Gonorrhea

                              Gonorrhea

                                                                    What is gonorrhea?

Gonorrhea is a bacterial infection caused by the organism Neisseria gonorrheae that is transmitted by sexual contact. Gonorrhea is one of the oldest known sexually transmitted diseases. It is estimated that over one million women are currently infected with gonorrhea. Among women who are infected, 25%-40% also will be infected with chlamydia, another type of bacteria that causes another STD. (Chlamydia infection is discussed later in this article.)

Contrary to popular belief, gonorrhea cannot be transmitted from toilet seats or door handles. The bacterium that causes gonorrhea requires very specific conditions for growth and reproduction. It cannot live outside the body for more than a few seconds or minutes, nor can it live on the skin of the hands, arms, or legs. It survives only on moist surfaces within the body and is found most commonly in the vagina, and, more commonly, the cervix. (The cervix is the end of the uterus that protrudes into the vagina.) It can also live in the tube (urethra) through which urine drains from the bladder. Gonorrhea can even exist in the back of the throat (from oral-genital contact) and in the rectum.

Symptoms of gonorrhea

Over 50% of infected women have no symptoms, especially in the early stages of the infection. Symptoms of gonorrhea include burning or frequent urination, a yellowish vaginal discharge, redness and swelling of the genitals, and a burning or itching of the vaginal area. If untreated, gonorrhea can lead to a severe pelvic infection with inflammation of the Fallopian tubes and ovaries. Gonorrheal infection of the Fallopian tubes can lead to a serious, painful infection of the pelvis known as pelvic inflammatory disease or PID. PID occurs in 10%-40% of women with gonorrheal infection of the uterine cervix. Symptoms of pelvic infection include fever, pelvic cramping, abdominal pain, or pain with intercourse. Pelvic infection can lead to difficulty in becoming pregnant or even sterility. Occasionally, if the infection is severe enough, a localized area of infection and pus (an abscess) forms, and major surgery may be necessary and even lifesaving. Gonorrhea infection in people with conditions causing serious abnormal immune function, such as AIDS, can also be more serious.

Diagnosis of gonorrhea

Testing for gonorrhea is done by swabbing the infected site (rectum, throat, cervix) and identifying the bacteria in the laboratory either through culturing of the material from the swab (growing the bacteria) or identification of the genetic material from the bacteria. Sometimes the tests do not show bacteria because of sampling errors (the sampled area does not contain bacteria) or other technical difficulties, even when the woman has an infection. Newer tests to diagnose gonorrhea involve the use of DNA probes or amplification techniques (for example, polymerase chain reaction, or PCR) to identify the genetic material of the bacteria. These tests are more expensive than cultures but typically yield more rapid results.

Treatment of gonorrhea

In the past, the treatment of uncomplicated gonorrhea was fairly simple. A single injection of penicillin cured almost every infected person. Unfortunately, there are new strains of gonorrhea that have become resistant to various antibiotics, including penicillins, and are therefore more difficult to treat. Fortunately, gonorrhea can still be treated by other injectable or oral medications.

Uncomplicated gonococcal infections of the cervix, urethra, and rectum, are usually treated by a single injection of ceftriaxone intramuscularly or by 400mg of cefixime (Suprax) in a single oral dose. For uncomplicated gonococcal infections of the pharynx, the recommended treatment is 125 mg of ceftriaxone in a single IM dose.

Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, and rectum are 2 g of spectinomycin in nonpregnant women (not available in the United States) in a single IM dose or single doses of cephalosporins (ceftizoxime, 500 mg IM; or cefoxitin, 2 g IM, administered with probenecid (Benemid), 1 g orally; or cefotaxime, 500 mg IM).

Treatment should always include medication that will treat chlamydia [for example, azithromycin (Zithromax, Zmax) or doxycycline (Vibramycin, Oracea, Adoxa, Atridox and others)] as well as gonorrhea, because gonorrhea and chlamydia frequently exist together in the same person. The sexual partners of women who have had either gonorrhea or chlamydia must receive treatment for both infections since their partners may be infected as well. Treating the partners also prevents reinfection of the woman. Women suffering from PID require more aggressive treatment that is effective against the bacteria that cause gonorrhea as well as against other organisms. These women often require intravenous administration of antibiotics.

It is important to note that doxycycline, one of the recommended drugs for treatment of PID, is not recommended for use in pregnant women.

Gonorrhea is one of the easier STDs to prevent because the bacterium that causes the infection can survive only under certain conditions. The use of condoms protects against gonorrhea infection. Since the organism can live in the throat, condoms should be used during oral-genital contact as well.

Facts About Ovarian Cancer

Facts About Ovarian Cancer

What is ovarian cancer?

The ovaries are the part of the female reproductive system that produce eggs every month during a woman's reproductive years. They are located on either side of the lower abdomen. Ovarian cancer occurs when cells in the ovary grow and divide uncontrollably. The cells may form a tumor on the ovary, or they also can break off from the main tumor and spread to other parts of the body. Although ovarian cancer can spread throughout the entire body, in most cases it stays in the abdomen and affects organs such as the intestines, liver and stomach. There are several types of ovarian cancer. However, most cancers of the ovary come from the cells that make up the outer lining of the ovary.

How common is ovarian cancer?

A woman’s risk of getting ovarian cancer during her lifetime is about one in 67. The risk of getting this cancer and dying from it is one in 95. Ovarian cancer is the eighth most common cancer in women, excluding skin cancer. It is the fifth leading cause of cancer death in women.

What are the symptoms of ovarian cancer?

The initial symptoms are similar to gastrointestinal illness and indigestion, making the disease hard to diagnose. For this reason, many women are not diagnosed until late in the development of ovarian cancer. Signs and symptoms of ovarian cancer may include:

general abdominal discomfort and/or pain (gas, indigestion, pressure, bloating, cramps)

nausea, diarrhea, constipation and frequent urination

loss of appetite

feeling of fullness even after a light meal

weight gain or loss with no known reason

abnormal bleeding from the vagina may occur as a late symptom

These symptoms may be caused by ovarian cancer or by other less serious conditions. It is important to check with a doctor about any of these symptoms.

What are some risk factors for ovarian cancer?

The exact causes of ovarian cancer are not known. However, studies show that the following risk factors may increase the chance of developing this disease:

Family history — first-degree relatives (mother, daughter, sister), especially if two or more have had the disease. A family history of breast or colon cancer also is associated with an increased risk of developing ovarian cancer.

Age — most ovarian cancers occur in women 50 years of age or older, with the highest risk in women older than 60.

Non-childbearing — women who have never had children. In fact, the more children a woman has had, the less likely she is to develop ovarian cancer.

Personal history — women who have had breast or colon cancer may be at greater risk.

Obesity – women who are obese have a higher rate of death from ovarian cancer.

Fertility drugs — drugs that cause women to ovulate may slightly increase a woman's risk.

Talc — some studies suggest that women who have used talc in the genital area for many years may be at increased risk of developing ovarian cancer.

Hormone replacement therapy (HRT) — some evidence suggests that women who use HRT after menopause may have a slightly increased risk of developing this disease.

How is ovarian cancer diagnosed?

Many times women with ovarian cancer have no symptoms or just mild symptoms until the disease is in an advanced stage. Ovarian cancer is difficult to diagnose and is often diagnosed after the disease is advanced. Some diagnostic exams and tests that may be useful are:

Pelvic exam — includes feeling the uterus, vagina, ovaries, fallopian tubes, bladder and rectum to find any abnormality in their shape or size.

Ultrasound — uses high-frequency sound waves. These waves are aimed at the ovaries and produce a pattern of echoes to create a picture (sonogram). Healthy tissues, fluid-filled cysts and tumors look different on this picture.

CA-125 assay — a blood test used to measure the level of CA-125, a tumor marker that is often found in higher-than-normal amounts in the blood of women with ovarian cancer as well as other cancers.

Lower Gastrointestinal series or barium enema — a series of X-rays of the colon and rectum. The pictures are taken after the patient is given an enema with a white, chalky solution containing barium. The barium outlines the colon and rectum making tumors or other abnormal areas easier to see.

Computerized Axial Tomography (CAT) scan — a series of detailed pictures of the organs inside the body created by a computer linked to an X-ray machine.

Biopsy — the removal of tissue for examination under a microscope. A definitive diagnosis of ovarian cancer requires surgery. The initial surgery has two purposes. First, to remove any cancer that exists (or as much as possible), including removing the ovaries and the uterus; and second, to sample tissues and surrounding lymph nodes to determine where the tumor has spread and the stage of the disease. The best prognosis for survival occur when all the cancer can be removed.

What are the treatment options for ovarian cancer?

After diagnosis, a doctor will suggest one or more options for treatment. The type of treatment depends on the type of cancer and the stage of the disease. If surgery has not been performed yet, the exact stage may not be known. The main treatments for ovarian cancer are surgery, chemotherapy and radiation or a combination of the three