Weight loss and diet plan for a healthy lifestyle.

In general, treatment with only one of the agents [monotherapy] has been found to be inferior to treatment with two or more of the drugs [combination therapy). Most providers have now abandoned monotherapy because the data so clearly demonstrate that combination therapy works significantly better. However, combination therapy raises the possibility of more potential side effects and involves greater cost. Thus, once again, any treatment plan must be individualized.

The goal of treatment is to decrease the viral load to undetectable levels. If the viral load is greater than 30,000 to 50,000, then medication should be considered even if the T-helper-cell count is stable and a person is feeling well physically. If the T-helper-cell count is decreasing, or a person is experiencing progression of the infection with various opportunistic infections, then medications should be considered even if the viral load is low and stable.

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If a person who has not been immunized has been exposed to one who is infectious with hepatitis B, the exposed person should receive the vaccination series as well as a dose of immune globulin specifically directed against hepatitis B. The vaccination itself, if given after exposure, offers some protection against acquiring the infection. Adding a shot of immune globulin improves the outcome. Immune globulin is a collection of antibodies that help to protect against infection on an acute basis; it provides a “boost” for the immune system, but only for a short time, so the vaccination series is given at the same time to offer long-term immunity as well.

Vaccination plus immune globulin is a good idea after sustaining a needle-stick injury, receiving a bite from someone who is a carrier of hepatitis B or newly infected with hepatitis B, or sexual exposure to a person who is either a carrier or newly infected. If a person has sex with an infected partner, this combination can be given within fourteen days after the contact, but it offers the most protection if given within forty-eight hours of exposure. If there is a significant exposure from a needle-stick injury or from an exposure on a mucosal surface (such as the eyes or mouth), then this combination should be given within twenty-four to forty-eight hours after the exposure. In both of these scenarios, the follow-up vaccinations must be given at one- and six-month intervals.

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incidence: very common

cause: bacterium (Chlamydia trachomatis)

symptoms: burning with urination, discharge (but often none)

treatment: antibiotics

WHAT IS IT?

Recognized since 1970, chlamydia infections are among the most common genital infections. They are caused by the bacterium Chlamydia trachomatis. In addition to genital infections, chlamydia can also cause eye infection in newborns.

Some types of Chlamydia trachomatis can cause lymphogranuloma venereum (LGV), another sexually transmitted infection (see the entry for this disease). Other species of Chlamydia cause different infections. Chlamydia pneumoniae, for example, causes respiratory infection, and Chlamydia psittaci, which is transmitted from birds to humans, also causes a respiratory illness. Here the discussion will be limited to sexually transmitted Chlamydia trachomatis infections.

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If you are diagnosed with an infection, your health care provider may recommend that your partner be screened or treated for that infection. If this presents problems—because of any number of issues that can arise in our relationships with other people—you can ask your provider for suggestions about the best way to handle the situation. Sometimes role playing, with the health care provider acting as your partner, can help you find an effective way to communicate this news. You may want your provider to call your partner for you, or you may want to come to the office or clinic together so that everything can be explained. As discussed earlier, in some instances the local or state health department will help you notify your partner or partners. It may or may not be possible to determine who had the infection first, and in any case that’s not the most important thing: the most important thing is for both partners to receive treatment. It is a sign of respect and concern for your partner to let him or her know what is going on with you. Lack of symptoms doesn’t always mean lack of infection: even without symptoms, he or she could have the infection. This is the time to ask any questions, no matter how silly they may seem. The provider is there not only to diagnose and treat your infections, but also to educate you about STDs and help prevent you from putting yourself or anyone else at risk in the future. Abstinence and safe sex practices will usually be discussed Health care providers expect to receive phone calls from patients, so if you have questions about what was discussed during the examination, do not hesitate to contact your health care provider.

Regular sexual health care check-ups are as important a part of maintaining your health and well-being as a blood pressure check or a cholesterol screen. If you are currently sexually active, or are thinking about becoming active, find a health care provider in your community with whom you feel comfortable discussing these issues. Your health is worth it.

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Contrary to common misperceptions, not all itching in the female genital area is caused by yeast infections. Because of the availability of over-the-counter yeast treatments, however, many women self-treat for genital itching with these medications and never receive professional evaluation of their symptoms. For this reason, some women never receive an accurate diagnosis of what’s really causing their symptoms. For instance, a herpes outbreak may cause genital itching, which a woman may think is caused by a yeast infection; she may start treating herself with an over-the-counter cream. Her symptoms resolve, and she believes she has successfully treated the yeast infection, when in fact the herpes outbreak merely resolved on its own, which it will do without treatment. So even if you think your symptoms are “typical yeast” symptoms, it is a good idea to be evaluated by a health care provider while you are having symptoms (especially the first time you have these symptoms), or if the symptoms recur frequently.

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