Beginning February 23rd, MUSC Women’s Health will offer a specialty clinic for sexually transmitted infections (STI’s). The goal of the clinic is to offer screening, treatment, and counseling regarding STI’s.  We welcome women to bring their partners.

In celebration of these new services, Women Speak will be introducing a blog series about sexually transmitted infections.  Each installment will discuss a common STI, symptoms, diagnosis, treatment, pregnancy complications, long-term consequences, and prevention.  In this inaugural installment of the “The Lowdown on STD’s,” I will discuss Trichomonas.

Trichomonas vaginalis is the second most common STI in the United States with 3-4 million cases diagnosed each year.  Unfortunately, women of color are disproportionately represented.  The rates of Trichomonas in African American women seeking STI screening have been recorded as high as 13%.  In comparison to other STI’s, which are more common among adolescents, Trichomonas is frequently diagnosed in older women. 

Trichomonas is unique among sexually transmitted infections because it is not a virus or bacteria.  T. vaginalis is a single-celled protozoa that swims using a flagellated tail.  It is large enough to be seen using a low-power microscope.  (See picture)
 
In women, Trichomonas is a common cause of vaginal discharge and vulvar symptoms.  Men infected with Trichomonas most commonly have painful urination. Like other sexually transmitted infections, Trichomonas enters a woman’s body during sexual contact with an infected partner. It can live in both the vagina and around the opening of the bladder or urethra. 

Not all women who are infected by Trichomonas have symptoms.  For those that do, the most common is a foul-smelling vaginal discharge.  Other symptoms include: painful urination, vaginal and vulvar itching, and spotting after intercourse or between periods. If you are concerned about infection or have any of these symptoms, you should consult your physician.

Trichomonas can be diagnosed by your doctor.  A pelvic exam is required in which specimens are collected for microscopic examination or culture.  Most results are available in 1-5 days. It is treated with antibiotics, which should be taken by both partners.  Patients cannot drink alcohol within 48 hours of taking these medications.  If your partner is unable to receive treatment, it is necessary to use condoms to avoid re-infection.

During pregnancy, infection with Trichomonas has been associated with preterm labor and low birth weight.  Treatment of symptomatic women during pregnancy is recommended.  Untreated infection can lead to long-term consequences.  Women infected with Trichomonas are at an increased risk of acquiring HIV, the virus that causes AIDS.  Trichomonas can also increase the risk of infection with other common STI’s.  If Trichomonas is present during or shortly after gynecologic surgery, women can develop abscesses that require a longer period of therapy.  Screening and treatment are imperative to avoid these complications.

Trichomonas infection can be avoided by consistent use of condoms.  Latex condoms are the only form of birth control that prevents STI’s.  If you have any questions regarding Trichomonas or STI’s, please feel free to send questions via the comment function or attend our specialty clinics at MUSC Women’s Health.

by:  Gweneth Lazenby, M.D.

Request an appointment with a MUSC provider.

Urinary tract infections are one the most common reasons for doctor visits.  The urinary tract consists of the urethra, bladder, and kidneys.  UTI’s are more common in women, because the urethra is short and close to the vagina and rectum.  During her lifetime, a woman has a 6/10 risk of developing at least one urinary tract infection.  Given that UTI’s are so common, it is important to know the signs and symptoms, associated risk factors, and prevention and treatment measures.   
 
The most common symptoms of a bladder infection include pain during urination and increased frequency.  Less often, you may experience increased urge to urinate but make less urine, bad smelling urine, abdominal pain, and bloody urine.  If neglected, bladder infections can spread to the kidneys, which is a more serious infection.  Signs of kidney infection include back pain, fever, chills, and nausea.  These infections need immediate attention, especially if you are pregnant. 

Urinary tract infections should be treated with antibiotics.  Over the counter medications, such as pyridium, are for pain relief only and do not treat the infection.  If you are experiencing symptoms of a urinary tract infection, call your physician’s office.  Because 90% of bladder infections are caused by E. coli, your physician may call in an antibiotic prescription without a visit.  However, to determine the bacteria causing the infection and it’s susceptibility to antibiotics, a urine specimen must be sent to a lab.  Bacteria can become resistant to antibiotics, so it is important to call your physician if the symptoms are not resolving.

Treatment is half the battle, but understanding your risks for infection is key to avoiding UTI’s.  Factors associated with bladder infections are frequent sexual activity, diaphragm and spermicide use, incomplete bladder emptying, and poor hygiene.  Some medical conditions associated with bladder infections include pregnancy, diabetes, sickle cell trait, and kidney stones.  Postmenopausal women may experience more frequent UTI’s due to low estrogen levels.

In order to prevent a urinary tract infection, consider the following tips:

- Drink at least eight 8oz glasses of water a day
- Drink cranberry juice when you suspect a UTI to increase the acidity of your urine
- Go to the bathroom frequently and don’t hold your urine for long periods
- Urinate before and after sex
- Wipe from front to back

by:  Gweneth Lazenby, M.D.

Request an appointment with a MUSC provider.

December 1st is World AIDS Day.  AIDS or Acquired Immunodeficiency Syndrome is caused by Human Immunodeficiency Virus (HIV). HIV affects 1.1 million Americans, one quarter of whom are women. The majority of women acquire HIV through having sex with infected male partners.  Other routes of HIV transmission include: IV drug use, childbirth, breastfeeding, and blood transfusion.  Because most women are infected with HIV during their reproductive years, it is important to consider the effects of HIV on pregnancy and childbirth.

All women should take prenatal vitamins and be up to date on vaccinations before becoming pregnant. Prior to pregnancy, HIV positive women should have good viral control in order to prevent transmission to their baby.  If you are taking antiretrovirals it is imperative to discuss this with your doctor prior to becoming pregnant, because some medications should be avoided. If your partner is HIV negative, there are methods to avoid exposing him to HIV in order to become pregnant.  Your doctor can direct you to the best options for becoming pregnant and protecting your partner and baby from HIV infection.
 
Before antiretroviral medications were available, pregnant women had a 25% risk of transmitting HIV to their baby.  The majority of babies become infected during pregnancy, half at the time of delivery.  The rest are infected through breastfeeding.  Currently, women taking anti-retroviral medications have a 1-5% risk of having an HIV positive baby.  During pregnancy, the goal is to suppress the virus in the bloodstream to a very low level in order to reduce the rate of transmission to less than 1%.  HIV positive women should not breastfeed.   
 
The Center for Disease Control recommends routine HIV screening in all pregnant women.  Some women are known to have HIV before they become pregnant, but many are diagnosed at their first prenatal visit. Antiretroviral therapy is recommended during every pregnancy in order to prevent transmission to the baby.  Most women can start antiretrovirals by 14 weeks of pregnancy.  For the best prevention of transmission, the latest start of anti-retrovirals is 28 weeks of pregnancy.  All pregnant mothers with HIV should be seen by an Infectious Disease specialist to determine the safest, most effective anti-retrovirals during pregnancy.  HIV positive women require more visits and lab tests during pregnancy in order to ensure a good medication response.

HIV positive women should take antiretrovirals until delivery.  HIV positive women with low viral loads can attempt a vaginal delivery.  Women with higher viral loads should consider a c-section to prevent HIV transmission to their baby.  Typically, the c-section should be done before the start of labor, at approximately 38 weeks of pregnancy.  HIV positive women with prior c-sections are encouraged to consider a repeat c-section.  All HIV positive women should receive IV zidovudine (AZT) at least 3 hours before delivery.  AZT is an anti-retroviral and can decrease the rate of HIV transmission during labor. After delivery, women should resume taking their medications for HIV.  
  
After delivery, it is extremely important to continue with the planned anti-retroviral therapy.  All patients should discuss their postpartum HIV medication regimen with their doctor.  Stopping these medications without your doctor’s input can cause HIV to become resistant and difficult to treat.  All babies born to HIV positive mothers will be advised to take anti-retroviral therapy for approximately six weeks.  Babies need frequent blood tests up to 6 months of age to ensure they are HIV negative. 

Lastly, all women should have a plan for reliable birth control after delivery and experience the freedom to determine when their next child is born.  HIV positive women can use all the available methods of contraception: pills, injections, patches, vaginal rings, and IUDs.  Women who are interested in permanent sterilization should talk to their doctor in advance to ensure legal documentation is completed before delivery.  Condoms are the only method that can prevent HIV transmission during sex; therefore, HIV positive women should use condoms to protect partners from infection.

by:  Gweneth Lazenby, M.D.

Request an appointment with a MUSC provider.

Vaginal infections or vaginitis are a common reason women visit the gynecologist.  Signs and symptoms of vaginitis include: a change in vaginal discharge, an unpleasant odor, or itching.  Many women refer to these symptoms as a “yeast infection,” but not all vaginal infections are due to yeast.  The three most common types of vaginal infections are: yeast, bacterial vaginosis, and trichomonas.   

Yeast infections can occur anywhere in the body.  Vaginal yeast infections are usually caused by the species Candida albicans. Some women with chronic illness are more at risk for yeast infections. Signs and symptoms include a thick white discharge, itching, and occasionally burning with urination.  There are over the counter treatments for yeast infections in the form of vaginal creams and suppositories.  These medications are often effective, but if symptoms are not getting better, it is best to see a doctor.  Only a doctor can prescribe oral medication and stronger creams.

Bacterial vaginosis is the most common cause of vaginitis.  Bacterial vaginosis or BV is not caused by a specific organism.  BV occurs when the normal bacteria living in the vagina are replaced by others.  As a result, you may develop a change in odor and vaginal discharge.  BV is not a sexually transmitted infection, but it can increase your risk of acquiring one.  Your doctor can help with diagnosis and treat bacterial vaginosis with antibiotics. 

Trichomonas is the least common cause of vaginitis, and it is a sexually transmitted infection.  Trichomonas is the second most common sexually transmitted disease (STD) in the United States.  Symptoms of trichomonas include an unpleasant vaginal odor and discharge.  Some women experience itching.   Trichomonas can be treated, and both partners should take antibiotics.  Your doctor may advise you to have further STD testing done.

If you are experiencing any symptoms of vaginitis, it is important to contact and see your doctor.  Buying over the counter treatments may be effective for uncomplicated yeast infections, but it can lead to the delay of treatment for the other causes of vaginitis.       

by:  Gweneth Lazenby, M.D.