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Friday, September 05, 2008
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Other
Important STD's
As medical science has become more precise in
diagnosing infectious diseases, the list of known sexually transmitted
diseases (STDs) has grown. The National Institute of Allergy
and Infectious Diseases (NIAID) has published separate fact
sheets on some of the major STDs: chlamydial infection; gonorrhea;
pelvic inflammatory disease (PID); trichomoniasis and other
vaginal infections; syphilis; genital herpes; genital warts;
and AIDS. NIAID has prepared this fact sheet to provide information
on some of the other diseases that can be transmitted sexually:
Although some of these
diseases are less well-known in the United States than other STDs,
they are still important – some are especially significant for
pregnant women. Many of these infections are of serious concern
for people in other parts of the world, particularly in developing
countries.
Chancroid
Chancroid
("shan-kroid") is an important bacterial infection caused by
Haemophilus ducreyi, which is spread by sexual contact.
Periodic outbreaks of chancroid have occurred in the United
States, the last one being in the late 1980s. These outbreaks
are usually seen in minority populations in the inner cities,
especially in the southern and eastern portion of the country.
Globally, this disease is common in sub-Saharan Africa among
men who have frequent contact with prostitutes.
The infection begins with the appearance of painful open sores
on the genitals, sometimes accompanied by swollen, tender lymph
nodes in the groin. These symptoms occur within a week after
exposure. Symptoms in women are often less noticeable and may
be limited to painful urination or defecation, painful intercourse,
rectal bleeding, or vaginal discharge. Chancroid lesions may
be difficult to distinguish from ulcers caused by genital herpes
or syphilis. A physician must therefore diagnose the infection
by excluding other diseases with similar symptoms. People with
chancroid can be treated effectively with one of several antibiotics.
Chancroid is one of the genital ulcer diseases that may be associated
with an increased risk of transmission of the human immunodeficiency
virus (HIV), the cause of AIDS.
Cytomegalovirus Infections
Cytomegalovirus
(CMV) is a very common virus that infects approximately one-half
of all young adults in the United States. It rarely causes serious
consequences except in people with suppressed or impaired immune
systems or in infants, whose immune systems are still developing.
The virus, a member of the herpesvirus family, is found in saliva,
urine, and other bodily fluids. Because it is often found in
semen as well as in cervical secretions, the virus can be spread
by sexual contact; it also can be easily spread by other forms
of physical contact such as kissing. Day-care center staff for
children under the age of 3 are at increased risk of CMV infection
and should carefully wash their hands after changing diapers.
Like other herpesvirus infections, CMV is incurable; people
are infected with it for life. Although the virus usually remains
in an inactive state, it can reactivate from time to time.
Symptoms. In healthy
adults, CMV usually produces no symptoms of infection. Occasionally,
however, mild symptoms of swollen lymph glands, fever, and fatigue
may occur. These symptoms may be similar to those of infectious
mononucleosis.
Diagnosis. The ELISA
(enzyme-linked immunosorbent assay) test is commonly used to
detect levels of antibodies (disease-fighting proteins of the
immune system) in the blood. A number of other blood tests can
suggest a diagnosis of CMV infection, but no blood test can
reliably diagnose it. Although CMV can be isolated from urine
or other body fluids, it may be excreted months or years after
an infection; therefore, isolation of the virus from these fluids
is not a reliable method of diagnosing recent infection.
Complications. Babies
can be infected with CMV in the uterus if their mothers become
infected with the virus or develop a recurrence of a previous
infection during pregnancy. Although most babies infected with
CMV before birth do not develop any symptoms, CMV is the leading
cause of congenital infection in the United States. An estimated
6,000 babies each year develop life-threatening complications
of congenital CMV infection at birth or suffer serious consequences
later in life, including mental retardation, blindness, deafness,
or epilepsy. Investigators supported by NIAID are currently
studying how the virus interferes with normal fetal development
and at which stages the fetus is most susceptible to infection.
Congenital CMV is the most common cause of progressive deafness
in children.
When CMV is acquired after birth, or if it reactivates, it can
be life-threatening for persons with suppressed immune systems,
such as those receiving chemotherapy or persons who have received
immunosuppressant drugs for organ transplantation. Persons with
HIV infection or AIDS may develop severe CMV infections, including
CMV retinitis, an eye disease that can lead to blindness.
Treatment. NIAID
scientists are testing new antiviral drugs that might be effective
against CMV infections. The antiviral drugs foscarnet and ganciclovir
have been approved for treating people with AIDS-associated
CMV retinitis.
Prevention. There
is no intervention to prevent CMV. Use of the male condom may
reduce risk although virus in the saliva would be transmitted
by kissing or oral intercourse. Some experts believe that primary
or first-time exposure during pregnancy is a major cause of
CMV infection in newborns. Infants infected before or just after
birth are likely to be shedding CMV in saliva and urine, which
can infect others. Hand washing and proper handling of diapers
may reduce risk. Scientists are working to develop a vaccine
and other methods to provide immunity to CMV and offer protection
against severe disease.
Molluscum
Contagiosum
This common
viral infection most often affects young children, who pass
it to each other through saliva. In adults, however, the virus
is transmitted sexually, resulting in lesions on the genitals,
lower abdomen, buttocks, or inner thighs. Most people with the
infection do not have noticeable symptoms, although sometimes
the lesions, which are painless wart-like bumps, may itch or
become irritated. The lesions often heal without treatment,
although physicians may sometimes scrape them off or treat them
with chemical irritants.
Pubic Lice
Pubic lice
(pediculosis pubis or crab lice) are very tiny insects that
infest the pubic hair and survive by feeding on human blood.
These parasites are most often spread by sexual contact; in
a few cases, they may be picked up through contact with infested
bedding or clothing. An estimated 3 million people with new
cases of the infestation are treated each year in the United
States.>
Symptoms. The primary
symptom of infestation is itching in the pubic area. Scratching
may spread the lice to other parts of the body; thus, every
effort should be made to avoid touching the infected area, although
this may be difficult.
Diagnosis. Pubic
lice are diagnosed easily because they are visible to the naked
eye. They are pinhead size, oval in shape, and grayish, but
appear reddish-brown when full of blood from their host. Nits,
the tiny white eggs, also are visible and usually are observed
clinging to the base of pubic hair.
Treatment. Lotions
and shampoos that will kill pubic lice are available both over
the counter and by prescription. Creams or lotions containing
lindane, a powerful pesticide, are most frequently prescribed
for the treatment of pubic lice. Pregnant women may be advised
not to use this drug, and a physician's recommendations for
use in infants and small children should be followed carefully.
Itching may persist even after the lice have been eradicated.
This is because the skin has been irritated and requires time
to heal. A soothing lotion such as calamine may offer temporary
relief.
Prevention. All persons
with whom an infested individual has come into close contact,
including family and close friends as well as sex partners,
should be treated to ensure that the lice have been eliminated.
In addition, all clothing and bedding should be dry-cleaned
or washed in very hot water (125° F), dried at a high setting,
and ironed to rid them of any lice. Pubic lice die within 24
hours of being separated from the body. Because the eggs may
live up to six days, it is important to apply the treatment
for the full time recommended.
Scabies
Scabies
is a skin infestation with a tiny mite, Sarcoptes scabiei.
Scabies has become relatively common throughout the general
population. It is highly contagious and is spread primarily
through sexual contact, although it also is commonly transmitted
by contact with skin, infested sheets, towels, or even furniture.
Symptoms. Scabies
causes intense itching, which often becomes worse at night.
Small red bumps or lines appear on the body at sites where the
female scabies mite has burrowed into the skin to lay her eggs.
The areas most commonly affected include the hands (especially
between the fingers), wrists, elbows, lower abdomen, and genitals.
The skin reaction may not develop until a month or more after
infestation. During this time, a person may pass the disease
unknowingly to a sex partner or to another person with whom
he or she has close contact.
Diagnosis. Scabies
may be confused with other skin irritations such as poison ivy
or eczema. To make an accurate diagnosis, a doctor takes a scraping
of the irritated area and examines it under a microscope, to
reveal the presence of the mite.
Treatment. As with
pubic lice, lindane is an effective treatment for scabies. Pregnant
women should consult a doctor before using this product. Nonprescription
remedies such as sulfur ointment also are available. Sulfur
is fairly effective but may be objectionable because of its
odor and messiness. Itching can persist even after the infestation
has been eliminated because of lingering skin irritation. A
hydrocortisone cream or ointment or a soothing lotion may provide
relief from itching.
Prevention. Family
members and sex partners of a person with scabies are advised
to undergo treatment. Twenty-four hours after drug therapy,
a person with scabies infestation is no longer contagious to
others, even though the skin irritation may persist for some
time. As with pubic lice, special care must be taken to rid
clothing and bedding of any mites.
Human
T-Cell Lymphotropic Virus
The human
T-cell lymphotropic viruses (retroviruses), HTLV-I and HTLV-II,
are uncommon in the general U.S. population. They appear to
be most prevalent among IV drug users and persons who have multiple
sex partners, genital ulcers, or a history of syphilis. The
virus can be transmitted by blood or intimate sexual contact,
and can be passed from mother to child during pregnancy and
through breast milk.
Most infected persons remain healthy carriers of the virus.
In rare cases, however, HTLV-I can cause adult T-cell leukemia/lymphoma
(ATL), a rare and aggressive cancer of the blood. Infected persons
also may develop myelopathy, a neurologic disorder that affects
the muscles in the legs. In addition, researchers think that
HTLV-I plays a role in the development of B-cell chronic lymphocytic
leukemia. HTLV-II can cause another rare cancer called hairy-cell
leukemia. Because the chances of curing ATL rely on early detection,
scientists are studying protein in the blood of HTLV-I-infected
persons that may help predict who will develop the disease.
Blood donations are screened routinely for HTLV-I. Because lab
tests cannot easily distinguish between HTLV-I and HTLV-II,
experts believe many cases of HTLV-II are eliminated from the
blood supply as well.
Research
STD research
that is supported and conducted by NIAID will help in the search
for new ways to diagnose, treat, and prevent these infections.
This is important not only for the well-being of our adult population
but also for the health of future generations.
National Institutes
of Health
June 1998
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