Antidepressants Blog

Test results are generally straightforward—either positive or negative—but occasionally they are not. Some people have an antibody in their systems that reacts positively to the ELISA test but is not an antibody to HIV; nevertheless, the test shows a positive or reactive result.

That is why any positive ELISA test must be confirmed by another test (usually the Western blot assay) to make sure it is accurate. Approximately 1 out of every 200 people who are tested has a positive ELISA test when they are not in fact infected.

This test can also be falsely positive or reactive because of medical conditions in which excess antibody is formed (such as some rheumatologic diseases, like lupus and rheumatoid arthritis), a recent immunization, or a recent viral illness. The body is constantly making antibodies in response to one thing or another, and sometimes such an antibody can “trip” the test positive. On the other hand, some people do not have an obvious risk factor such as these but nevertheless have reactive ELISA tests, even though they are not infected with HIV. The ELISA test has a sensitivity of 93.4-99.6 percent, and a specificity of 99.2-99.8 percent. This means that between 93 and 100 percent of people who are truly positive will test positive, and that of those who test negative 99-100 percent are really not infected. The ELISA is therefore a reliable screening test, and—with appropriate follow-up and testing with the Western blot assay of blood that shows a reactive ELISA result— most people who are infected are detected.

The presence of antibodies to a certain combination of proteins from HIV on the Western blot assay determines whether or not a person is infected. To confirm that an ELISA test is positive, antibodies must be seen on a Western blot to at least two of the following three proteins: p24, gp41, and gp 120/160. This test may also take six months after a person has been infected to react positive.

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The vaccine is recommended for persons traveling to an area where hepatitis A is very common, including Africa, Asia except Japan, the Mediterranean basin, Eastern Europe, the Middle East, Central and South America, Mexico, and parts of the Caribbean. The Centers for Disease Control (404-332-4559) offers free travel information and recommendations about vaccines for people traveling to specific areas of the world. Others who may benefit from the vaccine are persons who engage in oral-anal intercourse, intravenous drug users, and daycare and institutional workers. Those with chronic liver problems may also benefit, since they may experience more serious illness if infected.

Within the United States, Native American and Alaskan Native populations are at higher risk for becoming infected with hepatitis A, so vaccination is recommended in them, as well as for people in areas of the country where the risk of infection is high.

This vaccine is only effective against hepatitis A; it offers no protection against other types of viral hepatitis. The average cost for each vaccine is about $40-70 for adults and less for the children’s vaccine.

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Although many women have never heard of it, BV is the most common disorder of the vagina. Many women will develop BV at some point in their lives, and about half of the women who visit their health care provider because of a vaginal discharge have it. Women of color appear to have a slightly higher risk of BV for unknown reasons.

A woman does not get BV from sexual contact with an infected male partner, but women who are sexually active, particularly women with multiple partners or new partners, are more likely to have the infection. Women who have sex with other women may transmit the bacteria that cause BV back and forth, especially if they share sex toys. Women who have never been sexually active and women in stable relationships can develop BV, as can women who have not had sex for a long period. BV also appears to occur more often in women who have other genital infections (such as chlamydia), women who douche (douching disrupts the normal bacterial population and allows the “bad bacteria” to overgrow), and women who use an intrauterine device (IUD) as a birth control method.

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Say a man’s prostate feels normal during a digital rectal exam, but his PSA is elevated and a biopsy has found cancer cells (this is considered stage Tic disease—see table 3.2). Is this significant cancer? Should action be taken? The new research suggests that for men with stage Tic disease, if any cancer is found in three needle cores, or in greater than 50 percent of any one needle core, or if the Gleason score (discussed in this chapter) is 7 or higher, then it’s highly likely that significant cancer is present in the prostate. On the other hand, if the cancer is Gleason 6 or less and is found in only one or two needle cores, cancer makes up less than half of these cores, and if the PSA density is less than 0.1 to

Table 3.2 Two Systems for Staging Prostate Cancer

Whitmore-

TNM

Jewett

Stage
Description
Stage
Description
Tla
Not palpable in a DRE; found incidentally when benign tissue is removed by TUR; 5 percent or less of the removed tissue is cancerous.
Al
Same as TNM
Tlb
Not palpable; found incidentally, but greater than 5 percent of the tissue removed by TUR is cancerous.
A2
Same as TNM
Tlc
Not palpable; identified by needle biopsy because of elevated PSA.

This category is not part of the Whitmore-Jewett system.
T2a
Palpable; involves less than half of one lobe.
BIN
Palpable; involves less than half of one lobe; is surrounded by normal tissue.
T2b
Palpable; involves more than half of one lobe, but not both lobes.
Bl
Palpable; involves less than one lobe.
T2c
Palpable; involves both lobes.
B2
Palpable; involves one entire lobe or more.
T3, T4
Palpable; penetrates the wall of the prostate and/or involves the seminal vesicles.
C
Same as TNM
N+
Has spread to lymph nodes.
Dl
Same as TNM
M+
Has spread to bone.
D2
Same as TNM
Note: These stages can be confusing; although the newer, more explicit TNM system is becoming more popular, many doctors tend to use both systems interchangeably.

0.15, there’s a good chance that the cancer in the prostate is insignificant (that there is less than 0.2 cubic centimeters of prostate cancer, and that it is confined solely to the prostate.)

Scientists at Johns Hopkins and elsewhere are also working to develop a more scientific means of prediction than the current one, which relies heavily on the human eye. Currently, much of the interpretation of cancer simply comes down to subjective guesswork, based on how hundreds of thousands of cells look under the microscope. On the horizon may be a computerized image analysis system that measures and quantifies various cell shapes and irregularities—and, in the process, creates more lucid pictures from a murky palette.

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FALLOPIAN TUBES

The Fallopian tubes are two thin, muscular tubes located between the upper (wider) part of the uterus and the ovaries. They transport the egg from the ovaries to the uterus, where it can be fertilized. The Fallopian tubes can become infected in pelvic inflammatory disease. Sometimes a fertilized egg can stop here instead of traveling to the uterus to implant. This type of ectopic pregnancy, called a tubal pregnancy, is a medical emergency, since such a pregnancy can lead to rupture of the tube and cause internal bleeding. This condition is more common in women who have had an infection in the tubes as a result of pelvic inflammatory disease, which often leads to scarring in the tubes.

OVARIES

Every woman has two ovaries, one on each side of the pelvic cavity. The ovaries are located at the ends of the Fallopian tubes. In addition to containing ova (eggs), the ovaries are vital in the production of the hormones estrogen and progesterone; they are analogous to the testicles in men. Each ovary is normally 3-4 cm across. Each month before a woman reaches menopause (the cessation of menstrual cycles, usually at about the age of fifty for most women), one of the ovaries releases an egg at the middle of the menstrual cycle. If the egg is not fertilized by sperm, then it does not implant in the uterus and menstruation occurs. The ovaries, too, can be infected in pelvic inflammatory disease.

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