Sexually Transmitted Diseases Overview (STDs)

Sexually transmitted diseases (STDs, venereal diseases) are among the most common infectious diseases in the United States today. STDs are sometimes referred to as sexually transmitted infections, since these conditions involve the transmission of an infectious organism between sex partners. More than 20 different STDs have been identified, and about 19 million men and women are infected each year in the United States, according to the CDC (2010). Depending on the disease, the infection can be spread through any type of sexual activity involving the sex organs, the anus, or the mouth; an infection can also be spread through contact with blood during sexual activity. STDs are infrequently transmitted by any other type of contact (blood, body fluids or tissue removed from an STD infected person and placed in contact with an uninfected person); however, people that share unsterilized needles markedly increase the chance to pass many diseases, including STD's (especially hepatitis B), to others. Some diseases are not considered to be officially an STD (for example, hepatitis types A, C, E) but are infrequently noted to be transferred during sexual activity. Consequently, some authors include them as STD's, others do not. Consequently, lists of STD's can vary, depending on whether the STD is usually transmitted by sexual contact or only infrequently transmitted. STDs affect men and women of all ages and backgrounds, including children. Many states require that Child Protective Services be notified if children are diagnosed with an STD. STDs have become more common in recent years, partly because people are becoming sexually active at a younger age, are having multiple partners, and do not use preventive methods to lessen their chance of acquiring an STD. People can pass STDs to sexual partners even if they themselves do not have any symptoms. Frequently, STDs can be present but cause no symptoms, especially in women (for example, chlamydia, genital herpes or gonorrhea). This can also occur in some men. Health problems and long-term consequences from STDs tend to be more severe for women than for men. Some STDs can cause pelvic infections such as pelvic inflammatory disease (PID), which may cause a tubo-ovarian abscess. The abscess, in turn, may lead to scarring of the reproductive organs, which can result in an ectopic pregnancy (a pregnancy outside the uterus), infertility or even death for a woman. Human papillomavirus infection (HPV infection), an STD, is a known cause ofcancer of the cervix. Many STDs can be passed from a mother to her baby before, during, or immediately after birth. Because the method of becoming infected is similar with all STDs, a person often obtains more than one pathogenic organism at a time. For example, many people (about 50%) are infected at a single sexual contact with both gonorrhea and chlamydia.

Sexually Transmitted Diseases (STDs) Causes

Depending on the disease, STDs can be spread with any type of sexual activity. STDs are most often caused by viruses and bacteria. The following is a list of the most common STDs, their causes and other

infections (see STDs with asterisk mark*) that may be transmitted on occasion by sexual activity, but are frequently not considered primarily to be an STD by many investigators: STDs caused by bacteria Chancroid (Haemophilus ducreyi) Chlamydia (Chlamydia trachomatis) Gonorrhea (Neisseria gonorrhea) Granuloma inguinale (Calymmatobacterium granulomatis) Lymphogranuloma venereum (Chlamydia trachomatis) Syphilis (Treponema pallidum) STDs caused by viruses Genital herpes (herpes simplex virus) Genital warts (human papillomavirus virus [HPV]) Hepatitis B and D, and infrequently, A*,C*,E* (hepatitis viruses, types A-E) HIV/AIDS (human immunodeficiency virus [HIV virus]) Molluscum contagiosum* (poxvirus) STD caused by protozoan Trichomoniasis (Trichomonas vaginalis) STD's* caused by fungi Jock itch (Tenia cruris)* Yeast infections* (Candida albicans) STD's caused by parasites Pubic lice or crabs (Pediculosis pubis) Scabies* Sarcoptes scabiei

Sexually Transmitted Diseases (STDs) Symptoms

Common STDs have a variety of symptoms (if symptoms develop at all) and many different complications, including death. Symptoms of STDs caused by bacteria Chancroid Symptoms Are not common in the United States but common in developing countries. Symptoms include painful ulcers on the genitals. Can be confused with syphilis or herpes Is treatable with antibiotics Chlamydia symptoms Most common of all STDs caused by bacteria. Cause no symptoms in about 80% of women and 50% of men When symptoms are present, commonly there is discharge from the vagina or the penis, and burning or pain during urination. Is transmitted through vaginal, oral, or anal sexual contact Ectopic pregnancy and infertility for women are potential serious complications. Is treatable with antibiotics Gonorrhea symptoms Discharge from the vagina or the penis Over 50% of infected women have no symptoms, but they can still transmit the disease to others. Painful urination Ectopic pregnancy, pelvic inflammatory disease (PID), infertility for women, Fitzhugh-Curtis syndrome (perihepatitis) and death are potential serious complications. Is treatable with antibiotics Granuloma inguinale (donovanosis) symptoms Not common in the U.S. Symptoms are painless genital ulcers in the groin area.

Is treatable with antibiotics, usually for three or more weeks Lymphogranuloma venereum

Not common in the U. S. Symptoms are abscesses (buboes) in the groin, rectum or other areas; fistulas that drain pus may occur and are treatable with antibiotics. Syphilis

Symptoms are mild and often go undetected initially Starts with a painless genital ulcer that goes away on its own Rash, fever, headache, achy joints Is treatable with antibiotics More serious complications associated with later stages of the disease if undetected and untreated Symptoms of STDs caused by viruses Genital herpes

Recurring outbreaks of blister-like sores on the genitals Can be transmitted from a mother to her baby during birth Reduction in frequency and severity of blister outbreaks with treatment but not complete elimination of infection. Can be transmitted by a partner who has herpes even if no blisters are present. Genital warts

Caused by a virus related to skin warts, human papillomavirus (HPV) Small, painless bumps in the genital or anal areas (sometimes in large clusters that look like cauliflower) Various treatments available (for example, freezing or painting the warts with medication) Vaccines are available against the most common types of HPV Hepatitis

Hepatitis B and D are most often associated with sexual contact, hepatitis A, C, E are less frequently transmitted by sexual contact.

Both may be transmitted via contact with blood; for hepatitis B, sexual transmission is believed to be responsible for 30% of the cases worldwide. The hepatitis B virus can cause both an initial (acute) and a chronic form of liver inflammation. Only 50% of acute infections with the hepatitis B virus produce symptoms. The initial phase of infection lasts a few weeks, and in most people (90%-95%), the infection clears. Acute infection can cause yellowish skin and eyes, fever, achy, tired (flu-like symptoms). Severe complications in some people, including cirrhosis and liver cancer may occur in a small percent of individuals infected with HBV. Treatments are available and remission is possible with some aggressive medications. Immunizations are available to prevent hepatitis B. HIV/AIDS

Spread primarily by sexual contact and from sharing IV needles Can be transmitted at the time a person becomes infected with other STDs No specific symptoms or physical signs confirm HIV infection. The average time from infection to the development of symptoms related to immunosuppression (decreased functioning of the immune system) is 10 years. Fatigue, night sweats, chills, or fever lasting several weeks, headaches, andcough may occur a few weeks after contracting the virus initially. Serious complications of AIDS include unusual infections or cancers, weight loss, intellectual deterioration (dementia), and death. No current cure but medications are available to slow disease progression. Molluscum contagiosum

Small (2-5mm) raised areas (papules) on the skin Contagious, usually by direct skin to skin contact Self-limited over months to years; treated with some topical creams Often cryotherapy (freezing) or surgical removal is performed Symptoms of STDs caused by protozoan Trichomonas

Frothy vaginal discharge with a strong odor Treated with antibacterial/antiprotozoal medicines Symptoms of STDs* caused by fungi Jock itch (genital itching or Tenia cruris)* (not always an STD)

Itchy groin skin, sometimes has a reddish color Is treated with topical antifungal medicines Yeast infection (Candidiasis)* (not always an STD)

Cheese-like vaginal discharge or whitish exudates sometimes with a reddish hue to the skin; it may occur around the foreskin of infected males; common symptoms are itching and burning sensation of the vagina or penis. Is treated with topical antifungal medicines in most cases Symptoms of STDs caused by parasites Pubic lice

Very tiny bugs that are found in pubic hair, sometimes referred to as "crabs" Can be picked up from clothing or bedding First noticed as itching in the pubic area Are treatable with creams, anti-lice agents, and combing Scabies

Skin infestation caused by a tiny mite Highly contagious Intense itching is the primary symptom, which worsens at night Spread primarily by sexual contact or from contact with skin, infested sheets, towels, or furniture Is treated with creams

When to Seek Medical Care

A medical examination may be necessary if a person believes he or she may have an STD or if he or she may have been exposed to someone with an STD. Being seen by a doctor as soon as possible after

exposure to an STD is important; these infections can easily spread to others and can have serious complications. Go to a hospital's emergency department in these circumstances if: an STD problem worsens; a fever develops with other symptoms; or if it will be a couple of days before the individual can be evaluated by a doctor.

Exams and Tests

Some STDs can be diagnosed without any tests at all (for example, pubic lice). Other STDs require a blood test or a sample of any unusual fluid (such as an abnormal discharge from the vagina or the penis for gonorrhea or chlamydia) to be analyzed in a lab to help establish a diagnosis. Some tests are completed while a person waits; other tests require a few days before a person may obtain the results (for example, syphilis).

Sexually Transmitted Diseases (STDs) Treatment Self-Care at Home

Home treatment of STDs is not recommended because prescription medications are usually necessary.

Medical Treatment
The treatment of an STD varies depending on the type of STD. Some STDs require a person to take antibiotic medication either by mouth or by injection; other STDs require a person to apply creams or special solutions on the skin. Often, reexamination by a doctor is necessary after the treatment to confirm that the STD is completely gone. Some STDs, such as genital herpes and HIV (which leads to AIDS), cannot be cured, only controlled with medication. For treatment of individual STD types, the reader is urged to click on the individual disease listed above.

Next Steps Follow-up

Sometimes people with STDs are too embarrassed or frightened to ask for help or information. However, most STDs are easy to treat. The sooner a person seeks treatment and warns sexual partners about the disease, the less likely the disease will do permanent damage, be spread to others, or be passed to a baby. If diagnosed with an STD, follow these guidelines: Seek treatment to stop the spread of the disease.

Notify sexual contacts and urge them to have a checkup. Take all of the prescribed medication, even if symptoms stop before all of the prescribed medication(s) are taken. Sometimes, follow-up tests are important so comply with the instructions given by the health care practitioner. Consult a doctor with specific needs and any questions about reinfection, sexual partner notification, and prevention. Avoid sexual activity while being treated for an STD.

Prevention
The best way to prevent STDs is to avoid sexual contact with others. If people decide to become sexually active, they can reduce the risk of developing an STD in these ways: Practice abstinence (refrain from sex entirely) or be in a monogamous relationship (both sexual partners are each other's only sexual partner). Delay having sexual relations as long as possible. The younger people are when they become sexually active, the higher the lifetime risk for contracting an STD. The risk also increases with the number of sexual partners. Correctly and consistently use a male latex condom. The spermicide nonoxynol-9, once thought to protect against STDs as well as to prevent pregnancy, has been proven to be ineffective for disease prevention. Do not rely on it. In addition, condoms are only about 90% effective in preventing STDs Have regular medical checkups even if you do not have symptoms of an STD. Learn the symptoms of STDs. Avoid douching because it removes some of the natural protection in the vagina. Vaccines against HPV and hepatitis B are available and effective.

Outlook
Most of the common STDs can be cured with treatment. In addition to the discomfort of the infection, some STDs can cause other, more serious, long-term problems, including infertility and problems in newborns infected by their mothers during pregnancy such as blindness, bone deformities, mental retardation, and infrequently, death. HIV can only be slowed, not eliminated, and may cause death.

Chlamydia Overview
Chlamydia is a bacterial infection disease transmitted when people have sexual relations. It is the most common sexually transmitted disease (STD) in the United States, with over 2.8 million affected individuals each year. Among adults, about 5% of the population is estimated to be infected. Among sexually active adolescent females, about 10% are infected. Infection with chlamydia is most commonly found among the following groups: Young adults (24 years and younger) People living in urban areas African Americans Those with lower social and economic status

Chlamydia Causes
Chlamydia is an infection caused by the bacterium Chlamydia trachomatis. The infection is transmitted in 2 ways: From one person to another through sexual contact (oral, anal, or vaginal). From mother to child with passage of the child through the birth canal. Chlamydia can cause pneumonia or serious eye infections in a newborn, especially among children born to infected mothers in developing countries.
What Are the Symptoms of Chlamydia in men and women?
Chlamydia is known as a "silent" disease because the majority of infected people have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure. In women, the bacteria initially infect the cervix and the urethra (urine canal). Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. If the infection spreads from the cervix to the fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. Chlamydial infection of the cervix can spread to the rectum. Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis. Pain and swelling in the testicles are uncommon. Men or women who have receptive anal intercourse may acquire chlamydial infection in the rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of women and men having oral sex with an infected partner.

Chlamydia Symptoms in Women No symptoms in 70% to 80% of cases (One study found that 3% of a sample of young adults 18 to 35 years of age had untreated chlamydia.)

Bleeding after sexual relations or betweenmenstrual periods Lower abdominal pain and burning pain during urination Discharge from the vagina Chlamydia Symptoms in Men

Like women, men who are infected may not show symptoms. Estimates of those with no symptoms range from 25% to 50% of infected men. Discharge from the penis Pain, burning during urination Inflammation or infection of a duct in the testicles, tenderness or pain in the testicles

When to Seek Medical Care

Call your doctor if you experience any of the following: Fever Abdominal pain Discharge from the penis or vagina Pain with urination Pain during intercourse Frequent urination Sexual contact with an infected person. Most often, a sexual partner is informed about a chlamydial infection, and this is the first indication of the presence of the disease. All partners of an infected person should be treated to prevent the spread of the infection back and forth. When to go to the hospital Chlamydial infections can develop into serious medical conditions if not treated. Women: Pelvic inflammatory disease is a serious medical condition, which occurs in 10% to 15% of untreated cases and can lead to sterility. Fever, abdominal pain, and vaginal discharge can be symptoms of this disease. Women with these symptoms need to go to a hospital's emergency department immediately for treatment.

Men: Fever, discharge from the penis, and painful urination may signal an infection, which may involve inflammation of the testicles. Men with these symptoms need to go to a hospital's emergency department immediately for treatment.

Chlamydia Diagnosis
The health care practitioner will conduct the following exams and tests. Physical Examination Tenderness for women in the area of the sex organs, pus from the vagina or penis, and fever could indicate an infection. Diagnostic Tests Diagnostic tests may be ordered that may include looking at samples of the discharge under a microscope or obtaining cultures to identify the disease-causing bacteria. Some diagnostic tests may include obtaining cultures or sending urine to the laboratory to determine if you are infected. You may also be tested for other sexually transmitted diseasesbecause many patients with chlamydia also have other infections such as gonorrhea ortrichomonas.

Chlamydia Treatment Chlamydia Medications

The health care practitioner may prescribe a single-dose antibiotic, such as azithromycin(Zithromax), taken as a pill. On the other hand, the doctor may choose an antibiotic, such asdoxycycline (Atridox, BioTab), to be taken as a pill twice a day for a week. Up to 95% of people will be cured after one course of antibiotics.

Follow-up
Finish the entire course of antibiotics your doctor prescribes, even if you're feeling fine and symptoms go away. Notify any and all sexual partners of infection. They should be treated or tested so the infection is not passed back and forth. Be retested if your symptoms continue or you think you have been reinfected. Having the infection once does not confer immunity to repeat infection. Use latex condoms during sexual intercourse.

Chlamydia Prevention
Use latex condoms when having sexual intercourse.

Avoid sexual contact with high-risk partners. Treat infected sexual partners or have them tested before having sexual relations. Up to one-fourth of sexual partners will be reinfected because the partner wasn't treated.

Chlamydia Prognosis
Treated with antibiotics, chlamydial infections can be cured 95% of the time. o Complications if not treated: Ten percent to 40% of women will develop pelvic inflammatory disease; 5% of women with pelvic inflammatory disease will develop a form of liver disease (perihepatitis). Women may develop chronic pelvic pain and become sterile due to blockage of the Fallopian tubes that allow the egg to be transported from the ovary to the women's womb. More common in men, some may develop sexually acquired reactive arthritis or Reiter syndrome. Men may experience painful swelling of the testicles.

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Genital Herpes Overview

Genital herpes is a common, highly infectious disease caused by a virus. It is transmitted from one person to another during sexual activity. Genital herpes causes blisters or groups of small ulcers (open sores) on and around the genitals in both men and women. Genital herpes cannot be cured; however, there are medications that can be prescribed to treat outbreaks and minimize the symptoms. Genital herpes is extremely widespread, largely because it is so contagious. Carriers can transmit the disease without having any symptoms of an active infection. At least 45 million Americans are infected with the genital herpes virus, with approximately one million new infections each year. As many as 80%-90% of those infected fail to recognize genital herpes symptoms or have no symptoms at all. The highest rates of infection are seen among the poor, those with less education, those usingcocaine, and those with many sexual partners.

Genital Herpes Causes

Genital herpes is caused by the herpes simplex virus (HSV). There are two types: HSV-1 and HSV-2. Most genital herpes infections are caused by HSV-2. HSV-1 is the usual cause of what most people call "fever blisters" in and around the mouth and can be transmitted from person to person through kissing. Less often, HSV-1 can cause genital herpes infections through oral sexual contact. The genital sores caused by either virus look the same.

Genital herpes is spread by direct contact with an infected person. Sexual intercourse and oral sex are the most common methods of spreading genital herpes. Any type of skin-to-skin contact, however, is capable of spreading herpes. Note: People with herpes may spread the disease even if they do not realize they have an infection. Furthermore, there is strong evidence that people with herpes can transmit infection even while their disease appears to be inactive and no sores can be visibly seen.

Many people remember having an episode of genital herpes when it occurs. But as many as 90% of those infected fail to recognize the symptoms or have no symptoms at all. It is not clear whether these people never had an initial herpes outbreak or whether they never noticed a mild infection. In these individuals genital herpes is still contagious, and they may have additional outbreaks, nonetheless.

Genital Herpes Symptoms

Signs of genital herpes tend to develop within three to seven days of skin-to-skin contact with an infected person. Genital herpes infections look like small blisters or ulcers (round areas of broken skin) on the genitals. Each blister or ulcer is typically only 1 to 3 millimeters (1/32 inch to 1/8th inch) in size, and the blisters or ulcers tend to be grouped into "crops." Usually the blisters form first, then soon open to form ulcers. Herpes infections may be painless or slightly tender. In some people, however, the blisters or ulcers can be very tender and painful. Location of genital herpes In men, genital herpes sores (lesions) usually appear on or around the penis. In women, the lesions may be visible outside the vagina, but they commonly occur inside the vagina where they can cause discomfort or vaginal discharge but cannot be seen except during a doctor's examination. The ulcers or blisters may also be found anywhere around the genitals (the perineum) and in and around the anus. First outbreak of genital herpes The first genital herpes outbreak is usually the most painful, and the initial episode may last longer than later outbreaks. Symptoms may last for two to four weeks. Some people develop other signs of genital herpes infection, particularly with the first episode including: fever, muscle aches, headaches (may be severe), vaginal discharge or painful urination, and

swollen and tender lymph nodes in the groin (these swell as the body tries to fight the infection). Later outbreaks of genital herpes

If the disease returns, later outbreaks generally have much less severe symptoms. Many people with recurrent disease develop pain or a tingling sensation in the area of the infection even before any blisters or ulcers can be seen. This is due to irritation and inflammation of the nerves leading to the infected area of skin. These are signs that an outbreak is about to begin. The condition is particularly contagious during this period, even though the skin still appears normal.

When to Seek Medical Care

With an initial outbreak, if an individual has signs or symptoms of a genital herpes infection, he or she should seek the care of a doctor as soon as possible, particularly if the diagnosis of genital herpes has not been previously diagnosed. Although genital herpes infections generally are not medical emergencies, treatment is more effective when it is started within the first few days of the outbreak. Later outbreaks rarely need immediate medical attention. If an individual has had a genital herpes outbreak before, discuss options for preventing further outbreaks with a doctor. People with severe underlying medical problems (particularly HIV or AIDS) are at higher risk of severe illness if the disease is untreated. These individuals should contact a doctor immediately upon noticing genital herpes sores. A pregnant woman with signs or symptoms of genital herpes must inform her doctor as soon as possible. Prompt medical therapy may reduce the risk of transmitting the disease to newborn children by exposure in the birth canal. In otherwise healthy people, genital herpes outbreaks rarely require hospital visits. If an individual is experiencing an initial episode of genital herpes and cannot be seen by a regular doctor within the first few days of the illness, it is advisable go to a hospital's emergency department to have medical treatment started. Some people can become quite ill from genital herpes infections. If an individual has a high fever, severe headache, shortness of breath, or extremefatigue, he or she should go to the hospital for evaluation. People with severe medical illnesses (particularly HIV or AIDS) may become very ill from genital herpes infections. The herpes virus may quickly spread to the brain, lungs, and other organs. Individuals in this situation should seek prompt medical attention for genital herpes outbreaks and go to a hospital if there is any sign of illness other than sores on the genitals.

Exams and Tests

Many doctors will begin treatment based only on the appearance of the sores, if the sores seem typical of herpes. Doctors may also take a swab of the sore and send the swab to the laboratory to see if the virus is present. A number of types of tests may be ordered to establish the diagnosis, including: a culture of the virus; polymerase chain reaction to demonstrate the genetic material of the virus; and using antibodies to the genital herpes virus to demonstrate the presence of the virus in clinical specimens. These types of tests generally require at least a few days. In some cases, blood tests to confirm the presence of an immune response to the herpes virus may be ordered.

Genital Herpes Treatment Self-Care at Home

Individuals infected with the genital herpes virus should: avoid excessive heat or sunlight, which makes the irritation more uncomfortable; not use perfumed or antibacterial soaps, feminine deodorant, or douches; wear comfortable, loose fitting cotton clothing; take aspirin, acetaminophen (Tylenol and others), or ibuprofen (Advil, Motrin, Nuprin, etc.) if helpful; and use cool cloths on the affected area if it soothes the pain.

Medications
Treatment with medication is effective in shortening the initial outbreak of the infection, lowers the chance that the infection will come back, and makes any later outbreaks less severe. There are similar antiviral drugs available for the treatment of genital herpes infection, These antiviral medications vary in cost and how often they should be taken. All should be taken for 7-10 days. The patient's doctor may extend the course of therapy if ulcers have not healed in 10 days. Examples of these antiviral medications include: o o o acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex).

For preventing later genital herpes outbreaks, people with recurring infections also may benefit from the antiviral medications. Treatment is started when therecurrence first begins and continues for five days. For continuous prevention, a few individuals who have frequent outbreaks (generally over six recurrences per year) can only control the outbreaks by taking medication every day. Acyclovir, famciclovir, and valacyclovir are all used to treat recurrent disease. This is known as suppressive therapy. Suppressive therapy has been shown to decrease the frequency of genital herpes recurrences by 70%-80% in those who have frequent recurrences, and many individuals taking this treatment report no symptomatic outbreaks.

Next Steps Follow-up

Anyone diagnosed with genital herpes must disclose their diagnosis with sexual partners. These partners should be advised to seek medical attention if they develop any signs of the illness. Generally, nothing needs to be done if the partner has no signs of developing a genital herpes infection.

Prevention
People with genital herpes outbreaks are highly contagious. Anyone with active disease should avoid any sexual contact when sores are present. Even the use of a condom does not prevent the spread of disease because not all sores are covered by the condom. Although the chance of spreading disease is greatest when sores are present, people who have had genital herpes may always be contagious to some degree, even if they have received medical treatment. The virus can become active and be transmitted to a sexual partner even when the skin appears completely normal. For this reason, safe sex practices (use of a condom) should be used between disease outbreaks to lessen the chance of spreading disease to a sexual partner.

Outlook
Treatment of genital herpes does not cure the disease. The virus usually lives (in an inactive form) in an infected person throughout their lifetime. Most people (85%) with genital herpes will have recurring outbreaks - sometimes 6 to 10 a year. Recurrences are likely to have less severe symptoms and sores usually last a shorter period of time.

For More Information

People with genital herpes are naturally concerned about the implications of the disease and how it might distress their sexual partner or partners. Some people with genital herpes find it difficult to cope with a disease that tends to recur and interfere with their lifestyle. Individuals with questions or concerns about living with genital herpes should be discussed with his or her doctor. Seek further information and support from various health-serving organizations such as these:

Centers for Disease Control and Prevention, National Center for HIV, STD & TB Prevention, Genital Herpes National Herpes Hotline (919) 361-8488 (8:00 a.m. to 9:00 p.m. EST) American Social Health Organization, Herpes Resource Center

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Genital Warts (HPV) Overview

Genital warts are flesh-colored or gray growths found in the genital area and anal region in both men and women. Genital warts are sometimes referred to as condyloma acuminata or venereal warts. They represent the most common sexually-transmitted disease caused by a virus. The warts are caused by the human papillomavirus (HPV). Infection with genital warts may not be obvious. Genital warts affect both men and women and can occur at any age. Most patients with genital warts are between the ages of 17-33 years. Genital warts are highly contagious. There is around a 60% risk of getting the infection from a single sexual contact with someone who has genital warts. In children younger than three years of age, genital warts are thought to be transmitted by nonsexual methods such as direct manual contact. Nevertheless, the presence of genital warts in children should raise the suspicion for sexual abuse. Up to 20% of people with genital warts will have other sexually transmitted diseases (STDs).

Genital Warts Causes (HPV)

Genital warts are caused by the human papillomavirus (HPV). Over 100 types of HPVs have been identified; about 40 of these types have the potential to infect the genital area. About 90% of genital warts are caused by two specific types of the virus (HPV-6 and -11), and these HPV types are considered "low risk," meaning they have a low cancer-causing potential. Other HPV types are known causes of premalignant changes and cervical cancers in women. HPV-16, one of the "high-risk" types, is responsible for about 50% of cervical cancers. HPV types 16, 18, 31, and 45 are other known "high risk" virus types. High-risk HPV types are also referred to as oncogenic HPV types. HPV is believed to cause 100% of cases of cervical cancer. Common warts are not the same as genital warts and are caused by different HPV types that infect the skin. The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years may occur, during which there is no evidence of infection. Generally, about two-thirds of people who have sexual contact with a partner who has genital warts develop them within three months.

Genital warts are indirectly associated with use of birth control pills due to increased sexual contact without the use of barrier protection, multiple sex partners, and having sex at an early age.

Genital Warts Symptoms (HPV)

Although genital warts are painless, they may be bothersome because of their location, size, or due to itching. The size may range from less than one millimeter (1 mm = 0.039 inches) across to several square centimeters (1 cm = 0.39 inches) when many warts join together. Men and women with genital warts will often complain of painless bumps, itching, and discharge. Rarely, bleeding or urinary obstruction may be the initial problem when the wart involves the urethral opening (the opening where urine exits the body.) Warts in more than one area are common. There may be a history of previous or concurrent sexually transmitted diseases(STDs). Specific descriptions In men, genital warts can infect the urethra,penis, scrotum, and rectal area. The warts can appear as soft, raised masses with a surface that can be smooth (on the penile shaft) or rough with many fingerlike projections (anal warts). Others may appear pearly, cauliflower-like, or rough with a slightly dark surface. Most lesions are raised, but some may be flat with only slight elevation above the skin surface. Sometimes lesions may be hidden by hair or in the inner aspect of the uncircumcised foreskin in males. In women, genital warts have a similar appearance and usually occur in the moist areas of the labia minora and vaginal opening. Lesions visible on the outer genitals warrant a thorough examination of the vaginal canal, cervix, and anorectal area. Most vaginal warts occur without symptoms. Rarely, women may experience bleeding after sexual intercourse, itching, or vaginal discharge.

When to Seek Medical Care

If you have genital warts, see a health care practitioner and discuss treatment options. Bleeding warts that cannot be controlled with direct pressure should be seen by a health care practitioner. Warts that obstruct the urethral opening and don't allow you to urinate are an emergency and should be treated as soon as possible.

Genital Warts Diagnosis

Diagnosis is often based on findings from the history and appearance of the genital warts.

Sometimes, lesions are only visible with an enhancing technique called acetowhitening. This technique involves the application of 5% acetic acid solution to the area of suspicion for about 5-10 minutes. Infected areas will turn white. Magnification of the area (colposcopy) using a scope may be necessary to see the lesions. In females, a colposcope may be used to look for lesions in the vaginal canal and on the cervix. A routine Pap smear should always be done in order to look for evidence of HPV infection and abnormal cells on the cervix. A biopsy can be performed if the lesion appears unusual or recurs after treatment. Special laboratory tests can also be used to confirm the presence of HPV infection.

Genital Warts Treatment (HPV) Self-Care at Home

Because genital warts essentially have no symptoms other than their appearance, there is little need for home treatment. It is important, however, to recognize that the warts exist. Take the necessary precautions to prevent trauma to the area, which can result in bleeding. Be careful to prevent transmission to a sexual partner. Because the warts themselves are infectious, avoid touching them. Do not pick or squeeze the warts.

Medical Treatment
There is no single effective cure for removal of genital warts. A number of treatment options exist; however, no treatment is 100% effective in eliminating warts and preventing them from coming back in all patients. It also is not possible to eliminate infection with human papillomavirus once it has occurred. Genital warts may go away on their own in about 10%-20% of people over a period of three to four months. Cryotherapy: This technique freezes the wart using liquid nitrogen or a "cryoprobe." It is an excellent first-line treatment because response rates are high with few side effects. Laser treatment: This treatment is used for extensive or recurrent genital warts. It may require local, regional, or general anesthesia. The laser physically destroys the HPV-induced lesion. Disadvantages include high cost, increased healing time, scarring, and potentially infectious viral particles in the air caused by the laser plume. Electrodesiccation: This technique uses an electric current to destroy the warts. It can be done in the office with local anesthesia. Of note, the resulting smoke plume may be infectious.

Medications

Several medications exist for treating genital warts and can be used as an alternative to other treatments. Podophyllum resin (Pod-Ben-25, Podofin) is topically applied by a health care practitioner. Podofilox (Condylox) can be topically applied at home and has a highercure rate than podophyllum resin. Podofilox also is useful for prevention. Trichloroacetic acid or bichloracetic acid is topically applied; however, the response is often incomplete and recurrence is higher and it may cause pain and burning. 5-Fluorouracil (Efudex) is applied as a cream, has a long treatment time, can cause burning and irritation, and has many side effects. Interferon alpha-n3 (Alferon N) is an injection used for warts that do not respond to other therapies; however, it has many side effects. Imiquimod (Aldara) is applied as a cream and local skin irritation is a common side effect.

Surgery
Cutting the warts away can be done as an office procedure with local anesthesia. It is usually done when the warts are small in size and number. Surgical destruction or excision has been more effective in eradicating genital warts than medical therapies, but it carries a relatively high recurrence rate of 25%55%.

Follow-up
Complete the necessary treatment as outlined by your health care practitioner. Women with genital warts should see their doctor for a routine Pap smear and investigation for HPV infection of the vaginal canal and cervix. If the genital warts are not successfully treated with the initial therapy, the individual will need to follow-up with a doctor or a dermatologist to discuss options for alternative treatment.

Genital Warts Prevention

In 2006, an HPV vaccine (Gardasil) was approved by the FDA. It is currently recommended for both males and females aged 9 to 26 years. This vaccine has been shown to be safe and 100% effective in preventing infection with the four most common HPV types (6, 11, 16, and 18) in women who have had no previous exposure to the virus. However, it is less effective in those who have already been infected with HPV, and it does not protect against all types of HPV infection. Studies are underway to determine whether the vaccine is safe and effective in older women and in males. Another vaccine against HPV types 16 and 18, Cervarix, has been approved by the FDA for females aged 10 to 25 years. Because no treatment is 100% effective, it is important to prevent the spread of HPV, which causes genital warts and some cancers whenever possible. Transmission of genital warts can be decreased if condoms are used and the infected individual refrains from sexual activity until therapy is completed.

Genital Warts Outlook

In many cases, genital warts fail to respond to treatment or come back even after an removal. Reappearance of abnormal cells on the cervix of women is not altered by treatment of their sexual partners. Recurrence rates of genital warts are greater than 50% after one year and have been attributed to the following factors: Recurrent infection from a sexual partner; infection with multiple HPV types is possible Potentially long incubation time of HPV Persistence of the virus in the surrounding skin, in the hair follicle, or in sites that are missed by the treatment used Deep lesions or lesions that cannot be detected

Genital warts often appear or increase in number during pregnancy. Dormant infections may also become activated. The presence of genital warts may make vaginal delivery difficult if they are in the cervix or vagina, and warts in these locations tend to bleed easily. The warts often disappear on their own after pregnancy. The real danger, however, is that newborns may become infected during passage through an infected birth canal. HPV can cause a very serious condition in children called recurrent respiratory papillomatosis (RRP). This is a life-threatening disease of the respiratory tract. The papillomas or warts appear and spread quickly, sometimes dangerously blocking the child's airway.

Synonyms and Keywords

genital warts, venereal warts, condylomaacuminata, human papillomavirus, HPV,sexually transmitted disease, STD, recurrent respiratory papillomatosis, RRP, Gardasil, HPV vaccine, Cervarix

Hepatitis B Overview
Hepatitis B is an infectious hepatitis caused by the hepatitis B virus (HBV). This infection has two possible phases; 1) acute and 2) chronic. 1. Acute hepatitis B refers to newly acquired infections. Affected individuals notice symptoms approximately 1 to 4 months after exposure to the virus. In most people with acute hepatitis, symptoms resolve over weeks to months and they are cured of the infection. However, a small number of people develop a very severe, life-threatening form of acute hepatitis called fulminant hepatitis. 2. Chronic hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection becomes chronic, it may never go away completely.

Approximately 90% to 95% of infected adults are able to fight off the virus so their infection is cured. Only about 5% to 10% of adults infected with HBV go on to develop chronic infection. Children are at much higher risk for chronic infection. Up to 90% of infected young children will fail to clear the virus from their bodies and go on to develop chronic infection. About two-thirds of people with chronic HBV infection are chronic carriers. These people do not develop symptoms, even though they harbor the virus and can transmit it to other people. The remaining one third develop "active" hepatitis, a disease of the liver that can be very serious. The liver is an important organ that filters toxins out of the blood, stores energy for later use, helps with digestion, and makes substances that fight infections and control bleeding. The liver has an incredible ability to heal itself, but long-term inflammation caused by HBV can result in permanent damage. Scarring of the liver is called cirrhosis, a condition traditionally associated withalcoholism but one that is also caused by chronic active hepatitis B infection. When this occurs, the liver can no longer carry out its normal functions and may fail completely. The only treatment for liver failure is liver transplant. Chronic hepatitis B also can lead to a type of liver cancer known as hepatocellular carcinoma. Any of these conditions can be fatal. About 15% to 25% percent of people with chronic hepatitis B die of liver disease. Hepatitis B is the most common serious liver infection in the world. Worldwide, about 350 million people are chronic carriers of HBV, of whom, more than 620,000 die from liver-related disease each year. In the United States, hepatitis B is largely a disease of young adults aged 20-50 years. About 800,000 to 1.4 million Americans are chronic hepatitis B virus carriers, and the disease causes about 3, 000 deaths each year. The good news is that infection with HBV is usually preventable because there is an effective vaccine. Use of the vaccine has resulted in an 82% decrease in the number of new infections reported in the United States each year.

Hepatitis B Transmission and Causes

The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to another via blood or fluids contaminated with blood. Another important route of transmission is from an infected mother to a newborn child, which occurs during or shortly after birth. Direct contract with blood may occur through the use of dirty needles during illicit drug use, inadvertent needle sticks experienced by healthcare workers, or contact with blood through other means. Semen, which contain small amounts of blood, and saliva that is contaminated with blood also carry the virus. The virus may be transmitted when these fluids come in contact with broken skin or a mucous membrane (in the mouth, genital organs, or rectum) of an uninfected person. People who are at an increased risk of being infected with the hepatitis B virus include the following:

Men or women who have multiple sex partners, especially if they don't use a condom Men who have sex with men Men or women who have sex with a person infected with hepatitis B virus People with other sexually transmitted diseases People who inject drugs with shared needles People who receive transfusions of blood or blood products People who undergo dialysis for kidney disease Institutionalized mentally handicapped people and their attendants, caregivers, and family members Health care workers who are stuck with needles or other sharp instruments contaminated with infected blood Infants born to infected mothers In some cases, the source of transmission is never known. You cannot get hepatitis B from the following activities:

Having someone sneeze or cough on you Hugging someone Handshaking a persons hand Breastfeeding your child Eating food or drinking water Casual contact (such as an office or social setting)

Hepatitis B Symptoms
Half of all people infected with the hepatitis B virus have no symptoms and may never realize that they have been infected. Adults are more likely to develop symptoms than children. For those who do get sick, symptoms usually develop within 1 to 4 months after exposure to the virus. The initial symptoms are often similar to the flu. Common symptoms of hepatitis B include: Appetite loss Feeling tired (fatigue)

Nausea and vomiting Itching all over the body Pain over the location of the liver (on the right side of the abdomen, under the lower rib cage) Jaundice (a condition in which the skin and the whites of the eyes turn yellow in color) Dark urine (the color of cola or tea) Pale-colored stools (grayish or clay colored) Many types of acute viral hepatitis such as hepatitis A and hepatitis C have symptoms that are indistinguishable from hepatitis B. Fulminate hepatitis is a severe form of acute hepatitis that can be life-threatening if not treated right away. Fortunately, fulminate hepatitis is rare. The symptoms of fulminate hepatitis develop very suddenly and may include:

Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (hepatic encephalopathy) Sudden collapse with fatigue Jaundice Swelling of the abdomen Prolonged nausea and vomiting can cause dehydration. Individuals with dehydration may notice these symptoms:

Extreme weakness Confusion or trouble concentrating Headache Lack of urination Irritability Symptoms of liver damage may include the following:

Fluid retention causing swelling of the belly (ascites) and sometimes the legs Weight gain due to ascites Persistent jaundice

Loss of appetite, weight loss, wasting Vomiting with blood in the vomit Bleeding from the nose, mouth, or rectum; or blood in the stool Hepatic encephalopathy (excessive sleepiness, mental confusion, and in advanced stages, development of coma)

When to Seek Medical Care

Call your health care professional if you have any of the following: Nausea and vomiting that does not go away in 1-2 days The inability to keep down liquids A high fever or fever that persists more than 2 days Yellow skin or eyes Dark-colored urine (like tea or cola) Pain in the abdomen. For severe symptoms including confusion or delirium go to a hospital emergency department. You should also contact your health care practitioner if you think you may have been exposed to the hepatitis B virus. If you have chronic hepatitis B infection and think you might be pregnant; or if you are pregnant and think you have been exposed to hepatitis B inform health care practitioner right away.

Hepatitis B Diagnosis
Hepatitis B infection is diagnosed with blood tests. These tests can detect pieces of the virus in the blood (antigens), antibodies against the virus, and viral DNA ('viral load'). Blood tests for HBV are often done when routine blood work shows abnormal liver function tests or in patients who are at an increased risk for exposure. If a patient has had a large amount of vomiting or has not been able to take in liquids,blood electrolytes may also be checked to ensure that the patient's blood chemistry is in balance. Other tests may be ordered to rule out other medical conditions. X-rays and other diagnostic images are needed only in very unusual circumstances. If a patient is diagnosed with chronic hepatitis B, they will need regular visits to their health care practitioner. Blood tests can help determine how active the infection is and whether there has been damage to the liver.

Blood tests alone may not be enough to guide treatment in chronic HBV. Other tests include: CT scan or ultrasound: These diagnostic imaging tests are used to detect the extent of liver damage and may also detect cancer of the liver caused by chronic hepatitis B. Liver biopsy: This involves removal of a tiny piece of the liver. It is usually done by inserting a long needle into the liver and withdrawing the tissue. The tissue is examined under a microscope to detect changes in the liver. A biopsy may be done to detect the extent of liver damage or to evaluate how well a treatment is working.

Hepatitis B Treatment
Acute hepatitis B usually resolves on its own and does not require medical treatment. If very severe, symptoms such as vomiting or diarrheaare present, the affected person may require treatment to restore fluids and electrolytes. There are no medications that can prevent acute hepatitis B from becoming chronic. If a person has chronic hepatitis B, they should see their health care provider regularly

Self-Care at Home
The goals of self-care are to relieve symptoms and prevent worsening of the disease. Drink plenty of fluids to prevent dehydration. Although, broth, sports drinks, gelatin, frozen ice treats (such as Popsicles), and fruit juices may be better because they also provide calories. Ask your physician before taking any medications, even those that are over-the-counter. Some medications depend on the liver, and liver damage may impair the body's ability to metabolize these drugs. If you are on prescription medications, check with your physician to see if the doses should be adjusted or if the medication should be temporarily discontinued. Avoid drinking alcohol until your health care practitioner allows it. Individuals with chronic HBV should avoid alcohol for the rest of their lives. Try to eat a diet that provides adequate nutrition. Take it easy. It may take some time for your energy level to return to normal. Avoid prolonged, vigorous exercise until symptoms start to improve. Call your health care practitioner for advice if your condition worsens or new symptoms appear. Avoid any activity that may spread the infection to other people (sexual intercourse, sharing needles, etc)

Medical Treatment
Acute hepatitis B infection Acute hepatitis B infection is not treated with antiviral medications.

If the infected person is dehydrated from vomiting or diarrhea, a doctor may prescribe IV fluids to help them feel better. Medications may also be used to control these symptoms. People with mild symptoms can be cared for at home. Chronic hepatitis B infection The degree of liver damage is related to the amount of active, replicating (multiplying) virus in the blood and liver. Regularly measuring the amount of HBV DNA ('viral load') in the blood gives your physician a good idea of how fast the virus is multiplying. The treatments now in use are classified as antiviral drugs, because they try to stop the virus from multiplying.

Antiviral agents, while the best therapy known for chronic hepatitis B, do not work in all individuals with the disease. There are several antiviral agents for chronic hepatitis B approved by the U.S. Food and Drug Administration (FDA). New drugs are always being tested and treatment recommendations are subject to change. Antiviral therapy is not appropriate for everyone with chronic HBV infection. It is reserved for people whose infection is most likely to progress to active hepatitis or cirrhosis. Decisions to start medications for treatment of hepatitis B are made by the patient and health care practitioner, often in consultation with a specialist in diseases of the digestive system (gastroenterologist) or liver (hepatologist). The decision to treat is guided by results of liver function tests, HBV DNA tests, and, frequently, liver biopsies after a complete history and physical examination. Treatment is usually started when blood tests indicate that liver functions are deteriorating and the amount of replicating HBV is rising. Many people never reach this point. For those who do, the interval between diagnosis and starting treatment is quite variable.

Hepatitis B Medications
All of the following medications described that are used to treat chronic hepatitis B are antiviral medications. They reduce the ability of the virus to reproduce in the body and give the liver a chance to heal itself. These drugs are not a cure for hepatitis B, but they do reduce the damage caused by the virus. Although these medications are similar in some ways, they differ in other important ways. Talk to your health care practitioner about the best medication for you. Pegylated interferon alfa-2b (Pegasys) Pegylated interferon is used alone or in combination with other medications. Pegylated interferon slows the replication of the virus and boosts the body's immune system to fight the infection. It works best in people who have relatively low levels of HBV DNA (low viral load).

Pegylated interferon usually is not given to people whose liver damage has progressed to cirrhosis, because it can make the liver damage worse. Treatment is often given for 48 weeks, which is shorter than for other medications, but pegylated interferon requires regular shots (injections) while other medications are taken orally. Pegylated interferon has unpleasant side effects in many people. The side effects are similar to having the flu. For many people, side effects are so severe that they cannot continue taking the medication. Liver function tests and HBV DNA tests are used to check how well the treatment is working. Interferon appears to stop the liver damage in up to 40% of people although relapse is possible. Nucleoside/nucleotide analogues (NAs) Nucleoside/nucleotide analogues (NAs) are compounds that mimic normal building blocks for DNA. When the virus tries to use the analogues, it is unable to make new viral particles. Examples of these agents include adefovir (Hepsera),entecavir (Baraclude), lamivudine (Epivir-HBV, Heptovir, Heptodin),Telbivudine (Tyzeka) and tenofovir (Viread).

NAs reduce the amount of virus in the body. Between 20% and 90% of patients may have levels reduced so far that they become undetectable. Obviously, this is a broad range. The higher success rates are achieved in patients who do not have "hepatitis B e antigen" (HBeAg). HBeAg is detected by a blood test and indicates that the virus is actively multiplying. Side effects are less common than with pegylated interferon. NAs have been associated with changes in body fat distribution, reduced blood cell counts, and increased levels of lactic acid in the blood. Rarely, NAs are associated with a severe flare of hepatitis that can be serious or fatal. HBV may become resistant to NAs over time. NAs do not cure the infection. Relapse is possible even in patients who have had a good response to treatment.

Surgery
There is no surgical therapy for hepatitis B. If liver damage is so severe that the liver starts to fail, liver transplant may be recommended. Liver transplant is a major process and surgery with an extended recovery period. It also depends on the availability of a matching donor liver. If liver transplant becomes a possibility for an individual, a health care practitioner will discuss the risks and benefits with them.

Hepatitis B Other Therapy

No herbs, supplements, or other alternative therapy is known to work as well as antiviral medication in slowing HBV replication and promoting liver healing in hepatitis B. At this time, no specific herb or herbal preparation is recommended.

Hepatitis B Vaccine
There is a vaccine against the hepatitis B virus (Engerix-B, Recombivax HB). It is safe and works well to prevent the disease. A total of 3 doses of the vaccine are given over several months. Hepatitis B vaccine is also produced as a combination product which includes othercommon childhood vaccinations. This can reduce the number of shots that a child needs at a single visit. The following groups should be vaccinated for hepatitis B: All children younger than 19 years, including all newborns - especially those born to mothers who are infected with HBV All health care and public safety workers who may be exposed to blood People who have hemophilia or other blood clotting disorders and receive transfusions of human clotting factors People who have end-stage renal diseaseincluding those who require hemodialysisfor kidney disease Travelers to countries where HBV infection is common. This includes most areas of Africa, Southeast Asia, China and Central Asia, Eastern Europe, the Middle East, the Pacific Islands, and the Amazon River basin of South America. People who are in prison People who live or work in residential facilities for developmentally disabled persons People who inject illegal drugs People with chronic liver disease such as hepatitis C People who have multiple sex partners or have ever had a sexually transmitted disease Men who have sex with men Persons with HIV People who have a sexual partner who is an HBV carrier. Household contacts of persons who are carriers of HBV. Anyone who wants to be vaccinated, regardless of risk factors. Hepatitis B immune globulin (BayHep B, Nabi-HB) is given along with the hepatitis B vaccine to unvaccinated people who have been exposed to hepatitis B.

These include close contacts of people with HBV infection, health care workers who are exposed to HBV-contaminated blood, and infants born to mothers infected with HBV. Giving the immune globulin and the vaccine together in these situations prevents transmission of the disease in 80% to 90% percent of cases.

Follow-up
If an individual has acute hepatitis B, a health care practitioner will draw blood and examine the person periodically to see if the infection is resolving. If the person develops chronic hepatitis B, they will need periodic examinations and blood tests on an ongoing basis. If these tests indicate that the virus is actively damaging the liver, the health care practitioner may suggest a liver biopsy or begin antiviral therapy. The individual will also be given a vaccine against hepatitis A, which is an unrelated virus that may cause severe liver disease in people who already carry hepatitis B. Chronic hepatitis B is associated with hepatocellular carcinoma. Fortunately, this is a rare cancer. A blood test can be used to detect a marker for this cancer or the cancer can be detected by abdominal ultrasound. Persons with chronic hepatitis B are usually screened periodically (every 6 to 12 months) for hepatocellular carcinoma, although it is not clear if this screening improves survival.

Hepatitis B Prevention
In addition to the hepatitis B vaccine, other ways to protect yourself from HBV infection include: If you are sexually active, practice safe sex. Correct use of latex condoms can help prevent transmission of HBV, but even when used correctly, condoms are not 100% effective at preventing transmission. Men who have sex with men should be vaccinated against both hepatitis A and hepatitis B. If you inject drugs, don't share needles or other equipment. Don't share anything (including grooming products) that might have blood on it, such as a razor, toothbrush, fingernail clippers, etc. Think about the health risks if you are planning to get a tattoo or body piercing. You can become infected if the artist or person piercing you does not sterilize needles and equipment, use disposable gloves, or wash hands properly. Health care workers should follow standard precautions and handle needles and sharps safely. If you are pregnant or think you might be pregnant, tell your health care practitioner if you have any of the risk factors for HBV infection.

Hepatitis B Prognosis
Some people rapidly improve after acute hepatitis B. Others have a more prolonged disease course with very slow improvement over several months, or with periods of improvement followed by worsening of symptoms.

A small group of people (about 1% of infected people) suffer rapid progression of their illness during the acute stage and develop severe liver damage (fulminate hepatitis). This may occur over days to weeks and may be fatal. Other complications of HBV include development of a chronic HBV infection. People with chronic HBV infection are at further risk for liver damage (cirrhosis), liver cancer, liver failure, and death.

Hepatitis C Overview
Hepatitis is a general term that means inflammation of the liver. This inflammation can be caused by infection. Hepatitis can also be caused by exposure to alcohol, certain medications, chemicals, poisons, and other toxins, or by other diseases. >Hepatitis C virus (HCV) is one of the many viruses that can cause inflammation of the liver. Inflammation of the liver caused by infection with HCV is referred to as hepatitis C. If the inflammation is not reversed, it becomes chronic (ongoing, long term) and can cause chronic liver disease, which can be serious or even fatal. At least 75% of people infected with hepatitis C develop chronic hepatitis C. If the disease progresses to the point at which the liver begins to fail (end stage liver disease), the only treatment is liver transplantation. Hepatitis C is an increasing public health concern in the United States and throughout the world. HCV is one of the most common causes of chronic liver disease in theUnited Statesand the most common cause of chronic viral hepatitis. It is believed to be the cause of about 15-20% of all cases of acute (new, short term) viral hepatitis and half of all cases of cirrhosis, end-stage liver disease, and liver cancer. About 4 million people in the United States have antibodies to HCV, meaning they have been infected with the virus at some point; as many as half of them do not know they have the infection.

Hepatitis C Causes
HCV is not related to the other viruses that cause hepatitis. Like the other hepatitis viruses, however, it is contagious. The hepatitis C virus is transmitted mainly by contact with blood or blood products. o Sharing of contaminated needles among IV drug users is the most common mode of transmission. Using a needle to inject recreational drugs, even onceseveral years ago, is a risk factor for hepatitis C. o Transfusion with infected blood or blood products, hemodialysis, or transplantation of organs from infected donors was once a common mode of transmission butis now rare. In 1992, a test became available for checking blood for HCV. Blood and blood products are now tested to ensure that they are not contaminated. As a result, cases of hepatitis C related to transfusion, hemodialysis, or transplantation have dropped to almost zero since then. Transfusion of blood or blood products before 1992 is a risk factor for hepatitis C. Less common causes of HCV transmission include the following:

o o o

From mother to infant atthe time of childbirth Through sexual intercourse with an infected person: Having multiple sex partners is a risk factor. Needle sticks with HCV-contaminated blood: This is mostly seen in health care workers. The risk of developing HCV infection after a needle stick is about 5-10%. You cannot get hepatitis C by living with, being near, or touching someone with the disease. You can get the disease by sharing a razor, nail clippers, or other such items with an infected person. The source of transmission is unknown in about 10% of people with acute hepatitis C and in about 30% of people with chronic hepatitis C.

Hepatitis C Symptoms
Although hepatitis C damages the liver, 80% of people with the disease do not have symptoms. In those who do,symptoms may not appear for10-20 years, or even longer. Even then, the symptoms usually come and go and are mild and vague. Unfortunately, by the time symptoms appear, the damage may be very serious. A minority of people have symptoms during the early acute phase of the infection. These symptoms typically develop 5-12 weeks after exposure to HCV. Some people describe the symptoms as beingflulike. The symptoms may last a few weeks or months. o Nausea o Vomiting o Diarrhea o Loss of appetite o Fatigue o o o o Pain over the liver (on the right side of the abdomen, just under the rib cage) Jaundice - A condition in which the skin and the whites of the eyes turn yellow Dark-colored urine (may look like cola or tea) Stoolsbecome pale in color (grayish or clay colored)

Prolonged nausea and vomiting can causedehydration. If you have been vomiting repeatedly, you may notice the following symptoms: o Fatigue or weakness o Confusion or difficulty concentrating o Headache o Not urinating o Irritability Chronic hepatitis C can lead tocirrhosis of the liver in many people, a condition traditionally associated with alcoholism. Cirrhosis is a condition in which healthy liver tissue is replaced by fibrous tissue,followed byscarlike hardening. As this happens, the liver gradually begins to fail, or lose its ability to carry out its normal functions. Eventually, symptoms develop. Symptoms of cirrhosisinclude the following: o Fluid retention causing swelling of the belly (ascites), legs, or whole body o Persistent jaundice

o o o o o o

Fatigue Disturbances in sleeping Itchy skin Loss of appetite, weight loss, wasting Vomiting with blood in the vomit Mental disturbances such as confusion, lethargy, extreme sleepiness, or hallucinations (hepatic encephalopathy)

When to Seek Medical Care

Call your health care provider in any of the following situations. He or she will probably want to see you. You have nausea and vomiting that does not go away in 1-2 days. Your skin or eyes turn yellow, or your urine is dark-brownish in color. Youhave pain in your abdomen (belly). You think that you might have been exposed to someone with hepatitis or think that you might be at risk for any reason. You have other medical problems and think that you might have hepatitis. If you cannot reach your health care provider, or if you have any of the following symptoms, go to a hospital emergency department without delay. You are vomiting and cannot keep down any fluids. You are having severe pain or high fever. You are becoming confused, delirious, or difficult to awaken.

Exams and Tests

Your health care provider will interview you about your illness. You will be asked about your symptoms and about any exposures to hepatitis viruses. If your doctor determines that you may be at risk for contracting hepatitis, you will have blood drawn. The laboratory will be able to determine whether you have been exposed to HCV and certain other hepatitis viruses. Several tests are available for this, but the most widely used test detects antibodies to these viruses. Antibodies are substances made by your body's immune system to defend against a specific infection. You won't have the antibody unless you have been infected with HCVunless the test was performed so soon after exposure that your immune system did not have time to make the antibody. Tests are also available to identify which of the 6 known strains (genotypes)of the virus is causing the infection. This can help determine the best treatment plan. The laboratory will also do several tests to determine how well your liver is functioning. Other tests will probably be done to check the effects of the infection on other body systems, such as the kidneys.

If you have had a large amount of vomiting or have not been able to take in liquids, your blood electrolytes will be checked to see if they are in balance. Liver biopsy is the ultimate test in hepatitis C. It is not necessary for diagnosis but gives useful information about the stage of disease (the amount of liver damage that has already occurred).

Hepatitis C Treatment Self-Care at Home

If you have symptoms, these measures will help you feel better faster. Take it easy; get plenty of rest. Drink plenty of fluids to prevent dehydration. Do not drink alcohol of any kind, including beer, wine, and hard liquor. Avoid medicines and substances that can cause harm to the liver such asacetaminophen (Tylenol) and other preparations that contain acetaminophen. Avoid prolonged, vigorous exercise until symptoms start to improve.

Medical Treatment
If you are dehydrated, your health care provider may prescribe IV fluids to help you feel better. If you are experiencing significant nausea and vomiting, you will receive medicines to help control these symptoms. If your symptoms are well controlled, you can be cared for at home. If dehydration or other symptoms are severe or if you are showing signs of confusion or delirium, then you may be hospitalized. The treatment that has shown the most promise in chronic hepatitis C is an agent called pegylated interferon alpha (Pegasys, PEG-Intron). This agent is often combined with an antiviral drug called ribavirin (Virazole). Decisions to start medications for treatment of hepatitis C are usually made in consultation with a gastroenterologist or liver specialist (hepatologist). The decision is based on the results of lab tests of liver function, on results of tests for HCV and liver biopsy, and on the person's age and general medical condition. Certain medical conditions preclude the use of interferon. Depression and certain other mental and neurologic disorders Active alcohol or drug abuse Autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, or psoriasis Low bloodhemoglobin level(anemia) or blood cell counts Cirrhosis that is severe enough to cause symptoms such as jaundice, wasting, fluid retention that causes swelling, or mental disturbances

Medications

Interferon alpha (Intron A): Interferon is a protein that the body makes naturally in response to viral infections in orderto fight the infection. It also has other actions in the body and has been used to treat a variety of diseases such as leukemias,other types of cancers, andmultiple sclerosis. Pegylation describes a chemical process that makes the interferon last longer in the body. Levels of the older type of interferon were difficult to regulate in the body. The drug had to be given several times a week. The pegylated type(Pegasys, PEG-Intron) is given only once a week and maintains a steady level in the blood between doses. This is a considerable advantage because interferon has to be taken by shot and has many side effects. More importantly, though, the pegylated formulation is more effective against HCV. Because interferon can be harmful to an unborn child, persons taking interferon must practice effective birth control during treatment and for at least 6 months afterward. Ribavirin (Virazole): Ribavirin is like an antibiotic for certain viruses. By itself, ribavirin has little effect on HCV, but interferon increases its potency. Ribavirin is usually given with interferon unless there is a particular reason not to give it to a specific individual. It has to be taken every day in 2 doses but is a pill rather than a shot. The combination of interferon alpha and ribavirin works betterthan interferon alone. The duration of treatment depends on the strain (genotype) of the virus. For genotype 1 and 4, the treatment is given for 48 weeks. For genotype 2, the treatment is only for24 weeks. During treatment, you will have blood drawn every few weeks to test the effects on your liver, kidneys, and blood. Treatment is followed by a period of no treatment in which the person's response to the treatment is checked. This is measured by the amount of HCV RNA (similar to DNA) in the person's blood. The level of HCV RNA goes down to nearly zero during treatment in about 70% of people. Treatment is considered successful if the RNA level remains near zero for at least 6 months after treatment. This occurs in about 55% of people treated with combination therapy and about 15% of people treated with interferon alone. Most people tolerate these drugs fairly well, although side effects are common. The side effects range from mild to debilitating. If they are severe enough, the person may have to stop taking one or both drugs, or take a lower dose. Lower doses generally do not work as well against the disease. Side effects of interferon can be bothersome in some people. Sometimes the symptoms are described as being like having the flu. The side effects often get better over time as treatment continues. Common side effects include the following: Fatigue Lowhemoglobin levelin the blood (anemia) or low blood cell counts Muscle aches Nausea and vomiting

Mild fevers Depression Irritability Headaches Weight loss Interferon can have other, less common side effects. You should discuss these with your health care provider before starting treatment. The side effects of ribavirin can be severe enough that the person has to switch to interferon-only therapy. Like interferon, ribavirin can be harmful to an unborn child, and persons taking ribavirin must practice effective birth control during treatment and for at least 6 months afterward. Common side effects include the following:

Fatigue Anemia Irritability Itching Skin rash Sinus congestion and cough

urgery
For end-stage liver disease, the only treatment thatwill cure the problemis liver transplantation.

Other Therapy
A significant number of people with hepatitis C cannot take interferon and ribavirin or cannot tolerate the side effects. In others, the drugs simply don't work on the virus. Research is ongoing to find other therapies for these people. Alternative therapies now in use for hepatitis C include several different herbs. It should be emphasized that none of these alternative and complementary therapies has been proven to work in any scientific study. They are not recommended by any medical authority as an alternative to interferon and ribavirin in people able to take these medications. The most promising complementary therapy is milk thistle. The active ingredient in milk thistle is thought to be a substance called silymarin. Studies done in animals suggest that silymarin may have antioxidant and anti-inflammatory effects and promote liver health in various ways. Milk thistle has not been studied specifically in people with hepatitis C, but it has been tested in people with cirrhosis and in people with chronic hepatitis. Unfortunately, results are not conclusive; some studies showed a positive effect, others did not. Milk thistle is available as capsules but not as tea. Other herbs that may have a positive effect arelicorice and ginseng. These herbs are thought to promote liver health and to boost the body's ability to fight the infection. Extreme care should be taken with licorice, however, as it can cause high blood pressure or even heart failure or cardiac arrest(heart stopping) if taken at too high a dose.

Other herbs may be taken as complementary therapy to help relieve the side effects of interferon. These include ginger (to reduce nausea) and St. John's wort(to relieve depression). Like all herbal preparations, the manufacture and contents of these products is not standardized in the United States and is not regulated by any government body. The potency and purity vary from product to product and are not predictable. Just because herbs are natural products does not mean they are always safe or helpful. Take herbal products and supplements with as much care as you would take any medicine. Talk to your health care provider if you are taking any herbs or supplements or are considering taking any.

Next Steps Follow-up

Follow all instructions that your health care provider gives you. A healthy lifestyle is more important than ever. Eat a varied, healthy diet, take part in some physical activity daily, and get plenty of rest. Drink plenty of water and other noncaffeinated fluids to stay well hydrated. Avoid alcoholic beverages and medicines such asnonsteroidal anti-inflammatory drugs (like Brufen, Aleve, Advil)that can be harmfulin people with liver disease. If you have symptoms, avoid prolonged or vigorous physical exercise until your symptoms improve. If symptoms worsen at any time, contact your doctor. The better you take care of yourself, the more likely you will be one of the many individuals who do well for many years.

Prevention
Right now, there is no vaccine for the prevention of HCV transmission. The best means of preventing transmission of HCV is to preventcontact withinfected blood and organs and to avoid high-risk sexual behavior such as multiple partners and anal contact. Avoiding alcohol and drugs that can damage the liver may help slow the rate of progression of the disease.

Outlook
Hepatitis C varies greatly in its long-term effects. Some people never develop severe complications of the disease. At least 75% of people infected with HCV develop chronic hepatitis, and30%of these people go on to developcirrhosis. Chronic liverdisease because of hepatitis Ccauses 10,000 deaths each year in the United States. Cirrhosis from chronic hepatitis C can lead to liver failure. If damage is severe, liver transplantation is the only treatment.

Cirrhosis from chronic hepatitis C may lead to liver cancer. A small number of people with hepatitis C develop complications outside the liver. These may affect the skin and connective tissues of the body, the blood or bone marrow, the muscles, the joints, or the kidneys.

HIV/AIDS Overview
HIV (human immunodeficiency virus) infection has now spread to every country in the world. Approximately 40 million people are currently living with HIV infection, and an estimated 25 million have died from this disease. The scourge of HIV has been particularly devastating in sub-Saharan Africa, but infection rates in other countries remain high. In the United States, approximately 1 million people are currently infected. Here are a few key points about the disease: Globally, 85% of HIV transmission is heterosexual.

In the United States, approximately one-third of new diagnoses appear to be related to heterosexual transmission. Male-to-male sexual contact still accounts for approximately half of new diagnoses in the U.S. Intravenous drug use contributes to the remaining cases. Because the diagnosis may occur years after infection, it is likely that a higher proportion of recent infections are due to heterosexual transmission.

Infections in women are increasing. Worldwide, 42% of people with HIV are women. In the United States, approximately 25% of new diagnoses are in women, and the proportion is rising.

There is good news on one front. New HIV infections in U.S. children have fallen dramatically. This is largely a result of testing and treating infected mothers, as well as establishing uniform testing guidelines for blood products. In order to understand HIV and AIDS, it is important to understand the meanings behind these terms:

HIV stands for the human immunodeficiency virus. It is one of a group of viruses known as retroviruses. After getting into the body, the virus kills or damages cells of the body's immune system. The body tries to keep up by making new cells or trying to contain the virus, but eventually the HIV wins out and progressively destroys the body's ability to fight infections and certain cancers.

AIDS stands for the acquired immunodeficiency syndrome. It is caused by HIV and occurs when the virus has destroyed so much of the body's defenses that immune-cell counts fall to critical levels or certain life-threatening infections or cancers develop.

HIV/AIDS Transmission
HIV is transmitted when the virus enters the body, usually by injecting infected cells or semen. There are several possible ways in which the virus can enter. Most commonly, HIV infection is spread by having sex with an infected partner. The virus can enter the body through the lining of the vagina, vulva, penis, rectum, or mouth during sex.

HIV frequently spreads among injection-drug users who share needles or syringes that are contaminated with blood from an infected person.

Women can transmit HIV to their babies during pregnancy or birth, when infected maternal cells enter the baby's circulation.

HIV can be spread in health-care settings through accidental needle sticks or contact with contaminated fluids.

Very rarely, HIV spreads through transfusion of contaminated blood or blood components. Blood products are now tested to minimize this risk. If tissues or organs from an infected person are transplanted, the recipient may acquire HIV. Donors are now tested for HIV to minimize this risk.

People who already have a sexually transmitted disease, such as syphilis,genital herpes, chlamydial infection, gonorrhea, or bacterial vaginosis, are more likely to acquire HIV infection during sex with an infected partner. The virus does not spread through casual contact such as preparing food, sharing towels and bedding, or via swimming pools, telephones, or toilet seats. The virus is also unlikely to be spread by contact with saliva, unless it is contaminated with blood.

HIV/AIDS Symptoms and Signs

Many people with HIV do not know they are infected. Many people do not develop symptoms after they first get infected with HIV. Others have a flu-like illness within several days to weeks after exposure to the virus. They complain of fever, headache, tiredness, and enlarged lymph nodes in the neck. These symptoms usually disappear on their own

within a few weeks. After that, the person feels normal and has no symptoms. This asymptomatic phase often lasts for years.

The progression of disease varies widely among individuals. This state may last from a few months to more than 10 years.

During this period, the virus continues to multiply actively and infects and kills the cells of the immune system.

The virus destroys the cells that are the primary infection fighters, a type of white blood cell called CD4 cells.

Even though the person has no symptoms, he or she is contagious and can pass HIV to others through the routes listed above.

AIDS is the later stage of HIV infection, when the body begins losing its ability to fight infections. Once the CD4 cell count falls low enough, an infected person is said to have AIDS. Sometimes, the diagnosis of AIDS is made because the person has unusual infections or cancers that show how weak the immune system is. The infections that happen with AIDS are called opportunistic infectionsbecause they take advantage of the opportunity to infect a weakened host. The infections include (but are not limited to)

pneumonia caused by Pneumocystis, which causes wheezing;

brain infection with toxoplasmosis which can cause trouble thinking or symptoms that mimic a stroke;

widespread infection with a bacteria called MAC (mycobacterium avium complex) which can cause fever and weight loss;

yeast infection of the swallowing tube (esophagus) which causes pain with swallowing;

widespread diseases with certain fungi like histoplasmosis, which can cause fever, cough, anemia, and other problems.

A weakened immune system can also lead to other unusual conditions:

lymphoma in (a form of cancer of the lymphoid tissue) the brain, which can cause fever and trouble thinking;

a cancer of the soft tissues called Kaposi's sarcoma, which causes brown, reddish, or purple spots that develop on the skin or in the mouth.

When to Seek Medical Care

If you have engaged in unprotected sex outside of a mutually monogamous relationship or shared needles while using drugs, you should have an HIV test. Early detection and treatment of the infection can slow the growth of HIV. If you are pregnant and infected with HIV, you may be able to reduce the risk to your unborn child by getting treatment early. You can also avoid infecting others if you know that you have the disease. Testing is available anonymously and confidentially. You can even test yourself at home. People known to have HIV infection or AIDS should go to the hospital any time they develop high fever, shortness of breath, coughing up blood, severe diarrhea, severe chest orabdominal pain, generalized weakness, severe headache, seizures, confusion, or a change in mental status. These may be the indication of a life-threatening condition for which an urgent evaluation in the hospital's emergency department is recommended. All infected people should be under the regular care of a physician skilled in the treatment of HIV and AIDS.

HIV/AIDS Diagnosis
HIV infection is commonly diagnosed by blood tests. There are three main types of tests that are commonly used: (1) antibody tests, (2) RNA tests, and (3) a combination test that detects both antibodies and a piece of the virus called the p24 protein. In addition, a blood test known as a Western blot is used to confirm the diagnosis.

No test is perfect. Tests may be falsely positive or falsely negative. For example, it can take some time for the immune system to produce enough antibodies for the antibody test to turn positive. This time period is commonly referred to as the "window period" and may last six weeks to three months following infection. Therefore, if the initial antibody test is negative, a repeat test should be performed three months later. Early testing is crucial, because early treatment for HIV helps people avoid or minimize complications. Furthermore, high-risk behaviors can be avoided, thus preventing the spread of the virus to others. Testing for HIV is usually a two-step process. First, an inexpensive screening test is done. If that test is positive, a second test (Western blot) is done to confirm the result. Antibody tests are the most common initial screening test used. There are different types of antibody screening tests available: Most commonly, blood is drawn for an enzyme immunoassay (EIA). The test is usually run in a local laboratory, so results can take one to three days to come back.

Other tests can detect antibodies in body fluids other than blood such as saliva, urine, and vaginal secretions. Some of these are designed to be rapid tests that produce results in approximately 20 minutes. These tests have accuracy rates similar to traditional blood tests.

HIV home-testing kits are available at many local drug stores. Blood is obtained by a finger prick and blotted on a filter strip. Other test kits use saliva or urine. The filter strip is mailed in a protective envelope to a laboratory to be tested. Results are returned by mail in one to two weeks.

All positive antibody screening tests must be confirmed with a follow-up blood test called the Western blot to make a positive diagnosis. If the antibody test and the Western blot are both positive, the likelihood of a person being HIV infected is >99%. Sometimes, the Western blot is "indeterminate," meaning that it is neither positive nor negative. In these cases, the tests are usually repeated at a later date. In addition, an RNA test for the virus might be done. Other tests, such as those that look for virus RNA and the combination test, are not commonly used for screening.

HIV/AIDS Treatment Medications

Over the past years, several drugs have become available to fight both the HIV infection and its associated infections and cancers. These drugs are called highly active antiretroviral therapy (HAART) and have substantially reduced HIV-related complications and deaths. However, there is no cure for HIV/AIDS. Therapy is initiated and individualized under the supervision of a physician who is an expert in the care of HIV-infected patients. A combination of at least three drugs is recommended to suppress the

virus from replicating and boost the immune system. The following are the different classes of medications used in treatment. Reverse transcriptase inhibitors: These drugs inhibit the ability of the virus to make copies of itself. The following are examples:

Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs). These include medications such aszidovudine (AZT/Retrovir), didanosine (ddI/Videx), zalcitabine (ddC/Hivid),stavudine (d4T/Zerit), l amivudine (3TC/Epivir), abacavir (ABC/Ziagen),emtricitabine (FTC/Emtriva), and tenofovir (Viread).

Non-nucleoside reverse transcriptase inhibitors (NNRTIS) are commonly used in combination with NRTIs to help keep the virus from multiplying. Examples of NNRTIs are efavirenz (Sustiva), nevirapine (Viramune), anddelavirdine (Rescriptor). Etravirine (Intelence), a newer member of this class of drugs, was approved by the U.S. FDA in 2008.

Protease inhibitors (PIs): These medications interrupt virus replication at a later step in its life cycle, preventing cells from producing new viruses. These include ritonavir (Norvir), a lopinavir and ritonavir combination (Kaletra),saquinavir (Invirase), indinavir sulphate (Crixivan), amprenavir (Agenerase),fosamprenavir (Lexiva), darunavir (Prezista), atazanavir (Reyataz), tipranavir(Aptivus), and nelfinavir (Viracept). Using PIs with NRTIs reduces the chances that the virus will become resistant to medications.

Fusion and entry inhibitors are newer agents that keep HIV from entering human cells. Enfuvirtide (Fuzeon/T20) was the first drug in this group. It is given in injectable form like insulin. Another drug called maraviroc (Selzentry) binds to a protein on the surface of the human cell and can be given by mouth. Both drugs are used in combination with other anti-HIV drugs.

Integrase inhibitors stop HIV genes from becoming incorporated into the human cell's DNA. This is a newer class of drugs recently approved to help treat those who have developed resistance to the other medications.Raltegravir (Isentress) was the first drug in this class approved by the FDA in 2007. Antiretroviral viral drugs stop viral replication and delay the development of AIDS. However, they also have side effects that can be severe. They include decreased levels of red or white blood cells, inflammation of the pancreas, liver toxicity, rash, gastrointestinal problems, elevated cholesterol level, diabetes, abnormal body-fat distribution, and painful nerve damage.

Pregnant women who are HIV-positive should seek care immediately because HAART therapy reduces the risk of transmitting the virus to the fetus. There are certain drugs, however, that are harmful to the baby. Therefore, seeing a physician to discuss anti-HIV medications is crucial.

Follow-up
People with HIV infection should be under the care of a physician who is experienced in treating the infection. All people with HIV should be counseled about avoiding the spread of the disease. Infected individuals are also educated about the disease process, and attempts are made to improve the quality of their life.

HIV Prevention
Despite significant efforts, there is no effective vaccine against HIV. The only way to prevent infection by the virus is to avoid behaviors that put you at risk, such as sharing needles or having unprotected sex. In this context, unprotected sex means sex without a barrier such as a condom. Because condoms break, even they are not perfect protection. Many people infected with HIV don't have any symptoms. There is no way to know with certainty whether a sexual partner is infected. Here are some prevention strategies: Abstain from sex. This obviously has limited appeal, but it absolutely protects against HIV transmission by this route.

Have sex with a single partner who is uninfected. Mutual monogamy between uninfected partners eliminates the risk of sexual transmission of HIV.

Use a condom in other situations. Condoms offer some protection if used properly and consistently. Occasionally, they may break or leak. Only condoms made of latex should be used. Only water-based lubricants should be used with latex condoms.

Do not share needles or inject illicit drugs.

If you work in a health-care field, follow recommended guidelines for protecting yourself against needle sticks and exposure to contaminated fluids.

If you have engaged in risky behaviors, get tested to see if you have HIV.

The risk of HIV transmission from a pregnant woman to her baby is significantly reduced if the mother takes medications during pregnancy, labor, and delivery and her baby takes medications for the first six weeks of life. Even shorter courses of treatment are effective, though not as optimal. The key is to get tested for HIV as early as possible in pregnancy. In consultation with their physician, many women opt to avoid breastfeeding to minimize the risk of transmission after the baby is born.

HIV/AIDS Prognosis
There is no cure for HIV infection. Before we had any treatment for the virus, people with AIDS lived only for a couple of years. Fortunately, medications have substantially improved the outlook and survival rates. Prevention efforts have sharply reduced HIV infection in young children and have the potential to sharply limit new infections in other populations. Medications have extended the average life expectancy, and many people with HIV can expect to live for decades with proper treatment. An increasing number have a normal life expectancy if they adhere carefully to medication regimens.

Medications help the immune system recover and fight infections and prevent cancers from occurring. Eventually, the virus may become resistant to the available drugs, and the manifestations of AIDS may develop.

Drugs used to treat HIV and AIDS do not eliminate the infection. It is important for the person to remember that he or she is still contagious even when receiving effective treatment.

Intensive research efforts are being focused on developing new and better treatments. Although currently there is no promising vaccine, work continues on this front.

Synonyms and Keywords

HIV/AIDS, human immunodeficiency virus, acquired immunodeficiency syndrome, sexually transmitted diseases, STDs, enzyme immunoassay, EIA, Western blot, AZT, zidovudine, ddC, zalcitabine, dideoxyinosine, d4T, stavudine, 3TC, lamivudine, highly active antiretroviral therapy, HAART, HIV symptoms, symptoms of HIV, AIDS symptoms, symptoms of AIDS