HIV TRANSMISSION: ZIDOVUDINE

A 1994 study showed that if infected mothers with CD4 counts greater than 200 took zidovudine during their pregnancies and were given zidovudine intravenously during delivery, and if the newborns were given zidovudine orally after birth, then the risk of transmission to the child decreased from 25 percent to about 8 percent. The babies suffered no harm from their mothers having received zidovudine. No trials have yet been concluded on the other medications for treatment of HIV to see if they offer similar benefits, but in certain situations (such as a high viral load for the mother, and thus a higher risk of transmission to the

baby), combination treatment with several medications is being tried. Studies are under way to determine if this approach injures the child or offers additional benefits over using zidovudine alone. A woman should discuss these options with her health care provider.

Because intervention with medication during the pregnancy may significantly decrease the chance that a baby will become infected, it is very important for a woman who is pregnant or who is thinking about becoming pregnant to know her HIV status. Testing is not mandatory, however, and the decision remains each woman’s alone.

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STD GONORRHEA TREATMENT: THE MEDICATION

Antibiotics can completely treat gonorrhea, although there may rarely be resistance to a medication. Early diagnosis and treatment are necessary to prevent such complications as scarring and infertility.

For gonorrheal infection of the eye, the oral antibiotics already listed are recommended, but for a longer time, usually a week or more. Alternatively, an injection of ceftriaxone may be given. Treatment is usually carried out in coordination with an ophthalmologist (eye doctor). If a joint infection with gonorrhea is suspected, the infected fluid is usually removed, and antibiotics are administered intravenously (through the veins) in the hospital. An orthopedist (a specialist in joint infections) is usually consulted in such cases. Gonorrhea that causes endocarditis, meningitis, or skin lesions throughout the body must also be treated with intravenous antibiotics in the hospital.

If symptoms persist after treatment with these medications, it is important to see your health care provider for a follow-up examination, for these treatments are sometimes not fully effective.

Sexual partners must be treated as well. This means everyone who has had sexual contact with an infected person in the last sixty days, even if they have no symptoms or evidence of infection on examination. In most states, if a person is diagnosed with gonorrhea, this fact is reported to the state health department, which then attempts to contact that person’s sexual partners to make sure they receive treatment.

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BARRIER METHODS DURING PREGNANCY

Women who are pregnant should be screened for evidence of infection and use a barrier method or abstain from sex during the pregnancy if their partner’s status for infections is not known. Routine screening of both the woman and her partner in the early stages of pregnancy will help to avert many problems. If a woman continues to be at risk during the pregnancy, then screening for STDs should be repeated during the pregnancy.

Women who are in stable relationships and are considering becoming pregnant should ask their partners to be tested for sexually transmitted infections if they have not been in the past. This should be considered even if the man does not have symptoms. You are in this together, and the only way to know about your risk for infections is for both of you to be tested and be educated about STDs. There is enough to worry about during the pregnancy without having to worry about sexually transmitted infections.

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PROSTATE CANCER SCREENING AND DIAGNOSIS: WHY NEEDLE BIOPSIES AREN’T PERFECT

Despite these improvements, needle biopsy doesn’t always give definitive answers. Sometimes the needle misses the cancer; sometimes what’s under the microscope is almost impossible to label definitively as cancer.

Some cancers, particularly those developing in the peripheral zone of the prostate, spread laterally—like a thin sheet of plankton on the surface of the sea. So it’s not uncommon that the biopsy needle goes in too deep and overshoots the target area. That’s why, in an attempt to get a comprehensive picture, doctors also take several tiny samples from throughout the prostate in what’s called a sextant biopsy (six biopsies, one from the top, middle and bottom of the gland on the right and left sides).

“Breast or lung cancer makes a solid nodule, just like a fist, that you usually can detect by palpation or imaging,” says a Johns Hopkins pathologist who is an expert in diagnosing prostate cancer. But prostate cancer tends to infiltrate normal tissue, meandering around normal cells. Or, as another Johns Hopkins scientist explains, it spreads out like a hand, whose fingers flow into nearby tissue “like a river flooding a valley.” In these cases there can be a significant amount of cancer, but not in the form of a “convenient” lump that’s easy to feel or see on ultrasound.

Thus, it’s not uncommon for a needle biopsy to be negative—even though cancer is present. This is called a false negative, and it can give both the urologist

and the patient “a false optimism that the cancer isn’t there,” the pathologist continues. So, even if one biopsy is suspicious and a repeat biopsy is negative, “that doesn’t rule out that the first biopsy wasn’t cancer.”

Imagine the difficulty of trying to capture this elusive tissue in a biopsy, using only a tiny needle. In some cases, it’s like looking with a needle in a haystack. The thin needles used for most prostate biopsies capture tiny cores of tissue—each about a millimeter thick—which pathologists then study under the microscope.

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THE REPRODUCTIVE SYSTEM: THE TESTES

The testes are a man’s reproductive organs. There are two of them, each less than two inches long and about an inch wide. Each testis lies protected in the scrotum, attached like a pocket watch on a chain to a spermatic cord, which, among other things, is responsible for supplying blood to the testis.

The testes are divided into hundreds of minuscule compartments, each of which contains at least one pair of threadlike, highly convoluted tubules. If these tubules were straightened out, each would stretch to two feet in length. These tiny tubules are joined, like plumbing pipes, to straighter tubes that are the body’s factories for sperm; the sperm-making process, called spermatogenesis, happens here. The testes are also the main source of the male hormone testosterone, which is responsible for fertility and for secondary sexual characteristics such as post-pubertal body hair and deepening of the voice.

Inside the scrotum are the testes, a man’s reproductive organs. Sperm are made here, in hundreds of threadlike, convoluted tubules. The tubules in each testis converge like a series of streams at the mouth of a river to form the head of the epididymis—a twisting, winding “greenhouse” where sperm mature and are stored until orgasm. During orgasm, two-thirds of ejaculated sperm are rocketed from the tail of the epididymis during a series of powerful muscle contractions.

The epididymis melts into still another tube, called the vas deferens—a hard, muscular cord, designed to pump sperm to the prostatic segment of the urethra. The vas deferens eventually meets with the duct of the seminal vesicle to form the ejaculatory duct.

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