AIDS and Infections

AIDS-related opportunistic infections
Having AIDS weakens your body’s immune system. Your immune system normally fights germs that enter your body. When AIDS makes it weak, it can’t fight germs well. This can lead to serious infections that don’t often affect healthy people. These are called opportunistic infections (OIs).
 
There are many types of OIs. Tuberculosis and a serious related disease, mycobacterium avium complex (MAC) are bacterial infections. Viral infections include cytomegalovirus (CMV) and hepatitis C. Fungi cause thrush (candidiasis), cryptococcal meningitis, pneumocystis carinii pneumonia (PCP) and histoplasmosis, and parasites cause crypto (cryptosporidiosis) and toxo (toxoplasmosis).
 
Having AIDS can make any infection harder to treat. People with AIDS are also more likely to suffer complications of common illnesses such as the flu.
 
The good news is that you can help prevent infections by taking your AIDS medicines. Other things that can help include practicing safe sex, washing your hands well and often and cooking your food well.

Prostatitis — chronic

Chronic prostatitis is swelling and irritation (inflammation) of the prostate gland that develops slowly and continues for a long period of time.
Chronic prostatitis is usually not caused by a bacterial infection. When it is caused by bacteria, chronic prostatitis may occur with or follow:
 
Acute prostatitis
Epididymitis
Urinary tract infection
Urethritis
 
Risks include:
 
Age over 30
Certain sexual practices (such as anal sex without a condom)
Excessive alcohol intake
Injury to the perineum (the area between the scrotum and anus)
These factors may cause congestion of the prostate gland, which produces a breeding ground for bacteria.
 
Other possible causes are related to stress and tightness of the pelvic muscles.
 
Symptoms
 
Blood in the urine
Decreased urine stream
Frequent urination
Incontinence
Low-grade fever
Pain with urination
Urinary hesitancy (delayed start of urination)
Low-grade or subtle symptoms may include:
 
Low back pain
Pain and burning with urination
Pain in the perineum or pelvic floor
Pain with bowel movement
Pain with ejaculation
Testicular pain
Note: There may be no symptoms.
 
Exams and Tests
 
A physical examination may show:
 
Discharge from the urethra
Enlarged, mildly tender prostate
Enlarged or tender lymph nodes in the groin area
Swelling and tenderness of the scrotum
Triple-void urine specimens may be collected for urinalysis and urine culture. Urine may be collected:
 
Initial stream
Mid-stream
After a prostate massage by examiner
Other tests may include:
 
Culture of prostate secretions
Semen analysis
 
Treatment
Treatment options for chronic prostatitis include a combination of medication, surgery, and lifestyle changes.
 
MEDICATIONS
 
Chronic prostatitis is treated with a long course (6 — 12 weeks or longer) of antibiotics. Trimethoprim-sulfamethoxazole (Bactrim) and ciprofloxacin (Cipro) are commonly used. Other antibiotics that may be used include:
 
Carbenicillin
Erythromycin
Nitrofurantoin
Tetracycline
Most antibiotics do not get into the prostate tissue well. Often, the infection continues even after long periods of treatment. After antibiotic treatment has ended, it is common for symptoms to return.
 
Stool softeners may be recommended to reduce discomfort with bowel movements.
 
Nonsteroidal anti-inflammatory medications (NSAIDs such as Aleve and Motrin) and alpha blockers (such as Hytrin, Flomax, and Cardura) may also be used.
 
SURGERY
 
Transurethral resection of the prostate may be necessary if antibiotic therapy is unsuccessful or the condition keeps returning. This surgery is usually not performed on younger men because it carries a risk of retrograde ejaculation, which can lead to sterility, impotence, and incontinence.
 
Prostate massage and myofascial release are other treatments that may help this condition.
 
OTHER THERAPY:
 
Frequent and complete urination is recommended to decrease the symptoms of urinary urgency. If the swollen prostate restricts the urethra, the bladder may not empty. Inserting a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary.
 
 
MONITORING:
 
See your health care provider for an exam after you finish taking antibiotics to make sure that the infection is gone.

Prostate cancer

Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man’s reproductive system. It wraps around the urethra, the tube that carries urine out of the body.

The cause of prostate cancer is unknown. Some studies have shown a relationship between high dietary fat intake and increased testosterone levels.
There is no known association with an enlarged prostate or benign prostatic hyperplasia (BPH).
Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.

The appropriate treatment for prostate cancer is not clear. Treatment options vary based on the stage of the tumor. In the early stages, talk to your doctor about several options including surgery, radiation therapy, or, in older patients, monitoring the cancer without active treatment.
Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy.
Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or performance on either a temporary or permanent basis. Discuss your concerns with your health care provider.

Pneumocystis carinii pneumonia

Pneumocystis carinii pneumonia (PCP) is a fungal infection of the lungs.

PCP is a pneumonia caused by the fungal organism Pneumocystis carinii (now renamed Pneumocystis jiroveci). This organism is common in the environment and does not cause illness in healthy people.
However, Pneumocystis carinii can cause a lung infection in in people with a weakened immune system due to any of the following conditions:
Bladder Cancer
Chronic use of corticosteroids or other medications that affect the immune system
HIV/AIDS
Solid organ or bone marrow transplant
PCP was a relatively rare infection before the AIDS epidemic. Before the use of preventive antibiotics for PCP, up to 70% of people in the U.S. with advanced AIDS would develop PCP.

PCP in those with AIDS usually develops slowly and is less severe. People with PCP who do not have AIDS usually get sick faster and are more acutely ill.
 
Symptoms include:
 
Cough — often mild and dry
Fever
Rapid breathing
Shortness of breath — especially with activity (exertion)

Leukoplakia

Leukoplakia is a precancerous lesion that develops on the tongue or the inside of the cheek as a response to chronic irritation. Occasionally, leukoplakia patches develop on the female external genitalia.
Leukoplakia is primarily a disorder of the mucous membranes of the mouth. It is caused by irritation. Lesions usually develop on the tongue, but they may also appear on the insides of the cheek.
 
Irritation may result from rough teeth or rough places on dentures, fillings, and crowns. It may also result from smoking or other tobacco use (smoker’s keratosis). Persons who smoke pipes are at high risk for developing this condition, as are those who hold chewing tobacco or snuff in the mouth for a long period of time.
 
Leukoplakia patches may develop on the female external genital area, but the cause is unknown.
 
Like other mouth ulcers, leukoplakia may become cancerous.
 
The disorder is most common in the elderly.
 
«Hairy» leukoplakia of the mouth is an unusual form of leukoplakia that is seen mostly in HIV-positive people. It may be one of the first signs of HIV infection. It can also appear in others when their immune systems are not working well, such as after a bone marrow transplant. It may be caused by the Epstein-Barr virus.
 
White patches usually appear on the tongue and sometimes on other places in the mouth. The condition may look like thrush, a type of candida infection that is also associated with HIV and AIDS in adults.
The primary symptom of leukoplakia is a skin lesion with the following characteristics:
 
Location
Usually on the tongue
May be on the inside of the cheeks
In females, occasionally on the genitals
Color
Usually white or gray
May be red (called erythroplakia)
Texture
Thick
Slightly raised
Hardened surface
The symptoms of hairy leukoplakia are painless, fuzzy, white patches on the tongue.
The typical white patch of leukoplakia develops slowly, over weeks to months. The lesion may eventually become rough in texture, and may become sensitive to touch, heat, spicy foods, or other irritation.
 
A biopsy of the lesion confirms the diagnosis. An examination of the biopsy specimen may find changes that indicate oral cancer.

Cervical cancer

Alternative Names   
 
Cancer — cervix
  
 Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina.
 
 Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of routine use of Pap smears.
 
Cervical cancers start in the cells on the surface of the cervix. There are two types of cells on the cervix’s surface: squamous and columnar. The majority of cervical cancers are from squamous cells.
 
The development of cervical cancer is usually very slow. It starts as a pre-cancerous condition called dysplasia. This pre-cancerous condition can be detected by a Pap smear and is 100% treatable. That is why it is so important for women to get regular Pap smears. Most women that are diagnosed with cervical cancer today have not had regular Pap smears or they have not followed up on abnormal results.
 
Undetected, pre-cancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for pre-cancerous changes to turn into cervical cancer. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread.
 
Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common virus that is spread through sexual intercourse. There are many different types of HPV, and many do not cause problems. However, only certain strains of HPV actually lead to cervical cancer. (Other strains may cause genital warts.)
 
Other risk factors for cervical cancer include:
 
Having sex at an early age
Multiple sexual partners
Sexual partners who have multiple partners or who participate in high-risk sexual activities
Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1960s to prevent miscarriage
Weakened immune system
Poor economic status (may not be able to afford regular Pap smears)
Symptoms   
 
Most ot the time, early cervical cancer has no symptoms. Symptoms that may occur can include:
 
Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling
Abnormal vaginal bleeding between periods, after intercourse, or after menopause
Periods become heavier and last longer than usual
Any bleeding after menopause
Symptoms of advanced cervical cancer may include:
 
Loss of appetite
Weight loss
Fatigue
Pelvic pain
Back pain
Leg pain
Single swollen leg
Heavy bleeding from the vagina
Leaking of urine or feces from the vagina
Bone fractures
Exams and Tests   
 
Pre-cancerous changes of the cervix and cervical cancer can not be seen with the naked eye. Special tests and tools are needed to spot such conditions.
 
Pap smears screen for pre-cancers and cancer, but do not offer the final diagnosis. If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination. 
 
Other tests may include:
 
Endocervical curettage (ECC) to examine the opening of the cervix
Cone biopsy
If the woman is diagnosed with cervical cancer, the health care provider will order more tests to determine how far the cancer has spread. This is called staging. Tests may include:
 
CT scan
Cystoscopy
MRI
Chest x-ray
Intravenous pyelogram (IVP)
Treatment   
 
Treatment of cervical cancer depends on the stage of the cancer, the size and shape of the tumor, the age and general health of the woman, and her desire to have children in the future.
 
Early cervical cancer can be cured by removing or destroying the pre-cancerous or cancerous tissue. There are various surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future.
 
Types of surgery for early cervical cancer include:
 
LEEP (Loop Electrosurgical Excision Procedure) — uses electricity to remove abnormal tissue
Cryotherapy — freezes abnormal cells
Laser therapy — uses light to burn abnormal tissue
A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures. However, in more advanced disease, a radical hysterectomy may be performed. This type of hysterectomy removes the uterus and much of the surrounding tissues, including internal lymph nodes and upper part of the vagina. In the most extreme surgery, called a pelvic exenteration, all of the organs of the pelvis, including the bladder and rectum, are removed.
 
Radiation may be used to treat cancer that has spread beyond the pelvis, or cancer that has returned. Radiation therapy is either external or internal. Internal radiation therapy uses a device filled with radioactive material, which is placed inside the woman’s vagina next to the cervical cancer. The device is removed when she goes home. External radiation therapy beams radiation from a large machine onto the body where the cancer is located. It is similar to an x-ray.
 
Chemotherapy uses drugs to kill cancer. Some of the drugs used for chemotherapy for cervical cancer include 5-FU, Cisplatin, Carboplatin, Ifosfamide, Paclitaxel, and Cyclophosphamide. Sometimes radiation and chemotherapy are used before or after surgery.
 
The type of cancer
The stage of the disease
The age and general physical condition of the woman
Pre-cancer conditions are completely curable when followed up and treated properly. The chance of being alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area is 92%.
 
However, the 5-year survival rate falls steadily as the cancer spreads into other areas.
 
Possible Complications   
 
Some types of cervical cancer do not respond well to treatment.
The cancer may come back (recur) after treatment.
Women who have treatment to save the uterus have a high risk of the cancer coming back (recurrence). 
Surgery and radiation can cause problems with sexual, bowel, and bladder function.
When to Contact a Medical Professional   
 
Call your health care provider if you:
 
Are a sexually active woman who has not had a Pap smear in the past year
Are at least 20 years old and have never had a pelvic examination and Pap smear
Think your mother may have taken DES when she was pregnant with you
Have not had regular Pap smears (ask your health care provider how often you should have one performed)
Prevention   
 
If you smoke, quit. Cigarette smoking is associated with an increased risk of cervical cancer.