Smileband Health issues

Chancroid 

What is chancroid?

Chancroid is a highly contagious yet curable sexually transmitted disease (STD) caused by the bacteria Haemophilus ducreyi [hum-AH-fill-us DOO-cray]. Chancroid causes ulcers, usually of the genitals. Swollen, painful lymph glands, or inguinal buboes [in-GWEEN-al BEW-boes], in the groin area are often associated with chancroid. Left untreated, chancroid may facilitate the transmission of HIV.

How common is it?

The prevalence of chancroid has declined in the United States. When infection does occur, it is usually associated with sporadic outbreaks. Worldwide, chancroid appears to have declined as well, although infection might still occur in some regions of Africa and the Caribbean. Chancroid, as well as genital herpes and syphilis, is a risk factor in the transmission of HIV infection.

A definitive diagnosis of chancroid requires the identification of H. ducreyi on special culture media that is not widely available from commercial sources; even when these media are used, sensitivity is less than 80 percent. No FDA-cleared PCR test for H. ducreyi is available in the United States, but such testing can be performed by clinical laboratories that have developed their own PCR test and have conducted a CLIA verification study.

The combination of a painful genital ulcer and tender suppurative inguinal adenopathy suggests the diagnosis of chancroid. A probable diagnosis of chancroid, for both clinical and surveillance purposes, can be made if all of the following criteria are met: 1) the patient has one or more painful genital ulcers; 2) the patient has no evidence of T. pallidum infection by darkfield examination of ulcer exudate or by a serologic test for syphilis performed at least seven days after onset of ulcers; 3) the clinical presentation, appearance of genital ulcers and, if present, regional lymphadenopathy are typical for chancroid; and 4) a test for HSV performed on the ulcer exudate is negative.

How do people get chancroid?

Chancroid is transmitted in two ways:

• sexual transmission through skin-to-skin contact with open sore(s).
• non-sexual transmission when pus-like fluid from the ulcer is moved to other parts of the body or to another person.

A person is considered to be infectious when ulcers are present. There has been no reported disease in infants born to women with active chancroid at time of delivery.

What are the signs or symptoms of chancroid?

• Symptoms usually occur within four days to ten days from exposure. They rarely develop earlier than three days or later than ten days.
• The ulcer begins as a tender, elevated bump, or papule, that becomes a pus-filled, open sore with eroded or ragged edges.
• The ulcer is soft to the touch (unlike a syphilis chancre that is hard or rubbery). The term soft chancre is frequently used to describe the chancroid sore.
• The ulcers can be very painful in men but women are often unaware of them.
• Because chancroid is often asymptomatic in women, they may be unaware of the lesion(s).
• Painful lymph glands may occur in the groin, usually only on one side; however, they can occur on both sides.

How is chancroid diagnosed?

Diagnosis is made by isolating the bacteria Hemophilus ducreyi in a culture from a genital ulcer. The chancre is often confused with syphilis, herpes or lymphogranuloma venereum; therefore, it is important that your health care provider rule these diseases out.
A Gram stain to identify H. ducreyi is possible but can be misleading because of other organisms found in most genital ulcers.

What is the treatment for chancroid?

Successful treatment for chancroid cures the infection, resolves the clinical symptoms, and prevents transmission to others. In advanced cases, scarring can result, despite successful therapy.
Antibiotics used to treat chancroid include; Azithromycin 11 g orally, Ceftriaxone 250 mg intramuscularly (IM), Ciprofloxacin 500 mg orally or Erythromycin 500 mg orally.
Ciprofloxacin is contraindicated for pregnent and lactating women.
Azithomycin and ceftriaxone offer the advantage of single-dose therapy. Worldwide, several isolates with intermediate resistance to either ciprofloxacin or erythromycin have been reported. However, because cultures are not routinely performed, data are limited regarding the current prevalence of antimicrobial resistance.

Follow-up

Patients should be re-examined three days to seven days after initiation of therapy. If treatment is successful, ulcers usually improve symptomatically within three days and objectively within seven days after therapy. If no clinical improvement is evident, the clinician must consider whether 1) the diagnosis is correct, 2) the patient is coinfected with another STD, 3) the patient is infected with HIV, 4) the treatment was not used as instructed, or 5) the H. ducreyi strain causing the infection is resistant to the prescribed antimicrobial. The time required for complete healing depends on the size of the ulcer; large ulcers might require greater than two weeks. In addition, healing is slower for some uncircumcised men who have ulcers under the foreskin. Clinical resolution of fluctuant lymphadenopathy is slower than that of ulcers and might require needle aspiration or incision and drainage, despite otherwise successful therapy. Although needle aspiration of buboes is a simpler procedure, incision and drainage might be preferred because of reduced need for subsequent drainage procedures.

Other Management Considerations

Men who are uncircumcised and patients with HIV infection do not respond as well to treatment as persons who are circumcised or HIV-negative. Patients should be tested for HIV infection at the time chancroid is diagnosed. If the initial test results were negative, a serologic test for syphilis and HIV infection should be performed three months after the diagnosis of chancroid.

Special Considerations

Pregnancy

Ciprofloxacin is contraindicated during pregnancy and lactation. No adverse effects of chancroid on pregnancy outcome have been reported.

How can chancroid be prevented?

• Abstinence (not having sex)
• Mutual monogamy [having sex with only one uninfected partner]
• Latex condoms for vaginal, oral and anal sex. Using latex condoms may protect the penis or vagina from infection, but does not protect other areas such as the scrotum or anal area. Chancroid lesions can occur in genital areas that are covered or protected by a latex condom, but may occur in areas that are not covered or protected by a condom. Latex condoms, when used consistently and correctly, can reduce the risk of chancroid, genital herpes, syphilis, and genital warts, only when the infected areas are covered or protected by the condom.

If you do get chancroid, avoid contact with the infected area to prevent chance of spreading the infection to other parts of the body.

Why worry?

Chancroid has been well established as a cofactor for HIV transmission. Moreover, persons with HIV may experience slower healing of chancroid, even with treatment, and may need to take medications for a longer period of time. Complications from chancroid include:

• In 50 percent of cases, the lymph node glands in the groin become infected within five to eight days of appearance of initial sores.
• Glands on one side become enlarged, hard, painful and fuse together to form a bubo (BEW-bo), an inflammation and swelling of one or more lymph nodes with overlying red skin. Surgical drainage of the bubo may be necessary to relieve pain.
• Ruptured buboes are susceptible to secondary bacterial infections.
• In uncircumcised males, new scar tissue may result in phimosis [constriction so the foreskin cannot be retracted over the head of the penis]. Circumcision may be required to correct this.

What should I tell my partner?

You should talk to your partner as soon as you learn you have chancroid. Telling a partner can be hard, but it's important that you talk to your partner as soon as possible so she or he can get treatment.

How do I address the subject with my health care provider?

If you have a genital ulcer or painful, swollen lymph nodes, you need to talk to your doctor about whether or not you should be tested. However, it's important to remember that some people, usually women, are asymptomatic. If you are having unprotected sex or discover that your partner is having unprotected sex with another person, you may want to ask your doctor about being tested for STDs.
 

Smileband Health issues

Pubic lice symptoms

Usually, the symptoms of pubic lice start about 5 days after you get them. Some people never have symptoms, or they think the symptoms are caused by something else (like a rash).

The most common symptom of pubic lice is intense itching in your pubic area. The itching and irritation is caused by your body’s reaction to the crabs’ bites.  

Pubic lice symptoms include:

• Lots of itching in your genital area.
• Super small bugs in your pubic hair. You can usually see pubic lice by looking closely, or you may need to use a magnifying glass. Pubic lice are tan or whitish-gray, and they look like tiny crabs. They get darker when they’re full of blood.
• Crab eggs (called nits) on the bottom part of your pubic hairs. Nits are really small and can be hard to see. They’re oval and yellow, white, or pearly. Nits usually come in clumps.
• Dark or bluish spots on the skin where pubic lice are living. These spots come from the crabs’ bites.
• Feeling feverish, run-down, or irritable.

Crabs usually hang out in your pubic hair around your genitals, which is why it’s easy to get them from sex. But crabs can sometimes end up in other kinds of coarse hair, like your eyelashes, eyebrows, chest hair, armpits, beard, or mustache. It’s really, really rare to get pubic lice in the hair on top of your head. 

Smileband Health issues

Anyone can get scabies. It is found all over the world and the mite is transmitted by direct and prolonged skin-to-skin contact with a person who has scabies. Sexual contact is the most common way scabies is transmitted. Transmission can also happen from parents to children, particularly mother-to-infant. The mite can only survive about 48 to 72 hours without human contact, so it is uncommon, though possible, for scabies to spread through infested bedding or furniture. Animals do not spread the same types of mites that cause human scabies, so it is not possible to catch scabies from a dog or cat. The type of scabies that can infest pets is called "mange." Mange mites can spread to humans and cause minor itching and redness, but those mites cannot survive or reproduce on human skin and will die out on their own, limiting symptoms in humans. People do not need to be treated if they come into contact with mange, but dogs and cats must be treated because mange can spread and cause fur loss, and scaly and itchy skin in pets. Symptoms of scabies are usually itching (which tends to be more intense at night), and a pimple like rash. Scabies rash can appear on any part of the body, but the most common sites are wrists, elbows, armpits, the skin between the fingers and toes and around the nails, and skin usually covered by clothing such as the buttocks, belt line, nipples, and penis. Infants and young children may have scabies rash on their head, face, neck, palms, and soles.

In some patients with weakened immune systems, scabies rash may become crusted. 

Smileband Health issues

A Thai Grandmother who lives with a rare condition that causes her face to melt is refusing surgery out of fear that it will kill her.  Abnormal growths began to spread across Wiang Boonmee's face causing her to lose sight in both eyes.

The 63-year-old's melting face has also twisted her nose and mouth out of shape so that they hang off her face.  Ms Boonmee has suffered with the condition for decades after developing it as a child.

She recently moved to Bangkok where despite her growths she earns a living by selling accessories on the street in the city centre.      

Previously from rural Surin the mother-of-one has received lots of attention after medics were contacted to reqeust assisstance for her, the Mirror reported. The disease Ms Boonmee is believed to be suffering with is related to neurofibromatosis, a genetic disorder that causes tumors to form on nerve tissue But despite the severely debilating condition she refuses to be operated on because she is scared that she will die during surgery.      

Ms Booneme, who also has two grandchildren, said: 'I have had this problem for a long time. More than I can remember. I have survived and I'm healthy and have a job.

'If I have an operation I might never wake up. I'm afraid I would not survive it.

'My daughter brings me here so I can sell flowers and camphor oils. I am happy and somebody gave me a donation this week, which I'm grateful for.'

Health workers were first contacted by Praew Wattana, 22, to ask for help after spotting her in the street a few weeks before.  

Smileband Health issues

• LadyCare magnets claim to 'naturally' cure the painful symptoms of menopause, which include hot flushes, headaches and exhaustion 
• Celebrities including Belinda Carlisle have described magnet therapy as a 'miracle cure'
• The process involves clipping a magnet to women's underwear
• Health expert Dr Jen Gunter has rubbished the claims, claiming all it will do is 'lighten your wallet' and the real cause of hot flushes is 'not yet known From hot flushes to headaches and exhaustion, the menopause can bring on a whole range of unwanted symptoms. For decades, women have turned to more traditional remedies such as HRT (hormone replacement therapy), which comes in different forms including patches and tablets. 
  But a site is now offering a quirky alternative to menopausal women, in the form of a magnet which is clipped into their underwear, a product championed by singer Belinda Carlisle. 
  However top health expert Dr Jen Gunter has slammed the so-called 'natural remedy', claiming that all it will do is 'lighten your wallet', and says that the true causes of hot flushes are 'not yet understood'. Ladycare magnets retail for between £35 to £50, and clipped to the front of underwear to be worn throughout the day, designed to refocus the body's energy.
  The makers claim the magnetic therapy has relieved the symptoms for 70% of women by re-balancing their autonomic nervous system. 
  A statement on site reads: 'We believe the technology helps by reducing excessive sympathetic nervous system activity and increasing parasympathetic activity, thus restoring equilibrium and creating a healthier balance between the two parts of the ANS.
  'Menopause symptoms are the result of diminished natural hormones, which then cause an imbalance of the ANS.'
  And singer Belinda, now 59, was so impressed with the product back in 2014, that she talked to MailOnline about the instant effect it had for her. After hitting the menopause in her late forties, she experienced extreme symptoms, admitting: 'I was getting around 40 flushes a day. I would sweat so badly it would be visible on me and I had to get into the habit of taking a change of clothes with me because my blouse and jeans would be wet through.'
  But this changed when she stumbled across the little-known magnet, admitting: 'Within 48 hours, I went from having 30 to 40 hot flushes to having none at all. I felt like the old Belinda again — in fact better than that.
  'Before I started getting the menopausal symptoms, I had suffered with really bad PMS: really bad depression and I had no energy. 

Smileband Health issues

The dreaded Aussie flu outbreak expected to be the worst in 50 years has taken hold of Britain as official figures reveal cases have more than doubled in one week. Government statistics show 1,111 people were struck down with flu as temperatures dropped last week - a 156 per cent jump on the previous seven days. 

The sharp rise in cases, released by Public Health England, has been triggered by a surge in two aggressive subtypes attacking the population simultaneously.

One includes the so-called 'Aussie flu', a strain of influenza A which wreaked havoc on hospitals in Australia during the country's winter.

The H3N2 subtype triggered two and a half times the normal number of cases in Australia. Britain's flu season tends to mirror what has happened there.

Experts fear the virulent flu strain, which has now reached the UK, could prove as deadly to humanity as the Hong Kong flu in 1968, which killed one million people. Usually, just one subtype, either influenza A or B, is responsible for the majority of  cases. It spreads much easier in the cold weather.

But last week 522 cases of influenza A and 546 of influenza B were recorded across England and Wales. Some 43 cases are yet to be identified.

Some 23 people have died from the flu outbreak so far this winter, with nearly a third of fatalities having occurred last week.

However, this winter's outbreak shows no signs of slowing down, as flu cases are expected to rocket even further in the coming weeks. Cases this year are almost 10 times higher than they were at the same point in 2015, according to the PHE data. Just 132 cases were recorded then.

But in 2015, Government figures suggested that the winter flu played a part in more than 16,000 deaths. Only 577 deaths were recorded in the previous winter. 

The total recorded in week 51 is also double that of last year, when 583 cases, mainly of the H3N2 subtype, were reported. 

The sharp rise in flu is only expected to cause further problems for the NHS, with cases of the winter vomiting bug also continuing to soar. 

Some 2,117 people have been infected with norovirus since July. The figure has raised at a steady level week-on-week since October.

Nick Phin, of PHE, said: 'Flu activity, as measured by a number of different systems, has continued to increase in the last week or two. 

'This is to be expected as the season progresses and at this point the numbers are in-keeping with previous years.

'The circulating flu strains match those in the current flu vaccine, so the vaccine remains the best defence against the virus.'

The PHE figures follow repeated predictions by researchers that the flu vaccine may only be 20 per cent effective this winter - just like last year. Some experts in Australia blamed this as a reason why they suffered such a severe flu outbreak. The vaccine used in the UK will be very similar. 

The WHO creates the vaccines in March, based on which flu strains they expected to be in circulation. They are then doled out in September.

Australia - whose winter occurs during the British summer - had one of its worst outbreaks on record, with two and a half times the normal number of cases. Some of the country's A&E units had 'standing room only' after being swamped by more than 100,000 cases of the H3N2 strain.  

The elderly with their compromised immune systems are particularly susceptible, and a spike in cases among young children has also been shown.

The flu season in the UK and the rest of the Northern Hemisphere tends to mirror what has happened in Australia and the Southern Hemisphere.

The same strains of the virus will circulate north in time for the British flu season, which typically begins in November and lasts until March.

Flu viruses are constantly changing proteins on their surface to avoid detection by the body's immune system - making it more deadly.

This transformation is called an 'antigenic shift' if it's large enough, and can lead to a pandemic. This was responsible for the swine flu outbreak in 2009.

The Aussie flu is transforming quickly, but not fast enough for experts to describe it as a shift. However, it is slowly building up immunity. 

Smileband Health issues

With only 5 per cent of the world’s population, Eastern and Southern Africa is home to half the world’s population living with HIV. Today the region continues to be the epicentre of the HIV/AIDS epidemic, with 48 per cent of the world’s new HIV infections among adults, 55 per cent among children, and 48 per cent of AIDS-related deaths [1]. 

The Southern Africa sub-region, in particular, experiences the most severe HIV epidemics in the world. Nine countries - Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe - have adult HIV prevalence rates of over 10 per cent. At an estimated 26.0 per cent, Swaziland has the highest HIV prevalence rate in the world, followed by Botswana (23.4 per cent) and Lesotho (23.3 per cent). With 5.6 million people living with HIV (17.3 per cent), South Africa is home to the world’s largest epidemic.

In the past 10 years, efforts to halt the spread of the epidemic by national governments and development partners have borne fruits: new infections among adults have decreased by more than 50 per cent in Botswana, Ethiopia, Malawi, Namibia, Rwanda, Zambia and Zimbabwe; and by more than 25 per cent in Kenya, Mozambique, South Africa, and Swaziland. Among children, the number of new infections has dropped from 330,000 in 2001, to 180,000 in 2011.

Despite the progress, there are still 17.1 million adults and children living with HIV in Eastern and Southern Africa, and the figure continues to increase as antiretroviral therapy (ART) ensures millions of people with HIV can now live a healthy life. Moreover, most people on ART start treatment late, limiting the overall impact of antiretroviral medicines. 

For many pregnant women living with HIV, such treatment remains out of reach, especially for those living in rural areas, and those fearful of stigma and discrimination if they are tested positive. Of the 960,000 pregnant women living with HIV in 2011, more than 90 per cent of them resided in just nine countries - South Africa, Mozambique, Uganda, Tanzania, Kenya, Zambia, Zimbabwe, Malawi and Ethiopia. Compared to adults, the progress in providing treatment to children is much slower. Out of the 2.2 million children who needed ART in 2011, only 33 per cent were receiving it.

The number of orphans due to AIDS continues to increase [2]. The region now has 10.5 million children who have lost one or both parents to AIDS. Against the mounting needs, care and support to the children made vulnerable by HIV and AIDS are nowhere near adequate. In most countries in the region, only around 20 per cent or less of these children receive some sort of external support.