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Antiviral medicines

Much like antibiotics, a particular set of antiviral is used to treat a particular set of virus. Viruses cannot reproduce on their own; they invade the human cell, attach themselves to it and replicate themselves. The drugs act by interfering with the virus and stopping it from entering the cell and replicating itself. Few antiviral drugs block the virus's entry into the cell itself, yet a few prevent the virus from replicating itself. A few anti-viral drugs stimulate the immune system so that the body can fight the viruses on its own. Antiviral drugs are used to cure conditions like common cold, flu, measles, mumps, chicken pox etc. Common antiviral drugs include Arbidol and Oseltamivir to treat influenza and Ritonavir - used to treat HIV infection.

Kaposi Sarcoma

Of the seven types of Sarcomas, the incidence of Kaposi Sarcoma, a type of skin cancer is found to be more prevalent in persons with immune deficiency disease like AIDS. The rate of Kaposi Sarcoma is reported to be 20 times more. It is estimated that 15% of HIV infected persons will develop Kaposi Sarcoma. The weakened immune system is unable to fight the Kaposi Sarcoma Herpes Virus. Thanks to HAART (highly active anti-retrovirus therapy), the incidence rate has decreased.


Sarcoma is a rare type of cancer. The malignant tumors occur in the body's connective tissues - the tissues that support, connect and bind various parts of the body. Muscles, fat, fibrous tissues, nerves, blood vessels, cartilage, bones and joint tissues are all connective tissues.

Sarcomas fall into three broad categories.

Soft tissue cancers

  • Benign (non cancerous)
  • Malignant (cancerous)

Primary bone cancer

Gastro-intestinal stromal tumors

Kaposi Sarcoma is a soft tissue sarcoma, malignant in nature.


Kaposi Sarcoma causes

Human herpes virus 8 (HHV8) also called Kaposi Sarcoma associated herpes virus (KSHV), a virus causes the infection. Though as many as 1 in 20 people may have this virus sans any symptom, certain groups of people are vulnerable to its effect and develop Kaposi Sarcoma. Mostly, people whose immune system isn't working properly either due to a medical condition or medication (immunosuppressive medications) can develop Kaposi sarcoma. The weakened immune system allows the HHV8 to multiply to high levels in the blood thus increasing the chance of developing Kaposi Sarcoma.


Kaposi Sarcoma symptoms

The first symptom is the lesion appearing on the skin. It can be bluish-red, or brown or purple spots or lesions on the skin, flat or as a slightly raised bump, linear or in a symmetrical distribution. In fact, the appearance of the lesion indicates the possibility of the person being infected with HIV or the condition it causes, namely, AIDS. Kaposi Sarcoma can also affect internal organs which can lead to a range of symptoms, depending on the organ that is affected.


Skin lesions

The lesions can appear anywhere on the body but in most cases the lesions appear on the face (ears, mouth and tip of the nose), legs and feet and the genital area. It could occur in a single area in the beginning. These can merge to form a large tumor.


Lymph nodes: Swollen lymph nodes are the symptoms of Kaposi Sarcoma affecting the lymph nodes.

Arms and legs: If Kaposi Sarcoma affects the lymph vessels, there is buildup of fluid in the arms and legs. This condition is called lymphoedema.

Lung problems: Kaposi Sarcoma affecting the lungs can lead to breathlessness and coughing up blood.

Digestive system: Nausea, vomiting, stomach pain and diarrhea are symptoms related to Kaposi Sarcoma affecting the digestive system.


HIV related Kaposi Sarcoma: Being HIV positive or having AIDS increases the risk factor of HIV-related Kaposi Sarcoma. Compared to women, men have higher chances as also gay and bisexual men who are HIV positive are at risk of HIV related Kaposi Sarcoma.


Classic Kaposi Sarcoma: A rare condition, classic Kaposi Sarcoma affects middle-aged and elderly men of Mediterranean or Ashkenzi Jewish descent. There is a high possibility of being born with a pre-existing genetic vulnerability to the HHV-8 virus.


Endemic African Kaposi sarcoma: This type is a common cancer in parts of Africa with high levels of HIV. In most cases, the reason is either undiagnosed HIV infection or a pre-existing genetic vulnerability to HHV-8 virus.


Transplant related Kaposi Sarcoma: After an organ transplant, a strong immune system can reject the new organ. In order to weaken the immune system thereby preventing the rejection of new organ, medications (immunosuppressant) are used. This makes the person vulnerable to HHV-8 virus infection.


Tests for diagnosis of Kaposi Sarcoma

For a definitive diagnosis, a small amount of tissue is removed for examination under the microscope. If the biopsy results confirm, further tests are required to know the spread to internal organs. X-ray, Endoscopy, Bronchoscopy, CT scan and photography are the diagnostic tests that reveal the spread of cancer - staging of the cancer.


Kaposi Sarcoma staging

For all cancer types, staging determines the treatment options and the patient's survival outlook. With regard to Kaposi Sarcoma, the staging is largely influenced by the person's weakened immune system and the presence of AIDS related infections. For Kaposi Sarcoma staging, doctors use the AIDS Clinical Trial Group system. Three factors are considered under the AIDS Clinical Trial Group system while categorizing patients in good risk group and poor risk group.


  • The extent of the tumor
  • The status of the immune system as measured by the number of certain immune cells (CD4 cells) present in the blood
  • Systemic illness

These factors have two subgroups. After assessing the features, the type of Kaposi Sarcoma, doctors discuss the most suitable treatment option.


Kaposi Sarcoma treatment

Kaposi Sarcoma is incurable but can be controlled with treatment. The stage, the type of Kaposi Sarcoma, the number of lesions, age and general health are considered by the doctors before determining the appropriate treatment option. It could be chemotherapy, immunotherapy, antiviral drugs or radiation therapy. There are possible side effects for each of these treatment options.


Chemotherapy: Chemo drugs can be given into a vein or by mouth to enter the blood stream to reach all areas of the body. Chemotherapy is a treatment option when the cancer has spread to many areas of the body. Chemo drugs cannot be given for long periods as it can weaken the immune system. Particularly for HIV infected patients, there is a need to strengthen the immune system. In such cases, combined antiretroviral therapy can be used along with chemo drugs. Drug interaction is taken into account before prescribing the combined therapy. After tests indicate control of Kaposi sarcoma, chemo drugs may be stopped and the treatment may continue with combined antiretroviral therapy alone.


Immunotherapy: Transplant related Kaposi Sarcoma is usually treated using immunosuppressant medications or immunotherapy. The aim is to strengthen the immune system so as to fight the HHV-8 while ensuring the body doesn't reject the transplanted organ. Alternatively, radiotherapy or chemotherapy may also be considered.


cART: Combination antiretroviral therapy (cART) involves the use of several different medications called antiretroviral therapy to lower HIV levels in the blood by slowing down the rate at which the virus can multiply.


Radiotherapy: If Kaposi Sarcoma spreads and affects the internal organs, symptoms such as breathlessness and swelling of the arms and legs cause immense distress. Radiotherapy is chosen as a treatment option as the high-energy rays destroy cancer cells cautiously without harming the healthy cells in the body.


Surgery: If the lesions are small, after injecting local anesthetic to numb the area, surgery is performed to remove the lesion.


Cryotherapy: Cryotherapy involves freezing small lesions with liquid nitrogen.


Retinoic acid gel: Retinoic acid is applied directly to the skin several times a day on the small lesions. After few weeks of application, significant improvement can be noticed.



Cervicitis

An inflammation of the cervix mainly due to an infection is Cervicitis. The infected cells of the cervix become irritated and may become red, swollen and ooze mucus and pus. They could bleed easily when touched. The most important cause of Cervicitis is sexually transmitted disease although many women do not test positive for any type of infection though contracted with Cervicitis.


Symptoms of Cervicitis

Many women do not exhibit any symptoms and if tested may be positive for Cervicitis. If present, the signs and symptoms include:


  • Vaginal discharge which could be grayish or pale yellow.
  • Abnormal vaginal bleeding or bleeding after sex, between periods.
  • Pain during sexual intercourse.
  • Pelvic or abdominal pain, fever in some cases.
  • Vaginal irritation
  • Pain in the vagina
  • Pressure or heaviness in the pelvis.

Serious symptoms might indicate a life-threatening condition and immediate medical care should be sought. If Cervicitis is suspected during pregnancy, there could be life-threatening symptoms including - high fever, severe nausea and vomiting and severe pelvic pain.


Causes of Cervicitis

Cervicitis is most often caused by an infection caught during sexual activity. Some sexually transmitted diseases include gonorrhea, Chlamydia, Herpes Virus and Trichomoniasis. Other possible causes for Cervicitis are:


  • Use of a diaphragm or cervical cap insertion into the pelvic area.
  • Allergy to condoms and latex
  • Chemical exposure
  • Many sexual partners
  • High risk sexual behavior
  • Sex at an early age.

When the vagina is overwhelmed by unhealthy and harmful bacteria, it can cause Cervicitis. Hormonal imbalance with relatively low estrogen or high progesterone may interfere with the body's ability to maintain healthy cervical tissue. Cancer treatment and radiation therapy can also cause Cervicitis.


Diagnosing Cervicitis

A doctor first gets a closer look at the cervix when Cervicitis is suspected. Then the doctor will swab the cervix, collect vaginal fluid and see how it bleeds. The patient's sexual history is noted. A routine examination of the cervix is conducted if you are pregnant or the doctor thinks that there is high risk for sexually transmitted disease like gonorrhea or Chlamydia. Inspection of the discharge under a microscope may show Trichomoniasis or Bacterial Vaginosis. Pap smear is also done. Rarely, colposcopy and biopsy of the cervix is necessary to rule out cancer.


Reducing risk of Cervicitis

You can reduce or lower the risk of Cervicitis by:


  • Avoiding known allergens.
  • Avoiding sexual intercourse.
  • Monogamous sexual partner.
  • Following instructions while using diaphragm or cervical cap.
  • Getting tested for STD infections annually.
  • Getting vaccinated against human papilloma virus.
  • Using condoms during sexual intercourse.

Treatment

If sexually transmitted infection is not the cause, then you do not need treatment for Cervicitis. If an infection is suspected, the main goal would be to eliminate the infection and prevent it from spreading to the uterus and fallopian tubes, in case of pregnancy.

In case of bacterial infections such as Chlamydia, Gonorrhea and others, antibiotics are used for treatment. Antiviral drugs may be used to treat herpes infections. Hormonal therapy with estrogen and progesterone may be used in women who have reached menopause. When such treatments fail, and Cervicitis is still present for a long time, then cryosurgery, electro cauterization and laser therapy are adopted.


The doctor would prescribe the line of treatment depending upon the cause of infection. The doctor may advice antibiotics, antifungal medications and antiviral medications. The doctor may also recommend treating the partner to rule out chances of infection again. It is recommended to avoid sexual contact till the partner has finished treatment.


If medications such as Antibiotics do not work in some cases, there are other options available recently:
Loop Electro surgical Excision Procedure (LEEP)
Cryotherapy, Electrocoagulation or Laser to cauterize the affected tissue.


Tips to prevent Cervicitis

Avoid chemical irritants such as deodorant tampons. When inserting any foreign objects into the vagina, make sure that they are properly placed. Be in a monogamous sexual relationship. Use latex condom every time of sex to lower the risk of getting sexually transmitted infections. A condom must be properly used every time.


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Bibliography / Reference

Collection of Pages - Last revised Date: May 25, 2019