Archive for the ‘Men’s Health-Erectile Dysfunction’ Category

HUMAN IMMUNODEFICIENCY VIRUS INFECTION – DEFINITION

Thursday, October 14th, 2010

The acquired immune deficiency syndrome (AIDS) characterised by ‘the presence of a reliably diagnosed disease at least moderately indicative of an underlying cellular immune deficiency in a person with no known underlying cause of cellular immune deficiency nor any other cause of reduced resistance reported to be associated with that disease’ was recognised in 1981 in male homosexuals. The patient population was subsequently found to contain intravenous drug abusers, prostitutes, persons who had received blood transfusions and some blood products, individuals from some African and Caribbean countries and the sexual partners and children of persons in these groups.

AIDS was subsequently discovered to be the most severe clinical expression of infection with human immunodeficiency virus (HIV), an RNA virus containing the enzyme reverse transcriptase. HIV is cytopathic for the CD4+ subset of T-lymphocytes and for various other cell types
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GENITAL HERPES – MANAGEMENT

Thursday, October 14th, 2010

At present, no cure is available. Treatment is largely symptomatic and consists of sedatives and analgaesics. Acyclovir (Zovirax), an antiviral agent, can shorten the clinical course of the primary lesion and may benefit patients with frequent severe recurrences. Indications for acyclovir are:
treatment of moderate or severe first episodes of genital herpes (200 mg 5 times daily — each 4 hours while awake — for 10 days);
suppressive treatment for patients with moderate to severe recurrent genital herpes (more than 10 attacks per year with microbiological confirmation) (200 mg 2 to 4 times per day);
treatment of acute lesions in immunosuppressed patients (5 mg/kg by slow IV infusion every 8 hours for 5 days);
suppressive treatment an in immunosuppressed patient with recurrent HSV;
treatment of neonatal infection; and
treatment of ophthalmic infections where idoxuridine proved ineffective (ophthalmic ointment).
Because genital herpes is recurrent and untreatable, patients with HSV are likely to be depressed. Patients and their partners can be assisted by counselling and support. Sexual abstinence should be practised while lesions are active. Patients can be taught to recognise the prodrome and minor symptoms which may indicate recurrence of infectivity. Condoms offer some protection.
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GENITAL HERPES – PREGNANCY AND DIAGNOSIS

Thursday, October 14th, 2010

Pregnant women should be asked if they or their partners have a history of HSV infection. Caesarean section should be considered for pregnant women with active lesions at term and patients with genital herpes should be referred for specialist opinion at least 4 weeks before term.

Deep ulcerated anogenital lesions and disseminated infections may occur in patients with HfV infection and other deficiencies of immune functioa

Diagnosis

The diagnosis can usually be made on clinical grounds; the differential diagnosis includes syphilis, chancroid and lymphogranuloma venereum. HSV may coexist with other STDs and appropriate investigations should be undertaken. HSV infection may be associated with a false positive FTA-ABS test (see p.25) but may also coexist with syphilis.

The diagnosis of HSV can be confirmed by culture of the virus. A positive diagnosis is usually available in 1 to 4 days but 14 days are required for a negative result. Rapid diagnosis may be made by examination of smears from ulcers for multinucleated cells and characteristic intranuclear inclusions or by the use of commercially available kits for the detection of HSV-2 antigens by ELISA or immunofluorescence techniques.

Microbiological confirmation is desirable if acyclovir is to be used and is required for an NHS authority to prescribe acyclovir to suppress recurrent infections.

Serological tests have no role in diagnosis. The only practical role for serology is to define persons who are seronegative and therefore susceptible.
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GENITAL HERPES – HERPES IN FEMALES CAN BE DISABLING; RELAPSING INFECTION; NEONATAL INFECTION

Thursday, October 14th, 2010

In females, herpetic infection may be complicated by urinary retention due either to local pain or to neurogenic bladder due to radiculitis. Herpes may cause an extensive necrotising lesion of the cervix which causes a sanguineous vaginal discharge and may resemble cervical carcinoma.

HSV infection may produce no symptoms and asymptomatic viral shedding from the cervix or other sites may occur.

Relapse may be attributed to emotional or physical stress, fever, trauma, hormonal changes, menstruation, sunlight, alcohol etc. Relapses are characterised by a milder prodromal period, lesions of 4 to 5 days average duration healing in 1 to 2 weeks and a milder degree of lymphadenopathy.

HSV has a high morbidity and mortality in neonates. The infection can be transmitted from mother to infant during parturition if the mother is actively shedding the virus. A higher rate of neonatal infection occurs if primary infection occurs late in the pregnancy and there is insufficient time for maternal antibody to develop and be transferred to the foetus.
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GENITAL HERPES – CLINICAL MANIFESTATIONS

Thursday, October 14th, 2010

The incubation period is usually from 3 to 6 days but may be longer.

In males, primary lesions usually occur on the penile shaft, prepuce or glans or the anal region.

In females, primary lesions occur commonly on the labia, clitoris, introitus and vagina. The cervix is involved in at least 50% of cases. In about 25%, the cervix is the only site of lesions and these cases may be asymptomatic.

Lesions may occur in the mouth or throat following oral sex.

Lesions may occur on the fingers, buttocks, torso and the eyes as a result of autoinoculation. Transmission may also occur on fomites.

Lesions are usually preceded by a 12-24 hour prodromal period characterised by local hypersensitivity or discomfort.

Multiple vesicles appear. They are surrounded by an areola of erythema. After 24 to 72 hours, the vesicles rupture to form painful superficial ulcers. Lesions of varying age and size coexist. Symptoms persist for 1 to 3 weeks. In 75% of cases, regional lymph nodes are enlarged and tender for up to 6 weeks.
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GENITAL HERPES – DEFINITION

Thursday, October 14th, 2010

Herpes is an increasingly common sexually transmitted infection caused by herpes simplex virus (HSV). There are two types, HSV-1 and HSV-2, which are clinically and epidemiologically similar. HSV-1 is often associated with lesions on the face and fingers and sometimes with genital lesions; it is usually acquired during childhood. HSV-2 is usually acquired after sexual activity commences and is almost entirely associated with genital herpes.
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LYMPHOGRANULOMA VENEREUM – CLINICAL MANIFESTATIONS

Thursday, October 14th, 2010

The incubation period is extremely variable ranging from 3 to 30 days. An herpetiform vesicle or papule develops at the site of infection. The vesicle ruptures and becomes a small painless punched-out ulcer which heals rapidly. The transient lesion may not be noticed. The primary lesion may take the form of a urethritis. In males, the primary lesion usually occurs on the penis. In females, the primary lesion usually develops on the vaginal wall or occasionally on the cervix and is rarely seen.

Up to 4 months later, unilateral or bilateral inguinal lymphadenopathy develops, often in association with headache, chills, sweats, weight loss, splenomegaly and migratory polyarthritis. Within 1 to 2 weeks, the nodes become tender and fluctuant and frequently ulcerate discharging purulent exudate. Buboes are more common in men. In women, deep iliac lymph nodes are usually involved.

In women, strictures of rectum and urethra and elephantiasis of the external genitalia (esthiomene) may develop. Rectal infections in homosexual men may progress from proctitis to rectal stricture.
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