Definition

A varicocele is an enlargement of the veins within the scrotum, (the loose bag of skin that holds the testicles).

Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to shrink.

Most varicoceles develop over time. With time, varicoceles may enlarge and become more noticeable. Fortunately, most varicoceles are easy to diagnose and many don't need treatment. If a varicocele causes symptoms, it often can be repaired surgically.

Symptoms

A varicocele often produces no signs or symptoms. Rarely, it may cause pain, Atrophy (Shrinking) of the Testicles. The pain may : Vary from dull discomfort or light or dual pain or a feeling of heaviness or to sharp pain.

• Pain Increase with sitting, standing or physical exertion, especially over
long periods.
• Pain Increase over the course of a day or during long weeks or running.
• Be relieved when you lie on your back.
• Low Testosterone level in blood.

Because a varicocele usually causes no symptoms, it often requires no treatment. Varicoceles may be discovered during a fertility evaluation or a routine physical exam.
However, if you experience pain or swelling in your scrotum or you discover a mass on your scrotum, contact your doctor. A number of conditions can cause a scrotal mass or testicular pain, some of which require immediate treatment.
Causes

Male reproductive system

Your spermatic cord carries blood to and from the testicles. It's not certain what causes varicoceles, but many experts believe a varicocele forms when the valves inside the veins in the cord prevent your blood from flowing properly. The resulting backup causes the veins to widen (dilate).

Varicoceles often form during puberty. They are most frequently diagnosed when a patient is 15-30 years of age, and rarely develop after the age of 40. They occur in 15–20% of all males, and it is the main cause of male infertility.

98% of idiopathic varicoceles occur on the left side, apparently because the left testicular vein connects to the renal vein (and does so at a 90-degree angle). However, a varicocele in one testicle can affect sperm production in both testicles.

There don't appear to be any significant risk factors for developing a varicocele. However, some research suggests that being overweight may increase your risk.

Complications

A varicocele may cause:

• Shrinkage of the affected testicle (atrophy). The bulk of the testicle comprises sperm-producing tubules. When damaged, as from varicocele, the testicle shrinks and softens. It's not clear what causes the testicle to shrink, but the malfunctioning valves allow blood to pool in the veins, which can result in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage.

• Infertility. It's not clear how varicoceles affect fertility. The testicular veins cool blood in the testicular artery, helping to maintain the proper temperature for optimal sperm production. By blocking blood flow, a varicocele may keep the local temperature too high, affecting sperm formation and movement (motility).

If the pain is sharp & you are not able to see your Doctor then u can use over-the-counter pain reliever and wear an athletic supporter to relieve pressure.

Tests and diagnosis

Your doctor will conduct a physical exam, which may reveal a twisted, nontender mass above your testicle that may feel like what's been described as a bag of worms. If it's large enough, your doctor will be able to feel it. If you have a smaller varicocele, your doctor may ask you to stand, take a deep breath and hold it while you bear down (Valsalva maneuver). This helps your doctor detect abnormal enlargement of the veins.

If the physical exam is inconclusive, your doctor may order a scrotal ultrasound. To ensure there isn't another reason for your symptoms. One such condition is a tumor that compresses the spermatic vein.

Treatments and drugs

Varicocele treatment may not be necessary. However, if your varicocele causes pain, testicular atrophy or infertility, you may want to undergo varicocele repair. The purpose of surgery is to seal off the affected vein to redirect the blood flow into normal veins. However, the effect of varicocele repair on fertility is unclear.

Although varicoceles typically develop in adolescence, it's less clear whether you should have varicocele repair at that time. Indications for repairing a varicocele in adolescence include progressive testicular atrophy, pain or abnormal semen analysis results.

Varicocele repair presents relatively few risks, which may include:

• Buildup of fluid around the testicles (hydrocele)
• Recurrence of varicoceles
• Damage to an artery
Repair methods include:
• Open surgery. This treatment usually is done on an outpatient basis, using general anesthetic or local anesthetic. Commonly, your surgeon will approach the vein through your groin (transinguinal), but it's also possible to make an incision in your abdomen or below your groin.

Advances in varicocele repair have led to a reduction of post-surgical complications. One advance is the use of the surgical microscope, which enables the surgeon to see the treatment area better during surgery. Another is the use of Doppler ultrasound, which helps guide the procedure.

You may be able to return to normal, nonstrenous activities after two days. As long as you're not uncomfortable, you may return to more strenuous activity, such as exercising, after two weeks.

Pain from this surgery generally is mild. Doctor may prescribe pain medication for the first two days after surgery. After that, your doctor may advise you to take over-the-counter (OTC) painkillers, to relieve discomfort or pain.

Doctor may advise you not to have sex for one to two weeks. You'll have to wait three or four months after surgery to get a semen analysis to determine whether the varicocele repair was successful in restoring your fertility.

• Laparoscopic surgery. Your surgeon makes a small incision in your abdomen and passes a tiny instrument through the incision to see and to repair the varicocele. This procedure requires general anesthesia.

• Percutaneous embolization. A radiologist inserts a tube into a vein in your groin or neck through which instruments can be passed. Viewing your enlarged veins on a monitor, the doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins, which interrupts the blood flow and repairs the varicocele. This procedure is done with local anesthesia on an outpatient basis. This procedure isn't as widely used as surgery.

Lifestyle and home remedies

If you have a varicocele that causes you minor discomfort but doesn't affect your fertility, you might try the following for pain relief:

• Take over-the-counter painkillers, such as Paracetamol etc.
• Wear an athletic supporter or Langot to relieve pressure.

Coming Soon

Human Immunodeficiency Virus (HIV) is a lentivirus (a member of the retrovirus family) that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections.

Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. Within these bodily fluids.

The four major routes of transmission are unsafe sex, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth (vertical transmission).

HIV infection in humans is considered pandemic by the World Health Organization (WHO).

From its discovery in 1981 to 2006, AIDS killed more than 25 million people. A third of these deaths are occurring in Sub-Saharan Africa, retarding economic growth and increasing poverty. According to current estimates, HIV is set to infect 90 million people in Africa, resulting in a minimum estimate of 18 million orphans.

HIV infects primarily vital cells in the human immune system such as helper T cells (to be specific, CD4+ T cells.

HIV infection leads to low levels of CD4+ T cells. When CD4+ T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections.

Most untreated people infected with HIV-1 eventually develop AIDS. These individuals mostly die from opportunistic infections or malignancies associated with the progressive failure of the immune system.

HIV progresses to AIDS at a variable rate affected by viral, host, and environmental factors; most will progress to AIDS within 10 years of HIV infection: some will have progressed much sooner, and some will take much longer.Treatment with anti-retrovirals increases the life expectancy of people infected with HIV.

Three main transmission routes for HIV have been identified. HIV-2 is transmitted much less frequently by the mother-to-child and sexual route than HIV-1.

UNAIDS and the WHO estimate that AIDS has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive pandemics in recorded history. .

Sub-Saharan Africa remains by far the worst-affected region, with an estimated 21.6 to 27.4 million people currently living with HIV.

South & South East Asia are second-worst affected with 15% of the total. AIDS accounts for the deaths of 500,000 children in this region. South Africa has the largest number of HIV patients in the world followed by Nigeria.

Countries such as Uganda are attempting to curb the epidemic by offering VCT (voluntary counselling and testing), PMTCT (prevention of mother-to-child transmission) and ANC (ante-natal care) services, which include the distribution of antiretroviral therapy.

Classification

There are two species of HIV known to exist: HIV-1 and HIV-2. HIV-1 is the virus that was initially discovered. It is more virulent, more infective, and is the cause of the majority of HIV infections globally. The lower infectivity of HIV-2 relatively poor capacity for transmission, HIV-2 is largely confined to West Africa.
Comparison Of HIV Species
Species Virulence Infectivity Prevalence Inferred Origin
HIV - 1 High High Global Common Chimpanzee
HIV - 2 Lower Low West Africa Sooty Mangabey

Signs & Symptoms

Infection with HIV-1 is associated with a progressive decrease of the CD4+ T cell count and an increase in viral load. The stage of infection can be determined by measuring the patient's CD4+ T cell count, and the level of HIV in the blood.

HIV infection has basically four stages : 1) Incubation period, 2) Acute infection, 3) Latency stage and 4) AIDS.

The initial incubation period upon infection is asymptomatic and usually lasts between two and four weeks. The second stage, acute infection, lasts an average of 28 days and can include symptoms such as fever, lymphadenopathy (swollen lymph nodes), pharyngitis (sore throat), rash, myalgia (muscle pain), malaise, and mouth and esophageal sores.

The Latency stage, which occurs third, shows few or no symptoms and can last anywhere from two weeks to twenty years and beyond. AIDS, the fourth and final stage of HIV infection shows as symptoms of various opportunistic infections.

Main symptoms of acute HIV infection.

The initial infection with HIV generally occurs after transfer of body fluids from an infected person to an uninfected one. The first stage of infection, the primary, or acute infection, is a period of rapid viral replication that immediately follows the individual's exposure to HIV leading to an abundance of virus in the peripheral blood with levels of HIV commonly approaching several million viruses per mL.

This response is accompanied by a marked drop in the numbers of circulating CD4+ T cells. This acute viremia is associated in virtually all patients with the activation of CD8+ T cells, which kill HIV-infected cells.

The CD8+ T cell response is thought to be important in controlling virus levels, which peak and then decline, as the CD4+ T cell counts rebound. A good CD8+ T cell response has been linked to slower disease progression and a better prognosis, though it does not eliminate the virus.

During this period (usually 2–4 weeks post-exposure) most individuals (80 to 90%) develop an influenza, the most common symptoms of which may include fever, lymphadenopathy, pharyngitis, rash, myalgia, malaise, mouth and esophageal sores, and may also include, but less commonly, headache, nausea and vomiting, enlarged liver/spleen, weight loss, thrush, and neurological symptoms. Infected individuals may experience all, some, or none of these symptoms. The duration of symptoms varies, averaging 28 days and usually lasting at least a week.

Because of the nonspecific nature of these symptoms, they are often not recognized as signs of HIV infection. Even if patients go to their doctors or a hospital, they will often be misdiagnosed as having one of the more common infectious diseases with the same symptoms. As a consequence, these primary symptoms are not used to diagnose HIV infection, as they do not develop in all cases and because many are caused by other more common diseases. However, recognizing the syndrome can be important because the patient is much more infectious during this period.

Latency stage

A strong immune defense reduces the number of viral particles in the blood stream, marking the start of the infection's clinical latency stage. Clinical latency can vary between two weeks and 20 years. During this early phase of infection, HIV is active within lymphoid organs, where large amounts of virus become trapped in the follicular dendritic cells (FDC) network.

The surrounding tissues that are rich in CD4+ T cells may also become infected, and viral particles accumulate both in infected cells and as free virus. Individuals who are in this phase are still infectious. During this time, CD4+ CD45RO+ T cells carry most of the proviral load.

AIDS

When CD4+ T cell numbers decline below a critical level of 200 cells per µL, cell-mediated immunity is lost, and infections with a variety of opportunistic microbes appear.

The first symptoms often include moderate and unexplained weight loss, recurring respiratory tract infections (such as sinusitis, bronchitis, otitis media, pharyngitis), prostatitis, skin rashes, and oral ulcerations.

Common opportunistic infections and tumors, most of which are normally controlled by robust CD4+ T cell-mediated immunity then start to affect the patient. Typically, resistance is lost early on to oral Candida species and to Mycobacterium tuberculosis, which leads to an increased susceptibility to oral candidiasis (thrush) and tuberculosis.

Later, reactivation of latent herpes viruses may cause worsening recurrences of herpes simplex eruptions.

Pneumonia caused by the fungus Pneumocystis jirovecii is common and often fatal. In the final stages of AIDS, infection with cytomegalovirus (another herpes virus) or Mycobacterium avium complex is more prominent. Not all patients with AIDS get all these infections or tumors, and there are other tumors and infections that are less prominent but still significant.

The majority of HIV infections are acquired through unprotected sexual relations. Sexual transmission can occur when infected sexual secretions of one partner come into contact with the genital, oral, or rectal mucous membranes of another.

The correct and consistent use of latex condoms reduces the risk of sexual transmission of HIV by about 85%.

In general, if infected blood comes into contact with any open wound, HIV may be transmitted. This transmission route can account for infections in intravenous drug users.

Since transmission of HIV by blood became known medical personnel are required to protect themselves from contact with blood by the use of universal precautions. People who give and receive tattoos, piercings, and scarification procedures can also be at risk of infection.

HIV has been found at low concentrations in the saliva, tears and urine of infected individuals, but there are no recorded cases of infection by these secretions and the potential risk of transmission is negligible..It is not possible for mosquitoes to transmit HIV.

Mother-to-child

The transmission of the virus from the mother to the child can occur in utero (during pregnancy), intrapartum (at childbirth), or via breast feeding. In the absence of treatment, the transmission rate up to birth between the mother and child is around 25%.[31] However, where combination antiretroviral drug treatment and Cesarian section are available, this risk can be reduced to as low as one percent.

Postnatal mother-to-child transmission may be largely prevented by complete avoidance of breast feeding.

Diagnosis

Many HIV-positive people are unaware that they are infected with the virus.

HIV-1 testing consists of initial screening with an enzyme-linked immunosorbent assay (ELISA) to detect antibodies to HIV-1.

Specimens with a reactive ELISA result are retested. If retest is reactive, the specimen is reported as repeatedly reactive and undergoes confirmatory testing with a more specific supplemental test (e.g., Western blot. Specimens that are repeatedly reactive by ELISA and reactive by Western blot are considered HIV-positive and indicative of HIV infection.

Modern HIV testing is extremely accurate.

Treatment

There is currently no publicly available vaccine or cure for HIV or AIDS. However, a vaccine that is a combination of two previously unsuccessful vaccine candidates was reported in September 2009 to have resulted in a 30% reduction in infections in a trial conducted in Thailand. Additionally, a course of antiretroviral treatment administered immediately after exposure, referred to as post-exposure prophylaxis, is believed to reduce the risk of infection if begun as quickly as possible.

Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART. This has been highly beneficial to many HIV-infected individuals since its introduction in 1996, when the protease inhibitor-based HAART initially became available.

Current HAART options are combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of antiretroviral agents.

In developed countries where HAART is available, doctors assess their patients thoroughly: measuring the viral load, how fast CD4 declines, and patient readiness. They then decide when to recommend starting treatment.

HAART neither cures the patient nor does it uniformly remove all symptoms; high levels of HIV-1, often HAART resistant, return if treatment is stopped. Moreover, it would take more than a lifetime for HIV infection to be cleared using HAART.

Despite this, many HIV-infected individuals have experienced remarkable improvements in their general health and quality of life.

The development of HAART as effective therapy for HIV infection has substantially reduced the death rate from this disease in those areas where these drugs are widely available.

Prognosis

Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years.

In areas where it is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly diagnosed HIV-infected person to 20–50 years.

Chancroid also known as soft chancre is a bacterial disease caused by bacteria called Haemophilus ducreyi that is spread only through sexual contact.

Causes

Chancroid is caused by a type of bacteria called Haemophilus ducreyi.

Symptoms

Within 1 to 10 days after getting chancroid, a person will get a small bump in the genitals. Within a few days, these bumps become filled with pus and eventually rupture, leaving painful, open sores in the genital region. These open sores are known as ulcers, and can range from one to three centimeters in diameter.

The ulcer:

• Ranges in size from 1/8 inch to 2 inches across
• Is painful
• Is soft
• Has sharply defined borders
• Has irregular or ragged borders
• Has a base that is covered with a grey or yellowish-grey material
• Has a base that bleeds easily if banged or scraped
About half of infected men have only a single ulcer. Women often have 4 or more ulcers. The ulcers appear in specific locations.
Common locations in men are:
• Foreskin (prepuce)
• Groove behind the head of the penis (coronal sulcus)
• Shaft of the penis
• Head of the penis (glans)
• Opening of the penis (urethral meatus)
• Scrotum

In women the most common location for ulcers is the outer lips of the vagina (labia majora). "Kissing ulcers" may develop. These are ulcers that occur on opposite surfaces of the labia.

Other areas such as the inner vagina lips (labia minora), the area between the genitals and the anus (perineal area), and inner thighs may also be involved. The most common symptoms in women are pain with urination and intercourse.

The ulcer may look like a chancre, the typical sore of primary syphilis.

Approximately half of the people infected with a chancroid will develop enlarged inguinal lymph nodes, the nodes located in the fold between the leg and the lower abdomen.

Half of those who have swelling of the inguinal lymph nodes will progress to a point where the nodes break through the skin, producing draining abscesses.

The swollen lymph nodes and abscesses are often referred to as buboes.

Tests

Chancroid is diagnosed by looking at the ulcer(s) and checking for swollen lymph nodes. There are no blood tests for chancroid.

Treatment

The infection is treated with antibiotics. Large lymph node swellings need to be drained, either with a needle or local surgery.
Chancroids in persons with HIV may take much longer to heal.

Prevention

Chancroid is a bacterial infection that is spread by sexual contact with an infected person. Avoiding all forms of sexual activity is the only absolute way to prevent a sexually transmitted disease.
However, safe sex behaviors may reduce your risk. The proper use of condoms, either the male or female type, greatly decreases the risk of catching a sexually transmitted disease.
You need to wear the condom from the beginning to the end of each sexual activity.
If you are currently sexually active, or are thinking about becoming sexually active, it is important to become familiar with all of the health risks involved. Unprotected or unsafe sexual practices can dramatically increase your risks of developing a sexually transmitted disease (STD).
Many of these STDs have a number of unpleasant side effects and can lead to severe health complications.

Comparison with Chancre (Syphilitic)

There are many differences and similarities between the conditions syphilitic chancre and chancroid (reference 1 and 2)

Similarities

• Both originate as pustules at the site of inoculation, and progress to ulcerated lesions
• Both lesions are typically 1-2 cm in diameter
• Both lesions are caused by sexually transmissible organisms
• Both lesions typically appear on the genitals of infected individuals
• Both lesions can present at multiple sites and with multiple lesions

Differences

• Chancre is a lesion typical of infection with the bacterium that causes syphilis, Treponema pallidum
• Chancroid is a lesion typical of infection with the bacterium Haemophilus ducreyi
• Chancres are typically painless, whereas chancroid are typically painful
• Chancres are typically non-exudative, whereas chancroid typically have a grey or yellow purulent exudate
• Chancres have a hard (indurated) edge, whereas chancroid have a soft edge.

Classification and external resources

Severe case of genital warts around the anus

Genital warts (known as condylomata acuminata or venereal warts) may be small, flat, flesh-colored bumps or tiny, cauliflower-like bumps. In men, genital warts can grow on the penis, near the anus, or between the penis and the scrotum. In women, genital warts may grow on the vulva and perineal area, in the vagina and on the cervix (the opening to the uterus or womb). Genital warts vary in size.

Genital warts are caused by the human papillomavirus (HPV). There are many kinds of HPV. Not all of them cause genital warts. HPV is associated with cancer of the vulva, anus and penis. However, it's important to note that HPV infection doesn't always lead to cancer.

Cause

HPV is a sexually transmitted infection (STI). The most common way to get HPV is by having oral, vaginal or anal sex with someone who is infected with HPV. The only sure way to prevent genital warts is to have sex. Sex only with a partner who is not infected with HPV.

Just because you can't see warts on your partner doesn't mean he or she doesn't have HPV. The infection can have a long incubation period. This means that months can pass between the time a person is infected with the virus and the time a person notices genital warts. Sometimes, the warts can take years to develop. In women, the warts may be where you can't see them--inside the body, on the surface of the cervix.

Using condoms may prevent you from catching HPV from someone who has it. However, condoms can't always cover all of the affected skin.

Symptoms

In many cases genital warts do not cause any symptoms, but they are sometimes associated with itching, burning, or tenderness. They may result in localized irritation.
Women who have genital warts inside the vagina may experience bleeding following sexual intercourse or an abnormal vaginal discharge. Rarely, bleeding or urinary obstruction may occur if the wart involves the urethral opening.

Treatment

Depending on the sizes and locations of warts (as well as other factors), a doctor will offer one of several ways to treat them. Podofilox is the first-line treatment due to its low cost.

Podofilox solution in a gel or cream can be applied by the patient to the affected area and is not washed off. Podofilox is safer and more effective than podophyllin.

Podophyllin and podofilox should not be used during pregnancy, as they are absorbed by the skin and could cause birth defects in the fetus.

Cryotherapy: This technique freezes the wart using liquid nitrogen or a "cryoprobe." It is an excellent first-line treatment because response rates are high with few side effects.

Laser treatment: This treatment is used for extensive or recurrent genital warts. It may require local, regional, or general anesthesia. Disadvantages include high cost, increased healing time, scarring.

Electrodesiccation: This technique uses an electric current to destroy the warts. It can be done in the office with local anesthesia. Of note, the resulting smoke plume may be infectious.

Surgical excision is best for large warts, and has a greater risk of scarring.