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In most clinical settings, testing for HIV involves a test called the ELISA, or enzyme-linked immunosorbent assay, as a first step. This is a test for antibody, or the body’s immune response to infection. It can be performed on blood or saliva in a medical setting as well as on blood through a home testing kit (available in most pharmacies and drug stores). The testing procedure for samples collected in the home test is the same as that for samples taken in a clinic.
This test is very sensitive. Most infected people (about 90 percent) will show a positive ELISA test about three months after the time of possible infection. Everyone who is positive should show a positive test six months after infection, although very rarely a positive result may take longer to show up. The risk of a false negative test after six months from infection is 0.001-0.3 percent, depending on the number of people infected in a particular geographic area.
People who do not form antibody may have a rare deficiency in antibody formation, called agammaglobulinemia.
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Thorough washing of the hands after using the restroom and avoiding anal-oral contact with an infected person generally prevent transmission of hepatitis A. In addition, in 1995 a breakthrough in the prevention of hepatitis A became available: a vaccine that offers protection against acquiring the infection. This vaccine is composed of whole hepatitis A virus that has been inactivated and therefore cannot cause infection. It is given in two doses as a shot in the deltoid muscle of the arm, waiting six to twelve months between doses. Adults older than age seventeen are given a higher dose than children two to seventeen years of age.
The first vaccine becomes effective about two weeks after it is given and offers about a 94 percent protection rate against acquiring hepatitis A. The second vaccine provides protection greater than 99 percent and is thought to last more than twenty years. A person who does contract hepatitis A after receiving the vaccine will experience milder symptoms than someone who has not been vaccinated. Children younger than two years of age should not receive the vaccine, nor should pregnant or nursing mothers. Most people tolerate the vaccine well, with allergic reactions rare and mild discomfort where the vaccine was given being the most common side effect.
Elderly people and any person older than forty who grew up in an area presenting a high risk of infection probably should be tested for the presence of immunity before receiving the vaccine. Giving the vaccine to someone who has already had the infection (and thus cleared it, providing lifelong immunity to reinfection) would not be harmful, but it would be unnecessary.
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incidence: very common
cause: bacteria such as Gardnerella, Bacteroides, and Mycoplasma
symptoms: vaginal discharge, fishy odor
treatment: antibiotics
The vagina normally contains a combination of several kinds of bacteria, including the most common vaginal bacterium, Lactobacillus. Bacterial vaginosis (BV) is a bacterial syndrome that occurs when other bacteria that also occur normally in the vagina—such as Gardnerella vaginalis, Bacteroides species, and Mycoplasma hominis—begin to reproduce rapidly and replace the normal bacteria. BV then, is a syndrome caused by an overgrowth of bacteria in the vagina that disturbs the normal balance of bacteria there. It is sometimes referred to women, it is the most common vaginal disorder.
In the past BV was called Gardnerella (referring only to one of the bacteria that can cause this infection) or nonspecific vaginosis (a term that has gone out of use since the causes of BV have been determined).
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One man had a biopsy that was considered negative by one pathologist. His urologist sent it to this pathologist for a second opinion. “There were about four glands of cancer. We called it cancer, he had his prostate out, and there was tumor all over.” But for every such patient, there’s another man who turns out to have very little cancer.
Which brings us to one very tough question: Do all men who have cancer on needle biopsies need aggressive therapy? Again, the problem lies in our ability to differentiate between harmless and malevolent cancer. “If it were my family member,” the pathologist confesses, “I wouldn’t want to take the chance.”
But eventually, the goal is not to treat all prostate cancers, but to predict which cancers are going to turn serious, and treat these tumors aggressively. And predict which cancers will remain indolent, and monitor them closely.
Until very recently, the technology that made early biopsy possible also made these judgment calls much tougher—pathologists had trouble correlating the amount of cancer on the needle with the amount of cancer in the entire prostate. But now, research from Johns Hopkins promises to shed fresh light— to make needle biopsy findings much more helpful in determining a man’s course of treatment.
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The seminal vesicles, each about two inches long, sit behind the bladder, next to the rectum, arching over the prostate like two wings or, perhaps, like two clusters of grapes; they appear more clumped than streamlined. Arching still higher over them, on either side, are the vasa deferentia, which meet the seminal vesicles at V-shaped angles; these form the ejaculatory ducts, slitlike openings that feed into the prostatic urethra.
The seminal vesicles are composed of alveoli, little cul-de-sacs that bear viscous secretions—critical in ensuring the consistency of semen. (They got their name from the belief once held that the vesicles stored semen and sperm; they don’t.)
Like the prostate and related tissues known as “sex accessory glands,” the seminal vesicles depend on hormones for their development and growth, and for their ability to produce secretions. The seminal vesicles are highly variable among species: They’re large in humans, rats, hamsters and some rabbits, but are missing altogether in dogs, cats and bears. One unusual point: The seminal vesicles, so similar to the prostate in many ways, are almost always free of abnormal growth—benign (as in BPH) as well as malignant. No one knows why.
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