lethal. There are several ways anthrax can cause illness. These are the 3 main ways anthrax affects humans:

Cutaneous (skin) anthrax

• Cutaneous (skin) anthrax causes a characteristic sore on the skin and results from exposure to the spores after handling sick animals or contaminated animal wool, hair, hides, or bone meal products. It is an occupational hazard for veterinarians, farmers, and people who handle animal products. Where the bacteria are common, human infection remains uncommon. Humans are relatively resistant, but the spores may gain access through even tiny breaks in the skin. Cutaneous anthrax is easy to cure if it is treated early with appropriate antibiotics.
• Inhalational anthrax results from breathing anthrax spores into the lungs. People who handle animal hides infested with spores may develop inhalational anthrax, known as woolsorter's disease. Once inhaled, the organisms multiply and may spread their toxins to the bloodstream and many other organs. Infection may spread from the liver, spleen, and kidneys back into the bloodstream, thus causing an overwhelming infection and death. This type of infection (known as septicemic anthrax) most commonly follows inhalational anthrax.
  
• Gastrointestinal anthrax results from eating meat products that contain anthrax. Gastrointestinal anthrax is difficult to diagnose. It can produce sores in the mouth and throat. A person who has eaten contaminated products may feel throat pain or have difficulty swallowing. This form of anthrax has a very high death rate.

Causes of Anthrax:

Anthrax is caused by the bacteria B anthracis. These are rod-shaped germs that can change from "normal" bacteria into spores (or single-celled seeds that can reproduce the bacteria).

Skin lesion of anthrax on face.

Signs and Symptoms of Anthrax:

• Cutaneous (skin) anthrax
  • Cutaneous anthrax occurs 1-7 days (usually 2-5) after spores enter the body through breaks in the skin.
  • This form most commonly affects the exposed areas of the arms and, to a lesser extent, the head and neck.
  • The infection may spread throughout the body in up to 20% of untreated cases.
  • Cutaneous anthrax begins as a small pimplelike lesion (a sore) that enlarges in 24-48 hours to form a "malignant pustule" at the site of the infection. This sore (about 2-3 cm or about an inch) is round with a raised edge. The sore is not painful. The central area of infection is surrounded by small blisters filled with bloody or clear fluid containing many bacteria. A black scab forms at the site of the sore in 7-10 days and lasts for 7-14 days before separating. The surrounding area may be swollen and painful and may last long after the scab forms.
  • Sores that affect the neck may cause swelling that could affect breathing.
  
  
• Inhalational anthrax
  • Inhalational anthrax begins abruptly, 1-60 days (usually 1-3 days) after inhaling large amounts of anthrax spores. The size of the spores is extremely important when it comes to causing disease, and this depends upon the techniques of the person producing the spores. Spores that are too small are inhaled but then immediately exhaled and do not remain in the lungs to cause disease. Spores that are made too large do not remain suspended in the air when released and drop to the ground and are thus never inhaled in the first place. Optimal sized spores for an anthrax biological weapon measure 1-5 micrograms in diameter.
  • A person may initially have no specific respiratory or breathing symptoms but might have a low-grade fever and a nonproductive cough. An exposed person may feel chest pain early in the illness and improve temporarily before rapidly progressing to having severe breathing problems.
  • Inhalational anthrax progresses rapidly with high fever, severe shortness of breath, rapid breathing, bluish color to the skin, a great deal of sweating, vomiting blood, and chest pain that may be so severe as to seem like a heart attack.
  • Inhalational anthrax usually causes death when the poisonous toxins produced by the bacteria overwhelm the body systems.
• Intestinal anthrax
  • Swallowing spores may cause intestinal anthrax 2-5 days later.
  • People with intestinal anthrax may have nausea, vomiting (also vomit blood), tiredness, no appetite, abdominal pain, and bloody diarrhea, plus a fever.
  • Intestinal anthrax is difficult to recognize. Shock and death may occur 2-5 days after it begins.
• Oropharyngeal (mouth and throat) anthrax
  • Swallowing of spores may result in anthrax appearing in the mouth and throat 2-7 days after exposure.
  • People with this type of anthrax may have a sore throat on one side or difficulty swallowing.
  • Death may occur because the person's throat may swell and cause difficulty breathing.
• Septicemic (bloodstream) anthrax
  • Septicemic anthrax refers to an overwhelming blood infection by anthrax. This can be a complication of inhalational anthrax.
  • Internal organs may become darkly colored with widespread bleeding. The bacteria multiply in the blood and overwhelm the red blood cells. The term anthrax is derived from the Greek word for coal and was descriptive in that the lesions produced turned black.
  • Most cases of septicemic anthrax occur following inhalational anthrax. The number of organisms released from the liver or spleen into the bloodstream overwhelm the body's defenses and produce massive amounts of lethal toxin that result in shock and death.
• Anthrax meningitis
  • This type of anthrax may complicate any form of anthrax and spread throughout the central nervous system and to the brain.

Skin lesions of anthrax on neck

Home Care

There is no home care for anthrax before a doctor makes the diagnosis.

When to Seek Medical Care

Anthrax develops rapidly, so immediate medical attention is required. Go to a hospital's emergency department if you have been or think you have been exposed to spores.

Physician Diagnosis:

• The skin lesions will eventually turn black. If you have a painless ulcer (sore) that is suspected to be cutaneous anthrax, the doctor will take a small sample of the fluid and see if it grows under special conditions in the laboratory. Samples will be viewed under a microscope. The anthrax bacteria will look different than other, similar organisms. If anthrax is suspected, laboratory personnel will take special care with the sample because it is considered a biohazard. Anthrax is not contagious from person to person, however, and standard hospital practices of hygiene, known as universal precautions, will prevent spread from one person to another.
  
• If you have cutaneous anthrax and have developed a fever and other symptoms throughout your body, the doctor may test your blood for the bacteria.
  
• If the doctor thinks you may have inhalational anthrax, you will have a chest x-ray or a CT scan. Other tests may be performed, including a lumbar puncture (spinal tap). You will also be admitted to the hospital.
  
• An infectious disease specialist may be among the doctors called in.

Chest x-ray showing widened chest cavity resulting from inhalation anthrax.

Anthrax Treatment:

The preferred way to treat anthrax is with antibiotics. The goal of antibiotics is to destroy the infection and prevent complications and death.

• Many antibiotics are effective against B anthracis and include the following:
  
  
  • Doxycycline (Vibramycin)
    
  • Penicillin
    
  • Amoxicillin (Trimox, Amoxil, Biomox)
    
  • Ampicillin (Marcillin, Omnipen, Polycillin, Principen, Totacillin)
    
  • Ciprofloxacin (Cipro)
    
  • Levofloxacin (Levaquin)
    
  • Gatifloxacin (Tequin)
    
  • Chloramphenicol (Chloromycetin)
• Severely ill people may be given medications through an IV. Treatment may continue for several weeks.
  
• People exposed to anthrax may be given preventive antibiotics usually to be taken for 60 days.

Prognosis and Follow-up:

• Prognosis: If treated early, people with cutaneous anthrax recover. Those with oropharyngeal or intestinal anthrax have a less favorable outcome, and people with inhalational anthrax have the worst outcomes. About one-half of the victims of the fall 2001 anthrax attacks died.
  
• Follow-up: With cutaneous anthrax, 80% of people who are not treated will recover. If treated, they may be given medication and sent home. A permanent circular scar may remain at the site of the original lesion. For others, with inhalational, meningeal, or septicemic anthrax, hospitalization is required.

Prevention:

An anthrax vaccine exists but is not readily available. It consists of a series of 6 immunizations given over 18 months. A booster is then available to be given annually, especially to those who have exposure to anthrax-containing animals or animal products. A skin test can determine if the vaccine is active.

To prevent infection from spores of B anthracis released in the air after a suspected bioterrorist attack, your doctor may prescribe ciprofloxacin or doxycycline for 60 days. Other antibiotics may be used once lab tests return showing which ones are effective.

>Genital herpes

Herpes simplex viruses (HSV)

Genital herpes is caused by infection with herpes simplex virus (HSV). There are two types of HSV, HSV-1 and HSV-2, both of which belong to a wider group called Herpesviridae. Another well-known virus in this group is varicella zoster virus, which causes chicken-pox and shingles.
In general:

• HSV-1 is acquired orally, causing cold sores.
• HSV-2 is acquired during sexual contact and affects the genital area.

Although genital herpes used to almost always be caused by HSV-2 infection, HSV-1 is accounting for an increasing number of cases of genital herpes in developed countries.
Only around 10-25 percent of people infected with HSV-2 are aware they have genital herpes. This is because genital herpes will often produce mild symptoms or no symptoms at all (asymptomatic infection). As a result, many cases of genital herpes go undiagnosed and frequently people unknowingly pass the virus on to their sexual partners.

Genital herpes symptoms and signs

If symptoms do occur, they will usually appear 2 to 7 days after exposure and last 2 to 4 weeks. Both men and women may have one or more symptoms, including:

• Itching or tingling sensations in the genital or anal area;
• small fluid-filled blisters that burst leaving small painful sores (see STD pictures);
• pain when passing urine over the open sores (especially in women);
• headaches;
• backache;
• flu-like symptoms, including swollen glands or fever.

Subsequent outbreaks are usually milder and last for a shorter period of time, usually 3 to 5 days. The sores are fewer, smaller, less painful and heal more quickly, and there are no flu-like symptoms. Subsequent outbreaks, or primary outbreaks in people who have had the virus for some time but have previously been asymptomatic, usually occur during periods of stress or illness when the immune system is functioning less efficiently than normal.

How is genital herpes is transmitted?

Genital herpes is passed on through skin contact with a person infected with the virus, most frequently during sex. The virus affects the areas where it enters the body. This can occur during:

• vaginal sex
• anal sex
• oral sex (HSV-1 or HSV-2)
• kissing (HSV-1 only)

Herpes is most infectious during the period when itchy sores start to appear on the skin during an outbreak. But even if an outbreak causes no visible symptoms or breaks in the skin, there is still a risk of the virus being passed on to another person through skin contact.

Where to go for help

If you have any symptoms or you are worried you may have been infected with an STD, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can.
Some countries have specific sexual health clinics that can help you directly. Check you local telephone directory to see if you have a clinic near you.

Testing for genital herpes

A herpes test will usually involve the following examinations, which are carried out by a doctor or nurse.

• A clinical examination will be done of a patient’s genital area.
• A sample will be taken, using a cotton wool or spongy swab, from any visible sores.
• Women may be given an internal pelvic examination (similar to a smear test).
• A sample of urine may be taken.

If the patient’s symptoms have already disappeared, or if there were no symptoms to begin with, a blood test can be taken to look for the virus. As in HIV testing, the herpes test works by searching for antibodies that the immune system produces to fight the virus. This means that the test is not effective until 3 months after exposure, as the body can take up to 3 months to produce an immune response.
It is possible to have more than one sexually transmitted infection at the same time, so it is advisable to have a full check-up.
Samples taken during an examination are sent to a laboratory for testing, and the result is usually available within 2 weeks, although this varies between countries.

Treatment for genital herpes

There is no cure for the herpes simplex virus and treatment is not essential, as an outbreak of genital herpes will usually clear up by itself. A doctor may however prescribe a course of antiviral tablets to reduce the severity of an outbreak. The antiviral tablets work by preventing the herpes simplex virus from multiplying.
Once the initial outbreak of herpes is over, the virus hides away in the nerve fibres adjacent to the infection site, where it remains dormant, causing no symptoms. It is possible for the dormant virus to be 'reactivated' in some people, in which case it travels back down the nerve to the skin surface.
Recurrences of genital herpes vary from person to person in frequency. Some will never experience an outbreak again, whilst others may have milder recurrences more than 6 times a year. Because these recurrent infections are milder, they often do not require treatment.
When receiving treatment for genital herpes, the doctor or health advisor will discuss the genital herpes infection and answer any questions. They will also want to know about any partners the patient has had sexual contact with within a recent period, as they will also be at risk of having genital herpes and should be tested.

Help during an outbreak

If you are suffering from an outbreak of genital herpes, there are several things you can do that may help make it easier to cope with:

• Take pain-killers (aspirin/paracetamol) for any pain.
• Gently bathe the sore areas with a salt solution (half a teaspoon of salt to half a pint of warm water) twice a day: it is soothing and helps the sores to dry out.
• Wear loose clothing so that the air can get to the sore areas.
• Place an ice-pack wrapped in a clean cloth or towel on the affected area.
• If passing urine is painful, try urinating in a bath of water, or pour water over yourself while urinating.
• Drink plenty of fluids, such as mineral water and soft drinks, to help neutralise the urine (it is important not to hold back from passing urine as this can cause further problems).
• Avoid sunbathing and using sunbeds.
• Get plenty of rest.

Taking care of yourself and your partner

During an outbreak of genital herpes, the sores are highly infectious and the virus can be passed on to others by direct contact. To prevent this from happening, you should avoid:

• Kissing when you or your partner have cold sores around the mouth;
• having oral sex when you or your partner have oral or genital sores;
• having any genital or anal contact, even with a condom or dental dam, when you or your partner has genital sores;
• using saliva to wet contact lenses if you have sores around your mouth.

Remember - wash your hands with soap before and after touching the sores.
Although the likelihood of transmitting genital herpes to your partner between outbreaks is much reduced, there is still some risk. Having genital herpes does not mean the end of your sex life. Ask your doctor or clinical health advisor for advice.
Remember, a condom will only protect against herpes infection if it covers all the sores. Herpes can also be transmitted by non-penetrative sex.

Complications

HIV and genital herpes

Those with suppressed immune systems are likely to have more frequent and severe recurring episodes of genital herpes. They may also have more asymptomatic outbreaks (where the virus travels up the nerve to the surface of the skin but causes no blisters) during which time the virus can be passed on.
A genital herpes infection increases the risk of becoming infected with HIV by up to three times in both men and women. This is due to the breaks in the skin caused by HSV, that facilitate entry of HIV.

Pregnancy and genital herpes

Having herpes does not affect a woman's ability to become pregnant. However, if herpes is transmitted in the first 3 months of pregnancy there is a small risk of a miscarriage. A first episode of herpes during pregnancy carries a greater risk of transmission to the baby. Becoming infected towards the end of pregnancy may cause the baby to be born early.
Though transmission of herpes from a mother to her newborn is rare, if it does occur, it can pose a serious risk to the baby. If left untreated, the infection can cause damage to a newborn's internal organs, skin, and central nervous system and may even prove fatal. Prompt testing and treatment with acyclovir of any baby thought to be at risk is therefore essential.
However, most women who have an outbreak (or even several outbreaks) of genital herpes during pregnancy have a normal delivery and a healthy baby.

>Syphilis

Introduction

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidium. The infection is usually sexually transmitted, in which case it is called venereal syphilis. It may also be passed from an infected mother to her unborn child, in which case it is known as congenital syphilis.
Syphilis has been uncommon since penicillin become widely available in the 1950s, although global syphilis statistics show that an estimated 12 million new infections still occur each year.

“The past decade has seen a rise in new cases of the almost forgotten ‘historic disease’ syphilis, particularly in certain risk groups.” Alexandra Geusau and Stefan Wöhrl, Medical University of Vienna 

Syphilis symptoms

The symptoms of syphilis are the same in men and women. They can be mild and difficult to recognise or distinguish from other STDs. Symptoms may take up to 3 months to appear after initial infection. Syphilis is a slowly progressing disease that has several stages. The primary and secondary stages of syphilis are very infectious.

Primary stage of syphilis

One or more painless ulcers (know as chancres) appear at the place where the syphilis bacteria entered the body. On average, this will be 21 days after sexual contact with an infected person. Chancres may be difficult to notice and are highly infectious. The usual locations for chancres are:

• On the vulva (outside the vagina) or on the cervix (neck of the womb) in women.
• On the penis in men.
• Around the anus and mouth (both sexes).

Without treatment, the ulcers take between 2 and 6 weeks to heal.
If the infection is not treated at this point then it will progress to the secondary stage.

Secondary stage of syphilis

If the infection has not been treated, the secondary stage of syphilis will usually occur from 3 to 6 weeks after the appearance of chancres. The symptoms often include:

• A flu-like illness, a feeling of tiredness and loss of appetite, accompanied by swollen glands (this can last for weeks or months).
• A non-itchy rash covering the whole body or appearing in patches.
• Flat, warty-looking growths on the vulva in women and around the anus in both sexes.
• White patches on the tongue or roof of the mouth.
• Patchy hair loss.

During this stage syphilis is very infectious and may be sexually transmitted to a partner. These symptoms will usually clear up within a few weeks, but may re-occur for years.
Treatment at any time during the first two stages of syphilis will cure the infection.

Latent and tertiary stages of syphilis

If a person infected with syphilis has not received treatment during the first two stages of the disease then it will progress to the latent stage. The person will no longer experience any symptoms of the earlier stages, but their infection can still be diagnosed with a blood test.
If left untreated, the infection may develop into symptomatic late syphilis, also known as the tertiary stage. This usually develops after more than 10 years and is often very serious. It is at this stage that syphilis can affect the heart and possibly the nervous system.
If treatment for syphilis is given during the latent stage the infection can be cured. However, any heart or nervous-system damage that occurred before the start of treatment may be irreversible.

How syphilis is transmitted

Syphilis can be transmitted through direct contact with a syphilis sore. The methods of transmission are:

• By having vaginal, anal or oral sex with someone who has the infection.
• From a mother to her unborn baby.

Syphilis cannot be passed on by sharing baths, toilets, towels or eating utensils.

Where to go for help

 If you have any symptoms or you are worried you may have been infected with syphilis, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can. Some countries also have specific sexual health clinics that can help you directly.

The diagnosis of syphilis

To find out if someone has syphilis, a doctor will usually carry out the following examinations and tests:

• A blood sample is taken and sent to an STD testing laboratory.
• A specimen of fluid is taken from all sores using a cotton swab and examined under a microscope.
• The genital area is examined for any primary signs of syphilis. The rest of the body is also checked.
• Women are given an internal examination to check for sores.
• A sample of urine is taken.

None of the examinations should be painful, but they may be slightly uncomfortable. The blood samples taken by the doctor are examined in a laboratory under a microscope to confirm a diagnosis. Various tests can be used on the blood sample. The most common and least expensive looks for antibodies.
The examinations and tests can be done as soon as a person thinks they might have become infected with syphilis. If the result is negative then it is usually recommended that the person retests at a later time, as it can take up to 3 months for the immune system to produce the antibodies that are detected by the test.

Treatment for syphilis

Treatment for syphilis usually consists of a two-week course of intramuscular penicillin injections or, in some cases, antibiotic tablets or capsules. If the patient has had syphilis for less than a year then fewer doses will be needed. If the patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, then the doctor should be informed so that alternative medication can be prescribed. It is important that the full course of treatment is completed. If treatment is interrupted then it may be necessary to start again from the beginning.
The patient will be asked about their sexual partners as it is important they are informed and tested as soon as possible. It is strongly advised to avoid any oral, vaginal or anal sex whilst having treatment, especially if the patient is in the early infectious stages of syphilis. Contact with any sores or rashes carries a risk of syphilis transmission.
After the treatment is completed the patient will be asked to attend the clinic at regular intervals for blood tests to check that the syphilis has gone.
Once a person has been treated and confirmed cleared of syphilis, any future blood tests (e.g. for immigration reasons) will still be positive, because the body retains antibodies against the bacteria. Doctors can give the person a certificate explaining that they have been treated and no longer have syphilis.
Treatment is only capable of killing the syphilis bacteria and preventing further damage. It cannot repair damage already done to organs, or prevent re-infection if the person is exposed to the bacteria again.

Prevention

Although using a condom reduces the chances of becoming infected with syphilis, it is not entirely effective. A condom may not cover all of the sores or rashes in the affected areas, and direct skin contact may result in transmission.
If a person has sex regularly with multiple partners, then it is advisable for them to get frequent STD check-ups.
A person can become re-infected with syphilis even if they have had effective treatment for a previous infection: past infection with syphilis does not make a person immune.

Congenital syphilis

Syphilis can infect a baby in the womb if the mother's infection is not treated. This is know as congenital syphilis. If a baby becomes infected then there is a high risk of stillbirth or miscarriage.
A newborn baby may not display any obvious symptoms of syphilis, but may develop serious complications within weeks if the disease is not treated.
In many countries, blood tests for syphilis are given to all pregnant women when they visit antenatal clinics. Women may also be offered other tests for other STDs, such as an HIV test when pregnant.
If a woman is found to be infected with syphilis, treatment can safely be given during pregnancy with no risk to the unborn baby.

>Gonorrhea

Introduction

Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrheoae. Gonorrhea affects both men and women and can infect the cervix, urethra, rectum, anus and throat. Gonorrhea is one of the most common sexually transmitted diseases (STDs) and the global gonorrhea statistics show that an estimated 62 million cases of gonorrhea occur each year, affecting more women than men. Gonorrhea is easily curable but if left untreated it can cause serious health problems such as pelvic inflammatory disease (PID), which can lead to abdominal pain and ectopic pregnancy in women. Untreated, gonorrhea can also lead to infertility, meningitis and septicaemia.

Gonorrhea symptoms

Symptoms of gonorrhea infection may appear 1 to 14 days after exposure, although it is possible to be infected with gonorrhea and have no symptoms. Men are far more likely to notice symptoms as they are more apparent. It is estimated that nearly half of the women who become infected with gonorrhea experience no symptoms, or have non-specific symptoms such as a bladder infection.
Gonorrhea symptoms can include:


Symptoms of gonorrhea infection may appear 1 to 14 days after exposure, although it is possible to be infected with gonorrhea and have no symptoms. Men are far more likely to notice symptoms as they are more apparent. It is estimated that nearly half of the women who become infected with gonorrhea experience no symptoms, or have non-specific symptoms such as a bladder infection.
Gonorrhea symptoms can include:


       In Women

• A change in vaginal discharge; it may appear in abundance, change to a yellow or greenish colour, and develop a strong smell.
• A burning sensation or pain whilst passing urine.
• Irritation and/or discharge from the anus.

       In Men

• A white or yellow discharge from the penis.
• A burning sensation or pain whilst passing urine.
• Irritation and/or discharge from the anus.

Route of transmission of gonorrhea

Gonorrhea is passed on through penetrative sex, including:

• vaginal sex
• anal sex
• oral sex - oral sex can either transmit gonorrhea from the genitals to the throat of the person giving the stimulation, or it can pass an infection from the throat to the genitals of the person receiving stimulation.

Less often it can be transmitted by:

• a person using their mouth and tongue to lick or suck another person's anus;
• a person putting fingers into the vagina, anus or mouth of someone infected with gonorrhea, then touching their own mouth, genitals or anus without washing their hands in between.

Where to go for help

 If you have any symptoms or you are worried you may have been infected with gonorrhea, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can.

Tests for gonorrhea

To test for gonorrhea an examination of the genital area will be carried out by a doctor or nurse and samples will be taken, using a cotton wool swab or sponge, from any infected areas - the cervix, urethra, anus or throat. Women will also be given an internal pelvic examination, similar to a smear test. A sample of urine may be taken.
None of these tests are painful, but they may cause minor discomfort. If a person has had anal sex, it is important they tell the doctor so that a swab can be taken from the rectum. They should also tell the doctor if they have had oral sex so swabs can be taken from the throat.

Gonorrhea diagnosis and treatment

Samples taken during the examination will be sent to a laboratory to be tested for the bacterium Neisseria gonorrheae and will usually be available within a week. This may vary depending on which country the patient is in. Some sexual health clinics have rapid testing services to provide immediate results. In these clinics the doctor will check the sample for gonorrhea bacteria under a microscope to confirm an infection straight away.
Treatment is easy and essential. The patient will be given an antibiotic in tablet, liquid or injection form.
If the patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, it is very important that the doctor is informed as this may affect treatment options. Once a course of treatment is started it is important to complete it, even if symptoms diminish, to ensure the infection is cured.
The doctor or health advisor will discuss the gonorrhea infection and answer any questions. They will also want to know about any partners the patient has had sexual contact with as they will also be at risk of having gonorrhea and should be tested.
The patient should not have penetrative sex until they have returned to the clinic and it is confirmed that the infection is gone. The doctor or health adviser will inform the patient which sexual activities are safe.

Follow-up

Once the patient has completed the course of treatment for gonorrhea, they should return to the clinic or their doctor for a check-up.
Some types of gonorrhea are resistant to certain antibiotics. Further tests will be done to ensure the infection has cleared. If it has not then different, usually stronger, antibiotics will be prescribed.

Complications

      In Women

• Gonorrhea can cause Pelvic Inflammatory Disease (PID), an inflammation of the fallopian tubes (the tubes along which an egg passes to get to the womb), which increases the future risk of ectopic pregnancy (a pregnancy outside the womb) or premature birth.
• If a woman is pregnant and has gonorrhea when giving birth, the infection may be passed on to her child. The baby could be born with a gonoccocal eye infection, which must be treated with antibiotics as it can cause blindness. It is better for the woman to get treatment before giving birth.

       In Men

• Gonorrhea can cause painful inflammation of the testicles and the prostate gland, potentially leading to epididymitus, which can cause infertility.
• Without treatment, a narrowing of the urethra or abscesses can develop after time. This causes considerable pain and problems whilst urinating.

Once gonorrhea has been successfully treated it will not come back unless the person becomes reinfected.

Prevention

Using a condom during sex can reduce the chances of getting or passing on gonorrhea. Latex condoms are proven to be over 99% effective when used consistently and correctly.

>Sexually transmitted diseases and STD symptoms

What are sexually transmitted diseases (STDs)?

Sexually transmitted diseases (STDs) are diseases that are mainly passed from one person to another during sex. There are at least 25 different sexually transmitted diseases with a range of different symptoms. These diseases may be spread through vaginal, anal and oral sex.
Most sexually transmitted diseases will only affect you if you have sexual contact with someone who has an STD. However there are some infections, for example scabies, which are referred to as STDs because they are most commonly transmitted sexually, but which can also be passed on in other ways.

What are sexually transmitted infections (STIs)?

Sexually transmitted infection (STI) is another name for sexually transmitted disease (STD). The name STI is often preferred because there are a few STDs, such as chlamydia, that can infect a person without causing any actual disease (i.e. unpleasant symptoms). Someone without symptoms may not think of themselves as having a disease, but they may still have an infection that needs treating.

How can you tell if you have a sexually transmitted disease?

You may become aware that you have an STD because of symptoms, or it may be that a sexual partner tells you they have an STD which they might have passed on to you. Some sexually transmitted diseases can be transmitted by an infected person even if they don't have any symptoms. Certain STDs can also be transmitted from a pregnant woman to her unborn child.
If you think you might have been exposed to an STD then you should go to see a doctor. Many sexually transmitted diseases can be easily cured, but if left untreated, they may cause unpleasant symptoms and could lead to long-term damage such as infertility. It is important that anyone diagnosed with an STD informs everyone they have had sex with within the past year (or everyone following the partner they believe may have infected them).

What are common STD symptoms?

STD symptoms vary, but the most common are soreness, unusual lumps or sores, itching, pain when urinating, and/or an unusual discharge from the genitals.
To see pictures of common STDs, please visit our STD pictures page.

Which are the most common sexually transmitted diseases?

Below are some of the most common STDs and other genital diseases. To find out more about HIV, visit our HIV page.

Bacterial Vaginosis

Bacterial Vaginosis (BV) is caused by an imbalance in the normal healthy bacteria found in the vagina. Although it is relatively harmless and may pass unnoticed, it can sometimes produce an abundance of unpleasant fishy smelling discharge.
BV is not strictly an STD as it is not transmitted via sexual intercourse. However, it can be exacerbated by sex and is more frequently found in sexually active women than those who have never had intercourse.
Whilst there is no clear explanation as to why BV occurs, there have been suggestions that the alkaline nature of semen could be one cause, as it may upset the acidic nature of the vaginal bacteria. Another cause can be the use of an intrauterine contraceptive device (coil).
A woman cannot pass BV to a man, but it is important she receives treatment as BV can occasionally travel up into the uterus and fallopian tubes and cause a more serious infection. Treatment for BV consists of applying a cream to the vagina or taking antibiotics.

Chlamydia

Chlamydia is one of the most commonly reported bacterial sexually transmitted diseases. It is caused by the chlamydia trachomatis bacterium. It infects the urethra, rectum and eyes in both sexes, and the cervix in women. If left untreated, long-term infection can lead to fertility problems in women. Chlamydia is transmitted through genital contact and/or sexual intercourse with someone already infected. Symptoms of chlamydia usually show between 1 and 3 weeks after exposure but may not emerge until much later.

Crabs or Pubic Lice

Enlargement of Phthirus pubis, the pubic or crab louse.

Crabs or pubic lice are small crab-shaped parasites that burrow into the skin to feed on blood. They live on coarse body hair, predominantly pubic hair, but can also be found in armpit hair, facial hair and even on eyelashes. The lice are yellow-grey in colour and use their crab-like claws to grip hair strands. They can sometimes be spotted moving on the skin.
Crabs are easily passed on during sex, but can also be passed on through sharing clothes, towels or bedding with someone who has them. Crabs cannot be transmitted via toilet seats or swimming pools.
Symptoms of crabs are usually noticed around 5 days to 7 weeks after infection and include:

• itchy skin;
• inflammation of the affected area;
• sometimes visible lice and eggs;
• spots of blood as lice feed from blood vessels in the skin.

Although there is no effective way to prevent becoming infected during sex, a person who has crabs can reduce the risk to others by washing bedding, towels and clothes on a hot wash to kill off the parasites.
Treatment for public lice is easy, consisting of special shampoos, lotions and creams that kill the lice and their eggs. It is not necessary to shave pubic hair as this is unlikely to remove all lice.

Genital warts

Genital warts are caused by some sub-types of human papilloma virus (HPV). They can appear on the skin anywhere in the genital area as small whitish or flesh-coloured bumps, or larger, fleshy, cauliflower-like lumps. They are unlikely to cause pain but may itch and can be difficult to spot. Often there are no other symptoms of genital warts, but if a woman has a wart on her cervix she may experience slight bleeding or unusual coloured vaginal discharge.

Gonorrhea

Gonorrhea (once known as the clap) is a sexually transmitted infection that can infect the urethra, cervix, rectum, anus and throat. Symptoms of gonorrhea usually appear between 1 and 14 days after exposure, but it is possible to have no symptoms. Men are more likely to notice symptoms than women. Symptoms can include:

• a burning sensation when urinating;
• a white/yellow discharge from the penis;
• a change in vaginal discharge;
• irritation or discharge from the anus (if the rectum is infected).

Hepatitis

Hepatitis refers to viral infections that cause inflammation of the liver. Several different types of hepatitis virus exist (labelled A to G), with hepatitis A, B and C being the most common. Hepatitis can occur following excessive and prolonged consumption of alcohol or the use of certain medicines and drugs, but it is most commonly caused by a virus. Read more about the different transmission routes of hepatitis.

Herpes

Herpes is caused by two strains of the herpes simplex virus, type 1 (HSV-1) and type 2 (HSV-2). HSV-2 is more common and usually manifests itself in the genital and anal area, whereas HSV-1 is more likely to affect the mouth and lips in the form of cold sores. On a global scale, HSV-2 is a very common STD. Symptoms of herpes usually appear 2 to 7 days after first exposure to the virus and last 2 to 4 weeks. Both men and women may have multiple symptoms, including:

• itching or tingling sensations in the genital or anal area;
• small fluid-filled blisters that burst leaving small painful sores;
• pain when passing urine over the open sores (especially in women);
• headaches;
• backache;
• flu-like symptoms, including swollen glands or fever.

Once the first outbreak of blisters has gone, the herpes virus hides away in nerve fibres near the infection site, where it remains dormant, causing no symptoms. Symptoms may come back later (particularly during times of stress and illness) but usually in less severe and shorter episodes. Read more about herpes.

Molluscum contagiosum

Molluscum contagiosum (MC, also known as water warts) is a common viral infection, which results in a skin disease. Small papules usually appear on exposed skin such as the torso, thighs, genitalia and anus, around 2 to 8 weeks after initial infection with the virus. The pearl-shaped papules are usually between 1 to 5 millimetres in diameter, are filled with a gungy, white, contagious, fluid, and often appear in clusters.
MC can be transmitted through direct skin-to-skin contact and also indirectly through sharing towels, baths or clothing with someone infected. It is not strictly an STD as it often occurs in children, especially those prone to skin conditions such as eczema. Children are more likely to assist transmission by scratching the infected sites, although it should be noted that the chance of passing on the virus is small.
MC is grouped with STDs because of the risk of transmission through close body contact during sex, which is why it is often screened for in sexual health clinics. The risk of becoming infected with MC can be reduced by:

• Using condoms during sex, although this only offers partial protection as MC can be passed on by anal/genital lesions not covered by the condom.
• Covering affected areas of skin (where possible) with clothing or sterile dressings.
• Not sharing baths, clothing and towels.

Molluscum lesions on an arm.

The recommended treatment is often to leave MC to clear up by itself (which usually takes around 6 to 18 months) as medical removal can leave scarring. If requested, the lesions can however be removed by various medical treatments such as cryotherapy (freezing), diathermy (burning), or currettage (cutting or scraping).
In an HIV-positive person, a large outbreak of molluscum contagiosum may indicate that the immune system is critically weak and it is advisable to seek medical attention.

Scabies

Scabies is an intensely itchy, contagious skin infestation of the parasitic mite Sarcoptes scabiei. The adult female mite is around 0.4 mm (one sixtieth of an inch) long and barely visible to the human eye, with the male being half that size. Female mites burrow into the outer layer of the skin (stratum croneum) to lay eggs. Symptoms begin 2 to 6 weeks after infection and include:

• Burrows that appear as silvery or brown wavy lines up to 15 millimetres (half an inch) in length. The burrows can appear anywhere, but usually occur on the webbing between fingers and toes, on the genitals, around the anus, or on the buttocks, elbows or wrists.
• An intensely itchy rash of inflamed pimple-like lumps (papules/lesions) as an allergic reaction to the mites, their eggs and faeces.
• Widespread itching, particularly at night or after baths when the body is warmer, as a reaction to the mites.

Again, scabies it not strictly a sexually transmitted disease, as the scabies mite can be passed on through other forms of prolonged direct skin contact. Scabies has been known to spread rapidly in crowded conditions where there is frequent contact between people, such as in care homes or child care facilities. It is also possible, but much less likely, to acquire the infestation through sharing clothes, towels or bedding with someone infected. Sexual activity does however carry a particularly high risk of transmission.
There is no effective way to prevent infection apart from avoiding direct skin contact with an infected person. If a person knows they are infected then they can prevent the infestation spreading by washing clothes and bedding on a hot wash to kill the mites (at 50 degrees Celsius / 120 Fahrenheit or above). Treatment comes in the form of lotions that can be bought from pharmacies without prescription and applied to the body to kill the parasites. It is recommended that all people in close contact, such as sexual partners or members of the household, should be treated at the same time, even if they are not yet showing any symptoms of infestation.

Syphilis

Syphilis is a bacterial infection caused by Treponema pallidium, which used to be known as the pox. It is usually sexually transmitted, but can also be passed from an infected woman to her unborn child. Syphilis progresses through several stages, of which the primary and secondary stages are very infectious. Syphilis symptoms can be difficult to recognise and may take 3 months to appear after sexual contact with an infected person. They include:http://www.avert.org/chlamydia.htm

• one or more painless ulcers on the penis, vagina, vulva, cervix, anus or mouth;
• small lumps in the groin due to swollen glands;
• a non-itchy rash;
• fever or flu-like symptoms.

Left untreated the infection progresses to a latent stage. This may be followed by tertiary syphilis, which can seriously affect organs such as the heart, and can sometimes lead to death.

Thrush

Thrush, also known as candidiasis, is a yeast infection caused by the Candida species of fungus. Thrush is not technically a sexually transmitted infection, as Candida is a common yeast that is found on the skin and genitals of most people, even those who have not had sex. Candida is usually suppressed by the immune system and the natural bacteria found in the body, but there are many things that can upset the balance and allow Candida to grow. Thrush occurs a lot less frequently in men.
The symptoms of a thrush infection are:

• In women - irritation, itching, thick white discharge, redness, soreness and swelling of the vagina and vulva.
• In men - irritation, discharge from the penis, difficulty pulling back the foreskin usually caused by the swelling of the head of the penis (balanitis).

There are many causes of thrush, but the most common are:

• In women, wearing nylon or lycra clothes that are too tight (the lack of air circulation can cause Candida to proliferate).
• Certain antibiotics or contraceptive pills that alter the pH balance of the vagina.
• A change in the hormonal balance in pregnant women, causing a change in the level of normal bacteria.
• Spermicides (found on some condoms) or perfumed toiletries that irritate the vagina or penis.
• Douching (washing out the vagina) or using tampons.
• Sexual contact (either genital or oral) with someone who carries the candida yeast.

Treatment for thrush involves applying an anti-fungal cream that contains clotrimazole. If an infection is recurring then fluconazole may be prescribed to be taken orally, unless the patient is pregnant. It may also be suggested to wash the genitals with water to avoid irritation and to wear loose fitting cotton underwear and clothes.

Trichomoniasis

Trichomoniasis (also known as Trich) is caused by the single-celled organism trichomonas vaginalis, which is transmitted through sex. It can infect the vagina and the male and female urethra. Often this STD presents no symptoms, though women are more likely to have symptoms than men. If symptoms do appear, they can include:

• discharge in both men and women (sometimes copious and unpleasant smelling in women);
• discomfort or pain whilst having sex;
• pain when urinating and inflammation of the urethra.

Women may also experience an inflammation of the vulva and they may develop cystitis (an infection of the urinary system).
Transmission is usually through vaginal, anal or oral sex with an infected person. The most effective prevention method is to practise safer sex by using condoms.
Treatment for both men and women is a drug called metronidazole which can be taken orally or applied as a gel. It is important for any sexual partners to also be treated as trichomoniasis can be carried and spread without symptoms. If a woman is pregnant then she should seek medical advice before pursuing treatment.