Health Issues

What is Sexually Transmitted Disease?
Sexually transmitted diseases (STDs) are among the most common infectious diseases today. More than 20 different STDs have been identified, and 13 million men and women are infected each year in the United States only. In India it also is spreading day by day. Depending on the disease, the infection can be spread through any type of sexual activity involving the sex organs or the mouth; the infection can also be spread through contact with blood during sexual activity.
STDs affect men and women of all ages and backgrounds.
STDs have become more common, partly because young people are becoming sexually active at a younger age and are having multiple partners.
People can pass STDs to sexual partners even if they themselves do not have any symptoms.
Frequently, STDs cause no symptoms, especially in women.
Health problems from STDs tend to be more severe for women than for men. Some STDs can cause pelvic infections that may lead to scarring of the reproductive organs, which can result in and ectopic pregnancy (a pregnancy outside the uterus) and infertility for women.
STDs in women may be related to cancer of the cervix
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 can easily pick up more than one infection at a time.
Experts believe that having an STD that is not AIDS increases one's risk for becoming infected with AIDS.

Sexually Transmitted Diseases Causes
Depending on the disease, STDs can be spread with any type of sexual activity. STDs are most often caused by viruses and bacteria.

Sexually Transmitted Diseases Symptoms

Common STDs have a variety of symptoms (if symptoms develop at all) and many different complications, including death.
Chlamydia
Most common of all STDs caused by bacteria
No symptoms in 80% of women and 50% of men
Discharge from the vagina or the penis, burning or pain during urination
Transmitted through vaginal, oral, or anal sexual contact
Ectopic pregnancy and infertility for women most serious complications
Treatable with antibiotics
More serious complications associated with later stages of disease if undetected and untreated
Cancroids
Causes painful ulcers on the genitals
Can be confused with syphilis or herpes
Treatable with antibiotics
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
Fatigue, night sweats, chills or fever lasting several weeks, headaches, cough
No current cure and generally fatal, with death usually occurring after 2-3 years; medication available to slow disease progression

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
If a fever develops with other symptoms
If it will be a couple of days before an appointment with a doctor

Exams and Tests
Some STDs can be diagnosed without any tests at all. Other STDs require a blood test or a sample of any unusual fluid (such as an abnormal discharge from the vagina or the penis) 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.

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 herpes and HIV (which leads to AIDS), cannot be cured, only controlled.

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.
Sometimes, follow-up tests are important.
Consult a doctor with specific needs and questions.
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:
Be abstinent (refrain from sex entirely) or be in a monogamous relationship (both sexual partners are each others' 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 spermicidal 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.
Have regular checkups.
Learn the symptoms of STDs.
Avoid having sex during menstruation (HIV is passed more easily at this time.)
Avoid anal intercourse or use a condom.
Avoid douching because it removes some of the natural protection in the vagina.

Tuberculosis Overview
Tuberculosis (TB) describes an infectious disease that has plagued humans since the Neolithic times. Two organisms cause tuberculosis – Mycobacterium Tuberculosis and Mycobacterium bovis.

Tuberculosis Causes
All cases of TB are passed from person to person via droplets. When someone with TB infection coughs, sneezes, or talks, tiny droplets of saliva or mucus are expelled into the air, which can be inhaled by another person.
Once infectious particles reach the alveoli (small saclike structures in the air spaces in the lungs), another cell, called the macrophage, engulfs the TB bacteria.
Then the bacteria are transmitted to the lymphatic system and bloodstream and spread to other organs occurs.
The bacteria further multiply in organs that have high oxygen pressures, such as the upper lobes of the lungs, the kidneys, bone marrow, and meninges -- the membrane-like coverings of the brain and spinal cord.
When the bacteria cause clinically detectable disease, you have TB.
People who have inhaled the TB bacteria, but in whom the disease is controlled, are referred to as infected. Their immune system has walled off the organism in an inflammatory focus known as a granuloma. They have no symptoms, frequently have a positive skin test for TB, yet cannot transmit the disease to others. This is referred to as latent tuberculosis infection or LTBI.
Risk factors for TB include the following:
HIV infection
low socioeconomic status
alcoholism
homelessness
crowded living conditions
diseases that weaken the immune system
migration from a country with a high number of cases
health-care workers

Tuberculosis Symptoms
You may not notice any symptoms of illness until the disease is quite advanced. Even then the symptoms -- loss of weight, loss of energy, poor appetite,fever , a productive cough, and night sweats -- might easily be blamed on another disease.
Only about 10% of people infected with M. tuberculosis ever develop tuberculosis disease. Many of those who suffer TB do so in the first few years following infection, but the bacillus may lie dormant in the body for decades.
Although most initial infections have no symptoms and people overcome them, they may develop fever, dry cough, and abnormalities that may be seen on a chest X-ray
This is called primary pulmonary Tuberculosis
Pulmonary tuberculosis frequently goes away by itself, but in 50%-60% of cases, the disease can return.

Tuberculosis pleuritis may occur in 10% of people who have the lung disease from tuberculosis.
The pleural disease occurs from the rupture of a diseased area into the pleural space, the space between the lung and the lining of the abdominal cavity.
These people have a nonproductive cough, chest pain and fever. The disease may go away and then come back at a later date.

In a minority of people with weakened immune systems, TB bacteria may spread through their blood to various parts of the body.
This is called military Tuberculosis and produces fever, weakness, loss of appetite, and weight loss.
Cough and difficulty breathing are less common.

Generally, return of dormant Tuberculosis infection occurs in the upper lungs. Symptoms include
common cough with a progressive increase in production of mucus and
Coughing up blood.
Other symptoms include the following:
fever,
loss of appetite,
weight loss, and
night sweats.
the lining covering the outside of the gastrointestinal tract.

When to Seek Medical Care
If someone among your family or close associates is found to be sick with active TB, you should see your doctor and be tested for tuberculosis.
The dangerous contact time is before treatment. However, once treatment with drugs starts, the sick person is noncontagious within a few weeks.
If you develop any side effects from medications prescribed to treat tuberculosis -- such as itching change in color of skin, tiredness, or excessive fatigue -- call your doctor immediately.

Exams and Tests
The doctor will complete the following tests to diagnose tuberculosis. You may not be hospitalized for either the initial tests or the beginning of treatment.
Chest X-Ray: The most common diagnostic test that leads to the suspicion of infection is a chest X-ray.
In primary TB, an X-ray will show an abnormality in the mid and lower lung fields, and lymph nodes may be enlarged.
Reactivated TB bacteria usually infiltrate the upper lobes of the lungs.
Miliary tuberculosis exhibits diffuse nodules.

Mantoux skin test also known as a tuberculin skin test (TST): This test helps identify people infected with M. tuberculosis but who have no symptoms. A doctor must read the test.
The doctor will inject 5 units of purified protein derivative (PPD) into your skin. If a raised bump of more than 5 mm (0.2 in) appears at the site 48 hours later, the test may be positive.
This test can often indicate disease when there is none (false positive). Also, it can show no disease when you may in fact have TB (false negative).

QuantiFERON-TB Gold test: This is a blood test that is an aid in the diagnosis of TB. This test can help detect active and latent tuberculosis. The body responds to the presence of the tuberculosis bacteria. By special techniques, the patient's blood is incubated with proteins from TB bacteria. If the bacteria are in the patient, the immune cells in the blood sample respond to these proteins with the production of a substance called interferon-gamma (IFN-gamma). This substance is detected by the test. If someone had a prior BCG vaccination (a vaccine against TB given in some countries but not the U.S.) and a positive skin test due to this, the QuantiFERON-TB Gold test will not detect any IFN-gamma.
Sputum testing: Sputum testing for acid-fast bacilli is the only test that confirms a TB diagnosis. If sputum (the mucus you cough up) is available, or can be induced, a lab test may give a positive result in up to 30% of people with active disease.
Sputum or other bodily secretions such as from your stomach or lung fluid can be cultured for growth of Mycobacterium to confirm the diagnosis.
It may take one to three weeks to detect growth in a culture, but eight to 12 weeks to be certain of the diagnosis.

Tuberculosis Treatment
Medical Treatment

Today, doctors treat most people with TB outside the hospital. Gone are the days of going to the mountains for long periods of bed rest. Doctors seldom use surgery.
Doctors will prescribe several special medications that you must take for six to nine months.
Standard therapy for active TB consists of a six-month regimen:
two months with Rifater (isoniazid, rifampin, andpyrazinamide)
four months ofisoniazid and rifampin(Rifamate,Rimactane)
ethambutol(Myambutol) or streptomycin added until your drug sensitivity is known (from the results of bacterial cultures)
Treatment takes that long because the disease organisms grow very slowly and, unfortunately, also die very slowly.
Doctors use multiple drugs to reduce the likelihood of resistant organisms emerging.
Often the drugs will be changed or chosen based on the laboratory results.
If doctors doubt that you are taking your medicine, they may have you come to the office for doses. Prescribing doses twice a week helps assure compliance.
The most common cause of treatment failure is people's failure to comply with the medical regimen. This may lead to the emergence of drug-resistant organisms. You must take your medications as directed, even if you are feeling better.
Another important aspect of tuberculosis treatment is public health.
Doctors likely will contact or trace your relatives and friends.
Your relatives and friends may need to undergo appropriate skin tests and chest X-Rays.

Prevention
Treatment to prevent TB in a single person aims to kill walled-up germs that are doing no damage right now but could break out years from now and become active.
If you should be treated to prevent sickness, your doctor usually prescribes a daily dose of isoniazid (also called INH), an inexpensive TB medicine.
You will take INH for up to a year, with periodic checkups to make sure you are taking it as prescribed and that it is not causing undesirable side effects.

Treatment also can stop the spread of TB in large populations.
The tuberculosis vaccine, known as bacilli Calmette-Guérin (BCG) may prevent the spread of tuberculosis and tuberculosis meningitis in children, but the vaccine does not necessarily protect against pulmonary tuberculosis. It can, however, result in a false-positive tuberculin skin test that in many cases can be differentiated by the use of the QuantiFERON-TB Gold test mentioned above.
Health officials generally recommend the vaccine in countries or communities where the rate of new infection is greater than 1% per year. BCG is not generally recommended for use in the United States because there is a very low risk of tuberculosis infection. It may be considered for very select patients at high risk for tuberculosis and who meet special criteria.
Media file 1: Tuberculous cavities in the right upper lobe are shown here.

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Media file 2: Tubercle bacilli in the lung tissue

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Media file 3: Kinyoun stain shows presence of mycobacteria in sputum sample.

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Media file 4: A 48-year-old foreign-born woman developed cough, sputum production, and blood-tinged sputum. Sputum staining showed tubercle bacilli. Her chest X-ray showed a cavity-like lesion in right upper lobe of her lung.

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Media file 5: Doctors treated the same woman with three medications for TB. One month later, she showed significant improvement, as seen by this repeat chest X-ray.

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Media file 6: Mantoux test is done to identify patients who are infected with the tuberculosis infection; they may or may not have the disease. This test is also used as a public-health measure to detect infection in patient's family and friends.

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Media file 7: Erythema nodosum skin condition sometimes seen in tuberculosis when there are spots on the shins, which are painful and red and disappear within a few weeks.

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Media file 8: Prior to the 1950s, medications were not available for treating tuberculosis. One of the treatments was placing paraffin wax sheets in the chest cavity to stop the infection. This patient had this treatment performed on her. This is of pure historical interest because this treatment is no longer performed.

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