By Dr. Andrew Lange
Physician, author and lecturer

Sexually transmitted diseases (STDs) can be transmitted without sex, that is, without intercourse. Even grandma kissing you at Christmas might pass on cold sores (a herpes virus). Chlymidia is a common STD and most people have never heard of it. Venereal diseases are often undiagnosed or hidden by symptoms that are common to other diseases. You can have an STD and never know it.

STDs are more common than you might think. It is largely the stigma and fear around these diseases that prevent their early detection and treatment. Testing usually consists of a simple blood or urine test. It is not complicated now to know what is going on in your body. But if you don't get tested you are putting yourself and your loved one at risk. If STDs are caught in the early stages they are easier to treat. You want to take care of these infections before they begin to undermine your health.

I had a patient in his 50s who came to be seen for a recurring rash on his back. He had it for years and had never been told what it was. I knew in a second it was a herpes infection that had migrated from an earlier contact. Most likely it had been a genital contact with someone who didn't even know they had herpes. He might have been spreading his infection also, not knowing he was doing so. We tested him and it came back positive. Some people don't want to know they have "VD," but he was glad because then he could be treated effectively rather than being treated for a rash and never getting better.

A landmark paper was published the Journal of the American Medical Association which showed for the first time the fact that patients with genital herpes "shed" virus from the genital tract, even when they don't have any obvious symptoms. They found that if the cultures were done daily for 100 days in these women, every single patient demonstrated shedding of the virus at some time.

According to the ACOG [American College of Obstetricians and Gynecologists] Committee on Adolescent Health Care and Committee on Gynecologic Practice, "Couples may engage in noncoital (that is, sex without intercourse) sexual activity instead of penile-vagina intercourse hoping to reduce the risk of sexually transmitted diseases and unintended pregnancy. Although these behaviors carry little or no risk of pregnancy, women (and men) engaging in noncoital behaviors may be at risk of acquiring sexually transmitted diseases." These include mutual masturbation, oral sex and anal sex. The risk of passing on STDs is increased by the fact that the public is not familiar with many of the common symptoms of STDs or that they resemble other illnesses like the flu or more common skin eruptions.

Getting Tested: Get the Proof You Need

It is extremely common for an infected person not to know they have an STD and unknowingly pass it on. Your best protection is for you and your partner to be tested. STD testing can be done confidentially. You don't even need a doctor's visit for most tests. For more information on getting low cost and confidential STD testing check out: www.saveonlabs.com/categories/STD-Testing. You need to know the facts to have safe sex.

The following review of STDs was compiled from information at the Center for Disease Control. They have an excellent website where you can go for more information.

Herpes simplex (HSV)
Symptoms of herpes-recurrent painful ulcers-can be treated, but the infection cannot be cured. Most people with herpes have no symptoms and are unaware of their infection. In a national household survey, less than 10 percent of people who tested positive with herpes knew they were infected. More than one in five Americans -- 45 million people -- are infected with genital herpes. With or without visible symptoms, the disease can be transmitted between sex partners, from mothers to newborns, and can increase a person's risk of becoming infected with HIV.

Signs and Symptoms of Herpes
HSV can appear and be transmitted through more than genital contact or kissing. Early viral shedding and eruptions on the mouth, genital, anal areas or even on the back can be mistaken for other skin eruptions. One patient complained of an eruption on his lower back he'd had for years off and on. I immediately knew it was herpes and that he might have unknowingly spread the disease to others. We got him tested and it came out positive for herpes.

Testing for Herpes
The first test you need if you have an outbreak is the IgM Herpes Simplex Virus (HSV) Types 1 and 2 test. IgM is an immunoglobulin from an immune response that increases during a current infection. HSV IgG antibody can be used to determine a previous history or if levels are compared to see if they have risen significantly, indicating a recurrent infection. Although it is not as sensitive, HSV antibody testing can be used to help diagnose an acute HSV infection.

HIV and AIDS
The CDC estimates that more than one million people in America may be infected with HIV and that as many as 250,000 of these may not know that they are infected and can pass on the virus to others.

Signs and Symptoms of HIV infection
HIV initially causes an acute illness with nonspecific or flu-like symptoms such as fatigue, headache, fever, and enlarged lymph nodes. Some people will not experience any noticeable symptoms. During this time period, the virus is present in large numbers and is carried throughout the body. HIV infects immune cells called CD4 T-cells (also called helper T cells) and slowly begins to decrease their numbers.

HIV Testing
The average time for the antibody to be detected is two weeks after exposure to the virus. One month to three months after you think you may have been exposed to the virus, additional testing will be required. 

Specific tests may include:

• HIV antibody testing -- ordered to diagnose HIV infection.

• p24 protein testing -- may be used to detect early HIV infection and to screen blood products for HIV.

• HIV viral load testing -- measures the quantity of HIV virus in the blood. Ordered to help decide when to start therapy and ordered at intervals to monitor the effectiveness of therapy.

• CD4 count -- measures the number of CD4 T-cells in the blood. Ordered at intervals to determine when to start HIV therapy. Also ordered to monitor therapy, HIV progression, and the status of the immune system.

• HIV genotypic resistance testing ordered when treatment is initiated, changed, and when there is evidence of treatment failure.

According to the Center for Disease Control, AIDS is diagnosed when your CD4 T-cell count drops below 200 or when you have HIV and an AIDS-related illness such as tuberculosis or pneumonia.

HPV
Human Papilloma Virus (HPV) is one of the most common STD's, yet most people do are not familiar with it. Most persons who are sexually active with a history of being with more than one person are at risk for becoming carriers of HPV. According to the US Centers for Disease Control and Prevention, 20 million people in this country are infected with HPV and over 6 million become newly infected each year. At least 50% of sexually active women and men contract HPV at some point in their lives. It is the leading cause of cervical cancer in women and a suspected cause in oral and throat cancers in both sexes. These diseases are not rare. Oral and throat cancers are the third most common cancer today. HPV is usually tested in women at the time of their PAP smears.

Hepatitis
The word "hepatitis" means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. Hepatitis is also the name of a family of viral infections that affect the liver. The most common types are hepatitis A, hepatitis B, and hepatitis C.

Overview of Hepatitis Viruses
Hepatitis A is a liver disease. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease. HAV infection is primarily transmitted by either person-to-person contact or through consumption of contaminated food or water.
Hepatitis B is a serious liver infection. HBV infection can cause acute illness and lead to chronic or lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. HBV is transmitted through cuts, infected needles or contact with mucous membranes (i.e. nose or mouth) or their discharges.

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV) that most often becomes a silent, chronic infection that can lead to cirrhosis (scarring), liver failure, liver cancer, and death. HCV is spread by contact with the blood of an infected person.

Hepatitis Signs
Acute hepatitis is often suspected and testing done because of the appearance of symptoms such as fever, loss of appetite, and nausea, often accompanied by dark urine, pale stools, and yellow discoloration of the skin and the whites of the eyes (jaundice or icterus).

Chronic hepatitis is more commonly detected as a result of abnormal routine test results. In a patient who is having no, few, or vague symptoms, hepatitis may be first discovered during routine testing such as a Comprehensive Metabolic Panel (CMP).

Hepatitis Testing

Hepatitis A
A blood test showing the presence of IgM anti-HAV in serum confirms the diagnosis of acute hepatitis A infection. Symptoms of this virus strain include nausea, vomiting, and diarrhea.

Hepatitis B
Anti-HBs+ : Indicates past or present infection and lasts indefinitely. Also may be detected in someone who has received immune globulin or an infant who has received antibodies from its mother. It also indicates the individual has been vaccinated, has received immune globulin, is immune, or is an infant who has received antibodies from its mother.

IgM anti-HBc+ : Indicates recent infection with HBV, usually within 4-6 months. 

HBeAg +: Indicates active viral replication and high infectivity. Persistence for 6 months after acute infection indicates progression to chronic HBV.

Hepatitis C Tests
Infection by the hepatitis C virus can be determined by a blood test that detects HCV antibodies in the blood. This test is not a part of a routine physical, and people must ask for a hepatitis C test. If the initial test is positive, a second test should be done to confirm the diagnosis and liver enzymes (a blood test) should be measured.

Gonnorhea
Gonorrhea is a very common infectious disease. CDC estimates that more than 700,000 persons in the US get new gonorrheal infections each year.

Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during delivery. People who have had gonorrhea and received treatment may get infected again if they have sexual contact with a person infected with gonorrhea.

Some men with gonorrhea may have no symptoms at all. However, some men have signs or symptoms that appear two to five days after infection; symptoms can take as long as 30 days to appear. Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles.

In women, the symptoms of gonorrhea are often mild, but most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.

Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements. Rectal infection also may cause no symptoms. Infections in the throat may cause a sore throat but usually causes no symptoms.

Testing for Gonnorhea
Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample for testing from the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send the sample to a laboratory for analysis. Gonorrhea that is present in the cervix or urethra can be diagnosed in a laboratory by testing a urine sample.

Chlymidia
Chlamydia is a common sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatis, which can damage a woman's reproductive organs. Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman ever recognizes a problem. Chlamydia also can cause discharge from the penis of an infected man.

Chlamydia is the most frequently reported bacterial sexually transmitted disease in the United States. Under-reporting is substantial because most people with chlamydia are not aware of their infections and do not seek testing. Also, testing is not often done if patients are treated for their symptoms. An estimated 2,291,000 non-institutionalized U.S. civilians ages 14-39 are infected with C. trachomatis based on the U.S. National Health and Nutrition Examination Survey. Women are frequently re-infected if their sex partners are not treated.
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.

Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection. Because the cervix (opening to the uterus) of teenage girls and young women is not fully matured and is probably more susceptible to infection, they are at particularly high risk for infection if sexually active. Since chlamydia can be transmitted by oral or anal sex, men who have sex with men are also at risk for chlamydial infection.

What are the symptoms of chlamydia?
Chlamydia is known as a "silent" disease because the majority of infected people have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure.
In women, the bacteria initially infect the cervix and the urethra (urine canal). Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. If the infection spreads from the cervix to the fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. Chlamydial infection of the cervix can spread to the rectum.

Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis. Pain and swelling in the testicles are uncommon.

Men or women who have receptive anal intercourse may acquire chlamydial infection in the rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of women and men having oral sex with an infected partner.

What complications can result from untreated chlamydia?
If untreated, chlamydial infections can progress to serious reproductive and other health problems with both short-term and long-term consequences. Like the disease itself, the damage that chlamydia causes is often "silent."

In women, untreated infection can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). This happens in about 10 to 15 percent of women with untreated chlamydia. Chlamydia can also cause fallopian tube infection without any symptoms. PID and "silent" infection in the upper genital tract can cause permanent damage to the fallopian tubes, uterus, and surrounding tissues. The damage can lead to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy (pregnancy outside the uterus). Chlamydia may also increase the chances of becoming infected with HIV, if exposed.

To help prevent the serious consequences of chlamydia, screening at least annually for chlamydia is recommended for all sexually active women age 25 years and younger. An annual screening test also is recommended for older women with risk factors for chlamydia (a new sex partner or multiple sex partners). All pregnant women should have a screening test for chlamydia.

Complications among men are rare. Infection sometimes spreads to the epididymis (the tube that carries sperm from the testis), causing pain, fever, and, rarely, sterility.

by Dr. Andrew Lange

Most of the articles you might have read on arthritis try to recommend treatments rather than what you can do to effect your body. Both Orthodox and Alternative treatments have shown success in treating the symptoms of arthritis, that is in the relief of symptoms. It is more important to find how our daily habits can significantly affect the inflammatory processes that contribute to arthritis.


The most common treatments for arthritis are those that affect an inflammatory chemical known as Cyclooxygenase or COX. Pharmacological inhibition of COX can provide relief from the symptoms of inflammation and pain. Non-steroidal anti-inflammatory (NSAIDs) drugs, such as aspirin and ibuprofen, exert their effects through inhibition of COX.

Unfortunately NSAIDs drugs used for these treatments were also found to have side effects. NSAIDs can make the overall disease process of arthritis worse, by depleting the very nutrients necessary for joint repair, including iron, folic acid and zinc. COX-2 inhibitors have been found to have serious cardiovascular effects, increasing the risk of atherothrombosis even with short-term use. A 2006 analysis of 138 randomized trials and almost 150 000 participants showed that selective COX-2 inhibitors are associated with a moderately increased risk of vascular events, mainly due to a twofold increased risk of myocardial infarction, that is heart attacks, and also that high-dose regimens of some traditional NSAIDs such as diclofenac and ibuprofen are associated with a similar increase in risk of vascular events.

What are the simplest ways to reduce inflammation in the body?

1. Keep moving: even though pain and stiffness can make you feel like skipping your exercise routine, research shows that staying active can help keep arthritis symptoms under control.

2. Diet. The Mediterranean diet consists primarily of fish, fruit, vegetables, cereals, and beans and contains less red meat and dairy products than do Western diets. In a recent study of Rheumatoid arthritis patients, those consuming the Mediterranean diet had a statistically significant 56 percent decrease in disease activity.

3. Omega-3 Oils. The research is solid. We have a preponderance of Omega-6 oils, which we do need, from polyunsaturated oils, such as olive and canola. Saturated fats from meat contribute to inflammation. You can reduce inflammation by reducing or eliminating saturated fats in the diet. By increasing Omega-3 oils from fish or algae sources we can alter the balance of our body's chemistry to reduce inflammation.

4. Repair your Gut. Having healthy intestines makes sure that the primary part of your immune system is working properly. Allergies, antibiotics and a lack of healthy bacteria called probiotics can alter the integrity of the gut lining. A poor gut integrity allows substances, such as allergens and other inflammatory substances to pass through the gut into the blood, which can affect our health systemically. Eating fermented foods, such as sauerkraut and yogurt helps to establish a healthy intestinal environment.

Remember that a lot of underlying conditions can cause arthritis. Help in the differential diagnosis and prognosis of arthritic disorders clarifies what steps you need to take in treatment. To find out more about testing and how you can save on health care go here. It will give you a start in your path to good health.

References:
Rheumatology International (2002;23:27-36).