Author Archives: dnaserver

Heart Health and Diabetes

What are the risk factors for heart disease?

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Heart disease is the most common cause of death in the United States (1) and the second leading cause of death in Canada (2). Approximately 18.2 million adults in the United States have coronary artery disease (the most common type of heart disease), and every year about 655,000 Americans die from heart disease (1).

There are several different factors that can increase the risk of heart disease (3). Some of these factors cannot be changed (e.g. genetic risk), while lifestyle changes can mitigate the risk associated with some of the other risk factors (e.g. abstaining from smoking).

In this article, we will discuss what can increase your risk of heart disease, and how you can try to minimize that risk.

Risk factors for heart disease include:

  • High blood pressure
  • High blood cholesterol
  • Overweight or obese
  • Prediabetes or diabetes
  • Smoking
  • Sedentary lifestyle
  • Family history
  • Unhealthy diet
  • Older than 55 for females or older than 45 for males

High blood pressure
High blood pressure can also be called hypertension. It is when blood flows through the arteries at higher-than-normal pressure. Normal blood pressure in adults is less than 120/80 mm Hg, while high blood pressure is when the systolic reading is at least 130 mm Hg or the diastolic reading is at least 80 mm Hg (4).

Most affected people are not even aware that they have high blood pressure until it causes a serious health problem, in particular heart disease. This is why health recommendations state that everyone aged 3 years or older should have their blood pressure checked at least once a year (4). Blood pressure checks are simple, painless, and very quick.

Following a heart-healthy lifestyle is often all that is required to lower high blood pressure. This should include a healthy diet, limited alcohol, regular physical exercise, maintenance of a healthy weight, abstaining from smoking, getting quality sleep, and managing stress. If these lifestyle changes do not adequately control blood pressure, medications may be prescribed (4). See our “How to keep a healthy heart” article for more information.

High blood cholesterol
Cholesterol is a waxy type of fat (lipid), which travels around the body in the blood. It is produced in adequate quantities in the liver, but can also be obtained from foods from animals. Cholesterol is an essential molecule, but only in moderation. Excess cholesterol can cause health complications and is particularly damaging to blood vessels. Total cholesterol levels below 200 mg/dL are considered desirable for adults (5).

Cholesterol is carried around the body by lipoproteins, particularly low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL-cholesterol is considered the “bad” cholesterol, as when in excess, it can get deposited in the blood vessels. In contrast, HDL-cholesterol is “good” cholesterol, as this gets scavenged from around the body and returned to the liver for recycling or excretion (6).

The National Cholesterol Education Program (NCEP) recommends that all adults 20 years of age and over should have a fasting lipoprotein profile (total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride) once every five years to screen for coronary heart disease risk (5). A blood test can measure your cholesterol levels. This can be through your doctor or simply use one of our at-home heart health tests for an accurate analysis.

The same heart-healthy lifestyle recommended to lower high blood pressure is also beneficial for reducing high cholesterol, and more information about specific foods to avoid is available here. Medications may also be required, with the most common being statins (7).

Overweight or obese
Overweight and obesity are becoming more and more common in the United States. Carrying excess body weight puts additional strain on your whole body, significantly increasing the risk of heart disease, as well as diabetes, cancers, sleep disorders, and metabolic syndrome.

Starting with a heart-healthy lifestyle is the best approach to losing excess weight and keeping it off. In particular, to be able to lose weight, energy output (through physical activity) needs to be more than energy input (through diet) (8). Medications and surgical procedures are other options, but physical activity is the first step. If you are physically inactive, start small and work from there. Any exercise is better than nothing!

Prediabetes or diabetes
Diabetes is a metabolic disorder that occurs when the pancreas is no longer able to make sufficient insulin, or when the body cannot make good use of the insulin it produces. This inhibits the control of blood glucose (sugar) levels and leads to raised blood glucose (hyperglycemia), which causes damage to various tissues and organs in the body. Hyperglycaemia can weaken blood vessels and increase the likelihood of cholesterol buildup and plaque formation, the very factors that contribute to heart disease (9). In fact, in the United States, at least 68% of people over 65 years with diabetes die from heart disease (10).

Type 2 diabetes is by far the most common form of diabetes, but can usually be prevented with healthy food choices and adequate physical activity. Pre-diabetes (also known as impaired glucose tolerance) is when blood glucose is higher than normal, but not high enough to be considered diabetes. Pre-diabetes is associated with an increased risk of type 2 diabetes, but diet and lifestyle changes can prevent the disease progression (9).

Monitoring and effectively controlling your blood sugar levels is very important for diabetic people to reduce the risk of heart complications as well as other diabetic complications. Measurements of HbA1c levels are a beneficial way to monitor blood sugar levels.

Smoking
Smoking contributes to a multitude of health problems, including as a major contributor to heart disease.

The chemicals in cigarettes can cause the cells lining the blood vessels to swell and become inflamed, narrowing the blood vessels. This contributes to the formation of atherosclerotic plaques, which occur when fat and cholesterol build-up. These cigarette chemicals also cause the blood to thicken and increase the risk of blood clots forming (11).

The more you smoke and the longer you continue to smoke, the higher your risk of heart disease. Quitting smoking reduces your risk of heart disease. Consider joining a support group if you are having trouble quitting smoking on your own.

Sedentary lifestyle
A sedentary lifestyle (lack of physical activity) is a significant risk factor for heart disease, as well as a risk factor for diabetes, high blood pressure, high cholesterol, and obesity – which are all other risk factors for heart disease! According to WHO, 60-85% of people around the world have sedentary lifestyles and nearly 2/3 of children also don’t get enough exercise (12). Being physically inactive increases your risk of heart disease just as much as smoking, high blood pressure, and high cholesterol (13).

So how much exercise do you need to improve your heart health? The American Heart Association recommends 30-60 minutes of aerobic exercise 3-4 times per week (13). This doesn’t need to be a workout at the gym or a 10 km run, just something as simple as an evening walk, dancing, or yard work will provide you with significant benefits for your heart and your lungs too.

Family history
A family history of heart disease may be indicative of an underlying genetic factor that increases the risk of heart problems. Common genetic variants that are linked to an increased risk of heart disease (particularly high cholesterol) include variants in the APOE, LDLR, APOB, and PCSK9 genes (14).

Although genetic testing is available to detect these risk variants, there is nothing that you can do to change your genetic risk of heart disease. However, knowing that you are genetically predisposed to heart disease may be just the push you need to improve your health and reduce your other risk factors.

It is also important to note that family history alone does not definitely mean you have inherited genetic risk factors. Unfortunately, poor diet and lifestyle are often “inherited” from your parents too. Don’t make the same poor choices that will lead you down the same path to heart disease.

Unhealthy diet
Good nutrition is essential for not just heart health, but also to lower the risk of obesity, diabetes, and certain cancers. However, according to the CDC, most Americans do not have a healthy diet. Less than 10% of adults eat enough fruits and vegetables, 90% consume too much sodium, and more than 50% have a sugary drink most days (15).

Although the easy food option might be a prepackaged and highly processed snack, it is the worst option for your heart health! Do your heart a favor and grab a fruit or vegetable snack, instead of that bag of chips.

Focus on consuming lots of nutrient-rich foods to obtain plenty of vitamins, fiber, and other nutrients. Include lots of vegetables, fruits, and whole grains, choose fat-free or low-fat dairy products over full-fat, obtain your protein from healthy sources (e.g. fish, lean meats, eggs, nuts, seeds, legumes) instead of fatty meats, and consume oils and foods high in monounsaturated and polyunsaturated fats (e.g. olive oil, nuts, salmon, avocados, tofu) in place of foods high in saturated and trans fats (3).

Older than 55 for females or older than 45 for males
Increasing age is obviously one of the risk factors that no one can change! But it is even more important when you’re older to get regular checkups and adequately monitor your health, so if anything is untoward, you can make changes before it is too late.

Annual measurements of blood pressure should continue. Lipid (cholesterol) analyses should increase from once every five years to an annual analysis, even in the absence of other risk factors (other than age) (16).

References:
1. Heart Disease Facts. Heart Disease. (Reviewed Sept 2020) CDC
2. Heart Disease in Canada. Government of Canada. (Modified Feb 2017)
3. Heart-Healthy Living. National Heart, Lung, and Blood Institute. NIH
4. High Blood Pressure. National Heart, Lung, and Blood Institute. NIH.
5. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. (2002). Circulation. 106 (25), 3143-421.
6. HDL (Good), LDL (Bad) Cholesterol and Triglycerides. American Heart Association. (2020).
7. Blood Cholesterol. National Heart, Lung, and Blood Institute. NIH.
8. Overweight and Obesity. National Heart, Lung, and Blood Institute. NIH.
9. What is Diabetes? National Institute of Diabetes and Digestive and Kidney Diseases. NIH
10. Lifestyle Changes for Heart Attack Prevention. Heart Attack. (Reviewed July 2015). American Heart Association.
11. Smoking and Cardiovascular Disease. CDC Fact Sheet.
12. Physical inactivity a leading cause of disease and disability, warns WHO. (April 2002). World Health Organization.
13. Physical Inactivity and Cardiovascular Disease. Department of Health, New York States.
14. Song Y, Stampfer MJ, Liu S (2004). Meta-Analysis: Apolipoprotein E Genotypes and Risk for Coronary Heart Disease. Ann Intern Med. 141(2): 137-147.
15. Poor Nutrition. National Center for Chronic Disease Prevention and Health Promotion. (Reviewed Jan 2021). CDC
16. Sazlina SG (2015) Health screening for older people – what are the current recommendations? Malays Fam Physician. 10(1), 2-10.

HIV

Viral load and viral suppression. What do they mean?

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HIV refers to the human immunodeficiency virus, which is a viral infection that targets the body’s immune system cells, such as macrophages, dendritic cells, and helper T cells (specifically CD4+ cells) (1). In the absence of effective treatment, the number of CD4+ cells declines, eventually leading to a loss of cell-mediated immunity and the development of acquired immunodeficiency syndrome (AIDS) (2).

Although there is no cure for HIV, there are very effective medicines available to prevent the progression of HIV and to prevent the transmission of HIV to others through sex.

These medicines, called antiretroviral therapy (ART), reduce the viral load, which refers to the amount of HIV in the body. Consistent use of ART keeps the viral load low and enables the immune system to recover and maintain a high CD4+ T cell count.

When the viral load is very low, it is referred to as viral suppression. HIV viral suppression is defined as less than 200 copies of HIV per milliliter of blood (3). This can also be called an “undetectable viral load”.

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 (3). 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 (3).

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 (4).

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 (3).

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 (5).

References:
1. Cunningham, AL, et al. (2010) Manipulation of dendritic cell function by viruses. Curr Opin Microbiol, 13 (4), 524-529.
2. Weiss RA. (1993) How does HIV cause AIDS? Science, 260 (5112), 1273-1279.
3. HIV Treatment. Reviewed May 2021. CDC.
4. HIV/AIDS. World Health Organization.
5. HIV Treatment: The Basics. (Reviewed March 2020)HIVinfo. NIH.gov.

Posted in HIV
Sexual Health

The importance of STD tests

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Sexually transmitted diseases (STDs) can also be known as sexually transmitted infections (STIs). They are infections that are usually spread from person to person during vaginal, anal, and oral sex. Many STDs are quite common but do not cause any symptoms, particularly in the early stages. However, despite being asymptomatic, infected individuals can still transmit the STD to any sexual partners. In addition, if the STD is left untreated, serious health complications can occur.

Have you been potentially exposed to an STD?
STDs can spread through vaginal, anal, or oral sex, and sometimes transmission can occur even with the correct use of a condom.

Are you experiencing potential symptoms of an STD?
These can include:

  • Sore or bumps in the genital area
  • Abnormal discharge from the penis or vagina
  • Painful and/or frequent urination
  • Itching, pain, and/or irritation in the penis, vagina, vulva, or anus
  • Flu-like symptoms

Of course, these symptoms can also be caused by something that is not an STD (e.g. a yeast infection) and many people with an STD do not actually experience any symptoms. The only way to be sure that you don’t have an STD is to get tested.

Testing is simple and easy.
Just a urine sample or finger-prick blood sample is all that is required. We offer STD testing from a sample collected in the privacy of your own home. The sample is then shipped to our fully accredited laboratory for very accurate testing using approved and validated testing procedures. Your results are quickly available in your secure online account.

Testing is important.
Many STDs can cause serious health complications if they are left untreated. For example, untreated chlamydia and gonorrhea infections in females can lead to pelvic inflammatory disease (PID), and PID-associated infertility, and chronic pelvic pain. Complications in males include epididymitis and prostatitis (1).

Some STD infections during pregnancy are particularly dangerous. For example, syphilis during pregnancy is associated with miscarriage, stillbirth, or infant death shortly after delivery in up to 40% of cases. Congenital syphilis occurs when an infected pregnant woman passes syphilis to her baby during pregnancy. For infected infants, treatment must begin immediately to prevent developmental delays, seizures, and other fatal complications (2).

In addition, if you have an STD (even if asymptomatic), it can increase the risk of contracting another STD, which may be more serious. For example, trichomoniasis infections are associated with a two to three-fold increased risk of HIV (3).

CDC recommendations for STD testing include (4):

  • Annual screening for chlamydia and gonorrhea in females 25 years and younger
  • Screening for chlamydia and gonorrhea during each pregnancy
  • Routine screening for chlamydia in men who have sex with men and high-prevalence settings
  • Annual screening for gonorrhea in males 25 years and younger
  • Screening for trichomoniasis in females with abnormal vaginal discharge
  • HIV testing at least once for everyone 13 – 64 years, with annual screening in higher-risk populations and screening during each pregnancy
  • Anybody potentially exposed to HIV should be tested immediately and again at six weeks, three months, and six months post-exposure
  • Hepatitis B testing in individuals born in countries with high prevalence, as well as during pregnancy and in high-risk populations
  • Hepatitis C testing at least once and during each pregnancy (except in populations where the prevalence of HCV is less than 0.1%), as well as routine testing in high-risk populations
  • Syphilis testing in anyone showing suggestive signs of syphilis, as well as during pregnancy and in high-risk populations

References:
1. Farley TA, Cohen DA, & Elkins W (2003). Asymptomatic sexually transmitted diseases: the case for screening. Prev Med, 36 (4), 502-509.
2. 2015 STD Treatment Guidelines Syphilis. CDC 2015, June 4.
3. Trichomoniasis Fact Sheet. CDC Feb 2020.
4. Workowski KA & Bolan GA (2015) Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep, 64 (RR-03), 1-137.

Vitamins and Minerals

Signs of vitamin D deficiency

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What is vitamin D?
Vitamin D is the “sunshine vitamin”. It acquired this nickname due to our body’s ability to synthesize vitamin D when the skin is exposed to sunshine. Vitamin D is also naturally present in a few foods and in fortified foods (1).

Vitamin D is a fat-soluble vitamin. It is essential for strong bones, as it promotes calcium absorption and maintains adequate serum calcium and phosphate concentrations for normal bone mineralization. Vitamin D also plays roles in controlling inflammation and cell growth, glucose (blood sugar) metabolism, and neuromuscular and immune function (2).

What are the symptoms of vitamin D deficiency?
Vitamin D deficiency can cause a range of symptoms, including:

  • Fatigue
  • Bone pain
  • Muscle weakness, aches, and cramping
  • Mood changes, e.g., depression

In children, rickets can occur as a result of long-term vitamin D deficiency (3). Rickets is now a rare disorder, which is characterized by soft and weak bones, which can cause a range of symptoms, including:

  • Skeletal deformities, such as bowed legs and thick wrists or ankles
  • Failure to thrive
  • Physical developmental delay
  • Dental abnormalities
  • Delayed motor skills
  • Muscle weakness
  • Bone pain, particularly in the legs, pelvis, and spine

In adults and adolescents, long-term vitamin D deficiency can also lead to osteomalacia, which is also characterized by soft and weak bones. Although adult bones are completely formed, they still undergo a constant remodeling process, and vitamin D deficiency causes defective bone mineralization during this process. Osteomalacia often doesn’t have any noticeable symptoms in the early stages, but eventually can lead to serious muscle weakness and bone pain, particularly in the legs, pelvis, and spine (3).

Vitamin D acts on cells throughout the body by binding to a specific receptor located on the cell surface. These receptors are present on almost all body cells. This means that vitamin D deficiency can also increase the risk of many other health complications (4), including:

  • Insulin resistance, high blood glucose, and diabetes
  • Obesity
  • Hypertension
  • Cardiovascular disease
  • Inflammatory diseases
  • Asthma in children
  • Specific cancers
  • Cognitive impairment and depression

There is even a possible link between vitamin D and COVID-19. Although evidence is a bit mixed and sparse, there may be a link between low vitamin D levels and an increased risk of serious health complications during a COVID-19 infection (5). Vitamin D deficiency is more common in obese and diabetic people, and it is these same populations that are associated with higher mortality in COVID-19 (6).

Whether or not the link between vitamin D deficiency and COVID-19 complications proves to be correct, ensuring you have adequate vitamin D levels is going to be beneficial to your overall health. Take our easy-to-use at-home Vitamin D Test to see if you have healthy vitamin D levels.

Vitamin D supplements are readily available if you are needing more, but be careful not to over-supplement, as vitamin D toxicity is possible (although very rare).

References:
1. Vitamin D: Fact Sheet for Health Professionals (2020, October 9). NIH
2. Jones G. (2014). Vitamin D. In A. C. Ross, B. Caballero, R. J. Cousins, K. L. Tucker, & T. R. Ziegler, Modern Nutrition in Health and Disease (11th ed). Philadelphia: Lippincott Williams & Wilkins.
3. Uday S, & Högler W. (2017). Nutritional Rickets and Osteomalacia in the Twenty-first Century: Revised Concepts, Public Health, and Prevention Strategies. Curr Osteoporos Rep, 15(4), 293-302.
4. Vitamin D Fact Sheet for Health Professionals. (Updated August 2021). National Institutes of Health, Office of Dietary Supplements.
5. Rubin R. (2021) Sorting out whether vitamin D deficiency raises COVID-19 risk. JAMA. 325(4), 329-330.
6. Weir EK et al. (2020) Does vitamin D deficiency increase the severity of COVID-19? Clin Med (Lond). 20(4), e107-e108.

Heart Health and Diabetes

What are the signs and symptoms of atherosclerosis?

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What is atherosclerosis?
Atherosclerosis is a condition that develops when fats, cholesterol, calcium, and other substances build up in and on the artery walls. This plaque formation narrows the arteries, making it harder for oxygen-rich blood to flow through. When an area of plaque ruptures, platelets can stick to the site of injury and form a blood clot, which further narrows the artery. In addition, this blood clot may break free and cause a blockage elsewhere in the body.

What causes atherosclerosis?
Atherosclerosis is caused by elevated cholesterol levels, particularly high levels of LDL cholesterol. LDL cholesterol is known as “bad” cholesterol, as it is the cholesterol carried by LDL particles and tends to get deposited around the body. In contrast, HDL cholesterol is considered “good” cholesterol, as the HDL particles collect cholesterol from around the body and deliver it to the body for recycling or excretion.

There are many factors that can contribute to elevated LDL cholesterol levels. People with certain genotypes have an increased risk, males generally have higher levels than females, and older people tend to have higher levels. Other contributing factors include excess alcohol consumption, a high-fat diet, low physical activity, and being overweight or obese.

Early changes from atherosclerosis
Sometimes the early atherosclerotic changes are called “silent” symptoms, as they often do undetected. High cholesterol levels can result in fatty deposits building up in the blood vessels, resulting in the formation of plaques that damage and decrease the diameter of the blood vessels. These plaques cause hardening of the arteries and blood clots often form in these narrowed blood vessels.

Painful symptoms
Atherosclerosis can severely decrease blood flow to certain tissues, and this is when individuals start to feel the effects of high cholesterol levels. Peripheral vascular disease occurs when a blood vessel is severely restricted in an arm, leg, or organs below the stomach. This causes extreme pain and cramping in the affected area, and can lead to ulcers, gangrene, and other infections. If the blood flow restriction occurs in the chest area, angina (chest pain) occurs. This pain is felt as a squeezing, suffocating, or burning feeling. Although angina is not a heart attack, it is a warning sign of an increased risk of a heart attack, and immediate medical attention should be received.

Serious symptoms
If atherosclerosis and associated blood clot occur in one of the blood vessels in the heart, the blood flow can be completely blocked. This is what occurs during a myocardial infarction (heart attack). The heart tissue usually supplied by the blocked blood vessel suddenly loses its blood and oxygen supply and can quickly die if the blockage is not removed. The severity of the heart attack depends on which blood vessel has been blocked. If the blockage occurs in a main coronary artery, a large area of heart tissue will be affected and a more serious heart attack occurs, with more severe consequences. If a smaller artery is blocked, less tissue damage occurs and the expected recovery is less complicated.

Heart attacks require immediate medical attention and no one should “tough out” a heart attack. The most common symptom of a heart attack is chest pain, which may extend to other upper body areas (shoulders, arms, back, neck, etc.). Some people experience severe unexplained pain in the upper body but do not actually experience any chest pain. Other symptoms include stomach pain, nausea, shortness of breath, anxiety, sweating, and dizziness. Often the symptoms are only mild to start, but if there is any suspicion of a heart attack, immediate medical attention is essential to minimize further complications.

If a blood vessel within the brain or supplying blood to the brain is blocked due to atherosclerosis and a blood clot, an atherothrombotic stroke occurs. Alternatively, a piece of plaque or blood clot can break loose from an atherosclerotic vessel in another part of the body and travel to the brain, and cause a blockage in a blood vessel in the brain. This is known as a cerebral embolism. Both stroke types result in the death of brain tissue in the regions lacking blood and oxygen supply due to the blood vessel blockage. Further brain damage (often after the stroke has occurred) can also occur due to the excessive accumulation of fluid in the brain, known as cerebral edema.

Immediate medical attention is essential for any indications of a stroke. The signs of a stroke occur very suddenly. They include numbness or weakness in the face or body, (especially on one side), confusion and trouble understanding or speaking, difficulty seeing out of one or both eyes, dizziness, loss of balance, and a severe headache. Not everyone will suffer from all of these symptoms, but if there is any possibility of a stroke, immediate medical attention must be received.

References:
1. Mozaffarian D, Benjamin EJ, Go AS, et al. (2015). Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 131: e29-322.
2. What is Cardiovascular Disease? American Heart Association.
3. Heart Disease in Women. National Heart, Lung and Blood Institute

Syphilis

Syphilis Quick Facts

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What is syphilis?
Syphilis is a sexually transmitted disease, which has been called “The Great Pretender”, as symptoms can resemble other diseases. Syphilis is primarily transmitted during sexual contact, or during pregnancy or childbirth from an infected mother to her infant (1).

What causes syphilis?
Syphilis is caused by infection with the bacterium Treponema pallidum subspecies pallidum.

What are the symptoms of syphilis?
Untreated syphilis infections have four distinct stages.

Primary syphilis is characterized by a skin lesion, called a chancre, which appears 10-90 days after infection. It can be a single chancre or multiple chancres may form (1). Chancres last 3-6 weeks and health whether or not treatment is received. If untreated, the infection progresses to the secondary stage (2).

Skin rashes and/or lesions in the mouth, vagina, or anus occur during the secondary stage of infection. Additional symptoms in the secondary stage can include fever, sore throat, hair loss, weight loss, swollen lymph glands, headaches, muscle aches, and fatigue (1). Like the primary symptoms, secondary symptoms will also disappear whether or not treatment is received. However, the syphilis infection will progress to the latent stage if adequate treatment does not occur (2).

The latent stage is not associated with any symptoms, except the syphilis-causing bacterium is still present. During the early latent stage, transmission can still occur. The latent stage can last for many years, with 15-40% of untreated individuals developing tertiary syphilis (3).

In some cases, the latent stage progresses to a potentially fatal tertiary stage. This can occur 10-30 years or more after acquiring a syphilis infection. Multiple different organ systems can be affected including the brain, nerves, eyes, heart, liver, bones, and joints.

Who is at risk of syphilis?
The primary high-risk populations for syphilis are men who have sex with men, and HIV-positive individuals. Other high-risk populations include individuals who have been incarcerated, sex workers, and members of certain racial groups (4).

How is syphilis diagnosed?
Syphilis diagnosis is by two types of laboratory analyses of a blood sample – nontreponemal and treponemal tests. Both are required for an accurate diagnosis.

How is syphilis treated?
Primary, secondary, and early latent stage syphilis (infection within 2 years) is treated with a single intramuscular dose of Benzathine penicillin G. Late latent stage syphilis (more than 2 years after original infection) requires three intramuscular doses of Benzathine penicillin G at weekly intervals (5).

References:
1. Kent ME & Romanelli F (2008). Reexamining syphilis: an update on epidemiology, clinical manifestations, and management. Ann Pharma, 42 (2), 226-236.
2. Syphilis – CDC Fact Sheet (Detailed). (2017, January).
3. Peeling RW, et al. (2017). Syphilis. Nat Rev Dis Primers, 3(17073).
4. Schwenk TL (2016, June 9). Screening High-Risk Populations for Syphilis. NEJM Journal Watch.
5. Workowski KA & Bolan GA (2015) Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep, 64 (RR-03), 1-137.

HIV

What is the difference between HIV and AIDS?

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HIV refers to the human immunodeficiency virus, which is a viral infection that targets the body’s immune system. If HIV is untreated, it can progress to acquired immunodeficiency syndrome (AIDS) (1).

HIV can be transmitted through certain bodily fluids (blood, semen, pre-seminal fluid, vaginal and rectal fluids, and breast milk). HIV is most commonly spread through vaginal or anal sex, or sharing needles, syringes, and other drug equipment. It can also be spread from a mother to her baby during pregnancy, childbirth, or breastfeeding (2).

Although there is no cure for HIV, there are effective medications (antiretroviral therapy, ART) to control the virus infection. ART slows down the replication of the virus to stop the disease from progressing and also prevents transmission to others (2).

There are three typical stages of an HIV infection (3).

  • Acute infection is when HIV is most infectious, although many people may not show any symptoms or only mild symptoms that are easily confused with other illnesses.
  • The second stage can be known as chronic infection, clinical latency, or asymptomatic HIV infection, as most individuals do not show any symptoms.
  • However, if HIV is left untreated, the damage to the body’s immune system gradually gets worse and worse and leads to the third stage known as acquired immunodeficiency syndrome (AIDS).

AIDS occurs due to the serious damage to the immune system caused by HIV. Symptoms can include rapid weight loss, extreme fatigue, depression, pneumonia, and increased susceptibility to other infections such as tuberculosis, severe bacterial infections, and certain cancers.

HIV disease progression can vary widely. Typically, untreated HIV infections progress to AIDS in 8-10 years, but it can be shorter or longer for some people. Most of those with untreated AIDS only survive about three years or less, depending on opportunistic infections and cancers (2).

References:
1. Weiss RA. (1993) How does HIV cause AIDS? Science, 260 (5112), 1273-1279.
2. HIV/AIDS. World Health Organization.
3. Symptoms of HIV. Clinical Info HIV.gov. July 2020.

Posted in HIV
Chlamydia and Gonorrhea

Gonorrhea Quick Facts

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What is gonorrhea?
Gonorrhea is a common sexually transmitted disease (STD) that is spread through sexual contact with the penis, vagina, mouth, or anus of an infected individual. Gonorrhea can also be transmitted from a mother with an untreated cervical infection to her newborn during childbirth (1).

What causes gonorrhea?
Gonorrhea is caused by infection with the bacterium Neisseria gonorrhoeae.

What are the symptoms of gonorrhea?
Males may exhibit symptoms of a gonorrheal infection; however, most infected females remain asymptomatic, with an estimated 85-90% of infected males showing symptoms and only ~20% of infected females (2) If symptoms occur, it’s usually 1-3 weeks after exposure. Symptoms can include:

  • Abnormal vaginal discharge
  • Bleeding between periods and/or after sexual intercourse
  • Increased urinary frequency
  • Dysuria – painful urination
  • Pain during sexual intercourse
  • Abdominal and/or pelvic pain
  • Urethral discharge
  • Testicular pain
  • Burning or itching in the urethra

Gonorrhea can also affect the rectum, resulting in rectal pain, discharge, and bleeding (3), and the throat, which may cause a sore throat (4).

Who is at risk of gonorrhea?
Any sexually active individual is at risk of gonorrheal infection, with an increased risk among younger individuals. Gonorrhea is a common STD in the United States with 583,405 cases reported to the CDC in 2018 (5).

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

How is gonorrhea treated?
Dual antibiotic treatment was previously recommended for gonorrhea infections due to antimicrobial resistance (6). However, due to other health concerns, now only ceftriaxone is recommended for treating gonorrhea in the United States (7). Repeat gonorrheal infections from sexual contact with an infected partner are common, increasing the risk of serious reproductive health complications. Antibiotics do not repair any permanent damage done by the disease (6).

References:
1. Sexually Transmitted Disease Surveillance, 2018. CDC. October 2019.
2. Gonorrhea Gonococcal Infection (clap, drip). New York State Department of Health. November 2006.
3. Klein EJ, et al. (1977). Anorectal gonococcal infection. Ann Intern Med, 86 (3), 340-346.
4. Wiesner PJ, et al. (1973). Clinical Spectrum of Pharyngeal Gonococcal Infection. N Engl J Med, 288 (4), 181-185.
5. Sexually transmitted Disease Surveillance 2018, Gonorrhea. CDC October 2019.
6. Workowski KA & Bolan GA (2015) Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep, 64 (RR-03), 1-137.
7. Gonococcal Infections Among Adolescents and Adults. Sexually Transmitted Infections Treatment Guidelines, 2021. (Reviewed July 2021).CDC.

Sexual Health

How common are STDs?

Posted on by dnaserver

Sexually transmitted diseases (STDs) can also be known as sexually transmitted infections (STIs). They are infections that are usually spread from person to person during vaginal, anal, and oral sex.

Many STDs are quite common with the CDC estimating there were 26 million new STDs in 2018 in the United States, with almost half of new STDs among youth aged 15 – 24 years (1).

The most common STDs are chlamydia, gonorrhea, trichomoniasis, and syphilis. Other STDs that we also offer at-home testing for are hepatitis B, hepatitis C, and HIV.

Chlamydia
Chlamydia is caused by infection with the bacterium Chlamydia trachomatis.

Over 1.7 million cases of chlamydia were reported to the CDC in 2018, with an increase to over 1.8 million reported cases in 2019. However, actual annual chlamydia cases are estimated to be closer to 2.86 million (1).

50-60% of new chlamydia infections occur in individuals aged between 15 and 24 years. Reported chlamydia rates are approximately two times higher in females compared to males (2). The prevalence of chlamydia varies between racial and ethnic groups, with significantly higher rates among blacks compared to whites (2).

Chlamydia is easily treated with oral antibiotics (3).

Gonorrhea
Gonorrhea is caused by infection with the bacterium Neisseria gonorrhoeae.

There were 583,405 cases of gonorrhea reported to the CDC in 2018, and 616,392 reported cases in 2019 (1).

50-60% of new gonorrhea infections occur in individuals aged between 15 and 24 years. Reported gonorrhea rates are higher in males than females (2). The prevalence of gonorrhea varies between racial and ethnic groups, with significantly higher rates among blacks compared to whites (2).

Dual antibiotic treatment was previously recommended for gonorrhea infections due to antimicrobial resistance (3). However, due to other health concerns, now only ceftriaxone is recommended for treating gonorrhea in the United States (4).

Trichomoniasis
Trichomoniasis is caused by infection with a protozoan parasite called Trichomonas vaginalis.

As of 2018, there are an estimated 2.6 million individuals with trichomoniasis in the United States (1).

Trichomoniasis prevalence is significantly higher among African American females (9.6-13%), compared to Hispanic (1.4%) and non-Hispanic white females (0.8-1.8%) (5).

Prescription antibiotics are an effective treatment for trichomoniasis (3).

Syphilis
Syphilis is caused by the bacterium Treponema pallidum subspecies pallidum. It has been called “The Great Pretender”, as symptoms can resemble other diseases. If syphilis is untreated it can cause serious health complications.

In 2018, there were 115,045 new syphilis cases reported in the United States. In 2019, this increased to 129,813 reported cases of all stages of syphilis, including 38,992 cases of primary and secondary syphilis, which are the most infectious stages of the disease. In 2019, there were 1,870 reported cases of congenital syphilis (when the fetus acquires syphilis before birth) (1).

Primary, secondary, and early latent stage syphilis (infection within 2 years) is treated with a single intramuscular dose of Benzathine penicillin G. Late latent stage syphilis (more than 2 years after original infection) requires three intramuscular doses of Benzathine penicillin G at weekly intervals (3).

Hepatitis B
Hepatitis refers to inflammation and damage to the liver. The most common causes of hepatitis are three viruses known as hepatitis A, B, and C. The hepatitis B virus is a major global health problem that can cause both acute (short-term) and chronic (long-term) diseases.

Hepatitis B is most prevalent in the western Pacific region and in Africa, where at least 6% of the adult population is infected. In the United States, a total of 3,322 cases of acute hepatitis B were reported to CDC in 2018, but actual estimates were closer to 21,600 (6).

There are no specific treatments for an acute hepatitis B infection with most adults not showing any symptoms and not progressing to chronic infection (7). 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 the virus, thereby slowing the progression of cirrhosis and reducing the risk of liver cancer, but they generally do not cure an infection, so must continue for life (7).

Prevention is the best option to avoid hepatitis B, as a very effective and safe vaccine is available (7).

Hepatitis C
Hepatitis refers to inflammation and damage to the liver. The most common causes of hepatitis are three viruses known as hepatitis A, B, and C. The hepatitis C virus causes acute (short-term) infections in some individuals, but in most individuals, the virus remains in the body causing serious chronic (long-term) infection.

In 2018, there were 3,621 new cases of hepatitis C reported to the CDC. However, actual estimates are closer to 50,300 new cases during 2018 (8). During 2013-2016, there were an estimated 2.4 million individuals in the United States with chronic hepatitis C (9). In 2018, there were 15,713 US death certificates with HCV recorded as an underlying or contributing cause of death (7), but actual numbers are estimated to be considerably higher (10).

Hepatitis C is treated with antiviral medications to eliminate the virus from the body. Newly developed “direct-acting” antivirals have improved treatment considerably with fewer side effects and shorter treatment periods. Nowadays, over 90% of individuals infected with hepatitis C can be cured with 8-12 weeks of oral therapy (11).

HIV
Human immunodeficiency virus (HIV) is a sexually transmitted infection, which occurs by contact or transfer of blood, semen, pre-ejaculate, and vaginal fluids. There are two types of HIV. HIV-1 is the virus that was initially discovered. It is more virulent and infective than HIV-2 and is associated with most of the HIV infections around the world. HIV-2 is not transmitted as easily and is predominantly confined to infections in West Africa (12).

An estimated 38 million individuals worldwide were living with HIV at the end of 2019 (12). In the United States, there were an estimated 1.2 million individuals living with HIV, with approximately 14% being unaware of their HIV status.

Although there is no cure for HIV, effective antiretroviral therapy (ART) ensures that infected individuals can live relatively normal lives and prevents the transmission of HIV.

References:
1.Sexually Transmitted Infections Prevalence, Incidence, and Cost Estimates in the United States. CDC Jan 25 2021
2. Sexually Transmitted Disease Surveillance, 2018. CDC
3. Workowski KA & Bolan GA (2015) Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep, 64 (RR-03), 1-137.
4. Gonococcal Infections Among Adolescents and Adults. Sexually Transmitted Infections Treatment Guidelines, 2021. (Reviewed July 2021).CDC.
5. Trichomoniasis Statistics. CDC Feb 27 2020.
6. Viral hepatitis surveillance—United States, 2017. CDC
7. Hepatitis B, World Health Organization. July 2020
8. Viral Hepatitis Surveillance Report 2018 — Hepatitis C. CDC. August 2020
9. Hofmeister MG, et al. (2019) Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013-2016. Hepatology, 69 (3), 1020-1031.
10. Mahajan R, et al. (2014) Mortality among persons in care with hepatitis C virus infection: The Chronic Hepatitis Cohort Study (CHeCS), 2006-2010. Clin Infect Dis, 58 (8), 1055-1061.
11. Initial Treatment of Adults with HCV Infection. August 2020
12. HIV/AIDS. World Health Organization.

Vitamins and Minerals, Women's Health

The importance of folate

Posted on by dnaserver

What is folate? And folic acid?
Folate is an important nutrient that is naturally present in many foods. Folic acid is the synthetic version (lab-made version) of folate that is added to enriched foods and is available as a dietary supplement.

Folate functions as a coenzyme. Enzymes are biological molecules that speed up reactions in the body and coenzymes are important for the full functionality of these enzymes. Without enough coenzymes (e.g. folate), multiple reactions in the body would slow down and things won’t function how they should.

Folate is important for the formation of DNA and RNA, the formation of neurotransmitters, the metabolism of amino acids, and the proper formation of the nervous system (1). So, in other words, absolutely essential for a healthy normally functioning body!

What are common sources of folate?
Folate is naturally present in a wide variety of foods, including vegetables, fruits, nuts, beans, seafood, eggs, dairy products, poultry, and grains. Folic acid is obtained as a dietary supplement and also from enriched bread, cereals, flours, cornmeal, pasta, rice, and other grain products, due to mandatory folic acid fortification programs in the United States (2).

How much folate do I need?
Folic acid has higher bioavailability than food folate, which means that the body can utilize a larger proportion of folic acid compared to food folate. At least 85% of folic acid is estimated to be bioavailable, while only approximately 50% of food folate is bioavailable (3). For this reason, recommended folate intakes are listed as dietary folate equivalents (DFE). 1 mcg DFE is equal to 1 mcg of folate from a food source, or 0.5-0.6 mcg folic acid from fortified foods or supplements.

Folate requirements vary depending on age and pregnancy/breastfeeding status (1):

  • Infants under 6 months require 65 mcg DFE per day
  • Infants 7-12 months require 80 mcg DFE per day
  • Toddlers 1-3 years require 150 mcg DFE per day
  • Recommendations gradually increase through childhood until the adult value of 400 mcg DFE per day by 14 years of age
  • Pregnant women should obtain 600 mcg DFE each day
  • Breastfeeding women should obtain 500 mcg DFE each day

Why do pregnant women need more folate?
Folate is essential for the proper formation of DNA—the genetic code providing instructions for everything in our body! During pregnancy, another entire human is being created, so there are added demands for many nutrients, in particular folate.

Females with low folate intake are at increased risk of giving birth to infants with neural tube defects, low birth weights, preterm delivery, and fetal growth retardation (3).

It is recommended that the added requirement during pregnancy and breastfeeding is obtained from dietary supplements as folic acid alone or as part of a prenatal vitamin.

What happens if I don’t obtain enough folate?
The total body content of folate is estimated to be 15-30 mg, with approximately half of this stored in the liver, and the remainder in blood and other tissues (3). Folate deficiency is typically associated with serum levels less than 3.5 ng/mL or whole blood levels less than 150 ng/mL. Folate deficiency usually occurs due to poor diet, alcoholism, and malabsorptive disorders (4).

The primary clinical sign of deficiency is megaloblastic anemia. This occurs because a folate deficiency means that new red blood cells are not generating as quickly as they should be, so there are fewer red blood cells to transport oxygen around the body (1). Anemia is characterized by:

  • Weakness
  • Fatigue
  • Difficulty concentrating
  • Irritability
  • Headaches
  • Heart palpitations
  • Shortness of breath

Folate deficiency is also linked to depression and mental fatigue. This is because folate is important for the proper functioning and formation of neurotransmitters in the brain. Neurotransmitters are chemical messengers that are required to pass signals between nerve fibers in the brain.

Serotonin and dopamine are two important neurotransmitters that contribute to a feeling of well-being and happiness—“feel-good hormones”! If you’re low in folate, these “feel-good hormones” don’t work as well as they should, and there is an increased risk of psychiatric conditions like depression (5).

Research shows that folic acid supplements can be effective at reducing depressive symptoms and improving brain function (6), as well as improving the effectiveness of other antidepressants (7).

Who is at increased risk of deficiency?
Folate deficiency can be more common in certain populations. Those that drink high amounts of alcohol are at increased risk, as alcohol inhibits proper folate absorption and increases the excretion of folate from the body too (3). People who have malabsorptive disorders, such as celiac disease and inflammatory bowel disease, are also at increased risk (4).

And, the most important risk group is pregnant women. This is due to the increased demands of the developing fetus. An entire new human is getting created, so understandably demands are high, and not just for folate either. Obtaining such high levels of folate and other nutrients can be difficult during pregnancy (especially if you’re unlucky enough to suffer from nausea too!) This is why all pregnant women, as well as those trying to conceive, should take vitamin supplements that include folic acid to reduce the risk of neural tube defects and other complications (1).

Conclusions
Folate is essential for the healthy functioning of your own brain and whole body, and the healthy development of a new baby for all those pregnant females out there!

Do you know if you are getting enough? Our simple to use Folate Test can tell you if you are deficient. Or better yet, take our Nutritional Deficiency Test to measure your folate levels, as well as your vitamin B12, vitamin D, and iron levels too.

References:
1. Folate: Fact Sheet for Health Professionals. (2020, June 3). NIH
2. Food Standards: Amendment of Standards of Identity For Enriched Grain Products to Require Addition of Folic Acid. (1996, March 5). Federal Register, 61(44), 8781-8797.
3. Bailey LB, & Caudill MA. (2012). Folate. In J. W. Erdman, I. A. Macdonald, & S. H. Zeisel, Present Knowledge in Nutrition. Washington, DC: Wiley-Blackwell. 321-342.
4. Carmel R. (2005). Folic Acid. In M. Shils, M. Shike, A. Ross, B. Caballero, & R. J. Cousins, Modern Nutrition in Health and Disease. 11th ed., Baltimore: Lippincott Williams & Wilkins. 470-481.
5. Miller AL. (2008) The Methylation, Neurotransmitter, and Antioxidant Connections Between Folate and Depression. Alt Med Rev. 13(2), 216-226.
6. Folate. Mental Health America.
7. Coppen A, Bolander-Gouaille C. (2005) Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol. 19(1), 59-65.