#nonhouseholder

[covid-safer-hotties]

Transmission of COVID-19 in Nightlife, Household, and Health Care Settings in Tokyo, Japan, in 2020 - Published Feb 24, 2023

Key Points

Question Which social settings are associated with large outbreaks and onward transmission of COVID-19?

Findings this case series study that analyzed 44 054 confirmed COVID-19 cases, transmission events in nightlife and health care settings were more likely to involve 5 or more cases. Household and health care cases were significantly less likely to generate onward transmission than nightlife cases.

Meaning This case series highlights the heterogenic characteristics of social settings regarding their roles in COVID-19 transmission and the significance of nightlife settings for further COVID-19 spread.

Abstract

Importance There have been few studies on the heterogeneous interconnection of COVID-19 outbreaks occurring in different social settings using robust, surveillance epidemiological data.

Objectives To describe the characteristics of COVID-19 transmission within different social settings and to evaluate settings associated with onward transmission to other settings.

Design, Setting, and Participants This is a case series study of laboratory-confirmed COVID-19 cases in Tokyo between January 23 and December 5, 2020, when vaccination was not yet implemented. Using epidemiological investigation data collected by public health centers, epidemiological links were identified and classified into 7 transmission settings: imported, nightlife, dining, workplace, household, health care, and other.

Main Outcomes and Measures The number of cases per setting and the likelihood of generating onward transmissions were compared between different transmission settings.

Results Of the 44 054 confirmed COVID-19 cases in this study, 25 241 (57.3%) were among male patients, and the median (IQR) age of patients was 36 (26-52) years. Transmission settings were identified in 13 122 cases, including 6768 household, 2733 health care, and 1174 nightlife cases. More than 6600 transmission settings were detected, and nightlife (72 of 380 [18.9%]; P < .001) and health care (119 [36.2%]; P < .001) settings were more likely to involve 5 or more cases than dining, workplace, household, and other settings. Nightlife cases appeared in the earlier phase of the epidemic, while household and health care cases appeared later. After adjustment for transmission setting, sex, age group, presence of symptoms, and wave, household and health care cases were less likely to generate onward transmission compared with nightlife cases (household: adjusted odds ratio, 0.03; 95% CI, 0.02-0.05; health care: adjusted odds ratio, 0.57; 95% CI, 0.41-0.79). Household settings were associated with intergenerational transmission, while nonhousehold settings mainly comprised transmission between the same age group. Among 30 932 cases without identified transmission settings, cases with a history of visiting nightlife establishments were more likely to generate onward transmission to nonhousehold settings (adjusted odds ratio, 5.30 [95% CI, 4.64-6.05]; P < .001) than those without such history.

Conclusions and Relevance In this case series study, COVID-19 cases identified in nightlife settings were associated with a higher likelihood of spreading COVID-19 than household and health care cases. Surveillance and interventions targeting nightlife settings should be prioritized to disrupt COVID-19 transmission, especially in the early stage of an epidemic.

[tomatoluvr69]

Please get out of my house pleeeease leave please get out of my house I literally cannot engage with a nonhousehold member right now I’m being held hostage and my phone chargers in the living room and I’m hungry and want a movie….please leave

[sweet-vanilla-sims]

Carlisle Update

So I made a post a few weeks ago about how I got a new computer and it's nice and runs things better. That is still true except after I transferred my saves and stuff from my old laptop I kinda just left it at that cause it took forever and I wanted to get in game and play but this computer is better and can do more. All this to say I got more period appropriate cc for my Carlisles after I saw some being posted and reblogged. So everyone is gonna be all redressed in the new clothes. I'm doing my best to make sure every sim in the save is dressed up in period appropriate wear now that I have it... I don't think I'll keep it up for the nonhousehold sims all the time so the kids and below will age up into silly randomized outfits I choose to ignore as usual but for a brief time everyone will be dressed appropriately or at least more appropriately.

[tetsuyaku]

what is Tatsuo's favorite non-household animal?

however my first thought was also chipmunks and idk why tbh (he also def as a soft spot for geckos only because he loves his team a lot)

[steep-endive]

Favorite Animals

Here's my list of favorite animals. None are in order. 

 1. Cats

- Both household and nonhousehold cats.

Why: Because they’re adorable and they’re very nice. Cats also are very soft. 

2. Sharks

- Any kind of sharks. 

Why: Because they’re very interesting. They have many things about them that make them sharks. 

3. Orca

- All orcas.

Why: I like them because they look like sharks even though they’re whales. 

[meetpositivesblog]

Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs was first published to: https://www.blog.meetpositives.com/ Hepatitis A, hepatitis B and HPV are the only vaccine-preventable STDs/STIs. (Not all HPV types are covered by the vaccine, so women who receive it still need Pap tests.) This is  the perfect time to think about protecting yourself from sexually transmitted viruses. These bacteria or infections can be passed from person to person primarily through a variety of sexual activities and they can only be diagnosed through testing since most of them shows no symptoms at all. The recent data shows that Hepatitis A, Hepatitis B and HPV are the only vaccine-preventable STDs/STIs.   First seen on: (http://www.columbia.edu/itc/hs/pubhealth/modules/reproductiveHealth/infections.html) Sexually transmitted infections (STIs) have historically been referred to as venereal disease, named for Venus, the goddess of love. Medical providers and public health practitioners today have replaced this term with more accurate and neutral terminology: sexually transmitted disease (STD) or sexually transmitted infection (STI). The term reproductive tract infection (RTI) is often used to describe infections that are sexually transmitted, as well as other common infections that may or may not be sexually transmitted (i.e. candidiasis, bacterial vaginosis). Epidemiology of STIs Sexually transmitted infections (STI's) are transmitted from person to person through vaginal, oral, or anal sex with an infected partner; and/or from a pregnant woman (if infected) to her fetus or baby during pregnancy and labor and delivery. In 2008, the CDC reported that a nationally representative study estimated that 1 in 4 teenage girls in the U.S. has an STD.  The study included the most common STDs: HPV, chlamydia, herpes simplex virus, and trichomoniasis. There are approximately 15 million new cases of sexually transmitted infection each year in the United States, and 340 million worldwide.30 The majority of STI's are asymptomatic (no symptoms). Asymptomatic infections can be transmitted to sexual partners. Having certain sexually transmitted infections increases the risk of acquiring or transmitting HIV. Gender Disparities Although the health risks associated with STIs affect both women and men, women are disproportionately affected. Women are more likely than are men to have asymptomatic infections, and also have greater biological susceptibility to acquire infections if exposed. Untreated STIs in women can lead to pelvic inflammatory disease (PID), infertility, ectopic pregnancy, cancers of the reproductive tract, pregnancy loss, neonatal morbidity and mortality, and an increased risk of HIV transmission. Untreated STIs in men can lead to an increased risk of HIV transmission, prostatitis, epididymitis, infertility, and reactive arthritis (formerly known as Reiter’s syndrome). Common Sexually Transmitted Infections There are over 20 different sexually transmitted infections, and other infections that are considered “sexually associated”. Viruses, and bacteria cause the majority of STIs. Bacterial STIs, which include infections such as chlamydia, gonorrhea, and syphilis, can be cured with antibiotics. Viral STIs, including HPV, herpes, hepatitis, and HIV, cannot be cured, though they can often be treated. The most common STIs are discussed below. You've probably received the advice previously to use protection and make sure that you get tested if you are sexually active. This is very important since most of the times a person infected with STI/STD viruses doesn't have any idea that they already have the virus. If you feel like you need a test, talk to your doctor about your concerns. First seen on: (http://www.cdc.gov/std/treatment/2010/vaccine.htm) Several STDs can be effectively prevented through pre-exposure vaccination with widely available vaccines, including HAV, HBV, and HPV. Vaccines for other STDs (e.g., HIV and HSV) are under development or are undergoing clinical trials. This guidance focuses largely on integrating the use of available vaccines into STD prevention and treatment activities. Every person being evaluated or treated for an STD should receive hepatitis B vaccination unless already vaccinated. In addition, some persons (e.g., MSM and IDUs) should receive hepatitis A vaccination. Hepatitis A Hepatitis A, caused by infection with HAV, has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease (CLD). However, 10%–15% of patients experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and most children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection. Video Credit HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of HAV is uncommon. HAV occasionally is detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated. In the United States, almost half of all persons with hepatitis A report having no risk factor for the disease. Among adults with identified risk factors, most cases occur among international travelers, household or sexual contacts, nonhousehold contacts (e.g., those encountered through play and daycare), and IDUs (437). Because transmission of HAV during sexual activity probably results from fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of hepatitis A. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection (e.g., MSM, illegal drug users, and persons with CLD), many of whom might seek services in STD clinics. Treatment Patients with acute hepatitis A usually require only supportive care, with no restrictions in diet or activity. Hospitalization might be necessary for patients who become dehydrated because of nausea and vomiting and is critical for patients with signs or symptoms of acute liver failure. Medications that might cause liver damage or are metabolized by the liver should be used with caution among persons with hepatitis A. Prevention Two products are available for the prevention of HAV infection: hepatitis A vaccine (Table 2) and immune globulin (IG) for IM administration. Hepatitis A vaccines are prepared from formalin-inactivated, cell-culture–derived HAV and have been available in the United States since 1995, initially for persons aged ≥2 years. In 2005, the vaccines were approved by FDA for persons aged ≥12 months, and the vaccine is available for eligible children and adolescents aged 70 years. Screening for HAV infection might be cost-effective in populations where the prevalence of infection is likely to be high (e.g., persons aged >40 years and persons born in areas of high HAV endemicity). The potential cost-savings of testing should be weighed against the cost and the likelihood that testing will interfere with initiating vaccination. Vaccination of a person who is already immune is not harmful. Postvaccination Serologic Testing Postvaccination serologic testing is not indicated because most persons respond to the vaccine. In addition, the commercially available serologic test is not sensitive enough to detect the low, but protective, levels of antibody produced by vaccination. Hepatitis B Hepatitis B is caused by infection with the hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. The highest concentrations of HBV are found in blood, with lower concentrations found in other body fluids including wound exudates, semen, vaginal secretions, and saliva (439,440). HBV is more infectious and relatively more stable in the environment than other bloodborne pathogens like HCV and HIV. HBV infection can be self-limited or chronic. In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at acquisition; approximately 90% of infected infants and 30% of infected children aged

http://hsvfacts.blogspot.com/2018/05/did-you-know-hepatitis-and-hpv-are_24.html

[realtalk-princeton]

Does no one realize that there is zero evidence that masks do anything if two people are in the same room together for an extended period of time? Gotta follow the science, not the politics.

Response from River:

from https://www.cdc.gov/mmwr/volumes/69/wr/mm6949e2.htm :

“Face mask use is most important in indoor spaces and outdoors when physical distance of ≥6 feet cannot be maintained.”

“Indoor venues, where distancing is not maintained and consistent use of face masks is not possible (e.g., restaurant dining), have been identified as particularly high-risk scenarios.”

“Community-level strategies” include “Issue policies or directives mandating universal use of face masks in indoor (nonhousehold) settings.”

the CDC also encourages people to avoid nonessential time indoors and you’re probably right that prolonged indoor contact may be risky even with masks on, but I don’t think it’s “politics” to say that you’re still better off maintaining masks + 6 feet indoors than not doing those things indoors. better safe than sorry even if you personally believe the risk is marginal or negligible. when you get to campus, it’s still important to follow princeton’s evidence-based policy no matter what you personally think of it

Response from Viola:

^^ Another really important concept in infectious disease is viral load (aka how much of the virus you have in your system) which can have implications for how ill you get after contracting the virus. While being indoors even with a mask on for a long period of time is still risky, you’re likely to be exposed to less virus bc of your mask which is good for everyone’s health and safety!

[slimy]

literally the only nonhousehold thing on ur list was a cellphone chain? like oh no this cute 5$ trinket is soooo much to ask for

once you click on my wishlist, the contract is sealed. you must buy me cute keychains to break the curse before time runs out……………. or else :0

[nedsecondline]

Public Health Decision Making during Covid-19 — Fulfilling the CDC Pledge to the American People | NEJM

Public Health Decision Making during Covid-19 — Fulfilling the CDC Pledge to the American People | NEJM

A recent report on contact tracing from South Korea, however, sheds light on this issue: household contacts of children 10 to 19 years of age had the highest rate of Covid-19 (18.6% tested positive, as compared with 11.8% of contacts of infected persons of all ages), while contacts of children 0 to 9 years of age had the lowest rate (5.3% tested positive).4 Rates of infection among nonhousehold…

[du-lich-saigon]

United Tightens Travel Rules for Emotional-Support Animals

United Airlines is tightening its requirements for passengers flying with emotional support animals following a surge in numbers and onboard incidents across the industry.

The move, announced Thursday, mirrors steps taken by Delta Air Lines Inc. DAL -0.62% last month. Other carriers are reviewing their policies after an effort by the Transportation Department to create new industrywide rules stalled last year.

United said the number of animals brought on for emotional support jumped 75% over the past year. Starting March 1, United will require passengers to certify that their animal will behave, and provide documentation from a veterinarian that it is fit and safe to fly.

The carrier already bans animals including hedgehogs, ferrets and nonhousehold birds from the cabin, and said it would continue to review that list. The airline last weekend barred a passenger from bringing a peacock on board a flight at Newark Liberty International Airport.

Related News

The unit of United Continental Holdings Inc. UAL -0.99% already requires passengers to notify the airline 48 hours in advance of plans to bring animals onboard.

United said it would maintain its policy for service animals, which don’t require advance notice or special documentation.

Delta last month said it would tighten its policies as of March 1 after an 84% increase in biting incidents and other disturbances since 2016.

Carriers said the lines between what counts as a service animal had become blurred.

“The Department of Transportation’s rules regarding emotional-support animals are not working as they were intended, and we need to change our approach in order to ensure a safe and pleasant travel experience for all of our customers,” United said.

The department last year worked on revising the existing rules, but didn’t issue new guidance. The transportation department plans to launch a new public consultation this year in an effort to refine its definition of what constitutes a service animal, said an agency spokesperson.

Critics of the airlines’ moves said they are trying to boost revenue with fees for flying animals in the hold, a charge the airlines deny.

Write to Doug Cameron at doug.cameron@wsj.com

Source Article

The post United Tightens Travel Rules for Emotional-Support Animals appeared first on DU-LICH-SAIGON.

Learn More At:http://www.du-lich-saigon.com/united-tightens-travel-rules-for-emotional-support-animals/

[fayecallasdatingblog]

Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs

The following post Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs is republished from: Meet Positives Herpes Dating Website

Hepatitis A, hepatitis B and HPV are the only vaccine-preventable STDs/STIs.

(Not all HPV types are covered by the vaccine, so women who receive it still need Pap tests.)

This is  the perfect time to think about protecting yourself from sexually transmitted viruses. These bacteria or infections can be passed from person to person primarily through a variety of sexual activities and they can only be diagnosed through testing since most of them shows no symptoms at all.

The recent data shows that Hepatitis A, Hepatitis B and HPV are the only vaccine-preventable STDs/STIs.

First seen on: (http://ift.tt/2aebCxa)

Sexually transmitted infections (STIs) have historically been referred to as venereal disease, named for Venus, the goddess of love. Medical providers and public health practitioners today have replaced this term with more accurate and neutral terminology: sexually transmitted disease (STD) or sexually transmitted infection (STI).

The term reproductive tract infection (RTI) is often used to describe infections that are sexually transmitted, as well as other common infections that may or may not be sexually transmitted (i.e. candidiasis, bacterial vaginosis).

Epidemiology of STIs

Sexually transmitted infections (STI's) are transmitted from person to person through vaginal, oral, or anal sex with an infected partner; and/or from a pregnant woman (if infected) to her fetus or baby during pregnancy and labor and delivery.

In 2008, the CDC reported that a nationally representative study estimated that 1 in 4 teenage girls in the U.S. has an STD.  The study included the most common STDs: HPV, chlamydia, herpes simplex virus, and trichomoniasis.

There are approximately 15 million new cases of sexually transmitted infection each year in the United States, and 340 million worldwide.30

The majority of STI's are asymptomatic (no symptoms). Asymptomatic infections can be transmitted to sexual partners.

Having certain sexually transmitted infections increases the risk of acquiring or transmitting HIV.

Gender Disparities

Although the health risks associated with STIs affect both women and men, women are disproportionately affected. Women are more likely than are men to have asymptomatic infections, and also have greater biological susceptibility to acquire infections if exposed.

Untreated STIs in women can lead to pelvic inflammatory disease (PID), infertility, ectopic pregnancy, cancers of the reproductive tract, pregnancy loss, neonatal morbidity and mortality, and an increased risk of HIV transmission.

Untreated STIs in men can lead to an increased risk of HIV transmission, prostatitis, epididymitis, infertility, and reactive arthritis (formerly known as Reiter’s syndrome).

Common Sexually Transmitted Infections

There are over 20 different sexually transmitted infections, and other infections that are considered “sexually associated”. Viruses, and bacteria cause the majority of STIs. Bacterial STIs, which include infections such as chlamydia, gonorrhea, and syphilis, can be cured with antibiotics. Viral STIs, including HPV, herpes, hepatitis, and HIV, cannot be cured, though they can often be treated. The most common STIs are discussed below.

You've probably received the advice previously to use protection and make sure that you get tested if you are sexually active. This is very important since most of the times a person infected with STI/STD viruses doesn't have any idea that they already have the virus. If you feel like you need a test, talk to your doctor about your concerns.

First seen on: (http://ift.tt/2aYGJtQ)

Several STDs can be effectively prevented through pre-exposure vaccination with widely available vaccines, including HAV, HBV, and HPV. Vaccines for other STDs (e.g., HIV and HSV) are under development or are undergoing clinical trials. This guidance focuses largely on integrating the use of available vaccines into STD prevention and treatment activities.

Every person being evaluated or treated for an STD should receive hepatitis B vaccination unless already vaccinated. In addition, some persons (e.g., MSM and IDUs) should receive hepatitis A vaccination.

Hepatitis A

Hepatitis A, caused by infection with HAV, has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease (CLD). However, 10%–15% of patients experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and most children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection.

Video Credit

HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of HAV is uncommon. HAV occasionally is detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated.

In the United States, almost half of all persons with hepatitis A report having no risk factor for the disease. Among adults with identified risk factors, most cases occur among international travelers, household or sexual contacts, nonhousehold contacts (e.g., those encountered through play and daycare), and IDUs (437). Because transmission of HAV during sexual activity probably results from fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of hepatitis A. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection (e.g., MSM, illegal drug users, and persons with CLD), many of whom might seek services in STD clinics.

Treatment

Patients with acute hepatitis A usually require only supportive care, with no restrictions in diet or activity. Hospitalization might be necessary for patients who become dehydrated because of nausea and vomiting and is critical for patients with signs or symptoms of acute liver failure. Medications that might cause liver damage or are metabolized by the liver should be used with caution among persons with hepatitis A.

Prevention

Two products are available for the prevention of HAV infection: hepatitis A vaccine (Table 2) and immune globulin (IG) for IM administration. Hepatitis A vaccines are prepared from formalin-inactivated, cell-culture–derived HAV and have been available in the United States since 1995, initially for persons aged ≥2 years. In 2005, the vaccines were approved by FDA for persons aged ≥12 months, and the vaccine is available for eligible children and adolescents aged <19 years through the VFC program (telephone: 800-232-4636).

Pre-exposure Vaccination

Persons in the following groups who are likely to be treated in STD clinic settings should be offered hepatitis A vaccine: 1) all MSM; 2) illegal drug users (of both injection and noninjection drugs); and 3) persons with CLD, including persons with chronic HBV and HCV infection who have evidence of CLD.

Pre Vaccination Serologic Testing for Susceptibility

Approximately one third of the U.S. population has serologic evidence of previous HAV infection, which increases with age and reaches 75% among persons aged >70 years. Screening for HAV infection might be cost-effective in populations where the prevalence of infection is likely to be high (e.g., persons aged >40 years and persons born in areas of high HAV endemicity). The potential cost-savings of testing should be weighed against the cost and the likelihood that testing will interfere with initiating vaccination. Vaccination of a person who is already immune is not harmful.

Postvaccination Serologic Testing

Postvaccination serologic testing is not indicated because most persons respond to the vaccine. In addition, the commercially available serologic test is not sensitive enough to detect the low, but protective, levels of antibody produced by vaccination.

Hepatitis B

Hepatitis B is caused by infection with the hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. The highest concentrations of HBV are found in blood, with lower concentrations found in other body fluids including wound exudates, semen, vaginal secretions, and saliva (439,440). HBV is more infectious and relatively more stable in the environment than other bloodborne pathogens like HCV and HIV.

HBV infection can be self-limited or chronic. In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at acquisition; approximately 90% of infected infants and 30% of infected children aged <5 years become chronically infected, compared with 2%–6% of persons who become infected as adults. Among persons with chronic HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma (HCC) is 15%–25%.

Video Credit

HBV is efficiently transmitted by percutaneous or mucous membrane exposure to blood or body fluids that contain blood. The primary risk factors associated with infection among adolescents and adults are unprotected sex with an infected partner, unprotected sex with more than one partner, MSM, history of other STDs, and illegal injection-drug use. In addition, several studies have demonstrated the horizontal transmission of HBV, including through premastication, as a less common source of transmission (441,442).

CDC’s national strategy to eliminate transmission of HBV infection includes 1) prevention of perinatal infection through routine screening of all pregnant women for HBsAg and immunoprophylaxis of infants born to HBsAg-positive mothers or mothers whose HBsAg status is unknown, 2) routine infant vaccination, 3) vaccination of previously unvaccinated children and adolescents through age 18 years, and 4) vaccination of previously unvaccinated adults at increased risk for infection (3,4). High vaccination coverage rates, with subsequent declines in acute hepatitis B incidence, have been achieved among infants and adolescents (4,437,443). In contrast, vaccination coverage among most high-risk adult groups (e.g., persons with more than one sex partner in the previous 6 months, MSM, and IDUs) has remained low, and most new infections occur in these high-risk groups (3,108,444-446). STD clinics and other settings that provide services to high-risk adults are ideal sites in which to provide hepatitis B vaccination to adults at risk for HBV infection. All unvaccinated adults seeking services in these settings should be assumed to be at risk for hepatitis B and should be offered hepatitis B vaccination.

Treatment

No specific therapy is available for persons with acute hepatitis B; treatment is supportive. Persons with chronic HBV infection should be referred for evaluation to a physician experienced in the management of CLD. Therapeutic agents cleared by FDA for treatment of chronic hepatitis B can achieve sustained suppression of HBV replication and remission of liver disease in some persons. In addition, patients with chronic hepatitis B might benefit from screening to detect HCC at an early stage.

Prevention

Two products have been approved for hepatitis B prevention: hepatitis B immune globulin (HBIG) and hepatitis B vaccine (3,4). HBIG provides temporary (i.e., 3–6 months) protection from HBV infection and is typically used as PEP either as an adjunct to hepatitis B vaccination in previously unvaccinated persons or alone in persons who have not responded to vaccination. HBIG is prepared from plasma known to contain high concentrations of anti-HBs. The recommended dose of HBIG is 0.06 mL/kg.

Hepatitis B vaccine contains HBsAg produced in yeast by recombinant DNA technology and provides protection from HBV infection when used for both pre-exposure vaccination and PEP. The two available monovalent hepatitis B vaccines for use in adolescents and adults are Recombivax HB (Merck and Co., Inc., Whitehouse Station, New Jersey) and Engerix-B (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania). A combination vaccine (hepatitis A and hepatitis B) for use in adults, Twinrix (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania), also is available. The recommended HBV dose varies by product and age of recipient (Table 3).

Pre-exposure Vaccination

Hepatitis B vaccination is recommended for all unvaccinated adolescents, all unvaccinated adults at risk for HBV infection, and all adults seeking protection from HBV infection. For adults, acknowledgement of a specific risk factor is not a requirement for vaccination.

Hepatitis B vaccine should be routinely offered to all unvaccinated persons attending STD clinics and to all unvaccinated persons seeking treatment for STDs in other settings. Other settings where all unvaccinated adults should be assumed to be at risk for hepatitis B and should receive hepatitis B vaccination include correctional facilities, facilities providing drug abuse treatment and prevention services, health-care settings serving MSM, and HIV testing and treatment facilities. All persons who receive clinical services in these settings should be offered hepatitis B vaccine unless they have a reliable vaccination history (i.e., a written, dated record of each dose of a complete series). In all settings, vaccination should be initiated even when completion of the vaccine series cannot be ensured.

Post Vaccination Testing for Serologic Response

Serologic testing for immunity is not necessary after routine vaccination of adolescents or adults. However, such testing is recommended for persons whose subsequent clinical management depends on knowledge of their immune status (e.g., health-care workers or public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids). In addition, post vaccination testing is recommended for 1) HIV-infected persons and other immunocompromised persons to determine the need for revaccination and the type of follow-up testing and 2) sex and needle-sharing partners of HBsAg-positive persons to determine the need for revaccination and for other methods to protect themselves from HBV infection.

If indicated, testing should be performed 1–2 months after administration of the last dose of the vaccine series by using a method that allows determination of a protective level of anti-HBs (i.e., ≥10 mIU/mL). Persons determined to have anti-HBs levels of <10 mIU/mL after the primary vaccine series should be revaccinated with a 3-dose series and provided with anti-HBs testing 1–2 months after the third dose. Persons who do not respond to revaccination should be tested for HBsAg. If HBsAg positive, the person should receive appropriate management (see Management of HBsAg-Positive Persons); if HBsAg negative, the person should be considered susceptible to HBV infection and counseled concerning precautions to prevent HBV infection and the need for HBIG PEP for any known exposure (see Postexposure Prophylaxis).

Exposure to Source with Unknown HBsAg Status

Unvaccinated persons who have a discrete, identifiable exposure to blood or body fluids containing blood from a source with unknown HBsAg status should receive the hepatitis B vaccine series, with the first dose initiated as soon as possible after exposure (preferably within 24 hours) and the series completed by using the age-appropriate dose and schedule. Exposed persons who are not fully vaccinated should complete the vaccine series. Exposed persons with written documentation of a complete hepatitis B vaccine series require no further treatment.

HIV Infection

HIV infection can impair the response to hepatitis B vaccination. HIV-infected persons should be tested for anti-HBs 1–2 months after the third vaccine dose (see Postvaccination Testing for Serologic Response). Modified dosing regimens, including a doubling of the standard antigen dose and administration of additional doses, might increase the response rate (130).

Management of HBsAg-Positive Persons

This section provides recommendations for management of all HBsAg-positive persons. Additional recommendations for management of HBsAg-positive persons who are coinfected with HIV are available (130).

All persons with HBsAg-positive laboratory results should be reported to the state or local health department.

To verify the presence of chronic HBV infection, HBsAg-positive persons should be retested. The absence of IgM anti-HBc or the persistence of HBsAg for 6 months indicates chronic HBV infection.

Persons with chronic HBV infection should be referred for evaluation to a physician from Meet Positives SM Feed http://ift.tt/2wr4FQu via IFTTT

[brittanyyoungblog]

Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs

The following post Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs is republished from: Meet Positives Herpes Dating Website

Hepatitis A, hepatitis B and HPV are the only vaccine-preventable STDs/STIs.

(Not all HPV types are covered by the vaccine, so women who receive it still need Pap tests.)

This is  the perfect time to think about protecting yourself from sexually transmitted viruses. These bacteria or infections can be passed from person to person primarily through a variety of sexual activities and they can only be diagnosed through testing since most of them shows no symptoms at all.

The recent data shows that Hepatitis A, Hepatitis B and HPV are the only vaccine-preventable STDs/STIs.

First seen on: (http://ift.tt/2aebCxa)

Sexually transmitted infections (STIs) have historically been referred to as venereal disease, named for Venus, the goddess of love. Medical providers and public health practitioners today have replaced this term with more accurate and neutral terminology: sexually transmitted disease (STD) or sexually transmitted infection (STI).

The term reproductive tract infection (RTI) is often used to describe infections that are sexually transmitted, as well as other common infections that may or may not be sexually transmitted (i.e. candidiasis, bacterial vaginosis).

Epidemiology of STIs

Sexually transmitted infections (STI's) are transmitted from person to person through vaginal, oral, or anal sex with an infected partner; and/or from a pregnant woman (if infected) to her fetus or baby during pregnancy and labor and delivery.

In 2008, the CDC reported that a nationally representative study estimated that 1 in 4 teenage girls in the U.S. has an STD.  The study included the most common STDs: HPV, chlamydia, herpes simplex virus, and trichomoniasis.

There are approximately 15 million new cases of sexually transmitted infection each year in the United States, and 340 million worldwide.30

The majority of STI's are asymptomatic (no symptoms). Asymptomatic infections can be transmitted to sexual partners.

Having certain sexually transmitted infections increases the risk of acquiring or transmitting HIV.

Gender Disparities

Although the health risks associated with STIs affect both women and men, women are disproportionately affected. Women are more likely than are men to have asymptomatic infections, and also have greater biological susceptibility to acquire infections if exposed.

Untreated STIs in women can lead to pelvic inflammatory disease (PID), infertility, ectopic pregnancy, cancers of the reproductive tract, pregnancy loss, neonatal morbidity and mortality, and an increased risk of HIV transmission.

Untreated STIs in men can lead to an increased risk of HIV transmission, prostatitis, epididymitis, infertility, and reactive arthritis (formerly known as Reiter’s syndrome).

Common Sexually Transmitted Infections

There are over 20 different sexually transmitted infections, and other infections that are considered “sexually associated”. Viruses, and bacteria cause the majority of STIs. Bacterial STIs, which include infections such as chlamydia, gonorrhea, and syphilis, can be cured with antibiotics. Viral STIs, including HPV, herpes, hepatitis, and HIV, cannot be cured, though they can often be treated. The most common STIs are discussed below.

You've probably received the advice previously to use protection and make sure that you get tested if you are sexually active. This is very important since most of the times a person infected with STI/STD viruses doesn't have any idea that they already have the virus. If you feel like you need a test, talk to your doctor about your concerns.

First seen on: (http://ift.tt/2aYGJtQ)

Several STDs can be effectively prevented through pre-exposure vaccination with widely available vaccines, including HAV, HBV, and HPV. Vaccines for other STDs (e.g., HIV and HSV) are under development or are undergoing clinical trials. This guidance focuses largely on integrating the use of available vaccines into STD prevention and treatment activities.

Every person being evaluated or treated for an STD should receive hepatitis B vaccination unless already vaccinated. In addition, some persons (e.g., MSM and IDUs) should receive hepatitis A vaccination.

Hepatitis A

Hepatitis A, caused by infection with HAV, has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease (CLD). However, 10%–15% of patients experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and most children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection.

Video Credit

HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of HAV is uncommon. HAV occasionally is detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated.

In the United States, almost half of all persons with hepatitis A report having no risk factor for the disease. Among adults with identified risk factors, most cases occur among international travelers, household or sexual contacts, nonhousehold contacts (e.g., those encountered through play and daycare), and IDUs (437). Because transmission of HAV during sexual activity probably results from fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of hepatitis A. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection (e.g., MSM, illegal drug users, and persons with CLD), many of whom might seek services in STD clinics.

Treatment

Patients with acute hepatitis A usually require only supportive care, with no restrictions in diet or activity. Hospitalization might be necessary for patients who become dehydrated because of nausea and vomiting and is critical for patients with signs or symptoms of acute liver failure. Medications that might cause liver damage or are metabolized by the liver should be used with caution among persons with hepatitis A.

Prevention

Two products are available for the prevention of HAV infection: hepatitis A vaccine (Table 2) and immune globulin (IG) for IM administration. Hepatitis A vaccines are prepared from formalin-inactivated, cell-culture–derived HAV and have been available in the United States since 1995, initially for persons aged ≥2 years. In 2005, the vaccines were approved by FDA for persons aged ≥12 months, and the vaccine is available for eligible children and adolescents aged <19 years through the VFC program (telephone: 800-232-4636).

Pre-exposure Vaccination

Persons in the following groups who are likely to be treated in STD clinic settings should be offered hepatitis A vaccine: 1) all MSM; 2) illegal drug users (of both injection and noninjection drugs); and 3) persons with CLD, including persons with chronic HBV and HCV infection who have evidence of CLD.

Pre Vaccination Serologic Testing for Susceptibility

Approximately one third of the U.S. population has serologic evidence of previous HAV infection, which increases with age and reaches 75% among persons aged >70 years. Screening for HAV infection might be cost-effective in populations where the prevalence of infection is likely to be high (e.g., persons aged >40 years and persons born in areas of high HAV endemicity). The potential cost-savings of testing should be weighed against the cost and the likelihood that testing will interfere with initiating vaccination. Vaccination of a person who is already immune is not harmful.

Postvaccination Serologic Testing

Postvaccination serologic testing is not indicated because most persons respond to the vaccine. In addition, the commercially available serologic test is not sensitive enough to detect the low, but protective, levels of antibody produced by vaccination.

Hepatitis B

Hepatitis B is caused by infection with the hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. The highest concentrations of HBV are found in blood, with lower concentrations found in other body fluids including wound exudates, semen, vaginal secretions, and saliva (439,440). HBV is more infectious and relatively more stable in the environment than other bloodborne pathogens like HCV and HIV.

HBV infection can be self-limited or chronic. In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at acquisition; approximately 90% of infected infants and 30% of infected children aged <5 years become chronically infected, compared with 2%–6% of persons who become infected as adults. Among persons with chronic HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma (HCC) is 15%–25%.

Video Credit

HBV is efficiently transmitted by percutaneous or mucous membrane exposure to blood or body fluids that contain blood. The primary risk factors associated with infection among adolescents and adults are unprotected sex with an infected partner, unprotected sex with more than one partner, MSM, history of other STDs, and illegal injection-drug use. In addition, several studies have demonstrated the horizontal transmission of HBV, including through premastication, as a less common source of transmission (441,442).

CDC’s national strategy to eliminate transmission of HBV infection includes 1) prevention of perinatal infection through routine screening of all pregnant women for HBsAg and immunoprophylaxis of infants born to HBsAg-positive mothers or mothers whose HBsAg status is unknown, 2) routine infant vaccination, 3) vaccination of previously unvaccinated children and adolescents through age 18 years, and 4) vaccination of previously unvaccinated adults at increased risk for infection (3,4). High vaccination coverage rates, with subsequent declines in acute hepatitis B incidence, have been achieved among infants and adolescents (4,437,443). In contrast, vaccination coverage among most high-risk adult groups (e.g., persons with more than one sex partner in the previous 6 months, MSM, and IDUs) has remained low, and most new infections occur in these high-risk groups (3,108,444-446). STD clinics and other settings that provide services to high-risk adults are ideal sites in which to provide hepatitis B vaccination to adults at risk for HBV infection. All unvaccinated adults seeking services in these settings should be assumed to be at risk for hepatitis B and should be offered hepatitis B vaccination.

Treatment

No specific therapy is available for persons with acute hepatitis B; treatment is supportive. Persons with chronic HBV infection should be referred for evaluation to a physician experienced in the management of CLD. Therapeutic agents cleared by FDA for treatment of chronic hepatitis B can achieve sustained suppression of HBV replication and remission of liver disease in some persons. In addition, patients with chronic hepatitis B might benefit from screening to detect HCC at an early stage.

Prevention

Two products have been approved for hepatitis B prevention: hepatitis B immune globulin (HBIG) and hepatitis B vaccine (3,4). HBIG provides temporary (i.e., 3–6 months) protection from HBV infection and is typically used as PEP either as an adjunct to hepatitis B vaccination in previously unvaccinated persons or alone in persons who have not responded to vaccination. HBIG is prepared from plasma known to contain high concentrations of anti-HBs. The recommended dose of HBIG is 0.06 mL/kg.

Hepatitis B vaccine contains HBsAg produced in yeast by recombinant DNA technology and provides protection from HBV infection when used for both pre-exposure vaccination and PEP. The two available monovalent hepatitis B vaccines for use in adolescents and adults are Recombivax HB (Merck and Co., Inc., Whitehouse Station, New Jersey) and Engerix-B (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania). A combination vaccine (hepatitis A and hepatitis B) for use in adults, Twinrix (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania), also is available. The recommended HBV dose varies by product and age of recipient (Table 3).

Pre-exposure Vaccination

Hepatitis B vaccination is recommended for all unvaccinated adolescents, all unvaccinated adults at risk for HBV infection, and all adults seeking protection from HBV infection. For adults, acknowledgement of a specific risk factor is not a requirement for vaccination.

Hepatitis B vaccine should be routinely offered to all unvaccinated persons attending STD clinics and to all unvaccinated persons seeking treatment for STDs in other settings. Other settings where all unvaccinated adults should be assumed to be at risk for hepatitis B and should receive hepatitis B vaccination include correctional facilities, facilities providing drug abuse treatment and prevention services, health-care settings serving MSM, and HIV testing and treatment facilities. All persons who receive clinical services in these settings should be offered hepatitis B vaccine unless they have a reliable vaccination history (i.e., a written, dated record of each dose of a complete series). In all settings, vaccination should be initiated even when completion of the vaccine series cannot be ensured.

Post Vaccination Testing for Serologic Response

Serologic testing for immunity is not necessary after routine vaccination of adolescents or adults. However, such testing is recommended for persons whose subsequent clinical management depends on knowledge of their immune status (e.g., health-care workers or public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids). In addition, post vaccination testing is recommended for 1) HIV-infected persons and other immunocompromised persons to determine the need for revaccination and the type of follow-up testing and 2) sex and needle-sharing partners of HBsAg-positive persons to determine the need for revaccination and for other methods to protect themselves from HBV infection.

If indicated, testing should be performed 1–2 months after administration of the last dose of the vaccine series by using a method that allows determination of a protective level of anti-HBs (i.e., ≥10 mIU/mL). Persons determined to have anti-HBs levels of <10 mIU/mL after the primary vaccine series should be revaccinated with a 3-dose series and provided with anti-HBs testing 1–2 months after the third dose. Persons who do not respond to revaccination should be tested for HBsAg. If HBsAg positive, the person should receive appropriate management (see Management of HBsAg-Positive Persons); if HBsAg negative, the person should be considered susceptible to HBV infection and counseled concerning precautions to prevent HBV infection and the need for HBIG PEP for any known exposure (see Postexposure Prophylaxis).

Exposure to Source with Unknown HBsAg Status

Unvaccinated persons who have a discrete, identifiable exposure to blood or body fluids containing blood from a source with unknown HBsAg status should receive the hepatitis B vaccine series, with the first dose initiated as soon as possible after exposure (preferably within 24 hours) and the series completed by using the age-appropriate dose and schedule. Exposed persons who are not fully vaccinated should complete the vaccine series. Exposed persons with written documentation of a complete hepatitis B vaccine series require no further treatment.

HIV Infection

HIV infection can impair the response to hepatitis B vaccination. HIV-infected persons should be tested for anti-HBs 1–2 months after the third vaccine dose (see Postvaccination Testing for Serologic Response). Modified dosing regimens, including a doubling of the standard antigen dose and administration of additional doses, might increase the response rate (130).

Management of HBsAg-Positive Persons

This section provides recommendations for management of all HBsAg-positive persons. Additional recommendations for management of HBsAg-positive persons who are coinfected with HIV are available (130).

All persons with HBsAg-positive laboratory results should be reported to the state or local health department.

To verify the presence of chronic HBV infection, HBsAg-positive persons should be retested. The absence of IgM anti-HBc or the persistence of HBsAg for 6 months indicates chronic HBV infection.

Persons with chronic HBV infection should be referred for evaluation to a physician from Meet Positives SMFeed 8 http://ift.tt/2wr4FQu via IFTTT

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Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs

The following post Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs is republished from: Meet Positives Herpes Dating Website

Hepatitis A, hepatitis B and HPV are the only vaccine-preventable STDs/STIs.

(Not all HPV types are covered by the vaccine, so women who receive it still need Pap tests.)

This is  the perfect time to think about protecting yourself from sexually transmitted viruses. These bacteria or infections can be passed from person to person primarily through a variety of sexual activities and they can only be diagnosed through testing since most of them shows no symptoms at all.

The recent data shows that Hepatitis A, Hepatitis B and HPV are the only vaccine-preventable STDs/STIs.

First seen on: (http://ift.tt/2aebCxa)

Sexually transmitted infections (STIs) have historically been referred to as venereal disease, named for Venus, the goddess of love. Medical providers and public health practitioners today have replaced this term with more accurate and neutral terminology: sexually transmitted disease (STD) or sexually transmitted infection (STI).

The term reproductive tract infection (RTI) is often used to describe infections that are sexually transmitted, as well as other common infections that may or may not be sexually transmitted (i.e. candidiasis, bacterial vaginosis).

Epidemiology of STIs

Sexually transmitted infections (STI's) are transmitted from person to person through vaginal, oral, or anal sex with an infected partner; and/or from a pregnant woman (if infected) to her fetus or baby during pregnancy and labor and delivery.

In 2008, the CDC reported that a nationally representative study estimated that 1 in 4 teenage girls in the U.S. has an STD.  The study included the most common STDs: HPV, chlamydia, herpes simplex virus, and trichomoniasis.

There are approximately 15 million new cases of sexually transmitted infection each year in the United States, and 340 million worldwide.30

The majority of STI's are asymptomatic (no symptoms). Asymptomatic infections can be transmitted to sexual partners.

Having certain sexually transmitted infections increases the risk of acquiring or transmitting HIV.

Gender Disparities

Although the health risks associated with STIs affect both women and men, women are disproportionately affected. Women are more likely than are men to have asymptomatic infections, and also have greater biological susceptibility to acquire infections if exposed.

Untreated STIs in women can lead to pelvic inflammatory disease (PID), infertility, ectopic pregnancy, cancers of the reproductive tract, pregnancy loss, neonatal morbidity and mortality, and an increased risk of HIV transmission.

Untreated STIs in men can lead to an increased risk of HIV transmission, prostatitis, epididymitis, infertility, and reactive arthritis (formerly known as Reiter’s syndrome).

Common Sexually Transmitted Infections

There are over 20 different sexually transmitted infections, and other infections that are considered “sexually associated”. Viruses, and bacteria cause the majority of STIs. Bacterial STIs, which include infections such as chlamydia, gonorrhea, and syphilis, can be cured with antibiotics. Viral STIs, including HPV, herpes, hepatitis, and HIV, cannot be cured, though they can often be treated. The most common STIs are discussed below.

You've probably received the advice previously to use protection and make sure that you get tested if you are sexually active. This is very important since most of the times a person infected with STI/STD viruses doesn't have any idea that they already have the virus. If you feel like you need a test, talk to your doctor about your concerns.

First seen on: (http://ift.tt/2aYGJtQ)

Several STDs can be effectively prevented through pre-exposure vaccination with widely available vaccines, including HAV, HBV, and HPV. Vaccines for other STDs (e.g., HIV and HSV) are under development or are undergoing clinical trials. This guidance focuses largely on integrating the use of available vaccines into STD prevention and treatment activities.

Every person being evaluated or treated for an STD should receive hepatitis B vaccination unless already vaccinated. In addition, some persons (e.g., MSM and IDUs) should receive hepatitis A vaccination.

Hepatitis A

Hepatitis A, caused by infection with HAV, has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease (CLD). However, 10%–15% of patients experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and most children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection.

Video Credit

HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of HAV is uncommon. HAV occasionally is detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated.

In the United States, almost half of all persons with hepatitis A report having no risk factor for the disease. Among adults with identified risk factors, most cases occur among international travelers, household or sexual contacts, nonhousehold contacts (e.g., those encountered through play and daycare), and IDUs (437). Because transmission of HAV during sexual activity probably results from fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of hepatitis A. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection (e.g., MSM, illegal drug users, and persons with CLD), many of whom might seek services in STD clinics.

Treatment

Patients with acute hepatitis A usually require only supportive care, with no restrictions in diet or activity. Hospitalization might be necessary for patients who become dehydrated because of nausea and vomiting and is critical for patients with signs or symptoms of acute liver failure. Medications that might cause liver damage or are metabolized by the liver should be used with caution among persons with hepatitis A.

Prevention

Two products are available for the prevention of HAV infection: hepatitis A vaccine (Table 2) and immune globulin (IG) for IM administration. Hepatitis A vaccines are prepared from formalin-inactivated, cell-culture–derived HAV and have been available in the United States since 1995, initially for persons aged ≥2 years. In 2005, the vaccines were approved by FDA for persons aged ≥12 months, and the vaccine is available for eligible children and adolescents aged <19 years through the VFC program (telephone: 800-232-4636).

Pre-exposure Vaccination

Persons in the following groups who are likely to be treated in STD clinic settings should be offered hepatitis A vaccine: 1) all MSM; 2) illegal drug users (of both injection and noninjection drugs); and 3) persons with CLD, including persons with chronic HBV and HCV infection who have evidence of CLD.

Pre Vaccination Serologic Testing for Susceptibility

Approximately one third of the U.S. population has serologic evidence of previous HAV infection, which increases with age and reaches 75% among persons aged >70 years. Screening for HAV infection might be cost-effective in populations where the prevalence of infection is likely to be high (e.g., persons aged >40 years and persons born in areas of high HAV endemicity). The potential cost-savings of testing should be weighed against the cost and the likelihood that testing will interfere with initiating vaccination. Vaccination of a person who is already immune is not harmful.

Postvaccination Serologic Testing

Postvaccination serologic testing is not indicated because most persons respond to the vaccine. In addition, the commercially available serologic test is not sensitive enough to detect the low, but protective, levels of antibody produced by vaccination.

Hepatitis B

Hepatitis B is caused by infection with the hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. The highest concentrations of HBV are found in blood, with lower concentrations found in other body fluids including wound exudates, semen, vaginal secretions, and saliva (439,440). HBV is more infectious and relatively more stable in the environment than other bloodborne pathogens like HCV and HIV.

HBV infection can be self-limited or chronic. In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at acquisition; approximately 90% of infected infants and 30% of infected children aged <5 years become chronically infected, compared with 2%–6% of persons who become infected as adults. Among persons with chronic HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma (HCC) is 15%–25%.

Video Credit

HBV is efficiently transmitted by percutaneous or mucous membrane exposure to blood or body fluids that contain blood. The primary risk factors associated with infection among adolescents and adults are unprotected sex with an infected partner, unprotected sex with more than one partner, MSM, history of other STDs, and illegal injection-drug use. In addition, several studies have demonstrated the horizontal transmission of HBV, including through premastication, as a less common source of transmission (441,442).

CDC’s national strategy to eliminate transmission of HBV infection includes 1) prevention of perinatal infection through routine screening of all pregnant women for HBsAg and immunoprophylaxis of infants born to HBsAg-positive mothers or mothers whose HBsAg status is unknown, 2) routine infant vaccination, 3) vaccination of previously unvaccinated children and adolescents through age 18 years, and 4) vaccination of previously unvaccinated adults at increased risk for infection (3,4). High vaccination coverage rates, with subsequent declines in acute hepatitis B incidence, have been achieved among infants and adolescents (4,437,443). In contrast, vaccination coverage among most high-risk adult groups (e.g., persons with more than one sex partner in the previous 6 months, MSM, and IDUs) has remained low, and most new infections occur in these high-risk groups (3,108,444-446). STD clinics and other settings that provide services to high-risk adults are ideal sites in which to provide hepatitis B vaccination to adults at risk for HBV infection. All unvaccinated adults seeking services in these settings should be assumed to be at risk for hepatitis B and should be offered hepatitis B vaccination.

Treatment

No specific therapy is available for persons with acute hepatitis B; treatment is supportive. Persons with chronic HBV infection should be referred for evaluation to a physician experienced in the management of CLD. Therapeutic agents cleared by FDA for treatment of chronic hepatitis B can achieve sustained suppression of HBV replication and remission of liver disease in some persons. In addition, patients with chronic hepatitis B might benefit from screening to detect HCC at an early stage.

Prevention

Two products have been approved for hepatitis B prevention: hepatitis B immune globulin (HBIG) and hepatitis B vaccine (3,4). HBIG provides temporary (i.e., 3–6 months) protection from HBV infection and is typically used as PEP either as an adjunct to hepatitis B vaccination in previously unvaccinated persons or alone in persons who have not responded to vaccination. HBIG is prepared from plasma known to contain high concentrations of anti-HBs. The recommended dose of HBIG is 0.06 mL/kg.

Hepatitis B vaccine contains HBsAg produced in yeast by recombinant DNA technology and provides protection from HBV infection when used for both pre-exposure vaccination and PEP. The two available monovalent hepatitis B vaccines for use in adolescents and adults are Recombivax HB (Merck and Co., Inc., Whitehouse Station, New Jersey) and Engerix-B (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania). A combination vaccine (hepatitis A and hepatitis B) for use in adults, Twinrix (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania), also is available. The recommended HBV dose varies by product and age of recipient (Table 3).

Pre-exposure Vaccination

Hepatitis B vaccination is recommended for all unvaccinated adolescents, all unvaccinated adults at risk for HBV infection, and all adults seeking protection from HBV infection. For adults, acknowledgement of a specific risk factor is not a requirement for vaccination.

Hepatitis B vaccine should be routinely offered to all unvaccinated persons attending STD clinics and to all unvaccinated persons seeking treatment for STDs in other settings. Other settings where all unvaccinated adults should be assumed to be at risk for hepatitis B and should receive hepatitis B vaccination include correctional facilities, facilities providing drug abuse treatment and prevention services, health-care settings serving MSM, and HIV testing and treatment facilities. All persons who receive clinical services in these settings should be offered hepatitis B vaccine unless they have a reliable vaccination history (i.e., a written, dated record of each dose of a complete series). In all settings, vaccination should be initiated even when completion of the vaccine series cannot be ensured.

Post Vaccination Testing for Serologic Response

Serologic testing for immunity is not necessary after routine vaccination of adolescents or adults. However, such testing is recommended for persons whose subsequent clinical management depends on knowledge of their immune status (e.g., health-care workers or public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids). In addition, post vaccination testing is recommended for 1) HIV-infected persons and other immunocompromised persons to determine the need for revaccination and the type of follow-up testing and 2) sex and needle-sharing partners of HBsAg-positive persons to determine the need for revaccination and for other methods to protect themselves from HBV infection.

If indicated, testing should be performed 1–2 months after administration of the last dose of the vaccine series by using a method that allows determination of a protective level of anti-HBs (i.e., ≥10 mIU/mL). Persons determined to have anti-HBs levels of <10 mIU/mL after the primary vaccine series should be revaccinated with a 3-dose series and provided with anti-HBs testing 1–2 months after the third dose. Persons who do not respond to revaccination should be tested for HBsAg. If HBsAg positive, the person should receive appropriate management (see Management of HBsAg-Positive Persons); if HBsAg negative, the person should be considered susceptible to HBV infection and counseled concerning precautions to prevent HBV infection and the need for HBIG PEP for any known exposure (see Postexposure Prophylaxis).

Exposure to Source with Unknown HBsAg Status

Unvaccinated persons who have a discrete, identifiable exposure to blood or body fluids containing blood from a source with unknown HBsAg status should receive the hepatitis B vaccine series, with the first dose initiated as soon as possible after exposure (preferably within 24 hours) and the series completed by using the age-appropriate dose and schedule. Exposed persons who are not fully vaccinated should complete the vaccine series. Exposed persons with written documentation of a complete hepatitis B vaccine series require no further treatment.

HIV Infection

HIV infection can impair the response to hepatitis B vaccination. HIV-infected persons should be tested for anti-HBs 1–2 months after the third vaccine dose (see Postvaccination Testing for Serologic Response). Modified dosing regimens, including a doubling of the standard antigen dose and administration of additional doses, might increase the response rate (130).

Management of HBsAg-Positive Persons

This section provides recommendations for management of all HBsAg-positive persons. Additional recommendations for management of HBsAg-positive persons who are coinfected with HIV are available (130).

All persons with HBsAg-positive laboratory results should be reported to the state or local health department.

To verify the presence of chronic HBV infection, HBsAg-positive persons should be retested. The absence of IgM anti-HBc or the persistence of HBsAg for 6 months indicates chronic HBV infection.

Persons with chronic HBV infection should be referred for evaluation to a physician from Meet Positives SM Feed 4 http://ift.tt/2wr4FQu via IFTTT

[travisandersondatingblog]

Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs

The following post Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs is republished from: Meet Positives Herpes Dating Website

Hepatitis A, hepatitis B and HPV are the only vaccine-preventable STDs/STIs.

(Not all HPV types are covered by the vaccine, so women who receive it still need Pap tests.)

This is  the perfect time to think about protecting yourself from sexually transmitted viruses. These bacteria or infections can be passed from person to person primarily through a variety of sexual activities and they can only be diagnosed through testing since most of them shows no symptoms at all.

The recent data shows that Hepatitis A, Hepatitis B and HPV are the only vaccine-preventable STDs/STIs.

First seen on: (http://ift.tt/2aebCxa)

Sexually transmitted infections (STIs) have historically been referred to as venereal disease, named for Venus, the goddess of love. Medical providers and public health practitioners today have replaced this term with more accurate and neutral terminology: sexually transmitted disease (STD) or sexually transmitted infection (STI).

The term reproductive tract infection (RTI) is often used to describe infections that are sexually transmitted, as well as other common infections that may or may not be sexually transmitted (i.e. candidiasis, bacterial vaginosis).

Epidemiology of STIs

Sexually transmitted infections (STI's) are transmitted from person to person through vaginal, oral, or anal sex with an infected partner; and/or from a pregnant woman (if infected) to her fetus or baby during pregnancy and labor and delivery.

In 2008, the CDC reported that a nationally representative study estimated that 1 in 4 teenage girls in the U.S. has an STD.  The study included the most common STDs: HPV, chlamydia, herpes simplex virus, and trichomoniasis.

There are approximately 15 million new cases of sexually transmitted infection each year in the United States, and 340 million worldwide.30

The majority of STI's are asymptomatic (no symptoms). Asymptomatic infections can be transmitted to sexual partners.

Having certain sexually transmitted infections increases the risk of acquiring or transmitting HIV.

Gender Disparities

Although the health risks associated with STIs affect both women and men, women are disproportionately affected. Women are more likely than are men to have asymptomatic infections, and also have greater biological susceptibility to acquire infections if exposed.

Untreated STIs in women can lead to pelvic inflammatory disease (PID), infertility, ectopic pregnancy, cancers of the reproductive tract, pregnancy loss, neonatal morbidity and mortality, and an increased risk of HIV transmission.

Untreated STIs in men can lead to an increased risk of HIV transmission, prostatitis, epididymitis, infertility, and reactive arthritis (formerly known as Reiter’s syndrome).

Common Sexually Transmitted Infections

There are over 20 different sexually transmitted infections, and other infections that are considered “sexually associated”. Viruses, and bacteria cause the majority of STIs. Bacterial STIs, which include infections such as chlamydia, gonorrhea, and syphilis, can be cured with antibiotics. Viral STIs, including HPV, herpes, hepatitis, and HIV, cannot be cured, though they can often be treated. The most common STIs are discussed below.

You've probably received the advice previously to use protection and make sure that you get tested if you are sexually active. This is very important since most of the times a person infected with STI/STD viruses doesn't have any idea that they already have the virus. If you feel like you need a test, talk to your doctor about your concerns.

First seen on: (http://ift.tt/2aYGJtQ)

Several STDs can be effectively prevented through pre-exposure vaccination with widely available vaccines, including HAV, HBV, and HPV. Vaccines for other STDs (e.g., HIV and HSV) are under development or are undergoing clinical trials. This guidance focuses largely on integrating the use of available vaccines into STD prevention and treatment activities.

Every person being evaluated or treated for an STD should receive hepatitis B vaccination unless already vaccinated. In addition, some persons (e.g., MSM and IDUs) should receive hepatitis A vaccination.

Hepatitis A

Hepatitis A, caused by infection with HAV, has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease (CLD). However, 10%–15% of patients experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and most children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection.

Video Credit

HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of HAV is uncommon. HAV occasionally is detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated.

In the United States, almost half of all persons with hepatitis A report having no risk factor for the disease. Among adults with identified risk factors, most cases occur among international travelers, household or sexual contacts, nonhousehold contacts (e.g., those encountered through play and daycare), and IDUs (437). Because transmission of HAV during sexual activity probably results from fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of hepatitis A. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection (e.g., MSM, illegal drug users, and persons with CLD), many of whom might seek services in STD clinics.

Treatment

Patients with acute hepatitis A usually require only supportive care, with no restrictions in diet or activity. Hospitalization might be necessary for patients who become dehydrated because of nausea and vomiting and is critical for patients with signs or symptoms of acute liver failure. Medications that might cause liver damage or are metabolized by the liver should be used with caution among persons with hepatitis A.

Prevention

Two products are available for the prevention of HAV infection: hepatitis A vaccine (Table 2) and immune globulin (IG) for IM administration. Hepatitis A vaccines are prepared from formalin-inactivated, cell-culture–derived HAV and have been available in the United States since 1995, initially for persons aged ≥2 years. In 2005, the vaccines were approved by FDA for persons aged ≥12 months, and the vaccine is available for eligible children and adolescents aged <19 years through the VFC program (telephone: 800-232-4636).

Pre-exposure Vaccination

Persons in the following groups who are likely to be treated in STD clinic settings should be offered hepatitis A vaccine: 1) all MSM; 2) illegal drug users (of both injection and noninjection drugs); and 3) persons with CLD, including persons with chronic HBV and HCV infection who have evidence of CLD.

Pre Vaccination Serologic Testing for Susceptibility

Approximately one third of the U.S. population has serologic evidence of previous HAV infection, which increases with age and reaches 75% among persons aged >70 years. Screening for HAV infection might be cost-effective in populations where the prevalence of infection is likely to be high (e.g., persons aged >40 years and persons born in areas of high HAV endemicity). The potential cost-savings of testing should be weighed against the cost and the likelihood that testing will interfere with initiating vaccination. Vaccination of a person who is already immune is not harmful.

Postvaccination Serologic Testing

Postvaccination serologic testing is not indicated because most persons respond to the vaccine. In addition, the commercially available serologic test is not sensitive enough to detect the low, but protective, levels of antibody produced by vaccination.

Hepatitis B

Hepatitis B is caused by infection with the hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. The highest concentrations of HBV are found in blood, with lower concentrations found in other body fluids including wound exudates, semen, vaginal secretions, and saliva (439,440). HBV is more infectious and relatively more stable in the environment than other bloodborne pathogens like HCV and HIV.

HBV infection can be self-limited or chronic. In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at acquisition; approximately 90% of infected infants and 30% of infected children aged <5 years become chronically infected, compared with 2%–6% of persons who become infected as adults. Among persons with chronic HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma (HCC) is 15%–25%.

Video Credit

HBV is efficiently transmitted by percutaneous or mucous membrane exposure to blood or body fluids that contain blood. The primary risk factors associated with infection among adolescents and adults are unprotected sex with an infected partner, unprotected sex with more than one partner, MSM, history of other STDs, and illegal injection-drug use. In addition, several studies have demonstrated the horizontal transmission of HBV, including through premastication, as a less common source of transmission (441,442).

CDC’s national strategy to eliminate transmission of HBV infection includes 1) prevention of perinatal infection through routine screening of all pregnant women for HBsAg and immunoprophylaxis of infants born to HBsAg-positive mothers or mothers whose HBsAg status is unknown, 2) routine infant vaccination, 3) vaccination of previously unvaccinated children and adolescents through age 18 years, and 4) vaccination of previously unvaccinated adults at increased risk for infection (3,4). High vaccination coverage rates, with subsequent declines in acute hepatitis B incidence, have been achieved among infants and adolescents (4,437,443). In contrast, vaccination coverage among most high-risk adult groups (e.g., persons with more than one sex partner in the previous 6 months, MSM, and IDUs) has remained low, and most new infections occur in these high-risk groups (3,108,444-446). STD clinics and other settings that provide services to high-risk adults are ideal sites in which to provide hepatitis B vaccination to adults at risk for HBV infection. All unvaccinated adults seeking services in these settings should be assumed to be at risk for hepatitis B and should be offered hepatitis B vaccination.

Treatment

No specific therapy is available for persons with acute hepatitis B; treatment is supportive. Persons with chronic HBV infection should be referred for evaluation to a physician experienced in the management of CLD. Therapeutic agents cleared by FDA for treatment of chronic hepatitis B can achieve sustained suppression of HBV replication and remission of liver disease in some persons. In addition, patients with chronic hepatitis B might benefit from screening to detect HCC at an early stage.

Prevention

Two products have been approved for hepatitis B prevention: hepatitis B immune globulin (HBIG) and hepatitis B vaccine (3,4). HBIG provides temporary (i.e., 3–6 months) protection from HBV infection and is typically used as PEP either as an adjunct to hepatitis B vaccination in previously unvaccinated persons or alone in persons who have not responded to vaccination. HBIG is prepared from plasma known to contain high concentrations of anti-HBs. The recommended dose of HBIG is 0.06 mL/kg.

Hepatitis B vaccine contains HBsAg produced in yeast by recombinant DNA technology and provides protection from HBV infection when used for both pre-exposure vaccination and PEP. The two available monovalent hepatitis B vaccines for use in adolescents and adults are Recombivax HB (Merck and Co., Inc., Whitehouse Station, New Jersey) and Engerix-B (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania). A combination vaccine (hepatitis A and hepatitis B) for use in adults, Twinrix (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania), also is available. The recommended HBV dose varies by product and age of recipient (Table 3).

Pre-exposure Vaccination

Hepatitis B vaccination is recommended for all unvaccinated adolescents, all unvaccinated adults at risk for HBV infection, and all adults seeking protection from HBV infection. For adults, acknowledgement of a specific risk factor is not a requirement for vaccination.

Hepatitis B vaccine should be routinely offered to all unvaccinated persons attending STD clinics and to all unvaccinated persons seeking treatment for STDs in other settings. Other settings where all unvaccinated adults should be assumed to be at risk for hepatitis B and should receive hepatitis B vaccination include correctional facilities, facilities providing drug abuse treatment and prevention services, health-care settings serving MSM, and HIV testing and treatment facilities. All persons who receive clinical services in these settings should be offered hepatitis B vaccine unless they have a reliable vaccination history (i.e., a written, dated record of each dose of a complete series). In all settings, vaccination should be initiated even when completion of the vaccine series cannot be ensured.

Post Vaccination Testing for Serologic Response

Serologic testing for immunity is not necessary after routine vaccination of adolescents or adults. However, such testing is recommended for persons whose subsequent clinical management depends on knowledge of their immune status (e.g., health-care workers or public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids). In addition, post vaccination testing is recommended for 1) HIV-infected persons and other immunocompromised persons to determine the need for revaccination and the type of follow-up testing and 2) sex and needle-sharing partners of HBsAg-positive persons to determine the need for revaccination and for other methods to protect themselves from HBV infection.

If indicated, testing should be performed 1–2 months after administration of the last dose of the vaccine series by using a method that allows determination of a protective level of anti-HBs (i.e., ≥10 mIU/mL). Persons determined to have anti-HBs levels of <10 mIU/mL after the primary vaccine series should be revaccinated with a 3-dose series and provided with anti-HBs testing 1–2 months after the third dose. Persons who do not respond to revaccination should be tested for HBsAg. If HBsAg positive, the person should receive appropriate management (see Management of HBsAg-Positive Persons); if HBsAg negative, the person should be considered susceptible to HBV infection and counseled concerning precautions to prevent HBV infection and the need for HBIG PEP for any known exposure (see Postexposure Prophylaxis).

Exposure to Source with Unknown HBsAg Status

Unvaccinated persons who have a discrete, identifiable exposure to blood or body fluids containing blood from a source with unknown HBsAg status should receive the hepatitis B vaccine series, with the first dose initiated as soon as possible after exposure (preferably within 24 hours) and the series completed by using the age-appropriate dose and schedule. Exposed persons who are not fully vaccinated should complete the vaccine series. Exposed persons with written documentation of a complete hepatitis B vaccine series require no further treatment.

HIV Infection

HIV infection can impair the response to hepatitis B vaccination. HIV-infected persons should be tested for anti-HBs 1–2 months after the third vaccine dose (see Postvaccination Testing for Serologic Response). Modified dosing regimens, including a doubling of the standard antigen dose and administration of additional doses, might increase the response rate (130).

Management of HBsAg-Positive Persons

This section provides recommendations for management of all HBsAg-positive persons. Additional recommendations for management of HBsAg-positive persons who are coinfected with HIV are available (130).

All persons with HBsAg-positive laboratory results should be reported to the state or local health department.

To verify the presence of chronic HBV infection, HBsAg-positive persons should be retested. The absence of IgM anti-HBc or the persistence of HBsAg for 6 months indicates chronic HBV infection.

Persons with chronic HBV infection should be referred for evaluation to a physician from Meet Positives SM Feed 3 http://ift.tt/2wr4FQu via IFTTT

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Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs was first published to: www.blog.meetpositives.com Hepatitis A, hepatitis B and HPV are the only vaccine-preventable STDs/STIs. (Not all HPV types are covered by the vaccine, so women who receive it still need Pap tests.) This is  the perfect time to think about protecting yourself from sexually transmitted viruses. These bacteria or infections can be passed from person to person primarily through a variety of sexual activities and they can only be diagnosed through testing since most of them shows no symptoms at all. The recent data shows that Hepatitis A, Hepatitis B and HPV are the only vaccine-preventable STDs/STIs.   First seen on: (http://www.columbia.edu/itc/hs/pubhealth/modules/reproductiveHealth/infections.html) Sexually transmitted infections (STIs) have historically been referred to as venereal disease, named for Venus, the goddess of love. Medical providers and public health practitioners today have replaced this term with more accurate and neutral terminology: sexually transmitted disease (STD) or sexually transmitted infection (STI). The term reproductive tract infection (RTI) is often used to describe infections that are sexually transmitted, as well as other common infections that may or may not be sexually transmitted (i.e. candidiasis, bacterial vaginosis). Epidemiology of STIs Sexually transmitted infections (STI's) are transmitted from person to person through vaginal, oral, or anal sex with an infected partner; and/or from a pregnant woman (if infected) to her fetus or baby during pregnancy and labor and delivery. In 2008, the CDC reported that a nationally representative study estimated that 1 in 4 teenage girls in the U.S. has an STD.  The study included the most common STDs: HPV, chlamydia, herpes simplex virus, and trichomoniasis. There are approximately 15 million new cases of sexually transmitted infection each year in the United States, and 340 million worldwide.30 The majority of STI's are asymptomatic (no symptoms). Asymptomatic infections can be transmitted to sexual partners. Having certain sexually transmitted infections increases the risk of acquiring or transmitting HIV. Gender Disparities Although the health risks associated with STIs affect both women and men, women are disproportionately affected. Women are more likely than are men to have asymptomatic infections, and also have greater biological susceptibility to acquire infections if exposed. Untreated STIs in women can lead to pelvic inflammatory disease (PID), infertility, ectopic pregnancy, cancers of the reproductive tract, pregnancy loss, neonatal morbidity and mortality, and an increased risk of HIV transmission. Untreated STIs in men can lead to an increased risk of HIV transmission, prostatitis, epididymitis, infertility, and reactive arthritis (formerly known as Reiter’s syndrome). Common Sexually Transmitted Infections There are over 20 different sexually transmitted infections, and other infections that are considered “sexually associated”. Viruses, and bacteria cause the majority of STIs. Bacterial STIs, which include infections such as chlamydia, gonorrhea, and syphilis, can be cured with antibiotics. Viral STIs, including HPV, herpes, hepatitis, and HIV, cannot be cured, though they can often be treated. The most common STIs are discussed below. You've probably received the advice previously to use protection and make sure that you get tested if you are sexually active. This is very important since most of the times a person infected with STI/STD viruses doesn't have any idea that they already have the virus. If you feel like you need a test, talk to your doctor about your concerns. First seen on: (http://www.cdc.gov/std/treatment/2010/vaccine.htm) Several STDs can be effectively prevented through pre-exposure vaccination with widely available vaccines, including HAV, HBV, and HPV. Vaccines for other STDs (e.g., HIV and HSV) are under development or are undergoing clinical trials. This guidance focuses largely on integrating the use of available vaccines into STD prevention and treatment activities. Every person being evaluated or treated for an STD should receive hepatitis B vaccination unless already vaccinated. In addition, some persons (e.g., MSM and IDUs) should receive hepatitis A vaccination. Hepatitis A Hepatitis A, caused by infection with HAV, has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease (CLD). However, 10%–15% of patients experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and most children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection. Video Credit HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of HAV is uncommon. HAV occasionally is detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated. In the United States, almost half of all persons with hepatitis A report having no risk factor for the disease. Among adults with identified risk factors, most cases occur among international travelers, household or sexual contacts, nonhousehold contacts (e.g., those encountered through play and daycare), and IDUs (437). Because transmission of HAV during sexual activity probably results from fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of hepatitis A. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection (e.g., MSM, illegal drug users, and persons with CLD), many of whom might seek services in STD clinics. Treatment Patients with acute hepatitis A usually require only supportive care, with no restrictions in diet or activity. Hospitalization might be necessary for patients who become dehydrated because of nausea and vomiting and is critical for patients with signs or symptoms of acute liver failure. Medications that might cause liver damage or are metabolized by the liver should be used with caution among persons with hepatitis A. Prevention Two products are available for the prevention of HAV infection: hepatitis A vaccine (Table 2) and immune globulin (IG) for IM administration. Hepatitis A vaccines are prepared from formalin-inactivated, cell-culture–derived HAV and have been available in the United States since 1995, initially for persons aged ≥2 years. In 2005, the vaccines were approved by FDA for persons aged ≥12 months, and the vaccine is available for eligible children and adolescents aged 70 years. Screening for HAV infection might be cost-effective in populations where the prevalence of infection is likely to be high (e.g., persons aged >40 years and persons born in areas of high HAV endemicity). The potential cost-savings of testing should be weighed against the cost and the likelihood that testing will interfere with initiating vaccination. Vaccination of a person who is already immune is not harmful. Postvaccination Serologic Testing Postvaccination serologic testing is not indicated because most persons respond to the vaccine. In addition, the commercially available serologic test is not sensitive enough to detect the low, but protective, levels of antibody produced by vaccination. Hepatitis B Hepatitis B is caused by infection with the hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. The highest concentrations of HBV are found in blood, with lower concentrations found in other body fluids including wound exudates, semen, vaginal secretions, and saliva (439,440). HBV is more infectious and relatively more stable in the environment than other bloodborne pathogens like HCV and HIV. HBV infection can be self-limited or chronic. In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at acquisition; approximately 90% of infected infants and 30% of infected children aged

http://hsvfacts.blogspot.com/2018/05/did-you-know-hepatitis-and-hpv-are_16.html

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Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs

The following post Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs is republished from: Meet Positives Herpes Dating Website

Hepatitis A, hepatitis B and HPV are the only vaccine-preventable STDs/STIs.

(Not all HPV types are covered by the vaccine, so women who receive it still need Pap tests.)

This is  the perfect time to think about protecting yourself from sexually transmitted viruses. These bacteria or infections can be passed from person to person primarily through a variety of sexual activities and they can only be diagnosed through testing since most of them shows no symptoms at all.

The recent data shows that Hepatitis A, Hepatitis B and HPV are the only vaccine-preventable STDs/STIs.

First seen on: (http://ift.tt/2aebCxa)

Sexually transmitted infections (STIs) have historically been referred to as venereal disease, named for Venus, the goddess of love. Medical providers and public health practitioners today have replaced this term with more accurate and neutral terminology: sexually transmitted disease (STD) or sexually transmitted infection (STI).

The term reproductive tract infection (RTI) is often used to describe infections that are sexually transmitted, as well as other common infections that may or may not be sexually transmitted (i.e. candidiasis, bacterial vaginosis).

Epidemiology of STIs

Sexually transmitted infections (STI's) are transmitted from person to person through vaginal, oral, or anal sex with an infected partner; and/or from a pregnant woman (if infected) to her fetus or baby during pregnancy and labor and delivery.

In 2008, the CDC reported that a nationally representative study estimated that 1 in 4 teenage girls in the U.S. has an STD.  The study included the most common STDs: HPV, chlamydia, herpes simplex virus, and trichomoniasis.

There are approximately 15 million new cases of sexually transmitted infection each year in the United States, and 340 million worldwide.30

The majority of STI's are asymptomatic (no symptoms). Asymptomatic infections can be transmitted to sexual partners.

Having certain sexually transmitted infections increases the risk of acquiring or transmitting HIV.

Gender Disparities

Although the health risks associated with STIs affect both women and men, women are disproportionately affected. Women are more likely than are men to have asymptomatic infections, and also have greater biological susceptibility to acquire infections if exposed.

Untreated STIs in women can lead to pelvic inflammatory disease (PID), infertility, ectopic pregnancy, cancers of the reproductive tract, pregnancy loss, neonatal morbidity and mortality, and an increased risk of HIV transmission.

Untreated STIs in men can lead to an increased risk of HIV transmission, prostatitis, epididymitis, infertility, and reactive arthritis (formerly known as Reiter’s syndrome).

Common Sexually Transmitted Infections

There are over 20 different sexually transmitted infections, and other infections that are considered “sexually associated”. Viruses, and bacteria cause the majority of STIs. Bacterial STIs, which include infections such as chlamydia, gonorrhea, and syphilis, can be cured with antibiotics. Viral STIs, including HPV, herpes, hepatitis, and HIV, cannot be cured, though they can often be treated. The most common STIs are discussed below.

You've probably received the advice previously to use protection and make sure that you get tested if you are sexually active. This is very important since most of the times a person infected with STI/STD viruses doesn't have any idea that they already have the virus. If you feel like you need a test, talk to your doctor about your concerns.

First seen on: (http://ift.tt/2aYGJtQ)

Several STDs can be effectively prevented through pre-exposure vaccination with widely available vaccines, including HAV, HBV, and HPV. Vaccines for other STDs (e.g., HIV and HSV) are under development or are undergoing clinical trials. This guidance focuses largely on integrating the use of available vaccines into STD prevention and treatment activities.

Every person being evaluated or treated for an STD should receive hepatitis B vaccination unless already vaccinated. In addition, some persons (e.g., MSM and IDUs) should receive hepatitis A vaccination.

Hepatitis A

Hepatitis A, caused by infection with HAV, has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease (CLD). However, 10%–15% of patients experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and most children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection.

Video Credit

HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of HAV is uncommon. HAV occasionally is detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated.

In the United States, almost half of all persons with hepatitis A report having no risk factor for the disease. Among adults with identified risk factors, most cases occur among international travelers, household or sexual contacts, nonhousehold contacts (e.g., those encountered through play and daycare), and IDUs (437). Because transmission of HAV during sexual activity probably results from fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of hepatitis A. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection (e.g., MSM, illegal drug users, and persons with CLD), many of whom might seek services in STD clinics.

Treatment

Patients with acute hepatitis A usually require only supportive care, with no restrictions in diet or activity. Hospitalization might be necessary for patients who become dehydrated because of nausea and vomiting and is critical for patients with signs or symptoms of acute liver failure. Medications that might cause liver damage or are metabolized by the liver should be used with caution among persons with hepatitis A.

Prevention

Two products are available for the prevention of HAV infection: hepatitis A vaccine (Table 2) and immune globulin (IG) for IM administration. Hepatitis A vaccines are prepared from formalin-inactivated, cell-culture–derived HAV and have been available in the United States since 1995, initially for persons aged ≥2 years. In 2005, the vaccines were approved by FDA for persons aged ≥12 months, and the vaccine is available for eligible children and adolescents aged <19 years through the VFC program (telephone: 800-232-4636).

Pre-exposure Vaccination

Persons in the following groups who are likely to be treated in STD clinic settings should be offered hepatitis A vaccine: 1) all MSM; 2) illegal drug users (of both injection and noninjection drugs); and 3) persons with CLD, including persons with chronic HBV and HCV infection who have evidence of CLD.

Pre Vaccination Serologic Testing for Susceptibility

Approximately one third of the U.S. population has serologic evidence of previous HAV infection, which increases with age and reaches 75% among persons aged >70 years. Screening for HAV infection might be cost-effective in populations where the prevalence of infection is likely to be high (e.g., persons aged >40 years and persons born in areas of high HAV endemicity). The potential cost-savings of testing should be weighed against the cost and the likelihood that testing will interfere with initiating vaccination. Vaccination of a person who is already immune is not harmful.

Postvaccination Serologic Testing

Postvaccination serologic testing is not indicated because most persons respond to the vaccine. In addition, the commercially available serologic test is not sensitive enough to detect the low, but protective, levels of antibody produced by vaccination.

Hepatitis B

Hepatitis B is caused by infection with the hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. The highest concentrations of HBV are found in blood, with lower concentrations found in other body fluids including wound exudates, semen, vaginal secretions, and saliva (439,440). HBV is more infectious and relatively more stable in the environment than other bloodborne pathogens like HCV and HIV.

HBV infection can be self-limited or chronic. In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at acquisition; approximately 90% of infected infants and 30% of infected children aged <5 years become chronically infected, compared with 2%–6% of persons who become infected as adults. Among persons with chronic HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma (HCC) is 15%–25%.

Video Credit

HBV is efficiently transmitted by percutaneous or mucous membrane exposure to blood or body fluids that contain blood. The primary risk factors associated with infection among adolescents and adults are unprotected sex with an infected partner, unprotected sex with more than one partner, MSM, history of other STDs, and illegal injection-drug use. In addition, several studies have demonstrated the horizontal transmission of HBV, including through premastication, as a less common source of transmission (441,442).

CDC’s national strategy to eliminate transmission of HBV infection includes 1) prevention of perinatal infection through routine screening of all pregnant women for HBsAg and immunoprophylaxis of infants born to HBsAg-positive mothers or mothers whose HBsAg status is unknown, 2) routine infant vaccination, 3) vaccination of previously unvaccinated children and adolescents through age 18 years, and 4) vaccination of previously unvaccinated adults at increased risk for infection (3,4). High vaccination coverage rates, with subsequent declines in acute hepatitis B incidence, have been achieved among infants and adolescents (4,437,443). In contrast, vaccination coverage among most high-risk adult groups (e.g., persons with more than one sex partner in the previous 6 months, MSM, and IDUs) has remained low, and most new infections occur in these high-risk groups (3,108,444-446). STD clinics and other settings that provide services to high-risk adults are ideal sites in which to provide hepatitis B vaccination to adults at risk for HBV infection. All unvaccinated adults seeking services in these settings should be assumed to be at risk for hepatitis B and should be offered hepatitis B vaccination.

Treatment

No specific therapy is available for persons with acute hepatitis B; treatment is supportive. Persons with chronic HBV infection should be referred for evaluation to a physician experienced in the management of CLD. Therapeutic agents cleared by FDA for treatment of chronic hepatitis B can achieve sustained suppression of HBV replication and remission of liver disease in some persons. In addition, patients with chronic hepatitis B might benefit from screening to detect HCC at an early stage.

Prevention

Two products have been approved for hepatitis B prevention: hepatitis B immune globulin (HBIG) and hepatitis B vaccine (3,4). HBIG provides temporary (i.e., 3–6 months) protection from HBV infection and is typically used as PEP either as an adjunct to hepatitis B vaccination in previously unvaccinated persons or alone in persons who have not responded to vaccination. HBIG is prepared from plasma known to contain high concentrations of anti-HBs. The recommended dose of HBIG is 0.06 mL/kg.

Hepatitis B vaccine contains HBsAg produced in yeast by recombinant DNA technology and provides protection from HBV infection when used for both pre-exposure vaccination and PEP. The two available monovalent hepatitis B vaccines for use in adolescents and adults are Recombivax HB (Merck and Co., Inc., Whitehouse Station, New Jersey) and Engerix-B (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania). A combination vaccine (hepatitis A and hepatitis B) for use in adults, Twinrix (GlaxoSmithKline Biologicals, Pittsburgh, Pennsylvania), also is available. The recommended HBV dose varies by product and age of recipient (Table 3).

Pre-exposure Vaccination

Hepatitis B vaccination is recommended for all unvaccinated adolescents, all unvaccinated adults at risk for HBV infection, and all adults seeking protection from HBV infection. For adults, acknowledgement of a specific risk factor is not a requirement for vaccination.

Hepatitis B vaccine should be routinely offered to all unvaccinated persons attending STD clinics and to all unvaccinated persons seeking treatment for STDs in other settings. Other settings where all unvaccinated adults should be assumed to be at risk for hepatitis B and should receive hepatitis B vaccination include correctional facilities, facilities providing drug abuse treatment and prevention services, health-care settings serving MSM, and HIV testing and treatment facilities. All persons who receive clinical services in these settings should be offered hepatitis B vaccine unless they have a reliable vaccination history (i.e., a written, dated record of each dose of a complete series). In all settings, vaccination should be initiated even when completion of the vaccine series cannot be ensured.

Post Vaccination Testing for Serologic Response

Serologic testing for immunity is not necessary after routine vaccination of adolescents or adults. However, such testing is recommended for persons whose subsequent clinical management depends on knowledge of their immune status (e.g., health-care workers or public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids). In addition, post vaccination testing is recommended for 1) HIV-infected persons and other immunocompromised persons to determine the need for revaccination and the type of follow-up testing and 2) sex and needle-sharing partners of HBsAg-positive persons to determine the need for revaccination and for other methods to protect themselves from HBV infection.

If indicated, testing should be performed 1–2 months after administration of the last dose of the vaccine series by using a method that allows determination of a protective level of anti-HBs (i.e., ≥10 mIU/mL). Persons determined to have anti-HBs levels of <10 mIU/mL after the primary vaccine series should be revaccinated with a 3-dose series and provided with anti-HBs testing 1–2 months after the third dose. Persons who do not respond to revaccination should be tested for HBsAg. If HBsAg positive, the person should receive appropriate management (see Management of HBsAg-Positive Persons); if HBsAg negative, the person should be considered susceptible to HBV infection and counseled concerning precautions to prevent HBV infection and the need for HBIG PEP for any known exposure (see Postexposure Prophylaxis).

Exposure to Source with Unknown HBsAg Status

Unvaccinated persons who have a discrete, identifiable exposure to blood or body fluids containing blood from a source with unknown HBsAg status should receive the hepatitis B vaccine series, with the first dose initiated as soon as possible after exposure (preferably within 24 hours) and the series completed by using the age-appropriate dose and schedule. Exposed persons who are not fully vaccinated should complete the vaccine series. Exposed persons with written documentation of a complete hepatitis B vaccine series require no further treatment.

HIV Infection

HIV infection can impair the response to hepatitis B vaccination. HIV-infected persons should be tested for anti-HBs 1–2 months after the third vaccine dose (see Postvaccination Testing for Serologic Response). Modified dosing regimens, including a doubling of the standard antigen dose and administration of additional doses, might increase the response rate (130).

Management of HBsAg-Positive Persons

This section provides recommendations for management of all HBsAg-positive persons. Additional recommendations for management of HBsAg-positive persons who are coinfected with HIV are available (130).

All persons with HBsAg-positive laboratory results should be reported to the state or local health department.

To verify the presence of chronic HBV infection, HBsAg-positive persons should be retested. The absence of IgM anti-HBc or the persistence of HBsAg for 6 months indicates chronic HBV infection.

Persons with chronic HBV infection should be referred for evaluation to a physician from Meet Positives SM Feed 5 http://ift.tt/2wr4FQu via IFTTT