How to prevent HIV infection
HIV is difficult to catch. Body fluids containing the virus must go directly into your blood or tissues through a break in the skin or body lining membranes such as the lining of the vagina or rectum. These fluids are:
• blood (including menstrual blood)
• semen
• fluid from the vagina and cervix
• breast milk.
The virus has been found in very small amounts in saliva, but there is little evidence that it has been passed on through saliva. Similarly, there have not been any reports of transmission associated with vomit, urine or faeces.
HIV is transmitted through:
• unprotected vaginal or anal sexual intercourse with an infected person
• injection with a needle or syringe contaminated with infected blood
• pregnancy, in the womb or during delivery, though less than one in five infants born to infected mothers are infected at birth
• breast-feeding, which doubles the risk of a baby becoming infected. The risk is less if the baby doesn’t have its mother’s milk for two weeks after delivery. This is because colostrum contains much more HIV than milk produced later.
Prevention seems straightforward. Never have any sort of injection with a needle or syringe that has been used by anyone else, and never have unprotected sex (that is without use of a condom) unless you are certain that your partner is not infected. These are the main risks. Also, we should all follow the habits of general hygiene that protect against the spread of all infectious diseases.
If you do accidentally come in contact with, say, the blood of an accident victim, don’t panic. It’s extremely unlikely that infection could occur under these circumstances, but if you’re worried, talk to your doctor about whether treatment or a test is advisable, even if only to reassure you that all is well.
Any woman known to carry HIV will have been well advised on how to prevent its spread to others and how best to look after her health.
The statisticians of the epidemic would be pleased if we were all tested so that the real prevalence of HIV infection could be known. I believe that such an enormously expensive exercise is at present unnecessary. Most women will know whether they have ever been at risk of infection.
Who should be tested?
If you have the slightest fear that you may have been infected, I would recommend a test so that you’ll know where you stand and not be wracked by uncertainly. Remember that over 99 of every 100 women at ‘high risk’ tested so far have been negative. Reasons for having the test include:
• if you had a blood transfusion between 1980 and 1985 in Australia. If you’ve ever had a transfusion overseas, ask your doctor whether you should be tested
• if you have ever shared needles or syringes
• if you have ever had a sexual partner whom you suspect may have had sex overseas, multiple female partners, any male partners or has ever injected drugs. Blood for the test can be collected by your doctor, any public hospital or at any sexual health or family planning clinic. Before taking the test, read the pamphlets (available wherever tests are done), which explain what the test and its results mean, and how you can avoid HIV. If you have any concerns about the test or whether you should have it, speak to a doctor, nurse or counsellor. You can be sure that any information you give when taking the test is confidential.
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Acute cystitis
In every case of suspected cystitis the diagnosis should be confirmed by laboratory examination of the urine to identify any bacteria and see what antibiotics will get rid of them. A mid-stream urine specimen should be collected before any treatment is started. However, you will usually be given antibiotics at the first visit, especially if your doctor has looked at your urine under the microscope and seen that it contains pus and blood.
It’s important to check with your doctor when the laboratory report returns to make sure that you’re taking the right antibiotic, which should start to relieve symptoms within 24 hours. Most doctors also like to confirm that the infection has cleared completely by a follow-up urine test after you’ve finished the treatment course; this is particularly important if you’ve had recurrent infections.
It’s also very important to complete the full course of antibiotics. If you have a tendency to develop thrush when you take antibiotics, tell your doctor so that you can have some antifungal treatment on hand.
Here are some other ways to relieve the symptoms of an acute attack while waiting for specific treatment to work.
• Drink as much water as you can to dilute your urine and help flush out the infection.
• Empty your bladder whenever you feel the urge: never try to hold on if you have a urinary infection. Be sure to completely empty the bladder each time.
• Avoid coffee, strong tea, cola drinks (caffeine irritates the bladder) and alcohol.
• Take something to make your urine alkaline, such as a teaspoonful of bicarbonate of soda in a glass of water, or one of the proprietary urinary alkalinisers your pharmacist will recommend.
• Avoid intercourse until all symptoms have gone.
Chronic and recurrent cystitis
If you have chronic or recurrent bladder symptoms it’s very important to have a thorough urinary tract examination so that the cause can be found and treated. Recurrent cystitis can be a symptom of mm serious conditions. Tests usually include X-rays of the kidneys and bladder and perhaps cystoscopy and biopsy of the
bladder lining. It’s also important to check that you’re not diabetic.
If you get repeated infections after sex (proved by bacteria being found in your urine), you should see a specialist urology to discover the cause of the problem. It may be that you have a chronic infection of the mucus-secreting glands near the urethral outlet, or some other bladder or urethral condition that can be corrected. Your doctor may advise you to take low-dose antibiotics daily to prevent further infections until the cause can be treated. However, bladder symptoms after sex aren’t always due to infection. It takes about eight hours for an infection to get established in the bladder, so if symptoms come on very soon after sex, they’re likely to be due to the urethral syndrome.
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Endometritis
Endometritis is infection of the lining of the uterus. It can occur after childbirth or after spontaneous or induced abortion, especially if the uterus is not completely empty of all fragments of the placenta. It is treated by antibiotics and, if necessary, removal of any retained placental tissue.
Endometritis is also part of PID.
Prolapse
When the structures that hold the uterus in place become weakened or abnormally stretched (usually during pregnancy or delivery), the uterus may drop down from its normal position. This is called uterine prolapse. The cervix may move further down in the vagina, and may even protrude through the entrance to the vagina.
As the uterus moves downwards, it pulls the vaginal walls and often the bladder and rectum with it. When the front wall of the vagina and part of the bladder sag downwards, it is called a cystocoele. When the back wall of the vagina and part of the rectum sag downwards, a rectocoele has formed. Either or both may bulge outside the vagina. If the perineum has been torn during delivery and not repaired, cystocoele and/or rectocoele can occur without uterine prolapse.
Not all women who develop prolapse of the pelvic organs have had children. Anything that increases pressure in the abdomen, such as chronic cough, chronic constipation and obesity, puts excessive strain on the pelvic supports and can lead to prolapse. Also, the pelvic supports weaken with age and with reduced production of oestrogen. Many women with prolapse find that symptoms will begin or are aggravated after the menopause.
Symptoms of prolapse
Symptoms depend on which organs are prolapsed and how much. A mild prolapse may not cause any problems.
Prolapse of the uterus can cause a dragging feeling in the lower abdomen and back, increased vaginal discharge and perhaps the feeling that something is coming out of the vagina. Symptoms are usually relieved by lying down.
If cystocoele is present, symptoms include difficulty in starting and stopping urination, urinary frequency, feeling that
the bladder needs emptying again soon after you’ve been to the toilet, and problems controlling the bladder. Recurrent urinary infections can result if the blade never empties properly.
Rectocoele can cause difficulty emptying the bowel, in spite of a constant feeling that the rectum is full and needs to
be emptied. Constipation can become a problem.
Treatment of prolapse
This depends on how severe the symptoms are and the extent of the prolapse Slight prolapse of the uterus without symptoms needs no treatment. Moderate uterine prolapse can often be helped by wearing a strong ring pessary in the vagina to hold up the uterus and to help lift associated cystocoele and rectocoele. If the supports of the uterus are so stretched that the uterus protrudes from the vagina, surgical repair is usually needed.
Mild and moderate degrees of cystocoele and rectocoele are often greatly helped by exercises and other physiotherapy to strengthen the muscles of the pelvic floor and improve emptying and control of the bladder and bowel. However, if these muscles are not only weak but also badly torn or otherwise damaged, surgery may be the only answer.
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Absence or underdevelopment of the ovaries is rare, and is due to abnormal combinations of sex genes. The most common is failure of the sex gene from the sperm to be transferred at fertilisation, resulting in a single X sex chromosome. This is called Turner’s syndrome. Because XX is needed for ovaries to develop and Y for testis development, people with Turner’s syndrome have no gonads, but have tubes, uterus, vagina and female external genitals. There may be associated congenital problems such as heart and bone defects, webbing of the neck and growth retardation resulting in short stature.
Without ovaries to produce oestrogen, none of the characteristic female developments of puberty can take place. If Turner’s syndrome is diagnosed (by tests showing abnormal genes and absence of ovarian hormones, and if the ovaries can’t be found by laparotomy), hormone replacement treatment must be given to complete development and so that health can be maintained during adult life. If a woman without ovaries has a normal uterus and vagina, menstruation will follow hormone treatment.
It is always very hard to explain to a young woman that she was born without ovaries or without a uterus, because it means that she will never be able to have children of her own. If the vagina is also absent, the prospect of needing surgery or the use of dilators to be able to have intercourse is an additional distress. Very sensitive counselling is needed to help overcome grief and to try to prevent sexual maladjustment.
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Most testing can be completed within few months. At the first visit your doctor will take a thorough medical history and will usually carry out on both you and your partner a general physical examination that will also include examining the reproductive system. This may indicate which tests you need. The reason for doing any test, what the test involves, its cost and the results will be fully explained to you: if not, ask.
Some of the following tests may be advised.
Starting a basal body temperature chart This is cheap, easy and no risk. If it shows that you’re ovulating, it’s reassuring and tells you when intercourse is most likely to result in conception.
Sperm count (semen analysis) This is the simplest test, needing only a sample of semen to be sent for examination. You’ll be given instructions on how to collect the specimen. Semen analysis is usually done early and may be repeated two weeks later if the first count is low. Sperm counts that are temporarily reduced, for example by a bout of high fever, will have returned to normal after about three months.
Blood tests for hormones If a woman’s blood contains the hormone progesterone during the second half of her menstrual cycle, that’s strong evidence that she has ovulated.
Hysterosalpingogram (HSG) This is an X-ray of the uterus and tubes, to see whether the shape of the uterine cavity is abnormal or there is tubal blockage.
Laparoscopy This is a surgical procedure in which the uterus, tubes and ovaries are inspected.
Hysteroscopy This is to check the shape and lining of the uterine cavity.
Falloposcopy This is to inspect the interior of the tubes.
Post-coital test (Sims-Huhner test) Within a few hours of having sex during the fertile phase of your cycle, some mucus is taken from the cervix and examined under the microscope immediately to see whether sperm are present and surviving.
Sperm migration test This is also called the mucus penetration test. Mucus from your cervix is collected during the fertile phase. The rate of progress of your partner’s and donor’s sperm through your mucus are compared with their rate of progress through a donor’s mucus.
Not all these tests may be necessary. The result of one test may suggest certain other tests such as looking for sperm antibodies, genetic tests, and biopsy of the testis, ovary or lining of the uterus. If no abnormality is found, it means that the subfertility is due to something we don’t know about reproduction.
Many people are distressed by the intrusiveness of the tests, and by a sense of being judged on their results. One woman expressed her anguish:
There is no inner recess of me left unexplored, unprobed, unmolested. Now when we haw sex I think that what used to be beautiful and very private is now degraded and very public. I take my charts to the doctor like a child bringing home a school report. Did I
do well? Did I ovulate? Did I have sex at the right times?
If you can air these feelings with your partner, doctor, counsellor or others in the same boat, you may feel better about them.
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