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Common Infectious Diseases

Hepatitis HIVLyme Disease

 

About Hepatitis

What is Hepatitis?
Hepatitis means “inflammation of the liver.” There are seven known types of hepatitis, but it is usually caused by one of three viruses: Hepatitis A, B or C. The effects of each virus are different. In some cases, viral Hepatitis can lead to cirrhosis (scarring of the liver), which can lead to serious life-threatening diseases, including cancer of the liver. People can die from Hepatitis.
What is the difference between Hepatitis A, B, and C?
Hepatitis A (HAV) is caused by a virus found in feces (people’s stool). You can get it by coming in contact with infected feces. The most common way is by swallowing food or liquids that get contaminated by hands that are not washed thoroughly after using the toilet. You can also get Hepatitis A through sexual acts like ‘rimming’ (licking someone’s anus) or via oral sex on a male’s penis after he has had anal sex.

Almost everyone infected with Hepatitis A completely recovers in about 4 to 8 weeks. Although there are not always symptoms, you may suffer from nausea, vomiting, jaundice (yellow skin and/or eyes), diarrhea, and/or extreme lack of energy. Hepatitis A is rarely dangerous unless accompanied by Hepatitis C. You can pass Hepatitis A to another person even if there are no symptoms. After recovery of Hepatitis A you can not spread it to others and you will be immune from getting it again. The immune system develops antibodies that can fight off future exposure.

Hepatitis B (HBV) is caused by a virus that lives in body fluids that include blood, semen, vaginal fluid and breast milk. You can get it by having unprotected vaginal, anal, or oral sex with someone infected with Hepatitis B. There is also high risk in sharing needles (tattoos, ear-piercing, drug needles). Because it is transmitted so easily through body fluids, you can also get it by touching someone’s open sore or cut with your own open sore or cut, or by sharing items (toothbrushes, razors, etc). Hepatitis can also be passed from a pregnant mother to her child.

When infected with Hepatitis B, the sickness may start gradually, usually lasting a month or two. Some people have no symptoms, but they can include yellow skin or eyes, feeling tired, fever, loss of appetite, stomach pain, nausea, swollen glands, pain in the joints, dark urine, skin rash, weight loss, liver pain (upper right side of the belly just below the rib cage). Only about 1% of people with HBV die, and most people recover completely within about 6 months. However, about 5-10% of people remain capable of spreading the virus for the rest of their lives and can develop chronic liver disease.

Hepatitis C (HCV) is caused by a virus found in the blood. Although some information about how this is passed from person to person is not clear, it is very clear that it is transmitted through blood to blood contact, such as sharing needles (to inject drugs, or for tattoos, ear-piercing, etc.). In the past, some people got Hepatitis C from blood transfusions, but today the risk is small, since blood for transfusions is screened. In a few instances, a woman has passed the virus to her baby during pregnancy or birth, but this is not common.

Most people do not realize they are infected with Hepatitis C. Very few people develop the usual symptoms of jaundice, fever, and flu-like symptoms that can last up to 6 weeks, right after getting infected. Others discover they’re infected years later when they get sick and testing confirms the virus. A large percentage of people (75-80%) with Hepatitis C never clear the virus out of their body and continue to infect others.

What are the signs and symptoms of active Hepatitis infection?
Unfortunately, Hepatitis often goes undiagnosed because symptoms are mild or suggest only a flu-like illness. Many people have no symptoms at all. The only way to know for sure if you have Hepatitis is to have a blood test. Ask a doctor or needle exchange site where you can get tested, or call the Help-for-Hep hotline at 877‑435‑7443. You are usually safe to get tested within two weeks after potential exposure, to know for sure.

Symptoms can include fatigue, mild fever, muscle or joint aches, nausea/vomiting, loss of appetite, mild stomach pain, loss of taste for cigarettes, diarrhea, dark urine, light-colored stools, and jaundice (skin and/or the whites of the eyes look yellow).

Is there a vaccine, treatment, or a cure for Hepatitis?
There are vaccines that can keep you from getting Hepatitis A or Hepatitis B. There is currently no vaccine for Hepatitis C. The vaccine for Hepatitis A consists of two shots over 6 months. The Hepatitis B vaccine consists of 3 shots over 5-6 months. To get full protection (immunity) against Hepatitis A or B, you must get all of the shots in each series.

Almost everyone infected with Hepatitis A completely recovers in about 4 to 8 weeks. There is no medication for Hepatitis A. Rest and avoiding things that are toxic to your liver (like alcohol), help the healing process. In severe cases that require hospitalization, there are medicines that can lessen the symptoms.

There is no cure for Hepatitis B or C. However, there are treatments that can help improve the symptoms of Hepatitis B and C.

Many people use alternative or complimentary therapies such as acupuncture, herbs and vitamins to treat Hepatitis A, B, and C. Although some people report that these therapies work, their effectiveness has yet to be scientifically proven.

Where can I get Hepatitis A and B vaccines?
It is always a good idea to get screened for Hepatitis A or B antibodies before you get vaccinated to make sure you aren’t already infected. Any health provider should be able to screen you or provide you with the vaccines. Some clinics will only vaccinate you if you are a certain age, if you ask, or if you are a regular patient. If you do not have a regular health provider or are having trouble finding one who will vaccinate you, you can ask your local city or county health department where to go. You can also call the Help-for-Hep hotline at 877‑435‑7443.

How can I avoid getting Hepatitis?
To prevent getting Hepatitis A:

  • Get vaccinated
  • Be careful to only eat food prepared under clean conditions
  • Wash your hands thoroughly after using the bathroom and before cooking or eating
  • Use protection when having sex (condoms, dental dams, latex gloves) especially when practicing anal sex, or combinations of anal-oral sex

To prevent getting Hepatitis B:

  • Get vaccinated
  • Use protection when having sex (condoms, dental dams, latex gloves)
  • Do not share needles of any kind with others
  • Use new, sterile syringes and equipment

To prevent getting Hepatitis C:

  • Avoid contact with other people’s blood.
  • Do not share needles of any kind with others
  • Don’t share toothbrushes, razors, or other personal articles that might contain blood.

How can I learn more about hepatitis?

Hepatitis HIVLyme Disease

 

About HIV

What are HIV & AIDS?
Human Immunodeficiency Virus (HIV) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). As HIV slowly ravages the body’s immune system, HIV disease progresses. AIDS is the final stage of HIV disease. AIDS is a technical word — defined by the federal government — and is diagnosed by having a T-cell (the most basic element of the immune system) count of less than 200 or the presence of certain opportunistic infections. HIV is the virus, AIDS is the disease, and “HIV disease” is the most appropriate way to describe the continuum of HIV and AIDS.
Is AIDS over? Is there a cure?
There is not a cure for HIV disease. A variety of drugs are used to slow down the damage that HIV does to the immune system. When they are effective, these drugs reduce the amount of HIV in a person’s body. However, the drugs do not totally rid the body of the virus. There is not a cure.
How do these drugs work?
HIV anti-viral drugs slow down the replication of the virus and the destruction of the immune system. They work for approximately half of those who take them. Their long-term effectiveness is unknown, and they require a complicated pill-taking regimen, which often produces significant and occasionally life-threatening side effects. The drugs are also costly, about as much as buying a new car every year. 
How is HIV transmitted?
The virus must be present; meaning an individual must be infected with HIV in order to infect others. The virus needs access into the other person’s bloodstream. HIV is introduced into the bloodstream through open cuts or sores and through contact with mucus membranes. Transmission is most likely to happen when exposed to body fluids that have high concentrations of the virus.

Blood, mother’s milk, semen and vaginal fluid discharged during sexual activity can contain high concentrations of the virus. Oral contact with blood, semen, and vaginal fluids presents a risk of infection as well. The virus has not been found in sweat or tears.

Can I get HIV from mosquitoes?
Mosquitoes or other sucking and biting insects do not transmit HIV. For a mosquito to infect someone, it would have to bite a person who was infected. Then, it would have to either immediately travel to someone else and infect that person from tiny drops of infected blood left on the sucker, or it would have to process the virus in its saliva and inject it into the next person. Mosquitoes do not do either of these things.

They do not travel from person to person. They do not carry enough blood on their suckers to infect anyone else they bite. And, they do not process the virus in their saliva. Once inside a mosquito, the virus lives for only a short time. Thus, the saliva mosquitoes inject into people cannot have HIV. If HIV were spread via animals and insects, there would be a high infection rate in people of all ages.

Can I get the virus from casual contact?
HIV is a fragile and hard-to-get virus. You do not get HIV from: sneezing or coughing, touching, hugging, dry kissing, public restrooms, saunas or showers, pools, sharing towels, sharing eating utensils or drinks, or being friends with a person who has HIV.
Is the blood supply safe?
Yes. Since 1985, all blood has been tested for HIV, hepatitis and other infectious agents. If you had a blood transfusion prior to 1985, you may want to consider being tested for HIV.
Where did AIDS come from?
Until February of 1999, no one knew for sure where the HIV virus came from. There were several theories but nothing proven. In February, an international team of scientists reported that they had traced the roots of HIV-1 to a subspecies of chimpanzees in Africa. The researchers stated that chimpanzees are hunted and sold in the “bushmeat” trade, which during the slaughtering process may have placed people at risk for cross-species transmission through open cuts or sores. 
Is there a new strain of HIV?
HIV is a virus and is able to mutate. There are two identified strains of HIV. HIV-1 and HIV-2. HIV-2 is not as virulent as HIV-1 and is epidemic only in West Africa. HIV testing in the United States usually only screens for HIV-1. Blood banks and plasma centers screen for both.
Are condoms effective in preventing HIV transmission?
The Centers for Disease Control and Prevention (CDC) state that correct and consistent use of a latex barrier for protection during sex greatly reduces the risk of transmitting HIV. Knowing how to use a latex barrier correctly is important. Failure is largely due to incorrect or inconsistent use. Make sure that the barrier is latex or polyurethane; natural or lambskin barriers have pores that HIV is able to pass through.

Never use oil-based lubricants like Vaseline®, salad oil or chocolate, which can cause tears and leaks in the latex, ultimately causing it to break. Instead, use a water-based lubricant such as K-Y® Jelly. Also, observe the expiration date on the condom package and tear it open carefully. Never use a product that has been previously used or exposed to heat or sun.

Can I get HIV from unprotected oral sex?
Yes, there are documented cases of HIV infection from oral sex with both men and women. Body fluids exchanged through sexual activity can enter cuts in the mouth and get into the bloodstream. Also, certain cells in the mucus lining of the mouth may carry HIV into the lymph nodes or bloodstream. Reduce the risk of HIV during oral sex by using a latex or polyurethane barrier such as a condom or dental dam.
What if I have another Sexually Transmitted Infection (STI)?
Research has shown that HIV transmission is 2-5 times more likely to occur when another sexually transmitted infection (STI) is present.
Isn't abstinence the only way to prevent HIV?
Abstaining from sexual activity or certain sexual behaviors can certainly eliminate risk. So can eliminating alcohol or other drug use that may impair judgment when in sexual situations. However, abstinence also has its own “failure rates.” It is equally important for people to know how to reduce risk as it is for them to know how to eliminate it.
How is HIV transmitted through injecting drug use?
When needles and syringes are used for injecting drug use, blood gets into the injection equipment. If the initial user is infected with HIV and shares the equipment with someone else, the infected blood in the injection equipment will be injected directly into the body of the next person. In addition to HIV, other germs can be transmitted through injecting drug use. Transmission of Hepatitis C, a Hepatitis strain for which there is no vaccine, is another example of a disease that can be passed when needles and syringes are shared for injecting drug use. There are now excellent treatment options for cure, but medications are very expensive and cost upwards of $50,000 for a full course.  An ounce of prevention is worth $50,000 to $90,000 in this case.
How can the risk of HIV infection from injecting drug use be reduced?
Groups such as the American Medical Association, the American Bar Association, and the American Pharmaceutical Association all recommend providing access to clean syringes to reduce disease risk among those who are unable to abstain from injecting drugs.
Can I get HIV from my doctor or dentist?
In the U.S., there has only been one documented case of HIV transmission from a health care provider to a patient. This case was reported in 1989 and involved a Florida dentist, and the controversy about its reliability continues.

Health care workers are mandated by federal law to follow certain infection control guidelines to prevent infections from being passed from health care worker to patient and from patient to health care worker.

In Minnesota, HIV-positive health care workers must report themselves to the state, and can continue practicing only by adhering to certain safety restrictions. 

We all know how HIV is spread, so why continue to spend money on prevention?
HIV is like many other social and public health issues involving behavior, such as seatbelt use and speeding; people need to be continually reminded. Also, HIV prevention education reaches young people, many for the first time, with comprehensive sexual health information.

Do I need to get tested? Where can I get tested?
If you think you may have been exposed to the HIV virus through unprotected sex or the sharing of unclean needles, go to your doctor or an HIV testing site and ask for an HIV test. The most commonly used test to find out if a person is infected with HIV looks for the antibodies to the virus. Antibodies are produced by the immune system to fight the virus. The antibodies can take three to six months to show up in a person’s blood. The time immediately after infection is known as the window period. During this time, an HIV test may come back negative because your body hasn’t started to produce antibodies against HIV. You can transmit the virus during this window period.

It is important to consistently reduce your risk, however, it is especially important to refrain from any unprotected sex and/or the sharing of unclean needles during the window period in order to get the most accurate test result. 


Hepatitis HIVLyme Disease

 

About Lyme Disease

What is Lyme disease?
Lyme disease is a bacterial infection caused by a spiral shaped microorganism called a spirochete. The name of the Lyme disease bacterium is Borrelia burgdorferi; consequently the disease is often called Lyme borreliosis.
How is Lyme disease spread?
An infected deer tick transmits Lyme disease when it feeds on an animal or human for 36-48 hours or more. Lyme disease is not spread by other types of tick nor is it spread by mosquito or fly bites. It is not contagious from person to person.
Do mosquitoes spread Lyme disease?
No, mosquitoes do not transmit Lyme disease.
How do ticks carrying Lyme disease differ from other ticks?
The most important distinction is size. The ticks that transmit Lyme disease are much smaller than dog and cattle ticks. The nymphal stages of the deer tick which are chiefly responsible for transmitting infections to humans are black and no bigger than a pinhead. The adult ticks, which may transmit infections in the fall, are only slightly larger.
What are the early symptoms of Lyme disease?
The earliest signs of Lyme disease are flu-like symptoms (fatigue, chills, fever, headache, muscle and joint pains) and a very characteristic skin rash called erythema migrans. This rash generally appears as a red circular patch that expands slowly, often to a very large size. It has an average diameter of 5 to 6 inches (range 2 inches to 2 feet). The center of the patch may clear as the rash enlarges, resulting in a ring-like appearance. The rash may be warm but is usually not painful. Smaller secondary rashes may appear at other sites, including the face. The rash appears an average of 1 to 2 weeks after the tick has fed (range = 3-30 days).
What are the later symptoms of Lyme disease?
Some of the symptoms of Lyme disease may not appear until weeks or months after the initial onset of illness. The infection may inflame the heart, leading to disturbances of the heart rhythm. Lyme disease may affect the nervous system causing muscle weakness of the face and limbs or pain and numbness. Meningitis, an inflammation of the covering of the brain may occur, resulting in a stiff neck and severe headache. In later states of the disease, arthritis may develop, and the joints may become red, swollen and painful. Large joints such as the knee, elbow, or shoulder are commonly affected, whereas the ankle, wrist, jaw, and finger joints are affected less often. Lyme arthritis usually affects only one or two joints. Arthritis involving multiple joints is less likely to be a result of Lyme disease. Lyme disease may also cause disabling neurological disorders such as confusion, memory loss, and emotional lability.
How is Lyme disease diagnosed?
Lyme disease is diagnosed from its clinical features and with the aid of blood tests when necessary. When the erythema migrans rash is observed, no serologic tests are necessary. For later manifestations of the illness, serologic tests are generally used. Often the serologic test does not become positive until several weeks after the onset of illness. A positive blood test does not necessarily mean that the symptoms are due to Lyme disease. Other types of infections may interfere with Lyme disease testing and result in a false positive test. Furthermore, the level of the antibody does not correlate with disease activity; it cannot be used to monitor success of therapy.

Other diagnostic tests that are occasionally used to help in the diagnosis include a PCR test on joint or spinal fluid, a nuclear medicine SPECT scan of the brain, and neuropsychological tests. Patients with late-stage Lyme disease affecting the brain may have characteristic memory deficits that may be demonstrated on standardized neuropsychological tests. PCR tests on blood and urine have not yet been demonstrated to reliably correlate with disease activity. A Lyme Urine Antigen Test has also not been reproducibly demonstrated in published clinical studies in medical journals to correlate with disease activity. Newer tests are continuing to be developed in research laboratories.

Because of over reliance on the blood tests, Lyme disease tends to be over diagnosed, particularly in people with vague symptoms. With all of the media attention given to Lyme disease, increasing numbers of people are requesting blood tests for themselves or their children, even though their symptoms are not actually suggestive of Lyme disease. Such patients may subject themselves to costly diagnostic evaluations and potentially harmful treatment.

Can Lyme disease be treated and cured?
Yes. Most Lyme disease patients treated in early stages of the disease when only the rash and flu-like symptoms are present will respond favorably to therapy and remain well. Even among patients not treated until later stages of the disease, the majority respond to therapy. In a small proportion of cases, symptoms may recur and additional courses of antibiotics are necessary. Rare patients with arthritis (swollen joints) may not respond to even repeated courses of antibiotics. Other therapies including steroids and even surgery may be required for symptomatic relief. Permanent damage to joints occurs in a small number of patients.
What antibiotics are used to treat Lyme disease?
Doxycycline or amoxicillin are used to treat most patients with Lyme disease. Cefuroxime axetil (Ceftin™), clarithromycin (Biaxin™), and azithromycin (Zithromax™) have also been shown in clinical studies to have activity in the early stages of Lyme disease. These last three drugs are much more costly than amoxicillin and doxycycline and have not been shown to be any more effective than the standard agents. In fact, in one study, Zithromax™ was shown to be less effective than amoxicillin. Cefixime (Suprax™), has not been shown to be useful for treatment of Lyme disease. Combinations of oral antibiotics will only increase side effects and expense without improving outcome. Intravenous antibiotics such as ceftriaxone (Rocephin™), cefotaxime (Claforan™), and penicillin G are used to treat central nervous system involvement such as meningitis.
How long do I need to be treated for Lyme disease?
Oral antibiotics are usually given for 21 days for early Lyme disease and for up to 60 days for Lyme arthritis. Intravenous therapy is usually prescribed for 14-30 days depending on the severity of the illness and the response to therapy. A patient’s symptoms may take from six to nine months to completely resolve after antibiotics are completed. A longer course of antibiotics will not hasten resolution of the symptoms. Occasionally a patient’s symptoms will recur or progress after treatment and a second course of antibiotics may be prescribed. Any patient whose symptoms either do not improve or worsen after therapy must be thoroughly reevaluated to assure that the diagnosis is correct. Another illness may cause symptoms that are mistakenly ascribed to Lyme disease.
Do the antibiotics have side effects?
Any medication may have side effects in some patients. Rash, diarrhea, vaginal yeast infections, and fever are a few of the more common side effects that may occur. Therefore, it is important to prescribe antibiotics only if they are truly needed and not to treat for a longer duration than is necessary.
Should I have a repeat blood test after I have been treated?
No. The blood test measures what is called an antibody, the body’s response to fighting an infection. It does not measure the infection itself. Antibodies may remain positive for many years after infection, and thus a repeat test provides no information regarding success of treatment.
Are there special problems if Lyme disease occurs during pregnancy?
Lyme disease acquired in pregnancy may lead to infection of the fetus. Although rare cases of fetal infection resulting in malformations and miscarriage have been reported, there have been no reported instances of an adverse outcome when the expectant woman was adequately treated.
Where does Lyme disease occur?
Lyme disease occurs in a nearly worldwide distribution in Europe, northern Asia and North America. In the United States, the risk of Lyme disease is greatest in three areas: (1) Mid-Atlantic and New England States from Maryland to Boston; (2) Upper mid-west in Wisconsin and Minnesota; (3) Pacific coast, especially northern California. Over 80% of the nation’s cases occur in these three areas.
Is Lyme disease spreading?
Yes. The tick that carries Lyme disease is now present in areas of the country where it had not been recognized previously. The tick can be spread by birds, deer, and by humans transporting pets, including horses.
Where am I likely to be exposed to ticks carrying Lyme disease?
Deer ticks are spread  through the movement of deer and the white-footed mouse, primarily. Wooded areas and tall grasses are areas where ticks will pick up a passing host. Potentially, animals that are both indoor and outdoor pets could bring ticks into contact with humans also.
Do other illnesses cause symptoms similar to Lyme disease?
Yes. Although the erythema migrans rash of Lyme disease is unlikely to be caused by other illnesses, a ring-shaped rash that appears hours rather than days after a tick bite is not a sign of Lyme disease. It is a local irritation that also occurs with other insect bites. Other infections and diseases may cause rashes which mimic the erythema migrans rash of Lyme disease.

Pain, swelling, or stiffness of joints may indicate various forms of arthritis such as rheumatoid or osteoarthritis. Reiter’s syndrome, another type of arthritis, may occur after gastrointestinal or venereal infections. Children may develop juvenile rheumatoid arthritis or rheumatic fever. All of these diseases may cause symptoms that may be confused with Lyme disease.

Other infections may cause fever, headache, muscle aches, and fatigue. Examples include enteroviral infections, leptospirosis, Rocky Mountain spotted fever, and ehrlichiosis. If persistent severe fatigue is a prominent symptom, mononucleosis, chronic fatigue syndrome, fibromyalgia and even depression may be the cause.

Is there a vaccine available against Lyme disease?
Although a vaccine was developed and tested, it is not available now. The manufacturer of Lymerix withdrew the vaccine in February of 2002. There is currently no vaccine in the U.S. for Lyme disease.
What should I do if I get a tick bite?
There is no reason to panic, as the chances of contracting Lyme disease are low. The safest and most effective way to remove an attached tick is to grasp the tick’s mouth area with clean tweezers as close to the skin as possible. If tweezers are not available, fingers should be wrapped first in tissue. Then, pull upward with a steady, even pressure. Do not twist. Take care not to crush the tick or to handle it with bare fingers. Also, do not put a hot match to the tick or try to smother it with petroleum jelly, nail polish, or other noxious substances, since this only prolongs exposure time and may cause the tick to eject the Lyme organisms into the body. Once the tick is removed, wash the bite area with soap and water or with an antiseptic to destroy any contaminating microorganisms.

 

Hepatitis HIVLyme Disease