As noted previously, if left untreated, the lesions eventually disappear on their own, but the process may take several months. To speed up this process, there are two treatment options. The first is freezing the lesions with liquid nitrogen—which is also the standard treatment for another sexually transmitted skin infection, genital warts. Another common treatment for warts, topical liquids such as podophyllin (10-25% solution) or trichloroacetic acid (80-90% solution), can be used either alone or in addition to the liquid nitrogen. These treatments basically destroy the virus as well as the skin cells containing the virus. The second treatment option is to nick the skin of the lesions with a sterile needle and then express the central core of virus.
This is easier if the lesions are larger. The lesions tend to be well vascularized, so bleeding can occur with this method. Patients can be taught to perform this procedure themselves.
The lesions are usually not red, tender, or filled with pus. If these features are noted, it may be a sign that there is a secondary bacterial infection, most often with the common bacteria found on the skin, such as staphylococcus and streptococcus. Such infections occur in about 40 percent of those with molluscum infection. If a secondary bacterial infection is suspected, antibiotic treatment may be necessary.
As discussed previously, the classic symptoms of blisters and ulcers do not occur in everyone who has herpes. If symptoms do develop, however, they usually do so within two to twenty days of first infection. After infection with herpes, whether or not a person develops symptoms, the virus moves from the skin into the nerve endings that supply the area of the skin that was infected. It migrates along the nerve endings to the nerve root body, or ganglion, which is near the spinal cord. Here the virus remains quiet, or dormant, and then periodically migrates back out to the surface of the skin.
When the virus migrates back to the surface of the skin, a person may develop symptoms, such as a sore or itching or tingling on the skin, or he or she may remain completely symptom free. The condition in which there are symptoms is called an outbreak; when the virus comes to the surface of the skin and doesn’t cause symptoms, the condition is referred to as asymptomatic or subclinical shedding of the virus. Sometimes there is a warning that the virus is reactivating; this warning, called a prodrome, may consist of itching, tingling, or pain in the area where the outbreak takes place, but before there is any evidence on the skin. However, not everyone experiences prodromes.
Two things are clear, however: people who are newly infected (for less than a year) have more asymptomatic shedding than those who have been infected for a longer time, and people who experience more frequent symptomatic outbreaks also tend to shed the vims more often without symptoms than those who rarely have outbreaks.
This bacterial infection is treated with antibiotics. In the United States, the first choices are doxycycline or trimethoprim-sulfamethoxazole. Ciprofloxacin and erythromycin are second choices.
Although treatment is only successful if it is continued until the infection has been cleared—usually in about three weeks—and the infection may recur if the antibiotics are stopped sooner, it is sometimes difficult for various reasons for people to take the full course of antibiotics. Studies are under way to determine whether medications such as azithromycin, which remain in the body longer (and thus require fewer doses to be taken), are a reasonable alternative.
As enzymes go, PSA is kind of a tough guy. Like a feisty slugger always looking for a fight, it actively attacks proteins at every opportunity. In the bloodstream, however, PSA is usually restrained by inhibitors that prevent it from breaking down proteins; like a member of a chain gang, it is tied up, or bound.
In one promising new area of research, scientists are working to characterize the forms of PSA in the bloodstream. Is the PSA bound to the inhibitors, or is it on the loose—is it free? Currently, the tests doctors use to measure PSA detect both the bound and unbound molecules. But it might be helpful if we could tell which was which; new evidence indicates that the amount of bound PSA in the blood may be higher in men with prostate cancer than in men with BPH. If this proves to be true, one day soon it may be possible to distinguish between the PSA arising from prostate cancer and the PSA arising from BPH by measuring both its bound and free forms.
In the future, we’ll see a new, more specific generation of PSA assays, tests capable of quantifying different forms of the molecule in the bloodstream. Such tests may provide useful clinical information, not only for diagnosis of prostate cancer, but also for evaluation and follow-up.
Believe it or not, diet even has an effect on hormones such as testosterone. A diet that’s low in fat and high in fiber lowers the amount of testosterone in the blood, and hormones such as testosterone play a big role in the growth of prostate cancer. One study found blood testosterone levels in young black men to be about 15 percent higher than those of young white men; a similar study found that Dutch men had higher levels of male hormones than Japanese men. Also, studies of American men have found that they have higher levels of DHT (dihydrotestosterone) metabolites than Japanese men. (DHT is the active form of male hormone in the prostate.) Some investigators interpret this to mean that more DHT may be the cause of the cancer. However, DHT is produced by the secondary organs of reproduction (such as the prostate), and Oriental men tend to have smaller hair follicles and prostates. Which is the cause and which the effect? The lower DHT may simply reflect the fact that Japanese men have inherendy smaller secondary organs of reproduction, which contribute less DHT to the circulation.