Vaginitis/Trichomoniasis

Trichomoniasis is a sexually transmitted infection caused by a parasitic organism Trichomonas vaginalis. This infection commonly affects women between ages sixteen and thirty-five, although males can become infected as well. It is often referred to as vaginitis or “trich.”

The parasite that causes trichomoniasis cannot live in the rectum or the mouth, so the only modes of transmission are penis-to-vagina intercourse or vulva-to-vulva contact with someone who is already infected. The symptoms of the infection vary for males and females.

Women will often experience itching on or around the genitals, including the inner thighs, labia, vulva, or vagina. In some cases, the labia may appear swollen as well. Along with this discomfort, women will develop a vaginal discharge that is green-white or yellowish in color with a foul or strong smelling odor. Often females will also feel pain or irritation during urination or sexual intercourse.

In males, there are rarely symptoms, and the infection may go away in a few weeks without treatment. In some cases, males may suffer from urethral discharge or itching, burning with urination or ejaculation and in rare cases may develop conditions such as prostatitis or epididymitis as a result.

Vaginitis is actually the technical term for any infection or inflammation of the vagina. Most women will experience some form of vaginitis at least once in their lives. Vaginitis can be can be caused by a variety of things, so it is important that a physician determine the exact cause in order to prescribe the appropriate treatment.

While there are several different kinds of vaginitis, the most common is a yeast infection. This is what most people think of when they hear the term “vaginitis.” This infection is caused by the Candida fungus. It occurs when bacteria that balances against the fungus is too low, and the fungus grows too large in number, thus causing the infection.

With a yeast infection, abnormal vaginal discharge will typically be thick and white, similar to the consistency of cottage cheese. This type of infection happens frequently with the use of antibiotics or during pregnancy. Uncontrolled diabetes can also trigger the infection.

In some cases, vaginitis will cause no irritation and will produce no discharge. In these instances, the infection is found during a woman’s routine gynecological examination. Irritated cells will be seen by the physician and diagnosed appropriately.

Human Immunodeficiency Virus (HIV/AIDS) 

AIDS is a chronic, life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging or destroying the cells of your immune system, HIV interferes with your body's ability to effectively fight off viruses, bacteria and fungi that cause disease. This makes you more susceptible to certain types of cancers and to opportunistic infections your body would normally resist, such as pneumonia and meningitis. The virus and the infection itself are known as HIV. The term acquired immunodeficiency syndrome (AIDS) is used to mean the later stages of an HIV infection.

In the 25 years since the first reports of the disease, AIDS has become a global epidemic. Worldwide, an estimated 38.6 million people are living with HIV, nearly half of them women and girls between the ages of 15 and 24. And though the spread of the virus has slowed in some countries, it has escalated or remained steady in others. In 2005, more than 4 million people were newly infected with HIV; 25 million have died of AIDS since the epidemic began.

Despite improved treatments and better access to care for people in the hardest-hit parts of the world, most experts agree that the pandemic is still in the early stages. With a vaccine probably decades away, the best hope for stemming the spread of HIV now lies in prevention, treatment and education.

Signs and symptoms

The symptoms of HIV and AIDS vary, depending on the phase of infection. When first infected with HIV, you may have no symptoms at all, although it's more common to develop a brief flu-like illness two to six weeks after becoming infected. But because the signs and symptoms of an initial infection — which may include fever, headache, sore throat, swollen lymph glands and rash — are similar to those of other diseases, you might not realize you've been infected with HIV.

Even if you don't have symptoms, you're still able to transmit the virus to others. Once the virus enters your body, your own immune system also comes under attack. The virus multiplies in your lymph nodes and slowly begins to destroy your helper T cells (CD4 lymphocytes) — the white blood cells that coordinate your entire immune system.

You may remain symptom-free for eight or nine years or more. But as the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic symptoms such as:

• Swollen lymph nodes — often one of the first signs of HIV infection
• Diarrhea
• Weight loss
• Fever
• Cough and shortness of breath

During the last phase of HIV — which occurs approximately 10 or more years after the initial infection — more serious symptoms may begin to appear, and the infection may then meet the official definition of AIDS. In 1993, the Centers for Disease Control and Prevention (CDC) redefined AIDS to mean the presence of HIV infection as shown by a positive HIV-antibody test plus at least one of the following:

• The development of an opportunistic infection — an infection that occurs when your immune system is impaired — such as Pneumocystis carinii pneumonia (PCP)
• A CD4 lymphocyte count of 200 or less — a normal count ranges from 600 to 1,000

By the time AIDS develops, your immune system has been severely damaged, making you susceptible to opportunistic infections. The signs and symptoms of some of these infections may include:

• Soaking night sweats
• Shaking chills or fever higher than 100 F for several weeks
• Dry cough and shortness of breath
• Chronic diarrhea
• Persistent white spots or unusual lesions on your tongue or in your mouth
• Headaches
• Blurred and distorted vision
• Weight loss

You may also begin to experience signs and symptoms of later stage HIV infection itself, such as:

• Persistent, unexplained fatigue
• Soaking night sweats
• Shaking chills or fever higher than 100 F for several weeks
• Swelling of lymph nodes for more than three months
• Chronic diarrhea
• Persistent headaches

If you're infected with HIV, you're also more likely to develop certain cancers, especially Kaposi's sarcoma, cervical cancer and lymphoma, although improved treatments have reduced the risk of these illnesses.

Symptoms of HIV in children
Children who are HIV-positive often fail to gain weight or grow normally. As the disease progresses, they may have difficulty walking or delayed mental development. In addition to being susceptible to the same opportunistic infections that adults are, children may have severe forms of common childhood illnesses such as ear infections (otitis media), pneumonia and tonsillitis.

Causes

Normally, white blood cells and antibodies attack and destroy foreign organisms that enter your body. This response is coordinated by white blood cells known as CD4 lymphocytes. These lymphocytes are also the main targets of HIV, which attaches to the cells and then enters them. Once inside, the virus inserts its own genetic material into the lymphocytes and uses them to make copies of itself.

When the new copies of the virus break out of the host cells and enter the bloodstream, they search for other cells to attack. In the meantime, the old host cells and some uninfected CD4 cells die from the effects of the virus. The cycle repeats itself again and again. In the process, billions of new HIV particles are produced every day. Eventually, the number of CD4 cells in the body decreases, leading to severe immune deficiency, which means your body can no longer effectively fight off viruses and bacteria that cause disease.

How HIV is transmitted
You can become infected with HIV in several ways, including:

• Sexual transmission. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. You can also become infected from shared sexual devices if they're not washed or covered with a condom. The virus is present in the semen or vaginal secretions of someone who's infected and enters your body through small tears that can develop in the rectum or vagina during sexual activity. If you already have another sexually transmitted disease, you're at much greater risk of contracting HIV. Contrary to what researchers once believed, women who use the spermicide nonoxynol-9 also may be at increased risk. This spermicide irritates the lining of the vagina and may cause tears that allow the virus into the body.
• Transmission through infected blood. In some cases, the virus may be transmitted through blood and blood products that you receive in blood transfusions. This includes whole blood, packed red cells, fresh-frozen plasma and platelets. In 1985, American hospitals and blood banks began screening the blood supply for HIV antibodies. This blood testing, along with improvements in donor screening and recruitment practices, has substantially reduced the risk of acquiring HIV through a transfusion.
• Transmission through needle sharing. HIV is easily transmitted through needles and syringes contaminated with infected blood. Sharing intravenous drug paraphernalia puts you at high risk of HIV and other infectious diseases such as hepatitis. Your risk is greater if you inject drugs frequently or also engage in high-risk sexual behavior. Avoiding the use of injected drugs is the most reliable way to prevent infection. If that isn't an option, you can reduce your risk by sterilizing injection paraphernalia with household bleach or by participating in a needle exchange program that allows you to trade used needles and syringes for sterile ones.
• Transmission through accidental needle sticks. Transmission of the virus between HIV-positive people and health care workers through needle sticks is low. Experts put the risk at far less than 1 percent.
• Transmission from mother to child. Each year, nearly 600,000 infants are infected with HIV, either during pregnancy or delivery or through breast-feeding. The rate of mother-to-child transmission in resource-poor countries is as much as 40 percent higher than it is in the developed world. But if women receive treatment for HIV infection during pregnancy, the risk to their babies is significantly reduced. Combinations of HIV drugs may reduce the risk of mother-to-child transmission even more. In the United States, most pregnant women are pre-screened for HIV, and anti-retroviral drugs are readily available. Not so in developing nations, where women seldom know their HIV status, and treatment is often limited or nonexistent. When medications aren't available, Caesarean section is sometimes recommended instead of vaginal delivery, but this isn't a good option for women in resource-poor countries, where it poses additional risks for both mother and child. Other options, such as vaginal disinfection, haven't proved effective.
• Other methods of transmission. In rare cases, the virus may be transmitted through organ or tissue transplants or unsterilized dental or surgical equipment.

Ways HIV is not transmitted
To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. You can't become infected through ordinary contact — hugging, dancing or shaking hands — with someone who has HIV or AIDS.

Risk factors

HIV crosses all cultures, national borders and religions. Anyone of any age, race, sex or sexual orientation can be infected, but you're at greatest risk of HIV/AIDS if you:

• Have unprotected sex with multiple partners. You're at risk whether you're heterosexual, homosexual or bisexual. Unprotected sex means having sex without using a new latex or polyurethane condom every time.
• Have unprotected sex with someone who is HIV-positive.
• Have another sexually transmitted disease, such as syphilis, herpes, chlamydia, gonorrhea or bacterial vaginosis.
• Share needles during intravenous drug use.
• Have hemophilia and received blood products between 1977 and April 1985 — the date standard testing for HIV began.
• Received a blood transfusion or blood products before 1985.
• Have fewer copies of a gene called CCL3L1 that helps fight HIV infection.

Newborns or nursing infants whose mothers tested positive for HIV but did not receive treatment also are at high risk.

When to seek medical advice

If you think you may have been infected with HIV or are at risk of contracting the virus, seek medical counseling as soon as possible. Tests are available that can determine your status. The idea of being tested for HIV infection is frightening for many people, yet a majority of Americans say they would support routine HIV testing for all adults. What's more, testing itself doesn't make you HIV-positive or HIV-negative and is important not only for your own health but also to prevent transmission of the virus to others.

You can be tested by your doctor or at a hospital, the public health department, a Planned Parenthood clinic or other public clinics. Many clinics don't charge for HIV tests. Be sure to choose a place in which you feel comfortable and that offers counseling before and after testing. Don't let concern about what people may think stop you from being tested. For a referral, or to make an appointment for an HIV test at a Planned Parenthood clinic near you, call 800-230-PLAN, or 800-230-7526. You can also contact your local or state health department.

If you're pregnant, you may want to get tested even if you think you're not at risk. If you are HIV-positive, treatment with anti-retroviral drugs during your pregnancy can greatly reduce the chances you'll pass the infection to your baby. And if you engage in a high-risk behavior such as unprotected sex or sharing needles during intravenous drug use, experts recommend that you get tested for HIV every three to six months.

All states and U.S. territories now report positive HIV and AIDS test results to state public health officials to help track the spread of the disease. Most states use name reporting, but the results are released only to the health department and not to anyone else — including the federal government, employers, insurance companies and family members — without your express permission. In addition, legal provisions ensure the highest degree of confidentiality with regard to name-based HIV data. A few states, including Montana and Oregon, use name-to-code reporting. Don't let the HIV reporting policy prevent you from seeking testing or treatment. If you are concerned about having your name reported, many states offer anonymous testing centers. If you do test positive and seek treatment, however, you will likely have to provide your name to your doctor.

Screening and diagnosis

HIV is diagnosed by testing your blood or oral mucus for the presence of antibodies to the virus. The CDC encourages voluntary HIV testing as a routine part of medical care for all adolescents and adults ages 13 to 64, in new recommendations issued in September 2006. Although the CDC says that everyone should be tested at least once, yearly testing is recommended only for people at high risk of infection.

Unfortunately, HIV tests aren't accurate immediately after infection because it takes time for your body to develop these antibodies — usually about 12 weeks. In rare cases, it can take up to six months for an HIV test to become positive.

For years, the only available test for HIV was the enzyme-linked immunosorbent assay (ELISA) test that looked for antibodies to the virus in a sample of your blood. If this test was positive — meaning you had antibodies to HIV — the same test was repeated. If the repeat test was also positive for HIV antibodies, you'd then have another confirming blood test called the Western blot test, which checks for the presence of HIV proteins. The Western blot test was important because you may have non-HIV antibodies that cause a false-positive result on the ELISA test. Combining the two types of tests helped ensure that the results were accurate, and you'd receive a diagnosis of HIV only if all three tests were positive.

The downside is that it can take up to two weeks to get the results of the ELISA and Western blot tests, a period of time that can take an emotional toll and that discouraged many people from returning to get their test results. Now, however, several "rapid" tests can give highly accurate information within as little as 20 minutes.

These tests look for antibodies to the virus using a sample of your blood or fluids collected on a treated pad that's rubbed on your upper and lower gums. The oral test is almost as sensitive as the blood test and eliminates the need for drawing blood. A positive reaction on a rapid test requires a confirming blood test. And because the tests are relatively new and were originally approved for use only in certified laboratories, they may not be available in all locations.

Home tests
A quick search of the Internet can turn up dozens of "do-it-yourself" HIV tests even though it's illegal to market most of these tests in the United States. Currently, the Food and Drug Administration (FDA) has approved only one HIV test for home use. The Home Access HIV test, marketed by Home Access Health, is as accurate as a clinical test, and all positive results are automatically retested.

Unlike a home pregnancy test, you don't perform the test yourself. Instead, you mail in a drop of your blood, then call a toll-free number to receive your results in three to seven business days. This approach ensures your privacy and anonymity — you're identified only by a code number that comes with your kit. The greatest disadvantage is that you're not offered the counseling that you typically receive in a clinic or doctor's office, although you're given referrals for medical and social services. No matter what type of test you choose, if you test positive for an HIV infection, tell your sexual partner or partners right away so that they can be screened and take steps to protect themselves.

If you receive a diagnosis of HIV/AIDS, your doctor will use a test to help predict the probable progression of your disease. This test measures the amount of virus in your blood (viral load). Studies have shown that people with higher viral loads generally fare more poorly than do those with a lower viral load. Viral load tests are also used to decide when to start and when to change your treatment.

Herpes

Herpes is a broad term that is used to describe the two incurable viruses that cause sores on the mouth or genital area. Oral herpes is caused by the herpes simplex virus – 1 (HSV-1) and genital herpes is caused by herpes simplex virus – 2 (HSV-2). Although HSV – 1 generally affects the area of the move and HSV – 2 generally affects the area around the genitals, either disease could be transmitted to the other area of the body. The disease is spread through intimate skin to skin contact during a time when the afflicted person is shedding the disease. Although they are often symptomatic at this time, this is not always the case. Avoiding intimate contact while you are displaying symptoms can help to curb the spread of the disease but since it can also be spread when a person is not displaying symptomatic, many people unknowingly pass on the disease.

The Symptoms of Herpes

Since herpes is an incurable disease, it is always present in the afflicted person but they may not always be symptomatic. An outbreak is the term used to describe when a person with herpes is showing symptoms of the disease. In some cases an outbreak may be triggered by stress but other times there is no obvious cause for the outbreak. The symptoms of herpes vary between those that are caused by the HSV - 1 virus and those that are caused by the HSV – 2 virus. The symptoms of the HSV – 1 virus are sores around the mouth and nostrils that are often referred to as cold sores. These sores are often painful and itchy. The symptoms of the HSV – 2 virus usually begin with small red bumps on the penis in men or near the vagina in women. These red bumps may also be present near the anus or on the perineum. The bumps develop into blisters and then become itchy and painful. These blisters will heal without leaving a scar. It is wise to avoid intimate contact from when the first symptoms appear until they completely disappear to avoid spreading the disease. An additional symptom of genital herpes may include painful urination or defecation.

Syphilis

Syphilis is a sexually transmitted disease that occurs most often among men and women in their early to mid-twenties. The progression of the disease goes through three stages, although not all stages may necessarily be manifest.

The first stage, also called the primary stage, typically begins with a sore located at the site of the infection. The sore shows up as a lesion and is called a chancre, normally appearing as a crater or ulcer on the penis, vagina, mouth, lips or any other part of the body where an infection can occur. This lesion normally takes about three to four weeks to develop and typically heals of its own after about a week. However, just because the sore goes away doesn’t mean that the infection goes away, too. It simply makes its way into the second stage.

The second stage is often accompanied by a skin rash marked by small brown sores. This rash can appear any time from thee weeks to six weeks after the chancre appears and may cover the entire body or just parts of it. The rash almost always appears on the palms of the hand and the soles of the feet, however. It is important to keep contact down to the barest possible minimum during this stage because any physical contact whatever with broken skin can spread the infection. Typically the rash heals within a matter of weeks or months. This stage is also accompanied by a wide variety of other symptoms, including:

• Fever
• Joint pain
• Muscle aches
• Sore throat
• Flu like symptoms
• Headache
• Decreased appetite
• Patchy hair loss
• Swollen lymph nodes

The third stage, also known as the early latent phase, is distinguished by sporadic reversion to earlier symptoms experienced during the second phase. It is possible for someone with syphilis to exhibit no symptoms more than two years after the beginning of this stage, but still be able to infect others through either sexual intercourse or a blood transfusion.

Roughly one-third of those with latent syphilis will progress to a fourth stage after several years, or even decades. This stage is known as tertiary syphilis and it can infect the heart, brain, skin and bones. Since the advent of antibiotics, however, this stage has become rare.

Genital Warts

Genital warts are also known as condyloma or condylomata acuminata. This is a sexually transmitted disease that is caused by variants of the human papillomavirus (HPV). The variants usually include HPV6 and HPV11. This is a disease that is spread through intimate contact and that has 5.5 million new cases annually in the United States. The rapid spread of this disease is due to the fact that approximately 2/3 of those who are exposed to the disease, develop the disease combined with the fact that many of those who are already afflicted are unaware that they have the disease. It usually becomes clear within three months of the initial contact that the disease has been contracted but sometimes it may not be obvious for years. Genital warts are treatable through medications and surgeries but it is important to not that they can also be linked to serious medical concerns. HPV has been linked to cervical cancer and therefore those who contract the virus should be diligent to prevent the spread of this disease.

The Symptoms of Genital Herpes

In general genital herpes effects the tissue in an around the genital area but it can also be present in the mouth of someone who has engaged in oral sex with a partner who has genital herpes. They symptoms of genital herpes often include small flesh colored bumps on the skin in the genital area. These bumps may also take on a cauliflower effect. The bumps can range in size from 1 millimeter or they may multiple and develop into clusters of a significant size that are obvious even to the naked eye. Women who are inflected with genital warts usually experience symptoms on the vulva, vaginal walls and sometimes the anus. Men who suffer from genital warts can have symptoms develop on the tip or shaft of the penis as well as scrotum or the anus. Other symptoms of this disease include itching or burning in the genital areas. The warts may be flat and difficult to notice but if you are experiencing other symptoms such as itching or burning and discomfort or bleeding during intercourse, it is recommended that you see a doctor who can determine if the symptoms are present by applying an acetic acid solution to the area and viewing it through a microscope. The acetic acid will turn the warts a white color and make them more visible through the microscope.

Hepatitis B

What is hepatitis?

Hepatitis is an inflammation of the liver caused by certain viruses and other factors, such as alcohol abuse, some medications and trauma. Its various forms affect millions of Americans. Although many cases of hepatitis are not a serious threat to health, infection with certain hepatitis viruses can become chronic (long-lasting) and can sometimes lead to liver failure and death.

How many kinds of viral hepatitis are there?

There are four major types of viral hepatitis, all caused by different viruses: hepatitis A, hepatitis B, hepatitis C and delta hepatitis. This "HealthBeat" focuses on hepatitis B.

What is hepatitis B and how is it transmitted?

Infection with the hepatitis B virus (HBV) may be without any symptoms, mild or severe. Among adults infected by HBV, 90 percent to 94 percent recover completely and have no long term effects. Six percent to 10 percent will become chronic carriers of HBV and will be at risk of developing cirrhosis or liver cancer. Over time, hepatitis B can destroy the liver (cirrhosis) and can cause liver cancer.

HBV is spread by direct contact with blood or other body fluids of infected people. (Delta hepatitis is spread the same ways as HBV; however, it is a defective hepatitis virus that can only be acquired in the presence of hepatitis B virus.)

Each year, an estimated 200,000 to 300,000 persons in the United States become infected with HBV. In Illinois, there were 591 cases of HBV reported in 1990; this declined to 315 reported cases in 1994.

Since the disease is not easily spread, persons with HBV do not pass the virus to others through casual contact, such as shaking hands or sharing a work space or bathroom facility. HBV is most commonly transmitted by sharing drug needles, by engaging in high-risk sexual behavior (especially anal sex), from a mother to her baby during childbirth and in the health-care setting.

What are the symptoms of hepatitis B?

Many people infected with viral hepatitis have no symptoms. For example, about one-third of people infected with HBV have a completely "silent" disease. When symptoms are present, they may be mild or severe. The most common early symptoms are mild fever, headache, muscle aches, fatigue, loss of appetite, nausea, vomiting and diarrhea. Later symptoms may include dark coffee-colored, rather than dark yellow, urine, clay-colored stools, abdominal pain, and yellowing of the skin and whites of the eyes (jaundice).

About 15 percent to 20 percent of patients develop short-term arthritis-like problems. Another one-third of those with hepatitis B develop only mild flu-like symptoms without jaundice. Very severe hepatitis B is rare, but it is life-threatening. Signs and symptoms, which require immediate medical attention, include prolonged blood clotting time, personality changes and agitated behavior.

Can people with no symptoms pass hepatitis B to others?

Some people infected with HBV become chronic carriers of the virus, although they may have no symptoms. There are an estimated 1.5 million HBV carriers in the United States and 300 million carriers worldwide. Children, when exposed to HBV, are at greatest risk of becoming carriers. Up to 90 percent of babies who become infected at birth with HBV, and up to half of youngsters who are infected before 5 years of age, become chronic carriers.

How is hepatitis B diagnosed?

Several blood tests can detect signs of HBV even before symptoms develop. These tests measure liver function and identify HBV antigens (certain portions of the hepatitis B virus) or antibodies (proteins produced by the body in response to the virus) in the blood.

How is hepatitis B treated?

There are no specific treatments for the acute symptoms of viral hepatitis B. Doctors recommend bed rest, preventing dehydration, a healthy diet and avoidance of alcoholic beverages.

A synthetic form of the protein interferon alpha is used to treat people with chronic hepatitis B. The drug improves liver function in some people with hepatitis and diminishes symptoms, although it may cause side effects such as headache, fever and other flu-like symptoms.

Most patients with mild to severe acute hepatitis begin to feel better in two to three weeks and recover completely within four to eight weeks. People with HBV infection who also become infected with the hepatitis C virus at the same time may be at particular risk for developing severe, life-threatening hepatitis.

Many chronic carriers remain symptom free or develop only a mild condition, chronic persistent hepatitis. However, approximately 25 percent go on to develop the most serious complications of viral hepatitis: cirrhosis of the liver, liver cancer and immune system disorders.

How can hepatitis B be prevented?

The most effective means of preventing hepatitis B virus infection is to avoid contact with the blood and body fluids, including semen and vaginal secretions, of infected individuals. People who have hepatitis B virus infection should

• Avoid sharing items that could infect others, such as razors or toothbrushes.
• Protect sex partners from exposure to semen, vaginal fluids or blood through the proper use of latex condoms.

There are several vaccines available to prevent hepatitis B. Vaccination should be considered by people at high risk of infection: male homosexuals and heterosexuals with multiple partners, people who receive hemodialysis or blood products, household and sexual contacts of HBV carriers, and users of street drugs who share needles. Many health care and laboratory workers who handle blood and other body fluids also are vaccinated. People who come into direct contact with the blood or body fluids of an HBV carrier may receive one or more injections of hepatitis B immune globulin, sometimes in combination with hepatitis B vaccine. Immune globulin offers temporary protection, while the vaccine provides long-lasting immunity.

In an effort to eliminate chronic carriers of HBV, the U.S. Centers for Disease Control and Prevention (CDC) recommends that all newborn babies be vaccinated against the hepatitis B virus. The CDC and other groups have recommended that pregnant women be screened for hepatitis B as part of routine prenatal care. If the mother is infected, her baby can be given hepatitis B immune globulin and vaccine immediately after birth.

Hepatitis C

What is hepatitis C and how is it transmitted?

This type of hepatitis is caused by the hepatitis C virus (HCV), which infects approximately 36,000 persons each year in the United States. Although generally a mild condition, hepatitis C is much more likely than hepatitis B to lead to chronic liver disease. People infected with HCV can become chronic carriers of the virus, although they may have no symptoms. It is estimated that there are approximately 4 million HCV chronic carriers. Around 70 percent of all HCV carriers will develop chronic liver disease, regardless of whether they have symptoms.

HCV is spread primarily by exposure to human blood. Approximately 80 percent of persons who share needles to inject drugs are infected with HCV. Persons who receive blood transfusions face some risk, although it is very low since testing of donated blood for HCV began in 1990. Hepatitis C has been transmitted between sex partners and among household members, but the degree of risk is believed to be low. HCV is not spread by food or water or casual contact, such as shaking hands or sharing a work space or bathroom facility.

What are the symptoms of hepatitis C?

Many people infected with hepatitis C have no symptoms. When symptoms are present, they can range from mild to severe. The most common early symptoms are mild fever, headache, muscle aches, fatigue, loss of appetite, nausea, vomiting and diarrhea. Later symptoms may include dark coffee-colored rather than dark yellow urine, clay-colored stools, abdominal pain, and yellowing of the skin and/or whites of the eyes (jaundice).

Who should be tested for hepatitis C?

It is recommended that the following persons be routinely tested for hepatitis C:

• Persons who have ever (even if only one time) injected illegal drugs
• Persons who received blood products for treatment of bleeding problems prior to 1987 (those who received clotting factor concentrates produced before 1987)
• Persons who were ever on chronic renal dialysis
• Persons with persistently elevated liver function tests
• Persons who were notified they received a blood transfusion from a donor who later tested positive for HCV
• Persons who received a blood transfusion before July 1992
• Persons who receive an organ transplant before July 1992
• Health care, emergency medical and public safety workers who received an accidental needle stick or had mucous membrane exposure to HCV-positive blood
• Children born to HCV-positive mothers

Can people with no symptoms pass hepatitis C to others?

Yes. Infected persons, regardless of whether they have symptoms or not, can transmit their infection to others.

How is hepatitis C diagnosed?

A test is now available to identify antibody (proteins produced by the immune system in response to the virus) to HCV, which is present in approximately 50 percent of persons with early hepatitis C infections and in almost all with chronic hepatitis C infections. There are other tests that can confirm a positive antibody test result and tell the physician if the infection is causing damage to the liver. A liver biopsy sometimes is needed to enable the physician to determine the degree of damage to the liver.

How is hepatitis C treated?

There are no specific treatments for the symptoms of acute hepatitis C. Doctors recommend bed rest, preventing dehydration, a healthy diet and avoidance of alcoholic beverages. Most patients with mild to severe hepatitis C begin to feel better in two to three weeks and recover completely from their symptoms within four to eight weeks.

Synthetic forms of the protein interferon are used to treat some people with chronic hepatitis C. This can improve liver function in some people with hepatitis and diminishes symptoms, although it may cause side effects such as headache, fever and other flu-like symptoms. Sometimes this drug is used in combination with another drug, ribavirin. Treatment is effective in 10 percent to 40 percent of patients.

Many chronic carriers remain symptom free or develop only a mild condition, chronic persistent hepatitis. However, approximately 50 percent go on to develop the most serious complications of viral hepatitis: cirrhosis of the liver and liver cancer.

How can hepatitis C be prevented?

The most effective means of preventing hepatitis C is to avoid contact with human blood. Do not inject illegal drugs and do not share toothbrushes, razors or other items that might have blood on them.

No vaccines yet exist for HCV.

What do I do if I test positive for HCV?

You should have a medical evaluation to help determine that the HCV test result is not a false positive. Your physician may repeat the test or may see you regularly for a few months to test blood samples for liver enzymes and do a follow-up test again in six months. Persons who have hepatitis C should be considered potentially infectious. They should not donate blood, body organs, other tissue, or semen. Toothbrushes, razors or other items that could become contaminated with blood should not be shared. Cuts, open sores or other breaks in the skin should be covered to prevent the risk of blood exposures to others. When seeking medical or dental care, persons with HCV infections should inform those responsible for their care of their HCV status so that they can be appropriately evaluated.

Do not use alcohol, see your physician, do not take new over-the-counter drugs without first talking to your physician, and get vaccinated against hepatitis A and hepatitis B.

Although sexual transmission has occurred, presently there is little reported evidence that chronically infected persons infect long-term sex partners in mutually monogamous relationships. Current information suggests there is no need in changing current sexual practices for a person with a steady sexual partner. Persons with HCV infection who have multiple sexual partners should reduce their number of sexual partners and inform prospective sexual partners so that appropriate precautions (latex condoms) can be used.

Approximately 5 percent of HCV-positive women transmit their infection to their infants (this rate is higher if the mother is also infected with HIV). HCV-positive mothers can breastfeed their babies as long as their nipples are not cracked or bleeding.