Zika Update: A New Way to Test for This Infection

Blood sample positive with Zika virusThe CDC (Centers for Disease Control and Prevention) recently updated its guidelines concerning the testing of pregnant women who have a possible Zika virus infection or exposure.  It must always be noted that most people with the Zika virus infection are either asymptomatic or have mild clinical symptoms.  Mild clinical symptoms can be an acute onset of a fever, a rash, joint pain, and/or conjunctivitis.

There is new data suggesting that the virus can be detected in the blood and urine for 2 weeks after the infection begins.  This testing of the urine and blood for the virus should be performed for:

  • Symptomatic pregnant women in less than 2 weeks after the symptoms begin
  • Asymptomatic pregnant women in less than 2 weeks after a possible exposure

After this 2-week window, blood testing should begin for the Zika virus IgM antibody, which the body makes in response to a new Zika virus infection.  If this is found to be positive, there was definitely an infection and close fetal evaluation should begin.

As always, you should discuss the Zika virus problem with your health care provider so you can get the best possible care.

-Dr. P

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4 Quick Zika Virus Facts – Treatment, Testing, How It Spreads, and Prevention

Zika VirusLet’s look at some Zika virus facts:

1. Treatment

At the moment, there are no approved drugs or vaccines for the Zika infection, but scientists are working on a vaccine.  Since the infection itself seems to be mild and short-lived, fluids and Tylenol are mostly recommended.

2. Testing

Testing to determine if you have had the virus is mainly confined to pregnant women and symptomatic travelers who have visited the areas where the virus has spread.  At this time, testing is done at only a state or federal lab and getting results can take weeks.

3. How It Spreads

The Zika virus is spread by the Aedes aegypti mosquito and through sex with an infected partner.  It is important for pregnant women to know the travel history of their sexual partners.

4. Prevention

Preventing mosquito bites is the best way to protect yourself from this virus.  Use the time-tested methods of bug sprays and cover-ups, and eliminate any standing water where mosquitoes can lay eggs.  You should check your window screens and keep the air conditioners on if possible because mosquitoes hate the cold.

-Dr. P

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Is the Effect of Birth Control Decreased in Overweight Women?

Young woman looking at her contraceptive pillsJust yesterday one of my patients asked me about the effectiveness of the morning-after pill in a woman like herself, who was overweight.  I knew that obesity could be associated with a decrease in the effectiveness of the birth control pill and the morning-after pill, but I could not give her better information.

Recently, there were a few review articles showing that studies are limited.  Let me give you some questions to ask your health care provider about this situation, especially since about 25% of women in the childbearing age group are considered to be obese based on their BMI:

  • How effective is the birth control pill in overweight women?
  • Being overweight, is there a pill that could be more effective?
  • Could a vaginal ring or IUD be a better consideration?
  • Is the risk of blood clots increased with the pill?
  • Does bariatric surgery have any effects with the use of the pill?

I hope these questions will open the door for a good discussion so that the best medical treatment plan can be established.

-Dr. P

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What Factors Lead You to Vaginitis?

Vaginitis - Printed Diagnosis with Blurred Text. On Background of Medicaments Composition - Red Pills, Injections and Syringe.

Let us continue our update and review of vaginitis from my last post about this topic.

To better understand why vaginitis occurs, let us look at the vaginal environment.  The lining of the vagina is made of squamous epithelial cells.  These are flat and stratified, which means that there are multiple layers of these calls.  These cells are rich in glycogen – a storage form of glucose.  Remember, glucose is the most important simple sugar, and it is used as a source of energy for all human functions.

The squamous cells are continuously being shed from the lining and the glycogen in these becomes the energy for the lactobacilli that are naturally found in the vagina.  These bacteria convert the glucose into lactic acid, which keeps the vaginal environment in an acidic state, helping to maintain the normal vaginal bacterial flora plus preventing abnormal organisms from growing.

Microscopic view of Trichomonas vaginalis
Trichomonas vaginalis

If you disrupt the normal community of organisms, vaginitis can occur.  There are many factors that can affect this natural environment:

  • Pregnancy
  • Estrogen levels, for example, a menopausal state where estrogen levels are decreased
  • Different phases of the menstrual cycle
  • Sexual activity
  • Sexually transmitted diseases
  • Different medications such as oral contraceptives and antibiotics

-Dr. P

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Why Testing for Thrombophilia Before Using Birth Control Is Important

Raquel Goldstein, RPA-C, MS, is a physician assistant at Dr. Polcino’s office. Today she speaks about thrombophilia’s effect on a woman using birth control. Since about 10% of women will carry thrombophilia, it is important to be informed about this genetic trait and what is recommended if it is identified.

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Herpes Information Made Simple

…..A few times a week a new case of genital herpes presents to my office, and the patient always experiences great psychological and physical pain and stress.  The classic presentatioBeautiful Woman with Pencil and Folder Isolated on White.n of HSV (herpes simplex virus) is a painful group of vesicles and ulcers.

…..The infections are classified as primary, non-primary first episode, or recurrent.  The primary infection is the most painful and may be associated with tender lymph nodes as well as a fever and body aches.  If not treated, these primary lesions can last 2 to 6 weeks.  Recurrences vary in their frequency; however, 50% of patients will have one within 6 months.  These recurrences are generally milder with fewer lesions and a much shorter course.

Herpes, Type 1 and Type 2

…..HSV is a DNA virus classified into two subtypes, 1 and 2, based on various proteins making up the virus.  HSV-1 is primarily the cause of herpes of the mouth and in the past was said to be the cause of infections above the waist.  It can also be responsible for genital infections, and these infections are becoming more common, especially among young women.

…..HSV-2 is almost always a genital infection.  The virus is spread through direct contact with mucosa (moist tissue like the vagina and lips/mouth) or damaged, irritated skin.  Incubation of the virus lasts for about a week, and the virus then reproduces in the superficial layers of the skin, causing inflammation and damage.  During the first infection, the virus enters the nerve cells and becomes dormant.  The virus can reactivate and cause ulcerative disease or shed without any symptoms.

…..Let me leave you with a few facts:

  • In the US, 20% of women have had an HSV-2 infection
  • Most infections are spread by those who are unaware of having HSV
  • Recurrent disease is more common in those with type 2, compared to those with type 1

Methods of Herpes Treatment

 …..For now we will finish our discussion of herpes.

…..During a symptomatic outbreak, the treatment consists of supportive measures such as oral and topical pain medications and special genital hygiene.  An antiviral medication can be added to decrease the viral shedding and the duration of the painful ulcers.  These medications should be started at the onset of the symptoms.

…..Acyclovir and valacyclovir are the two most common antivirals used and have a long history of safety in pregnancy.  There are some patients who experience frequent attacks, and a daily treatment of these medications can greatly suppress the episodes and therefore decrease the chance of spreading to a sexual partner.

…..In the future we will have a discussion of herpes and pregnancy, but for now I am going to get a donut.

-Dr. P

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A New Birth Control Option That May Suit You

Smiling Woman…..Earlier this year, the FDA approved a new IUD (intrauterine device) for the first time in over 10 years.  It is marketed under the name Skyla, and it is a hormone-releasing system similar to another FDA approved IUD.  However, it uses a lower amount of hormone called levonorgestrel, which is a synthetic progesterone, and it is constructed with a smaller frame and inserter.  Here is some more information:

  • This new IUD is used as a contraceptive and can help control heavy menstrual bleeding.
  • Because of its smaller size, it may enable an IUD to be available to women who would normally have difficulty with the placement of an apparatus like this, for instance, someone who has not had children or women who have had Caesarian births.
  • The hormone system produces a local affect inside the uterus, which usually decreases the menstrual bleeding.  Because of the lower dose of hormones used as compared to another similar IUD, this  one provides continuous pregnancy protection for 3 years as compared to 5 with the higher amount of hormones.  In addition, the lower hormone level may be associated with a slightly greater bleeding pattern.
  • It is a latex-free product.

…..It is good to have a new option for women seeking a continuous birth control method.  Please speak to your health care professional, because with its smaller size and lower hormone level, this may right for you.

-Dr. P

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A New Medication to Help a Painful Menopausal Symptom

.
MH900370730In February 2013, the FDA (Food and Drug Administration) of the US approved a new drug for the treatment of dyspareunia (painful sexual relations), caused by the thinning of the vulva and vaginal tissues in the menopausal time of life.

The drug is called Osphena (ospemifene), and it acts as a tissue selective estrogen protagonist and antagonist.  This means that in some tissues, like the uterine lining and the vulva/vagina tissues, the ospemifene stimulates the tissue like estrogen, and in other tissues it acts like an anti-estrogen.

  • This is a medication in the same family as tamoxifen, which is used in breast cancer treatment and prevention protocols.
  • Dyspareunia is decreased because ospemifene has been shown to stimulate the vaginal mucosal tissue.
  • Osphena is an oral tablet which is taken daily.
  • It is contraindicated in patients with estrogen dependent cancers, a history of stroke or blood clots, or a cardiac history.
  • With this medication, there has been a reported increase in hot flushes.
  • This new medication may appeal to women who are not interested in using estrogen vaginal treatments or systemic hormone replacement therapy.

If you are suffering with this menopausal problem, speak to your health care professional because help is available, and this new medication may be an answer for you.

-Dr. P

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What Factors Place Adolescents at an Increased Risk of Developing STIs?

Young women are at a high risk of acquiring STIs (sexually transmitted infections) and of developing the serious complications of untreated chlamydial and gonococcal infections.  Almost half of all STIs occur in teenagers and young adults between the ages of 15 and 25.  Physical and behavioral factors place the sexually active teenager at an increased risk to develop these infections.

Physically, the cervix is more vulnerable to these infections because it has not fully developed, exposing more susceptible cells to the infections.  Since the young woman may be coming into contact with these infectious agents for the first time, her immune defenses are not strong.

Behavioral risk factors include having multiple new sexual partners and not using condoms or not using condoms properly.  The U.S. Department of Health and Human Services has a goal to increase the simultaneous use of both condoms and hormonal contraception (birth control pills).  This combination of methods is highly effective in preventing a pregnancy and preventing the acquisition of STIs.  Yet currently, some studies reveal that only about 5% of adolescent females are using this practice.

-Dr. P

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Emergency Contraception – Continuing the Conversation

The side effects of these treatments include nausea and vomiting along with irregular vaginal bleeding.  Some patients will complain of breast tenderness, abdominal pain, dizziness, and headaches.

These types of emergency contraception have been used woman-509973_640successfully when initiated up to 72 hours after intercourse.  This was the findings with the initial studies.  However, more recent findings indicate that they are still moderately effective when used up to 5 days after intercourse.

Lastly, we should mention the use of the copper IUD for emergency contraception.  This has been used since 1976 (when inserted within 5 days after unprotected intercourse).  One advantage of this treatment is that the IUD can be left in and serve as a long-term treatment for contraception.  Sometimes this treatment may not be as easily available to the patient, and the placement of the IUD may not be easily accomplished in a patient who is young and has not had a baby before.

-Dr. P

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What’s Emergency Contraception All About?

…..Lbeautiful-15767_640et us get back to our discussion of emergency contraception.  The research on emergency contraception began in the 1960s, and the first treatment protocols arrived in 1974.

…..The two most common protocols are the progesterone only pill (Plan B) and the estrogen and progesterone pills.  Plan B consists of only one pill, and the second regime of estrogen and progesterone is a two-dose treatment 12 hours apart.  Both of these treatments are available over-the-counter for women 17 or older.  For women under 17, a prescription is necessary.

…..There is no clear reason for how the emergency contraception works.  A few explanations have been promulgated:

  • Inhibition or delay of ovulation
  • Interference with sperm transport or penetration of the egg
  • Thickening of cervical mucous
  • Impairment of ovarian hormone production

…..Remember that emergency contraception is effective only before a pregnancy has occurred.  If a pregnancy has already been established, studies have shown that the emergency contraception does not harm the developing fetus nor increase risks to the ongoing pregnancy.

…..To be continued!!!!!!

-Dr. P

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The Availability of Emergency Contraception

With the mornings crisp and clear, it is certain that fall is in full swing.  As I have mentioned before, since my life has always revolved around the school year, this is my time for new projects.  Our anti-aging/bio-identical hormone program is being updated, and the new treatment options are becoming available for our practice family.  I promise to keep you informed.

Today I want to begin to update you on emergency contraception.  This is a therapy to prevent pregnancy after unprotected or not totally protected intercourse.  It is not an abortion, and it does not cause an woman-593141_640abortion if you are already pregnant.  Most people call this treatment the Morning After Pill or Plan B, but regrettably, these phrases are not known or used as much as they should be.

With half of all pregnancies unintended and 40% of these pregnancies ending in abortion, it is imperative that this treatment is more known.  Women seeking this treatment are typically under 25, and the common indication is a broken condom, missed oral contraceptive pills, or a failure to use any birth control at all.  It should not replace our normal contraceptive methods, but should be available and used when necessary to prevent an unintended pregnancy.

-Dr. P

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