Author Archives: dnaserver

Sexual Health

I tested positive for an STD. Should my partner get tested too?

Posted on by dnaserver

Many sexually transmitted diseases (STDs) are more common than you may realize, particularly in sexually active youth aged 15 – 24 years. Thankfully most STDs are easily treated and there are no long-term health complications.

Discussing a positive STD test result with your sexual partner can be very intimidating. There is quite a lot of stigma associated with STDs, despite the fact that many of them are quite common. Unfortunately, if you test positive for an STD, that is a conversation that really needs to take place.

Who should get tested?
All of your recent and current sexual partners should be tested, even if you consistently use condoms and your partner is not experiencing any symptoms. Although correct condom use does reduce the risk of transmitting STDs, it does not eliminate the risk, and many STDs are asymptomatic, meaning that there are no obvious symptoms, yet they can still be transmitted to others.

In addition, if you are successfully treated for an STD, but your partner is not tested and treated, you are at risk of your partner passing the STD to you again. Recurrent infections are associated with an increased risk of serious health complications.

For example, an initial chlamydia infection may only cause mild symptoms or no symptoms at all, and it is easily treated with oral antibiotics. However, untreated and recurrent chlamydia infections are associated with an increased risk of pelvic inflammatory disease in females. This can lead to chronic pelvic pain, pregnancy complications, and even infertility.

Tips for having the uncomfortable STD conversation

  • Choose the right timing. Ideally not just before or during sex! Make sure you are in a private setting with no distractions.
  • Know some of the facts. Examples:
    • Let them know how common the STD is: There are an estimated 2.86 million chlamydia cases in the United States every year (1)
    • Explain how the STD can be treated: Oral antibiotics for chlamydia are simple and effective (2). Early treatment reduces the risk of any long-term health complications.
    • Discuss how easy the test is. Our at-home test kits are ideal for this situation! No need to make a doctor’s appointment for sample collection or laboratory analysis. A blood sample is not even required for chlamydia and gonorrhea testing – just a self-collected urine sample.
  • Reiterate how many STDs may not cause any symptoms in some people, but testing is still important.
  • Consider your safety. Is your partner going to react angrily if this STD test result may indicate dishonesty?

References:
1. Sexually Transmitted Infections Prevalence, Incidence, and Cost Estimates in the United States. Jan 25 2021.
2. Workowski KA & Bolan GA (2015) Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep, 64 (RR-03), 1-137.

Heart Health and Diabetes

Why measure your HbA1c levels?

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What is HbA1c?
Hemoglobin A1c (HbA1c) is glycated hemoglobin, which basically means hemoglobin with some sugar (glucose) attached.

Hemoglobin is a protein within red blood cells that carries oxygen around the body. Blood glucose naturally attaches to this hemoglobin, so the more glucose in the blood, the more HbA1c will form.

Red blood cells survive for about 8-12 weeks. This means that HbA1c levels provide a good reflection of average blood glucose levels over that timeframe (1).

HbA1c tests can:

  • Identify people with prediabetes (slightly elevated blood sugar and an increased risk of diabetes)
  • Diagnose diabetes
  • Monitor how well diabetes treatment is working in diabetics (2)

Why is an HbA1c test more informative than a blood glucose test?
Blood glucose tests are simple and many diabetics have home blood glucose monitors. However, blood glucose levels fluctuate, so a blood glucose test just measures the concentration of glucose at only the timepoint at which the blood sample was collected.

In contrast, an HbA1c test provides an average blood glucose level for the preceding 2-3 months (lifetime of the red blood cells). This provides a better understanding of where your blood glucose levels are at over an extended period.

HbA1c tests also have the distinct advantage of not requiring fasting. Often a blood glucose test taken at a doctor’s office requires a period of fasting (8-12 hours) prior to sample collection (3).

Why should I take an HbA1c test?
The CDC recommends people over the age of 45 should get screened for diabetes and prediabetes. An HbA1c test is the most informative and convenient test for this screening. People who have normal HbA1c values (<5.7%) usually don’t need to be screened again for three years, while those with prediabetes levels (5.7-6.4%) should be tested again in 1-2 years (4).

People under 45 years with certain risk factors may also need to take an HbA1c test. These risk factors include being overweight or obese, high blood pressure, history of heart disease, and physical inactivity (4).

HbA1c testing for diabetics
Individuals who have been diagnosed with type 2 diabetes (HbA1c level of 6.5% or higher) should use HbA1c tests to monitor the control of their blood glucose levels and ensure that they are attaining the recommended goal of <7.0% for diabetic adults. For well-controlled diabetes, HbA1c testing may only be required once or twice a year, while more frequent testing may be needed for other diabetics (4).

Higher HbA1c levels are associated with an increased risk of diabetic health complications, such as retinopathy, heart failure, and peripheral vascular disease (5). Higher levels of HbA1c are also associated with an increased risk of peripheral arterial disease, even among patients without diabetes (6).

Are there times when an HbA1c test is not useful?
Yes, there are various factors that may lead to misleading %HbA1c results, including diseases that affect hemoglobin (e.g. anemia), specific supplements (e.g. vitamins C and E), pregnancy, significant blood loss, high cholesterol, kidney, and liver disease (1). Alternative blood glucose testing methods may be required in those patients.

How can I lower my blood glucose?
A combination of diet, exercise, and medication can lower blood glucose levels and hence lower HbA1c levels. Several studies, including the Diabetes Control and Complications Trial (7), have demonstrated that improving HbA1c by 1% for people with diabetes reduces the risk of microvascular complications by 25%. More information about lowering high blood glucose is available here.

References:
1. Hemoglobin A1C (HbA2c) Test. MedlinePlus. (Updated August 2021)
2. Understanding A1C. American Diabetes Association.
3. Fonseca V, Inzucchi SE, Ferrannini E. (2009). Redefining the diagnosis of diabetes using glycated hemoglobin. Diabetes Care. 32(7), 1344- 1345.
4. All About Your A1C. CDC. (Reviewed August 2021)
5. Eeg-Olofsson K, et al. (2010). New aspects of HbA1c as a risk factor for cardiovascular diseases in type 2 diabetes: an observational study from the Swedish National Diabetes Register (NDR). J Int Med. 268(5), 471-482.
6. Muntner O, et al. (2005). Relationship Between HbA1c Level and Peripheral Arterial Disease. Diabetes Care. 28(8), 1981-1987.
7. The Diabetes Control and Complications Trial Research Group. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 329(14), 977–986.

Sexual Health

What are the symptoms of some of the common STDs?

Posted on by dnaserver

Many common sexually transmitted diseases (STDs) share the same or very similar symptoms. These include:

  • Abnormal discharge
  • Painful and/or frequent urination
  • Pain during sexual intercourse
  • Itching, irritation or pain in the genital area
  • Small lumps or sores in the genital area

Of course, many common STDs also don’t cause any symptoms at all! For example, for chlamydia, only an estimated 10% of infected males show symptoms and 5-30% of infected females (1). This is why routine testing is very important to detect, treat, and prevent the spread of STDs. Our easy-to-use at-home sample collection kits make STD testing even simpler. If you are concerned about a recent potential exposure, take an STD test today.

Abnormal discharge:
Chlamydia, gonorrhea, and trichomoniasis can all cause abnormal discharge from the vagina in females and penis in males. This is typically a yellowish discharge in females and a white, cloudy or watery discharge in males. Sometimes the discharge can have a slightly green tinge and also have an unpleasant smell.

Non-STD health issues can also cause abnormal discharges, including urinary tract infections and yeast infections (2). Taking a simple STD test is an easy way to rule out a potential STD.

Painful and/or frequent urination:
Chlamydia, gonorrhea, trichomoniasis, and herpes are all associated with pain while urinating (dysuria). But once again, many non-STD health issues can also cause dysuria, including urinary tract infections, yeast infections, urethritis, certain prostate conditions, bladder and kidney stones, and certain medications (3).

Frequent urination is another common symptom of STDs, but can also be caused by kidney disease, urinary tract infection, pregnancy, prostate problems, and diabetes among other things (4).

Pain during sexual intercourse:
Chlamydia, gonorrhea, trichomoniasis, and herpes can also cause pain during sexual intercourse. Non-STD health issues in females that can also cause painful sex include vaginismus, vaginal infections, endometriosis, menopause, pelvic inflammatory disease (which can itself be a complication of an STD) (5). In males, other causes of painful sex include Peyronie’s disease, a tight foreskin, or prostatitis (6).

Itching, irritation, or pain in the genital area
Chlamydia, trichomoniasis, and herpes can cause discomfort in the genital area, particularly in females. This may be just mild irritation or severe itching and pain. Other causes of irritation include yeast infection and bacterial vaginosis in females, jock itch in males, and allergies in both genders. Sweating, tight clothing, and certain substances (e.g. soap) can also contribute to itchy genitals (7).

Small lumps or sores in the genital area
Syphilis, herpes, and human papillomavirus (HPV) are all associated with skin lumps and sores in and around the genitals.

For syphilis, a skin lesion known as a chancre occurs during primary infection. It can be a single painless chancre, or multiple painful and tender chancres (8).

Genital herpes can cause a patch of small red or white bumps, which are often painful. These pus-filled sores eventually burst to leave an ulcer-like sore on the skin (9).

HPV can cause warts in the genital area. These can be flat lesions, small cauliflower-like bumps, or tiny stem-like protrusions (10).

References:
1. Farley TA, Cohen DA, & Elkins W (2003). Asymptomatic sexually transmitted diseases: the case for screening. Prev Med, 36 (4), 502-509.
2. Barad DH (2020). Vaginal Discharge. Merck Manual Consumer Version.
3. Michels TC, Sands JE (2015). Dysuria: Evaluation and Differential Diagnosis in Adults. Am Fam Physician. 92 (9), 778-788.
4. Maddukuri G (2021). Excessive or Frequent Urination. Merck Manual Consumer Version.
5. Why Does it Hurt When I Have Sex? American Society for Reproductive Medicine.
6. Why does sex hurt? NHS. Reviewed May 2021.
7. 8 reasons your groin itches and how to get relief. American Academy of Dermatology Association.
8. Kent ME & Romanelli F (2008). Reexamining syphilis: an update on epidemiology, clinical manifestations, and management. Ann Pharmacother, 42 (2), 226-236.
9. Genital Herpes – CDC Fact Sheet (Detailed). CDC. Reviewed July 2021.
10. Genital HPV Infection – Fact Sheet. CDC. Reviewed January 2021.

HIV

How is HIV treated?

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There is no cure for HIV. However, antiretroviral therapy (ART) is a very effective treatment to prevent the progression of HIV and to prevent the transmission of HIV to others. It enables HIV-positive individuals to live relatively normal, healthy lives (1).

What is ART?
ART is a life-long daily treatment that must be strictly followed. It is a combination of different HIV medicines (HIV regimen) that work by suppressing the replication of the virus. This reduces the amount of HIV in the body, known as viral load. HIV viral suppression is defined as less than 200 copies of HIV per milliliter of blood (2).

When this viral load is at undetectable levels (viral suppression), it doesn’t mean the virus is gone completely, but it does prevent the disease from progressing and means there is effectively no risk of passing HIV to others through sex (2). It also reduces the risk of transmission through shared needles and syringes, from a mother to her baby during pregnancy and at birth, and during breastfeeding. However, current recommendations in the United States state that HIV-positive mothers should not breastfeed their babies even if they have an undetectable viral load (2).

At the end of 2019, an estimated 59% of individuals on ART had achieved suppression of the HIV virus with no risk of transmitting the virus to others through sex (1).

It is important to remember that ART does not prevent the transmission of other STDs. So just because you or your partner are on ART, other safe sex practices are still important.

What are the HIV medicines in an HIV regimen?
There are seven classes of HIV medicines, which are classified based on how they fight HIV (3):

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Nucleoside reverse transcriptase inhibitors (NRTIs)
  • Protease inhibitors (PIs)
  • Fusion inhibitors
  • CCR5 antagonists
  • Integrase strand transfer inhibitors (INSTIs)
  • Post-attachment inhibitors

HIV regimens can differ between individuals and are selected based on various factors, including possible side effects, potential drug interactions, and disease progression.

When to start ART?
ART should be started as soon as possible following an HIV diagnosis. It doesn’t matter how healthy you are or how long you have had HIV.

ART is life-long and must be taken as prescribed on a daily basis. If ART is not taken consistently, drug-resistant HIV strains can develop, meaning the medications will no longer be effective (2).

Routine viral load and CD4+ T cell monitoring are important to ensure that treatment is effective and maintaining viral load at undetectable levels in the blood (3).

If the treatment is discontinued, HIV will continue to replicate increasing the risk of HIV transmission and the disease can progress to AIDS (3).

What are the potential side effects of ART?
HIV medicines available nowadays generally cause fewer side effects than some HIV medicines used in the past (4). However, some people do still experience a range of side effects, which can include:

  • Nausea and vomiting
  • Diarrhea
  • Difficulty sleeping
  • Dry mouth
  • Headache
  • Rash
  • Dizziness
  • Fatigue
  • Pain

What other treatment options are there?
Methods are also available to reduce the risk of contracting HIV. Pre-exposure prophylaxis (PrEP) is a daily medication that individuals at high risk of HIV (e.g. partner of an HIV-positive person) can take to minimize their risk of HIV infection. There are currently two FDA-approved PrEP medications that reduce the risk of contracting HIV via sex by up to 99% (5).

Post-exposure prophylaxis (PEP) is an emergency medication that must be started within 72 hours of exposure. PEP is a short course of medication that reduces the risk of infection but should not be used to replace other HIV and STD prevention methods (6).

References:
1. HIV/AIDS. World Health Organization.
2. HIV Treatment. CDC. Reviewed May 2021.
3. HIV Treatment: The Basics. NIH.gov (Reviewed March 2020)
4. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Clinical Info. HIV.gov (Updated June 20201)
5. FDA approves second drug to prevent HIV infection as part of ongoing efforts to end the HIV epidemic. FDA News Release. (October 2019).
6. PEP (Post-Exposure Prophylaxis). CDC. (Reviewed May 2021)

Posted in HIV
Women's Health

What is progesterone?

Posted on by dnaserver

Progesterone is a female sex hormone that is primarily produced in the corpus luteum in normally menstruating women. The corpus luteum is a temporary structure that forms after the ovarian follicle ruptures and releases an egg at ovulation (around day 14 of the menstrual cycle). The main role of progesterone is to prepare the body for pregnancy (1).

Why is progesterone so important for pregnancy?
Straight after ovulation, progesterone starts preparing the body for pregnancy. It stimulates an increase in the lining of the womb and the secretion of nutrients to provide the perfect environment for the implantation of a fertilized egg. Progesterone also inhibits muscular contractions of the uterus that would prevent a fertilized egg from implanting (2).

After a fertilized egg becomes implanted, the placenta forms and takes over the production of progesterone at around 6-12 weeks. The placenta continues to produce progesterone for the remainder of the pregnancy, with progesterone levels steadily rising throughout pregnancy (3).

Throughout the pregnancy, progesterone is important for the development of the fetus, as well as stimulating the growth of maternal breast tissue in preparation for breastfeeding and strengthening the pelvic wall muscles in preparation for labor (3).

What happens if an egg is not fertilized?
If egg fertilization and implantation do not occur, the corpus luteum breaks down and progesterone production falls. This causes the growth of the womb lining to cease and start to break down and menstruation occurs again (2).

Does progesterone have any other roles?
Yes, progesterone is also important for non-pregnancy-related health. Progesterone acts in non-reproductive tissues, often in partnership with estradiol. Examples include estradiol reduction of bone resorption and progesterone stimulation of bone formation, and coordinated increases in nitric oxide activity to improve blood flow (4).

What are normal progesterone levels?
Progesterone levels fluctuate during each menstrual cycle. They are low (<0.5 ng/mL) during the follicular phase, with a rapid rise following the luteinizing hormone (LH) surge at ovulation to 10-25 ng/mL. If no conception occurs, progesterone levels decline, and menstruation beings. If an egg is fertilized, the corpus luteum maintains progesterone levels until around week six. The placenta produces progesterone for the remainder of the pregnancy, with levels increasing up to 45 ng/mL in the first trimester, and 230 ng/mL in the third trimester (5).

What are the risks of low progesterone?
Abnormally low progesterone levels are observed in the mid-luteal phase in females who have disorders of ovulation. This luteal phase deficiency is associated with infertility and spontaneous abortion and is estimated to occur in approximately 10% of infertile women (6). Low progesterone levels during the first 10 weeks of pregnancy are indicative of threatened abortion and ectopic pregnancy (7).

References:
1. Weigel NL, & Rowan BG. (2001). Estrogen and progesterone action. In L. J. DeGroot, & J. L. Jameson, Endocrinology (Vol. 3, 2053-2060). Philadelphia: WB Saunders Co.
2. Progesterone. Encyclopedia Britannica. (Edited August 2020)
3. You and Your Hormones. An education resource from the Society of Endocrinology. (Reviewed July 2021)
4. Prior JC. (2011). Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause. Facts Views Vis Obgyn, 3 (2), 109-120.
5. Pagana KD, Pagana TJ, Pagana TN. Mosby’s Diagnostic & Laboratory Test Reference. 14th ed. St. Louis, Mo: Elsevier; 2019.
6. Rosenberg SM, Luciano AA, & Riddick DH. (1980). The luteal phase defect: the relative frequency of, and encouraging response to, treatment with vaginal progesterone. Fertil Steril, 34, 17-20.
7. Witt BR, Wolf GC, & Wainwright CJ. (1990). Relaxin, CA-125, progesterone, estradiol, Schwangerschaft protein, and human chorionic gonadotropin as predictors of outcome in threatened and nonthreatened pregnancies. Fertil Steril, 53, 1029-1036.

Sexual Health

Will using condoms prevent me catching an STD?

Posted on by dnaserver

Consistent and correct use of male latex condoms does dramatically reduce the risk of transmitting STDs. However, condoms do not eliminate the risk of STD transmission.

How are STDs transmitted?
STDs, such as chlamydia, gonorrhea, and HIV, are usually transmitted through contact between infected secretions from the vagina or urethra and mucosal surfaces of the anus, vagina, urethra, or cervix. Syphilis, genital warts (herpes), and human papillomavirus (HPV) typically cause ulcers or sores in the genital area, and transmission can occur when the ulcer/sore comes into contact with a mucosal surface.

How do condoms reduce transmission?
Latex condoms effectively prevent the contact between infected secretions and mucosal surfaces of a sexual partner. However, condoms are not 100% effective, particularly if they are used incorrectly. In addition, they can be less effective at preventing the transmission of STDs that cause genital sores (e.g. syphilis), especially if the condom does not cover the sore.

What reduces the effectiveness of a condom?
There are many mistakes in using condoms that are actually more common than you might realize. These include using:

  • An expired condom, which increases the risk of breakage during sex
  • Teeth to open the condom pack. This can damage the condom and increase the risk of breakage.
  • A condom that is too tight. The semen needs somewhere to go!
  • A condom with air left at the tip. This can cause it to burst during sex.
  • A partially unrolled condom. It needs to be fully unrolled to fit properly and prevent slipping off during sex.
  • An oil-based lubricant. These can weaken the latex. Stick to water-based lubrication to increase comfort and reduce the risk of condom tearing during sex.

Tips for using condoms correctly
These are the dos and don’ts for condom use as recommended by the CDC (1):

  • DO use a condom every time you have sex.
  • DO put on a condom before having sex.
  • DO read the package and check the expiration date.
  • DO make sure there are no tears or defects.
  • DO store condoms in a cool, dry place.
  • DO use latex or polyurethane condoms.
  • DO use a water-based or silicone-based lubricant to prevent breakage.
  • DON’T store condoms in your wallet as heat and friction can damage them.
  • DON’T use nonoxynol-9 (a spermicide), as this can cause irritation.
  • DON’T use oil-based products like baby oil, lotion, petroleum jelly, or cooking oil because they will cause the condom to break.
  • DON’T use more than one condom at a time.
  • DON’T reuse a condom.

Do I still need to get tested even if I always use condoms?
Yes. Condoms unfortunately do not eliminate the risk of STD transmission. So if you think you have been exposed to an STD and/or you are experiencing potential STD symptoms, get an STD test to keep yourself and your sexual partners safe and healthy.

Routine STD screening is still recommended for sexually active individuals, particularly with multiple sexual partners, even if condoms are consistently used.

References:
1. External (sometimes called Male) Condom Use. CDC. June 21, 2021.

Men's Health

Prostate-specific antigen (PSA). What is it and why measure it?

Posted on by dnaserver

Prostate-specific antigen (PSA) is a protein predominantly produced in the prostate by both normal and malignant cells. Blood levels of PSA are a useful indicator of prostatic pathology, to evaluate men at risk of prostate cancer, and for assessment after treatment.

What are the roles of PSA?
In normal healthy individuals, PSA is secreted into the seminal fluid in high concentrations to liquefy seminal gel by proteolytic cleavage of gel-forming proteins. This helps to increase sperm mobility. A small amount of PSA is also normally found in the blood as a result of leakage from the prostate gland (1).

What are normal blood PSA levels?
Healthy males generally have blood total PSA levels less than 4 ng/mL. Although most studies to establish this normal range have been conducted in predominantly white male populations; hence how applicable this value is to other racial or ethnic groups requires further investigation (2).

What do elevated blood PSA levels mean?
High levels of PSA in the blood can be indicative of prostate cancer, but may also occur due to benign (non-cancerous) conditions, including prostatitis (inflammation of the prostate), urinary tract infection, and benign prostatic hyperplasia (BPH, enlargement of the prostate) (3). More info about other causes of high PSA is available here. 

There are three major forms of PSA in the blood, two of which are detectable using current lab techniques – complexed PSA and free PSA (1). The differing levels of these two detectable forms are useful for distinguishing between individuals with BPH and prostate cancer, particularly in men with total PSA levels between 4.1 and 10 ng/mL. Although both abnormalities result in increased total blood PSA, the proportion of free PSA is much higher in individuals with BPH compared to prostate cancer patients (4).

What are the benefits of measuring blood PSA levels?
Prostate cancer is the most frequently diagnosed cancer and second leading cause of cancer deaths in men in the United States (5). Early diagnosis of small tumours that are confined to the prostate provides the best prognosis for recovery from prostate cancer. However, there are often no symptoms in the early stages of prostate cancer. Analyses of blood PSA levels are the most accurate and non-invasive way to detect prostate cancer, particularly in the early stages. These analyses are usually combined with, or followed up by, digital rectal examination (6).

References:
1. McCormack RT, et al. (1995). Molecular Forms of Prostate-Specific Antigen and the Human Kallikrein Gene Family: A New Era. Urology, 45, 729-744.
2. Prostate-Specific Antigen (PSA) Test. National Cancer Institute, NIH. (Updated Feb 2021)
3. Partin AW, Oesterling JE. (1994). The Clinical Usefulness of Prostate Specific Antigen: Update 1994. J Urol, 152, 1358-1368.
4. Ito K, et al. (2003). Free/total PSA ratio is a powerful predictor of future prostate cancer morbidity in men with initial PSA levels of 4.1 to 10.0 ng/mL. Urology. 61(4), 760-4.
5. Parker SL, et al. (1997). Cancer Statistics, 1997. CA Cancer J Clin, 47, 5-27.
6. Crawford ED, et al. (1996). Serum Prostate-Specific Antigen and Digital Rectum Examination for Early Detection of Prostate Cancer in a National Community-Based Program. Urology, 47, 863-869.

Hepatitis

Hepatitis C Quick Facts

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What is hepatitis C?
Hepatitis C is a virus that causes acute (short-term) infections in some individuals, but in most individuals, the virus remains in the body causing serious chronic (long-term) infection (1).

How does hepatitis C spread?
Hepatitis C is usually transmitted through exposure to blood from an infected individual (1).

  • The most common way is through sharing needles
  • Other potential sources of infection include:
    • At birth (~6% of infants of infected mothers)
    • Sexual intercourse (rare but more common in men who have sex with men)
    • Healthcare exposures
    • Blood transfusions and organ transplants (now very uncommon)
    • Unregulated tattoos or body piercings
    • Sharing personal items that have been in contact with infected blood (e.g. glucose monitors, razors)

What are the symptoms of hepatitis C?
Many individuals with an acute hepatitis C infection remain asymptomatic and are unaware they are infected. However, it is still possible for viral transmission to occur even in the absence of symptoms. Symptoms may appear 2-12 weeks post-exposure and include:

  • Yellowing of the skin or eyes
  • Lack of appetite
  • Diarrhea and vomiting
  • Fever
  • Dark urine
  • Joint pain

More than 50% of infected individuals go on to develop a chronic infection (2), which again often doesn’t cause any noticeable symptoms at least for quite a long period.

Over several decades, mild to severe liver disease develops in most affected individuals, including cirrhosis and liver cancer (3).

Several factors increase the risk of the development of cirrhosis in infected individuals, including being male, >50 years, increased alcohol consumption, hepatitis B or HIV coinfection, and immunosuppressive therapy (3). Chronic HCV infection is a common reason for a liver transplant in the United States (4).

Due to a general lack of symptoms, often individuals infected with hepatitis C are only diagnosed through screening for blood donation or during a routine health check-up (1).

Who is at risk of hepatitis C?
Groups that have an increased risk of hepatitis C include:

  • HIV-positive individuals
  • Injectable drug users
  • Individuals on hemodialysis
  • Healthcare workers
  • Children born to hepatitis C-positive mothers

How is hepatitis C diagnosed?
Hepatitis C diagnosis is by laboratory analyses from a blood sample. The initial test detects antibodies that are produced by the immune system of an infected individual in response to the hepatitis C infection. The presence of these antibodies indicates that an individual has either a current or past hepatitis C infection. Additional testing to detect hepatitis C virus RNA is required to diagnose an active infection and determine the viral load.

How is hepatitis C treated?
Hepatitis C is treated with antiviral medications to eliminate the virus from the body. Newly developed “direct-acting” antivirals have improved hepatitis C treatment considerably with fewer side effects and shorter treatment periods. Nowadays, over 90% of infected individuals can be cured with 8-12 weeks of oral therapy (5).

Effective treatment slows down the progression of inflammation and scarring of the liver and reduces the chances of liver cancer. However, antivirals do not help repair any tissue damage that has already occurred.

References:
1. Viral Hepatitis – Q&As from the Public. (2020, July). CDC.
2. Liang TJ, Rehermann B, Seef LB, & Hoofnagle JH. (2000) Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med, 132(4), 296-305.
3. Thomas DL & Seef LB. (2005) Natural history of hepatitis C. Clin Liver Dis, 9(3), 383-398.
4. Definition & Facts of Liver Transplant. March 2017.
5. Initial Treatment of Adults with HCV Infection. August 2020.

Hepatitis

Hepatitis B Quick Facts

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What is hepatitis B?
Hepatitis B is a major global health problem that can cause both acute (short-term) and chronic (long-term) liver disease (1).

How does hepatitis B spread?
In regions of the world with the highest rates of hepatitis B, perinatal transmission (mother to child at birth) is the most common mode of transmission. Horizontal transmission (exposure to infected blood), especially from an infected child to an uninfected child under the age of five years is also common (1).

Hepatitis B can also spread through needle stick injury, tattooing, piercing, sharing drug needles and syringes, and other exposures to infected blood, saliva, vaginal, and seminal fluids. Sexual transmission can occur, with more common occurrences in men who have sex with men, heterosexuals with multiple sex partners, and sex workers (and their clients) (1).

What are the symptoms of hepatitis B?
Many individuals with acute hepatitis B remain asymptomatic and are unaware they are infected. However, it is still possible for viral transmission to occur even in the absence of symptoms. In symptomatic individuals, yellowing of the skin or eyes, nausea, vomiting, abdominal pain, dark urine, and fatigue can last several weeks or persist for up to six months (1).

In some individuals, hepatitis B can develop into a chronic infection. This is common in infants and young children but rare (less than 5%) in adults. Chronic hepatitis B can develop into cirrhosis or liver cancer (2). Symptoms can include:

  • Fatigue
  • Weakness
  • Lower leg swelling
  • Yellow skin
  • Fluid accumulation in the abdomen
  • Spider-like blood vessels on the skin
  • Nausea
  • Indigestion
  • Pain at the top right of the abdomen or in the right shoulder (referred pain)

Who is at risk of hepatitis B?
Groups that have an increased risk of hepatitis B include:

  • Children of hepatitis B-positive mothers
  • Individuals who frequently require blood or blood products
  • Dialysis patients
  • Incarcerated persons
  • Injectable drug users
  • Close contacts of hepatitis B-infected individuals
  • Individuals with multiple sexual partners
  • Healthcare workers

How is hepatitis B diagnosed?
Hepatitis B diagnosis is by laboratory analyses from a blood sample. The most commonly detected component is the hepatitis B surface antigen (HBsAg). This can be detected within 30 to 60 days after infection, and remains detectable during both acute and chronic infections.

How is hepatitis B treated?
There are no specific treatments for an acute infection. Maintaining an adequate nutritional and fluid intake is important, particularly as additional fluids may be lost through vomiting and diarrhea.

Medications are available for chronic hepatitis B, but only 10% to 40% of individuals with chronic hepatitis B will require treatment. These medications suppress the replication of HBV, thereby slowing the progression of cirrhosis and reducing the risk of liver cancer, but they generally do not cure an HBV infection, so must continue for life (1).

A very effective and safe vaccination for hepatitis B is available. This vaccine induces protective antibody levels in more than 95% of individuals, with protection lasting for at least 20 years and probably lifelong.

References:
1. Hepatitis B, World Health Organization. July 2020.
2. Hepatitis B Questions and Answers for Health Professionals. CDC. July 2020.

Trichomoniasis

Trichomoniasis Quick Facts

Posted on by dnaserver

What is trichomoniasis?
Trichomoniasis is a common sexually transmitted disease (STD) that is spread through sexual contact with the penis or vagina of an infected individual.

What causes trichomoniasis?
Trichomoniasis is caused by infection with a protozoan parasite called Trichomonas vaginalis (1).

What are the symptoms of trichomoniasis?
Only approximately 30% of infected individuals show symptoms with the majority remaining asymptomatic (2). Some individuals show symptoms 5 to 28 days post-exposure, while symptoms occur in others much later, or symptoms may disappear then reappear (3).

Symptoms in males can include:

  • Itching or irritation inside the penis
  • Painful burning sensation after urination or ejaculation
  • Increased urination
  • Abnormal discharge from the penis

Symptoms in females can include:

  • Itching or irritation of the vagina
  • Painful and more frequent urination
  • Endocervical bleeding
  • Abnormal vaginal discharge with an unpleasant odor

Trichomoniasis infections are associated with an increased risk of contracting other STDs, particularly a 2- to 3-fold increased risk of HIV (2).

Who is at risk of trichomoniasis?
Any sexually active individual is at risk of trichomoniasis. Factors that are associated with a higher prevalence of trichomoniasis in the United States include increased poverty level, lower educational level, and unmarried status (4).

How is trichomoniasis diagnosed?
Modern nucleic acid amplification testing (NAAT) provides the most sensitivity and specificity for a trichomoniasis diagnosis. These can be performed on vaginal swabs (either clinician- or patient-collected) or urine.

How is trichomoniasis treated?
Prescription antibiotics are an effective treatment for trichomoniasis. Repeat infections from sexual contact with an infected partner are common; hence treatment of all sexual partners should occur at the same time.

References:
1. Soper D (2004). “Trichomoniasis: under control or undercontrolled?” Am J Obstet Gynecol. 190(1), 281-90.
2. Trichomoniasis Fact Sheet. CDC. Feb 2020. 
3. Satterwhite CL, et al. (2013). Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2008. Sex Transm Dis, 40(3), 187-193.
4. 2015 Sexually Transmitted Diseases Treatment Guidelines, Trichomoniasis. CDC. June, 2015.