Health News. Lots of resources and information

All persons diagnosed with HIV infection should have a skin test and chest X-ray to check for tuberculosis. Those determined to be positive must have treatment to prevent a reactivation of the disease, to which they will be more susceptible once infected with a virus that suppresses the immune system. A test for syphilis (the Venereal Disease Research Laboratory [VDRL] test or rapid plasma reagin [RPR] test) must also be done for the same reason.

Testing for toxoplasmosis should also be carried out after the initial diagnosis. As will be discussed later, people who have toxoplasma antibody have a history of infection, even though they may not remember being infected, since infection is frequently symptom free. This puts them at risk for reactivation of the infection as their medical condition worsens. Immunization against pneumococcal pneumonia, influenza (yearly, in the fall), and hepatitis B for sexually active persons is also recommended.

The health care provider of an infected person will use the CD4 or T-helper-cell count and monitor the person’s physical condition to decide on the best time to start the various medications available to treat HIV infection. Then again, a person may decide that he or she does not ever want to start these medications.

There can be significant variation in an individual’s CD4 count, even on a daily basis. A “normal” CD4 count is greater than 500; however, if a person without HIV infection experiences a serious illness or stress, this number can temporarily drop below 500. Similarly, most HIV-infected people will have CD4 counts greater than 500 during the early part of their infection. This daily variation can sometimes be up to 150 points in HIV-positive individuals, and even more in those who are HIV negative. A CD4 count that is significantly different from the previous count should be rechecked, ideally at the same time of day that the first count was obtained, to determine if the variation is real. This is a situation in which the newer viral load test can be useful.

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Sexual Contact. Hepatitis B can be passed through anal, vaginal, and oral sex, and possibly even through kissing. The risk of infection with hepatitis B increases with the number of sexual partners a person has. The fastest-growing group of infected people is heterosexuals. In one study, 21 percent of heterosexuals with more than five sexual partners in the past four months had hepatitis B, whereas those with fewer than five partners had a lifetime risk of infection of 6 percent. Sexual partners of people who are infected have a high risk of becoming infected themselves. People who know their partners are infected should be immunized. In fact, it could be argued that any sexually active adult should be immunized.

Mother-to-Child Transmission. If a woman is infected during her pregnancy, particularly during the last trimester of pregnancy, or if she is a carrier for hepatitis B infection, she has a high risk of infecting her child. Infection can occur while the child is in the womb, but it most often occurs during delivery, possibly from mixing of maternal and fetal blood. Children who are infected at birth more often than not become carriers themselves. A baby born to a mother who is infected with hepatitis B may show some evidence of infection in the blood at birth, but the baby may not be truly infected, because it may be the mother’s antibody that is being seen in the blood. However, a baby who persists in showing evidence of infection in the blood about four months after delivery can be assumed to be truly infected. Immunizing at-risk babies at delivery offers a good possibility of preventing these babies from becoming infected.

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incidence: very rare

cause: bacteria (Hemophilus ducreyi)

symptoms: genital ulcers, lymph node swelling

treatment: antibiotics

WHAT IS IT?

Chancroid is a sexually transmitted infection of the genital area caused by the bacteria Hemophilus ducreyi. The primary symptom of chancroid is painful genital ulcers. Having any sexually transmitted disease that causes genital ulcers makes a person more susceptible to acquiring human immunodeficiency virus (HIV) infection, because breaks in the skin make it easier for HIV to be transmitted.

HOW IS CHANCROID TRANSMITTED? Chancroid is transmitted through genital, oral, or anal sexual contact with an infected person. Chancroid is usually transmitted by a person who has a sore or sores, but the disease can be transmitted by someone who has no sores.

Condom use decreases the risk of transmission but may not eliminate it if a person has sores outside the area that a condom protects.

There is no evidence that the disease can be transmitted from one person to another by nonsexual contact, but an infected person can rarely spread the infection to other areas of his or her body by touching infected genital skin and then touching the other areas.

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We know PSA can signal the presence of cancer. But can PSA be more specific—can it tell a doctor the stage of a man’s tumor? Yes, it can. However, as always, PSA is tricky, and the PSA level alone doesn’t tell the whole story.

As a tumor gets bigger, the PSA level generally goes up. And, as the tumor grows, it tends to be overrun by the more malignant, poorly differentiated cancer cells. These poorly differentiated cancer cells elevate PSA less per gram of tissue than well-differentiated cancer cells. Therefore, the PSA level doesn’t go up in a directly corresponding way.

That’s why PSA can be normal even when cancer has spread to the seminal vesicles or pelvic lymph nodes, or it can be higher than expected in men with cancer that’s confined to the prostate. So, the true meaning of PSA can’t be interpreted without knowing the Gleason score.

Scientists at Johns Hopkins have found a more accurate way to estimate the exact extent of prostate cancer, using a special table that correlates clinical stage, Gleason score, and PSA (see table 3.3).

Even though prostate cancer may appear to be confined to the prostate on examination, surgery may reveal a different story – often, the cancer turns out to be more extensive than it seemed at first. That’s because insidious, microscopic bits of cancer can sneak past the prostate wall, and these can’t always be found with the digital rectal exam, biopsy, transrectal ultrasound or other diagnostic methods.

Because surgery is only indicated for the cancers that truly are localized to the prostate, it would be better for everyone to know before the operation how extensive the cancer is.

So, how to predict which cancers may have spread beyond the prostate wall? Tables 3.3a—3.3d were developed by Johns Hopkins researchers after a study of the course of prostate cancer in 1,186 men who had radical prostatectomy.

The tables are designed to help you and your doctor predict your definitive pathological stage and best course of treatment. For example, if you have stage T2a disease, with a Gleason score of 5 and a PSA less than 4, there is an 81 percent chance that the cancer will be completely confined to your prostate. On the other hand, if your Gleason score is 8 and your PSA is is, the likelihood drops to 29 percent. With this information and an estimation of your overall health and longevity, you and your doctor can decide whether or not it’s reasonable to select curative forms of therapy, or simply to adopt a policy of watchful waiting, in which the tumor is treated only after it produces symptoms.

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Anatomically, the prostate is divided into five zones: anterior, which occupies 30 percent of the space and consists mainly of smooth muscle; peripheral, the largest segment, which contains three-fourths of the glands in the prostate; central, which holds most of the remaining glands; preprostatic tissue, which plays a key role during ejaculation (muscles here prevent semen from flowing back into the bladder); and transition, which surrounds the urethra and is the sole site of benign prostatic hyperplasia (BPH). Most prostate cancer occurs in the peripheral zone. Also, this is the region most likely to be tapped in a needle biopsy of the prostate.

The prostate is not the sole basis for a man’s fertility or potency. Some animals that have had their prostate (or, in fact, their seminal vesicles—but not both) removed remain fertile. But growth of the prostate clearly is linked to sexual development: Starting at puberty, the prostate enlarges five times in size— from a weight of about 4 grams to 20 grams—by about age 20. For the next several decades, prostatitis is the most common form of prostate trouble; then, after about age 50, BPH and prostate cancer take over as the problems to worry about.

Most animals have a prostate. But only humans and dogs are prone to prostate trouble, and nobody knows why. What makes bulls, for instance, immune to prostate cancer? Why don’t cats get BPH? Again, a mystery.

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