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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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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When Should Young Women Start Getting Pap Smears?

5461276006_df3a5a44b8_zCervical cancer was once the number one cancer killer, but with the introduction of the Pap smear almost 60 years ago, this cancer has become increasingly rare.  The guidelines for cervical cancer screening are always evolving, and the American Society for Colposcopy and Cervical Pathology (ASCCP) has been at the forefront of these changes.

The relationship between high-risk HPV (human papillomavirus) and the development of pre-cervical and cervical cancer has been well established.  Thankfully, most HPV infections are short-lived and not detected within 1-2 years.  Only a small percentage of infected women will go on to develop a high-grade cervical abnormality or cervical cancer.

More than 80% of all women will develop a genital HPV infection by the time they reach the age of 50.  HPV infections are the most common in young women, and again, these infections are cleared by most young women in less than two years.

We now have a good understanding of the natural history of HPV infections and the development of cervical cancer and the pre-cancers.  ASCCP’s guidelines advise that cervical cancer screening should begin at age 21 regardless of the age of sexual initiation.  Since most of the infections in the young will regress, starting a screening program at an earlier age may result in many unnecessary treatment interventions.

Remember to always discuss your particular concerns and develop your individual screening program with your healthcare professional.

-Dr. P

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What Makes You at Risk for Hepatitis C?

…..Recently, the newspapers have been full of articles concerning the hepatitis C virus (HCV) and a new medication that reportedly cures people with the chronic type of the disease.  It is a very expensive drug, but the results have been wonderful; so I think it is time to give a little review of this disease.Hepatitis C Risk Factors 2

…..Hepatitis C is a contagious disease that is usually transmitted through blood contact with an infected person.  When first getting the disease (acute HCV), there may be no symptoms or only mild flu-like symptoms.  Most people do not even know that they have the disease, and most will go on to develop the chronic HCV, which is a long-term illness.

…..Of those with the chronic illness, about 25% will develop a severe liver disease such as cirrhosis or cancer.  At this time, baby boomers seem to be at the highest risk for the chronic version of this disease.  This will include the population born between 1945 and 1965.

…..The risk factors include:

  • Having a blood transfusion before 1992
  • Being on kidney dialysis
  • Sexual contact with an infected partner
  • Obtaining a tattoo or body piercing with an unclean instrument
  • Being exposed as a health care worker
  • Injecting drugs

…..Since baby boomers are many times more likely to have chronic HCV than other age populations, a screening blood test should be considered for this age group.  Feeling tired seems to be the most common symptom of the disease, so talk to your health care professional to see if a test should be considered for you!

-Dr. P

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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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Some Points You May Not Know About HPV

Let us continue our HPV informational journey with a few essential points:

  • HPV infections are almost exclusively acquired from sexual exposure.Some Points You May Not Know About HPV
  • The virus has been detected in multiple sites on both the male and female genital areas.
  • The cervix is the most common site for the infection.
  • Transmission between the mother and infant has been documented, with exposure during the delivery being suggested as the most common cause of the fetal infection.  This is considered a vertical form of transmission.  Some studies suggest a vertical transmission rate of about 25% with almost all neonatal infections cleared by the first year of life.

-Dr. P

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What Other Issues Can HPV Cause?

It was not until the early 1980s that the association HPV Researchbetween the human papillomavirus (HPV) and genital tract infections became apparent.  A German research physician had isolated the HPV 16 and implicated its role in the development of cervical cancer, so a new scientific journey had begun.

We now know that the persistence of an HPV infection is necessary for the development of cervical cancers, and it is implicated in the majority of other genital tract infections in both men and women.  It is time to start our journey to a better understanding of a virus that affects so many of us!

Click here to continue to: Some Points You May Not Know About HPV

-Dr. P

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Gonorrhea – A Condition Which Often Lacks Symptoms

…..teenage depression - teen woman sitting thinkingNext in my series about sexually transmitted infections in adolescents, we will be discussing gonorrhea.

…..Gonorrhea is a common STI in the adolescent and young adult population (15 to 25).  There are about 750,000 cases each year, with women having a slightly higher rate than men.  We should use the same targeted screening that is used for chlamydial infections (with all women under 25 being tested).  The same risk factors are associated with gonorrhea and chlamydia, and with both, more than 50% of women are asymptotic.

…..When there are symptoms, they may include vaginal discharge, pelvic pain, or pain with urination.  Again, if there is a delay in diagnosing and implementing the treatment of an infection, severe pelvic problems can develop.

…..There are specific antibiotic protocols for treatment that are available.  These days, consideration must be made for antibiotic resistance, which has been developing.  Lastly, with all persons found to have gonorrhea, there should be testing for HIV, syphilis, and chlamydia.

-Dr. P

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Urgent Facts About Chlamydia, a Common STI

…..Sexually transmitted infections in adolescents continued…

…..CChlamydia Infohlamydia is one of the most common infectious diseases in the United States, with somewhere between 1 to 3 million cases each year among women ages 15 to 45. The most affected group is between ages 15 and 19, followed by 20 to 25 as the second most affected group.

…..One problem in finding this infection is that less than half of the most affected women are screened for Chlamydia trachomatis. The Center for Disease Control (CDC) guidelines suggest a yearly screening for chlamydia on all sexually active women who are 25 and younger, and testing should be performed for women over 25 if they have a new sexual partner or multiple partners. Women should also seek testing if they experience abdominal or pelvic pain, vaginal discharge, painful intercourse, pain with urination, or irregular bleeding.

…..Testing usually entails a speculum exam with a Q-tip swab of the cervix. If the speculum exam is a problem for the adolescent, then a vaginal swab can be performed. The patient can even collect a vaginal swab test privately if necessary.

…..After a woman is treated, reinfection is common, and having a treated infection does not provide immune protection against future infections. It is therefore advised that a repeat test be performed a few months after a treated infection.

…..If there is a delay in treatment of this infection, then there is an increased chance of developing an infection of the pelvis, called pelvic inflammatory disease (PID), which can lead to infertility. Some studies suggest that PID can develop in up to 30% of women with their first chlamydial infection.

…..There are many antibiotic treatment plans suggested by the CDC, and they all are very successful. The adolescent and her partner should avoid intercourse for 7 days after both partners have been treated.  Ideally, the patient should refer for testing any sexual partner that she encountered within the last 1-2 months.

-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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Methods of Herpes Treatment

…..I hope this finds all of my friends doing well.  For now we will finish our discussion of herpes.

…..DuSciencering 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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Herpes, Type 1 and Type 2

…..The weather on Long Island continues to be perfect beach weather; I hope everyone is taking the time to enjoy the outdoors, spending wonderful times with family and friends.

…..Let’s get back to our review of the herpes simplex virus (HSV).  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 interesting factsH2:

  • 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

-Dr. P

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Herpes Information Simplified

…..Welcome to my new blog!  I will try to bring you women’s health news in clear, straightforward language that hopefully will make you better informed.

…..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 presentation 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.

…..At our next visit, we will review the different subtypes of HSV and the current treatments.  Until then, remember to wear sunblock daily to protect yourself from the damaging sun.

-Dr. P

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