Health-Medical-Fitness-Diet-zb: august 2012

vineri, 31 august 2012

German circumcision ban 'dangerous': Jewish group

"We are very concerned that Europe becomes a place where circumcision is made illegal or denigrated," Abraham Cooper from the Simon Wiesenthal Centre told reporters after meeting the German justice minister over the issue.

"That would be extraordinary dangerous and injurious for the Jewish community," he added.

Cooper said he was satisfied after his meeting with Justice Minister Sabine Leutheusser-Schnarrenberger and said he expected the government to introduce legislation protecting the rite "before the end of the year".

Members of parliament signed up to a cross-party motion in July calling on the government to draw up legislation that "ensures that the circumcision of boys carried out to medically professional standards and without undue pain is fundamentally permissible".

In a ruling published in June, a court in the western German city of Cologne ruled that circumcision on religious grounds was tantamount to grievous bodily harm and therefore illegal.

The ruling prompted outrage and Jewish and Muslim community leaders joined forces to condemn it in the strongest possible terms, seeing a threat to the freedom of religion in Germany.

Diplomats have acknowledged privately that the ruling has proved "disastrous" to Germany's international image, particularly in light of its Nazi past.

Chancellor Angela Merkel is reported to have said that the ruling risked making Germany a "laughing stock".

Turkey's Europe Minister Egemen Bagis wrote in an opinion article in Tuesday's edition of the Sueddeutsche Zeitung that the ruling was in danger of threatening religious freedom in Germany.

Israeli President Shimon Peres has also weighed into the controversy, telling his German counterpart in a letter last week that circumcision is "at the core of Jewish identity".

Cooper said: "It's true on economic areas, when Germany sneezes, Europe catches a cold."

"On this issue we want to make sure that it won't spread."

Healer Charged in 16 HIV Infections

A self-styled healer has been indicted by a Swiss court on charges that he intentionally infected 16 people with HIV, the virus that causes AIDS, in cases going back more than a decade, authorities said Thursday.

The unidentified man was indicted by a five-judge panel in Bern-Mitelland regional court on charges of intentionally spreading human disease and causing serious bodily harm, offenses that carry maximum penalties of five to 10 years respectively, said the regional prosecutor's office in Bern, the Swiss capital.

The office said in a statement that most of the victims attended a music school that the man operated.

A spokesman for the prosecutor, Christof Scheurer, said the man also practiced as an unlicensed, self-styled acupuncturist — a trade which he is believed to have used between 2001 and 2005 as a pretext to prick and infect some of his victims with blood that was infected with AIDS.

HIV is transmitted through bodily fluids such as blood, semen or breast milk.

The police investigation concluded that the man had used various pretexts to prick his victims, but it remained unclear exactly what objects he had used. In other cases, the investigation found, the self-described healer — who is not HIV-positive — had served his victims drinks that made them pass out so he could infect them.

"The defendant denies everything that is alleged," the prosecutor's statement added.

The cases apparently came to light when Bern hospital Inselspital began to investigate similar complaints of infections in connection with a so-called healer.

Prosecutors say the probe, which was launched after one alleged victim filed a criminal complaint in early 2005, has finally been completed, but that it took years because of a number of difficulties ranging from the use of genetic testing to identifying victims while adhering to protections for patient privacy.

Proceedings against a second suspect in the case have been permanently closed, the statement said, because his involvement could not be confirmed.

miercuri, 29 august 2012

Docs Strengthen Stance on Circumcision

The nation's most influential pediatricians group says the health benefits of circumcision in newborn boys outweigh any risks and insurance companies should pay for it.

In its latest policy statement on circumcision, a procedure that has been declining nationwide, the American Academy of Pediatrics moves closer to an endorsement but says the decision should be up to parents.

"It's not a verdict from on high," said policy co-author Dr. Andrew Freedman. "There's not a one-size-fits-all-answer." But from a medical standpoint, circumcision's benefits in reducing risk of disease outweigh its small risks, said Freedman, a pediatric urologist in Los Angeles.

Recent research bolstering evidence that circumcision reduces chances of infection with HIV and other sexually spread diseases, urinary tract infections and penis cancer influenced the academy to update their 13-year-old policy.

Their old stance said potential medical benefits were not sufficient to warrant recommending routinely circumcising newborn boys. The new one says, "The benefits of newborn male circumcision justify access to this procedure for those families who choose it." The academy also says pain relief stronger than a sugar-coated pacifier is essential, usually an injection to numb the area.

In this Aug. 23, 2012, photo, social worker Shannon Coyne poses for a portrait with her 11-month-old son in Philadelphia. Coyne and her husband decided against circumcision for their son. The nation's most influential pediatricians group says the health benefits of circumcision in newborn boys outweigh any risks and insurance companies should pay for it. In its latest policy statement on circumcision, a procedure that has been declining nationwide, the American Academy of Pediatrics moves closer to an endorsement but says the decision should be up to parents. (AP Photo/Matt Rourke) Close

The federal Centers for Disease Control and Convention has estimated circumcision costs range from about $200 to $600 nationwide. Coverage varies among insurers and several states have stopped Medicaid funding for circumcisions.

The new policy was published online Monday in Pediatrics. It comes amid ongoing debate over whether circumcision is medically necessary or a cosmetic procedure that critics say amounts to genital mutilation. Activists favoring a circumcision ban made headway in putting it to a vote last year in San Francisco but a judge later knocked the measure off the city ballot, ruling that regulating medical procedures is up to the state, not city officials.

In Germany, Jewish and Muslim leaders have protested a regional court ruling in June that said circumcision amounts to bodily harm.

Meantime, a recent study projected that declining U.S. circumcision rates could add more than $4 billion in health care costs in coming years because of increased illness and infections.

Circumcision involves removing foreskin at the tip of the penis. The procedure can reduce germs that can grow underneath the foreskin, and complications, including bleeding and infection, are rare, the academy says.

Despite the U.S. decline, about half of baby boys nationwide still undergo circumcision, or roughly 1 million each year. The country's overall rate is much higher than in other developed nations, but U.S. rates vary by region and are higher in areas where it is a cultural or religious tradition, including among Jews and Muslims.

Psychologist Ronald Goldman, director of an anti-circumcision group, the Circumcision Resource Center, said studies show circumcision causes loss of sexual satisfaction — a claim the academy said is not supported by the research it reviewed — and can be psychologically harming. Goldman contends medical studies showing benefits are flawed and that the academy's new position is "out of step" with medical groups in other developed countries.

Infections among homeless could fuel wider epidemics: study

With an estimated 650,000 homeless people in the United States and around 380,000 in Britain, experts said high levels of infection would not only cause yet more poverty and distress for those without homes, but could also become a wider problem.

"Infections in homeless people can lead to community infections and are associated with malnutrition, long periods of homelessness and high use of medical services," said Seena Fazel, a senior research fellow in clinical science at the University of Oxford who led the study.

Fazel and his team analyzed more than 40 research papers on levels of HIV, hepatitis C and TB among homeless people from 1984 to 2012.

They found that in the United States, for example, TB rates were at least 46 times greater in the homeless than in the general population, and the prevalence of hepatitis C viral infection was more than four times higher.

In Britain, TB rates were about 34 times higher in homeless people than in the general population, and the prevalence of hepatitis C viral infection was nearly 50 times higher.

For HIV, rates of infection were typically between 1 and 20 times higher in homeless people in the United States than the general population, but no studies were found for Britain.

Fazel said his findings suggested the best way to fight back against these and other infectious diseases was to focus on the homeless as one of the highest risk groups.

"Because ... numbers of homeless people are high in some countries, improvements in care could have pronounced effects on public health," he said.

Fazel, whose study was published in The Lancet Infectious Diseases journal, said similar patterns were found in most other countries where data were available. Other countries covered in the study included France, India, Sweden, Ireland and Brazil.

According to United Nations estimates, about 100 million people worldwide are homeless. It is well known that rates of illness and premature death are particularly high in this group.

TB kills an estimated 1.4 million people annually, and about 9 million people are newly infected each year around the world.

Because it is a bacterial infection that spreads through the air in droplets when infected people cough and sneeze, it can develop into community outbreaks.

Anyone with active TB can easily infect another 10 to 15 people a year, and because successful treatment for TB requires months of antibiotics, patient care can be expensive.

In the United States, nearly 60,000 new cases of the human immunodeficiency virus (HIV) that causes AIDS are reported nationally every year.

The researchers said this research focused on HIV, Hepatitis C and TB because their initial work suggested these were the most heavily studied infections among homeless populations.

But they noted the homeless also have high rates of other infectious diseases, including hepatitis A and B, diphtheria, foot problems and skin infections.

(Editing by Andrew Heavens)

Porn film production on hold after Los Angeles syphilis case

The actors can return to work in 10 days after taking antibiotics and doctors have recommended treating all adult film actors as a precaution, the Los Angeles-based Free Speech Coalition said in a statement on its website late on Monday.

It added that filming had been halted since the weekend.

"Clearly our industry's priority is the health and well-being of our performers," Diane Duke, the executive director of the Free Speech Coalition, said in the statement.

Porn producers in the Los Angeles area, which is the heart of the U.S. adult film industry and home to an estimated 1,000 performers, are under pressure to ensure condom use on sets to prevent the spread of the AIDS virus and other sexually transmitted diseases.

Existing California workplace laws already mandate the use of condoms by porn performers, but critics say that statute is not specifically aimed at the industry and is widely flouted.

A Los Angeles ballot initiative in November will ask voters to require the county health department to require condom use by adult film performers.

The Los Angeles County Department of Public Health said in a statement on Monday that it was "investigating recent reports of possible cases of syphilis in the adult film industry."

It was unclear exactly how many porn actors have tested positive for syphilis. The Free Speech Coalition said on its website that a single performer had tested positive for the disease.

But Peter Kerndt, the director of the county's sexually transmitted disease programs, told the Los Angeles Times in an article posted on its website on Friday that his agency had received reports of at least five possible cases.

Sarah Kissel, a spokeswoman for the Department of Public Health, declined on Tuesday to say how many cases had been reported to the county.

The nonprofit AIDS Healthcare Foundation has led a campaign to involve local officials in regulating the use of condoms in the adult film industry. In January, it succeeded in persuading Los Angeles city officials to adopt a condom requirement for porn performers. The city is still determining how to enforce the policy, but it will not cover studio sound stages.

A ballot initiative in November, which resulted from a signature-gathering drive by the AIDS Healthcare Foundation, would require county health officials to impose a more far-reaching requirement for condoms on porn sets, and that would apply to shoots in studio sound stages.

The Free Speech Coalition last year called for a temporary moratorium on filming after a performer tested positive for HIV. The actor was later found to not have the virus.

(Reporting by Alex Dobuzinskis; Editing by Cynthia Johnston and Paul Simao)

Benefits of circumcision outweigh risks, U.S. pediatrics group says

The change was prompted by scientific evidence that suggests circumcision can reduce the risk of urinary tract infections in infants and cut the risk of penile cancer and sexually transmitted diseases, including HIV and the human papillomavirus or HPV, which causes cervical and other cancers.

Although the AAP's 1999 statement was fairly neutral, the new statement, published on Monday in the journal Pediatrics, comes down in favor of the procedure, saying the health benefits of newborn male circumcision "justify access to this procedure for families who choose it."

"We're not saying you have to have it," said Dr. Andrew Freedman, a pediatric urologist at Cedars-Sinai Medical Center in Los Angeles who chaired the AAP's circumcision task force.

"We're saying if a family thinks it is in the child's best interests, the benefits are enough to help them do that," he said.

Based on a review of more than 1,000 scientific articles, the task force said male circumcision does not appear to adversely affect penile sexual function, sensitivity of the penis or sexual satisfaction.

The AAP said parents should be given unbiased information about the procedure and be allowed to make the call on their own.

But the group did say it is imperative that those performing circumcision are adequately trained, that they use sterile techniques and offer effective pain management.

GROWING DEBATE

Circumcision, the surgical removal of the foreskin of the penis, is a ritual obligation for infant Jewish boys, and is also a common rite among Muslims, who account for the largest share of circumcised men worldwide.

The wider U.S. population adopted the practice due to potential health benefits, but those advantages have become the subject of debate, including recent efforts to ban circumcision in San Francisco and Germany.

In Germany, the debate over circumcision has landed in the courts. Last week, an unnamed doctor in Germany filed charges against a rabbi for performing ritual circumcisions on infant boys, two months after a court in Cologne angered Jews and Muslims by banning the practice.

In the United States, the new guidelines may begin to turn the tide on infant circumcision, which has begun to fall in recent years as insurers have balked at paying for a procedure without a strong medical justification.

In as many as 18 U.S. states, the Medicaid program for the poor has stopped paying for the procedure, a trend some doctors fear could significantly increase U.S. health costs because of increased cases of urinary tract and HIV infections.

"The American Academy of Pediatrics had formerly been on the discouraging side," said Dr. Peter Richel, chief of pediatrics, at Northern Westchester Hospital in Mount Kisco, New York.

"If, indeed, we can cut down on a greater incidence statically of HIV or HPV, then I am certainly all for that."

'SHORT SHRIFT'

In a statement issued on Friday in anticipation of the guidelines, the anti-circumcision group Intact America said most of the studies underlying the new guidelines are based on research done on adult men in Africa.

"The task force has failed to consider the large body of evidence from the developed world that shows no medical benefits for the practice, and has given short shrift, if not dismissed out of hand, the serious ethical problems inherent in doctors removing healthy body parts from children who cannot consent," said Georganne Chapin, the group's executive director.

Dr. Douglas Diekema, a pediatric bioethicist from the Seattle Children's Research Institute and the University of Washington who served on the task force, said the group considered a wide range of ethical issues, including pain experienced by the child and whether parents have the right to make the decision without the child's consent.

"There is no decision you can make that doesn't potentially put a child at risk. If you choose to circumcise, there is a risk he'll grow up to be a man who wishes he wasn't circumcised," Diekema said.

Diekema said waiting until the child is older to make the choice about circumcision would lose much of these early benefits, and because the foreskin is thicker in a teen than in an adolescent, the procedure carries more risks.

"I really don't think there is an easy answer," he said.

What was clear, Diekema said, was the issue of pain.

"We were unanimously agreed that it's inappropriate to do this procedure without adequate pain control. That, in many ways, is one of the biggest ethical issues," he said.

Rabbi Shmuel Goldin of the Ahavath Torah congregation in Englewood, New Jersey, and president of the Rabbinical Council of America, said circumcisions done for religious purposes do not typically involve pain medication, but he noted that the procedure is quick and has a long tradition of success.

"We've performed it for centuries with no adverse effects to our children."

Even so, he worries about the lawsuits in Germany trying to ban circumcision.

"For us, it is such a critical component of our religious life that an attempt to eradicate it is an attempt to eradicate our religion. To have this happening in Germany, given our history, is particularly saddening to us."

(Reporting by Julie Steenhuysen; Editing by Lisa Shumaker)

U.S. health panel likely to make HIV tests routine

The U.S. Preventive Services Task force, a government-backed group of clinicians and scientists, is expected to make a new recommendation on HIV screening available for public comment before the end of the year.

Health officials close to the panel, speaking on condition of anonymity, see it making a positive recommendation for routine screening, updating their current position, issued in 2005, which leaves the decision up to doctors.

Under President Barack Obama's healthcare law, passed in 2010, insurers are required to cover preventive services that are recommended by the task force.

"This would be one of those major sea changes ... moving away from what has been somewhat the segmentation of HIV - either by population, by geography," said Michael Kharfen, chief of community outreach for the Washington, D.C., Department of Health. Kharfen, who worked on the frontlines of the HIV epidemic in New York in the 1980s, recalls when the prognosis for the disease was "practically certain you were going to die.

"It still will take culture change for medical providers, but this will be a tremendous leap," he said.

The HIV/AIDs epidemic remains a significant health challenge in the United States, with an estimated 1.2 million people living with the disease. Of this group, the U.S. Centers for Disease Control and Prevention (CDC) estimates that 20 percent are unaware of their infection.

Nearly 60,000 new cases of the human immunodeficiency virus that causes AIDS are reported nationally every year.

The CDC and other prominent groups have already called for routine HIV screening as a way to reach a much broader population and reduce the stigma some associate with showing up at an HIV clinic. But a recommendation from the task force would carry greater weight, as the U.S. health reform law of 2010 will require insurers to cover preventive services it endorses.

Global health officials have also stepped up the call for earlier treatment of people infected with HIV. New studies show that the latest HIV medications not only can extend the lives of patients for decades but are also one of the most potent ways of preventing their sexual partners from contracting the disease. Early treatment of HIV has been reported to cut transmission risk to uninfected partners by 96 percent.

"All healthcare providers have a responsibility to find cases of HIV because we don't know where they are," said Dr. Lisa Fitzpatrick, who directs the United Medical Center, an HIV clinic in Washington. While doctors in the past focused on higher risk groups such as men who have sex with men, she said, "HIV is in the general population now."

WEIGHING THE EVIDENCE

In 2006 the CDC recommended testing everyone between the ages of 13-64 at least once. They have since been joined by professional groups such as the American College of Physicians and the HIV Medicine Association.

The fact that the CDC and the task force came to different conclusions, even in the face of similar evidence, is likely to have stemmed from differences in their respective missions.

"We are looking at public health. The task force may be looking more at clinical care and the integration of prevention services within the clinical setting," said CDC Executive Director Kevin Fenton.

The task force is charged with weighing the potential harm of a test against its possible benefits. In 2005 the panel was not convinced by the available evidence that widespread screening would have the desired effect of helping prevent new infections by changing the behavior of the patient who tested positive.

"We did not find that evidence at that time compelling enough to say that we were confident that more people would benefit than the people who had HIV detected," said Dr. Michael LeFevre, co-chair of the task force.

"Obviously that was seven years ago," he said, noting that new scientific evidence has since emerged showing that the very treatment of infected people can help prevent them from passing on the disease. He said that will be factored into the panel's recommendation this fall.

THE COST EQUATION

While the task force doesn't factor cost into its considerations, the CDC and other healthcare providers do. Researchers at Stanford University estimate that over a 20-year period, expanding HIV testing to the general U.S. population would reach $27 billion dollars.

A more cost-effective solution proposed by the researchers, and in line with CDC recommendations, would be to do a one-time screening of the general population, followed up by annual testing in areas with greater prevalence of the disease.

Such a strategy would prevent an estimated 212,000 new infections and even lead to long-term healthcare savings, when the lifetime cost of $367,000 for HIV treatment is considered.

Private initiatives have also sought to make HIV screening more accessible and affordable. The CDC has a pilot program with drugstore chain Walgreen Co and other pharmacies for free, rapid HIV tests, whose wholesale cost is about $20 each.

The U.S. Food and Drug Administration recently approved the first over-the-counter, self-administered HIV test from OraSure Technologies, which is expected to sell for $60. A positive result would require follow-up at a doctor's office.

Adding an HIV screening to a routine blood exam would amount to $1.50 per patient.

LeFevre, a primary care doctor in Missouri, cautions that the barriers to testing go beyond the rating of a single agency.

"I can't think of another blood test in all of my practice that carries that baggage," he says of the pre-test consent, counseling, and post-test follow-up that HIV screening requires.

United Medical Center's Fitzpatrick agrees.

"This test is all about talking about sex and facing things about your patient that you feel uncomfortable facing," she said. "For years this was considered a gay disease so doctors did not get into the habit of talking about HIV or thinking that their patients might have HIV because they may not have had gay patients or they might not have known they have gay patients."

(Editing by Michele Gershberg and Prudence Crowther)

Syphilis scare prompts call to halt US porn shoots

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or whatever the crisis may be — has a life of its own. Men and women keep dying, and U.S. policies keep accelerating the centrifugal forces that are driving the country toward civil conflict, which may have profound implications for future regional and international security." — Sarah Chaynes, a senior associate with the Carnegie Endowment for International Peace in commentary published Sunday as analysts say that the a public worn down by a war that began just a month after the Sept. 11, 2001 attacks, no longer cares about Afghanistan, and that the war has slipped off the radar screens and is now considered by many to be over.

Porn group: filming to halt during syphilis probe

One performer has tested positive, and the performer's sexual partners are being notified, according to Joanne Cachapero, a spokeswoman for the Free Speech Coalition.

The voluntary, temporary moratorium on production is expected to shutter a multi-billion dollar industry "until the risk to performers in the industry has been properly assessed and all performers have been tested," the trade association said in a statement.

On Friday, the Los Angeles County Public Health Department announced an investigation into at least five possible cases of syphilis that were reported last week.

Cachapero said the group is calling on all performers, more than 1,000, to be tested. Because the illness can be difficult to detect, the trade group's medical experts have ordered preventative shots of antibiotics for performers. After performers get the shots, they can go back to work within 10 days, Cachapero said.

According to the Centers for Disease Control and Prevention, syphilis is transmitted through direct contact with syphilis sores, which mainly occur on the external genitals, vagina, anus or inside the rectum. The disease can be transmitted through a variety of sex acts.

A single shot of penicillin can cure a person who has had syphilis for less than a year, according to the CDC. Additional doses are necessary for people who have had the STD for a longer period.

County public health spokeswoman Sarah Kissell acknowledged the investigation Monday but declined an interview seeking details of its scope or an update of its findings.

The porn industry has held self-imposed moratoriums following news of diseased performers before.

In 2011, major porn producers stopped filming for nearly a week after an adult film performer tested positive for HIV, which causes AIDS. The Free Speech Coalition said the case was later determined to have been a false report.

In late 2010, porn actor Derrick Burts was diagnosed as HIV-positive, and his case was confirmed, briefly halting production.

In 2004, at least five performers tested positive for HIV, prompting another brief self-imposed moratorium.

The AIDS Healthcare Foundation, an advocacy group that has called for the use of condoms in all pornography, said Monday that the industry is incapable of policing itself and protecting its performers.

The group is backing a November ballot measure that will allow Los Angeles county voters to mandate the use of condoms during pornography shoots.

The Free Speech Coalition opposes the measure, saying the industry is a tight-knit community that has been proactive in testing and protecting the welfare of performers.

___

Shaya Tayefe Mohajer can be reached at http://www.twitter.com/APShaya .

Pediatricians Group Praises Benefits of Circumcision for Male Infants

Evidence for the long-term health benefits of circumcision for newborn boys has been mounting for years. Today the influential group the American Academy of Pediatrics (AAP) declared that the procedure is, indeed, beneficial and that it should be covered by public and private health insurance plans. The recommendation was published online August 27 in Pediatrics.

Previously the group was less committal on the subject of circumcision, their last guidelines noting that it was not “a medical necessity for the well-being of the child.” But “since that time, substantial contributions have been made to the peer-reviewed literature,” The AAP noted.

The new statement comes after five years of work by the group’s Task Force on Circumcision and an analysis of 15 years of the medical literature on circumcision. The new recommendations are also backed by the American College of Obstetricians and Gynecologists.

With the removal of part or all of the penis’s foreskin, a male child’s risk of urinary tract infections, sexually transmitted infections including the human papillomavirus (HPV) and penile cancer are reduced, the organization noted. Removing the skin reduces the areas that infectious bugs can linger. A study published earlier this year in Cancer linked circumcision to a 15 percent lower risk of getting prostate cancer. Circumcision has also been shown to drastically reduce the spread of HIV, and the World Health Organization now recommends it as a preventive strategy. A 2011 study found that circumcision, including that of adults and adolescents, in many African countries could prevent millions of new HIV infections in both men and women on that continent over the next decade, saving lives and billions of dollars in future health care costs.

With all of this evidence, “the procedure’s benefits justify access to this procedure for families who choose it,” the task force concluded. The group recommends that circumcision should be performed by trained medical workers, using sterilized equipment and adequate pain management. It acknowledges that the procedure does carry risks, but most of them are minor such as local infection and more major complications are rare. And circumcising a newborn appears to carry the lowest risk of complications compared to other age groups.

The rate of male newborn circumcisions has been declining in the U.S. since the late 1990s, from roughly 62 percent in 1999 to 57 percent in 2008, according to the National Hospital Discharge Survey. Without insurance coverage, newborn male circumcision can cost upward of $600, and public and private health plans do not always cover the procedure.

The group does not go so far as to insist every male baby be circumcised, despite the medical evidence for its benefits. “Parents should weigh the health benefits and risks in light of their own religious, cultural and personal preferences,” the task force noted in their more detailed technical report, also published online August 27 in Pediatrics. It also might not be appropriate for infants who have other medical complications, or it might be delayed for health or cultural traditions.

“Ultimately, this is a decision that parents will have to make,” Susan Blank a pediatrician affiliated with the New York City Department of Health and Mental Hygiene and who chaired the task force, said in a prepared statement. But “parents are entitled to medically accurate and non-biased information about circumcision,” and should talk with their doctors early in pregnancy to ensure adequate decision making time and to establish whether they can get insurance coverage for the procedure, she noted.

Follow Scientific American on Twitter @SciAm and @SciamBlogs. Visit ScientificAmerican.com for the latest in science, health and technology news.
© 2012 ScientificAmerican.com. All rights reserved.

Only one gonorrhea drug left for routine cases: CDC

The U.S. Centers for Disease Control and Prevention said on Thursday it no longer recommends the use of cefixime, marketed under the brand name Suprax by Lupin Ltd, because it is becoming less effective. That leaves the injectable generic antibiotic ceftriaxone, used in combination with another antibiotic, as the last treatment option.

"The change in antibiotic treatment guidelines we are making today is a critical pre-emptive strike to preserve the last effective treatment option," said Dr. Gail Bolan, director of the CDC's Sexually Transmitted Disease Prevention division.

"This will not solve the problem of drug-resistant gonorrhea once and for all, but it may buy us time to allow researchers and drug developers to develop new treatments," Bolan told reporters in a telephone briefing.

Until new treatments reach the market, experts say the best way to reduce the risk of drug-resistant gonorrhea is to rapidly diagnose the disease and fight it with combinations of two or more types of antibiotics at the same time.

This technique is used in the treatment of some other infections like tuberculosis in an attempt to make it more difficult for the bacteria to learn how to overcome the drugs.

SUPERBUG STRAINS

If left untreated, gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy, stillbirths, severe eye infections in babies and infertility in both men and women.

In the United States, there are approximately 300,000 reported cases of gonorrhea each year, but because infected people often have no symptoms, the actual number of cases is likely closer to 700,000, Bolan said.

So-called "superbug" drug-resistant strains of gonorrhea accounted for almost one in 10 cases of sexually transmitted disease in Europe in 2010, more than double the rate of the year before, health officials from the Stockholm-based European Centre for Disease Prevention and Control said in June.

Dr. Robert Kirkcaldy of the CDC said there have so far been no U.S. cases of "untreatable" gonorrhea, in which the germ resists all known treatments, but U.S. laboratory data suggest resistance is beginning to emerge.

The guidelines also recommend that healthcare providers closely monitor their patients for treatment failure, and retest patients with persistent symptoms with a culture-based gonorrhea test, which can identify antibiotic-resistant infections.

Doctors said cefixime may be needed as an alternative treatment option in some cases. If ceftriaxone is not readily available, providers may prescribe a dual therapy of cefixime plus one of two other antibiotics: azithromycin or doxycycline.

In addition to closely monitoring for resistance nationally, CDC said it is working with the World Health Organization to monitor for emerging resistance on the global level.

The agency is also collaborating with the National Institutes of Health to test new combinations of existing drugs.

(Additional reporting by Kate Kelland in London; Editng by Michele Gershberg)

Porn Actor Tests Positive for Syphilis

A porn actor's positive syphilis test has prompted an industry-wide moratorium on adult film production.

The Free Speech Coalition, a porn industry trade group, has asked movie producers to suspend work on X-rated films and videos while actors get tested and treated for the sexually-transmitted bacterial infection.

"I always appreciate how our industry comes together in a time of need," Diane Duke, the group's executive director, said in a statement. "Clearly our industry's priority is the health and well-being of our performers."

Doctors from the coalition's Adult Production Health and Safety Services will test all porn performers for syphilis using the rapid plasma reagin test -- a screening test that spots infection-induced antibodies. They will also administer prophylactic antibiotics to protect uninfected performers from the disease.

"Once the performer receives antibiotics, he or she will be available to work within 10 days," the coalition said in a statement, adding that several porn production companies have offered to cover the cost of syphilis testing and treatment.

The decision on when to lift the production moratorium will be made "as more information is revealed," according to the coalition.

The signs and symptoms of syphilis -- from painless sores on the genitals or mouth to skin rashes and swollen lymph nodes -- can take years to emerge, according to the U.S. Centers for Disease Control and Prevention. And if left untreated, the disease can lead to numbness, paralysis, blindness, dementia, and even death.

While less common than chlamydia and gonorrhea, syphilis cases are on the rise in California. Between 2010 and 2011, the number of syphilis cases jumped 18 percent, according to data from the state Department of Public Health obtained by the Los Angeles Times.

The syphilis scare comes less than a year after a porn actor's positive HIV test halted adult film production, prompting calls for mandatory condom use in X-rated shoots.

"There really cannot be an argument over the fact that these performers would be far safer if they used condoms," Michael Weinstein, president of the AIDS Healthcare Foundation, told ABC News at the time.

Subsequent testing revealed the HIV test result was a false positive. Nevertheless, the foundation plans to highlight the syphilis incident on a Nov. 6 ballot measure mandating condom use in L.A. porn production, according to a statement.

Porn film production on hold after Los Angeles syphilis cases

The actors can return to work in 10 days after taking antibiotics, and doctors have recommended treating all adult film actors as a precaution, the Los Angeles-based Free Speech Coalition said in a statement on its website late on Monday.

It added that filming had been halted since the weekend.

"Clearly our industry's priority is the health and well-being of our performers," Diane Duke, the executive director of the Free Speech Coalition, said in the statement.

Porn producers in the Los Angeles area -- the heart of the U.S. adult film industry and home to an estimated 1,000 performers -- are under pressure to ensure condom use on sets to prevent the spread of the AIDS virus and other sexually transmitted diseases.

Existing California workplace laws already mandate the use of condoms by porn performers, but critics say that statute is not specifically aimed at the industry and is widely flouted.

A Los Angeles ballot initiative in November will ask voters to force the county health department to require condom use by adult film performers.

Dr. Jonathan Fielding, the director of the Los Angeles County Department of Public Health, said his agency was investigating less than a dozen reported cases of syphilis involving the adult film industry.

All the cases so far involved adult film performers or their partners, Fielding said.

"It's not surprising that there would be a lot of cases in the adult film industry, since they are having a lot of unprotected sex and often with multiple partners," he said.

The AIDS Healthcare Foundation, which has led a campaign to involve local officials in regulating the use of condoms in the adult film industry, was critical of the porn industry decision to have all its performers receive antibiotic treatment, rather than take the time to trace the outbreak.

"They just want to throw an antibiotic blanket over the whole thing," AIDS Healthcare President Michael Weinstein said.

His nonprofit succeeded in January in persuading Los Angeles city officials to adopt a condom requirement for porn performers. The city is still determining how to enforce the policy, but it will not cover studio sound stages.

BALLOT INITIATIVE

A ballot initiative due in November that AIDS Healthcare supports would go further and require county health officials to impose requirements for condoms on porn sets that would apply to shoots in studio sound stages.

The Free Speech Coalition said the syphilis test that porn industry doctors were administering could not diagnose a recent infection because the test has a 90-day window.

Joanne Cachapero, a spokeswoman for the Free Speech Coalition, said her group "would rather err on the side of caution" and ensure "as many performers as possible receive testing and treatment."

(Reporting by Alex Dobuzinskis; Editing by Cynthia Johnston and Cynthia Osterman)

CDC Issues New Guidelines to Ward Off Gonorrhea Superbug

The CDC's new guidelines for the treatment of gonorrhea specifically advise doctors to stop treating the disease with the antibiotic cefixime as their first course of action. Cefixime is one of the last remaining antibiotics that are still effective in treating the disease. As such, the CDC is now recommending a cocktail of other drugs be used to treat the infection before resorting to cefixime.

Here is some of the key information regarding the CDC's new guidelines and gonorrhea's increased drug resistance.

* Jonathan Zenilman, who works for Johns Hopkins, told NPR on Thursday that gonorrhea infections used to be able to be treated by a whole host of common antibiotics, including penicillin and tetracycline.

* The use of these common antibiotics to treat a wide-ranging list of infections, along with the disease's ability to mutate rapidly, has slowly rendered them ineffective in treating gonorrhea, according to Zenilman.

* A report by WebMD back in June stated that gonorrhea started becoming resistant to common antibiotics like penicillin or tetracycline in the 1980's.

* There are now only two antibiotics that can still effectively fight gonorrhea--cefixime and ceftriaxone.

* The CDC's new guidelines now recommend that doctors begin treating a patient's gonorrhea infection with a single injection of ceftriaxone, in combination with the more common antibiotics doxycycline or azithromycin in pill form.

* By advising doctors to use a single injectable dose of ceftriaxone along with more common antibiotics, scientists at the CDC are hoping to delay the moment when both ceftriaxone and cefixime also become ineffective, according to USA Today.

* The director of the CDC's Sexually Transmitted Disease Prevention division, Gail Bolan, called the CDC's new treatment guidelines a "critical preemptive strike to preserve the last effective treatment option," as quoted by Reuters.

* The first known failure of ceftriaxone and cefixime to successfully treat a case of gonorrhea reportedly occurred in Japan in 2003. In 2009, a so-called gonorrhea "superbug" was found there as well. It has been subsequently found at least once in Spain and France, but not yet in the U.S., according to USA Today.

Vanessa Evans is a musician and freelance writer based in Michigan, with a lifelong interest in health and nutrition issues.

FDA approves 4-in-1 HIV combination pill

The agency approved Gilead Sciences' Stribild as a once-a-day treatment to control HIV in adults who have not previously been treated for infection.

The pill contains two previously approved antiviral drugs, emtricitabine and tenofovir disoproxil fumarate, currently sold as the combination pill Truvada. Those drugs are combined with two new drugs: elvitegravir and cobicistat. Elvitegravir interferes with one of the enzymes that HIV needs to multiply. Cobicistat helps prolong the effect of elvitegravir.

Company studies showed that 88 to 90 percent of patients taking Stribild had an undetectable level of HIV in their blood after 48 weeks, compared with 87 percent for patients taking Atripla, another HIV drug that contains Truvada and one other drug.

An estimated 1.2 million Americans have HIV, which develops into AIDS unless treated with antiviral drugs. AIDS causes the body's immune system to break down, leading to infections which are eventually fatal.

Patients can live relatively healthy, normal lives when treated with antiviral cocktails.

Like most other HIV drugs, Stribild will carry a boxed warning about potentially dangerous side effects, including severe liver problems and the buildup of lactic acid. More common side effects include nausea and diarrhea.

Earlier this year, Gilead received FDA approval to market Truvada as the first preventive medicine for healthy people who are at high risk of acquiring HIV. Truvada was first approved in 2004 for patients already infected with the virus.

Gilead Sciences Inc. is based in Foster City, Calif. Shares of the company fell 10 cents to close at $57.19 and then added 11 cents in after-hours trading.

US approves new once-a-day pill to treat HIV

The single daily dose of Stribild provides a complete treatment regimen for HIV infection, the US Food and Drug Administration said in a statement, and is meant for people who have not already received treatment with other HIV drugs.

"Through continued research and drug development, treatment for those infected with HIV has evolved from multi-pill regimens to single-pill regimens," said Edward Cox, director of the Office of Antimicrobial Products in the FDA's Center for Drug Evaluation and Research.

"New combination HIV drugs like Stribild help simplify treatment regimens."

The new pill, previously called Quad, is made by Gilead Sciences in California and "should be available to patients by the end of the week," company spokeswoman Erin Rau told AFP.

The company said it tested the pill in two double-blind clinical trials of more than 1,400 patients.

Results showed that Stribild performed as well or better than two other treatment combinations, and brought virus readings down to undetectable levels in around nine of 10 patients after 48 weeks.

"Therapies that address the individual needs of patients are critical to enhancing adherence and increasing the potential for treatment success," Gilead chief John Martin said in a company statement.

But some advocates say the new pill is priced far too high.

"We wanted to see (a price of) no more than the current drug," said Michael Weinstein, president of the AIDS Healthcare Foundation, referring to Gilead's previously approved three-in-one pill, Atripla. But he said the price will be about a third higher than the three-pill combo.

The new drug "is not a significant improvement over existing therapies," Weinstein told AFP, adding the cost will "severely limit access" to the new medication.

Gilead is charging wholesalers $28,500 a year for the drug, but said it will provide discounts to state assistance programs and has created a patient financial-assistance program, Rau said.

This is Gilead's third single-tablet anti-HIV combination therapy, the company noted, adding it is still seeking approval for the newest offering in Australia, Canada and the European Union.

To get the drug to HIV patients in the developing world, where millions lack access to effective treatment options, generic versions are being developed -- with permission and help from Gilead -- by a number of Indian manufacturers and the Medicines Patent Pool, a non-profit that helps facilitate generic drug-making.

The drug combines Truvada -- another Gilead offering approved in 2004, that combines emtricitabine and tenofovir disoproxil fumarate to fight an enzyme that HIV needs to replicate -- with elvitegravir, another enzyme-fighting drug, and cobicistat, which enhances the effects of elvitegravir.

The FDA said further study is required to determine the quad-drug's safety for women and children, how resistance may develop, and whether the drug interacts with other drugs.

Stribild will also be required to carry a label warning patients and health care providers the drug can cause fatal side effects, including severe liver problems, and a build-up of lactic acid in the blood. The FDA said the label is also required for many other HIV-fighting drugs.

But Gilead said that during the studies, "most adverse effects were mild to moderate." The FDA said patients commonly experienced nausea and diarrhea.

The drug also weakened bones and caused or worsened kidney problems -- both of which will be mentioned in a warning on the drug's label.

Truvada was previously approved as a treatment for people infected with HIV to be used in combination with other antiretroviral drugs.

In July, it was also approved for use by healthy at-risk adults to prevent HIV, the first-ever daily pill approved for that purpose.

This year, the FDA also approved the first rapid HIV test that can be bought without a prescription and taken at home.

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Fewer circumcisions could cost the US billions: study

"We find that each circumcision not performed will lead to $313 of increased expenditures over that lifetime," said senior investigator Aaron Tobian, of the Johns Hopkins University team that did the study.

The number pits health care costs if the boy is circumcised -- about $291 for the procedure -- against the projected cost of treating infections or cancers that studies have shown are more likely if he is not.

In all, the nearly 25 percent drop in circumcisions since the 1980s could run up a tab of about $2 billion in health care costs, the study found.

And if US circumcision rates were to drop as low as one in 10, the average across Europe, the research team estimated the associated rise in medical expenses would total $4.4 billion over the lifetimes of a decade of babies.

Throughout the 1970s and 1980s, about 79 percent of all baby boys were circumcised in the United States, according to the Center for Disease Control and Prevention (CDC).

But in 2010, that number dropped to just below 55 percent.

The decrease comes amid an outcry from so-called "intactivists" who argue that circumcision is an unnecessary mutilation of baby boys who have no ability to consent.

And circumcisions may become even more rare as a number of states stop covering the procedure in their Medicaid programs -- the public health insurance programs for low income Americans.

Most recently, Colorado and South Carolina joined 16 other states that decline to fund infant circumcision.

In a memo announcing the change in December 2010, South Carolina said it was part of a package to save money, adding that "medically-necessary circumcisions" will still be covered with prior approval.

In California, where the Medicaid program has declined to pay for circumcisions for more than a decade, activists recently tried to get a measure on November's election ballot that would ban circumcision entirely -- a move blocked by the state's governor, with a law outlawing the ban.

-- Keep circumcision routine --

But Tobian said that science indicates all circumcisions are medically "very beneficial and valuable."

"If there were a vaccine to prevent HIV acquisition, genital herpes, HPV, penile and cervical cancer, bacterial vaginosis and trichomoniasis, the medical community would rally behind this intervention as a game-changing tool to reduce sexually transmitted infections."

And that is just what circumcision, a procedure to remove the foreskin, does, according to three randomized trials, "the gold standard of medical evidence," he maintained.

Critics argue circumcision is medically invasive and less effective than safe sex practices, such as using condoms, at reducing sexually transmitted infections.

Tobian agreed that condoms are highly effective, but contended they are not used enough.

"In the United States, we've had three decades of safe sex education, but just last year, there were 19 million new sexually transmitted infections that cost our health care system $17 billion."

He could not say whether Europe, with its long-standing lower rates of male circumcision, has a correspondingly higher rate of the sexually-transmitted infections and their associated medical costs.

It is too difficult a comparison because "we have very different racial and socioeconomic backgrounds and different transmission dynamics," he said.

He also took issue with opponents who argue the procedure is a form of genital mutilation.

He cited a study in Kenya that asked men who were circumcised as adults to compare their sexual satisfaction before and after the procedure. More than half said they noticed "increased penile sensation and enhanced ease of reaching an orgasm with a circumcision."

Tobian and his team urge all state Medicaid programs and private insurers to cover male circumcision. They also suggest that the American Academy of Pediatrics should include a recommendation that all infant boys be circumcised.

The World Health Organization has recommended male circumcision as an "efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence," according to its website.

The study was published Monday in the "Archives of Pediatrics & Adolescent Medicine."

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Women Are 'Duped' in Quest for Perfect Vagina, Says Doctor

The 30-year-old writer posed as a patient in search of fodder for a story, and got an education in how doctors can tighten flabby tissue in a vaginoplasty, cut back the inner and outer lips of the labia and sometimes open the clitoral hood.

Berliet wrote about her experience in an article called "Designer Parts," for the Atlantic magazine.

The doctor was professional, Berliet told ABCNews.com, but after the physical exam, his "pushy" colleague, left alone with Berliet to answer her questions, was "an incredible enthusiast.

"She essentially told me my boyfriend would propose to me after the surgery was done," said Berliet. "If women are at all insecure and go for a consultation, it makes you feel more vulnerable and insecure. The vagina on the charts looked like a porn star."

Corrective gynecological surgery has been available for decades to help women with incontinence or sagging of the vaginal canal after childbirth.

But experts say thousands of women, especially younger ones, now seek such procedures as vaginoplasty and labiaplasty, which can cost between $3,000 and $10,000 and are not covered by insurance, to enhance the appearance of their genitalia or to achieve some sort of sexual ideal. The American College of Aesthetic Plastic Surgeons reports 2,140 women elected such surgeries in 2010. The International Society of Aesthetic Plastic Surgeons says twice as many have been performed in the U.S. annually -- nearly 5,200.

But these numbers might be on the low side. "We don't know the exact number, because a lot are done at surgery centers and it's hard to keep track," said Dr. Cheryl B. Iglesia, a reconstructive pelvic surgeon and director of the female program at the National Center for Advanced Pelvic Surgery in Washington, D.C. "There isn't a code that we have. And people are paying cash up front.

"It's really concerning, because [the trend] is really reaching younger ages, in their teens," Iglesia said. "I heard of a mother taking in a 16-year-old and 11-year-old wanting to get it done. It's just not right." In an editorial in the June issue of the journal Obstetrics and Gynecology, Iglesia said women were being "misled or confused about what is 'normal.'"

"There are great variations of "normal," Iglesia said. "Labia can be anywhere from 5 millimeters to 5 centimeters."

She said that Internet pornography and removing pubic hair through Brazilian waxing or shaving give women unrealistic expectations about their bodies -- or what they believe men like or want -- and goes as far as to compare vaginal rejuvenation procedures to "new age female circumcision."

In 2007, the American College of Obstetricians and Gynecologists warned about vaginoplasties and labiaplasties that were not medically indicated, questioning their safety and effectiveness.

The biggest risks in such procedures are infection, altered sensation, dyspareunia (painful contractions of the vagina), adhesions and scarring, according to ACOG, which says women need to be informed about the lack of data on these procedures and their "potential complications."

Iglesia said she had done reversal procedures for women whose vaginoplasties were so tight, they had pain during sex.

Others had labiaplasty that left them with labia that "looked like Swiss cheese," Iglesia said. Sometimes the nerves around the clitoris were damaged.

Online forums reveal numerous accounts of "botched" surgeries.

"Six weeks ago a surgeon ... sewed my perineum/labia up over the opening to my vagina, covering it like a biological chastity belt," wrote one woman on the site Real Self. "I can't have sex or a gyn exam and am in pain from the pulling/tearing at that spot. ... She tore the right labia minora and made it one third the size of left labia minora, but I'm not correcting that -- too painful."

Iglesia believes women have been "duped" by an entire culture that is oversexualized.

"Everyone sees 'Sex in the City' and are getting their public hair removed and looking down there," she said. "They are watching Internet porn and looking at Playboy and Penthouse with a lot of touched up and airbrushed pictures."

With pubic waxing and grooming, younger women are "comparing," she said. "They feel like they are abnormal."

Dr. Bernard Stern, an Alexandria, Va., ob/gyn certified in plastic surgery, who has performed nearly 3,000 vaginal rejuvenation procedures, acknowledged there were practitioners who were not properly trained but said it was up to women themselves to check for credentials and photos of results.

"I never suggest to any woman that she 'needs' vaginal cosmetic surgery," said Stern.

While Stern said he never explicitly tells women his procedure will make them more sexually attractive, his website, with a photo of him leaning over a sexy woman's backside on an exam table could suggest otherwise. The woman is wearing high heels and smiling.

Stern told ABCNews.com that he requires all his patients to undergo psychological testing before he will perform vaginal rejuvenation procedures, and he often turns women away, particularly if their husbands or partners are pressuring them to have the surgery.

All Stern's patients must sign a three-page consent form that explains the potential risks and benefits of vaginoplasty and labiaplasty.

"I have never had a patient lose sensation from a vaginoplasty and from a labiaplasty (done properly). The only thing lost is pain from stretching, pulling, getting stuck," said Stern.

"I am not guaranteeing increased sexual response," he said. "If a woman perceives her labia and or vagina as improved from vaginal cosmetic surgery, it can affect her quality of life and self-esteem, and therefore she may experience increased female sexual response."

The American College of Obstetricians and Gynecologists and Iglesia's biggest criticism of vaginal rejuvenation is the absence of blind studies, the scientific gold standard that requires the subject or the investigator (or both) is unaware of which subjects are in the experimental or control groups.

Stern said he had developed his own techniques that his studies have found to be safe. He acknowledged, though, that his studies were "retroactive" -- he surveyed patients after he'd treated them.

Berliet, the writer who went undercover to investigate vaginal rejuvenation for the Atlantic, said the doctor she saw was upfront about the risks and potential rewards of vaginal rejuvenation.

She doesn't fault the medical profession as much as a society that places more value on cosmetic surgery than sex education.

Berliet cited an August 2011 study in the British Journal of Medicine that found 40 percent of women who'd asked about genital reconstruction "reported the desire to go through with it even after being informed that their labias were normal."

"Young girls should know what anatomy looks like," said Berliet. "Male genitals just hang out and you can sense a variation in what a penis looks like. But girls' are tucked between their legs, and they assume the worst in the body part.

"We are a culture that embraces plastic surgery in other ways to improve ourselves," she said. "It's scary."