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- Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.
- A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
- Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
- There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
- The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
- Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
- The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
- Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).
- Unclear or conflicting scientific evidence:
- Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
- Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
- Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
- Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
- Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
- Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
- Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
- Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
- Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
- Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
- Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
- Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
- Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
- Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
- Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
- Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
- Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
- Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
- Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
- Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
- Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
- Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
- Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
- Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
- Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
- There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
- Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
- Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
- Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
- Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
- Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
- Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
- Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
- Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
- Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
- Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
- Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
- Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
- TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
- Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
- Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
- Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
- Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
- Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
- Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
- Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
- Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
- Fair negative scientific evidence:
- Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- In order to prevent wounds from occurring, healthcare providers recommend that individuals: take care when using sharp objects such as knives, scissors, saws, and trimmers; wear shoes or boots on the feet; use helmets when riding a bicycle; use helmets, kneepads, wrist protectors, and elbow pads when using in-line skates or skateboards; and avoid picking up broken pieces of glass and handling razor blades.
- If bedridden or immobile with diabetes, circulation problems, incontinence, or mental disabilities, healthcare providers recommend that the individual be checked for pressure sores every day. Also, look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters. In addition, take the following steps: change position at least every two hours to relieve pressure; use items that can help reduce pressure such as pillows, sheepskin, foam padding, and powders from medical supply stores; eat healthy, well-balanced meals; exercise daily, including range-of-motion exercises for immobile patients; and keep skin clean and dry. Incontinent people need to take extra steps to limit moisture.
- Individuals with diabetes should check their feet daily for blisters, sores, or other wounds in order to prevent serious infection and possibly amputation.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Academy of Family Physicians. .
- American Academy of Pediatrics. .
- Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
- Centers for Disease Control and Prevention. .
- Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
- Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
- de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
- Natural Standard: The Authority on Integrative Medicine. .
- National Institute of Allergy and Infectious Diseases. .
- Pieper B, Sieggreen M, Nordstrom CK, et al. Discharge knowledge and concerns of patients going home with a wound. J Wound Ostomy Continence Nurs. 2007;34(3):245-53; quiz 254-5.
- Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.
- Overview: Chlamydia is a curable sexually transmitted infection (STI) of the genital tract. If left untreated, chlamydia may damage the genital tract and lead to serious illnesses, including pelvic inflammatory disease (PID) in females and inflammation of the tubes that carry semen (epididymitis) in males.
- According to the U.S. Centers for Disease Control and Prevention (CDC), nearly three million Americans become infected with chlamydia each year. Although chlamydia can affect people of all ages, in the United States it is most common among teenagers.
- A bacterium called Chlamydia trachomatis causes chlamydia. Most cases of chlamydia are transmitted from person to person through oral, anal, or vaginal sex. Pregnant women may also pass the infection onto their babies during vaginal childbirth. This is because the newborn is exposed to the mother's blood and other bodily fluids during birth.
- Symptoms: During the early stages of chlamydia, most patients experience few or no symptoms of an infection. In general, symptoms usually develop one to three weeks after the bacterium has entered the body.
- If patients develop the infection after vaginal sex, common symptoms include painful urination, vaginal or penile discharge, lower abdominal pain, painful sexual intercourse in women, and testicular pain in men.
- If patients develop the infection after anal sex, rectal inflammation usually occurs. This inflammation typically causes pain and mucus discharge.
- If patients touch their eyes after touching bodily secretions (e.g. semen or vaginal discharge) that are infected with chlamydia, they may develop an eye infection called pinkeye (conjunctivitis). Left untreated, pinkeye may lead to permanent blindness.
- Newborns who contract chlamydia during childbirth usually develop pneumonia and/or severe eye infections, which may lead to blindness.
- Complications: Patients infected with chlamydia are more vulnerable to other STDs, including the human immunodeficiency virus (HIV), gonorrhea, and syphilis, if they are exposed to them. Therefore, patients who test positive for chlamydia are often tested for other STDs.
- Females with untreated chlamydia may develop pelvic inflammatory disease (PID). This is an infection of the fallopian tubes, uterus, and cervix. If left untreated, PID may cause permanent damage to the reproductive tract, which may lead to infertility. It may also lead to long-term pelvic pain.
- Males with untreated chlamydia may develop a condition called epididymitis. This condition is characterized by inflammation of the tubes near the testicles that carry semen. Symptoms may include fever, scrotal pain, and swelling.
- The infection may also spread to the prostate gland in males, causing inflammation (prostatitis). Symptoms of prostatitis may include pain during or after sex, fever, painful urination, and lower back pain.
- Diagnosis: Patients should talk to their healthcare providers to determine how often they should be tested for chlamydia. Patients who have symptoms of chlamydia or suspect that they may have been exposed to chlamydia should be tested. The CDC recommends that all pregnant women are screened for chlamydia during the first prenatal examination and possibly later on in the pregnancy.
- The standard diagnostic test for chlamydia is a culture swab. For females, the healthcare provider may swab the discharge from the cervix. For males, the healthcare provider inserts a thin swab into the tip of the penis to retrieve a sample of fluid from the urethra. In some cases, the healthcare provider may swab the anus. The sample is then rubbed on a petri dish. If the patient has chlamydia, Chlamydia trachomatis will grow on the petri dish.
- A urine analysis may also be performed. A sample of the patient's urine is analyzed in a laboratory for the presence of the disease-causing bacteria.
- Treatment: Chlamydia is curable. Patients take prescription antibiotics, such as azithromycin (Zithromax®), doxycycline, or erythromycin (ERYC® or Ery-Tab®), by mouth. Treatment may last up to 10 days. Patients should take their medications exactly as prescribed. Even if symptoms go away, medications should not be stopped early because the bacteria may still be present in the body.
- The patient's sexual partner(s) will also require treatment, even if they do not have symptoms of the infection. Otherwise, the patient may become re-infected with chlamydia.
- Overview: Genital herpes, also called herpes simplex type 2 (HHV-2), is an incurable viral infection that is characterized by painful sores on the genitals.
- Genital herpes can only be contracted through direct sexual contact, including genital-to-genital, mouth-to-genital, or hand-to-genital contact with an infected partner. Individuals cannot contract the virus through kissing. Occasionally, oral-genital contact can spread oral herpes to the genitals (and vice versa). Individuals with active herpes lesions on or around their mouths or on their genitals should only engage in oral sex if they use a condom or place a small piece of latex, called a dental dam, over the vagina or anus.
- The chance of a pregnant woman passing herpes to her baby is highest if the first infection occurs near the time of delivery. The virus can be transmitted to the fetus through the placenta during pregnancy or during vaginal childbirth. First-time infection during pregnancy leads to an increased risk of miscarriage, decreased fetal growth, and preterm labor. About 30-50% of infants who are born vaginally to a mother with first-time infection become infected with the herpes virus. Of babies born to women experiencing recurrent outbreaks at the time of birth, one to four percent become infected with the herpes-simplex virus.
- After an initial or primary infection, herpes viruses establish a period called latency, during which the virus is present in the cell bodies of nerves that attach to the area of the original viral outbreak (e.g. genitals, mouth, and lips). At some point, this latency ends and the virus becomes active again. While active, the virus begins to multiply (called shedding) and becomes transmittable again. This shedding may or may not be accompanied by symptoms. During reactivation, the virus multiplies in the nerve cell and is transported outwardly via the nerve to the skin. The ability of herpes virus to become latent and reactive explains the long-term, recurring nature of a herpes infection.
- Recurrence of the viral symptoms is usually milder than the original infection. Recurrence may be triggered by menstruation, sun exposure, illnesses that cause fevers, stress, immune system imbalances, and other unknown causes. However, not all patients experience a second outbreak.
- Symptoms: Genital herpes typically causes painful, watery blisters to develop on the skin, mucous membranes (e.g. the mouth or lips), or genitals. The location of these blisters depends on where contact was made during transmission. Lesions heal with a crust-forming scab, the hallmark of herpes. Many individuals with recurrent disease develop pain in the area of the infection even before any blisters or ulcers can be seen. This pain is due to irritation and inflammation of the nerves leading to the infected area of skin. These are signs that an outbreak is about to start. An individual is particularly contagious during this period, even though the skin still appears normal.
- Diagnosis: A viral culture uses specimens taken from the blister, fluid in the blister, or sometimes spinal fluid. The samples are sent to a laboratory where they are analyzed. It takes between one and 14 days to detect the virus in the preparation made from the specimen. This test is useful, but it is sometimes difficult to detect the virus in the sample.
immunofluorescence assay is a diagnostic technique used to identify antibodies to the HHV-2. These antibodies are proteins that help the body fight against HHV-2. If the specific antibodies are present, a positive diagnosis is made. This test is less expensive, more accurate, and faster than a viral culture. However, it may take up to 30 days for antibodies to build up to detectable levels. Therefore, if herpes is highly suspected and results are negative soon after possible exposure to the virus, a repeat test may be recommended.
- A polymerase chain reaction (PCR) test may also be performed to determine whether the virus itself is present in the patient's blood. A sample of the patient's blood is taken and sent to a laboratory. If the virus' genetic makeup (DNA) is present, a positive diagnosis is made. The virus can even be detected during the latent stages of the infection.
- Treatment: Although there is no cure for genital herpes, medications are available to minimize the number of outbreaks, reduce the likelihood of viral shedding, and decrease the likelihood of transmission.
- There are three antiviral medications that the U.S. Food and Drug Administration (FDA) has approved for the treatment of genital herpes. Approved antiviral drugs include acyclovir (Zovirax®), valacyclovir (Valtrex®), and famciclovir (Famvir®). Antiviral medication is commonly prescribed for patients having a first episode of genital herpes, but they can be used for recurrent episodes as well. There are two kinds of treatment regimens: episodic therapy and suppressive therapy.
- With episodic therapy, the patient begins taking the medication at the first sign of an outbreak. The medication is then taken for several days to hasten the recovery or healing or to prevent a full outbreak from fully occurring. All three of the approved medications help shorten the amount of time that a person may experience symptoms of herpes. However, results may vary from person to person.
- Suppressive therapy is used in individuals with recurrent genital herpes who want to prevent outbreaks. Patients who have six or more outbreaks per year may take antiviral medications on a regular basis, before symptoms appear. For these individuals, studies have reported that suppressive therapy may reduce the number of outbreaks by at least 75% while the medication is being taken. Suppressive therapy may completely prevent outbreaks in some patients. Suppressive therapy may need to be taken for the rest of the patient's life.
- Side effects of antiviral medicines include
stomach upset, loss of appetite, nausea, vomiting, diarrhea, headache, dizziness, and/or weakness.
- Overview: Gonorrhea, sometimes called the clap, is a curable bacterial infection that affects the sex organs. If left untreated, gonorrhea may lead to infertility.
- Gonorrhea is caused by a bacterium called Neisseria gonorrhoeae. Gonorrhea is transmitted through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired.
- Pregnant females with untreated gonorrhea may pass the infection onto their babies during vaginal childbirth (not cesarean section).
- The bacterium can only live outside of the body for a few seconds. Therefore, the infection cannot be transmitted through toilet seats or other objects such as towels or clothing.
- Symptoms: Most patients develop symptoms of gonorrhea one to 10 days after the bacterium enters the body. Some patients may be infected for months before symptoms develop. More than 50% of females with gonorrhea do not experience any symptoms.
- Common symptoms of gonorrhea include thick or bloody discharge from the penis or vagina, pain or burning sensation during urination, frequent urination, and pain during sexual intercourse.
- Anorectal gonorrhea may develop in males or females after anal intercourse with an infected person. In some cases, the infection may spread from the genitals to the anus. Anorectal gonorrhea may cause some discomfort in and discharge from the anal area, but many patients do not experience any symptoms.
- Oral sex can cause pharyngeal gonorrhea. Symptoms of pharyngeal gonorrhea commonly include pain when swallowing and redness of the throat and tonsils.
- If a patient touches an eye after touching bodily fluids that contain the bacteria, it may cause pinkeye (conjunctivitis). Symptoms may include reddening and inflammation of the eye(s).
- Newborns with gonorrhea may develop permanent blindness and infection of the joints and blood.
- Complications: In females, untreated gonorrhea may lead to pelvic inflammatory disease (PID). This is an infection of the fallopian tubes, uterus, and cervix. If left untreated, PID may cause permanent damage to the reproductive tract, which may lead to infertility. It may also lead to long-term pelvic pain.
- Males with untreated gonorrhea may develop a condition called epididymitis. This condition is characterized by inflammation of the tubes near the testicles that carry semen. Symptoms may include fever, scrotal pain, and swelling.
- In rare cases, Neisseria gonorrhoeae may enter the bloodstream and infect other parts of the body, such as the skin, joints, or internal organs. Symptoms may include fever, swelling, joint pain and stiffness, rash, and skin sores.
- Diagnosis: Patients should talk to their healthcare providers to determine how often they should be tested for gonorrhea. Patients who have symptoms of gonorrhea or suspect they may have been exposed to gonorrhea should be tested.
- The standard diagnostic test for gonorrhea is a culture swab. For females, the healthcare provider may swab the discharge from the cervix. For males, the healthcare provider inserts a thin swab into the tip of the penis to retrieve a sample of fluid from the urethra. In some cases, the healthcare provider may swab the anus. The sample is then rubbed on a petri dish. If the patient has gonorrhea, Neisseria gonorrhoeae will grow on the petri dish.
- A urine analysis may also be performed. A sample of the patient's urine is analyzed in a laboratory for the presence of the disease-causing bacteria.
- Treatment: Gonorrhea is curable. Patients typically take antibiotics, such as ciprofloxacin (Cipro® or Cipro XR®), ofloxacin (Floxin®), and levofloxacin (Levaquin®).
- Babies with gonorrhea also receive antibiotics. In addition, medication, such as silver nitrate, is usually applied to the baby's eyes immediately after birth. This has been shown to help prevent the infection from spreading into the eyes.
- Even if symptoms go away, medications should not be stopped early because the bacteria may still be present in the body. If the medication is stopped too early, the remaining bacteria in the body may mutate and become resistant to treatment. Once the bacterium is resistant to a medication, the antibiotic is no longer effective.
- Overview: The human immunodeficiency virus (HIV) is a virus that progresses to AIDS (acquired immune deficiency syndrome). HIV primarily attacks the immune defense system, making the patient extremely vulnerable to opportunistic infections. Opportunistic infections are illnesses that occur in individuals who have weakened immune systems.
- HIV primarily infects and destroys immune cells called CD4 T-cells. Healthy individuals have a CD4 cell count between 600 and 1,200 cells per microliter of blood. HIV patients who are not receiving treatment have less than 600 CD4 cells per microliter of blood. AIDS patients, who have CD4 cell counts that are lower than 200, have the greatest risk of developing opportunistic infections that may be fatal.
- HIV is transmitted from person to person via bodily fluids including blood, semen, vaginal secretions, and breast milk. Therefore, it can be transmitted through sexual contact with an infected person, by sharing needles/syringes with someone who is infected, through breastfeeding, during vaginal birth or, less commonly (and rare in countries where blood is screened for HIV antibodies), through transfusions with infected blood.
- Symptoms: Many patients experience no symptoms when they first become infected with HIV. After one or two months, an estimated 80-90% of HIV patients develop flu-like symptoms including headache, fever, fatigue, and enlarged lymph nodes. These symptoms usually disappear after one week to one month and are often mistaken for another viral infection, such as the flu. Despite having minimal or no symptoms during this stage, individuals are very infectious because the virus is present in large quantities in bodily fluids.
- After the initial infection with HIV, the next stage is called clinical latency. Although patients experience few or no symptoms during the clinical latency stage, the infection may still be passed to others. Once infected with HIV, the clinical latency stage may last 10 or more years in adults or up to two years in children who are born with HIV infection. The length of this asymptomatic period varies in individuals. Some people may start to experience more serious symptoms within a few months, while others may be symptom-free for several years. The virus can also hide inside infected cells and lay dormant. Patients can still transmit the virus to others when the virus is dormant.
- As the immune system continues to weaken many symptoms appear, including inflamed lymph nodes (swollen glands) that may be enlarged for longer than three months. Other symptoms often experienced months to years before the onset of AIDS include fatigue, weight loss, frequent fevers and sweats, persistent or frequent yeast infections (oral or vaginal), persistent skin rashes, flaky skin, pelvic inflammatory disease (PID) in women that does not respond well to treatment, and short-term memory loss.
- In addition, some individuals develop a painful nerve disease called shingles or frequent and severe herpes infections that cause sores to develop on the mouth, genitals, or anus. Infected children may be sick often, grow or gain weight slowly, or take longer to develop important mental and motor skills.
- Although treatment can slow the progression of HIV, nearly all patients eventually develop AIDS. Once the patient's CD4 T-cell count is less than 200 cells per microliter of blood, their condition has progressed to AIDS, the final stage of the disease. Some patients are diagnosed with AIDS after they developan AIDS-defining illness, such as Pneumocystis jiroveci pneumonia (formerly called Pneumocystis carinii or PCP). The first symptoms of AIDS often include moderate and unexplained weight loss, recurring respiratory tract infections, and oral ulcerations.
- Patients with AIDS have the greatest risk of developing opportunistic infections and tumors. Opportunistic infections and tumors may include tuberculosis, thrush, herpes viruses, shingles, Epstein-Barr virus, pneumonia, and a type of cancer called Kaposi's sarcoma (KS). In the last stages of AIDS, it is common for individuals to develop respiratory infections, including cytomegalovirus or mycobacterium avium complex (MAC) infections.
- Diagnosis: HIV is diagnosed after HIV antibodies or HIV itself is detected in the patient's body. As soon as the virus enters the body, the immune system produces antibodies, which are proteins that detect and bind to HIV. The presence of these antibodies, which may take months to build up to detectable levels in the blood, oral fluid, and urine, can be used to determine whether HIV is in the body.
- It may take some time for the immune system to produce enough antibodies for the antibody test to detect them. This time period, known as the "window period," varies among patients. Most people will develop detectable antibodies two to eight weeks after exposure, with the average being 25 days. However, some individuals might take longer to develop detectable antibodies. Ninety-seven percent of patients develop antibodies within the first three months following the time of their infection. In very rare cases, it can take up to six months to develop antibodies to HIV. Therefore, if a patient tests negative for HIV in the first three months after possible exposure, repeat testing should be considered longer than three months after the exposure.
- In the United States, the test results must remain confidential. Individuals who are younger than 18 years old can consent to or refuse to be tested for HIV, without the involvement of their legal guardians. Test results may not be released to the patient's legal guardian(s) without his/her consent
- Treatment: Currently, there is no cure for HIV/AIDS. Patients may receive a combination of anti-HIV drugs called antiretrovirals. These drugs interfere with the virus's ability to multiply, which subsequently boosts the immune system. HIV patients typically receive a combination of antiretroviral drugs, called highly active antiretroviral therapy (HAART), because a single patient may have several different strains (types) of the virus circulating in the blood. The combination of drugs also helps prevent mutations from occurring. The different strains of the virus may respond differently to specific types of drugs. HAART is a combination of at least three drugs from at least two different classes. There are four major classes of antiretrovirals: fusion inhibitors, protease inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Each drug class disrupts different stages of HIV's life cycle.
- Although HAART may help patients live longer lives, these drugs do not reduce the risk of transmitting the disease to someone else.
- Many new HIV drugs are under investigation. The U.S. Food and Drug Administration is expected to approve a CCR5 receptor antagonist, called maraviroc (Celsentri®), and an integrase inhibitor, called raltegravir (Isentress®), in late 2007.
Human papilloma virus (hpv)
- Overview: The human papilloma virus (HPV) is a viral infection that sometimes causes genital warts (also called venereal warts). There are more than 100 different types of HPV, but only a few cause genital warts.
- HPV is highly contagious. The infection may be transmitted through direct contact with the virus during oral, anal, or vaginal sex. It may also be transmitted after touching objects (e.g. towels, bed linens, or clothing) that have come into contact with an infected person.
- There is currently no cure for HPV. Although treatment can help manage symptoms, females with HPV have a much greater risk of developing cervical cancer than females who are not infected with HPV. It has also been associated with other types of genital cancers,
including cancer of the penis, anus, vulva, and vagina.
- In June 2006, the U.S. Food and Drug Administration (FDA) approved the first HPV vaccine called Gardasil®. The vaccine is expected to prevent most cases of cervical cancer due to HPV types included in the vaccine. However, patients will not be protected if they
have been infected with the HPV type(s) prior to vaccination, and the drug does not protect against less common types of HPV.
- Symptoms: Most patients develop symptoms within three months of exposure to HPV. However, some patients may not develop symptoms for several years, and others may not experience any symptoms at all.
- Common symptoms include small swellings in the genital area, multiple warts that form cauliflower-shaped clusters, itching or discomfort in the genital area, and bleeding during intercourse. Warts may spread to other areas of the body. Symptoms may worsen during pregnancy.
- Complications: HPV has been shown to cause cervical cancer in females. In addition, certain types of HPV have also been associated with cancer of the anus, vagina, vulva, and penis. Regular pelvic exams and Pap tests are recommended to diagnose and treat infections quickly.
- Genital warts may also lead to complications during pregnancy. In some patients, the warts may enlarge, making it difficult to urinate. Also, warts on the vaginal wall may reduce flexibility of the vaginal tissues during childbirth. In rare cases, a baby born to a mother with genital warts may develop warts in the throat. In such cases, surgery may be required to remove the warts and prevent airway obstruction.
- Diagnosis: An acetic acid solution may be applied to the patient's genitals. This solution helps the healthcare provider detect warts because it turns warts a white color. Then, a specialized microscope, called a colposcope, is used to view the warts. If they are characteristic of HPV, a positive diagnosis is made.
- It is especially important for women to undergo routine pelvic exams and Pap tests because HPV increases a female's risk of developing cervical cancer. Patients diagnosed with HPV may need to have a Pap test every three to six months. Patients should talk to their healthcare providers to determine how often they should be screened.
- Treatment: There is currently no cure for HPV. However, many treatments are available to manage symptoms. Even if genital warts are no longer present, the virus is never eliminated from the body. This means warts may come back in the future.
- Patients should not use over-the-counter wart removers for genital warts. These products are not designed for genital warts and they may cause serious side effects. Patients should consult their healthcare providers to determine the safest and most effective way to remove warts.
- Many creams and ointments, such as imiquimod (Aldara®) and podofilox (Condylox®), may be applied directly to the skin to remove warts. Healthcare providers may also apply a chemical called trichloroacetic acid (TCA) to the skin to burn off warts. These medications may damage condoms, making them less effective.
- Many surgical procedures, including cryotherapy, electrocautery, surgical incision, and laser removal, are available to remove warts. During cryotherapy, a healthcare provider applies liquid nitrogen to freeze off the wart. During electrocautery, an electrical current is used to burn off warts. Surgical incisions, which involve using a scalpel and other surgical instruments to remove the wart, may also be used. During laser treatments, the warts are removed with an intense beam of light. These procedures are usually only performed for severe warts that do not respond to other types of treatment.
- Patients should not have sex while they are receiving treatment. Sexual partners of patients who have been diagnosed with HPV should be tested and treated for STDs.
Pelvic inflammatory disease (pid)
- Overview: Pelvic inflammatory disease (PID) is an infection of the female reproductive organs that causes pain and swelling. If left untreated, PID may cause scarring and permanently damage the reproductive organs. Without treatment, some patients may become infertile or experience complications during pregnancy.
- PID usually develops when a sexually transmitted bacteria enters the uterus and reproduces in the upper genital tract. The most common bacteria that causes PID also cause the sexually transmitted diseases (STDS) gonorrhea and chlamydia.
- Symptoms: Common symptoms of pelvic inflammatory disease include pain in the lower abdomen and pelvis, irregular menstrual bleeding, foul-smelling vaginal discharge, lower back pain, fever, fatigue, diarrhea, vomiting, pain during intercourse, and difficulty or pain during urination.
- Up to 50% of females with PID develop chronic pelvic pain that may last for months or years. PID may cause scarring in the fallopian tubes and other organs that may cause pain during exercise, ovulation, and sexual intercourse.
- Diagnosis: Pelvic inflammatory disease (PID) is diagnosed after a pelvic examination, cervical cultures, and/or analysis of the vaginal discharge. The reproductive organs, including the uterus, will appear inflamed during a pelvic exam. Cervical cultures and/or analyses of vaginal discharge are performed to detect the presence of bacteria known to cause PID. If bacteria are present, a positive diagnosis is made.
- Treatment: Antibiotics are the standard treatment for pelvic inflammatory disease. These medications, which are usually taken by mouth, kill the disease-causing microorganism. Severe infections that have spread to the kidneys may require hospitalization and intravenous antibiotics. Commonly prescribed antibiotics include amoxicillin (Amoxil® or Trimox®), nitrofurantoin (Furadantin® or Macrodantin), trimethoprim (Proloprim®), and trimethoprim/sulfamethoxazole (Bactrim® or Septra®). Symptoms usually start to improve after a few days of treatment.
- Patients should take medications exactly as prescribed. Even if symptoms appear to go away, patients should take all of their medication because there may still be bacteria in the body. Stopping medication early may allow the infection to return. Also, stopping medication early may lead to antibiotic resistance. The few remaining bacteria in the body that survive most of the antibiotic therapy are the most difficult to kill. If the bacteria become resistant to treatment, the medications will no longer be effective if taken in the future.
- Treating sexually transmitted diseases (STDs), such as gonorrhea, promptly reduces the risk of developing pelvic inflammatory disease (PID).
- Sexual partners of patients who have been diagnosed with PID should be tested and treated for STDs.
- Overview: Syphilis is a bacterial infection that initially causes skin sores and rashes to form on the genitals, skin, and mucus membranes. Although this infection is curable, it can be fatal if it is not treated quickly. If left untreated, syphilis may cause permanent damage to other organs, such as the brain and heart.
- Syphilis is caused by a bacterium called Treponema pallidum. There are four different stages of syphilis: primary, secondary, latent, and tertiary. The disease is contagious during the primary and secondary stages, and sometimes, the latent period.
- Most cases of syphilis are transmitted during oral, anal, or vaginal sex. A patient may also acquire the infection if his/her blood comes into contact with an infected patient's blood. It may also be transmitted through direct contact with an infected person's skin sore. An infected pregnant woman may also transmit the infection onto her fetus during pregnancy. This is because the mother's infected blood passes through the placenta and to the baby.
- Treponema pallidum is not able to survive outside of the body. Therefore, the disease cannot be transmitted by sharing clothing, toilet seats, or other objects with an infected person.
- Symptoms: Symptoms of syphilis vary with each stage. Initial symptoms during the primary stage typically develop 10 days to three months after exposure. Symptoms commonly include enlarged lymph nodes near the groin and a small painless chancre sore on the part of the body where the bacterium was transmitted. Chancre sores are most common on the tongue, lips, genitals, or rectum. Some patients may develop several sores. If patients do not receive treatment, the symptoms will go away on their own within three to six weeks. However, this does not mean that the infection is gone. In fact, it means that the infection is progressing to the secondary stage.
- Symptoms of secondary syphilis develop two to 10 weeks after the first chancre sore appears. Symptoms may include a skin rash that causes small reddish-brown sores, fever, fatigue, general feeling of discomfort, soreness, and aching. If the patient does not receive treatment during this stage, symptoms may go away within a few weeks or repeatedly go away and come back for as long as one year. Even if symptoms are not present, the infection will continue to worsen without treatment.
- Some patients experience a period called latent syphilis before tertiary symptoms develop. During the clinical latency stage, no symptoms are present. This stage may last one to two years.
- The tertiary stage may develop immediately after the secondary stage or one to two years after the latent stage. This is the final and most severe stage of the infection. During the tertiary stage, syphilis may cause permanent organ damage and death. It often causes brain (neurological) problems, which may include stroke, infection and inflammation of the membranes that surround the brain and spinal cord (meningitis), numbness, poor muscle coordination, deafness, visual problems or blindness, changes in personality, and dementia. Syphilis may also affect the heart, causing bulging (aneurysm) and inflammation of blood vessels, including the aorta, which is the body's main artery. It may also cause valvular heart disease, such as aortic valve stenosis (when the valve becomes narrowed). All of these symptoms are potentially life threatening.
- Babies born with syphilis may develop symptoms that are apparent at birth or several weeks after birth. Syphilis progresses much quicker and is more likely to cause complications in infants than adults. If the baby does not receive prompt treatment, serious and life-threatening complications may develop. Symptoms may include bone abnormalities, depressed nose bridge (saddle nose), vision and hearing problems (that may lead to deafness or blindness), swollen joints, screwdriver-shaped teeth (Hutchinson's teeth), and scarring where chancre sores developed.
- Complications: In general, patients with syphilis have an increased risk of developing the human immunodeficiency virus (HIV). This is because a syphilis chancre sore provides an easy way for HIV to enter the body.
- Diagnosis: In order to prevent life-threatening complications of syphilis, patients should be tested if they have symptoms of syphilis or suspect that they were exposed to syphilis. Doctors recommend annual STD screenings for patients who have increased risks of developing STDs. This includes patients who have multiple sexual partners, engage in unprotected sex, or who have sexual partners who have or have previously had an STD. Routine testing is especially important for detecting syphilis because symptoms may come and go.
- If the patient has sores that are characteristic of syphilis, a healthcare provider may scrape a small sample of cells from affected skin. The cells are then analyzed under a microscope for the presence of Treponema pallidum. If the bacterium is present, a positive diagnosis is made. If patients do not have sores, a blood test may be used to diagnose syphilis. A sample of blood is taken from the patient and analyzed for antibodies to the bacterium that causes syphilis. These antibodies are proteins that are specialized to detect and help destroy the bacterium. If the antibodies are present, a positive diagnosis is made.
- If it is suspected that the infection has spread to the brain, a healthcare provider may recommend a test called a lumbar puncture. During the procedure, a long thin needle is inserted into the lower back. A small sample of fluid from the spine (cerebrospinal fluid) is removed and analyzed under a microscope for the disease-causing bacteria.
- Treatment: If treated early, patients with syphilis can expect a full recovery. Patients receive one to three injections of an antibiotic called penicillin. This medication kills the bacterium and cures syphilis. Even if a pregnant mother receives treatment for syphilis, the newborn should also receive antibiotics as a precautionary measure. Patients should avoid sexual contact with their partners during treatment in order to prevent transmitting the infection.
- During the first day of antibiotic treatment, many patients experience the Jarisch-Herxheimer reaction. Researchers believe that this reaction occurs because so many bacteria are dying at once. Symptoms, which usually only last one day, may include fever, nausea, aching pain, and headache.
- Sexual partners of patients who have been diagnosed with syphilis should be tested and treated for STDs.
- Overview: Trichomoniasis is a sexually transmitted infection that usually causes pain, inflammation, and irritation in the vagina, penis, and urethral tissues. Although trichomoniasis may affect males or females, symptoms are more common among females.
- Trichomoniasis is caused by Trichomonas vaginalis, a microscopic parasite, called a protozoan.
- Symptoms: Females typically develop foul-smelling vaginal discharge that may appear foamy and yellow or green in color. Vaginal itching and pain during urination may also occur.
- Males typically experience penile discharge, pain during urination, and pain and swelling of the scrotum (caused by epidiymitis).
- Diagnosis: For females, the healthcare provider may swab the discharge from the cervix. For males, the healthcare provider inserts a thin swab into the tip of the penis to retrieve a sample of fluid from the urethra. The sample is then analyzed under a microscope. If the parasite is present, a positive diagnosis is made.
- Treatment: Patients take the antibiotic metronidazole (Flagyl®) by mouth to kill the parasite and cure the infection. This drug is not safe during pregnancy. Pregnant females who are infected typically apply an antibiotic cream, called clotrimazole (Gyne-Lotrimin, Mycelex-7®), to the genitals. Patients should abstain from sex while they are receiving treatment.
- Sexual partners of patients who have been diagnosed with trichomoniasis should be tested and treated for STDs.
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.