Health Fitness Topics

Fruits and Vegetables that keep you hydrated

2017-05-11T06:07:00.000-07:00

Seasons change and so do the veggies and fruits on our plate. Seasonal vegetables and fruits come for a reason. They fulfil the essential nutrients required by our body, like the summer fruits, berries and cucumbers that help in keeping our body well hydrated.

Watermelon

Appropriately named, this fruit contains 92 per cent water. Other contents of the watermelon are magnesium and calcium that too help in rehydration. This summer staple food is also enriched with potassium, vitamin A and C.Watermelon fruit is 91% water, contains 6% sugars, and is low in fat.In a 100 gram serving, watermelon fruit supplies 30 calories and low amounts of essential nutrients (table). Only vitamin C is present in appreciable content at 10% of the Daily Value. Watermelon pulp contains carotenoids, including lycopene

Cucumbers

Cucumbers contain 96.7 per cent water. They have no saturated fat and are high in vitamin K, vitamin B6 and iron.In a 100 gram serving, raw cucumber (with peel) is 95% water, provides 16 calories and supplies low content of essential nutrients, as it is notable only for vitamin K at 16% of the Daily Value.

Strawberries

Strawberries are a perfect treat for summer. These sweet berries contain 92 per cent water and are loaded with fibre and vitamin C.One serving (100 g) of strawberries contains approximately 33 kilocalories, is an excellent source of vitamin C, a good source of manganese, and provides several other vitamins and dietary minerals in lesser amounts.Few studies have directly examined the effects of eating strawberries on human health. However, limited research indicates that strawberry consumption may be associated with a decreased cardiovascular disease risk and that phytochemicals present in strawberries have anti-inflammatory or anticancer properties in laboratory studies

Strawberries contain a modest amount of essential unsaturated fatty acids in the achene (seed) oil.

Celery

Celery contains 95.4 per cent water and loaded with fibre. Celery is rich in minerals like potassium and vitamin K.Celery is used in weight-loss diets, where it provides low-calorie dietary fibre bulk. Celery is often incorrectly thought to be a "negative-calorie food," the digestion of which burns more calories than the body can obtain. In fact, eating celery provides positive net calories, with digestion consuming only a small proportion of the calories taken in

Lettuce

Lettuce is also packed with water content. It contains 96 per cent water. Add lettuce in salads or in sandwiches and keep your body hydrated.Depending on the variety, lettuce is an excellent source (20% of the Daily Value, DV, or higher) of vitamin K (97% DV) and vitamin A (21% DV) (table), with higher concentrations of the provitamin A compound, beta-carotene, found in darker green lettuces, such as Romaine.With the exception of the iceberg variety, lettuce is also a good source (10-19% DV) of folate and iron

Tomatoes

A tomato is 95% water, contains 4% carbohydrates and less than 1% each of fat and protein (table). In a 100 gram amount, raw tomatoes supply 18 calories and are a moderate source of vitamin C (17% of the Daily Value), but otherwise are absent of significant nutrient content.

Green peppers

Peppers are highly nutritious. They have more Vitamin C than an orange, and a typical bell pepper contains more than 100% of the daily recommended value for Vitamin C. They also have relatively high amounts of Vitamin B6. Fresh fruit is 94% water. Dried pepper fruit has a much different nutritional value due to the dehydration and concentration of vitamins and minerals.

Spinach

In a 100 g (3.5 oz) serving providing only 23 calories, spinach has a high nutritional value, especially when fresh, frozen, steamed, or quickly boiled. It is a rich source (20% or more of the Daily Value, DV) of vitamin A, vitamin C, vitamin K, magnesium, manganese, iron and folate (table). Spinach is a good source (10-19% of DV) of the B vitamins riboflavin and vitamin B6, vitamin E, calcium, potassium, and dietary fiber.

Broccoli

A 100 gram serving of raw broccoli provides 34 kcal and is an excellent source (20% or higher of the Daily Value, DV) of vitamin C and vitamin K. Raw broccoli also contains moderate amounts (10–19% DV) of several B vitamins and the dietary mineral manganese, whereas other essential nutrients are in low content. Broccoli has low content of carbohydrates, protein, fat, and dietary fiber.Boiling broccoli reduces the levels of sulforaphane, with losses of 20–30% after five minutes, 40–50% after ten minutes, and 77% after thirty minutes. However, other preparation methods such as steaming, microwaving, and stir frying had no significant effect on the compounds.Broccoli also contains the carotenoid compounds lutein and zeaxanthin in amounts about 6 times lower than in kale.

Grapefruit

Grapefruit is a rich source (>20% of the Daily Value, DV in a 100 gram serving) of vitamin C, contains the fiber pectin, and the pink and red hues contain the beneficial antioxidant lycopene.Studies have shown grapefruit helps lower cholesterol, and there is evidence that the seeds have antioxidant properties. Grapefruit forms a core part of the "grapefruit diet", the theory being that the fruit's low glycemic index is able to help the body's metabolism burn fat

How does PEP works?

2016-09-22T23:05:00.001-07:00

PEP is recommended because it has been observed that systemic infection does not occur immediately after an exposure and there is a brief window period of opportunity available to contain or eradicate HIV from body before wide spread cellular infection occur. After a needle-stick injury, immune cells (dendritic) in skin present the HIV to T-lymphocytes and natural killer cells. It is seen that in monkey models, Simian immunodeficiency virus (SIV) when injected into vagina, virus is engulfed by immune cells in the vaginal lining. Within 2 days SIV is found in inguinal lymph nodes. Within 5 days SIV infected T-cells and free SIV can be detected in blood stream 9. Migration of SIV after rectal or penile tip exposure follows a similar time frame. PEP can stop viral replication during this early period before it gains a 'foothold' in the body.

Determination of the Exposure Code in PEP

2016-09-22T23:00:00.000-07:00

Exposure code can be defined as per the flow chart given below. It may be classified into three categories, EC-1, EC-2 and EC-3, depending upon the severity of exposure.

PEP Initial Evaluation

2016-09-18T22:40:00.000-07:00

What is considered to be a potential exposure to HIV, HBV or HCV?
For transmission of blood borne pathogens (HIV, HBV and HCV) to occur, an exposure must include both of the following:
• Infectious body fluid
o Blood, semen, vaginal fluids, amniotic fluids, breast milk, cerebrospinal fluid, pericardial fluid, peritoneal fluid, pleural fluid and synovial flood can transmit HIV, HBV and HCV.
• Note that saliva, vomitus, urine, feces, sweat, tears and respiratory secretions do not transmit HIV (unless visibly bloody). The risk of HBV and HCV transmission from non-bloody saliva is negligible.
• A portal of entry
(percutaneous, mucous membrane, cutaneous with non-intact skin).
If both of these factors are not present, there is no risk of transmission and further evaluation is not required.

What baseline testing should be performed after an exposure?
(If no exposure occurred or Source Person tests negative, no testing is clinically indicated. Testing may be considered for other purposes including medico legal concerns or as per institutional protocols.)
Source Person (SP):
• HIV Ab (rapid HIV Ab testing preferred if accessible)*
• HCV Ab
• HBV surface Ag
*If SP’s rapid HIV Ab test is positive, assume this is a true positive and send confirmatory testing, usually with a Western Blot test. See below*.
Exposed Person (EP):
• HIV Ab
• HCV Ab
• HBV testing: Depends on immunization status.
Note that most healthcare and public safety personnel have been vaccinated against hepatitis B. If previously vaccinated and they know they responded to the vaccination series (a positive titer is >10mIU/mL, but most do not know their titer), they are considered to have lifelong immunity and require no further testing or treatment. Similarly, if employee health records indicate they responded to the vaccination series, they are considered to be immune. For all others, see the “Exposures to HBV and HCV” section of this guide.

*Is the rapid HIV test accurate enough to decide on whether to give PEP?
Yes, the rapid HIV test is extremely sensitive and specific and can be used to determine whether to offer PEP. A positive rapid HIV test should be considered a true positive for the purposes of PEP decision-making. A negative rapid test should be considered a true negative. Investigation of whether a source might be in the “window period” is unnecessary for determining whether HIV PEP is indicated unless acute retroviral syndrome is clinically suspected.

How PEP Works

2016-09-16T22:53:00.000-07:00

We don’t have a cure for HIV, but we do have the next best thing: Prevention. In addition to condoms, clean needles, and public education, there is a now a new tool in the fight against the spread of HIV: post-exposure prophylaxis (PEP) medication. Also known as the HIV morning-after pill, these drugs help to drastically reduce the risk of contracting HIV if taken soon after exposure. Here’s what you need to know to keep yourself and your loved ones safe.

PEP is an antiretroviral medicine (ART) taken after potential exposed to HIV to prevent becoming infected. According to Aids.gov, PEP must be started within 72 hours after a recent possible exposure to HIV, but the sooner you start PEP, the better.

Once prescribed PEP, you will need to take it either once or twice daily for 28 days. The drugs work by helping the immune system to stop the virus from multiplying inside the body’s cells. According to Get PEP.com, cells that are already infected usually die naturally within a short period of time, and without means of reproducing, the virus is unable to spread and therefore infect an individual.

Unfortunately, PEP is not 100 percent effective at preventing HIV infections. In some cases, patients do not take the drug at the prescribed dosage for the prescribed amount of time. Other times, patients are infected with a strain of HIV which the drugs cannot work against, or the initial viral exposure was too great for the drugs to be effective.

The drugs are often given to those who believe they have been exposed to HIV, either through unprotected sex, shared needles, or victims of sexual assault. In addition, the drug costs between $600 and $1,000 and is meant to be used only in emergency situations, and should not be the go-to means of protection against the virus. Those who are possibly often exposed to HIV, such as individuals with HIV-positive partners, are advised to instead take PrEP, a daily drug that works similarly to lower infection risk.

PEP can have minor non-life threatening side effects such as nausea. Those who cannot afford to pay for the drug may qualify for either reimbursement or free medication through special programs.

What is emergency HIV treatment?

2016-09-15T00:17:00.001-07:00

Do you think you have been exposed to HIV within the last 72 hours?

If yes, you may be able to get treatment to prevent HIV infection.

Post-exposure prophylaxis, or PEP, is another name for emergency HIV treatment. PEP is not a cure for HIV, it is a form of HIV prevention. It is a short course of antiretroviral drugs that stops exposure to HIV from becoming a life-long infection.

Taking PEP
PEP can cause side effects such as nausea and fatigue. DO NOT stop taking PEP - talk to your healthcare professional.
PEP must be taken as soon as possible to be effective and no later than 72 hours after exposure to HIV.
PEP must be taken at the same time every day for 4 weeks.1

Can I get PEP?
Not everyone is given PEP and it is not available everywhere. A healthcare professional will advise you if they think you should take PEP. Do not assume you will be offered it.

Usually you should only take PEP if...
it has not been longer than 72 hours since exposure to HIV
you are not already living with HIV
a mucous membrance (including: eyes, mouth, vagina, rectum) has had direct contact with someone’s bodily fluid that might be infectious
an open wound has had direct conact with someone’s bodily fluid that might be infectious
the source of exposure is infected with HIV or their HIV status is unknown.

PEP and HIV testing
It’s normal to feel anxious about being infected with HIV. Don’t let being worried stop you from getting an HIV test.

If you took PEP - get tested 3 and 6 months after potential exposure.
If you didn’t take PEP - get tested 3 months after potential exposure.
PEP in pregnancy

Certain PEP drugs can be taken during pregnancy. However, some drugs should not be used for PEP if you are pregnant. Speak to a healthcare professional about your options.

PEP during breastfeeding
PEP can be taken when breastfeeding. PEP reduces the chance of passing HIV to your baby via breastfeeding. Follow the advice of your healthcare professional and national breastfeeding guidelines.

PEP after sexual assault
If you have been sexually assaulted seek urgent medical help. A healthcare professional will advise you what to do next and they may suggest taking PEP.

Assault is never your fault. You have the right to report it to your local authority if you want to.

You might also need...
Urgent treatment for other sexually transmitted infections (STIs) or blood borne viruses.
Emergency contraception to prevent unwanted pregnancies:
the morning after pill must be taken within 72 hours
the intrauterine device (IUD or coil) can be fitted within 5 days of unprotected sex.
Emotional support, advice and counseling

Getting the right support is important before, during and after taking PEP. It can help address any concerns or fears that you might have. Attend follow-up visits with your healthcare team regularly.

PEP must not be used as a frequent way to prevent HIV infection. Use condoms and safer sex practices to prevent sexual transmission of HIV.

Where to get PEP?

If you think that you have been exposed to HIV visit a healthcare clinic, doctor or pharmacy immediately.

You have the right to:

enquire about PEP
refuse PEP
have confidential support and advice
stop taking PEP.

Can PEP stop HIV?

2016-09-13T00:08:00.000-07:00

Post-exposure prophylaxis (PEP) may stop you developing an HIV infection if you’ve been exposed to the virus. However, it doesn’t always work.
You may have been exposed to HIV if you've:
had unprotected sex (without using a condom)
had sex with someone with HIV and the condom broke
been injured with an HIV-infected needle

What is PEP?
PEP is a course of anti-HIV medication. You must start the treatment as soon as possible after you’ve been exposed to HIV, ideally within a few hours. The medicines must be taken every day for four weeks.
PEP is unlikely to work if it’s started after 72 hours (three days) and it won’t usually be prescribed after this time.
PEP makes infection with HIV less likely. However, it’s not a cure for HIV and it doesn’t work in all cases. Some strains of HIV aren't affected by the medicines.
Also, the treatment may not work if you:
take the medicines incorrectly
don't start taking the medicines soon enough

What are the side effects of PEP?
PEP can have severe side effects, such as:
prolonged headaches
diarrhoea
nausea
vomiting
If you’re already HIV-positive, but don’t know it, you could develop drug resistance to PEP if you don’t take your doses properly. This could limit your treatment options in the future.

Where can I get PEP?
PEP is only available on prescription. You can get PEP from:
a sexual health or genitourinary medicine (GUM) clinic
an A&E department of a hospital
However, PEP may not be available in all areas of England. GPs can't usually prescribe PEP.
Find your nearest GUM clinic
Find your nearest A&E department
When you request to have PEP, you’ll be asked some questions, such as:
who you had sex with, to assess your risk of exposure to HIV
whether you had oral, vaginal or anal sex
whether the other person definitely had HIV – and if known, what was their "viral load"

PEP and HIV tests
You’ll be asked to take an HIV test before starting PEP treatment, to check whether you already have HIV. If you don’t agree to an HIV test, you won't be given PEP.
You’ll also need an HIV test after the treatment, to check that it’s been successful.

Safe sex
HIV can’t be cured. Don't rely on PEP to prevent HIV, because it doesn’t always work.
Using a condom is the best way to prevent the spread of sexually transmitted infections (STIs), including HIV.

Ways to Ease your Hangover

2016-05-10T02:46:00.001-07:00

The chirping birds sound like nuclear-powered crows cawing through loudspeakers, and all that blond daylight streaming through the window has an acidic effect on your eyes. You are - lamentably, maybe corruptly, avoidably, but quite certainly - hung over. And the biggest question is: What can you do about it?

Now all is not lost, because if you are all geared up for hangover, you sure can reduce its effects too. And as our granny’s would say- is the dad of stopping all evils.

Here are some tricks which will help you sail through the day after as painlessly as probable.

Never drink on an empty stomach.

Drink but do munch along.

Darlings, do not act macho. Prove your ego elsewhere!

Mixing is a big no-no. Spare that poor liver of yours!

If you are drinking 2 parts of alcohol, sip at least 1 part of water along.

Cold Water

The swift splash of cold water, will give you much needed push. This rush provokes the quick production of adrenaline in the body. As a result, the adrenaline elevates your easiness for the hangover’s effects. The headache and the profound sensation will steadily reduce. Depending on your luck, it may suddenly vanish even!

Water, milk, juice- Drink it all!

Drinking, which weakens your body and makes you feel weighty, is one of the terrible after-effects of binging on drinks. So to avoid dehydration just gulp tons of water and let it all be flushed. However, make sure you are not found near coffee in any case as it further aggravates the headache and dehydrate you.

Sleep Over Your Drinks Rage

Even after taking proper medication, you still don’t feel all right; then the super excellent solution to deal with it- is just to sleep on it. Despite the fact that, the main worry is, how do you put yourself to slumber with a bad migraine?

Soothing music – Let your mood be influenced to make you the king of la la land. Play soft jazz or blues, even though urbane, these songs induce a sleepy feel, which assists you in your cause to recuperate from a hangover.

Puke the inside turmoil out - Puking is pretty rough but it is the lesser of two ills when compared to an awful hangover. While we're on the subject, it is also an useful hangover remedy. After puking, you will feel much relaxed, as all the toxins will be washed out of your system. Force it or let it come out with its own flow, just do it, we say!

Scalp Massage – Tel maalish is one just going one step closer to heaven. Try it and you’ll be left asking for more.

Bedtime Story - This option may look childlike, but it is really valuable. As the tale jogs, your ears get familiarized to it. And soon you’ll be waving to your dreamland.

QUICK BITES

Never drink on an empty stomach.

Drink but do munch along.

The swift splash of cold water, will give you much needed push.

Puke the inside turmoil out.

Health Benefits Grapefruit

2016-05-05T06:11:00.001-07:00

The grapefruit (Citrus × paradisi) is a subtropical citrus tree known for its sour to semi-sweet fruit. Grapefruit is a hybrid originating in Barbados as an accidental cross between two introduced species, sweet orange and pomelo or shaddock , both of which were introduced from Asia in the seventeenth century. When found, it was named the "forbidden fruit"; and it has also been misidentified with the pomelo.A nutritious member of the citrus family, grapefruits are large, tart and tangy fruits known primarily for their vitamin C content. The fruit, often mistaken for a pomelo, can be found with either white, pink, or red pulps – all with different levels of sweetness while offering very similar benefits. The best part? While grapefruits are normally in season from winter through early spring, you can experience the health benefits of grapefruit all year round.

The evergreen grapefruit trees usually grow to around 5–6 meters (16–20 ft) tall, although they can reach 13–15 m (43–49 ft). The leaves are glossy dark green, long (up to 15 centimeters (5.9 in)) and thin. It produces 5 cm (2 in) white four-petaled flowers. The fruit is yellow-orange skinned and generally an oblate spheroid in shape; it ranges in diameter from 10–15 cm (3.9–5.9 in). The flesh is segmented and acidic, varying in color depending on the cultivars, which include white, pink and red pulps of varying sweetness (generally, the redder varieties are sweeter). The 1929 US Ruby Red (of the Redblush variety) has the first grapefruit patent.

Colors and flavors

Grapefruit comes in many varieties. One way to differentiate between varieties is by the flesh color of fruit they produce. The most popular varieties cultivated today are red, white, and pink hues, referring to the internal pulp color of the fruit. The family of flavors range from highly acidic and somewhat sour to sweet and tart. Grapefruit mercaptan, a sulfur-containing terpene, is one of the substances which has a strong influence on the taste and odor of grapefruit, compared with other citrus fruits.

Nutritional properties

Grapefruit is a rich source (>20% of the Daily Value, DV in a 100 gram serving) of vitamin C, contains the fiber pectin, and the pink and red hues contain the beneficial antioxidant lycopene. Studies have shown grapefruit helps lower cholesterol, and there is evidence that the seeds have antioxidant properties. Grapefruit forms a core part of the "grapefruit diet", the theory being that the fruit's low glycemic index is able to help the body's metabolism burn fat.

Grapefruit seed extract (GSE) has been shown to have strong antimicrobial properties against fungi. It is also believed to have antimicrobial properties for bacteria; however, there are no known studies that demonstrate its efficacy. Additionally, although GSE is promoted as a highly effective plant-based preservative by some natural personal care manufacturers, studies have shown that the apparent antimicrobial activity associated with GSE preparations is merely due to contamination with synthetic preservatives.

There is a popular myth that grapefruits contain high amounts of spermidine, a simple polyamine that may be related to aging. The myth probably relies on the confusion between spermidine and putrescine. While citrus fruits show high amounts of putrescine, they contain very little spermidine.

Health Benefits of Grapefruit

Seeing as grapefruits are rich in essential vitamins and minerals, there is no doubt that the fruit can provide numerous health benefits. Below you will learn about at least 10 grapefruit health benefits that you can share with your friends and family.

High level of Antioxidants

Grapefruit contains a high concentration of Vitamin C as it’s a citrus fruit. Vitamin C is a strong antioxidant.It helps in preventing and provides protection against the cold and flu. It does so by strengthening the immune system.It’s not Vitamin C alone that ensures the strengthening of the immune system; Vitamin C combines with other nutrients and vitamins to optimize the immune function. The high amount of antioxidants in grapefruit fight the damage caused by free radicals and oxidative stress. Thus, it protects from skin cancer and gives a youthful appearance to the skin by stunting the aging process.Also, grapefruit nourishes skin to protect from many skin disease

An Incredible Lift to the Immune System

Copious amounts of vitamin C helps prevent or fight the common cold. There are some indicators that vitamin C may also protect against cancers of the mouth and stomach. Grapefruit also combat free radicals that can reek havoc in the body. Cancer, stroke, and heart attack may all related to unchecked free radicals.

Liver Cleansing, Detoxifcation

Grapefruit contains numerous liver-cleansing agents. Among them are vitamin C, various antioxidants, and phytonutrients called limonoids that helps toxic compounds to excrete from the liver by making them more water soluble. The fruit also contains a flavonoid compound known as naringenin, as mentioned earlier, which causes the liver to burn fat rather than store it.

Protect from Inflammation

Grapefruit is a rich source of antioxidants like Vitamin C that protects from inflammation.Vitamin C is necessary for the synthesis of collagen that repairs and heals blood vessels, tendons, joints, and bones.This way it protects from inflammation and pain caused due to the severity of inflammatory conditions. Its function makes it a valuable aid in the treatment of osteoporosis and arthritis.It controls the severity and degeneration of bones which is a characteristic of arthritis.

Natural Fat Burner

Grapefruit that burns fat is not a simple rumor or fad. Scientific research reveals the amazing power of this wonderful breakfast or anytime fruit. Simply enjoy a glass of grapefruit juice or half of a grapefruit before each meal to reap the benefits. Those who participated in the experiment lost up to four pounds in twelve weeks.

Helps Treat Gum Disease
According to a study published in the British Dental Journal, consuming 2 grapefruits each day for two weeks results in significantly less bleeding of the gums. Grapefruits were shown to drastically increase plasma vitamin C levels and help manage periodontal disease.

Reduces Cholesterol

LDL or Low-Density Lipoprotein is termed as bad cholesterol whereas HDL, the High-Density Lipoprotein is considered good cholesterol.Though grapefruit has no cholesterol in its composition, compounds present in grapefruit helps in the reduction of LDL cholesterol and increase the levels of HDL cholesterol.Studies have conclusively shown that Red grapefruit followed by white grapefruit are very useful in improving the cholesterol levels and balance in the body.But this is not an overnight process. It shows results only when regularly consumed over a long period

Promoting a Healthy Pregnancy
Rich in folate and vitamin C, grapefruits can be great for promoting a healthy pregnancy. Vitamin C works to promote proper bone growth, bone development tissue repair, and helps to maintain cell strength in the womb. Folate, an extremely important B vitamin for pregnant mothers, helps prevent birth defects like spina bifida and helps the baby to grow sufficiently.

Lowers your Risk of Diabetes

Diabetes is a lifestyle disease increasingly becoming common in the middle-aged population.Nowadays even children are falling prey to the condition called Juvenile diabetes or type I diabetes.Type I diabetes occurs in newborn infants or younger children and requires massive external insulin supplementation.Type II diabetes occurs more often in people who are much older. It begins at the age of about forty years and can be controlled by maintaining healthy active lifestyle and managing diabetes-friendly diet.Diabetics cannot eat a majority of fruits because of their high sugar content. The good news is that they can safely eat grapefruit and, in fact, increased consumption helps to reduce and burn the starch and sugar content in the body. Even if you are not diagnosed with diabetes, but have a family history that makes you vulnerable to it, then you should include grapefruit in your diet.

Health Benefits of Mosambi Sweet lime Citrus limetta

2016-05-05T06:02:00.004-07:00

Citrus limetta, alternatively considered to be a cultivar of Citrus limon, is a species of citrus, commonly known as sweet lime, sweet lemon, and sweet limetta.

It is native to South- and Southeast Asia and cultivated in the Mediterranean Basin.

In Iran it is called Limu Shirin

In North India, it is commonly called mousambi, mosambi, or musambi .

In South India, it is called Moosambi in Kannada and Malayalam, Bathaya Kaayalu Cheeni Kaayaluin Telugu, and sathukudi in Tamil.

In Nepali, it is called Mausam.

In Sindh it is known as mosami.

In France it is sometimes called bergamot; it should not be confused with Citrus bergamia, the Bergamot orange.

It is a different fruit from the Palestinian sweet lime and from familiar sour limes such as the Key lime and the Persian lime.

Sweet lime is almost exclusively served as juice, and is the most common available citrus juice in India, Pakistan and Bangladesh. The juice is commonly sold at mobile road stalls, where it is freshly pressed, sometimes served with a salty chat masala or kala namak, unless the vendor is told not to add it.

Like most citrus, the fruit is rich in vitamin C, providing 50 mg per 100 g serving. In Iran it is used to treat influenza and common cold.

The tree is used for ornamental purposes as well as for graft stock.

Mosambi or Sweet lime is also known as the mousambi, musambi (in North India), Moosambi (in South India), Mishta nimbuka (in Sanskrit), Meeta nimbuka (in Hindi), sweet lemon (in Persian) and sweet limetta. It is a citrus fruit (belongs to the Citrus family) which was first originated in the regions of Mediterranean Southeast Asia.

Health Benefits Of Mosambi:

Mosambi is a versatile fruit with a sweet and sour taste. This amazing fruit renders terrific nutritional value. This fruit is widely consumed in the form of drinks, jams, pickles, candies, snacks and sorbets. The juice of this fruit is also versatile and is used in salads and to marinate meat. Some of the health benefits of mosambi are given below.

Sweet lime or Mosambi juice is very famous juice all through the India, Pakistan and Bangladesh and can be found in almost every season (however, sufficiently available in July, August and November, March.) at road side shops and fruit mandi. People generally like drinking its juice during summer season by adding some salty chat masala, kala namak and etc.

Benefits of Mosambi for Digestive System

Stimulates Digestive System Functioning

Mosambi has a high content of flavonoids that stimulate the digestive system by increasing the secretion of digestive juices, acids and bile. Hence, mosambi juice is often recommended to people suffering from indigestion, irregular bowel movement and other gastrointestinal problems. Thus, it aids digestion by neutralizing the acidic digestive juices produced by the stomach and flushes out the toxins from the excretory system. The compounds found in this fruit are beneficial for peristaltic motion. Sweet lime also helps in controlling diarrhea, nausea and vomiting.

Cures Digestive System Disorders

Mosambi helps in curing some common digestive system disorders like nausea, indigestion, irregular bowel movements and etc.

Boosts Digestion Process

It boosts up the digestion process as it helps in neutralizing the extra acids produced by stomach as well as flushes out body toxins through excretory system.

It keeps peristaltic motion healthy and helps in controlling nausea, vomiting and diarrhea.

Relieves Constipation

Sweet lime makes bowel tract smooth and provides relief from the constipation as it is contains good level of dietary fibers which acts as roughage (purgative property) and makes stool soft and easy passage.

Promotes Healing of Ulcers

Flavonoids found in it called Limomin Glucoside has anti carcinogenic, antioxidant and antibiotic properties thus helps in healing internal wounds called ulcers (oral and peptic).

Benefits of Mosambi in Scurvy Disease

Treats Scurvy

Scurvy is a disease caused by the deficiency of vitamin C. This disease is characterized by bleeding, swollen gums, frequent bouts of flu and cold, ulcers in the mouth and tongue, and cracked lip corners. The sweet limes can stop the bleeding of gums. Mix mosambi juice with a few drops of pure water and add a pinch of black salt to the mixture. This mixture should be applied to the affected gums for an immediate relief from bleeding gums. Halitosis (bad breath) can be eliminated by sipping lime juice and sucking on lime rinds.

Fulfills Need of Vitamin C

Regular intake of mosambi (whole or juice) helps in reducing all the symptoms of scurvy disease by fulfilling the level of required vitamin C in the body.

Controls Bleeding Gums

Sweet lime makes gums stronger than before and helps in controlling bleeding from gums and bad breath problem.

Benefits of Mosambi Juice/Sweet Lime Juice

Energizes Body

Regular intake of mosambi juice helps in relieving fatigue and weakness due to motion sickness.

Relieves Heart Burn and Acidity

Drinking a glass of mosambi juice on daily basis helps in relieving from heartburn and acidity.

Prevents from Sunstroke and Dehydration

It has ability to prevent from the sunstroke and dehydration during summer season as it contains lots of water, essential vitamins, electrolytes and minerals.

Reduces Muscle Cramps

It is highly preferred by the sport persons and athletes after their hard work out sessions as it fulfills the water level and reduces muscle cramps.

Maintains Blood Sugar Level

Sweet lime juice is very beneficial for the diabetic patients if the mixture of mosambi juice, amla juice and honey is taken with empty stomach in the early morning.

Prevents from Eye Disorders

Its antioxidant and anti-bacterial nature provides eye protection from various infections like conjunctivitis and age related muscular degeneration.

Improves The Immune System:

The regular consumption of mosambi juice brings about an improvement in the overall heart functioning. Thus, it ensures proper blood circulation and contributes to a much healthier immune system. Vitamin C boosts the immunity levels and prevents cold.

Benefits of Mosambi Juice in Pregnancy

Promotes Better Growth of Fetus

Sweet lime juice is good source of potassium, calcium and vitamin C which are necessarily required by the growing fetus for the proper growth and development.

Promotes Functioning of Brain and Nervous System

Its cooling property keeps brain and nervous system functions smooth thus prevents from brain fever and mental issues during pregnancy to both mother and baby.

Boosts Blood Circulation

Mosambi juice has high level of vitamin C which boosts the blood circulation all through the body thus keeps both mother and baby healthy.

Benefits of Mosambi Juice in jaundice

Regularizes Liver Functioning

Mosambi juice is considered that it reduces the symptoms of jaundice by regularizing the liver functioning and controlling bile secretion in the body thus highly preferred by the doctor for the people suffering from jaundice.

Cures Respiratory Problems

It helps in curing asthma and other respiratory problems if mosambi juice is taken by mixing some cumin seeds and dry ginger powder.

Prevents from Infection

Sweet lime provides relief during tonsillitis and its painful symptoms as it is rich in vitamin C which reduces infections of cold, cough and fever as well as soothes irritating, dry, itchy and sore throat.

Benefits of Sweet lime Juice for men

Strengthens Body and Improves Sperm Count

Regular consumption of mosambi juice enhances appetite level, purifies blood as well as raises the sperm quality and count among men.

Benefits of Citrus limetta Juice for Hair

Its antiseptic and antibacterial properties add lots of benefits towards beauty therapies which are mentioned below:

Strengthens Hair

It helps in strengthening hair because of its richness in vitamins and minerals.

Treats Hair Loss

Mosambi juice helps in treating split hair ends and dandruff problem.

Promotes Hair Growth

It makes hair bright, shiny, long, natural black and strong as it provides all the required nutrients for the hair growth and maintenance.

Provides Natural Color to Hair

It is rich source of copper mineral which involve in the formation of pigment melanin thus provides natural color to the hair.

Benefits of Citrus limetta Juice for Skin

Provides Wonderful Skin

Drinking mosambi juice regularly is very good for getting wonderful skin as it contains high vitamin C level (used in manufacturing various skincare products and medicinal supplements in order to treat dry, rough skin, improving skin tone, speeding up healing and so many.

Removes Dark Pigmentation and Spots

It has mild bleaching and cleansing property and helps to get rid of dark pigmentation, spots, acne, pimples, blemishes and etc.

Lightens Skin Tone

It provides glowing, radiant and smooth skin by reducing the scars of insect bite and lightening the skin tone if consumed regularly.

Detoxify Body

Sweet lime juice helps in detoxifying the body which provides natural glow and shine to the skin.

Cures Dark and Cracked Lips

It helps in lightening the dark skin on lips as well as curing cracked lips.

Other Health Benefits of Sweet lime

Used to Prepare Various Medicines

Oil extracts from mosambi is used in manufacturing various medicines (balms, inhalers, vaporizers and etc) treating respiratory problems because of its anti-congestive property.

Prevents from Infection

Its richness of vitamin C helps in boosting immunity level which ultimately helps body to stay at bay from various infections and disorders like heart disorders, improper blood circulation, cold, flu and etc.

Prevents from Bone Problems

Sweet lime provides protection against rheumatoid arthritis, osteoarthritis, inflammations and swellings thus good to maintain the health of bones.

Regularizes BP and Cholesterol Level

It helps in maintaining normal cholesterol level, blood pressure and weight loss if a glass of little warm water is taken with mosambi juice and honey.

Removes Body Toxins

It contains high level of potassium electrolyte which manages proper blood flow all over the body thus detoxifies kidneys, liver and bladder by removing toxins which ultimately reduces occurrence of infections and urinary disorders.

Prevents Accumulation of Uric Acid

Its antioxidant nature prevents accumulation of uric acid and bad effects of free radicals in the body by flushing out all the unnecessary uric acids and neutralizing free radicals.

Nutritional Benefits of Mosambi/Sweet Lime per 100 g

Energy: 43 kcal

Carbohydrate: 9.3 g

Water: 88 g

Sugar: 1.7 g

Dietary fibers: 0.5 g

Fat: 0.3 g

Protein: 0.7-0.8 g

Vitamins

Vitamin C: 50 mg

Vitamin A: 20 IU

Minerals

Calcium: 40 mg

Iron: 0.7 mg

Phosphorus: 30 mg

Potassium: 490 mg

Physical Changes To Your Body by HIV

2016-04-29T22:45:00.001-07:00

As HIV disease progresses in your body, you may notice physical changes. Some changes may occur as side-effects of medical treatment for HIV. Others may occur as a result of the impact that HIV (or AIDS) has on your body.

BODY FAT CHANGES
Some medications you may take to control HIV cause changes in the way your body produces, uses, and stores fat. These changes are called lipodystrophy. This condition causes you to gain or lose fat in particular parts of your body.

You can get extra fat in the following places:

Abdomen
Neck
Breasts (both men and women)
Face

In addition, you can also develop small deposits of fat, called lipomas, elsewhere on your body.
Other changes can occur when the fat under your skin (called subcutaneous fat) is lost. This can occur in your:

Face
Arms
Legs
Buttocks

It is important to note that these changes in the way your body handles fat can also coincide with changes in cholesterol, an increase in triglycerides, increases in blood sugar, and lowered sensitivity to insulin, which may lead to diabetes.

WASTING SYNDROME
Wasting syndrome is the involuntary loss of more than 10% of your body weight, in addition to more than 30 days of either diarrhea or weakness and fever. Wasting refers to a loss of muscle mass, although part of the weight loss may also be due to loss of fat. HIV-associated wasting syndrome is considered an AIDS-defining condition.

While this is often a sign of late stage disease, wasting syndrome can be treated by:
Proper diet
Medications to stimulate appetite
Medications to control diarrhea
Hormonal therapy to build muscle

Health Benefits of Apple

2016-04-28T05:45:00.001-07:00

The apple tree is a deciduous tree in the rose family best known for its sweet, pomaceous fruit, the apple. It is cultivated worldwide as a fruit tree, and is the most widely grown species in the genus Malus. The tree originated in Central Asia, where its wild ancestor, Malus sieversii, is still found today. Apples have been grown for thousands of years in Asia and Europe, and were brought to North America by European colonists. Apples have religious and mythological significance in many cultures, including Norse, Greek and European Christian traditions.

Apple trees are large if grown from seed, but small if grafted onto roots (rootstock). There are more than 7,500 known cultivars of apples, resulting in a range of desired characteristics. Different cultivars are bred for various tastes and uses, including cooking, eating raw and cider production. Apples are generally propagated by grafting, although wild apples grow readily from seed. Trees and fruit are prone to a number of fungal, bacterial and pest problems, which can be controlled by a number of organic and non-organic means. In 2010, the fruit's genome was decoded as part of research on disease control and selective breeding in apple production.

About 80 million tons of apples were grown worldwide in 2013, and China produced almost half of this total.The United States is the second-leading producer, with more than 6% of world production. Turkey is third, followed by Italy, India and Poland. Apples are often eaten raw, but can also be found in many prepared foods (especially desserts) and drinks. Many beneficial health effects are thought to result from eating apples; however, two types of allergies are attributed to various proteins found in the fruit.

Health Benefits of Apple

Apples are the second most popular fruit in the US (bananas are the first),1 with each American eating about 19 pounds a year.

Undoubtedly, many of those apples are consumed right now, during the fall, which is peak season for apples in the US. This is one sweet treat that you can feel good about eating, too, as apples are packed with disease-fighting vitamins, antioxidants and more, easily making them one of the top-ranked fruits for your health

Apples Ranked Second Highest for Antioxidant Activity

Compared to other commonly consumed fruits in the US, apples ranked second for highest antioxidant activity. However, they ranked highest for the proportion of free phenolic compounds, which means they are not bound to other compounds in the fruit and therefore may be more easily absorbed into your bloodstream.

Notably, much of apples' antioxidant power is contained in the peel, where you'll find antioxidants like catechin, procyanidins, chlorogenic acid, ploridizin and more.

Apples are filled with soluble fiber (5 grams)

This fiber has been shown to reduce intestinal disorders, including diverticulitis, hemorrhoids and possibly some types of cancer.

Helps control insulin levels by releasing sugar slowly into the bloodstream.

Cleanses and detoxifies, which helps eliminate heavy metals, such as lead and mercury.

According to Chinese Medicine: Apples strengthen the heart, quench thirst, lubricate the lungs, decrease mucous and increase body fluids.

An Apple a Day to Keep 5 Chronic Diseases Away?

A wealth of research suggests that eating apples may impact your health in a number of beneficial ways:

Brain Health: Apples have been found to protect neuron cells against oxidative stress-induced neurotoxicity and may play an important role in reducing the risk of neurodegenerative disorders, such as Alzheimer's disease.

Stroke: Eating apples is linked to a decreased risk of stroke.

Diabetes: Three servings of apples (and other fruits, such as blueberries and grapes) is linked to a 7 percent lower risk of type 2 diabetes.

This may be due to their beneficial role in blood sugar regulation, as apples contain compounds that may:

Lessen absorption of glucose from your digestive tract

Stimulate beta cells in your pancreas to secrete insulin

Increase uptake of glucose from your blood by stimulating insulin receptors

Cancer: Apples have a number of properties that may help reduce the risk of cancer, including antimutagenic activity, antioxidant activity, anti-inflammatory mechanisms, antiproliferative and apoptosis-inducing activity, as well as "novel mechanisms on epigenetic events and innate immunity." According to the journal Planta Medica.

"Apple products have been shown to prevent skin, mammary and colon carcinogenesis in animal models. Epidemiological observations indicate that regular consumption of one or more apples a day may reduce the risk for lung and colon cancer."

Heart Disease: Eating apples is associated with a lower risk of death from heart disease, an association that's thought to be related to their content of antioxidant flavonoids.

An apple has only 50-80 calories and has no fat or sodium

Apples provide a source of potassium which may promote heart health

What Hiv Does In Your Body

2016-04-28T05:27:00.002-07:00

Without treatment, HIV advances in stages, overwhelming your immune system and getting worse over time. The three stages of HIV infection are: (1) acute HIV infection, (2) clinical latency, and (3) AIDS (acquired immunodeficiency syndrome).

However, there’s good news: by using HIV medicines (called antiretroviral therapy or ART) consistently, you can prevent HIV from progressing to AIDS. ART helps control the virus so that you can live a longer, healthier life and reduce the risk of transmitting HIV to others.

These are the three stages of HIV infection:

ACUTE HIV INFECTION STAGE

Within 2-4 weeks after HIV infection, many, but not all, people develop flu-like symptoms, often described as “the worst flu ever.” Symptoms can include fever, swollen glands, sore throat, rash, muscle and joint aches and pains, and headache. This is called “acute retroviral syndrome” (ARS) or “primary HIV infection,” and it’s the body’s natural response to the HIV infection.

During this early period of infection, large amounts of virus are being produced in your body. The virus uses CD4 count to replicate and destroys them in the process. Because of this, your CD4 cells can fall rapidly. Eventually your immune response will begin to bring the level of virus in your body back down to a level called a viral set point, which is a relatively stable level of virus in your body. At this point, your CD4 count begins to increase, but it may not return to pre-infection levels. It may be particularly beneficial to your health to begin ART during this stage.

During the acute HIV infection stage, you are at high risk of transmitting HIV to your sexual or drug using partners because the levels of HIV in your blood stream are very high. For this reason, it is very important to take steps to reduce your risk of transmission.

CLINICAL LATENCY STAGE

After the acute stage of HIV infection, the disease moves into a stage called the “clinical latency” stage. “Latency” means a period where a virus is living or developing in a person without producing symptoms. During the clinical latency stage, people who are infected with HIV experience no symptoms, or only mild ones. (This stage is sometimes called “asymptomatic HIV infection” or “chronic HIV infection.”)

During the clinical latency stage, the HIV virus continues to reproduce at very low levels, although it is still active. If you take ART, you may live with clinical latency for several decades because treatment helps keep the virus in check. (Read more about HIV treatment.) For people who are not on ART, the clinical latency stage lasts an average of 10 years, but some people may progress through this stage faster.

People in this symptom-free stage are still able to transmit HIV to others, even if they are on ART, although ART greatly reduces the risk of transmission.

If you have HIV and you are not on ART, then eventually your viral load will begin to rise and your CD4 count will begin to decline. As this happens, you may begin to have constitutional symptoms of HIV as the virus levels increase in your body.

AIDS

This is the stage of HIV infection that occurs when your immune system is badly damaged and you become vulnerable to opportunistic infections. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), you are considered to have progressed to AIDS. (In someone with a healthy immune system, CD4 counts are between 500 and 1,600 cells/mm3.) You are also considered to have progressed to AIDS if you develop one or more opportunistic illnesses, regardless of your CD4 count.

Without treatment, people who progress to AIDS typically survive about 3 years. Once you have a dangerous opportunistic illness, life-expectancy without treatment falls to about 1 year. However, if you are taking ART and maintain a low viral load, then you may enjoy a near normal life span. You will most likely never progress to AIDS.

FACTORS AFFECTING DISEASE PROGRESSION

People living with HIV may progress through these stages at different rates, depending on a variety of factors, including their genetic makeup, how healthy they were before they were infected, how soon after infection they are diagnosed and linked to care and treatment, whether they see their healthcare provider regularly and take their HIV medications as directed, and different health-related choices they make, such as decisions to eat a healthful diet, exercise, and not smoke.

Time Between HIV Infection and AIDS

Factors that may shorten the time between HIV and AIDS:

Older age

HIV subtype

Co-infection with other viruses (like tuberculosis or hepatitis C)

Poor nutrition

Severe stress

Your genetic background

Factors that may delay the time between HIV and AIDS:

Taking antiretroviral therapy consistently

Staying in regular HIV care

Closely adhering to your doctor’s recommendations

Eating healthful foods

Taking care of yourself

Your genetic background

By making healthy choices, you have some control over the progression of HIV infection.

Not everyone is diagnosed early. Some people are diagnosed with HIV and AIDS concurrently, meaning that they have been living with HIV for a long time and the virus has already done damage to their body by the time they find out they are infected. These individuals need to seek a healthcare provider immediately and be linked to care so that they can stay as healthy as possible, as long as possible. Use the HIV Testing and Services Locator to find an HIV provider near you.

What Does HIV Positive Mean?

2016-04-17T22:18:00.001-07:00

Being diagnosed as "HIV-positive" means that you have been exposed to the Human Immunodeficiency Virus (HIV)and that two HIV tests—a preliminary enzyme immunoassay (EIA) test and a confirmatory Western blot test—have both come back positive for antibodies to HIV.

Being HIV-positive means that it is possible for you to pass the virus along to others, including your sexual partners. If you are female, you could also pass it along to your unborn child.

Once you have been infected with HIV, you will always carry it in your body. There is no cure for HIV. It is a serious, infectious disease that can lead to death if it isn't treated.

But many scientific and technological advances have made HIV a chronic manageable disease. Many people with HIV lead healthy, happy, and productive lives and learn how to cope with the disease.

This is why it is so important to know your HIV status. Knowing that you are HIV-positive gives you the ability to protect your own health and the health of your partners and children.

Being HIV-positive does NOT mean you have AIDS. AIDS is the most advanced stage of HIV disease. Proper treatment can keep you from developing AIDS.

Where Did HIV Come From

2016-04-14T04:51:00.000-07:00

There are a few different ideas that have been put forward to explain how HIV came about. The two thrown around most, by far, are: “The government did it,” or “It was definitely people having sex with monkeys!”

There are lots of conspiracy theories surrounding HIV; some people do not believe it causes AIDS at all, and others believe that HIV is a man-made virus.

HIV-1 from chimpanzees and gorillas to humans

Scientists generally accept that the known strains (or groups) of HIV-1 are most closely related to the simian immunodeficiency viruses (SIVs) endemic in wild ape populations of West Central African forests. Particularly, each of the known HIV-1 strains is either closely related to the SIV that infects the chimpanzee subspecies Pan troglodytes troglodytes (SIVcpz) or closely related to the SIV that infects western lowland gorillas (Gorilla gorilla gorilla), called SIVgor. The pandemic HIV-1 strain (group M or Main) and a very rare strain only found in a few Cameroonian people (group N) are clearly derived from SIVcpz strains endemic in Pan troglodytes troglodytes chimpanzee populations living in Cameroon. Another very rare HIV-1 strain (group P) is clearly derived from SIVgor strains of Cameroon. Finally, the primate ancestor of HIV-1 group O, a strain infecting 100,000 people mostly from Cameroon but also from neighboring countries, has been recently confirmed to be SIVgor.[6] The pandemic HIV-1 group M is most closely related to the SIVcpz collected from the southeastern rain forests of Cameroon (modern East Province) near the Sangha River. Thus, this region is presumably where the virus was first transmitted from chimpanzees to humans. However, reviews of the epidemiological evidence of early HIV-1 infection in stored blood samples, and of old cases of AIDS in Central Africa have led many scientists to believe that HIV-1 group M early human center was probably not in Cameroon, but rather farther south in the Democratic Republic of the Congo, more probably in its capital city, Kinshasa (formerly Léopoldville).

Using HIV-1 sequences preserved in human biological samples along with estimates of viral mutation rates, scientists calculate that the jump from chimpanzee to human probably happened during the late 19th or early 20th century, a time of rapid urbanisation and colonisation in equatorial Africa. Exactly when the zoonosis occurred is not known. Some molecular dating studies suggest that HIV-1 group M had its most recent common ancestor (MRCA) (that is, started to spread in the human population) in the early 20th century, probably between 1915 and 1941. A study published in 2008, analyzing viral sequences recovered from a recently discovered biopsy made in Kinshasa, in 1960, along with previously known sequences, suggested a common ancestor between 1873 and 1933 (with central estimates varying between 1902 and 1921). Genetic recombination had earlier been thought to "seriously confound" such phylogenetic analysis, but later "work has suggested that recombination is not likely to systematically bias", although recombination is "expected to increase variance".The results of a 2008 phylogenetics study support the later work and indicate that HIV evolves "fairly reliably". Further research was hindered due to the primates being critically endangered. Sample analyses resulted in little data due to the rarity of experimental material. The researchers, however, were able to hypothesize a phylogeny from the gathered data. They were also able to use the molecular clock of a specific strain of HIV to determine the initial date of transmission, which is estimated to be around 1915-1931.

HIV-2 from sooty mangabeys to humans

Similar research has been undertaken with SIV strains collected from several wild sooty mangabey (Cercocebus atys atys) (SIVsmm) populations of the West African nations of Sierra Leone, Liberia, and Ivory Coast. The resulting phylogenetic analyses show that the viruses most closely related to the two strains of HIV-2 that spread considerably in humans (HIV-2 groups A and B) are the SIVsmm found in the sooty mangabeys of the Tai forest, in western Ivory Coast.

There are six additional known HIV-2 groups, each having been found in just one person. They all seem to derive from independent transmissions from sooty mangabeys to humans. Groups C and D have been found in two people from Liberia, groups E and F have been discovered in two people from Sierra Leone, and groups G and H have been detected in two people from the Ivory Coast. These HIV-2 strains are probably dead-end infections, and each of them is most closely related to SIVsmm strains from sooty mangabeys living in the same country where the human infection was found.

Molecular dating studies suggest that both the epidemic groups (A and B) started to spread among humans between 1905 and 1961 (with the central estimates varying between 1932 and 1945).

HIV AIDS Treatments Prevention Management

2016-04-11T04:07:00.000-07:00

Yes, today HIV is a manageable disease. HIV medications have significantly changed the course of HIV infection since the early days of the epidemic and with the proper care and treatment, you can live a healthy life.

The sooner you take steps to protect your health, the better. Early treatment with antiretroviral drugs and a healthy lifestyle can help you stay well. Prompt medical care prevents the onset of AIDS and some life-threatening AIDS-related conditions.

To view the personal stories of others who have been diagnosed with HIV and learn how they managed their infection and got the virus under control with medication, visit AIDS.gov’s Positive Spin.

The most significant change that has taken place in HIV prevention and in the thinking and strategies of many public health workers and prevention advocates since the last edition of Preventing HIV is a much greater emphasis on the role of HIV treatment as a method of HIV prevention. A few advocates feel that we may not even need new treatments (like vaccines) and new approaches (like pre-exposure prophylaxis) to significantly reduce HIV transmission, but may simply need to step up what we are already doing, namely treating people who have HIV. This is a minority view, but, encouraged by new evidence of the efficacy of HIV treatment as prevention, many experts and advocates now believe that the provision of ARVs may be one of the most important elements of any strategy to end the HIV epidemic. At the very least it provides another powerful reason to expand access to treatment.

While AIDS remains incurable, patients are living much longer – even decades after infection – because of the development of many effective medications to suppress the virus. The most effective type are known as antiretroviral drugs, which are often taken in combination to prevent the patient from becoming resistant to any one drug.

According to the National Institutes of Health, the most common antiretroviral drugs fall into three categories:

Reverse transcriptase inhibitors, which keep the virus from reproducing

Protease inhibitors, which interfere with an HIV protein that produces infectious particles

Fusion inhibitors, which prevent the virus from entering healthy cells

Doctors verify if medications are working through blood tests, which measure levels of various infection-fighting blood cells as well as the level of HIV in the blood. Even when the virus is undetectable, AIDS is not cured and can still be transmitted to others.

Other HIV/AIDS treatment focuses around living a healthy lifestyle with optimum nutrition, sleep and exercise. Regular doctor’s visits are also scheduled, with frequency depending on viral levels in the blood and what symptoms are present, according to the American Academy of Family Physicians.

Prevention

More than 56,000 Americans become infected with HIV each year, according to the U.S. Department of Health and Human Services. While some AIDS patients have been infected through blood transfusions during medical procedures, preventing infection usually depends on avoiding risky habits or behaviors that lead to exposure to the virus, which can be transmitted through blood, bodily fluids such as semen and infected needles.

Prevention measures include:

Knowing yours and your partners’ HIV status

Using latex condoms correctly during every sexual encounter, whether gay or straight

Limiting the number of sexual partners

Abstaining from injectable drug use

Seeking medical treatment immediately after suspected HIV exposure, since medications can sometimes prevent infection if started early

It’s just as important to know the ways HIV cannot be spread, such as by:

Saliva, tears or sweat

Water or air

Casual contact such as closed-mouth kissing or shaking hands

Insects, including mosquitoes

The advent in 1996 of potent combination antiretroviral therapy (ART), sometimes called HAART (highly active antiretroviral therapy) or ART (effective combination antiretroviral therapy), changed the course of the HIV epidemic.1 These “cocktails” of three or more antiretroviral drugs used in combination gave patients and scientists new hope for fighting the epidemic,2 and have significantly improved life expectancy—to decades rather than months.1,3

For many years, scientists believed that treating HIV-infected persons also significantly reduced their risk of transmitting the infection to sexual and drug-using partners who did not have the virus. The circumstantial evidence was substantial, but no one had conducted a randomized clinical trial— the gold standard for proving an intervention works. That changed in 2011 with the publication of findings from the HIV Prevention Trials Network (HPTN) 052 study, a randomized clinical trial designed in part to evaluate whether the early initiation of ART can prevent the sexual transmission of HIV among heterosexual couples in which one partner is HIV-infected and the other is not. This landmark study validated that early HIV treatment has a profound prevention benefit: results showed that the risk of transmitting HIV to an uninfected partner was reduced by 96%.4

As a concept and a strategy, treating HIV-infected persons to improve their health and to reduce the risk of onward transmission—sometimes called treatment as prevention— refers to the personal and public health benefits of using ART to continuously suppress HIV viral load in the blood and genital fluids, which decreases the risk of transmitting the virus to others. The practice has been used since the mid- 1990s to prevent mother-to-child, or perinatal, transmission of the virus. Research published in 1994 showed that zidovudine, more commonly known as AZT, when given to HIV-infected pregnant women and to their newborns reduced the risk of perinatal transmission from about 25% to 8%.5 Since then, routinely testing pregnant women and treating infected mothers with ART during pregnancy, delivery, and while breastfeeding, when practiced according to recommendations, has reduced the mother’s risk of transmitting HIV to her child by 90%.6 In one study, women who received at least 14 days of ART reduced the risk of transmitting HIV to their babies to less than 1%.

Symptoms and diagnosis of HIV/Aids

2016-04-09T04:33:00.003-07:00

When a person is first exposed to HIV, they may show no symptoms for several months or longer. Typically, however, they experience a flu-like illness that includes fever, chills, headache, fatigue, muscle aches and enlarged lymph nodes in the neck and groin areas.This early illness is often followed by a “latency” phase where the virus is less active and no symptoms are present, according to the U.S. Department of Health and Human Services. This latent period can last up to a decade or more.

People who become infected with HIV may not have any symptoms for up to 10 years, but they can still pass the infection to others. After you come in contact with the virus, it can take up to 3 months for a blood test to show that you have HIV.

Symptoms related to HIV are usually due to a different infection in the body. Some symptoms related to HIV infection include:

Diarrhea

Fatigue

Fever

Frequent vaginal yeast infections

Headache

Mouth sores, including yeast infection (thrush)

Muscle stiffness or aching

Rashes of different types, including seborrheic dermatitis and psoriasis

Sore throat

Swollen lymph glands

Note: Many people have no symptoms when they are diagnosed with HIV.

Diagnosis & Tests

Since HIV/AIDS can set off so many other illnesses, it may be difficult initially to pinpoint the source. Typically, however, these illnesses appear in clusters over a short period of time, cluing patients and doctors into the presence of the virus.

According to NIAID, two types of blood tests can confirm HIV/AIDS infection:

ELISA, or enzyme-linked immunosorbent assay, which detects disease-fighting proteins called antibodies that are specific to HIV; and

Western blot, which detects antibodies that bind to specific HIV proteins

After someone is first infected it may take weeks or months for the immune system to produce enough detectable antibodies in an HIV blood test. Ironically, an infected person’s viral load may be very high during this time, making the infection exceptionally contagious.

Because of this, the CDC recommends routine HIV testing for all adolescents, adults and pregnant women, and advises that everyone between the ages of 13 and 64 should be tested at least once.

Conventional HIV/AIDS tests are sent to a laboratory for analysis and may take a week or more for results. A rapid HIV test is also available that offers results in about 20 minutes, but positive results from either type of test are confirmed with a second test.

Treatment

Doctors usually recommend medicine for patients who are committed to taking all their medications and have a CD4 count below 500 cells/mm3 (which is a sign that of a weakened immune system). Some people, including pregnant women and people with kidney or neurological problems related to HIV, may need treatment regardless of their CD4 count.

It is extremely important for people with HIV to take all doses of their medications, otherwise the virus may become resistant to the drugs. Therapy always involves a combination of antiviral drugs. Pregnant women with HIV infection are treated to reduce the chance of transmitting HIV to their babies.

People with HIV infection need to become educated about the disease and treatment so that they can be active participants in making decisions with their health care provider.

Common Myths About HIV and AIDS

2016-04-01T05:54:00.001-07:00

Myth 1: I can get HIV by being around people who are HIV positive.

The evidence shows that HIV is not spread through touch, tears, sweat, or saliva. You cannot catch HIV by:

• Breathing the same air as someone who is HIV-positive

• Touching a toilet seat or doorknob handle after an HIV-positive person

• Drinking from a water fountain

• Hugging, kissing, or shaking hands with someone who is HIV-positive

• Sharing eating utensils with an HIV-positive person

• Using exercise equipment at a gym

You can get it from infected blood, semen, vaginal fluid, or mother’s milk.

Myth 2: I can get HIV from mosquitoes.

Because HIV is spread through blood, people have worried that biting or bloodsucking insects might spread HIV. Several studies, however, show no evidence to support this — even in areas with lots of mosquitoes and cases of HIV. When insects bite, they do not inject the blood of the person or animal they have last bitten. Also, HIV lives for only a short time inside an insect.

Myth 3: I’m HIV-positive, my life is over.

“With proper treatment, we now expect people with HIV to live a normal life span,” says Dr. Michael Horberg, national director of HIV/AIDS for Kaiser Permanente.

“Since 1996, with the advent of highly active, antiretroviral therapy, a person with HIV in an industrialized nation can expect to live a normal life span, so long as they take their prescribed medications,” adds Dr. Amesh A. Adalja, a board-certified infectious disease physician with the University of Pittsburgh

Myth 4: Sex with partners from the countryside has no risk of HIV.
FALSE! Who knows exactly with whom and where their partner has had sex - and whether they used protection? And: HIV infections happen in small towns as well!

Myth 5: If I’m receiving treatment, I can’t spread the HIV virus.

When HIV treatments work well, they can reduce the amount of virus in your blood to a level so low that it doesn’t show up in blood tests. Research shows, however, that the virus is still “hiding” in other areas of the body. It is still essential to practice safe sex so you won’t make someone else become HIV-positive.

Myth 6: My partner and I are both HIV positive -there’s no reason for us to practice safe sex.

Not all strains of HIV are the same, and being infected with more than one can lead to greater complications, or a “superinfection,” according to Dr. Schochetman.

“The new HIV strain may exhibit a different drug resistance profile than the original HIV infection,” he explains. “And the new virus may show resistance to the current treatment, or cause the current treatment option to be ineffective.”

Myth 7: I could tell if my partner was HIV-positive

You can be HIV-positive and not have any symptoms for years. The only way for you or your partner to know if you’re HIV-positive is to get tested.

Myth 8: Male circumcision prevents HIV

Male circumcision does not prevent HIV infection; it only decreases the likelihood of infection. Several studies have shown that male circumcision reduces a man’s risk by up to 60%. These findings have led the government to embark on a campaign to provide free male circumcision services.

When a man has sex, the penis gets micro cuts from friction, which is generally how HIV enters a male’s body. The foreskin has millions of CD4 receptors, the type of white blood cells that HIV latches on to.

Myth 9: Traditional Medicines can cure HIV

The role of traditional healers has been controversial. This is largely due to the South African government’s promotion of traditional medicine as an alternative to ARVs, up until 2008. This included punting the untested claims and ‘cures’ of people. Traditional medicines have not been empirically proven to cure HIV, there may be herbs that reduce symptoms of HIV opportunistic infections, however to date there is no cure for HIV.

Myth 10: I can be cured from HIV if I have sex with a virgin

Sex with a virgin does not cure HIV. Sexual intercourse whether with a virgin or non-virgin is the primary manner in which HIV is spread. If will only pass the virus to the virgin who may/may not be HIV negative.

Myth 11 : I can’t get HIV from oral sex

It’s true that oral sex is less risky than some other types of sex. But you can get HIV by having oral sex with either a man or a woman who is HIV-positive. Always use a latex barrier during oral sex.

Myth 12: ARVs disfigure you

Today this rarely happens. In the past, some ARVs displaced fat in people’s bodies. One such drug, D4T, also known as Stavudine, was on the South African list for HIV treatment until early last year. It is a cheap drug that works efficiently but has many side effects, such as the loss of fat in the legs, arms and face, resulting in people’s bodies looking “unbalanced”. The state replaced it in April last year with a drug with fewer side effects, TDF.

Others, such as AZT, have also been linked to displacing fat in the body. Some drugs cause fat to show up in the stomach, the back of the neck or the breasts in both men and women. But this almost never happens today as doctors are better equipped to monitor the drugs’ side effects and have a range of replacement drugs to choose from. In extraordinary circumstances of fat displacement, the government offers free liposuction or breast removal surgery.

Myth 13: If I or my partner were HIV positive, we could not have children

HIV-infected women are fertile and can have children. If mothers and their babies use the correct medication, it’s possible for HIV-positive women to have HIV-negative babies.

Without using drugs, there is a 30% chance that HIV-infected women will pass the virus on to their babies in the womb, during birth or by breastfeeding. But if the mother and baby, or even just one of them, use short courses of ARVs, mostly nevirapine and AZT, transmission rates are reduced significantly. This treatment is available for free at government clinics and hospitals.

Mia Malan works for the Discovery Centre for Health Journalism at Rhodes University.

What is Aids

2016-03-31T04:07:00.001-07:00

AIDS stands for acquired immunodeficiency syndrome:

A - Acquired. This condition is acquired, meaning that a person becomes infected with it.

I - Immuno. HIV affects a person's immune system, the part of the body that fights off germs such as bacteria or viruses.

D - Deficiency. The immune system becomes deficient and does not work properly.

S - Syndrome. A person with AIDS may experience other diseases and infections because of a weakened immune system.

AIDS can develop when HIV weakens a person’s immune system so their body is no longer able to protect itself against infections and diseases that a normal immune system would fight off. As a result, an HIV positive person may show symptoms of different infections and diseases called opportunistic infections. When someone shows symptoms of one or more of these infections, they are considered to have AIDS. Different people with AIDS may experience different clinical problems, depending on what specific opportunistic infections they develop. People who are diagnosed with AIDS can recover and regain their health, but they will still be HIV positive.

Think of AIDS as advanced HIV disease. A person with AIDS has an immune system so weakened by HIV that the person usually becomes sick from one of several opportunistic infections or cancers such as PCP (a type of pneumonia) or KS (Kaposi sarcoma, a type of cancer that affects the skin and internal organs in HIV), wasting syndrome (involuntary weight loss), memory impairment, or tuberculosis. If someone with HIV is diagnosed with one of these opportunistic infections (even if the CD4 count is above 200), he or she is said to have AIDS. AIDS usually takes time to develop from the time a person acquires HIV--usually between 2 to 10 years or more.

Once a person has been diagnosed with AIDS, she or he is always considered to have AIDS, even if that person's CD4 count goes up again and/or they recover from the disease that defined their AIDS diagnosis.

What is HIV

2016-03-29T00:58:00.000-07:00

HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome, or AIDS. Unlike some other viruses, the human body cannot get rid of HIV. That means that once you have HIV, you have it for life.

No safe and effective cure currently exists, but scientists are working hard to find one, and remain hopeful. Meanwhile, with proper medical care, HIV can be controlled. Treatment for HIV is often called antiretroviral therapy or ART. It can dramatically prolong the lives of many people infected with HIV and lower their chance of infecting others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can have a nearly normal life expectancy.

HIV affects specific cells of the immune system, called CD4 cells, or T cells. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. When this happens, HIV infection leads to AIDS.

HIV stands for human immunodeficiency virus. It is the virus that can lead to acquired immunodeficiency syndrome or AIDS if not treated. Unlike some other viruses, the human body can’t get rid of HIV completely, even with treatment. So once you get HIV, you have it for life.

HIV attacks the body’s immune system, specifically the CD4 cells (T cells), which help the immune system fight off infections. Untreated, HIV reduces the number of CD4 cells (T cells) in the body, making the person more likely to get other infections or infection-related cancers. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. These opportunistic infections or cancers take advantage of a very weak immune system and signal that the person has AIDS, the last stage of HIV infection.

No effective cure currently exists, but with proper medical care, HIV can be controlled. The medicine used to treat HIV is called antiretroviral therapy or ART. If taken the right way, every day, this medicine can dramatically prolong the lives of many people infected with HIV, keep them healthy, and greatly lower their chance of infecting others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.

AIDS stands for Acquired Immune Deficiency Syndrome and is caused by HIV. The names HIV and AIDS can be confusing because both terms describe the same disease. Think of AIDS as advanced HIV disease. A person with AIDS has an immune system so weakened by HIV that the person usually becomes sick from one of several opportunistic infections or cancers such as PCP (a type of pneumonia) or KS (Kaposi sarcoma, a type of cancer that affects the skin and internal organs in HIV), wasting syndrome (involuntary weight loss), memory impairment, or tuberculosis. If someone with HIV is diagnosed with one of these opportunistic infections (even if the CD4 count is above 200), he or she is said to have AIDS. AIDS usually takes time to develop from the time a person acquires HIV--usually between 2 to 10 years or more.

Diagnosis and Prevention of Trichomoniasis

2016-03-22T04:57:00.001-07:00

Trichomoniasis is a common cause of vaginitis. It is a sexually transmitted infection, and is caused by the single-celled protozoan parasite Trichomonas vaginalis producing mechanical stress on host cells and then ingesting cell fragments after cell death. Trichomoniasis is primarily an infection of the urogenital tract; the most common site of infection is the urethra and the vagina in women.

There were about 58 million cases of trichomoniasis in 2013

Signs and Symptoms

Most people infected with trichomonas vaginalis do not have any symptoms. Symptoms experienced include pain, burning or itching in the penis, urethra (urethritis), or vagina (vaginitis). Discomfort for both sexes may increase during intercourse and urination. For women there may also be a yellow-green, itchy, frothy, foul-smelling ("fishy" smell) vaginal discharge. In rare cases, lower abdominal pain can occur. Symptoms usually appear within 5 to 28 days of exposure

Causes

The human genital tract is the only reservoir for this species. Trichomonas is transmitted through sexual or genital contact.

Genetic sequence

A draft sequence of the Trichomonas genome was published on January 12, 2007 in the journal Science confirming that the genome has at least 26,000 genes, a similar number to the human genome. An additional ~35,000 unconfirmed genes, including thousands that are part of potential transposable elements, brings the gene content to well over 60,000.

Diagnosis

There are three main ways to test for Trichomoniasis.

The first is known as saline microscopy. This is the most commonly used method and requires an endocervical, vaginal, or penile swab specimen for examination under a microscope. The presence of one or multiple trichomonads constitutes a positive result. This method is cheap but has a low sensitivity (60-70%) often due to an inadequate sample, resulting in false negatives.

The second diagnostic method is culture, (InPouch TV culture test, BioMed Diagnostics, San Jose, CA) which has historically been the “gold standard” in infectious disease diagnosis. Trichomonas Vaginalis culture tests are relatively cheap; however, sensitivity is still somewhat low (70-89%).

The third method includes the nucleic acid amplification tests (NAATs) which are more sensitive. These new NAATs include the Xpert TV (Cepheid, Sunnyvale, CA), APTIMA Trichomonas assay (Gen-Probe Inc, San Diego, CA) and the AFFIRM VPIII (BD Diagnostics, Sparks, MD). These tests are more costly than microscopy and culture, and are highly sensitive (80-90%).

Prevention

Use of male condoms may help prevent the spread of trichomoniasis, although careful studies have never been done that focus on how to prevent this infection. Infection with Trichomoniasis through water is unlikely because Trichomonas vaginalis dies in water after 45–60 minutes, in thermal water after 30 minutes to 3 hours and in diluted urine after 5–6 hours.

Currently there are no routine standard screening requirements for the general U.S. population receiving family planning or STI testing. The Centers for Disease Control and Prevention (CDC) recommends Trichomoniasis testing for females with vaginal discharge and can be considered for females at higher risk for infection or of HIV-positive serostatus.

The advent of new, highly specific and sensitive trichomoniasis tests present opportunities for new screening protocols for both men and women. Careful planning, discussion, and research are required to determine the cost-efficiency and most beneficial use of these new tests for the diagnosis and treatment of trichomoniasis in the U.S., which can lead to better prevention efforts.

A number of strategies have been found to improve follow-up for STI testing including email and text messaging as reminders of appointments.

Treatment

Treatment for both pregnant and non-pregnant patients usually utilizes metronidazole (Flagyl), 2000 mg by mouth once. Caution should be used in pregnancy, especially in the first trimester. Sexual partners, even if asymptomatic, should also be treated.

For 95-97% of cases, infection is resolved after one dose of metronidazole. Studies suggest that 4-5% of trichomonas cases are resistant to metronidazole, which may account for some “repeat” cases. Without treatment, trichomoniasis can persist for months to years in women, and is thought to improve without treatment in men. Women living with HIV infection have better cure rates if treated for 7 days rather than with one dose.

Screening

Evidence from a randomized controlled trials for screening pregnant women who do not have symptoms for infection with trichomoniasis and treating women who test positive for the infection have not consistently shown a reduced risk of preterm birth. Further studies are needed to verify this result and determine the best method of screening. In the US, screening of pregnant women without any symptoms is only recommended in those with HIV as trichomonas infection is associated with increased risk of transmitting HIV to the fetus.

Chlamydia Symptoms and Treatment

2016-03-19T00:55:00.000-07:00

Chlamydia infection is a common sexually transmitted infection in humans caused by the bacterium Chlamydia trachomatis. The term Chlamydia infection can also refer to infection caused by any species belonging to the bacterial family Chlamydiaceae. C. trachomatis is found only in humans. Chlamydia is a major infectious cause of human genital and eye disease. Chlamydia conjunctivitis or trachoma is a common cause of blindness worldwide. The World Health Organization (WHO) estimates that it accounted for 15% of blindness cases in 1995, but only 3.6% in 2002.

Chlamydia can be spread during vaginal, anal, or oral sex, and can be passed from an infected mother to her baby during childbirth. Between half and three-quarters of all women who have a chlamydial infection of the cervix have an inflamed cervix without symptoms and may not realize they are infected. In men, infection by C. trachomatis can lead to inflammation of the penile urethra causing a white discharge from the penis with or without a burning sensation during urination. Occasionally, the condition spreads to the upper genital tract in women (causing pelvic inflammatory disease) or to the epididymis in men (causing inflammation of the epididymis). C. trachomatis is naturally found living only inside human cells.

Chlamydia infection can be effectively cured with antibiotics. If left untreated, chlamydial infections can cause serious reproductive and other health problems with both short-term and long-term consequences. Research is ongoing in the prevention of this infection.

Chlamydia infection is one of the most common sexually transmitted infections worldwide. In 2013 about 141 million cases occurred. In the United States about 1 million individuals are infected with chlamydia. The word chlamydia is from the Greek, meaning "cloak".

Signs and symptoms

Genital disease

Women

Chlamydial infection of the neck of the womb (cervicitis) is a sexually transmitted infection which is asymptomatic for 50–70% of women infected with the disease. The infection can be passed through vaginal, anal, or oral sex. Of those who have an asymptomatic infection that is not detected by their doctor, approximately half will develop pelvic inflammatory disease (PID), a generic term for infection of the uterus, fallopian tubes, and/or ovaries. PID can cause scarring inside the reproductive organs, which can later cause serious complications, including chronic pelvic pain, difficulty becoming pregnant, ectopic (tubal) pregnancy, and other dangerous complications of pregnancy.

Chlamydia is known as the "silent epidemic" as in women, it may not cause any symptoms in 70–80% of cases, and can linger for months or years before being discovered. Signs and symptoms may include abnormal vaginal bleeding or discharge, abdominal pain, painful sexual intercourse, fever, painful urination or the urge to urinate more often than usual (urinary urgency).

Men

In men, those with a chlamydial infection show symptoms of infectious inflammation of the urethra in about 50% of cases. Symptoms that may occur include: a painful or burning sensation when urinating, an unusual discharge from the penis, testicular pain or swelling, or fever. If left untreated, chlamydia in men can spread to the testicles causing epididymitis, which in rare cases can lead to sterility if not treated. Chlamydia is also a potential cause of prostatic inflammation in men, although the exact relevance in prostatitis is difficult to ascertain due to possible contamination from urethritis

Eye disease

Chlamydia conjunctivitis or trachoma was once the most important cause of blindness worldwide, but its role diminished from 15% of blindness cases by trachoma in 1995 to 3.6% in 2002. The infection can be spread from eye to eye by fingers, shared towels or cloths, coughing and sneezing and eye-seeking flies. Newborns can also develop chlamydia eye infection through childbirth . Using the SAFE strategy (acronym for surgery for in-growing or in-turned lashes, antibiotics, facial cleanliness, and environmental improvements), the World Health Organization aims for the global elimination of trachoma by 2020

Joints

Chlamydia may also cause reactive arthritis—the triad of arthritis, conjunctivitis and urethral inflammation—especially in young men. About 15,000 men develop reactive arthritis due to chlamydia infection each year in the U.S., and about 5,000 are permanently affected by it. It can occur in both sexes, though is more common in men.

Infants

As many as half of all infants born to mothers with chlamydia will be born with the disease. Chlamydia can affect infants by causing spontaneous abortion; premature birth; conjunctivitis, which may lead to blindness; and pneumonia. Conjunctivitis due to chlamydia typically occurs one week after birth (compared with chemical causes (within hours) or gonorrhea (2–5 days)).

Other conditions

A different serovar of Chlamydia trachomatis is also the cause of lymphogranuloma venereum, an infection of the lymph nodes and lymphatics. It usually presents with genital ulceration and swollen lymph nodes in the groin, but it may also manifest as rectal inflammation, fever or swollen lymph nodes in other regions of the body.

Transmission

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.

Pathophysiology

Chlamydiae have the ability to establish long-term associations with host cells. When an infected host cell is starved for various nutrients such as amino acids (for example, tryptophan), iron, or vitamins, this has a negative consequence for Chlamydiae since the organism is dependent on the host cell for these nutrients. Long-term cohort studies indicate that approximately 50% of those infected clear within a year, 80% within two years, and 90% within three years.

The starved chlamydiae enter a persistent growth state wherein they stop cell division and become morphologically aberrant by increasing in size. Persistent organisms remain viable as they are capable of returning to a normal growth state once conditions in the host cell improve.

There is much debate as to whether persistence has in vivo relevance. Many believe that persistent chlamydiae are the cause of chronic chlamydial diseases. Some antibiotics such as ß-lactams can also induce a persistent-like growth state, which can contribute to the chronicity of chlamydial diseases.

Diagnosis

The diagnosis of genital chlamydial infections evolved rapidly from the 1990s through 2006. Nucleic acid amplification tests (NAAT), such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement amplification (SDA) now are the mainstays. NAAT for chlamydia may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine. NAAT has been estimated to have a sensitivity of approximately 90% and a specificity of approximately 99%, regardless of sampling from a cervical swab or by urine specimen. In women seeking an STI clinic and a urine test is negative, a subsequent cervical swab has been estimated to be positive in approximately 2% of the time.

At present, the NAATs have regulatory approval only for testing urogenital specimens, although rapidly evolving research indicates that they may give reliable results on rectal specimens.

Because of improved test accuracy, ease of specimen management, convenience in specimen management, and ease of screening sexually active men and women, the NAATs have largely replaced culture, the historic gold standard for chlamydia diagnosis, and the non-amplified probe tests. The latter test is relatively insensitive, successfully detecting only 60–80% of infections in asymptomatic women, and often giving falsely positive results. Culture remains useful in selected circumstances and is currently the only assay approved for testing non-genital specimens.

Screening

For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection. Risk factors include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, and inconsistent condom use. For pregnant women, guidelines vary: screening women with age or other risk factors is recommended by the U.S. Preventive Services Task Force (USPSTF) (which recommends screening women under 25) and the American Academy of Family Physicians (which recommends screening women aged 25 or younger). The American College of Obstetricians and Gynecologists recommends screening all at risk, while the Centers for Disease Control and Prevention recommend universal screening of pregnant women. The USPSTF acknowledges that in some communities there may be other risk factors for infection, such as ethnicity. Evidence-based recommendations for screening initiation, intervals and termination are currently not possible. For men, the USPSTF concludes evidence is currently insufficient to determine if regular screening of men for chlamydia is beneficial. They recommend regular screening of men who are at increased risk for HIV or syphilis infection.

In the United Kingdom the National Health Service (NHS) aims to:

Prevent and control chlamydia infection through early detection and treatment of asymptomatic infection;

Reduce onward transmission to sexual partners;

Prevent the consequences of untreated infection;

Test at least 25 percent of the sexually active under 25 population annually.

Retest after treatment

Treatment

C. trachomatis infection can be effectively cured with antibiotics once it is detected. Current guidelines recommend azithromycin, doxycycline, erythromycin, or ofloxacin. Agents recommended for pregnant women include erythromycin or amoxicillin.

An option for treating partners of patients (index cases) diagnosed with chlamydia or gonorrhea is patient-delivered partner therapy (PDT or PDPT), which is the clinical practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner.

Epidemiology

Globally, as of 2010, sexually transmitted chlamydia affects approximately 215 million people (3.1% of the population). It is more common in women (3.8%) than men (2.5%). In that year it resulted in about 1,200 deaths down from 1,500 in 1990.

CDC estimates that there are approximately 2.8 million new cases of chlamydia in the United States each year and that it affects around 2% of young people in that country. Chlamydial infection is the most common bacterial sexually transmitted infection in the UK.

Chlamydia causes more than 250,000 cases of epididymitis in the U.S. each year. Chlamydia causes 250,000 to 500,000 cases of PID every year in the United States. Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed

Cause and Prevention of Gonorrhea

2016-03-16T00:43:00.000-07:00

Gonorrhea is a sexually transmitted infection that is caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are a burning sensation with urination and discharge from the penis. Women have no symptoms about half the time or have vaginal discharge and pelvic pain. In both men and women, if gonorrhea is left untreated, it may spread locally, causing inflammation of the epididymis or pelvic inflammatory disease or throughout the body, affecting joints and heart valves.

Testing all women who are sexually active and less than 25 years of age each year is recommended. This same recommendation applies in men who have sex with men.

Gonorrhea can be prevented with the use of condoms. Treatment is usually with ceftriaxone, as resistance has developed to many previously used antibiotics. Ceftriaxone is typically given in combination with either azithromycin or doxycycline, as gonorrhea infections may occur along with chlamydia, an infection that ceftriaxone does not treat. Some strains of gonorrhea have begun showing resistance to this treatment, which will make infection more difficult to treat. Retesting is recommended three months after treatment.

An estimated 78 to 88 million cases of gonorrhea occur each year, out of the 448 million new cases of all curable STI each year – that also includes syphilis, chlamydia and trichomoniasis. Infections in women most commonly occur when they are young adults. In 2010, it caused about 900 deaths, down from 1,100 in 1990.

Signs and symptoms

Half of women with gonorrhea do not have symptoms, whereas others have vaginal discharge, lower abdominal pain, or pain with intercourse. Most infected men with symptoms have inflammation of the penile urethra associated with a burning sensation during urination and discharge from the penis. In men, discharge with or without burning occurs in half of all cases and is the most common symptom of the infection. Men and women can acquire gonorrhea of the throat from performing oral sex on an infected partner, usually a male partner. Such infection does not produce symptoms in 90% of cases, and produces a sore throat in the remaining 10%. In advanced cases, gonorrhea may cause a general feeling of tiredness similar to other infections. It is also possible for an individual to have an allergic reaction to the bacteria, in which case any appearing symptoms will be greatly intensified.

The incubation period is 2 to 14 days, with most symptoms appearing between 4 and 6 days after infection. Rarely, gonorrhea may cause skin lesions and joint infection (pain and swelling in the joints) after traveling through the blood stream (see below). Very rarely it may settle in the heart causing endocarditis or in the spinal column causing meningitis (both are more likely among individuals with suppressed immune systems, however).

One case in a man's lifetime is associated with the risk of developing prostate cancer.

Cause

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae.

Spread

The infection is usually spread from one person to another through vaginal, oral, or anal sex. Men have a 20% risk of getting the infection from a single act of vaginal intercourse with an infected woman. The risk for men that have sex with men is higher. Women have a 60–80% risk of getting the infection from a single act of vaginal intercourse with an infected man. A pregnant women can pass on the infection to her unborn infant.

A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant's eyes, it is referred to as ophthalmia neonatorum.

Among children it has been noted to spread through methods other than sex such as through contaminated objects. These objects have included baths, clothing, and towels. This however is very uncommon.

Diagnosis

Traditionally, gonorrhea was diagnosed with gram stain and culture; however, newer polymerase chain reaction (PCR)-based testing methods are becoming more common. In those failing initial treatment, culture should be done to determine sensitivity to antibiotics. All people testing positive for gonorrhea should be tested for other sexually transmitted diseases such as chlamydia, syphilis, and human immunodeficiency virus.

Screening

The United States Preventive Services Task Force recommends screening for gonorrhea in women at increased risk of infection, which includes all sexually active women younger than 25 years. Extragenital gonorrhea and chlamydia is highest in men who have sex with men. Gonorrheal infections in young women are missed with genital-only testing.

Screening for gonorrhea in women who are (or intend to become) pregnant, and who are found to be at high risk for sexually transmitted diseases, is recommended as part of prenatal care in the United States.

Prevention

As with most sexually transmitted diseases, the risk of infection can be reduced significantly by the correct use of condoms and can be removed almost entirely by limiting sexual activities to a mutually monogamous relationship with an uninfected person.

Those previously infected are encouraged to return for follow up care to make sure that the infection has been eliminated. In addition to the use of phone contact, the use of email and text messaging have been found to improve the re-testing for infection

Epidemiology

The World Health Organization estimates that 88 million cases of gonorrhea occur each year, out of the 448 million new cases of all curable STI each year – that also includes syphilis, chlamydia and trichomoniasis. As of 2010, it caused about 900 deaths down from 1,100 in 1990.

In the United Kingdom, 196 per 100,000 males 20 to 24 years old and 133 per 100,000 females 16 to 19 years old were diagnosed in 2005. In 2013, the CDC estimated that more than 820,000 people in the United States get a new gonorrheal infections each year. Fewer than half of these infections are reported to CDC. In 2011, 321,849 cases of gonorrhea were reported to the CDC. After the implementation of a national gonorrhea control program in the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported gonorrheal infections was 113. 5 per 100,000 persons.

In the US, it is the second-most-common bacterial sexually transmitted infections; chlamydia remains first. According to the CDC, "Overall, African Americans are most affected by gonorrhea. Blacks accounted for 69% of all gonorrhea cases in 2010.

History

Some scholars translate the biblical terms zav (for a male) and zavah (for a female) as gonorrhea.

It has been suggested that mercury was used as a treatment for gonorrhea. Surgeons' tools on board the recovered English warship the Mary Rose included a syringe that, according to some, was used to inject the mercury via the urinary meatus into any unfortunate crewman suffering from gonorrhea. The name "the clap", in reference to the disease, is recorded as early as the sixteenth century.

Silver nitrate was one of the widely used drugs in the 19th century. However, It became replaced by Protargol. Arthur Eichengrün invented this type of colloidal silver, which was marketed by Bayer from 1897 on. The silver-based treatment was used until the first antibiotics came into use in the 1940s.

The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record. One of the first reliable notations occurs in the Acts of the (English) Parliament. In 1161, this body passed a law to reduce the spread of "...the perilous infirmity of burning. " The symptoms described are consistent with, but not diagnostic of, gonorrhea. A similar decree was passed by Louis IX in France in 1256, replacing regulation with banishment. Similar symptoms were noted at the siege of Acre by Crusaders.

Coincidental to, or dependent on, the appearance of a gonorrhea epidemic, several changes occurred in European medieval society. Cities hired public health doctors to treat afflicted patients without right of refusal. Pope Boniface rescinded the requirement that physicians complete studies for the lower orders of the Catholic priesthood.

Medieval public health physicians in the employ of their cities were required to treat prostitutes infected with the "burning", as well as lepers and other epidemic victims. After Pope Boniface completely secularized the practice of medicine, physicians were more willing to treat a sexually transmitted disease.

Human experiments were conducted by the United States in Guatemala from 1946 to 1948 to find a cure for syphilis and gonorrhea. The United States formally apologized to Guatemala in 2010.

Signs Symptoms and Treatment of Syphilis

2016-03-14T05:50:00.000-07:00

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, and tertiary). The primary stage classically presents with a single chancre (a firm, painless, non-itchy skin ulceration) but there may be multiple sores. In secondary syphilis a diffuse rash which frequently involves the palms of the hands and soles of the feet occurs. There may also be sores in the mouth or vagina. In latent syphilis there are little to no symptoms which can last for years. In tertiary syphilis there are gummas (soft non-cancerous growths), neurological, or heart symptoms. Syphilis has been known as "the great imitator" as it may cause symptoms similar to many other diseases.

Syphilis is most commonly spread through sexual activity. It may also be transmitted from mother to baby during pregnancy or at birth, resulting in congenital syphilis. Other human diseases caused by related Treponema pallidum include yaws (subspecies pertenue), pinta (subspecies carateum), and bejel (subspecies endemicum). Diagnosis is usually made by using blood tests; the bacteria can also be detected using dark field microscopy. The Center for Disease Control recommends all pregnant women be tested.

The risk of syphilis can be decreased by latex condom use or not having sex. Syphilis can be effectively treated with antibiotics. The preferred antibiotic for most cases is benzathine penicillin G injected into a muscle. In those who have a severe penicillin allergy, doxycycline or tetracycline may be used. In those with neurosyphilis intravenous penicillin G potassium or ceftriaxone is recommended. During treatment people may develop fever, headache, and muscle pains, a reaction known as Jarisch-Herxheimer.

In 2013 syphilis infected about 315,000 people. During 2010 it caused about 113,000 deaths down from 202,000 in 1990. After decreasing dramatically with the availability of penicillin in the 1940s, rates of infection have increased since the turn of the millennium in many countries, often in combination with human immunodeficiency virus (HIV). This is believed to be partly due to increased promiscuity, prostitution, decreasing use of condoms, and unsafe sexual practices among men who have sex with men. In 2015, Cuba became the first country in the world to eliminate mother-to-child transmission of syphilis.

Signs and symptoms

Syphilis can present in one of four different stages: primary, secondary, latent, and tertiary, and may also occur congenitally. It was referred to as "the great imitator" by Sir William Osler due to its varied presentations.

Primary

Primary syphilis is typically acquired by direct sexual contact with the infectious lesions of another person. Approximately 3 to 90 days after the initial exposure (average 21 days) a skin lesion, called a chancre, appears at the point of contact. This is classically (40% of the time) a single, firm, painless, non-itchy skin ulceration with a clean base and sharp borders between 0.3 and 3.0 cm in size. The lesion may take on almost any form. In the classic form, it evolves from a macule to a papule and finally to an erosion or ulcer. Occasionally, multiple lesions may be present (~40%), with multiple lesions more common when coinfected with HIV. Lesions may be painful or tender (30%), and they may occur outside of the genitals (2–7%). The most common location in women is the cervix (44%), the penis in heterosexual men (99%), and anally and rectally relatively commonly in men who have sex with men (34%). Lymph node enlargement frequently (80%) occurs around the area of infection, occurring seven to 10 days after chancre formation. The lesion may persist for three to six weeks without treatment.

Secondary

Secondary syphilis occurs approximately four to ten weeks after the primary infection. While secondary disease is known for the many different ways it can manifest, symptoms most commonly involve the skin, mucous membranes, and lymph nodes. There may be a symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles. The rash may become maculopapular or pustular. It may form flat, broad, whitish, wart-like lesions known as condyloma latum on mucous membranes. All of these lesions harbor bacteria and are infectious. Other symptoms may include fever, sore throat, malaise, weight loss, hair loss, and headache. Rare manifestations include liver inflammation, kidney disease, joint inflammation, periostitis, inflammation of the optic nerve, uveitis, and interstitial keratitis. The acute symptoms usually resolve after three to six weeks; about 25% of people may present with a recurrence of secondary symptoms. Many people who present with secondary syphilis (40–85% of women, 20–65% of men) do not report previously having had the classic chancre of primary syphilis.

Latent

Latent syphilis is defined as having serologic proof of infection without symptoms of disease. It is further described as either early (less than 1 year after secondary syphilis) or late (more than 1 year after secondary syphilis) in the United States. The United Kingdom uses a cut-off of two years for early and late latent syphilis. Early latent syphilis may have a relapse of symptoms. Late latent syphilis is asymptomatic, and not as contagious as early latent syphilis.

Tertiary

Tertiary syphilis may occur approximately 3 to 15 years after the initial infection, and may be divided into three different forms: gummatous syphilis (15%), late neurosyphilis (6.5%), and cardiovascular syphilis (10%). Without treatment, a third of infected people develop tertiary disease. People with tertiary syphilis are not infectious.

Gummatous syphilis or late benign syphilis usually occurs 1 to 46 years after the initial infection, with an average of 15 years. This stage is characterized by the formation of chronic gummas, which are soft, tumor-like balls of inflammation which may vary considerably in size. They typically affect the skin, bone, and liver, but can occur anywhere.

Neurosyphilis refers to an infection involving the central nervous system. It may occur early, being either asymptomatic or in the form of syphilitic meningitis, or late as meningovascular syphilis, general paresis, or tabes dorsalis, which is associated with poor balance and lightning pains in the lower extremities. Late neurosyphilis typically occurs 4 to 25 years after the initial infection. Meningovascular syphilis typically presents with apathy and seizure, and general paresis with dementia and tabes dorsalis. Also, there may be Argyll Robertson pupils, which are bilateral small pupils that constrict when the person focuses on near objects, but do not constrict when exposed to bright light.

Cardiovascular syphilis usually occurs 10–30 years after the initial infection. The most common complication is syphilitic aortitis, which may result in aneurysm formation.

Congenital

Congenital syphilis is that which is transmitted during pregnancy or during birth. Two-thirds of syphilitic infants are born without symptoms. Common symptoms that develop over the first couple of years of life include enlargement of the liver and spleen (70%), rash (70%), fever (40%), neurosyphilis (20%), and lung inflammation (20%). If untreated, late congenital syphilis may occur in 40%, including saddle nose deformation, Higoumenakis sign, saber shin, or Clutton's joints among others

Cause of Syphilis

Bacteriology

Treponema pallidum subspecies pallidum is a spiral-shaped, Gram-negative, highly mobile bacterium. Three other human diseases are caused by related Treponema pallidum, including yaws (subspecies pertenue), pinta (subspecies carateum) and bejel (subspecies endemicum). Unlike subtype pallidum, they do not cause neurological disease. Humans are the only known natural reservoir for subspecies pallidum. It is unable to survive without a host for more than a few days. This is due to its small genome (1.14 MDa) failing to encode the metabolic pathways necessary to make most of its macronutrients. It has a slow doubling time of greater than 30 hours.

Transmission

Syphilis is transmitted primarily by sexual contact or during pregnancy from a mother to her fetus; the spirochaete is able to pass through intact mucous membranes or compromised skin. It is thus transmissible by kissing near a lesion, as well as oral, vaginal, and anal sex. Approximately 30 to 60% of those exposed to primary or secondary syphilis will get the disease. Its infectivity is exemplified by the fact that an individual inoculated with only 57 organisms has a 50% chance of being infected. Most (60%) of new cases in the United States occur in men who have sex with men. It can be transmitted via blood products. It is tested for in many countries and thus the risk is low. The risk of transmission from sharing needles appears limited.

It is not generally possible to contract syphilis through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing. This is mainly because the bacteria die very quickly outside of the body, making transmission via objects extremely difficult.

Diagnosis

Syphilis is difficult to diagnose clinically early in its presentation. Confirmation is either via blood tests or direct visual inspection using microscopy. Blood tests are more commonly used, as they are easier to perform. Diagnostic tests are unable to distinguish between the stages of the disease.

Blood tests

Blood tests are divided into nontreponemal and treponemal tests. Nontreponemal tests are used initially, and include venereal disease research laboratory (VDRL) and rapid plasma reagin tests. As these tests are occasionally false positives, confirmation is required with a treponemal test, such as treponemal pallidum particle agglutination (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs). False positives on the nontreponemal tests can occur with some viral infections such as varicella and measles, as well as with lymphoma, tuberculosis, malaria, endocarditis, connective tissue disease, and pregnancy. Treponemal antibody tests usually become positive two to five weeks after the initial infection. Neurosyphilis is diagnosed by finding high numbers of leukocytes (predominately lymphocytes) and high protein levels in the cerebrospinal fluid in the setting of a known syphilis infection

Direct testing

Dark ground microscopy of serous fluid from a chancre may be used to make an immediate diagnosis. Hospitals do not always have equipment or experienced staff members, whereas testing must be done within 10 minutes of acquiring the sample. Sensitivity has been reported to be nearly 80%, thus can only be used to confirm a diagnosis but not rule one out. Two other tests can be carried out on a sample from the chancre: direct fluorescent antibody testing and nucleic acid amplification tests. Direct fluorescent testing uses antibodies tagged with fluorescein, which attach to specific syphilis proteins, while nucleic acid amplification uses techniques, such as the polymerase chain reaction, to detect the presence of specific syphilis genes. These tests are not as time-sensitive, as they do not require living bacteria to make the diagnosis

Prevention

As of 2010, there is no vaccine effective for prevention. Several vaccines based on treponemal proteins reduce lesion development in an animal model, and research is ongoing. Abstinence from intimate physical contact with an infected person is effective at reducing the transmission of syphilis, as is the proper use of a latex condom. Condom use does not completely eliminate the risk. Thus, the Centers for Disease Control and Prevention recommends a long-term, mutually monogamous relationship with an uninfected partner and the avoidance of substances such as alcohol and other drugs that increase risky sexual behavior.

Congenital syphilis in the newborn can be prevented by screening mothers during early pregnancy and treating those who are infected. The United States Preventive Services Task Force (USPSTF) strongly recommends universal screening of all pregnant women, while the World Health Organization recommends all women be tested at their first antenatal visit and again in the third trimester. If they are positive, they recommend their partners also be treated. Congenital syphilis is still common in the developing world, as many women do not receive antenatal care at all, and the antenatal care others receive does not include screening, and it still occasionally occurs in the developed world, as those most likely to acquire syphilis (through drug use, etc.) are least likely to receive care during pregnancy. Several measures to increase access to testing appear effective at reducing rates of congenital syphilis in low- to middle-income countries.

Syphilis is a notifiable disease in many countries, including Canada the European Union, and the United States. This means health care providers are required to notify public health authorities, which will then ideally provide partner notification to the person's partners. Physicians may also encourage patients to send their partners to seek care. The CDC recommends that sexually active men who have sex with men be tested at least yearly.

Several strategies have been found to improve follow-up for STI testing including email and text messaging as reminders of appointments

Treatment

Early infections

The first-choice treatment for uncomplicated syphilis remains a single dose of intramuscular benzathine penicillin G. Doxycycline and tetracycline are alternative choices for those allergic to penicillin; due to the risk of birth defects these are not recommended for pregnant women. Resistance to macrolides, rifampin, and clindamycin is often present. Ceftriaxone, a third-generation cephalosporin antibiotic, may be as effective as penicillin-based treatment. It is recommended that a treated person avoid sex until the sores are healed.

Late infections

For neurosyphilis, due to the poor penetration of penicillin G into the central nervous system, those affected are recommended to be given large doses of intravenous penicillin for a minimum of 10 days. If a person is allergic, ceftriaxone may be used or penicillin desensitization attempted. Other late presentations may be treated with once-weekly intramuscular penicillin G for three weeks. If allergic, as in the case of early disease, doxycycline or tetracycline may be used, albeit for a longer duration. Treatment at this stage limits further progression, but has only slight effect on damage which has already occurred.

Jarisch-Herxheimer reaction

One of the potential side effects of treatment is the Jarisch-Herxheimer reaction. It frequently starts within one hour and lasts for 24 hours, with symptoms of fever, muscles pains, headache, and a fast heart rate. It is caused by cytokines released by the immune system in response to lipoproteins released from rupturing syphilis bacteria.

History of syphilis

The history of syphilis has been well studied, but the exact origin of syphilis is unknown. There are two primary hypotheses: one proposes that syphilis was carried to Europe from the Americas by the crew of Christopher Columbus, the other proposes that syphilis previously existed in Europe but went unrecognized. These are referred to as the "Columbian" and "pre-Columbian" hypotheses.

In late 2011, newly published evidence suggested that the Columbian hypothesis is the valid one.

The first written records of an outbreak of syphilis in Europe occurred in 1494/1495 in Naples, Italy, during a French invasion. Because it was spread by returning French troops, the disease was known as "French disease", and it was not until 1530 that the term "syphilis" was first applied by the Italian physician and poet Girolamo Fracastoro. The causative organism, Treponema pallidum, was first identified by Fritz Schaudinn and Erich Hoffmann in 1905. The first effective treatment (Salvarsan) was developed in 1910 by Sahachirō Hata in the laboratory of Paul Ehrlich which was followed by the introduction of penicillin in 1943. Many famous historical figures including Franz Schubert, Arthur Schopenhauer, and Édouard Manet are believed to have had the disease.

Origin

The exact origin of syphilis is unknown. Two primary theories have been proposed. It is widely agreed upon by historians and anthropologists that syphilis was present among the indigenous peoples of the Americas before Europeans traveled to and from the New World. However, whether strains of syphilis were present in the entire world for millennia, or if the disease was confined to the Americas in the pre-Columbian era, has been debated.

The Columbian theory holds that syphilis was a New World disease brought back by Columbus and Martín Alonso Pinzón. This would be an example of a Columbian Exchange. Columbus's voyages to the Americas occurred three years before the Naples syphilis outbreak of 1494. This theory is supported by genetic studies of venereal syphilis and related bacteria, which found a disease intermediate between yaws and syphilis in Guyana, South America.

The pre-Columbian theory holds that syphilis was present in Europe before the arrival of Europeans in the Americas. Some scholars during the 18th and 19th centuries believed that the symptoms of syphilis in its tertiary form were described by Hippocrates in Classical Greece. Skeletons in pre-Columbus Pompeii and Metaponto in Italy with damage somewhat similar to that caused by congenital syphilis have also been found.[ However, these claims have not been submitted for peer review, and the evidence that has been made available to other scientists is weak. Nevertheless Douglas W. Owsley, a physical anthropologist at the Smithsonian Institution, and other supporters of this idea, say that many medieval European cases of leprosy, colloquially called lepra, were actually cases of syphilis. Although folklore claimed that syphilis was unknown in Europe until the return of the diseased sailors of the Columbian voyages, Owsley says that "syphilis probably cannot be "blamed"—as it often is—on any geographical area or specific race. The evidence suggests that the disease existed in both hemispheres from prehistoric times. It is only coincidental with the Columbus expeditions that the syphilis previously thought of as "lepra" flared into virulence at the end of the 15th century." Lobdell and Owsley wrote that a European writer who recorded an outbreak of "lepra" in 1303 was "clearly describing syphilis."

Historian Alfred Crosby suggests both theories are partly correct in a "combination theory". Crosby says that the bacterium that causes syphilis belongs to the same phylogenetic family as the bacteria that cause yaws and several other diseases. Despite the tradition of assigning the homeland of yaws to sub-Saharan Africa, Crosby notes that there is no unequivocal evidence of any related disease having been present in pre-Columbian Europe, Africa, or Asia. Crosby writes, "It is not impossible that the organisms causing treponematosis arrived from America in the 1490s...and evolved into both venereal and non-venereal syphilis and yaws." However, Crosby considers it more likely that a highly contagious ancestral species of the bacteria moved with early human ancestors across the land bridge of the Bering Straits many thousands of years ago without dying out in the original source population. He hypothesizes that "the differing ecological conditions produced different types of treponematosis and, in time, closely related but different diseases."

However, in late 2011 the Yearbook of Physical Anthropology published an appraisal by George Armelagos of Emory University, Molly Zuckerman, and Kristin Harper of previous studies that the "skeletal data bolsters the case that syphilis did not exist in Europe before Columbus set sail." The scientific evidence as determined by a systematic review of all published, peer-reviewed instances, best supports the theory that syphilis was unknown in Europe until Columbus returned from the Americas.

Skeletal evidence that reputedly showed signs of syphilis in Europe and other parts of the Old World before Christopher Columbus made his voyage in 1492 does not hold up when subjected to standardized analyses for diagnosis and dating, according to an appraisal in the current Yearbook of Physical Anthropology. This is the first time that all 54 previously published cases have been evaluated systematically, and bolsters the case that syphilis came from the New World.

— Science Daily, Skeletons point to Columbus voyage for syphilis origins

The historical origin of syphilis has modern social effects. The arrival of Europeans in the New World resulted in the damaging effects of colonialism and the spread of deadly diseases like smallpox that European explorers unintentionally brought to the Americas. According to biologist Marlene Zuk, "The origin of syphilis has always held an implied accusation: if Europeans brought it to the New World, the disease is one more symbol of Western imperialism run amok, one more grudge to hold against colonialism."

European outbreak

The first well-recorded European outbreak of what is now known as syphilis occurred in 1495 among French troops besieging Naples, Italy. It may have been transmitted to the French via Spanish mercenaries serving King Charles of France in that siege. From this centre, the disease swept across Europe. As Jared Diamond describes it, "[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months." The disease then was much more lethal than it is today. Diamond concludes,"[B]y 1546, the disease had evolved into the disease with the symptoms so well known to us today." The epidemiology of this first syphilis epidemic shows that the disease was either new or a mutated form of an earlier disease.

Researchers concluded that syphilis was carried from the New World to Europe after Columbus' voyages. Many of the crew members who served on this voyage later joined the army of King Charles VIII in his invasion of Italy in 1495, resulting in the spreading of the disease across Europe and as many as five million deaths. The findings suggested Europeans could have carried the nonvenereal tropical bacteria home, where the organisms may have mutated into a more deadly form in the different conditions and low immunity of the population of Europe. Syphilis was a major killer in Europe during the Renaissance. In his Serpentine Malady (Seville, 1539) Ruy Diaz de Isla estimated that over a million people were infected in Europe.

Historical terms

The name "syphilis" was coined by the Italian physician and poet Girolamo Fracastoro in his pastoral noted poem, written in Latin, titled Syphilis sive morbus gallicus (Latin for "Syphilis or The French Disease") in 1530. The protagonist of the poem is a shepherd named Syphilus (perhaps a variant spelling of Sipylus, a character in Ovid's Metamorphoses). Syphilus is presented as the first man to contract the disease, sent by the god Apollo as punishment for the defiance that Syphilus and his followers had shown him. From this character Fracastoro derived a new name for the disease, which he also used in his medical text De Contagionibus ("On Contagious Diseases").

Until that time, as Fracastoro notes,[not in citation given] syphilis had been called the "French disease" in Italy, Poland and Germany, and the "Italian disease" in France. In addition, the Dutch called it the "Spanish disease", the Russians called it the "Polish disease", and the Turks called it the "Christian disease" or "Frank (Western European) disease" (frengi). These "national" names were generally reflective of contemporary political spite between nations and frequently served as a sort of propaganda; the Dutch, for example, had a colonial rivalry with the Spanish, so referring to Syphilis as the 'Spanish' disease reinforced a politically useful perception that the Spanish were immoral or unworthy. The inherent xenophobia of the terms also stemmed from the disease's particular epidemiology, often being spread by foreign sailors and soldiers during their frequent sexual contact with local prostitutes.

During the 16th century, it was called "great pox" in order to distinguish it from smallpox. In its early stages, the great pox produced a rash similar to smallpox (also known as variola). However, the name is misleading, as smallpox was a far more deadly disease. The terms "Lues" (or Lues venerea, Latin for "venereal plague") and "Cupid's disease" have also been used to refer to syphilis. In Scotland, syphilis was referred to as the Grandgore. The ulcers suffered by British soldiers in Portugal were termed "The Black Lion"

Historical treatments

There were originally no effective treatments for syphilis, although a number of remedies were tried. Mercury was a common, long-standing treatment for syphilis, and its use has been suggested to date back to The Canon of Medicine (1025) by the Persian physician Ibn Sina (Avicenna), although this is only possible if syphilis existed in the Old World prior to Columbus (see Origins section). Giorgio Sommariva of Verona is recorded to have used mercury to treat syphilis in 1496, and is often recognized as the first physician to have done so, although he may not have been a physician. During the sixteenth century, mercury was administered to syphilitic patients in various ways, including by rubbing it on the skin, by applying a plaster, and by mouth. A "Fumigation" method of administering mercury was also used, in which mercury was vaporized over a fire and the patients were exposed to the resulting steam, either by being placed in a bottomless seat over the hot coals, or by having their entire bodies except for the head enclosed in a box (called a "tabernacle") that received the steam. The goal of mercury treatment was to cause the patient to salivate, which was thought to expel the disease. Unpleasant side effects of mercury treatment included gum ulcers and loose teeth. Mercury continued to be used in syphilis treatment for centuries; an 1869 article by TJ Walker discussed administering mercury by injection for this purpose.

Guaiacum was a popular treatment in the sixteenth century and was strongly advocated by Ulrich Von Hutten and others. Because guaiacum came from Hispaniola where Columbus had landed, proponents of the Columbian theory contended that God had provided a cure in the same location from which the disease originated. In 1525, the Spanish priest Francisco Delicado, who himself suffered from syphilis, wrote El modo de adoperare el legno de India discussing the use of guaiacum for treatment of syphilis. Although guaiacum did not have the unpleasant side effects of mercury, guaiacum was not particularly effective, at least not beyond the short term, and mercury was thought to be more effective. Some physicians continued to use both mercury and guaiacum on patients. After 1522, the Blatterhaus — an Augsburg municipal hospital for the syphilitic poor — would administer guaiacum (as a hot drink, followed by a sweating cure) as the first treatment, and use mercury as the treatment of last resort.

Another sixteenth-century treatment advocated by the Italian physician Antonio Musa Brassavola was the oral administration of Root of China, a form of sarsaparilla (Smilax). In the seventeenth century, English physician and herbalist Nicholas Culpeper recommended the use of heartsease (wild pansy).

Before effective treatments were available, syphilis could sometimes be disfiguring in the long term, leading to defects of the face and nose ("nasal collapse"). Syphilis was a stigmatized disease due to its sexually transmissible nature. Such defects marked the person as a social pariah, and a symbol of sexual deviancy. Artificial noses were sometimes used to improve this appearance. The pioneering work of the facial surgeon Gasparo Tagliacozzi in the 16th century marked one of the earliest attempts to surgically reconstruct nose defects. Before the invention of the free flap, only local tissue adjacent to the defect could be harvested for use, as the blood supply was a vital determining factor in the survival of the flap. Tagliacozzi's technique was to harvest tissue from the arm without removing its pedicle from the blood supply on the arm. The patient would have to stay with their arm strapped to their face until new blood vessels grew at the recipient site, and the flap could finally be separated from the arm during a second procedure.

As the disease became better understood, more effective treatments were found. An antimicrobial used for treating disease was the organo-arsenical drug Salvarsan, developed in 1908 by Sahachiro Hata in the laboratory of Nobel prize winner Paul Ehrlich. This group later discovered the related arsenic, Neosalvarsan, which is less toxic. Unfortunately, these drugs were not 100% effective, especially in late disease, and were sometimes unpredictably toxic to patients.

It was observed that sometimes patients who developed high fevers were cured of syphilis. Thus, for a brief time malaria was used as treatment for tertiary syphilis because it produced prolonged and high fevers (a form of pyrotherapy). This was considered an acceptable risk because the malaria could later be treated with quinine, which was available at that time. Malaria as a treatment for syphilis was usually reserved for late disease, especially neurosyphilis, and then followed by either Salvarsan or Neosalvarsan as adjuvant therapy. This discovery was championed by Julius Wagner-Jauregg, who won the 1927 Nobel Prize for Medicine for his discovery of the therapeutic value of malaria inoculation in the treatment of neurosyphilis. Later, hyperthermal cabinets (sweat-boxes) were used for the same purpose. These treatments were finally rendered obsolete by the discovery of penicillin, and its widespread manufacture after World War II allowed syphilis to be effectively and reliably cured.

History of diagnosis

In 1905, Schaudinn and Hoffmann discovered Treponema pallidum in tissue of patients with syphilis. One year later, the first effective test for syphilis, the Wassermann test, was developed. Although it had some false positive results, it was a major advance in the detection and prevention of syphilis. By allowing testing before the acute symptoms of the disease had developed, this test allowed the prevention of transmission of syphilis to others, even though it did not provide a cure for those infected. In the 1930s the Hinton test, developed by William Augustus Hinton, and based on flocculation, was shown to have fewer false positive reactions than the Wassermann test. Both of these early tests have been superseded by newer analytical methods.

While working at the Rockefeller University (then called the Rockefeller Institute for Medical Research) in 1913, Hideyo Noguchi, a Japanese scientist, demonstrated the presence of the spirochete Treponema pallidum in the brain of a progressive paralysis patient, associating Treponema pallidum with neurosyphilis. Prior to Noguchi's discovery, syphilis had been a burden to humanity in many lands. Without its cause being understood, it was sometimes misdiagnosed and often misattributed to damage by political enemies. It is called "the great pretender" for its variety of symptoms. Felix Milgrom developed a test for syphilis. The Hideyo Noguchi Africa Prize, was named to honor the man who identified the agent in association with the late form of the infectious disease

Health Benefits of Jaggery

2016-03-14T05:33:00.000-07:00

Jaggery is a traditional non-centrifugal cane sugar consumed in Asia and Africa.It is a concentrated product of date, cane juice, or palm sap (see palm sugar) without separation of the molasses and crystals, and can vary from golden brown to dark brown in color. It contains up to 50% sucrose, up to 20% invert sugars, and up to 20% moisture, with the remainder made up of other insoluble matter, such as wood ash, proteins, and bagasse fibers. Jaggery is mixed with other ingredients, such as peanuts, condensed milk, coconut, and white sugar, to produce several locally marketed and consumed delicacies.

Unrefined, it is known by various names, including panela, in other parts of the world.

Origins and production

Jaggery is made of the products of sugarcane and the date palm tree. The sugar made from the sap of the date palm is both more prized and less commonly available outside of the regions where it is made. The date palm is tapped for producing jaggery in West Bengal, South India, Bangladesh, Pakistan, Nepal and Sri Lanka. In Sri Lanka, syrup extracts from kithul (Caryota urens) trees are widely used for jaggery production. This is considered the best jaggery available on the local market and is more highly valued than that from other sources.

All types of the sugar come in blocks or pastes of solidified concentrated sugar syrup heated to 200 °C (392 °F). Traditionally, the syrup is made by boiling raw sugarcane juice or palm sap in large, shallow, round-bottom vessels.

Preparation of jaggery

Cutting of sugar cane in a field in India.

Historically, the sugar cane cultivators used crushers which were ox-driven. Nowadays all the crushers are power-driven. These crushers are located in fields near the sugar crop. The cut and cleaned sugar cane is put into the crusher. The extracted sugar cane juice is collected in a big vessel. A certain quantity of the juice is transferred to a smaller vessel for heating on a furnace.

The vessel is heated for about one hour. Dried wood pulp from the crushed sugar cane is used as fuel for the furnace. While boiling the juice, some lime is added to it so that all the wood particles are collected on top of the juice in a froth during boiling which is skimmed off. Finally the juice is thickened and reduced to nearly one- third of the original volume. This hot liquid is golden in color. It is stirred continuously and lifted with a spatula to observe whether it forms a thread or drips dropwise while falling. If it forms many threads, it has completely thickened. Now it is poured into a shallow flat bottomed concrete tank to cool and solidify. The tank is large enough to allow only a thin coat of this hot liquid to form at its bottom, so as to increase the surface area for quick evaporation and cooling. After cooling down the jaggery becomes a soft solid which is now pressed into the desired shape for selling at the market.

The quality of the jaggery is judged by its color; brown means it is higher in impurities and golden-yellow implies it is relatively pure. Due to this grading scale there are malpractices of adding color or harmful chemicals to simulate the golden color.

Jaggery, also called gurh, is used as an ingredient in sweet and savory dishes across India, Pakistan, Bangladesh, Nepal, Sri Lanka as well as in Afghanistan and Iran. For example, a pinch of it is sometimes added to sambar, rasam, and other staples. Jaggery is added to lentil soups (dal) to add sweetness to balance the spicy, salty and sour components, particularly in Gujarati cuisine.

Maharashtra is the largest producer and consumer of jaggery most vegetable dishes, curries, and dals contain it. This is specially used during Makar Sankranti for making a dessert called tilgul. In Gujarat, known as gô during Makara Sankranti, a similar preparation called tal na ladu or tal sankli is made. In rural Maharashtra and Karnataka, water and a piece of jaggery is given when someone arrives home from working under a hot sun.

Molasses a byproduct of the production of jaggery, is used in rural Maharashtra and Karnataka as a sweetener. It contains many minerals not found in ordinary sugar and is considered beneficial to health in traditional Ayurvedic medicine. It is an ingredient of many sweet delicacies, such as gur ka chawal ("jaggery rice"), a traditional Rajasthani or Punjabi dish.

Jaggery is high in vitamin and minerals such iron, which helpful to anaemia patient. It also contains many minerals like Magnesium, Potassium, Calcium, Selenium, Manganese and Zinc which are very important for healthy body.

1. Prevents constipation: Jaggery activates the digestive enzymes in the body, stimulates bowel movements and thus helps prevent and relieve constipation.

2. Detoxes the liver: Jaggery helps cleanse the liver by flushing out harmful toxins from the body. So if you want to effectively detox your body, bite into a piece of jaggery.

3. Treats flu-like symptoms: Fight symptoms of a cold and cough with the help of gur. All you need to do is mix it with warm water and drink up, or even add it in your tea instead of sugar to reap the benefits.

4. Blood purifier: One of the most well-known benefits of jaggery is its ability to purify the blood. When consumed on a regular basis and in limited quantities, it cleanses the blood, leaving your body healthy.

5. Boosts immunity: Jaggery is loaded with antioxidants and minerals such as zinc and selenium, which in turn help prevent free-radical damage and also boost resistance against infections. Jaggery also helps increase the total count of haemoglobin in the blood.

6. Cleanses the body: Jaggery is one of the best natural cleansing agents for the body, hence it is advised to eat jaggery to remove unwanted particles from the body. It efficiently cleans the respiratory tract, lungs, intestines, stomach and food pipe. Eating jaggery is highly recommended for people working in heavily polluted areas such as factories or coal mines.

7. Eases menstrual pain: Jaggery contains many important nutrients, which important for healthy body, so it is very effective for menstrual problem. Gur is also useful to gives relief from cramp and stomach ache which are related to menstruation.

8. Cure Anaemia: Jaggery is great source of iron and folate. Iron and Folate maintain normal level of red blood cells and help to treat anaemia. Jaggery also gives an instant energy which cures the problem of fatigue and gives energy to your body, which one of the best Benefits of Jaggery for Pregnant Women.

9. Boosts intestinal health: Jaggery also boosts intestinal strength due to its high magnesium content. With every 10 gram of jaggery, you get 16 mg of magnesium, which is 4 percent of the daily requirement of this mineral.

10. Cools the stomach: Jaggery helps in maintaining normal body temperature which helps in keeping your stomach cool. Experts recommend drinking Gur Sharbat (jaggery soaked in ice cold water) during the summer months to cool off.

11. Maintain Blood Pressure: Jaggery is a rich source of potassium and sodium and both are very helpful to maintain a level of acid in your body. It also takes care of level of blood pressure in your body. It is one of Best Benefits of Jaggery to maintain your blood pressure level.

12. Cure Cough and Cold: It has ability to cure naturally cold and cough efficiently. Eating raw jaggery is very beneficial. You can make tea using gur or mix it with warm and drink to reduce problem of cold and cough. Jaggery is also very effective of migraines and headaches.

13. Relieves joint pain: "If you suffer from aches and pains in your joints, eating jaggery can provide you with much-needed relief", says Dr. Manoj K. Ahuja, Sukhda Hospital. You can eat it with a piece of ginger to alleviate joint pain, or even drink a glass of milk with jaggery every day to help strengthen the bones, thus preventing joint and bone problems such as arthritis.

14. Improve Metabolism and Help in weight loss: It is high in potassium, and it help to maintain electrolytes and also building up of muscles and boost metabolism in body. These things play a vital role to reduce weight, make it able to help in weight lose.

"Jaggery is surprisingly effective as an aid for weight loss. This is because jaggery is a rich source of potassium, which is a mineral that helps in the balance of electrolytes as well as building muscles and boosting metabolism. Potassium also helps in the reduction of water retention, which helps in managing your weight", says Delhi-based Nutritionist Anshul Jaibharat. These factors play an important role in effective weight loss, so if you're looking to lose some unwanted pounds, include this food in your diet.

15. Good source of energy: While sugar is a simple carbohydrate that gets absorbed in the bloodstream instantly and gives instant energy, jaggery is a complex carbohydrate that gives energy to the body gradually and for a longer time. This means that the levels of blood sugar do not get raised immediately. It also helps prevent fatigue and weakness of the body.

16.Good for sperm count : As per Ayurveda, consume it with powder of amla can beneficial to improve the quality of sperm count. It also helps in production of sperm in your body. It can reduce weakness in men and remove urinary problem in men. It is great Benefits of Jaggery for Sex life. Also it contain high amount of iron which great to improve hair growth.

17.Beauty Benefits of Jaggery or Gur:There are many Benefits of Jaggery for skin like nourish your skin, make skin healthy and glowing, reduce acne, blemish free skin, reduce sign of aging, and remove dark spot and wrinkles. Jaggery has natural properties which can your skin to stay healthy to all time

18. Maintain Temperature of Body : It has anti-allergic ingredient, which can help your body to maintain you temperature. It is great for the patient of Asthma, because Asthma patient must need a general temperature of body for all time. It is wonderful Benefits of Jaggery for the patient of Asthma.

19. Treat Urinary Problem : It last but not Least Health Benefits of Gur. Jaggery is made from sugarcane and sugarcane is works as natural diuretic, so it is useful to stimulate urination. It can also help in reduce inflammation of bladder. You can drink glass of milk with it to cure urinary problem and also to improve urine flow.