incidence: very common
cause: protozoan (Trichomonas vaginalis)
symptoms: genital itching, redness, discharge; often none in men
treatment: antibiotics
WHAT IS IT?
Trichomoniasis (“trich”) is an infection caused by a protozoan organism called Trichomonas vaginalis. It is a common sexually transmitted infection.
HOW COMMON IS IT?
Trichomoniasis is probably the most common sexually transmitted infection in the world. Each year, about three million women are diagnosed with the disease in the United States alone. A similar number of men are probably infected, but the statistics are available only for women, since it is they who usually have symptoms and seek health care.
Who is at highest risk? People are more likely to be infected if they have unprotected sex with multiple partners. The more sexual partners a person has, the higher the likelihood that he or she will become infected with trichomoniasis. In one study, trichomoniasis was found in about 5 percent of women on routine gynecological visits, in about 13-25 percent of women attending sexually transmitted disease clinics, and in 50-75 percent of prostitutes.
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There is no doubt that emotional and physical stress can have negative effects on the immune system, and many believe that stress triggers outbreaks of their herpes. Recent studies have shown that stress does not in fact cause frequent outbreaks; instead, those with herpes may become stressed as the virus is reactivating, possibly even before they notice symptoms. Then, when an outbreak occurs, they believe it was the stress that triggered the outbreak. However, it is often difficult to draw such fine distinctions between cause and effect, and techniques to lower stress do make herpes more manageable for most people.
Counseling may be helpful to deal with the emotional issues that many face when dealing with herpes. Regular exercise can reduce stress as well as provide other benefits. Setting aside adequate time for sleep and taking a break every day for relaxation (even as little as fifteen minutes) can also be helpful. Meditation practices, such as yoga and tai chi, have shown positive results for some people, not only in controlling herpes, but also in maintaining overall well-being. Biofeedback has shown promising results. Techniques such as respiration-based relaxation, guided imagery, and cognitive stress management may help to shorten herpes outbreaks, lessen their severity, and decrease the tension resulting from herpes outbreaks.
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As mentioned earlier, some strains of HPV cause cervical cancer and also make people more likely to develop skin cancer in the genital area, particularly anal cancer and penile cancer in men and vulvar cancer in women. The percentage of people who have the genital warts virus and go on to develop cancer is very small, however, considering that 40-70 percent of the population may be infected with HPV.
Cancer of the vulva in women and the penis in men and anal carcinoma (particularly in men who receive anal sex from other men) are most commonly caused by types 16 and 18 of the virus, which are not the most common types that cause external warts. On the other hand, if warts in these areas of the body have an unusual appearance, a biopsy should be performed to screen for cancer. A health care provider who has experience in treating warts should be consulted.
Each year in the United States, approximately 16,000 women develop cervical cancer, and about 4000 women die each year from the disease. Types 16 and 18 of the warts virus have the strongest connection with cervical cancer, but some of the other strains have also been linked to cancer. HPV types 16 and 18 are the most common types of warts virus found in sexually active adults, and when cervical cancer lesions are studied, types 16 and 18 are found in the lesions about 90 percent of the time. However, these are not the types that usually cause external warts; those are types 6 and 11.
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Introduced in 1994, female condoms are inserted into the vagina to offer a protective sheath. Their invention was a significant breakthrough, giving heterosexual women control over protecting themselves from an unwanted pregnancy and sexually transmitted infections in any this spermicide, it may aid in the situation, including times when a man refuses to use a condom. Women are more vulnerable to acquiring sexually transmitted infections than men, and because they often have fewer symptoms they may not be diagnosed as readily. Until now, the most reliable method of protection for a woman who had sex with a man was the male condom—and that method depended completely on the man’s agreement to use one.
The female condom available in the United States is made of plastic or polyurethane and is lubricated with a silicone-based lubricant. It consists of a pouch with a ring at each end. One ring is inserted into the vagina and fits around the cervix as does a diaphragm. The outer ring covers part of the labia, providing protection of the covered areas from some sexually transmitted infections that require skin-to-skin contact for transmission. These types of condoms may offer more protection than male condoms against infections that are transmitted through skin-to-skin contact, such as herpes and genital warts, although this has not yet been proven. The female condom can be inserted up to two hours before sexual contact and is removed after sexual intercourse. It is also used just once.
Because it is made of plastic, the female condom is not damaged by heat as is the male latex condom, and it can be used with either oil-or water-based lubricants. It prevents penetration by common sexually transmitted bacteria and viruses. Each female condom costs a bit more than a male condom. The failure rates resulting in pregnancy are similar to those for the diaphragm and cervical cap—about 15-18 percent. This rate may be due partly to incorrect use, as with male condoms, and this percentage may well decrease as a woman gains experience in using the female condom.
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PSA velocity has the potential to be highly valuable in detecting prostate cancer, and in distinguishing it from BPH early—particularly now, when an increasing number of men are returning to their doctor every year for a digital rectal examination and PSA test. PSA velocity is a fluid continuum, not a cut-and-dried, one-shot reading. It’s like having a prostate barometer—your doctor doesn’t have to wait for the PSA score to reach a magic number (currently, it’s 4 nanograms per milliliter). With PSA velocity, what matters is a significant change over time—an average consistent increase of more than 0.75 nanograms per milliliter a year, over the course of three tests separated by at least 12 to 18 months. Say over 24 months a man’s PSA level went up from 1.2 to 2.3 to 3.6. Clearly, something’s going on here. This obvious, steady rise could enable a doctor monitoring PSA velocity to detect clinically significant, curable prostate cancer in its earliest, most subtie stages, instead of waiting for the PSA level to reach the magic 4, and then doing further tests. “So the potential for PSA velocity means we can make a more accurate diagnosis of prostate cancer at even lower levels then the raw cutoff of 4, because it works at any level,” says one of the researchers. (At present, it’s unclear what rate of change is significant in men with PSA greater than 10.) Also, PSA velocity is more specific. If doctors use the PSA level of 4 as a cutoff point, about 40 percent of men who only have BPH undergo unnecessary biopsies. But with PSA velocity, this number is reduced; only 10 percent of men with BPH undergo an unnecessary biopsy.
Because of such studies, many doctors are excited about PSA velocity. However—although it’s a big improvement over looking at a bald PSA score and trying to figure out what it means—even PSA velocity isn’t a perfect system. One big point to remember: 25 percent of men with prostate cancers that are growing do not have a big increase in their PSA. So, just because your PSA isn’t high, and just because your PSA isn’t going up, that doesn’t mean you don’t have cancer, and it doesn’t mean that your cancer isn’t growing.
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