Ectopic Pregnancy

Ectopic Pregnancy
Ectopic means "out of place." In an ectopic pregnancy, a fertilized egg has implanted outside the uterus. The egg settles in the fallopian tubes more than 95% of the time. This is why ectopic pregnancies are commonly called "tubal pregnancies." The egg can also implant in the ovary, abdomen, or the cervix, so you may see these referred to as cervical or abdominal pregnancies.
None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life. A classical ectopic pregnancy never develops into a live birth.

What Are the Signs and Symptoms?
Ectopic pregnancy can be difficult to diagnose because symptoms often mirror those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, or frequent urination.
Pain is usually the first red flag. You might feel pain in your pelvis, abdomen, or, in extreme cases, even your shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). Most women describe the pain as sharp and stabbing. It may concentrate on one side of the pelvis, and it may come and go or vary in intensity.
Any of the following additional symptoms can suggest an ectopic pregnancy:
vaginal spotting or bleeding
dizziness or fainting (caused by blood loss)
low blood pressure (also caused by blood loss)
lower back pain
What Causes an Ectopic Pregnancy?
An ectopic pregnancy results from a fertilized egg's inability to work its way quickly enough down the fallopian tube into the uterus. An infection or inflammation of the tube may have partially or entirely blocked it. Pelvic inflammatory disease (PID) is the most common of these infections.
Endometriosis (when cells from the lining of the uterus detach and grow elsewhere in the body) or scar tissue from previous abdominal or fallopian surgeries can also cause blockages. More rarely, birth defects or abnormal growths can alter the shape of the tube and disrupt the egg's progress.
How Is It Diagnosed?
If you arrive in the emergency department complaining of abdominal pain, you'll likely be given a urine pregnancy test. Although these tests aren't sophisticated, they are fast - and speed can be crucial in treating ectopic pregnancy.
If you already know you're pregnant, or if the urine test comes back positive, you'll probably be given a quantitative hCG test. This blood test measures levels of the hormone human chorionic gonadotropin (hCG), which is produced by the placenta. The hormone hCG appears in the blood and urine as early as 10 days after conception, and its levels double every 2 days for the first 10 weeks of pregnancy. If hCG levels are lower than expected for your stage of pregnancy, doctors are one step closer to diagnosing ectopic pregnancy.
The doctor will also give you a pelvic exam to locate the areas causing pain, to check for an enlarged, pregnant uterus, or to find any masses in your abdomen. You'll probably also get an ultrasound examination, which shows whether the uterus contains a developing fetus or if masses are present elsewhere in the abdominal area. But the ultrasound may not be able to detect every ectopic pregnancy.
A less commonly performed test, a culdocentesis, may be used to look for internal bleeding. In this test, a needle is inserted into the space at the very top of the vagina, behind the uterus and in front of the rectum. Any blood or fluid found there likely comes from a ruptured ectopic pregnancy.
Even with the best equipment, it's hard to see a pregnancy that's less than 6 weeks along. If your doctor can't diagnose ectopic pregnancy but can't rule it out, he or she may ask you to return every 2 days to measure your hCG levels. If these levels don't rise as quickly as they should, the doctor will continue to monitor you carefully until 6 weeks, when an ultrasound can be used.
What Are the Options for Treatment?
Treatment of an ectopic pregnancy varies, depending on its size and location and whether you want the ability to conceive again.
An early ectopic pregnancy can sometimes be treated with an injection of methotrexate, which dissolves the fertilized egg and allows your body to reabsorb it. This nonsurgical approach minimizes scarring of your pelvic organs.
If the pregnancy is further along, you'll likely need surgery to remove the abnormal pregnancy. In the past, this was a major operation, requiring general anesthesia and a large incision across the pelvic area. This may still be necessary in cases of emergency or extensive internal injury.
However, the pregnancy may sometimes be removed using laparoscopy, a less invasive surgical procedure. The surgeon makes a small incision in the lower abdomen and then inserts a laparoscope. This long, hollow tube with a lighted end allows the doctor to view internal organs and insert other instruments as needed. Sometimes, a second small abdominal incision is made for the instruments. The ectopic pregnancy is then surgically removed and any damaged organs are repaired or removed. General or regional anesthesia may be used.
Whatever your treatment, the doctor will want to see you regularly afterward to make sure your hCG levels return to zero. This may take up to 12 weeks. An elevated hCG could mean that some ectopic tissue was missed. This tissue may have to be removed using methotrexate or additional surgery.
What About Future Pregnancies?
Approximately 30% of women who have had ectopic pregnancies will have difficulty becoming pregnant again. Your prognosis depends mainly on the extent of the damage and the surgery that was done.
If the fallopian tube has been spared, the chances of a future successful pregnancy are 60%. Even if one fallopian tube has been removed, the chances of having a successful pregnancy with the other tube can be greater than 40%.
The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 15% chance of having another.
Who's at Risk for an Ectopic Pregnancy?
The risk of ectopic pregnancy is highest for women who are between 35 and 44 years old and have had:
PID
a previous ectopic pregnancy
surgery on a fallopian tube
infertility problems or medication to stimulate ovulation
Some birth control methods can also increase your risk of ectopic pregnancy. If you get pregnant while using progesterone-only oral contraceptives, progesterone intrauterine devices (IUDs), or the morning-after pill, you're more likely to have an ectopic pregnancy.
When Should You Call Your Doctor?
If you believe you're at risk for an ectopic pregnancy, meet with your doctor to discuss your options before you become pregnant. There's nothing anyone can do to prevent ectopic pregnancy, but you can make sure it's detected early.
You and your doctor may want to plan on checking your hormone levels starting at 10 days or scheduling an ultrasound at 6 weeks to ensure that your pregnancy is developing normally.
Call your doctor immediately if you're pregnant and experiencing any of the signs or symptoms of ectopic pregnancy. When it comes to detecting an ectopic pregnancy, "better safe than sorry" is more than just a cliche.

FAINTING

FAINTING

What is fainting?Fainting can be caused by a number of factors linked to a person's heart, circulation, blood pressure and breathing. The type of fainting attack described here is the most frequent and can happen at any time to otherwise healthy people. What triggers fainting?Things that trigger fainting include stressful situations, excitement and pain. This could include visiting the doctor for a blood sample, or being in an overheated or overcrowded room. Fainting typically occurs in connection with both physical and mental strain, and especially if a person does not feel well to start with.Fainting can occur suddenly and unexpectedly. Often, everything goes black. The person then turns pale, starts sweating and possibly feels sick. It can happen while standing, sitting down or if one gets up too quickly.What to do if someone feels faint Usually people have some idea that they're going to faint and can warn the people around them.If you know someone is going to faint, or suspect that it is going to happen, help the person lie down, preferably with their head low and the legs raised. This helps the blood flow back to the brain. Never try to get them up, as this will only make the problem worse.If they become unconscious, it rarely takes more than a few minutes to regain consciousness completely, although the arms and legs might still feel weak. If a person tries to get up too fast, they may feel dizzy and perhaps even faint again.If a person feels faint and isn't able to lie down, they should sit instead, putting their head between their knees. A friend should hold the person's hand behind his or her head and press downwards. At the same time, the person feeling faint should push their head upwards. This makes the blood flow to the brain, reducing the symptoms and reducing the risk of fainting.How to avoid fainting People who faint easily should pay attention to the situations that trigger their fainting attacks. If you think you are going to faint, alert the people around you so they can be prepared for what might happen. Fainting attacks are normally short. If a person is unconscious for more than one or two minutes without any signs of regaining consciousness, additional first aid may be needed.For any unconscious person, the safest position to place them in is the 'recovery' position - on their side with their chin up slightly so that they can breathe easily. Stay with an unconscious person until they recover, or help arrives, if at all possible.

What is syphilis?

What is syphilis?
Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.
How common is syphilis
In the United States, health officials reported over 36,000 cases of syphilis in 2006, including 9,756 cases of primary and secondary (P&S) syphilis. In 2006, half of all P&S syphilis cases were reported from 20 counties and 2 cities; and most P&S syphilis cases occurred in persons 20 to 39 years of age. The incidence of P&S syphilis was highest in women 20 to 24 years of age and in men 35 to 39 years of age. Reported cases of congenital syphilis in newborns increased from 2005 to 2006, with 339 new cases reported in 2005 compared to 349 cases in 2006.
Between 2005 and 2006, the number of reported P&S syphilis cases increased 11.8 percent. P&S rates have increased in males each year between 2000 and 2006 from 2.6 to 5.7 and among females between 2004 and 2006. In 2006, 64% of the reported P&S syphilis cases were among men who have sex with men (MSM).
How do people get syphilis
Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.
What are the signs and symptoms in adults?
Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission occurs from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, transmission may occur from persons who are unaware of their infection.
Primary StageThe primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.
Secondary Stage
Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
Late StageThe latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. This latent stage can last for years. The late stages of syphilis can develop in about 15% of people who have not been treated for syphilis, and can appear 10 – 20 years after infection was first acquired. In the late stages of syphilis, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.
How does syphilis affect a pregnant woman and her baby?
The syphilis bacterium can infect the baby of a woman during her pregnancy. Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die.
How is syphilis diagnosed?
Some health care providers can diagnose syphilis by examining material from a chancre (infectious sore) using a special microscope called a dark-field microscope. If syphilis bacteria are present in the sore, they will show up when observed through the microscope.
A blood test is another way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe, and inexpensive blood test. A low level of antibodies will likely stay in the blood for months or years even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.
What is the link between syphilis and HIV?
Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV if exposed to that infection when syphilis is present.
Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous membranes, such as syphilis, disrupt barriers that provide protection against infections. The genital ulcers caused by syphilis can bleed easily, and when they come into contact with oral and rectal mucosa during sex, increase the infectiousness of and susceptibility to HIV. Having other STDs is also an important predictor for becoming HIV infected because STDs are a marker for behaviors associated with HIV transmission.
What is the treatment for syphilis?
Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.
Because effective treatment is available, it is important that persons be screened for syphilis on an on-going basis if their sexual behaviors put them at risk for STDs.
Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.
Will syphilis recur?
Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection. Only laboratory tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Talking with a health care provider will help to determine the need to be re-tested for syphilis after being treated.
How can syphilis be prevented?
The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior. It is important that sex partners talk to each other about their HIV status and history of other STDs so that preventive action can be taken.
Genital ulcer diseases, like syphilis, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of syphilis, as well as genital herpes and chancroid, only when the infected area or site of potential exposure is protected.
Condoms lubricated with spermicides (especially Nonoxynol-9 or N-9) are no more effective than other lubricated condoms in protecting against the transmission of STDs. Use of condoms lubricated with N-9 is not recommended for STD/HIV prevention. Transmission of a STD, including syphilis cannot be prevented by washing the genitals, urinating, and/or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex and to see a doctor immediately.

Gonorrhoea What is gonorrhoea?

Gonorrhoea
What is gonorrhoea?
Gonorrhoea is a venereal disease caused by the bacteria Neisseria gonorrhoeae. The disease most frequently affects 15 to 25-year-olds, although the number of cases has fallen in recent years.
How do you contract gonorrhoea?
Gonorrhoea is mainly transmitted through sexual contact. However, mothers infected with gonorrhoea can also transfer the disease to their children during delivery. If untreated, such children may develop a serious inflammation of the eyes, which can result in blindness. To prevent this, lapsis (silver nitrate) used to be applied to the baby's eyes soon after birth. The treatment was discontinued in 1985, and is only used today if an inflammation of the eyes actually develops.
What are the symptoms of gonorrhoea? Of those infected, approximately half the women and a third of the men do not show any symptoms.In men, the primary symptom is painful urination. Levels of pain can often be extremely severe. Discharge is also seen from the urethra (the tube through which urine passes from the body). At first, this discharge is slimy and of limited quantity but it quickly develops into a more substantial yellowish substance. Homosexual men can develop gonorrhoea in the rectum. This varies from being symptom-free to involving the painful discharge of bloody pus from the rectum.In women, the symptoms tend to be more limited, normally consisting of painful urination and an increasing amount of discharge from the vagina. In both sexes, a throat infection can occur as a result of oral sex with an infected partner. In most cases there are no further symptoms but sometimes a sore throat is accompanied by fever. Who is at risk?
People with multiple partners.
People who do not practise safe sex.
Good advice
Practise safe sex - use a condom.
If you think you may have been infected, contact your doctor who will examine you and your partner or partners and provide treatment if necessary.
Remember that assessment for a sexually transmitted disease is always available at a genitourinary medicine (GUM) clinic. The telephone number for your local clinic can be found in the telephone directory.
How does the doctor diagnose gonorrhoea? The bacteria can be detected through obtaining a smear from the urethra, the neck of the uterus, the throat or the rectum then examining it under a microscope. What if it is left untreated? If gonorrhoea is left untreated it can develop into an inflammation of the sexual organs in women and an inflammation of the epididymis in men.In women, a possible long-term consequence of gonorrhoea is closure of the Fallopian tubes. If this happens, the passage of the fertilised egg into the uterus is made difficult and the risk of sterility and ectopic pregnancy increases.In very rare cases, gonorrhoea can spread to the whole body through the veins. This results in painful joints, rashes, high temperature, and shivering. In extreme cases, cerebrospinal meningitis and inflammation of the heart might develop. Resistant types of gonorrhoea from certain parts of the world such as Asia and Africa can be particularly difficult to treat.How is gonorrhoea treated? Gonorrhoea is treated with antibiotics. If you suspect you are infected, it is extremely important that both you and your partner or partners are examined by a doctor. What medicines are used?Antibiotics against gonorrhoea, such as ciprofloxacin (eg Ciproxin) or ofloxacin (eg Tarivid).

HIV, AIDS What Is HIV?

HIV, AIDS
What Is HIV?
"HIV" stands for Human Immunodeficiency Virus.
Many people also refer to HIV as the "AIDS virus."

How Is the Virus Transmitted?
HIV lives in blood and other body fluids that contain blood or white blood cells. People have gotten HIV through:
· unprotected sexual intercourse with an HIV-infected person. This includes vaginal or anal intercourse, and oral sex on a man or woman without a condom or other barrier. Intercourse while a woman is having her period, or during outbreaks of genital sores or lesions (caused by herpes and other sexually transmitted diseases) can increase the risk of HIV transmission.
· sharing drug injection equipment (needles and/or works); or being accidentally stuck by needles or sharp objects contaminated with infected blood.
· infected blood used in transfusions, and infected blood products used in the treatment of certain diseases and disorders (like hemophilia), before March, 1985. (Since 1985, federally mandated screening of the blood supply has reduced the risk of transmission through this route to 1 in 255,000.)
· pregnancy, childbirth, and/or breastfeeding, where the virus is passed from mother to child.
· transplanted organs from infected donors. (Routine screening of organ donors also began in 1985.)
HIV and AIDS are not transmitted through casual contact (that is, where no blood or body fluids are involved). HIV is what gets passed from person to person. People don't "catch AIDS"; they "become infected with HIV."

What Does an "HIV-Positive" Test Result Mean?
A positive test result means your body has been infected by the human immunodeficiency virus-and that you are capable of transmitting it to others. The test did not look for the actual virus itself, but found evidence of it in your blood. There's no way to tell from this result who gave you the virus, how long you've had it, or when it will begin to affect your health. You may see or hear the results called "HIV-positive," "HIV+," "HIV-antibody positive," or "seropositive for HIV." These terms all mean the same thing. People who have been infected with the human immunodeficiency virus are said to have "HIV disease." While the virus itself is not a disease, it progressively damages the body's immune system. This puts you at risk for developing illnesses you wouldn't otherwise get.
At this time, doctors don't know of any way to rid the body of HIV. There is no cure. Once you've been infected, you have it for life.

How Does HIV Harm the Body?
Viruses tend to be specialists. They zero in on a few particular types of cells in the body and move in. The human immunodeficiency virus is best known for targeting the T cells of the immune system. However, it can also attack cells of the brain, nervous system, digestive system, lymphatic system, and other parts of the body.
The immune system is made up of specialized cells in the bloodstream that fight off invading germs to keep the body healthy. The "T" cells (also referred to as "T4," "helper-T," or "CD4" cells) are the brains of the operation. These white blood cells identify invaders and give orders to soldier-type cells, which then battle various bacteria, viruses, cancers, fungi, and parasites that can make a person sick.
Like all viruses, the HIV is only interested in one thing: reproducing itself. Once it has attacked and moved into a T cell, it converts that cell into a miniature virus factory. Eventually there are so many new viruses in the cell that the T cell explodes, scattering the HIV back into the bloodstream. The virus then moves on to fresh T cells and repeats the process. Over time, the HIV can destroy virtually all of an infected person's T cells in this manner.

Then What Happens?
With fewer and fewer "leaders" to rely on for warnings, the "soldier" cells become powerless. They can no longer recognize and fight off common organisms that would not present a problem to a healthy immune system. These organisms may be lying dormant in the body already, or may enter from outside. The immune system's weakness gives them the opportunity to wake up, multiply, and cause illness. Thus, we call these illnesses "opportunistic infections." People with fully functioning immune systems are almost never troubled by these particular infections-but those with damaged immune systems are highly vulnerable to them.

So What's the Connection Between HIV and AIDS?
When a person with an HIV-weakened immune system comes down with one or more of these rare opportunistic infections, or has a T cell count below 200 or 14%, that person may be diagnosed by a doctor as having AIDS. "AIDS" stands for "Acquired Immune Deficiency Syndrome." The "syndrome" part means that AIDS is not a single disease but a collection of diseases. The Centers for Disease Control (CDC) has put together a list of 26 "AIDS-defining illnesses" in adults. Diagnosis of AIDS in children involves a list of slightly different ailments.
AIDS can be thought of as the most severe form of HIV disease. All but a handful of medical experts now believe that HIV is the primary agent that leads to the development of AIDS.