Antidepressants Blog

New techniques to detect trichomonas are being studied; they employ the polymerase chain reaction test, which looks for the genetic material of the protozoa. Blood tests designed to detect the body’s immune response to the infection are also under study These newer tests are not yet used routinely in clinical practice.

Trichomoniasis is harder to diagnose in men than in women. Cultures can be taken from the urethra in men to make the diagnosis, although this approach often does not reveal trichomonas, even in men who have the infection. The only evidence may be white blood cells from a urethral swab test seen under the microscope on nongonococcal urethritis). Trichomonas infection is estimated to cause between 2 and 5 percent of cases of nongonococcal urethritis in men in the United States. Men most often seek treatment for trichomonas because their partners have been diagnosed with trichomoniasis rather than as a result of symptoms they have noticed in themselves.

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Most people who are infected with HIV have no symptoms: they feel fine, they look fine, and they would not know they were infected unless they were tested. However, between 30 and 70 percent of newly infected people develop a flu-like illness within two to six weeks of becoming infected. Symptoms usually last one or two weeks and include a sore throat, fever, night sweats, lymph node swelling throughout the body, muscle aches, and a diffuse flat, red rash over the entire body. The symptoms resolve on their own.

It is during this time that most people develop antibodies to the infection, a process called seroconversion. Antibodies are proteins that the immune system makes in response to infections. It is also at this time that people have a large amount of the virus circulating in their systems, and there can also be a temporary drop in the number of circulating CD4 cells (the specific type of cell of the immune system that the virus infects), owing to direct damage by the virus. Because these symptoms are so vague, those experiencing them may seek no medical care at this time. If they do seek medical care, they may be diagnosed with HIV infection or misdiagnosed with one of the many other viral infections that can cause similar symptoms. Again, not everyone has these symptoms, and, certainly, not every cold or flu signals HIV infection. Soon after initial infection the body begins to succeed in keeping the virus in check, and a person remains symptom free, on average, for ten years. During this time, it is not uncommon for infected people to notice lymph node enlargement throughout the body. Lymph nodes, which are found in many locations in the body, may swell as a result of infections and malignancies, both of which stimulate the immune system. Because HIV infection involves constant stimulation of the immune system, the nodes are often swollen, even early in an infection. Indeed this may be the only symptom of HIV infection at this time.

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Pap smear results are reported in four ways, known as the class system, the CIN (cervical intraepithelial neoplasia) system, the descriptive system, and the Bethesda system. Which system is used depends on the laboratory to which the specimen was sent. The results are reported as follows:

1. Class I

CIN system: normal

Descriptive system: no abnormal cells seen, or negative

Bethesda system: within normal limits

A follow-up Pap smear is recommended in one year.

2. Class II

CIN system: normal, with a description given of any findings that may be unusual

Descriptive system: atypical cells, as seen with cervicitis and other infections

Bethesda system: infection, reactive or reparative changes seen, or atypical cells of unknown significance (ASCUS)

Although this is still a “negative” Pap smear in terms of cancer screening, either infection or “atypical” cells may be seen, and these may or may not be precancerous. Any infection must be identified and treated and a follow-up Pap smear performed, usually in three to six months. If no infection is present, another Pap smear in three to six months is still indicated. In addition to infection, some other causes of these changes may include atrophy (thinning) of the tissues as seen postmenopause and the presence of an intrauterine device. If the abnormalities persist or progress on the follow-up smear, then a colposcopic examination of the cervix is in order.

3. Class III

CIN system: CIN I-III

Descriptive system: dysplasia (mild to severe)

Bethesda system: squamous intraepithelial lesion (low- to high-grade squamous intraepithelial lesion [SIL])

This category encompasses a wide range of possible Pap smear results. In general, the lower the grade or number, the lower the need for concern, although close follow-up is recommended for all women whose Pap results fall into this category. About two-thirds of the lower-grade lesions resolve without treatment.

For the lower-grade lesions (CIN I, mild dysplasia, or low-grade SIL), a follow-up Pap smear should be performed in three to six months, or a colposcopy could be done at the start. If a total of three follow-up Pap smears at six-month intervals come back as normal, then a schedule of yearly Pap smears can be resumed. A colposcopy and a biopsy of suspicious lesions are recommended if the changes do not resolve on their own or if the changes progress to a higher-grade lesion.

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For men or women performing oral-genital sex on a female partner or oral-anal sex on any partner, latex barriers will offer the most protection against transmission of sexually transmitted infections. One type of latex barrier used for this purpose is the dental dam, which is a small (six-inch) square of latex commonly used in dentists’ offices to prevent splattering of oral secretions into the dentist’s face during procedures. Many people also use them for protection during oral sex by placing the dam over the female partner’s genitals or the female or male partner’s anal area before beginning oral sex. They come in different flavors, which can make using them more fun. You may want to wash off the dam before use, since sometimes there is a dusting of powder on it, to which some people may have an allergic reaction. In addition, it’s a good idea to put a dab of water-based lubricant on the side that comes into contact with the partner’s genital or anal area, since this enhances the pleasure. Dental dams tend to be thicker than condoms or gloves and therefore may offer less sensory pleasure. Dental dams are available from stores that sell dental supplies or stores or mail-order businesses that sell sex toys.

Another option for oral-female genital or oral-anal sex is cutting open a condom or a latex glove and using it in the same way. Again, since spermicide tastes bad to many people, unlubricated condoms are a better choice for this method than lubricated ones. Condoms can be purchased in most pharmacies and grocery stores, and latex gloves are also available in most pharmacies.

There are plastic options as well. Plastic may offer better sensory stimulation, since it is thinner than latex yet it probably provides the same degree of protection. It is a good option for those who have a sensitivity to latex. The newer plastic condoms can be split down the middle and placed over a partner’s genitals or anal area to permit the performance of safer oral sex. Another alternative is household plastic wrap. Although there aren’t any scientific studies to show that plastic wrap offers good protection, it is better than no protection, and it offers the option of using as big a piece as you need. You may want to use more than one layer of plastic wrap for extra protection. Plastic barriers can be used with water- or oil-based lubricants, and putting a small amount on the side that touches your partner can enhance his or her pleasure.

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Seeking advice about a problem related to sexuality can be difficult. Because of this, many people with sexual health concerns never seek help for their problems. Others go to their health care providers, but once they get there they are too embarrassed to mention what is really worrying them. Some people who do try to get proper care find that their health care provider is also embarrassed or doesn’t have expertise in issues related to sexual health, so they don’t get the attention, understanding, or treatment that they need. Finally, there are those who never have themselves tested because they are afraid of what the results might be.

There are many good reasons to overcome embarrassment and fear and seek medical advice if you suspect that you may have a sexually transmitted disease. Someone who is infected but doesn’t know it, for example, can still infect his or her sexual partners, and pregnant women who are infected with certain STDs may pass the infections to their babies during the pregnancy or at delivery. There are infections of the reproductive tract that can cause infertility in both men and women if they are not detected and treated in time. Some STDs can cause cancer or death. Many infections are curable, however, so early detection and treatment are essential for your long-term health.

If you are convinced of the importance of early detection of sexually transmitted infection, and if you are committed to being vigilant about your sexual health, what should you do? You may decide that you want to be tested on a regular basis, say every six months to a year, especially if you are sexually active and not in a steady, monogamous relationship. People who are in steady, monogamous relationships may want to be tested before they become intimate. You may want to make STD screening part of your annual physical examination. These are all good ideas, and so is getting tested after any unprotected sexual contact with a partner whose status for infection is unknown.

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