STORY BYPart I:
Runaway Viruses
New research findings offer promise to reduce the number of Americans who become infected with the viral sexually transmitted diseases, herpes simplex virus (HSV) and human papilloma virus (HPV).
And just in time, it appears. According to recent reports, about half of all sexually-active youths will contract a sexually transmitted disease (STD) by the age of 25.
And half of all new cases of STDs will come from the same age group.
"Approximately 18.9 million new cases of STD occurred in 2000, of which 9.1 million (48 percent) were among persons aged 15 to 24," a report from the Centers for Disease Control and Prevention states.
An estimated 45 million Americans are currently infected with herpes simplex virus type 2, the virus that causes most cases of genital herpes.
"Now there are new blood tests that can accurately identify antibodies to herpes type 1 (which typically causes cold sores) and herpes type 2," explains Lisa M. Hollier, MD, assistant professor in maternal-fetal medicine in the Department of Obstetrics, Gynecology and Reproductive Sciences at The University of Texas Medical School at Houston.
"This STD is one of the most prevalent, and infections are on the rise. Many persons who have HSV show no signs of disease. They never get tested, and they pass it on," Hollier says. The new blood tests can identify people with the infection so that they can take steps to prevent infecting others.
Advances in serologic (blood) testing is important because, unless a person is actively breaking out, it can be difficult to diagnose, much less, nail down the herpes strain and type. And knowing the enemy can help with treatment and transmission reduction.
Hollier explains that though type1 is generally regarded as the strain that causes cold sores in or around the mouth, it can take up residence in the uro-genital area, most likely from oral sex. Type1 recurrence rate is generally lower, but if found in the genital area, type1 can still be a danger during childbirth, if the baby passes through the birth canal during the infectious stage (of either types of herpes.)
"The interesting thing here is that type 2 isn't often found in the oral area," Hollier says. In other words, if type 2 is detected by blood test, in almost every case you are going to have herpes residing in the genital area and rarely in the mouth.
Symptomatically, many infected persons experience only vague itching or discomfort. There are no ulcers to see, to culture or count. First episode break-outs sometimes are so light that a person ignores it. Women can miss ulcers that occur in the vaginal canal. Teens are embarrassed to mention discomfort to their parents. Girls tend to rationalize discomfort as symptoms to a yeast infection.
Before serologic testing, a person had to wait for an actual episode to be diagnosed conclusively. At that point, the ulcer or lesion could be cultured. And by then, chances were good that the infected person had already passed it along. Herpes is contagious a day or two before ulcers appear (prodromal phase) and for a few days after they are healed (viral shedding phase.)
Another breakthrough is in medications. Since herpes is a virus, there is no "cure" for the disease. Acyclovir and valacyclovir are both antiviral therapies that work to suppress the virus. And they have been proven successful.
In a recent study, the infected partner was treated with valacyclovir every day. The result was twofold: it reduced the frequency and duration of outbreaks in the infected partner and reduced transmission to the non-infected partner.
These medications also have been used in the last month of pregnancy (beginning at the 36th week). The expectant mother's HSV outbreaks were generally decreased by half. "This translates into fewer Cesarean deliveries-the treatment currently recommended to an expectant mother who has an outbreak at the time of delivery," says Hollier. The medication is well-tolerated by the mother and doesn't harm the baby.
Staying Ahead of the Race
Until recently, no one was compiling a national infection rate of HPV. It just wasn't one of those STDs that required a report to a health agency. Evidence suggests though that HPV, the virus that causes genital warts and is turning millions of pap smears "positive" for presence of cervical cancer cells each year is reaching epidemic numbers.
Three STDs comprise 88 percent of all new cases, says the CDC report. Chlamydia, a bacteria and trichomoniasis, a parasitic infection (discussed in Part II) have medications that can kill them. HPV, a virus, has no curative medication treatment. Like any other virus, there is no "antibiotic" therapy.
"The estimated number of new infections of HPV on an annual basis of 15-24 year-olds is 4.6 million—74 percent of the total of new infections," Hollier adds.
HPV has numerous strains and sub-types, not all of which lead to cervical cancer. Some strains are higher-risk than others. Some strains result in genital warts that a gynecologist and a patient can see. Other women have no idea they have HPV until their pap smears, (a biopsy of the cervix) come back questionable.
A huge step forward is the development and recent approval of an HPV vaccine. Hollier notes, "This concept of vaccination to prevent HPV holds tremendous promise to reduce the risk of cervical cancer."
UPDATED: 8-09-2006
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Dr. Lisa Hollier is an assistant professor in maternal-fetal medicine in the Department of Obstetrics, Gynecology and Reproductive Sciences at the UT Medical School.
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Tetanus booster for adults
Tetanus does not result from the rusty nail or whatever created the wound. The danger lies in the bacteria Clostridium tetani that lives in the soil or manure on that nail or gardening tool. When these spores get into a wound—deep or shallow—they can produce a potent toxin. Also called lockjaw, tetanus seriously affects the central nervous system and can be fatal.
Onset of symptoms can occur anytime from three days to three weeks. Call your health care provider if you have an open wound, particularly if:
Adults should have a tetanus booster shot every 10 years, known as the Td vaccine. It is a "2-in-1" vaccine that protects against tetanus and diphtheria. It contains a slightly different dose of diphtheria vaccine than what you received as a child. It can be given to anyone older than 7 years and is injected, usually into the arm.
Instead of the standard Td booster every 10 years, adults between the ages of 19 and 65 should receive Tdap one time in their adulthood to boost the immune system for pertussis, as well as tetanus and diphtheria.
Diphtheria, a contagious bacterial infection created that causes severe inflammation of the throat and larynx and can also affect the whole body. Pertussis or “whooping cough” is a serious bacterial infection that afflicted children and infants before vaccines were available. Adults may be infected later in life as their immunities wane. Neither of these infections are related to tetanus, but both vaccines are compatible and convenient to use with the tetanus booster.
