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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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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Are You Prepared for This Summer’s Tiniest Villains?

I was working in my garden, and guess what I discovered yesterday, once again?  I spotted another tick on myself!  Because of this, I thought it would be a great time to discuss ticks all over again – what they do, what you should do if you find one on yourself, and all about Lyme disease.

Are You Prepared for This Summer’s Tiniest Villains-742474_1280Over 30,000 new cases of Lyme disease are diagnosed each summer, and 90% occur in 10 states.  New York is one of those states.  This disease is an infection caused by the bacteria called Borrelia burgdorferi, which enters the body from an infected deer tick’s bite.

While the tick is attached, it begins to suck blood from the victim, and at this time, it regurgitates the bacteria back into the person’s system.  Most of the infections in humans are caused from the bites of immature ticks called nymphs, which are the size of poppy seeds.  The disease can also be transmitted from the bite of an adult deer tick, but because they are larger, they are more likely to be discovered before having time to transmit the disease.

The Infectious Disease Society of America does not recommend antibiotics for everyone who has been bitten by a tick.  If the rash of Lyme disease develops, then antibiotics are advised.

The rash is the easily noticed circular “bull’s eye” target-like rash.  This rash can begin anywhere from 1 to 4 weeks after the bite.  It starts out being the size of a quarter and can widen to 6 to 9 inches as the bacteria spread out.  If your anxiety of developing the disease is great, many doctors will treat you with doxycycline if you do not have an allergy to the medication.

You Found a Tick on Yourself – What Are the Next Steps?

Once you have discovered that a tick is on your body, you remove it with tweezers.  Try to detach it at the base of the tick’s attachment.  If it is removed within 24 to 48 hours, it is unlikely that it has infected you withTick Removal Display Image Lyme disease.  Also, it is important to remember that only 1 in 20 people bitten with an infected tick will develop the disease.  Not every deer tick carries the Borrelia burgdorferi bacteria, with usually 1 in 5 being carriers in high risk areas.

An Alternate Way to Remove Those Ticks!

I recently learned about a different way to help remove a tick.  Take a cotton ball and put liquid soap on it.  Cover the discovered tick with the cotton ball and rub the soap on the tick for a few seconds.  Usually the tick will dislodge on its own and be stuck to the cotton ball as you take it away.  Hopefully you will not need to try this method but keep it in the back of your mind.

What Is Most Likely to Happen if You Are Diagnosed with Lyme Disease?

When Lyme disease has been diagnosed because you have the “bull’s eye” rash from a tick bite or a positive blood test, your medical team will usually prescribe an antibiotic regimen.  Depending upon your history of allergies, two of the most common treatments are amoxicillin (500 mg three times a day for 14 to 21 days) or doxycycline (100 mg twice a day for 14 to 21 days).

Bull's Eye Rash (Tick)

Intravenous antibiotic treatments are not often needed, but they are needed when the Lyme infections are more serious.  These would include infections around the brain and spinal cord (meningitis) or heart (carditis).

I would like to leave you with two interesting facts about Lyme disease.  If for some reason you get the infection and do not obtain treatment with an antibiotic, you have about a 10-15% risk of developing Lyme arthritis, and this needs to be treated with a different antibiotic plan.

Even after treating Lyme disease and having no blood tests pointing to an active disease, about 10-20% of people will not feel well for months, having complaints of being exhausted and joint pain.  Antibiotics do not seem to be the answer for this frustrating condition.  The passage of time is the ultimate treatment.

Enjoy your summer and always check your clothes and body for ticks after working or playing outdoors in a grassy area.  Then take a shower, which removes the ticks off your body and prevents those troublesome bites!

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-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 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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You Found a Tick on Yourself – What Are the Next Steps?

Once you have discovered that a tick is on your body, you remove it with a tweezers.  Try to detach it at the base of the tick’s attachment.  If it is removed within 24 to 48 hours, it is unlikely that it has infected you with Lyme disease. Also, it is important to remember that only 1 in 20 people bitten with an infected tick will develop the disease.  Not every deer tick carries the Borrelia burgdorferi bacteria, with usually 1 in 5 being carriers in high risk areas.Tick Removal Display Image

The Infectious Disease Society of America does not recommend antibiotics for everyone who has been bitten by a tick. If the rash of Lyme disease develops, then antibiotics are advised.

The rash is the easily noticed circular “bull’s eye” target-like rash. This rash can begin anywhere from 1 to 4 weeks after the bite. It starts out being the size of a quarter and can widen to 6 to 9 inches as the bacteria spread out. If your anxiety of developing the disease is great, many doctors will treat you with doxycycline if you do not have an allergy to the medication.

Find out more in: What is Most Likely to Happen if You Are Diagnosed with Lyme Disease?

The blog post preceding this one: This Little Surprise in Your Garden Can Cause a Big Problem

-Dr. P

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This Little Surprise in Your Garden Can Cause a Big Problem

Two days after working in the garden, I was taking a shower, and on my shoulder I found a dark raised lump that looked like an apple seed. Of course I panicked, took a nail clipper, grasped the bottom of the “seed,” and then pulled it off. It was a tick! I put it down next to the sink and it started to walk. Again I panicked, crushed it, and flushed it down the toilet.Garden M.O. USENext, the ever-calm OB/GYN doctor quietly called his wife to let her know what happened and to check the rest of my body for ticks. Surely you know that is not the manner in which I spoke. Thank God I was smart enough many years ago to have found a calm and cool wife who then helped me check for any other ticks, and none were found.

The next morning, again while taking a shower, on my abdomen I found another dark spot. This time it was much smaller, black, and I did not notice it the morning before. It was another tick.

Later that day, I went to see my personal physician, who happens to be one of my dearest friends. He is an expert on Lyme disease and took care of me. This story has prompted me to write about this problem and get some basic information to my friends.

Over 30,000 new cases of Lyme disease are diagnosed each summer, and 90% occur in 10 states.  New York is one of those states. This disease is an infection caused by the bacteria called Borrelia burgdorferi, which enters the body from an infected deer tick’s bite.

While the tick is attached to us, it begins to suck blood from the victim, and at this time, it regurgitates the bacteria into the person’s system. Most of the infections in humans are caused from the bites of immature ticks called nymphs, which are the size of poppy seeds. The disease can also be transmitted from the bite of an adult deer tick, but because they are larger, they are more likely to be discovered before having time to transmit the disease.

Continue to: You Found a Tick on Yourself – What Are the Next Steps?

-Dr. P

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