Living and Dying in Brick City (12 page)

A sexually transmitted infection caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2); HSV-2 causes most genital herpes.

Symptoms:
Minimal or none, but can appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. May include a second crop of sores and flu-like symptoms, including fever and swollen glands.

Treatment:
No cure, but antiviral medications can shorten and prevent outbreaks. Daily suppressive therapy for symptomatic herpes can reduce transmission to partners.

Health Concerns:
First episode can produce several (typically four or five) outbreaks (symptomatic recurrences) within a year, but the recurrences usually decrease in frequency over time. Can cause recurrent painful genital sores in many adults, and herpes infection can
be severe in people with suppressed immune systems. Frequently causes psychological distress in those who know they are infected. Can lead to potentially fatal infections in babies. In rare cases, the herpes virus can enter the brain and cause encephalitis, an extremely rare but serious brain disease.

A very common infection caused by a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract.

Symptoms:
No symptoms for most women and some men, but when they do appear: burning sensation during urination; penile discharge that is white, yellow, or green; swollen and painful testicles; increased vaginal discharge or vaginal bleeding between periods; rectal itching; rectal soreness; rectal bleeding; painful bowel movements; sore throat.

Treatment:
Antibiotics

Health Concerns:
If untreated in women, it may cause reproductive problems; in men, it can cause epididymitis, a painful condition of the ducts attached to the testicles that may lead to infertility. Can spread to the blood or joints, which can become life-threatening. Can be passed from an infected pregnant woman to her baby, where it can cause blindness, joint infection, or a life-threatening blood infection.

HIV damages a person’s body by destroying specific blood cells that are crucial to helping the body fight diseases. AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has difficulty fighting diseases, including certain cancers.

Symptoms:
None, or flu-like symptoms within a few weeks of infection.

Treatment:
Current combinations of medications can limit or slow down the destruction of the immune system and improve the health
of people living with HIV, and may reduce their ability to transmit the virus. Most common HIV tests use blood to detect infection. Tests using saliva or urine are also available. Some tests take a few days for results, but there are also rapid HIV tests that can give results in about twenty minutes. Positive HIV tests must be followed up by a second test to confirm the positive result, a process that can take a few days to a few weeks.

Health Concerns:
Early HIV infection is associated with many diseases, including cardiovascular disease, kidney disease, liver disease, and cancer.

The most common sexually transmitted infection.

Symptoms:
None

Treatment:
None for the virus itself, but there
are
treatments for the diseases that HPV can cause. Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer. The vaccines are given in three shots. For best protection, it’s important to take all three doses. The vaccines are most effective when received at eleven or twelve years of age. Talk to a doctor about the appropriate one.

Health Concerns:
In 90 percent of cases, the body’s immune system clears HPV naturally within two years. If not cleared, can cause: genital warts, throat warts (respiratory papillomatosis), cervical cancer, or other less common cancers of the vulva, vagina, penis, anus, and oropharynx (back of throat, including base of tongue and tonsils).

Refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus), and other reproductive organs.

Symptoms:
Subtle or none; or lower abdominal pain, fever, bleeding, and pain in the right upper abdomen (rare).

Treatment:
Antibiotics

Women who douche may have a higher risk of developing PID, compared with women who do not. Douching changes the vaginal flora (organisms that live in the vagina) in harmful ways, and can force bacteria from the vagina into the upper reproductive organs. Women who have an intrauterine device (IUD) may have a slightly increased risk of PID near the time of insertion, compared with women using other contraceptives or no contraceptive at all. Risk is greatly reduced if a woman is tested and, if necessary, treated for STIs before an IUD is inserted.

Health Concerns:
Can damage the fallopian tubes and tissues in and near the uterus and ovaries and lead to serious consequences, including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), abscess formation, and chronic pelvic pain.

Bacterial infection that is often called “the great imitator” because so many of its signs and symptoms are indistinguishable from those of other diseases.

Symptoms:
Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. May present no symptoms for years, yet sufferers remain at risk for late complications if they are not treated. Also may include paralysis, numbness, gradual blindness, dementia, difficulty coordinating muscle movements, or death.

The primary stage is usually marked by the appearance of a single sore (called a “chancre”), but there may be multiple sores. The time between infection and the start of the first symptom can range from ten to ninety days (average twenty-one days).

Skin rash and mucous membrane lesions characterize the secondary stage, which typically starts with the development of a rash on one or more areas of the body. The typical secondary syphilis rash appears as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. But rashes with a different appearance may occur on other parts of the body. Other symptoms include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment the infection will progress to the latent (hidden) and possibly late stages of the disease.

Treatment:
A single intramuscular injection of penicillin, an antibiotic, if infection is less than a year. Additional doses are needed for someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available for treatment.

Health Concerns:
In the late stages, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.

Common infection caused by a protozoan parasite.

Symptoms:
None; itching or irritation inside the penis, burning after urination or ejaculation, discharge from penis; itching, burning, redness, or soreness of female genitals, discomfort with urination, thin discharge with unusual smell, uncomfortable sex.

Treatment:
Laboratory test needed for diagnosis; can sometimes be cured with a single dose of prescription antibiotics.

Health Concerns:
Preterm delivery in pregnant women.

O
ne unforgettable winter day in 2002, I knocked on the door of A3 and found a friendly couple waiting for me. The husband, a bank executive, was tall and well dressed. His wife, an elementary school teacher, didn’t look anywhere near the age listed on her chart, thirty-nine. Classy and attractive, even in a hospital gown, she smiled and nodded as I introduced myself. Studying her chart, I could see that the patient, Mrs. Givens, was experiencing vaginal bleeding and abdominal cramps. I assumed she was pregnant, since the chart stated that her last menstrual period had been nine weeks earlier.

It didn’t take long to discover that she was the more outspoken of the couple.

“Doctor, we are hardworking people,” she began, sitting upright on the examining table. “We pay our tithes and rarely question God’s reason for our failure to have a baby.”

She was dry-eyed and calm.

“This is my sixth pregnancy, but I have no children,” she continued. “There is nothing that I want more than to have a child. I’ve read books, attended seminars on parenting; I’m ready to be a mom.”

But repeatedly she had miscarried. Her doctors could give her
no explanation. That morning had started out fine, she said, but her heart sank when she got to work and discovered she was bleeding. She left work immediately and went home to lie down and pray. Unfortunately, though, soon she started feeling stomach cramps. She called her husband, who came home and rushed her to the hospital.

“Here, you should take a look at this,” Mrs. Givens said, handing me a worn brown book—a journal, organized by dates, describing every detail of this and her previous pregnancies. She’d highlighted everything from her last menstrual period to prayer services. The journal provided an extraordinarily thorough look at her medical history. As I read some of the entries, Mr. Givens stood behind his wife like a bodyguard. The two of them seemed to have a close and loving relationship.

I noticed that Mrs. Givens had starred the date of a previous positive pregnancy test, and then I skipped to an entry six weeks later: “I prayed and prayed that it wouldn’t happen,” I read. “The bleeding started this morning. I rushed to the emergency department. This is our fourth time. I knew that I was miscarrying, but hoped maybe the doctors could save this one. I did everything I was told. I don’t know if I can do this again.”

I was still thumbing through the journal when Mrs. Givens interrupted. “Doctor, last time, the doctor told me they couldn’t do anything. That was two years ago. My husband and I have been married for eight years. I can’t lose another pregnancy. This is our last try. I said I would try until I’m forty, then no more.”

She repeated it firmly: “After my fortieth birthday, no more tries.”

I tried to sound optimistic. “Mrs. Givens, before making assumptions, let’s finish your history and perform a physical exam. We’ll order some lab work and perform an ultrasound to see where we are with this pregnancy.”

“What was your name again?” she asked.

“Dr. Davis,” I reminded her.

Mrs. Givens wasn’t done with her story yet. “Dr. Davis, we have relatives and friends who are now on their second and third children. Every time I visit my cousins and friends, I wonder why—why can’t we have the same joy?”

She had truly believed God would see her through, but I could see her faith starting to bend. “What’s wrong with me? If only I could make it past the twenty-sixth week,” she said.

Clearly she knew that at twenty-six weeks most premature babies have a decent chance at survival. But on this day, she was only seven weeks pregnant, eight at best.

“Today isn’t happening,” she said dully.

She quizzed me about whether she could have a “cervical cerclage,” a medical procedure in which the cervix is practically sewn shut to keep it from opening prematurely and expelling the growing fetus. I could see that Mrs. Givens knew her stuff, had collected a ton of information. I explained that while the cerclage is a great option in some cases, she wasn’t advanced enough in her pregnancy to consider it. A normal pregnancy lasts thirty-seven to forty-two weeks. Every week is a necessary phase in the development of an organ or body part, I said. Science has yet to discover a way to shorten the pregnancy process.

“At an early stage the body miscarries for many reasons, whether it’s anatomical, your body structure, or something wrong with the fetus, like genetic abnormalities,” I told her. “It’s the body’s way of handling such situations.”

I sensed that she felt somehow to blame, and so I assured her she had not done anything wrong and that, in fact, from what I read in her journal, I could tell she’d been one of the most careful and deliberate pregnant women I’d seen. But Mrs. Givens seemed to be devolving right in front of me, suddenly becoming withdrawn,
wrapping her arms around herself, and slowly rocking back and forth.

I glanced down at my watch and realized I had to move things along. Calling for a nurse to assist me, I wheeled my stool over so I could perform a pelvic exam. Once I placed the speculum, I could see a steady flow of maroon blood rushing out of Mrs. Givens’s cervix. Not good. The bleeding likely meant she was shedding her uterine lining, fetus included. Probing with my hands, I could tell the cervix was closed. At least that was a good sign. An open cervix would have certainly signified an impending miscarriage. Perhaps bed rest could save the baby. A small chance, but a chance nonetheless.