Health related information and news from around the world.

incidence: common

cause: virus (Molluscum contagiosum)

symptoms: painless, dimpled bumps

treatment: topical treatments, but will resolve without treatment

WHAT IS IT?

Molluscum contagiosum (molluscum for short) is a skin infection caused by the virus Molluscum contagiosum, which is a member of the poxvirus family. It is usually a relatively benign infection that causes harmless skin lesions and does not become chronic. Molluscum is very common among children, who often have lesions on the face, trunk or extremities and who usually acquire the infection through nonsexual contact. Adults usually acquire the infection in the genital area through sexual contact.

Since most people do not seek treatment for molluscum and the infection is not reportable to health departments in the United States, it is difficult to estimate how common it is. It is a commonly seen skin problem in pediatric clinics and sexually transmitted disease clinics. It occurs throughout the United States and the world, but it is probably more common in warmer areas.

People who have compromised immune systems, such as those with acquired immunodeficiency syndrome (AIDS), often have extensive lesions on the face and other areas of the body. It is not clear whether the virus is latent on the skin and becomes active when the immune system weakens or whether persons with AIDS are more vulnerable to new infection.

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very common virus (herpes simplex virus), painful sores on the skin, with many variations, no cure; antivirals to treat and prevent symptoms

WHAT IS IT?

Herpes is a viral infection caused by the herpes simplex virus (HSV), of which there are two types: herpes simplex 1 (HSV-1) and herpes simplex 2 (HSV-2). Although HSV-1 and HSV-2 are distinctly different viruses, they cause similar symptoms. HSV-1 usually occurs around the mouth (where it causes cold sores), and HSV-2 usually occurs in the genital and anal areas. However, infection with these viruses can occur anywhere on the body. Mucosal skin surfaces—such as those around the mouth, genitals, and eyes—are most vulnerable, as are areas of broken skin.

The Greek word herpes means “to creep,” referring to the way in which the virus moves along nerves from the root bodies out to the surface of the skin. Genital herpes was first recognized as an STD in the 1700s, but the virus itself was not identified until the early 1960s. The herpes simplex viruses are only two of the viruses in the herpes virus family, which also includes the varicella-zoster virus, which causes chicken pox and shingles; the Epstein-Barr virus, which causes mononucleosis; and cytomegalovirus.

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For people with CMV infection that is symptom free, no treatment is necessary. For people with CMV symptoms, two medications, foscar-net and ganciclovir, have been effective in treating the disease (although the virus remains in the body, the symptoms are controlled). Both of these medications are given intravenously, and both have potential side effects. A new, oral form of ganciclovir is now available as well. In persons with AIDS who are being treated, these medications must often be taken continuously, since stopping them would allow the virus to become active again.

The medication that has been used to treat herpes simplex infections, acyclovir, has not been effective in the treatment of CMV.

Researchers are working to develop a vaccine to prevent the acquisition of CMV but so far no vaccine has effectively provided long-term protection.

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Picture someone ice-fishing—cutting a tiny, inconspicuous hole, dropping a line and bringing out a big fish. That’s the idea behind laparoscopic surgery. It’s much less invasive than traditional surgery that involves an incision, and the benefits to patients include shorter hospitalization, quicker recovery time, less postoperative pain, and a better cosmetic result—a few tiny holes, for example, instead of a scar several inches long.

There is a growing movement in surgery to be minimally invasive—to make smaller holes, not big incisions, and, whenever possible, to use the body’s natural passageways, such as the urethra, to reach internal organs. One doctor describes it as “surgery through telescopes.” (The concept itself is not new; use of the endoscope as a means of exploring the body dates back to the turn of this century.) This is the thinking behind the laparoscopic techniques to reach the pelvic lymph nodes in men with prostate cancer.

A man is diagnosed as having early-stage disease. Because there’s no evidence that the cancer has spread, he’s a candidate for curative therapy— surgery or radiation. But as we know, unfortunately, sometimes cancer has indeed spread, in tiny amounts, to the lymph nodes.

So: Is the cancer really localized? For many men who undergo radical prostatectomy (the retropubic procedure), this question is answered before surgery, for others, it’s answered on the operating table. Before even touching the prostate during a radical prostatectomy, the surgeon removes the patient’s pelvic lymph nodes and sends them to pathology, where sections of the nodes are frozen and examined for cancer. If widespread cancer is found, the surgeon doesn’t remove the prostate because it wouldn’t do any good. But the man still must spend several days in the hospital to recover from the incision.

For this and other reasons, an increasing number of men are undergoing laparoscopic pelvic lymphadenectomy (dissection of the lymph nodes) as a means of staging prostate cancer. It has minimal side effects, a brief hospital stay (one or two days), and men can go back to work in one to two weeks. Some men are even having this done as outpatients.

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As with breast cancer, there seems to be a close association between a family history of prostate cancer and a man’s risk of developing the disease. Big deal, you may be thinking: If prostate cancer is inevitable for so many men—if it’s so common—then what difference does it make if it runs in my family? Unfortunately, the prostate cancer that runs in families is much more likely to strike at a younger age, when a man might not even be looking for trouble or having yearly prostate exams.

Recently, scientists at Johns Hopkins showed the undeniable link between a family history of prostate cancer and a man’s probability of developing the disease (see table 2.1). This study showed that if your father or brother has prostate cancer, your risk is two times greater than the average American man’s

Table 2.1 Does Prostate Cancer Run in Tour Family?

Number of Affected

Relatives
Risk
Father and/or brothers

One
2-fold
Two
5-fold
Father/brother or

Grandfather/uncle

One
1.5-fold
Two
2.3-fold
Note: Your risk of developing prostate cancer starts at about 13 percent and goes up from there, depending on your number of affected relatives.

(which is about 13 percent). It goes up from there: Depending on the number of affected relatives you have and the age at which they develop the disease, your risk could be as high as 50 percent. Does your family history suggest hereditary prostate cancer (HPC) ? You fall into this category if you have three first-degree relatives (a father or brothers) who develop prostate cancer, or two first-degree relatives, if both developed it before age 55, or if prostate cancer has occurred in three generations in your family (grandfather, father, son). Note: HPC can be inherited, from either your father or your mother. For this reason, it’s important to find out from both your father and mother about a history of prostate cancer in their brothers and father. (If neither relative is living, ask other family members, or investigate family records.) Men in families with HPC have a 50 percent chance of developing prostate cancer and are more likely to develop it at a younger age than most men. In HPC families, men should have a digital rectal examination and PSA test every year, beginning at age 40.

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