GynoFiles

After years of thinking the interior of the uterus is a sterile place, and that babies develop in a sterile bubble, the advances in genomics have shown that the uterus has it's own microbiome as well. Just like we now know that the bladder, the placenta, and the vagina each are not sterile, but have their only healthy bacterial environment.  In a paper in the Am J of Obstetrics and Gynecology Dr. Linda Giudice points out that we are soon going to be able to understand your personal biology to help you be treated more individually. Thus the microbiome that no one checked in the past is going to be checked in the future we predict!    A study out of the University of Washington has just shown that DNA from bacteria are present in 95% of uterine specimens at the time of hysterectomy. This refutes the long held theory that the uterus is sterile. By also looking at local tissue markers for infection, in most cases there was no inflammation although there were bacteria....

The CDC just updated guidelines on STD testing . Gynos are the ideal provider to help sit you down and discuss STD's and to help you plan testing, retesting, and treatment. In some cases we treat women who are known to have had a high risk exposure. In other cases we recommend preventions, such as vaccines, condoms, and spermicide. Your age, your overall health, and specifically your vaginal health could put you at risk for contracting STDs, and at risk for worse complications from an STD that you do contract. The guidelines were very detailed and contain many recommendations covering situations of those who have the most risk, usually stemming from the women who have sex with multiple partners or many lifetime partners. One caveat about the new STD guidelines, they specifically address pap smear testing that may not go along with the plan your gyno has for you specifically. Risk assessment discussions are also a reason to continue annual visits with your gyno.

In a fascinating look at the environment of the uterus and fallopian tubes at the time of hysterectomy, it is now discovered that the uterus is not a sterile environment. Dr. Shana Miles of Walter Reed Hospital . We have long ago known that the microbiologic environment of the vagina is extremely important to maintaining health. It has been shown that we all have unique types and number of bacteria in the vagina. They vary by age, by our health, by medical treatments such as antibiotic use, and the numbers and types of bacteria in the vagina even seem to have an ethnic component . And ways to improve the bacterial environment are part of routine gynecologic care, although we now have new ways to improve these colonies as well, including the MonaLisa Vaginal Procedure . In the paper Dr Miles presented at the ACOG Annual Clinical Meeting the results of cultures of the uterus, the fallopian tubes, and the ovaries were shown to have bacteria in 90% of the samples! It is true that the ty...

Still not here, but would be handy if we could have medications that when inserted would prevent a woman from getting an STD no matter what the exposure was! This sort of product would be called a microbicide, and WHO has a good review of them . The NIH is working on this topic as well . Although Ebola keeps in the news, in gyno world prevention of HIV, and other serious STDs such as hepatitis, syphilis, and the infections that cause pelvic inflammatory disease (PID) are still what we gab about. Several organizations are pushing hard to get these products developed . Three have failed in later stages of clinical research: SAVVY, Carraguard, and cellulose sulfate gel. But Invisible Condom is still working it's way through research trials and still shows promise. Dr. Francois-Xavier Mbopi-Keou the lead author in the recent study was quoted as saying that "as many of 2.5 million cases of HIV could be averted over a three year period of time if even a partially effective microb...

Liver disease is often caused by a virus, is serious if becomes chronic, and many of the viral infections are treatable if not preventable. Ask your gyno if you need this testing at your next appointment. Hepatitis B and C can cause liver disease or liver cancers although they are viruses that couple potentially be cleared spontaneously from your body. The United States Preventative Task Force estimates between 700,000 and 2.2 million people in the U.S. have chronic Hepatitis B,   The Centers for Disease Control and Prevention (CDC) estimates that the number of new cases ofacute HCV infection in the United States is about  17,000 cases per year . Indeed, estimates are that between 15% and 25% of people with chronic Hepatitis B (HBV) eventually die of cirrhosis or liver cancer. People with chronic HBV can also transmit the infection to others, the task force noted, and screening could identify people who might benefit from treatment or other interventions. Testing for he...

If you had an STD treated the next step is to figure out if you were really cured. About 80-90% of women will eliminate their HPV infection within 8-24 months. Although some who we think are clear have just reduced their virus amount by about 90% to undetectable levels. The good news about reducing your viral amount to undetectable levels is that cervical cancer is often kept at bay by just having an immune system fight it off. About 10 to 15% of women will come back with positive tests again in the next year of a positive test for CT or GC . does that mean the antibiotics failed? Well, sometimes yes, but most times, probably you were re-exposed. Since the researchers can't honestly be sure who was re-exposed they have a tough time telling women who was just not treated. Test of cure — Testing for Chlamida. trachomatis (CT) following effected treatment from your gyno with the standard azithromycin or doxycycline is normally not recommended. Exceptions include women who have pers...

MRSA of the Mons Cancer signs may truly be revealed if listening to your body, so here are some signs to listen to, which is the gyno's way of promoting #RealWorldEvidence 1. Abnormal Bleeding 2. Pelvic Pain 3. Bleeding After Sex 4. Bleeding After Menopause 5. Abdominal Swelling 6. Unexplained Weight Loss 7. Pain With Sex 8. Abnormal Feeling of Fullness 9. Vulvar Sore that Will Not Heal 10. Hard Lump In the Abdomen MRSA of the Vulva

Most women worry about their pap smears showing cancer. We worry the most about a pap that shows high grade squamous intraepithelial neoplasia (HGSIL), but of women who have the low grade form, LGSIL about a third will still have serious precancer. And pap tests do show more than just cancer or precancer, they can help figure out infection or precancer. If you have culture tests, often they are the best check of infection. There are ways to detect infection, including tests on the pap cells themselves, or on the liquid that the pap cells are suspended in after collections. So if you get a pelvic exam, find out what types of infection tests. Years ago the only time we could identify an infection would have been to culture for it. Now tests of the organism with tests called PCR are actually done. With these PCR tests, technically we cannot say if it is still an active infection, or a newly treated infection, but eventually all tests go to negative if some one is treated. Infections ...

Syphilis has been called a sexually transmitted disease (STD) or sexually transmitted infection (STI), and in the USA it is. However  there is a form of syphilis that you can have, but you didn't catch. The condition is bejel , it is a non-venereal form of the disease. In third world countries it is known by a variety of names including belesh, dichuchwa, frenga, njovera, skerljevo, sahel and siti, depending upon the native language and culture. The disease is caused by the parasite Treponema palladium  and it is detected by the same blood tests we use to detect syphilis in those who did acquire the disease sexually. But bejel is an endemic condition that is primarily in Bedouin tribes and in other pockets of the Middle East and parts of Africa. Like other endemic diseases at times it was very prevalent in these populations, and thus spread between children by direct contact and its spread is aided by living in unhygienic conditions. Sexually transmitted syphilis generally ...

Vulvar abscess, due to MRSA Hidradenitis Suppurativa Hidradenitis Suppurativa is not the same skin infections that can occur in the same area of the body. If you have a small pimple that begins to develop into a boil, and perhaps gets red skin around the edge of it, this is likely a condition actually known as cellulitis, that will, if not treated with the proper antibiotics develop into a potentially dangerous infection. If the organisms are resistant staphylococcus then the infection can get into the blood stream and cause an infection of the body. Some staph infections are quite contagious as well. Hidradenitis is a chronic inflammation, that doesn't really respond to antibiotics. Hidradenitis is more likely to respond to controlling insulin resistance and metabolic syndrome and stopping smoking. It is important to get medical attention and supervision, and to do what it takes to prevent secondary infections. For the top picture intravenous antibiotics and perhaps drain...

You don't know if you are infected if you haven't been tested! Chlamydia and gonorrhea are often a silent disease, and at least 1/4 HIV patients do not know their status, and only 1/10 women with Herpes know they have that. So the right STD test is very important. What STD tests are best, this is something to gab with your gyno about? Blood tests for HIV? Hepatitis B? Hepatitis C? Syphilis? Previous Chlamydia infection? How about pregnancy test? Maybe a drop can answer a lot of these questions. We don't always have to do whole tube of blood tests, in fact just a drop of blood will do for some of these tests! But for many of these tests you will have to give more.  Just passing your test shouldn't make you not still have safe sex, but knowing your status and getting STD treatment will help you prevent partner infection. A new study just released by the CDC called the National Youth Risk Behavior Survey said that students are having multiple partners and that 40% of new ...

In recent studies, using tests specifically for research (you cannot just go to a lab and get this test) they have been studying the fact that, although HPV infections are technically only in very superficial tissue, we do form an immune reaction to exposure to the virus. This is basically the information that was used to develop the first HPV vaccines, but with those vaccines the antibody levels may be slightly different or better than antibodies we can form by being exposed. Castellasgue and researchers have been discovering that most people who get exposed to the HPV virus will form some sort of naturally acquired antibodies. They have discovered that in response to getting exposed to HPV about 50-70% of individuals can be found to even develop develop type-specific antibodies, in other words, an antibody which would even show which type of HPV you have become infected with. It is as of yet unclear whether naturally acquired antibodies provides future protection against rein...

Thyphoid fever killed over 35,000 individuals at the turn of the 20th century. It seems difficult to understand, since the germ theory of disease seems so ingrained in our culture now, but the lack of understanding of the germ theory and the issues of the asymptomatic carrier of infection was the reason these infections could kill so many individuals. In 1900 they didn't yet understand as to how someone could pass disease but not necessarily be sick, so they never thought to educate or treat those without overt illness.  Public health officials in New York began tracking outbreaks of typhoid. A tireless public servant, George Soper, through diligent detective work, discovered that faceless woman cook, a Mary Mallon was a common link to series of cases. Once the authorities  tracked her down Soper dispatched a Dr. S. Josephine Baker to round her up. Once tests confirmed this woman was a healthy individual who carried typhoid, but didn't have typhoid, they b...

Just when we see doctors and patients calling for less antibiotic use in general a team from Scotland has a new idea to cure the medical condition of running to the bathroom too frequently: More Antibiotics! This group, reporting from  Glasgow, Scotland at the 41st annual meeting of the International Continence Society came up with a novel idea that a group of patients with Overactive bladders and white blood cells in their urine probably had a degree of inflammation going on in their bladder accounting for the symptoms. In fact  Dr. Kiren Gill, of University College London, UK, told Reuters Health. "We think about half of patients with OAB may have bacteria in their urine." The team looked at groups with antibiotic treatment alone, verses treatment with antibiotics and the commonly used overactive bladder medicines, or just the medical treatment group alone and these did not receive antibiotics.The success rates of cure in these groups was an outstandingly good 75-85%...

It is not true that if you have an IUD that you will suffer from the ubiquitous infections women worry and write about. In fact it is more likely that the IUD doesn't raise your basic infection risk. Now if you are someone who is at high risk for infection, that is a different issue. Remember that many pelvic infections are not symptomatic. So if you are worried, get checked first for an undetected pelvic infection prior to deciding on whether to get the IUD. Some infections do lead to pelvic inflammatory disease (PID), but then the question is how often does a chlamydia infection or a gonorrhea infection actually produce PID without an IUD so that we could really understand the risks of getting a serious infection like PID when you have an IUD. What we are encouraging women to do is to come in to gab with your gynecologist when you have new partners so that we can help you figure out your risks and if you need additional screening tests. For women who hate pelvic examina...

Chlamydia tracomatis (CT) is the most common bactterial STD reported to the CDC each eary. We have about 1 million cases reported each year, but probably over 2 million Americans are carriers without knowning they are infected. There are many reasons to be treated, and prevention of the diseases it causes is one of the best. Here is a list of possible disease conditions (or infected areas) that can be caused by CT: an infection of the urethra, would feel like a bladder infection (urethritis) white of the eye infection (conjunctivitis) lining infection of the uterus (endometritis) uterine tubal infection (salpingitis)  cervix infection (cervicitis) inflamation of the rectum, the last 6 inches of the lower colon, or the anus (proctitis) infection of the surface or surrounding area of the liver (perihepatitis) arthritis if it infects a joint, or if it progresses to a whole system wide disease it is called Reiter's syndrome Mou...

No clapping for the clap. It may get the best of us. The CDC has checked the gonorrhea being passed around for the past ten years by testing men in over 30 cities around the country. Over the past few decades standard treatments have all followed these paths including the antibiotics sulfonamides, penicillin, and tetracycline. In 2007, the CDC stopped recommending any fluoroquinolone regimens and now cephalosporins have been the last treatment known to be really effective. So we now give cefixime or ceftriaxone along with azithromycin. And the important thing to remember, you cannot always be tested by cultures. Most labs do DNA tests, which tests for the organisms presence. If you have a treatment that has failed your gyno may want to try to find a lab that will indeed do a gonorrhea culture test, which can test for the organism, and test for how sensitive the organism is to the medicine you were given for your treatment. Cures now may have to be evaluated by a follow up check up to...

Dr.Harold Morowitz wrote an essay reviewing the first edition of the Merck Manual, which was published in 1899. He was most struck by the extraordinary number of worthless treatments for many of the conditions. He noticed there were over 95 ineffective gonorrhea treatments, and he commented "it is a natural feeling to something than to do nothing." I'm not sure what all these were, but some no doubt had significant risk as well as being non-therapeutic! Since the fields of bacteriology and biochemistry were brand new sciences, it's not surprising that the effectiveness of therapies was questionable and had not been honed. But as we sit at our next gyno appointment with a condition that may not yet have been fully diagnosed, remember what the forefathers of physicians today realized, sometimes treatment for treatment's sake alone is not always the best course of action. 

Pharmaceutical industries have not developed much in the way of new antibiotics for a long time. There are a number of factors, most due to the problems of profit. But not always in the negative ways that you think. Physicians are taught to not use antibiotics liberally, but only when necessary, and to use the most tried and true, and least expensive antibiotics first. Antibiotics may also seem to be the answer to sudden epidemics. Take the E.coli outbreak in Europe that is occurring now. We often treat E.coli bladder infections, but with these E.coli, they overwhelm one's systems so much that antibiotics would cause massive toxin release and actually worsen the patient's condition. Yet we do need some new antibiotics to help fight emerging infections, or the growing resistance some common bacteria are showing. Congress has had to weigh in on the situation with a proposal to boost the development of new antibiotic s. We may see some progress, but these studies are very highl...

The Human Papilloma Virus (HPV) is the cause of cervical cancer. Those that get infection ith HPV, and if you are diagnosed with CIN 3, the likelihood is that you will develop cancer in 8.1-12.6 years according to the Dec 2013 bulletin from ACOG. For those with a scientific bent, they want to understand this pesky virus. HPV virus is tiny by virus standard, less than 8000 paired pieces of DNA. There are many strains of this virus, and to be a strain it's DNA has to be almost pure, at least 7200 of the pairs have to be unique. The HPV Virus is unique because it's mighty although it's little. The tiny virus DNA can make some powerful proteins that can unlock a cell's control and cause it to grow out of control, in other words cause it to be cancerous. The part of the virus that performs this is the E6 and the E7 region. HPV viruses, the so called low risk and the high risk viruses all make proteins from their E6 and E7 regions, but for some reason the most potent prote...