Thursday, March 31, 2016

What is Aids

AIDS stands for acquired immunodeficiency syndrome:

A - Acquired. This condition is acquired, meaning that a person becomes infected with it.
I - Immuno. HIV affects a person's immune system, the part of the body that fights off germs such as bacteria or viruses.
D - Deficiency. The immune system becomes deficient and does not work properly.
S - Syndrome. A person with AIDS may experience other diseases and infections because of a weakened immune system.

AIDS can develop when HIV weakens a person’s immune system so their body is no longer able to protect itself against infections and diseases that a normal immune system would fight off.  As a result, an HIV positive person may show symptoms of different infections and diseases called opportunistic infections. When someone shows symptoms of one or more of these infections, they are considered to have AIDS. Different people with AIDS may experience different clinical problems, depending on what specific opportunistic infections they develop. People who are diagnosed with AIDS can recover and regain their health, but they will still be HIV positive.

Think of AIDS as advanced HIV disease. A person with AIDS has an immune system so weakened by HIV that the person usually becomes sick from one of several opportunistic infections or cancers such as PCP (a type of pneumonia) or KS (Kaposi sarcoma, a type of cancer that affects the skin and internal organs in HIV), wasting syndrome (involuntary weight loss), memory impairment, or tuberculosis. If someone with HIV is diagnosed with one of these opportunistic infections (even if the CD4 count is above 200), he or she is said to have AIDS. AIDS usually takes time to develop from the time a person acquires HIV--usually between 2 to 10 years or more.

Once a person has been diagnosed with AIDS, she or he is always considered to have AIDS, even if that person's CD4 count goes up again and/or they recover from the disease that defined their AIDS diagnosis.

Tuesday, March 29, 2016

What is HIV

HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome, or AIDS. Unlike some other viruses, the human body cannot get rid of HIV. That means that once you have HIV, you have it for life.

No safe and effective cure currently exists, but scientists are working hard to find one, and remain hopeful. Meanwhile, with proper medical care, HIV can be controlled. Treatment for HIV is often called antiretroviral therapy or ART. It can dramatically prolong the lives of many people infected with HIV and lower their chance of infecting others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can have a nearly normal life expectancy.

HIV affects specific cells of the immune system, called CD4 cells, or T cells. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. When this happens, HIV infection leads to AIDS.

HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome or AIDS if not treated. Unlike some other viruses, the human body can’t get rid of HIV completely, even with treatment. So once you get HIV, you have it for life.

HIV attacks the body’s immune system, specifically the CD4 cells (T cells), which help the immune system fight off infections. Untreated, HIV reduces the number of CD4 cells (T cells) in the body, making the person more likely to get other infections or infection-related cancers. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. These opportunistic infections or cancers take advantage of a very weak immune system and signal that the person has AIDS, the last stage of HIV infection.

No effective cure currently exists, but with proper medical care, HIV can be controlled. The medicine used to treat HIV is called antiretroviral therapy or ART. If taken the right way, every day, this medicine can dramatically prolong the lives of many people infected with HIV, keep them healthy, and greatly lower their chance of infecting others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.

AIDS stands for Acquired Immune Deficiency Syndrome and is caused by HIV. The names HIV and AIDS can be confusing because both terms describe the same disease. Think of AIDS as advanced HIV disease. A person with AIDS has an immune system so weakened by HIV that the person usually becomes sick from one of several opportunistic infections or cancers such as PCP (a type of pneumonia) or KS (Kaposi sarcoma, a type of cancer that affects the skin and internal organs in HIV), wasting syndrome (involuntary weight loss), memory impairment, or tuberculosis. If someone with HIV is diagnosed with one of these opportunistic infections (even if the CD4 count is above 200), he or she is said to have AIDS. AIDS usually takes time to develop from the time a person acquires HIV--usually between 2 to 10 years or more.

Once a person has been diagnosed with AIDS, she or he is always considered to have AIDS, even if that person's CD4 count goes up again and/or they recover from the disease that defined their AIDS diagnosis.

Tuesday, March 22, 2016

Diagnosis and Prevention of Trichomoniasis

Trichomoniasis is a common cause of vaginitis. It is a sexually transmitted infection, and is caused by the single-celled protozoan parasite Trichomonas vaginalis producing mechanical stress on host cells and then ingesting cell fragments after cell death. Trichomoniasis is primarily an infection of the urogenital tract; the most common site of infection is the urethra and the vagina in women.

There were about 58 million cases of trichomoniasis in 2013

Signs and Symptoms
Most people infected with trichomonas vaginalis do not have any symptoms. Symptoms experienced include pain, burning or itching in the penis, urethra (urethritis), or vagina (vaginitis). Discomfort for both sexes may increase during intercourse and urination. For women there may also be a yellow-green, itchy, frothy, foul-smelling ("fishy" smell) vaginal discharge. In rare cases, lower abdominal pain can occur. Symptoms usually appear within 5 to 28 days of exposure

The human genital tract is the only reservoir for this species. Trichomonas is transmitted through sexual or genital contact.

Genetic sequence
A draft sequence of the Trichomonas genome was published on January 12, 2007 in the journal Science confirming that the genome has at least 26,000 genes, a similar number to the human genome. An additional ~35,000 unconfirmed genes, including thousands that are part of potential transposable elements, brings the gene content to well over 60,000.

There are three main ways to test for Trichomoniasis.

The first is known as saline microscopy. This is the most commonly used method and requires an endocervical, vaginal, or penile swab specimen for examination under a microscope. The presence of one or multiple trichomonads constitutes a positive result. This method is cheap but has a low sensitivity (60-70%) often due to an inadequate sample, resulting in false negatives.

The second diagnostic method is culture, (InPouch TV culture test, BioMed Diagnostics, San Jose, CA) which has historically been the “gold standard” in infectious disease diagnosis. Trichomonas Vaginalis culture tests are relatively cheap; however, sensitivity is still somewhat low (70-89%).

The third method includes the nucleic acid amplification tests (NAATs) which are more sensitive. These new NAATs include the Xpert TV (Cepheid, Sunnyvale, CA), APTIMA Trichomonas assay (Gen-Probe Inc, San Diego, CA) and the AFFIRM VPIII (BD Diagnostics, Sparks, MD). These tests are more costly than microscopy and culture, and are highly sensitive (80-90%).

Use of male condoms may help prevent the spread of trichomoniasis, although careful studies have never been done that focus on how to prevent this infection. Infection with Trichomoniasis through water is unlikely because Trichomonas vaginalis dies in water after 45–60 minutes, in thermal water after 30 minutes to 3 hours and in diluted urine after 5–6 hours.

Currently there are no routine standard screening requirements for the general U.S. population receiving family planning or STI testing. The Centers for Disease Control and Prevention (CDC) recommends Trichomoniasis testing for females with vaginal discharge and can be considered for females at higher risk for infection or of HIV-positive serostatus.

The advent of new, highly specific and sensitive trichomoniasis tests present opportunities for new screening protocols for both men and women. Careful planning, discussion, and research are required to determine the cost-efficiency and most beneficial use of these new tests for the diagnosis and treatment of trichomoniasis in the U.S., which can lead to better prevention efforts.

A number of strategies have been found to improve follow-up for STI testing including email and text messaging as reminders of appointments.

Treatment for both pregnant and non-pregnant patients usually utilizes metronidazole (Flagyl), 2000 mg by mouth once. Caution should be used in pregnancy, especially in the first trimester. Sexual partners, even if asymptomatic, should also be treated.

For 95-97% of cases, infection is resolved after one dose of metronidazole. Studies suggest that 4-5% of trichomonas cases are resistant to metronidazole, which may account for some “repeat” cases. Without treatment, trichomoniasis can persist for months to years in women, and is thought to improve without treatment in men. Women living with HIV infection have better cure rates if treated for 7 days rather than with one dose.

Evidence from a randomized controlled trials for screening pregnant women who do not have symptoms for infection with trichomoniasis and treating women who test positive for the infection have not consistently shown a reduced risk of preterm birth. Further studies are needed to verify this result and determine the best method of screening. In the US, screening of pregnant women without any symptoms is only recommended in those with HIV as trichomonas infection is associated with increased risk of transmitting HIV to the fetus.

Saturday, March 19, 2016

Chlamydia Symptoms and Treatment

Chlamydia infection is a common sexually transmitted infection in humans caused by the bacterium Chlamydia trachomatis. The term Chlamydia infection can also refer to infection caused by any species belonging to the bacterial family Chlamydiaceae. C. trachomatis is found only in humans. Chlamydia is a major infectious cause of human genital and eye disease. Chlamydia conjunctivitis or trachoma is a common cause of blindness worldwide. The World Health Organization (WHO) estimates that it accounted for 15% of blindness cases in 1995, but only 3.6% in 2002.

Chlamydia can be spread during vaginal, anal, or oral sex, and can be passed from an infected mother to her baby during childbirth. Between half and three-quarters of all women who have a chlamydial infection of the cervix have an inflamed cervix without symptoms and may not realize they are infected. In men, infection by C. trachomatis can lead to inflammation of the penile urethra causing a white discharge from the penis with or without a burning sensation during urination. Occasionally, the condition spreads to the upper genital tract in women (causing pelvic inflammatory disease) or to the epididymis in men (causing inflammation of the epididymis). C. trachomatis is naturally found living only inside human cells.

Chlamydia infection can be effectively cured with antibiotics. If left untreated, chlamydial infections can cause serious reproductive and other health problems with both short-term and long-term consequences. Research is ongoing in the prevention of this infection.

Chlamydia infection is one of the most common sexually transmitted infections worldwide. In 2013 about 141 million cases occurred. In the United States about 1 million individuals are infected with chlamydia. The word chlamydia is from the Greek, meaning "cloak".

Signs and symptoms
Genital disease

Chlamydial infection of the neck of the womb (cervicitis) is a sexually transmitted infection which is asymptomatic for 50–70% of women infected with the disease. The infection can be passed through vaginal, anal, or oral sex. Of those who have an asymptomatic infection that is not detected by their doctor, approximately half will develop pelvic inflammatory disease (PID), a generic term for infection of the uterus, fallopian tubes, and/or ovaries. PID can cause scarring inside the reproductive organs, which can later cause serious complications, including chronic pelvic pain, difficulty becoming pregnant, ectopic (tubal) pregnancy, and other dangerous complications of pregnancy.

Chlamydia is known as the "silent epidemic" as in women, it may not cause any symptoms in 70–80% of cases, and can linger for months or years before being discovered. Signs and symptoms may include abnormal vaginal bleeding or discharge, abdominal pain, painful sexual intercourse, fever, painful urination or the urge to urinate more often than usual (urinary urgency).

For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection. Risk factors include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, and inconsistent condom use. Guidelines recommend all women attending for emergency contraceptive are offered Chlamydia testing, with studies showing up to 9% of women aged <25 chlamydia.="" had="" p="" years="">

In men, those with a chlamydial infection show symptoms of infectious inflammation of the urethra in about 50% of cases. Symptoms that may occur include: a painful or burning sensation when urinating, an unusual discharge from the penis, testicular pain or swelling, or fever. If left untreated, chlamydia in men can spread to the testicles causing epididymitis, which in rare cases can lead to sterility if not treated. Chlamydia is also a potential cause of prostatic inflammation in men, although the exact relevance in prostatitis is difficult to ascertain due to possible contamination from urethritis

Eye disease
Chlamydia conjunctivitis or trachoma was once the most important cause of blindness worldwide, but its role diminished from 15% of blindness cases by trachoma in 1995 to 3.6% in 2002. The infection can be spread from eye to eye by fingers, shared towels or cloths, coughing and sneezing and eye-seeking flies. Newborns can also develop chlamydia eye infection through childbirth . Using the SAFE strategy (acronym for surgery for in-growing or in-turned lashes, antibiotics, facial cleanliness, and environmental improvements), the World Health Organization aims for the global elimination of trachoma by 2020

Chlamydia may also cause reactive arthritis—the triad of arthritis, conjunctivitis and urethral inflammation—especially in young men. About 15,000 men develop reactive arthritis due to chlamydia infection each year in the U.S., and about 5,000 are permanently affected by it. It can occur in both sexes, though is more common in men.

As many as half of all infants born to mothers with chlamydia will be born with the disease. Chlamydia can affect infants by causing spontaneous abortion; premature birth; conjunctivitis, which may lead to blindness; and pneumonia. Conjunctivitis due to chlamydia typically occurs one week after birth (compared with chemical causes (within hours) or gonorrhea (2–5 days)).

Other conditions
A different serovar of Chlamydia trachomatis is also the cause of lymphogranuloma venereum, an infection of the lymph nodes and lymphatics. It usually presents with genital ulceration and swollen lymph nodes in the groin, but it may also manifest as rectal inflammation, fever or swollen lymph nodes in other regions of the body.

Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.

Chlamydiae have the ability to establish long-term associations with host cells. When an infected host cell is starved for various nutrients such as amino acids (for example, tryptophan), iron, or vitamins, this has a negative consequence for Chlamydiae since the organism is dependent on the host cell for these nutrients. Long-term cohort studies indicate that approximately 50% of those infected clear within a year, 80% within two years, and 90% within three years.

The starved chlamydiae enter a persistent growth state wherein they stop cell division and become morphologically aberrant by increasing in size. Persistent organisms remain viable as they are capable of returning to a normal growth state once conditions in the host cell improve.

There is much debate as to whether persistence has in vivo relevance. Many believe that persistent chlamydiae are the cause of chronic chlamydial diseases. Some antibiotics such as ß-lactams can also induce a persistent-like growth state, which can contribute to the chronicity of chlamydial diseases.

The diagnosis of genital chlamydial infections evolved rapidly from the 1990s through 2006. Nucleic acid amplification tests (NAAT), such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement amplification (SDA) now are the mainstays. NAAT for chlamydia may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine. NAAT has been estimated to have a sensitivity of approximately 90% and a specificity of approximately 99%, regardless of sampling from a cervical swab or by urine specimen. In women seeking an STI clinic and a urine test is negative, a subsequent cervical swab has been estimated to be positive in approximately 2% of the time.

At present, the NAATs have regulatory approval only for testing urogenital specimens, although rapidly evolving research indicates that they may give reliable results on rectal specimens.

Because of improved test accuracy, ease of specimen management, convenience in specimen management, and ease of screening sexually active men and women, the NAATs have largely replaced culture, the historic gold standard for chlamydia diagnosis, and the non-amplified probe tests. The latter test is relatively insensitive, successfully detecting only 60–80% of infections in asymptomatic women, and often giving falsely positive results. Culture remains useful in selected circumstances and is currently the only assay approved for testing non-genital specimens.

For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection. Risk factors include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, and inconsistent condom use. For pregnant women, guidelines vary: screening women with age or other risk factors is recommended by the U.S. Preventive Services Task Force (USPSTF) (which recommends screening women under 25) and the American Academy of Family Physicians (which recommends screening women aged 25 or younger). The American College of Obstetricians and Gynecologists recommends screening all at risk, while the Centers for Disease Control and Prevention recommend universal screening of pregnant women. The USPSTF acknowledges that in some communities there may be other risk factors for infection, such as ethnicity. Evidence-based recommendations for screening initiation, intervals and termination are currently not possible. For men, the USPSTF concludes evidence is currently insufficient to determine if regular screening of men for chlamydia is beneficial. They recommend regular screening of men who are at increased risk for HIV or syphilis infection.

In the United Kingdom the National Health Service (NHS) aims to:

Prevent and control chlamydia infection through early detection and treatment of asymptomatic infection;
Reduce onward transmission to sexual partners;
Prevent the consequences of untreated infection;
Test at least 25 percent of the sexually active under 25 population annually.
Retest after treatment

C. trachomatis infection can be effectively cured with antibiotics once it is detected. Current guidelines recommend azithromycin, doxycycline, erythromycin, or ofloxacin. Agents recommended for pregnant women include erythromycin or amoxicillin.

An option for treating partners of patients (index cases) diagnosed with chlamydia or gonorrhea is patient-delivered partner therapy (PDT or PDPT), which is the clinical practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner.

Globally, as of 2010, sexually transmitted chlamydia affects approximately 215 million people (3.1% of the population). It is more common in women (3.8%) than men (2.5%). In that year it resulted in about 1,200 deaths down from 1,500 in 1990.

CDC estimates that there are approximately 2.8 million new cases of chlamydia in the United States each year and that it affects around 2% of young people in that country. Chlamydial infection is the most common bacterial sexually transmitted infection in the UK.

Chlamydia causes more than 250,000 cases of epididymitis in the U.S. each year. Chlamydia causes 250,000 to 500,000 cases of PID every year in the United States. Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed

Wednesday, March 16, 2016

Cause and Prevention of Gonorrhea

Gonorrhea is a sexually transmitted infection that is caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are a burning sensation with urination and discharge from the penis. Women have no symptoms about half the time or have vaginal discharge and pelvic pain. In both men and women, if gonorrhea is left untreated, it may spread locally, causing inflammation of the epididymis or pelvic inflammatory disease or throughout the body, affecting joints and heart valves.

Testing all women who are sexually active and less than 25 years of age each year is recommended. This same recommendation applies in men who have sex with men.

Gonorrhea can be prevented with the use of condoms. Treatment is usually with ceftriaxone, as resistance has developed to many previously used antibiotics. Ceftriaxone is typically given in combination with either azithromycin or doxycycline, as gonorrhea infections may occur along with chlamydia, an infection that ceftriaxone does not treat. Some strains of gonorrhea have begun showing resistance to this treatment, which will make infection more difficult to treat. Retesting is recommended three months after treatment.

An estimated 78 to 88 million cases of gonorrhea occur each year, out of the 448 million new cases of all curable STI each year – that also includes syphilis, chlamydia and trichomoniasis. Infections in women most commonly occur when they are young adults. In 2010, it caused about 900 deaths, down from 1,100 in 1990.

Signs and symptoms
Half of women with gonorrhea do not have symptoms, whereas others have vaginal discharge, lower abdominal pain, or pain with intercourse. Most infected men with symptoms have inflammation of the penile urethra associated with a burning sensation during urination and discharge from the penis. In men, discharge with or without burning occurs in half of all cases and is the most common symptom of the infection. Men and women can acquire gonorrhea of the throat from performing oral sex on an infected partner, usually a male partner. Such infection does not produce symptoms in 90% of cases, and produces a sore throat in the remaining 10%. In advanced cases, gonorrhea may cause a general feeling of tiredness similar to other infections. It is also possible for an individual to have an allergic reaction to the bacteria, in which case any appearing symptoms will be greatly intensified.

The incubation period is 2 to 14 days, with most symptoms appearing between 4 and 6 days after infection. Rarely, gonorrhea may cause skin lesions and joint infection (pain and swelling in the joints) after traveling through the blood stream (see below). Very rarely it may settle in the heart causing endocarditis or in the spinal column causing meningitis (both are more likely among individuals with suppressed immune systems, however).

One case in a man's lifetime is associated with the risk of developing prostate cancer.

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae.

The infection is usually spread from one person to another through vaginal, oral, or anal sex. Men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman. The risk for men that have sex with men is higher. Women have a 60–80% risk of getting the infection from a single act of vaginal intercourse with an infected man. A pregnant women can pass on the infection to her unborn infant.

A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant's eyes, it is referred to as ophthalmia neonatorum.

Among children it has been noted to spread through methods other than sex such as through contaminated objects. These objects have included baths, clothing, and towels. This however is very uncommon.

Traditionally, gonorrhea was diagnosed with gram stain and culture; however, newer polymerase chain reaction (PCR)-based testing methods are becoming more common. In those failing initial treatment, culture should be done to determine sensitivity to antibiotics. All people testing positive for gonorrhea should be tested for other sexually transmitted diseases such as chlamydia, syphilis, and human immunodeficiency virus.

The United States Preventive Services Task Force recommends screening for gonorrhea in women at increased risk of infection, which includes all sexually active women younger than 25 years. Extragenital gonorrhea and chlamydia is highest in men who have sex with men. Gonorrheal infections in young women are missed with genital-only testing.

Screening for gonorrhea in women who are (or intend to become) pregnant, and who are found to be at high risk for sexually transmitted diseases, is recommended as part of prenatal care in the United States.

As with most sexually transmitted diseases, the risk of infection can be reduced significantly by the correct use of condoms and can be removed almost entirely by limiting sexual activities to a mutually monogamous relationship with an uninfected person.

Those previously infected are encouraged to return for follow up care to make sure that the infection has been eliminated. In addition to the use of phone contact, the use of email and text messaging have been found to improve the re-testing for infection

The World Health Organization estimates that 88 million cases of gonorrhea occur each year, out of the 448 million new cases of all curable STI each year – that also includes syphilis, chlamydia and trichomoniasis. As of 2010, it caused about 900 deaths down from 1,100 in 1990.

In the United Kingdom, 196 per 100,000 males 20 to 24 years old and 133 per 100,000 females 16 to 19 years old were diagnosed in 2005. In 2013, the CDC estimated that more than 820,000 people in the United States get a new gonorrheal infections each year. Fewer than half of these infections are reported to CDC. In 2011, 321,849 cases of gonorrhea were reported to the CDC. After the implementation of a national gonorrhea control program in the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported gonorrheal infections was 113. 5 per 100,000 persons.

In the US, it is the second-most-common bacterial sexually transmitted infections; chlamydia remains first. According to the CDC, "Overall, African Americans are most affected by gonorrhea. Blacks accounted for 69% of all gonorrhea cases in 2010.

Some scholars translate the biblical terms zav (for a male) and zavah (for a female) as gonorrhea.

It has been suggested that mercury was used as a treatment for gonorrhea. Surgeons' tools on board the recovered English warship the Mary Rose included a syringe that, according to some, was used to inject the mercury via the urinary meatus into any unfortunate crewman suffering from gonorrhea. The name "the clap", in reference to the disease, is recorded as early as the sixteenth century.

Silver nitrate was one of the widely used drugs in the 19th century. However, It became replaced by Protargol. Arthur Eichengrün invented this type of colloidal silver, which was marketed by Bayer from 1897 on. The silver-based treatment was used until the first antibiotics came into use in the 1940s.

The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record. One of the first reliable notations occurs in the Acts of the (English) Parliament. In 1161, this body passed a law to reduce the spread of "...the perilous infirmity of burning. " The symptoms described are consistent with, but not diagnostic of, gonorrhea. A similar decree was passed by Louis IX in France in 1256, replacing regulation with banishment. Similar symptoms were noted at the siege of Acre by Crusaders.

Coincidental to, or dependent on, the appearance of a gonorrhea epidemic, several changes occurred in European medieval society. Cities hired public health doctors to treat afflicted patients without right of refusal. Pope Boniface rescinded the requirement that physicians complete studies for the lower orders of the Catholic priesthood.

Medieval public health physicians in the employ of their cities were required to treat prostitutes infected with the "burning", as well as lepers and other epidemic victims. After Pope Boniface completely secularized the practice of medicine, physicians were more willing to treat a sexually transmitted disease.

Human experiments were conducted by the United States in Guatemala from 1946 to 1948 to find a cure for syphilis and gonorrhea. The United States formally apologized to Guatemala in 2010.

Monday, March 14, 2016

Signs Symptoms and Treatment of Syphilis

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, and tertiary). The primary stage classically presents with a single chancre (a firm, painless, non-itchy skin ulceration) but there may be multiple sores. In secondary syphilis a diffuse rash which frequently involves the palms of the hands and soles of the feet occurs. There may also be sores in the mouth or vagina. In latent syphilis there are little to no symptoms which can last for years. In tertiary syphilis there are gummas (soft non-cancerous growths), neurological, or heart symptoms. Syphilis has been known as "the great imitator" as it may cause symptoms similar to many other diseases.

Syphilis is most commonly spread through sexual activity. It may also be transmitted from mother to baby during pregnancy or at birth, resulting in congenital syphilis. Other human diseases caused by related Treponema pallidum include yaws (subspecies pertenue), pinta (subspecies carateum), and bejel (subspecies endemicum). Diagnosis is usually made by using blood tests; the bacteria can also be detected using dark field microscopy. The Center for Disease Control recommends all pregnant women be tested.

The risk of syphilis can be decreased by latex condom use or not having sex. Syphilis can be effectively treated with antibiotics. The preferred antibiotic for most cases is benzathine penicillin G injected into a muscle. In those who have a severe penicillin allergy, doxycycline or tetracycline may be used. In those with neurosyphilis intravenous penicillin G potassium or ceftriaxone is recommended. During treatment people may develop fever, headache, and muscle pains, a reaction known as Jarisch-Herxheimer.

In 2013 syphilis infected about 315,000 people. During 2010 it caused about 113,000 deaths down from 202,000 in 1990. After decreasing dramatically with the availability of penicillin in the 1940s, rates of infection have increased since the turn of the millennium in many countries, often in combination with human immunodeficiency virus (HIV). This is believed to be partly due to increased promiscuity, prostitution, decreasing use of condoms, and unsafe sexual practices among men who have sex with men. In 2015, Cuba became the first country in the world to eliminate mother-to-child transmission of syphilis.

Signs and symptoms
Syphilis can present in one of four different stages: primary, secondary, latent, and tertiary, and may also occur congenitally. It was referred to as "the great imitator" by Sir William Osler due to its varied presentations.

Primary syphilis is typically acquired by direct sexual contact with the infectious lesions of another person. Approximately 3 to 90 days after the initial exposure (average 21 days) a skin lesion, called a chancre, appears at the point of contact. This is classically (40% of the time) a single, firm, painless, non-itchy skin ulceration with a clean base and sharp borders between 0.3 and 3.0 cm in size. The lesion may take on almost any form. In the classic form, it evolves from a macule to a papule and finally to an erosion or ulcer. Occasionally, multiple lesions may be present (~40%), with multiple lesions more common when coinfected with HIV. Lesions may be painful or tender (30%), and they may occur outside of the genitals (2–7%). The most common location in women is the cervix (44%), the penis in heterosexual men (99%), and anally and rectally relatively commonly in men who have sex with men (34%). Lymph node enlargement frequently (80%) occurs around the area of infection, occurring seven to 10 days after chancre formation. The lesion may persist for three to six weeks without treatment.

Secondary syphilis occurs approximately four to ten weeks after the primary infection. While secondary disease is known for the many different ways it can manifest, symptoms most commonly involve the skin, mucous membranes, and lymph nodes. There may be a symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles. The rash may become maculopapular or pustular. It may form flat, broad, whitish, wart-like lesions known as condyloma latum on mucous membranes. All of these lesions harbor bacteria and are infectious. Other symptoms may include fever, sore throat, malaise, weight loss, hair loss, and headache. Rare manifestations include liver inflammation, kidney disease, joint inflammation, periostitis, inflammation of the optic nerve, uveitis, and interstitial keratitis. The acute symptoms usually resolve after three to six weeks; about 25% of people may present with a recurrence of secondary symptoms. Many people who present with secondary syphilis (40–85% of women, 20–65% of men) do not report previously having had the classic chancre of primary syphilis.

Latent syphilis is defined as having serologic proof of infection without symptoms of disease. It is further described as either early (less than 1 year after secondary syphilis) or late (more than 1 year after secondary syphilis) in the United States. The United Kingdom uses a cut-off of two years for early and late latent syphilis. Early latent syphilis may have a relapse of symptoms. Late latent syphilis is asymptomatic, and not as contagious as early latent syphilis.

Tertiary syphilis may occur approximately 3 to 15 years after the initial infection, and may be divided into three different forms: gummatous syphilis (15%), late neurosyphilis (6.5%), and cardiovascular syphilis (10%). Without treatment, a third of infected people develop tertiary disease. People with tertiary syphilis are not infectious.

Gummatous syphilis or late benign syphilis usually occurs 1 to 46 years after the initial infection, with an average of 15 years. This stage is characterized by the formation of chronic gummas, which are soft, tumor-like balls of inflammation which may vary considerably in size. They typically affect the skin, bone, and liver, but can occur anywhere.

Neurosyphilis refers to an infection involving the central nervous system. It may occur early, being either asymptomatic or in the form of syphilitic meningitis, or late as meningovascular syphilis, general paresis, or tabes dorsalis, which is associated with poor balance and lightning pains in the lower extremities. Late neurosyphilis typically occurs 4 to 25 years after the initial infection. Meningovascular syphilis typically presents with apathy and seizure, and general paresis with dementia and tabes dorsalis. Also, there may be Argyll Robertson pupils, which are bilateral small pupils that constrict when the person focuses on near objects, but do not constrict when exposed to bright light.

Cardiovascular syphilis usually occurs 10–30 years after the initial infection. The most common complication is syphilitic aortitis, which may result in aneurysm formation.

Congenital syphilis is that which is transmitted during pregnancy or during birth. Two-thirds of syphilitic infants are born without symptoms. Common symptoms that develop over the first couple of years of life include enlargement of the liver and spleen (70%), rash (70%), fever (40%), neurosyphilis (20%), and lung inflammation (20%). If untreated, late congenital syphilis may occur in 40%, including saddle nose deformation, Higoumenakis sign, saber shin, or Clutton's joints among others

Cause of Syphilis

Treponema pallidum subspecies pallidum is a spiral-shaped, Gram-negative, highly mobile bacterium. Three other human diseases are caused by related Treponema pallidum, including yaws (subspecies pertenue), pinta (subspecies carateum) and bejel (subspecies endemicum). Unlike subtype pallidum, they do not cause neurological disease. Humans are the only known natural reservoir for subspecies pallidum. It is unable to survive without a host for more than a few days. This is due to its small genome (1.14 MDa) failing to encode the metabolic pathways necessary to make most of its macronutrients. It has a slow doubling time of greater than 30 hours.

Syphilis is transmitted primarily by sexual contact or during pregnancy from a mother to her fetus; the spirochaete is able to pass through intact mucous membranes or compromised skin. It is thus transmissible by kissing near a lesion, as well as oral, vaginal, and anal sex. Approximately 30 to 60% of those exposed to primary or secondary syphilis will get the disease. Its infectivity is exemplified by the fact that an individual inoculated with only 57 organisms has a 50% chance of being infected. Most (60%) of new cases in the United States occur in men who have sex with men. It can be transmitted via blood products. It is tested for in many countries and thus the risk is low. The risk of transmission from sharing needles appears limited.

It is not generally possible to contract syphilis through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing. This is mainly because the bacteria die very quickly outside of the body, making transmission via objects extremely difficult.

Syphilis is difficult to diagnose clinically early in its presentation. Confirmation is either via blood tests or direct visual inspection using microscopy. Blood tests are more commonly used, as they are easier to perform. Diagnostic tests are unable to distinguish between the stages of the disease.

Blood tests
Blood tests are divided into nontreponemal and treponemal tests. Nontreponemal tests are used initially, and include venereal disease research laboratory (VDRL) and rapid plasma reagin tests. As these tests are occasionally false positives, confirmation is required with a treponemal test, such as treponemal pallidum particle agglutination (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs). False positives on the nontreponemal tests can occur with some viral infections such as varicella and measles, as well as with lymphoma, tuberculosis, malaria, endocarditis, connective tissue disease, and pregnancy. Treponemal antibody tests usually become positive two to five weeks after the initial infection. Neurosyphilis is diagnosed by finding high numbers of leukocytes (predominately lymphocytes) and high protein levels in the cerebrospinal fluid in the setting of a known syphilis infection

Direct testing
Dark ground microscopy of serous fluid from a chancre may be used to make an immediate diagnosis. Hospitals do not always have equipment or experienced staff members, whereas testing must be done within 10 minutes of acquiring the sample. Sensitivity has been reported to be nearly 80%, thus can only be used to confirm a diagnosis but not rule one out. Two other tests can be carried out on a sample from the chancre: direct fluorescent antibody testing and nucleic acid amplification tests. Direct fluorescent testing uses antibodies tagged with fluorescein, which attach to specific syphilis proteins, while nucleic acid amplification uses techniques, such as the polymerase chain reaction, to detect the presence of specific syphilis genes. These tests are not as time-sensitive, as they do not require living bacteria to make the diagnosis

As of 2010, there is no vaccine effective for prevention. Several vaccines based on treponemal proteins reduce lesion development in an animal model, and research is ongoing. Abstinence from intimate physical contact with an infected person is effective at reducing the transmission of syphilis, as is the proper use of a latex condom. Condom use does not completely eliminate the risk. Thus, the Centers for Disease Control and Prevention recommends a long-term, mutually monogamous relationship with an uninfected partner and the avoidance of substances such as alcohol and other drugs that increase risky sexual behavior.

Congenital syphilis in the newborn can be prevented by screening mothers during early pregnancy and treating those who are infected. The United States Preventive Services Task Force (USPSTF) strongly recommends universal screening of all pregnant women, while the World Health Organization recommends all women be tested at their first antenatal visit and again in the third trimester. If they are positive, they recommend their partners also be treated. Congenital syphilis is still common in the developing world, as many women do not receive antenatal care at all, and the antenatal care others receive does not include screening, and it still occasionally occurs in the developed world, as those most likely to acquire syphilis (through drug use, etc.) are least likely to receive care during pregnancy. Several measures to increase access to testing appear effective at reducing rates of congenital syphilis in low- to middle-income countries.

Syphilis is a notifiable disease in many countries, including Canada the European Union, and the United States. This means health care providers are required to notify public health authorities, which will then ideally provide partner notification to the person's partners. Physicians may also encourage patients to send their partners to seek care. The CDC recommends that sexually active men who have sex with men be tested at least yearly.

Several strategies have been found to improve follow-up for STI testing including email and text messaging as reminders of appointments

Early infections
The first-choice treatment for uncomplicated syphilis remains a single dose of intramuscular benzathine penicillin G. Doxycycline and tetracycline are alternative choices for those allergic to penicillin; due to the risk of birth defects these are not recommended for pregnant women. Resistance to macrolides, rifampin, and clindamycin is often present. Ceftriaxone, a third-generation cephalosporin antibiotic, may be as effective as penicillin-based treatment. It is recommended that a treated person avoid sex until the sores are healed.

Late infections
For neurosyphilis, due to the poor penetration of penicillin G into the central nervous system, those affected are recommended to be given large doses of intravenous penicillin for a minimum of 10 days. If a person is allergic, ceftriaxone may be used or penicillin desensitization attempted. Other late presentations may be treated with once-weekly intramuscular penicillin G for three weeks. If allergic, as in the case of early disease, doxycycline or tetracycline may be used, albeit for a longer duration. Treatment at this stage limits further progression, but has only slight effect on damage which has already occurred.

Jarisch-Herxheimer reaction
One of the potential side effects of treatment is the Jarisch-Herxheimer reaction. It frequently starts within one hour and lasts for 24 hours, with symptoms of fever, muscles pains, headache, and a fast heart rate. It is caused by cytokines released by the immune system in response to lipoproteins released from rupturing syphilis bacteria.

History of syphilis
The history of syphilis has been well studied, but the exact origin of syphilis is unknown. There are two primary hypotheses: one proposes that syphilis was carried to Europe from the Americas by the crew of Christopher Columbus, the other proposes that syphilis previously existed in Europe but went unrecognized. These are referred to as the "Columbian" and "pre-Columbian" hypotheses.

In late 2011, newly published evidence suggested that the Columbian hypothesis is the valid one.

The first written records of an outbreak of syphilis in Europe occurred in 1494/1495 in Naples, Italy, during a French invasion. Because it was spread by returning French troops, the disease was known as "French disease", and it was not until 1530 that the term "syphilis" was first applied by the Italian physician and poet Girolamo Fracastoro. The causative organism, Treponema pallidum, was first identified by Fritz Schaudinn and Erich Hoffmann in 1905. The first effective treatment (Salvarsan) was developed in 1910 by Sahachirō Hata in the laboratory of Paul Ehrlich which was followed by the introduction of penicillin in 1943. Many famous historical figures including Franz Schubert, Arthur Schopenhauer, and Édouard Manet are believed to have had the disease.


The exact origin of syphilis is unknown. Two primary theories have been proposed. It is widely agreed upon by historians and anthropologists that syphilis was present among the indigenous peoples of the Americas before Europeans traveled to and from the New World. However, whether strains of syphilis were present in the entire world for millennia, or if the disease was confined to the Americas in the pre-Columbian era, has been debated.

The Columbian theory holds that syphilis was a New World disease brought back by Columbus and Martín Alonso Pinzón. This would be an example of a Columbian Exchange. Columbus's voyages to the Americas occurred three years before the Naples syphilis outbreak of 1494. This theory is supported by genetic studies of venereal syphilis and related bacteria, which found a disease intermediate between yaws and syphilis in Guyana, South America.
The pre-Columbian theory holds that syphilis was present in Europe before the arrival of Europeans in the Americas. Some scholars during the 18th and 19th centuries believed that the symptoms of syphilis in its tertiary form were described by Hippocrates in Classical Greece. Skeletons in pre-Columbus Pompeii and Metaponto in Italy with damage somewhat similar to that caused by congenital syphilis have also been found.[ However, these claims have not been submitted for peer review, and the evidence that has been made available to other scientists is weak. Nevertheless Douglas W. Owsley, a physical anthropologist at the Smithsonian Institution, and other supporters of this idea, say that many medieval European cases of leprosy, colloquially called lepra, were actually cases of syphilis. Although folklore claimed that syphilis was unknown in Europe until the return of the diseased sailors of the Columbian voyages, Owsley says that "syphilis probably cannot be "blamed"—as it often is—on any geographical area or specific race. The evidence suggests that the disease existed in both hemispheres from prehistoric times. It is only coincidental with the Columbus expeditions that the syphilis previously thought of as "lepra" flared into virulence at the end of the 15th century." Lobdell and Owsley wrote that a European writer who recorded an outbreak of "lepra" in 1303 was "clearly describing syphilis."
Historian Alfred Crosby suggests both theories are partly correct in a "combination theory". Crosby says that the bacterium that causes syphilis belongs to the same phylogenetic family as the bacteria that cause yaws and several other diseases. Despite the tradition of assigning the homeland of yaws to sub-Saharan Africa, Crosby notes that there is no unequivocal evidence of any related disease having been present in pre-Columbian Europe, Africa, or Asia. Crosby writes, "It is not impossible that the organisms causing treponematosis arrived from America in the 1490s...and evolved into both venereal and non-venereal syphilis and yaws." However, Crosby considers it more likely that a highly contagious ancestral species of the bacteria moved with early human ancestors across the land bridge of the Bering Straits many thousands of years ago without dying out in the original source population. He hypothesizes that "the differing ecological conditions produced different types of treponematosis and, in time, closely related but different diseases."

However, in late 2011 the Yearbook of Physical Anthropology published an appraisal by George Armelagos of Emory University, Molly Zuckerman, and Kristin Harper of previous studies that the "skeletal data bolsters the case that syphilis did not exist in Europe before Columbus set sail." The scientific evidence as determined by a systematic review of all published, peer-reviewed instances, best supports the theory that syphilis was unknown in Europe until Columbus returned from the Americas.

Skeletal evidence that reputedly showed signs of syphilis in Europe and other parts of the Old World before Christopher Columbus made his voyage in 1492 does not hold up when subjected to standardized analyses for diagnosis and dating, according to an appraisal in the current Yearbook of Physical Anthropology. This is the first time that all 54 previously published cases have been evaluated systematically, and bolsters the case that syphilis came from the New World.

— Science Daily, Skeletons point to Columbus voyage for syphilis origins
The historical origin of syphilis has modern social effects. The arrival of Europeans in the New World resulted in the damaging effects of colonialism and the spread of deadly diseases like smallpox that European explorers unintentionally brought to the Americas. According to biologist Marlene Zuk, "The origin of syphilis has always held an implied accusation: if Europeans brought it to the New World, the disease is one more symbol of Western imperialism run amok, one more grudge to hold against colonialism."

European outbreak

The first well-recorded European outbreak of what is now known as syphilis occurred in 1495 among French troops besieging Naples, Italy. It may have been transmitted to the French via Spanish mercenaries serving King Charles of France in that siege. From this centre, the disease swept across Europe. As Jared Diamond describes it, "[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months." The disease then was much more lethal than it is today. Diamond concludes,"[B]y 1546, the disease had evolved into the disease with the symptoms so well known to us today." The epidemiology of this first syphilis epidemic shows that the disease was either new or a mutated form of an earlier disease.

Researchers concluded that syphilis was carried from the New World to Europe after Columbus' voyages. Many of the crew members who served on this voyage later joined the army of King Charles VIII in his invasion of Italy in 1495, resulting in the spreading of the disease across Europe and as many as five million deaths. The findings suggested Europeans could have carried the nonvenereal tropical bacteria home, where the organisms may have mutated into a more deadly form in the different conditions and low immunity of the population of Europe. Syphilis was a major killer in Europe during the Renaissance. In his Serpentine Malady (Seville, 1539) Ruy Diaz de Isla estimated that over a million people were infected in Europe.

Historical terms
The name "syphilis" was coined by the Italian physician and poet Girolamo Fracastoro in his pastoral noted poem, written in Latin, titled Syphilis sive morbus gallicus (Latin for "Syphilis or The French Disease") in 1530. The protagonist of the poem is a shepherd named Syphilus (perhaps a variant spelling of Sipylus, a character in Ovid's Metamorphoses). Syphilus is presented as the first man to contract the disease, sent by the god Apollo as punishment for the defiance that Syphilus and his followers had shown him. From this character Fracastoro derived a new name for the disease, which he also used in his medical text De Contagionibus ("On Contagious Diseases").

Until that time, as Fracastoro notes,[not in citation given] syphilis had been called the "French disease" in Italy, Poland and Germany, and the "Italian disease" in France. In addition, the Dutch called it the "Spanish disease", the Russians called it the "Polish disease", and the Turks called it the "Christian disease" or "Frank (Western European) disease" (frengi). These "national" names were generally reflective of contemporary political spite between nations and frequently served as a sort of propaganda; the Dutch, for example, had a colonial rivalry with the Spanish, so referring to Syphilis as the 'Spanish' disease reinforced a politically useful perception that the Spanish were immoral or unworthy. The inherent xenophobia of the terms also stemmed from the disease's particular epidemiology, often being spread by foreign sailors and soldiers during their frequent sexual contact with local prostitutes.

During the 16th century, it was called "great pox" in order to distinguish it from smallpox. In its early stages, the great pox produced a rash similar to smallpox (also known as variola). However, the name is misleading, as smallpox was a far more deadly disease. The terms "Lues" (or Lues venerea, Latin for "venereal plague") and "Cupid's disease" have also been used to refer to syphilis. In Scotland, syphilis was referred to as the Grandgore. The ulcers suffered by British soldiers in Portugal were termed "The Black Lion"

Historical treatments
There were originally no effective treatments for syphilis, although a number of remedies were tried. Mercury was a common, long-standing treatment for syphilis, and its use has been suggested to date back to The Canon of Medicine (1025) by the Persian physician Ibn Sina (Avicenna), although this is only possible if syphilis existed in the Old World prior to Columbus (see Origins section). Giorgio Sommariva of Verona is recorded to have used mercury to treat syphilis in 1496, and is often recognized as the first physician to have done so, although he may not have been a physician. During the sixteenth century, mercury was administered to syphilitic patients in various ways, including by rubbing it on the skin, by applying a plaster, and by mouth. A "Fumigation" method of administering mercury was also used, in which mercury was vaporized over a fire and the patients were exposed to the resulting steam, either by being placed in a bottomless seat over the hot coals, or by having their entire bodies except for the head enclosed in a box (called a "tabernacle") that received the steam. The goal of mercury treatment was to cause the patient to salivate, which was thought to expel the disease. Unpleasant side effects of mercury treatment included gum ulcers and loose teeth. Mercury continued to be used in syphilis treatment for centuries; an 1869 article by TJ Walker discussed administering mercury by injection for this purpose.

Guaiacum was a popular treatment in the sixteenth century and was strongly advocated by Ulrich Von Hutten and others. Because guaiacum came from Hispaniola where Columbus had landed, proponents of the Columbian theory contended that God had provided a cure in the same location from which the disease originated. In 1525, the Spanish priest Francisco Delicado, who himself suffered from syphilis, wrote El modo de adoperare el legno de India discussing the use of guaiacum for treatment of syphilis. Although guaiacum did not have the unpleasant side effects of mercury, guaiacum was not particularly effective, at least not beyond the short term, and mercury was thought to be more effective. Some physicians continued to use both mercury and guaiacum on patients. After 1522, the Blatterhaus — an Augsburg municipal hospital for the syphilitic poor — would administer guaiacum (as a hot drink, followed by a sweating cure) as the first treatment, and use mercury as the treatment of last resort.

Another sixteenth-century treatment advocated by the Italian physician Antonio Musa Brassavola was the oral administration of Root of China, a form of sarsaparilla (Smilax). In the seventeenth century, English physician and herbalist Nicholas Culpeper recommended the use of heartsease (wild pansy).

Before effective treatments were available, syphilis could sometimes be disfiguring in the long term, leading to defects of the face and nose ("nasal collapse"). Syphilis was a stigmatized disease due to its sexually transmissible nature. Such defects marked the person as a social pariah, and a symbol of sexual deviancy. Artificial noses were sometimes used to improve this appearance. The pioneering work of the facial surgeon Gasparo Tagliacozzi in the 16th century marked one of the earliest attempts to surgically reconstruct nose defects. Before the invention of the free flap, only local tissue adjacent to the defect could be harvested for use, as the blood supply was a vital determining factor in the survival of the flap. Tagliacozzi's technique was to harvest tissue from the arm without removing its pedicle from the blood supply on the arm. The patient would have to stay with their arm strapped to their face until new blood vessels grew at the recipient site, and the flap could finally be separated from the arm during a second procedure.

As the disease became better understood, more effective treatments were found. An antimicrobial used for treating disease was the organo-arsenical drug Salvarsan, developed in 1908 by Sahachiro Hata in the laboratory of Nobel prize winner Paul Ehrlich. This group later discovered the related arsenic, Neosalvarsan, which is less toxic. Unfortunately, these drugs were not 100% effective, especially in late disease, and were sometimes unpredictably toxic to patients.

It was observed that sometimes patients who developed high fevers were cured of syphilis. Thus, for a brief time malaria was used as treatment for tertiary syphilis because it produced prolonged and high fevers (a form of pyrotherapy). This was considered an acceptable risk because the malaria could later be treated with quinine, which was available at that time. Malaria as a treatment for syphilis was usually reserved for late disease, especially neurosyphilis, and then followed by either Salvarsan or Neosalvarsan as adjuvant therapy. This discovery was championed by Julius Wagner-Jauregg, who won the 1927 Nobel Prize for Medicine for his discovery of the therapeutic value of malaria inoculation in the treatment of neurosyphilis. Later, hyperthermal cabinets (sweat-boxes) were used for the same purpose. These treatments were finally rendered obsolete by the discovery of penicillin, and its widespread manufacture after World War II allowed syphilis to be effectively and reliably cured.

History of diagnosis
In 1905, Schaudinn and Hoffmann discovered Treponema pallidum in tissue of patients with syphilis. One year later, the first effective test for syphilis, the Wassermann test, was developed. Although it had some false positive results, it was a major advance in the detection and prevention of syphilis. By allowing testing before the acute symptoms of the disease had developed, this test allowed the prevention of transmission of syphilis to others, even though it did not provide a cure for those infected. In the 1930s the Hinton test, developed by William Augustus Hinton, and based on flocculation, was shown to have fewer false positive reactions than the Wassermann test. Both of these early tests have been superseded by newer analytical methods.

While working at the Rockefeller University (then called the Rockefeller Institute for Medical Research) in 1913, Hideyo Noguchi, a Japanese scientist, demonstrated the presence of the spirochete Treponema pallidum in the brain of a progressive paralysis patient, associating Treponema pallidum with neurosyphilis. Prior to Noguchi's discovery, syphilis had been a burden to humanity in many lands. Without its cause being understood, it was sometimes misdiagnosed and often misattributed to damage by political enemies. It is called "the great pretender" for its variety of symptoms. Felix Milgrom developed a test for syphilis. The Hideyo Noguchi Africa Prize, was named to honor the man who identified the agent in association with the late form of the infectious disease

Health Benefits of Jaggery

Jaggery is a traditional non-centrifugal cane sugar consumed in Asia and Africa.It is a concentrated product of date, cane juice, or palm sap (see palm sugar) without separation of the molasses and crystals, and can vary from golden brown to dark brown in color. It contains up to 50% sucrose, up to 20% invert sugars, and up to 20% moisture, with the remainder made up of other insoluble matter, such as wood ash, proteins, and bagasse fibers. Jaggery is mixed with other ingredients, such as peanuts, condensed milk, coconut, and white sugar, to produce several locally marketed and consumed delicacies.

Unrefined, it is known by various names, including panela, in other parts of the world.

Origins and production

Jaggery is made of the products of sugarcane and the date palm tree. The sugar made from the sap of the date palm is both more prized and less commonly available outside of the regions where it is made. The date palm is tapped for producing jaggery in West Bengal, South India, Bangladesh, Pakistan, Nepal and Sri Lanka. In Sri Lanka, syrup extracts from kithul (Caryota urens) trees are widely used for jaggery production. This is considered the best jaggery available on the local market and is more highly valued than that from other sources.

All types of the sugar come in blocks or pastes of solidified concentrated sugar syrup heated to 200 °C (392 °F). Traditionally, the syrup is made by boiling raw sugarcane juice or palm sap in large, shallow, round-bottom vessels.

Preparation of jaggery

Cutting of sugar cane in a field in India.
Historically, the sugar cane cultivators used crushers which were ox-driven. Nowadays all the crushers are power-driven. These crushers are located in fields near the sugar crop. The cut and cleaned sugar cane is put into the crusher. The extracted sugar cane juice is collected in a big vessel. A certain quantity of the juice is transferred to a smaller vessel for heating on a furnace.

The vessel is heated for about one hour. Dried wood pulp from the crushed sugar cane is used as fuel for the furnace. While boiling the juice, some lime is added to it so that all the wood particles are collected on top of the juice in a froth during boiling which is skimmed off. Finally the juice is thickened and reduced to nearly one- third of the original volume. This hot liquid is golden in color. It is stirred continuously and lifted with a spatula to observe whether it forms a thread or drips dropwise while falling. If it forms many threads, it has completely thickened. Now it is poured into a shallow flat bottomed concrete tank to cool and solidify. The tank is large enough to allow only a thin coat of this hot liquid to form at its bottom, so as to increase the surface area for quick evaporation and cooling. After cooling down the jaggery becomes a soft solid which is now pressed into the desired shape for selling at the market.

The quality of the jaggery is judged by its color; brown means it is higher in impurities and golden-yellow implies it is relatively pure. Due to this grading scale there are malpractices of adding color or harmful chemicals to simulate the golden color.

Jaggery, also called gurh, is used as an ingredient in sweet and savory dishes across India, Pakistan, Bangladesh, Nepal, Sri Lanka as well as in Afghanistan and Iran. For example, a pinch of it is sometimes added to sambar, rasam, and other staples. Jaggery is added to lentil soups (dal) to add sweetness to balance the spicy, salty and sour components, particularly in Gujarati cuisine.

Maharashtra is the largest producer and consumer of jaggery most vegetable dishes, curries, and dals contain it. This is specially used during Makar Sankranti for making a dessert called tilgul. In Gujarat, known as gô during Makara Sankranti, a similar preparation called tal na ladu or tal sankli is made. In rural Maharashtra and Karnataka, water and a piece of jaggery is given when someone arrives home from working under a hot sun.

Molasses a byproduct of the production of jaggery, is used in rural Maharashtra and Karnataka as a sweetener. It contains many minerals not found in ordinary sugar and is considered beneficial to health in traditional Ayurvedic medicine. It is an ingredient of many sweet delicacies, such as gur ka chawal ("jaggery rice"), a traditional Rajasthani or Punjabi dish.

Jaggery is high in vitamin and minerals such iron, which helpful to anaemia patient. It also contains many minerals like Magnesium, Potassium, Calcium, Selenium, Manganese and Zinc which are very important for healthy body.

1. Prevents constipation: Jaggery activates the digestive enzymes in the body, stimulates bowel movements and thus helps prevent and relieve constipation.

2. Detoxes the liver: Jaggery helps cleanse the liver by flushing out harmful toxins from the body. So if you want to effectively detox your body, bite into a piece of jaggery.

3. Treats flu-like symptoms: Fight symptoms of a cold and cough with the help of gur. All you need to do is mix it with warm water and drink up, or even add it in your tea instead of sugar to reap the benefits.

4. Blood purifier: One of the most well-known benefits of jaggery is its ability to purify the blood. When consumed on a regular basis and in limited quantities, it cleanses the blood, leaving your body healthy.

5. Boosts immunity: Jaggery is loaded with antioxidants and minerals such as zinc and selenium, which in turn help prevent free-radical damage and also boost resistance against infections. Jaggery also helps increase the total count of haemoglobin in the blood.

6. Cleanses the body: Jaggery is one of the best natural cleansing agents for the body, hence it is advised to eat jaggery to remove unwanted particles from the body. It efficiently cleans the respiratory tract, lungs, intestines, stomach and food pipe. Eating jaggery is highly recommended for people working in heavily polluted areas such as factories or coal mines.

7. Eases menstrual pain: Jaggery contains many important nutrients, which important for healthy body, so it is very effective for menstrual problem. Gur is also useful to gives relief from cramp and stomach ache which are related to menstruation.

8. Cure Anaemia: Jaggery is great source of iron and folate. Iron and Folate maintain normal level of red blood cells and help to treat anaemia. Jaggery also gives an instant energy which cures the problem of fatigue and gives energy to your body, which one of the best Benefits of Jaggery for Pregnant Women.

9. Boosts intestinal health: Jaggery also boosts intestinal strength due to its high magnesium content. With every 10 gram of jaggery, you get 16 mg of magnesium, which is 4 percent of the daily requirement of this mineral.

10. Cools the stomach: Jaggery helps in maintaining normal body temperature which helps in keeping your stomach cool. Experts recommend drinking Gur Sharbat (jaggery soaked in ice cold water) during the summer months to cool off.

11. Maintain Blood Pressure: Jaggery is a rich source of potassium and sodium and both are very helpful to maintain a level of acid in your body. It also takes care of level of blood pressure in your body. It is one of Best Benefits of Jaggery to maintain your blood pressure level.

12. Cure Cough and Cold: It has ability to cure naturally cold and cough efficiently. Eating raw jaggery is very beneficial. You can make tea using gur or mix it with warm and drink to reduce problem of cold and cough. Jaggery is also very effective of migraines and headaches.

13. Relieves joint pain: "If you suffer from aches and pains in your joints, eating jaggery can provide you with much-needed relief", says Dr. Manoj K. Ahuja, Sukhda Hospital. You can eat it with a piece of ginger to alleviate joint pain, or even drink a glass of milk with jaggery every day to help strengthen the bones, thus preventing joint and bone problems such as arthritis.

14. Improve Metabolism and Help in weight loss: It is high in potassium, and it help to maintain electrolytes and also building up of muscles and boost metabolism in body. These things play a vital role to reduce weight, make it able to help in weight lose.
"Jaggery is surprisingly effective as an aid for weight loss. This is because jaggery is a rich source of potassium, which is a mineral that helps in the balance of electrolytes as well as building muscles and boosting metabolism. Potassium also helps in the reduction of water retention, which helps in managing your weight", says Delhi-based Nutritionist Anshul Jaibharat. These factors play an important role in effective weight loss, so if you're looking to lose some unwanted pounds, include this food in your diet.

15. Good source of energy: While sugar is a simple carbohydrate that gets absorbed in the bloodstream instantly and gives instant energy, jaggery is a complex carbohydrate that gives energy to the body gradually and for a longer time. This means that the levels of blood sugar do not get raised immediately. It also helps prevent fatigue and weakness of the body.

16.Good for sperm count : As per Ayurveda, consume it with powder of amla can beneficial to improve the quality of sperm count. It also helps in production of sperm in your body. It can reduce weakness in men and remove urinary problem in men. It is great Benefits of Jaggery for Sex life. Also it contain high amount of iron which great to improve hair growth.

17.Beauty Benefits of Jaggery or Gur:There are many Benefits of Jaggery for skin like nourish your skin, make skin healthy and glowing, reduce acne, blemish free skin, reduce sign of aging, and remove dark spot and wrinkles. Jaggery has natural properties which can your skin to stay healthy to all time

18. Maintain Temperature of Body : It has anti-allergic ingredient, which can help your body to maintain you temperature. It is great for the patient of Asthma, because Asthma patient must need a general temperature of body for all time. It is wonderful Benefits of Jaggery for the patient of Asthma.

19. Treat Urinary Problem : It last but not Least Health Benefits of Gur. Jaggery is made from sugarcane and sugarcane is works as natural diuretic, so it is useful to stimulate urination. It can also help in reduce inflammation of bladder. You can drink glass of milk with it to cure urinary problem and also to improve urine flow.

Thursday, March 3, 2016

Consumption of Alcohol Harmful for People with HIV

Safe drinking limits for people living with HIV may need to be lower than the recommendations for the rest of the population, according to a large American study. The drinking habits and health outcomes of over 18,000 men living with HIV were compared with those of over 42,000 men who didn’t have HIV. Most participants were in their forties, fifties and sixties.

Alcohol contributes to a wide range of cancers, liver disease, stroke and heart disease.

Looking at deaths from any cause, the researchers found a strong relationship between the amount people with HIV drank and their risk of death. After adjusting for other factors that could influence the results, men who had 30 to 70 alcoholic drinks a month (i.e. one or two a day) had a 30% higher risk of death than men who hardly drank at all. Men who drank more than this (70 or more drinks a month) had a 50% greater risk.

In contrast, only the higher level of drinking (70 or more a month) made a difference to deaths in HIV-negative men.

There were similar results when looking at results of blood tests, liver function tests and other markers of poorer health – there wasn’t any level of alcohol consumption which was ‘safe’ for men with HIV.

One limitation of the study is that it only includes data on men. Nonetheless, the greater harm caused by a unit of alcohol in women is well established. The overall findings probably apply to women, but at lower levels of alcohol consumption.

Some other studies suggest that a person living with HIV who consumes the same amount of alcohol as an HIV-negative person would have higher levels of alcohol in their blood than the person without HIV. This effect may be especially pronounced in people who aren’t taking HIV treatment.

The researchers concluded that people with HIV who drink more than 30 alcoholic drinks a month are at increased risk of health problems. This was an American study, using American standard drinks – for example, one drink is a small can of beer, a small glass of wine or a shot of whisky. No more than 30 drinks a month would amount to no more than one drink a day.

UK health authorities calculate alcohol quantities differently, but recently released advice from the Chief Medical Officer is consistent with the recommendations of the American study. One “unit” of alcohol in the UK is roughly half of a standard drink in the US. The UK government now recommends alcohol consumption below 14 units a week, which is the same as 8 American standard drinks a week – i.e. roughly one drink a day. 

However very few people in the general population and even fewer people with HIV drink this little. But this is the first major study to show that there are particular advantages for people living with HIV to cut back on alcohol.