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The test most commonly used to follow the course of a person’s illness is the CD4 or T-helper-cell count. As mentioned earlier, the immune system that is attacked and destroyed by HIV; the number of circulating CD4 cells at any gave time offers insight into the progression of the illness and information about prognosis and response to therapy. Another type of immune system cell, the CD8 cell or T-suppressor cell, can also be measured, and the ratio of CD4 to CD 8 cells can be useful in monitoring the progress of the infection. These tests are not used to determine if someone has HIV infection. People with other medical problems can demonstrate a decline in their CD4-cell level for various reasons, and those with HIV can have normal CD4 counts.

Culture

Evaluation of the virus through culture is a technique that is not used in routine clinical practice, but mostly in the research setting. HIV is clinics) can help clarify these results if your health care provider has not explained them clearly difficult to grow in culture, and the process takes a long time. The tests described previously are more sensitive and cheaper.

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WHAT IS IT?

Hepatitis B is a virus that causes liver inflammation and damage. Recognized since the 1960s, it is a serious health concern in the United States and worldwide. The virus can cause acute as well as chronic infection, which increases the risk of later complications. So far, hepatitis B and hepatitis A are the only sexually transmitted infections that can be prevented with a vaccination.

HOW COMMON IS IT?

Approximately 300,000 people are infected with hepatitis B every year in the United States, and each year approximately 5000 people die as a result of the infection. Approximately 10 percent of the population in the United States show evidence of infection on blood testing. Even in the era of HIV and safer sex, the number of people newly infected is continuing to increase.

In the 1990s about 25 percent of new infective cases were transmitted by heterosexual contact, about 30 percent through the sharing of equipment for injection drug use, and 5-10 percent by sexual contact between men. Between 35 and 40 percent of people newly infected do not fall into any of these groups, however. Before the 1980s and awareness of the existence of HIV the group with the largest number of hepatitis infections was men who have sex with other men, but with the advent of safer sex practices in this group, heterosexual transmission is now more common.

The risk of becoming infected with hepatitis B increases with the number of sexual contacts a person has. People who have sex in exchange for money are at very high risk. Persons who have been diagnosed with another sexually transmitted disease are also at higher risk of being infected with hepatitis B, through unsafe sexual practices. In one study of 2000 people who were patients at an STD clinic, 28 percent of those twenty-five and older showed evidence of hepatitis B infection, whereas 7 percent of those younger than twenty-five showed evidence of infection. About 5 percent of those infected in the United States become carriers of the infection, as discussed later in this section.

There are some geographic differences in patterns of hepatitis B infection. In most Southeast Asian and some African countries, the rate of infection is high. About 90 percent of people in these countries have evidence in their blood of previous or current infection with hepatitis B, and approximately 10-20 percent of them are carriers of the infection.

Mothers who are chronically infected with hepatitis B have a greater than 80 percent chance of infecting their unborn children while in the womb and during delivery. If a child is infected, there is a high probability that he or she will become a carrier of hepatitis B as well; however, steps can be taken to help protect against infection of the newborn.

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The goal of treatment of BV is to rebalance the bacteria in the vagina, so that the predominant bacteria are once again the “good” bacteria, Lactobacillus, and the numbers of the “bad” bacteria are decreased. (Even a woman without BV may have some of the “bad” bacteria in her vagina, but unless they predominate they will not cause BV.) There are several ways to treat BV using either topical creams or oral medication.

The treatment of BV relieves symptoms, so that if a woman has BV but is symptom free, she may choose not to treat the condition. There are two exceptions. As mentioned previously, if an invasive genital procedure, such as the insertion of an IUD, is to be performed, which may cause the bacteria to travel up into the pelvic region, then the symptom-free woman with BV should be treated. In addition, in pregnancy, treatment should be considered because of the risks that the infection poses to both the mother and the child if left untreated, especially if a woman has delivered a premature infant in the past.

BV can be treated topically by applying cream or gel or orally by taking pills. Topical treatments include metronidazole gel and clindamycin cream; they are applied in the vagina for five days and seven days, respectively. A cream that was used in the past, triple-sulfa cream, is still prescribed by some health care providers, but it is not effective. If a woman is pregnant, clindamycin cream is usually not used because it isn’t as effective.

Oral metronidazole can be taken by mouth for seven days or in a single dose. The single dose is easier but is a little less effective. The other choice for oral treatment is taking oral clindamycin for seven days. Although oral metronidazole in the past was not thought to be safe in women during the first trimester of pregnancy because of its potential for harming the infant, the likelihood of any harm coming to the fetus from this drug has recently come into question.

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1. The skin will be examined. This is necessary because certain STDs cause rashes on the body as well as in the genital area.

2. If you are having symptoms in the mouth and throat, or have performed oral sex on a partner, the health care provider will inspect those areas with a bright light and may swab the throat to obtain samples to test for infections such as gonorrhea and chlamydia.

3. The skin of the genital area will be examined for rashes, sores, or bumps, some of which may be very small or may not be causing any symptoms you can feel, so you may not even know they are there. If a health care provider finds something, he or she may want to swab the area to facilitate specific tests to help in diagnosis. Sometimes a biopsy of a lesion is necessary to make the diagnosis. To take a biopsy, a small piece of tissue is removed and then examined in the laboratory. Some skin bumps—such as those caused by the virus that causes genital warts (human papillomavirus) or molluscum contagiosum—may be treated at this time.

The labia majora will be spread to see if there are any rashes, bumps, or sores on the labia minora or at the opening of the vagina.

The lymph nodes of the genital area will be examined. These glands are part of the immune system and sit at the top of the legs, in the groin area,- they may be swollen and tender when infection is present.

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The discharge of bacterial vaginosis is usually white to slightly gray in color and is usually not accompanied by significant irritation of the labia or vagina, although there may be mild itching. There is often a strong odor from the vagina, often described as a fishy odor, which can be more prominent after sexual intercourse or during menstruation. The symptoms may sometimes resolve on their own, only to recur again later.

Barbara had not had sex in over a year, so she was surprised when she noticed a discharge from her vagina. The discharge had a fishy odor and was grayish in color. There was a little bit of itching on her labia, but not as bad as when she had had yeast infections in the past. She tried douching, but the odor persisted—if anything, it got worse. She went to see her nurse practitioner, who did a careful pelvic examination and found evidence of bacterial vaginosis after examining vaginal secretions under the microscope. The nurse practitioner explained that bacterial vaginosis is not an STD, although it is more common in women who have been sexually active at some time in their lives.

Barbara was given samples of metronidazole cream to use for five days, and her symptoms went away. She was advised not to douche, because although douching may lessen some of the symptoms, it doesn’t cure vaginal infections. In fact, it may obscure evidence of the problem on examination, making diagnosis more difficult.

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