Chickenpox

Chickenpox is an infectious disease caused by the varicella virus. Most cases occur in children under age 15 but older children and adults can get it. It spreads very easily by coughing and sneezing, by direct contact, and by aerosolization of virus from skin lesions.

Symptoms
A skin rash of blister-like lesions, covering the body but usually more concentrated on the face, scalp, and trunk. Most, but not all, infected individuals have fever, which develops just before or when the rash appears. The disease is usually mild and lasts 5 to 10 days, but it may cause serious complications, such as bacterial infection of the skin, swelling of the brain, and pneumonia. Adolescents and adults are more at risk for severe disease.

Treatment
Parents can do several things at home to help relieve their childs chickenpox symptoms. Because scratching the blisters may cause them to become infected, keep your childs fingernails trimmed short. Calamine lotion and Aveeno (oatmeal) baths may help relieve some of the itching. Do not use aspirin or aspirin-containing products to relieve your child's fever. The use of aspirin in children with chickenpox has been associated with development of Reyes syndrome (a severe disease affecting all organs, but most seriously affecting the liver and brain, that may cause death). Use non-aspirin medications such as acetaminophen (e.g., Tylenol). Your health-care provider will advise you on treatment options. Acyclovir, famcyclovir, or valacyclovir (medicines that work against herpesviruses) are recommended for persons who are more likely to develop serious disease, including persons with chronic skin or lung disease, otherwise healthy individuals 13 years of age or older, and persons receiving steroid therapy. However, only acyclovir is currently licensed for use in treating varicella.

Vaccination
Chickenpox vaccine is the best way to prevent chickenpox. Vaccination not only protects vaccinated persons, it also reduces the risk for exposure in the community for persons unable to be vaccinated because of illness or other conditions, including those who may be at greater risk for severe disease. While no vaccine is 100% effective in preventing disease, the chickenpox vaccine is very effective: about 8 to 9 of every 10 people who are vaccinated are completely protected from chickenpox. In addition, the vaccine almost always prevents against severe disease.

Dengue fever
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Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses, DEN-1, DEN-2, DEN-3, and DEN-4. This disease used to be called "break-bone" fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking, hence the name. Dengue fever is found mostly during and shortly after the rainy season in tropical and subtropical areas of Africa, Southeast Asia, India, Central and South America, and Australia. Worldwide, more than 100 million cases of dengue infection occur each year. The dengue virus infections are transmitted via bite of an infected Aedes mosquito. Mosquitoes become infected when they bite infected humans, and later transmit infection to other people they bite. Two main species of mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all cases of dengue transmitted in this country. Dengue is not contagious from person to person.

Symptoms and Diagnosis

Symptoms of typical uncomplicated (classic) dengue usually start with fever within 5 to 6 days after being bitten by an infected mosquito. They include High fever, up to 105 degrees Fahrenheit Severe headache Retro-orbital (behind the eye) pain Severe joint and muscle pain Nausea and vomiting Rash The rash may appear over most of the body 3 to 4 days after the fever begins. Some people may get a second rash later in the disease.

Complications
Dengue infection may cause dengue hemorrhagic fever or dengue shock syndrome, which are more severe than the classic dengue. Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus Marked damage to blood and lymph vessels Bleeding from the nose, gums, or under the skin, causing purplish bruises This form of dengue disease can cause death.

Symptoms of dengue shock syndrome--the most severe form of dengue disease--include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus Fluids leaking outside of blood vessels Massive bleeding Shock (very low blood pressure) This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue infection. It is sometimes fatal, especially in children and young adults.

Treatment
There is no specific treatment for classic dengue fever, and most people will recover completely within 2 weeks. To help with recovery, health care experts recommend Getting plenty of bed rest Drinking lots of fluids Taking medicine to reduce fever The Centers for Disease Control and Prevention (CDC) advises people with dengue fever not to take aspirin. Acetaminophen or other over-the-counter pain-reducing medicines are safe for most people. For severe dengue symptoms, including shock and coma, early and aggressive emergency treatment with fluid and electrolyte replacement can be lifesaving.

Sexually transmitted diseases (STDs)

Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. While substantial progress has been made in preventing, diagnosing, and treating certain STDs in recent years, about 19 million new infections occur each year, almost half of them among young people ages 15 to 24. For information about specific STDs, please visit the pages from the left menu. The following is an excerpt of the prevention methods published by Centers for Disease Control and Prevention. Prevention Methods Abstinence and Reduction of Number of Sex Partners The most reliable way to avoid transmission of STDs is to abstain from sex (i.e., oral, 3

vaginal, or anal sex) or to be in a long-term, mutually monogamous relationship with an uninfected partner. Preexposure Vaccination Preexposure vaccination is one of the most effective methods for preventing transmission of some STDs. For example, because HBV infection is frequently sexually transmitted, hepatitis B vaccination is recommended for all unvaccinated, uninfected persons being evaluated for an STD. In addition, hepatitis A vaccine is licensed and is recommended for men who have sex with men (MSM) and illicit drug users (i.e., both injecting and noninjecting). A vaccine against human papillomavirus (HPV types 6, 11, 16, 18) is now available and licensed for females aged 9-26 years. Male Condoms When used consistently and correctly, male latex condoms are highly effective in preventing the sexual transmission of HIV infection and can reduce the risk for other STDs, including chlamydia, gonorrhea, and trichomoniasis, and might reduce the risk of women developing pelvic inflammatory disease (PID). Each latex condom manufactured in the United States is tested electronically for holes before packaging. Rates of condom breakage during sexual intercourse and withdrawal are approximately two broken condoms per 100 condoms used in the United States. The failure of condoms to protect against STD transmission or unintended pregnancy usually results from inconsistent or incorrect use rather than condom breakage. The following recommendations ensure the proper use of male condoms: Use a new condom with each sex act (e.g., oral, vaginal, and anal). Carefully handle the condom to avoid damaging it with fingernails, teeth, or other sharp objects. Put the condom on after the penis is erect and before any genital, oral, or anal contact with the partner. Use only water-based lubricants (e.g., K-Y Jelly, Astroglide, AquaLube, and glycerin) with latex condoms. Oil-based lubricants (e.g., petroleum jelly, shortening, mineral oil, massage oils, body lotions, and cooking oil) can weaken latex. Ensure adequate lubrication during vaginal and anal sex, which might require the use of exogenous water-based lubricants. To prevent the condom from slipping off, hold the condom firmly against the base of the penis during withdrawal, and withdraw while the penis is still erect. Female Condoms Laboratory studies indicate that the female condom (Reality, which consists of a lubricated polyurethane sheath with a ring on each end that is inserted into the vagina, is 4

an effective mechanical barrier to viruses, including HIV, and to semen. Vaginal Spermicides and Diaphragms Vaginal spermicides containing nonoxynol-9 (N-9) are not effective in preventing cervical gonorrhea, chlamydia, or HIV infection. Furthermore, frequent use of spermicides containing N-9 has been associated with disruption of the genital epithelium, which might be associated with an increased risk for HIV transmission. Therefore, N-9 is not recommended for STD/HIV prevention. In case-control and cross-sectional studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis; a randomized controlled trial will be conducted. On the basis of all available evidence, diaphragms should not be relied on as the sole source of protection against HIV infection. Diaphragm and spermicide use have been associated with an increased risk for bacterial urinary tract infections in women. Condoms and N-9 Vaginal Spermicides Condoms lubricated with spermicides are no more effective than other lubricated condoms in protecting against the transmission of HIV and other STDs, and those that are lubricated with N-9 pose the concerns that have been previously discussed. Use of condoms lubricated with N-9 is not recommended for STD/HIV prevention because spermicide-coated condoms cost more, have a shorter shelf-life than other lubricated condoms, and have been associated with urinary tract infection in young women. Rectal Use of N-9 Spermicides Recent studies indicate that N-9 might increase the risk for HIV transmission during vaginal intercourse. Although similar studies have not been conducted among men who use N-9 spermicide during anal intercourse with other men, N-9 can damage the cells lining the rectum, which might provide a portal of entry for HIV and other sexually transmissible agents. Therefore, N-9 should not be used as a microbicide or lubricant during anal intercourse. Nonbarrier Contraception, Surgical Sterilization, and Hysterectomy Sexually active women who are not at risk for pregnancy might incorrectly perceive themselves to be at no risk for STDs, including HIV infection. Contraceptive methods that are not mechanical barriers offer no protection against HIV or other STDs. Women who use hormonal contraception (e.g., oral contraceptives, Norplant, and Depo-Provera, have in-trauterine devices (IUD), have been surgically sterilized, or have had hysterectomies should be counseled regarding the use of condoms and the risk for STDs, including HIV infection. Emergency Contraception (EC) Emergency use of oral contraceptive pills containing levonorgesterol alone reduces the risk for pregnancy after unprotected intercourse by 89%. Pills containing a combination of ethinyl estradiol and either norgestrel or levonorgestrel can be used and reduce the risk for pregnancy by 75%. Emergency insertion of a copper IUD also is highly effective,

reducing the risk by as much as 99%. EC with oral contraceptive pills should be initiated as soon as possible after unprotected intercourse and definitely within 120 hours (i.e., 5 days). The only medical contraindication to provision of EC is current pregnancy. Providers who manage persons at risk for STDs should counsel women concerning the option for EC, if indicated, and provide it in a timely fashion if desired by the woman. Plan B (two 750 mcg levonorgestrel tablets) has been approved by FDA and is available in the United States for the prevention of unintended pregnancy.

Gonorrhea
Gonorrhea is a sexually transmitted disease (STD) caused by bacteria called Neisseria gonorrhoeae. These bacteria can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacteria can also grow in the mouth, throat, eyes, and anus. Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during delivery. It is estimated that more than 700,000 persons in the U.S. get new gonorrheal infections each year.

Symptoms and Diagnosis

Although many men with gonorrhea may have no symptoms at all, some men have some signs or symptoms that appear two to five days after infection; symptoms can take as long as 30 days to appear. Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles. In women, the symptoms of gonorrhea are often mild, but most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms. Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements. Rectal infection also may cause no symptoms. Infections in the throat may cause a sore throat but usually causes no symptoms. Health care providers usually use three laboratory techniques to diagnose gonorrhea.

Staining samples directly for the bacterium Detecting bacterial genes or DNA in urine Growing the bacteria in laboratory cultures The staining test works better for men than for women.

Complications
Untreated gonorrhea can cause serious and permanent health problems in both women and men. In women, gonorrhea is a common cause of pelvic inflammatory disease (PID). About one million women each year in the United States develop PID. Women with PID do not necessarily have symptoms. When symptoms are present, they can be very severe and can include abdominal pain and fever. PID can lead to internal abscesses (pus-filled "pockets" that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy. Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube. If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby. A health care provider can prevent infection of the baby's eyes by applying silver nitrate or other medicine to the eyes immediately after birth. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that can lead to infertility if left untreated. Gonorrhea can spread to the blood or joints. This condition can be life threatening. In addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea are more likely to transmit HIV to someone else.

Treatment
Health care providers usually prescribe a single dose of one of the following antibiotics to treat gonorrhea. Cefixime Ceftriaxone Ciprofloxacin Ofloxacin Levofloxacin 7

If you are pregnant, or are younger than 18 years old, you should not be treated with certain types of antibiotics. Your health care provider can prescribe the best and safest antibiotic for you. Gonorrhea and chlamydia often infect people at the same time. Therefore, health care providers usually prescribe a combination of antibiotics, such as ceftriaxone and doxycycline or azithromycin, which will treat both diseases. If you have gonorrhea, all of your sexual partners should get tested and then treated if infected, whether or not they have symptoms. Health experts also recommend that you not have sex until your infected partners have been treated.

Genital Herpes
Genital herpes is a sexually transmitted disease (STD) caused by herpes simplex virus (HSV). There are two types of HSV. HSV type 1 most commonly infects the mouth and lips, causing sores known as fever blisters or cold sores. It may also cause sores to the genitals. HSV type 2 mainly infects the genitals, but it also can infect the mouth. Most genital herpes is caused by HSV-2. Herpes viruses are released from the sores that the viruses cause. They may also be released between outbreaks from skin that does not appear to be broken or to have a sore. Most people get genital herpes by having sex with someone who is shedding the herpes viruses either during an outbreak or during a period with no symptoms. In the United States, 1 out of 5 teenagers and adults is infected with HSV.

Symptoms and Diagnosis

Most individuals with genital herpes have no or only minimal signs or symptoms. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years. Other symptoms that may accompany the first (and less often future) outbreak of genital herpes are fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area. Health care providers can diagnose genital herpes by visual inspection if the outbreak is typical, and by taking a sample from the sore(s) and testing it in a laboratory. HSV infections can be difficult to diagnose between outbreaks. Blood tests, which detect HSV1 or HSV-2 infection, may be helpful, although the results are not always clear-cut.

Complications
Genital herpes infections usually do not cause serious health problems in healthy adults. 8

In some people whose immune systems do not work properly, genital herpes outbreaks can be unusually severe and long lasting. Occasionally, people with normal immune systems can get herpes infection of the eye, called ocular herpes. Ocular herpes is usually caused by HSV-1 but sometimes by HSV2. It can occasionally result in serious eye disease, including blindness. A woman with herpes who is pregnant can pass the infection to her baby. A baby born with herpes might die or have serious brain, skin, or eye problems. Pregnant women who have herpes, or whose sex partner has herpes should discuss the situation with her health care provider. Together they can make a plan to reduce her or her baby's risk of getting infected. Babies who are born with herpes do better if the disease is recognized and treated early. Genital herpes, like other genital diseases that cause sores, is important in the spread of HIV infection.

Treatment
Although there is no cure for genital herpes, your health care provider might prescribe an antiviral medicine to treat your symptoms and to help prevent future outbreaks. This can decrease the risk of passing herpes to sexual partners. Medicines to treat genital herpes are Acyclovir (Zovirax) Famciclovir (Famvir) Valacyclovir (Valtrex)

Scarlet Fever
Scarlet fever is a disease caused by a bacterium called group A streptococcus, the same bacterium that causes strep throat. Scarlet fever is a rash that sometimes occurs in people that have strep throat. The rash of scarlet fever is usually seen in children under the age of 18.

Symptoms
The most common symptoms of scarlet fever are: A rash first appears as tiny red bumps on the chest and abdomen. This rash may then spread all over the body. It looks like a sunburn and feels like a rough piece of sandpaper. It is usually redder in the arm pits and groin areas. The rash lasts about 2-5 days. After the rash is gone, often the skin on the tips of the fingers and toes begins to peel. The face is flushed with a pale area around the lips.

The throat is very red and sore. It can have white or yellow patches. A fever of 101 degrees Fahrenheit (38.3 degrees Celsius) or higher is common. Chills are often seen with the fever. Glands in the neck are often swollen. A whitish coating can appear on the surface of the tongue. The tongue itself looks like a strawberry because the normal bumps on the tongue look bigger.

Transmission
The disease is spread through the mouth and nasal fluids of an infected person. If you touch your mouth, nose or eyes after touching something that has these fluids on them, you may become ill. Also, if you drink from the same glass or eat from the same plate as the sick person, you could also become ill. The best way to keep from getting sick is to wash your hands often and avoid sharing eating utensils.

Treatment
Scarlet fever can be treated with antibiotics.

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