How a koala with an S.T.D. could help humanity - Minneapolis Star Tribune

How a koala with an S.T.D. could help humanity - Minneapolis Star Tribune
Sexually Transmitted Diseases - Your Guide to STDs - WebMD
Lack of darker skin in textbooks, journals harms patients of color - STAT
Koalas With STDs Could Actually Prove Beneficial to Humans, Here's How - Nature World News

Posted: 16 Jul 2020 12:00 AM PDT

TOORBUL, Australia – Humans don't have a monopoly on sexually transmitted infections.

Oysters get herpes; rabbits get syphilis; dolphins get genital warts. But chlamydia — a pared-down, single-celled bacterium that acts like a virus — has been especially successful, infecting everything from frogs to fish to parakeets. You might say chlamydia connects us all.

This shared susceptibility has led some scientists to argue that studying, and saving, koalas may be the key to developing a long-lasting cure for humans. "We can observe what the vaccine does under real conditions," said Peter Timms, a microbiologist at the University of Sunshine Coast in Queensland who has spent the past decade developing a chlamydia vaccine for koalas.

In koalas, chlamydia's ravages are extreme, leading to severe inflammation, massive cysts and scarring of the reproductive tract. But the bacteria responsible is still remarkably similar to the human one, thanks to chlamydia's tiny, highly conserved genome: It has just 900 active genes, far fewer than most infectious bacteria.

Because of these similarities, the vaccine trials that Timms and Endeavour Veterinary Ecology, a wildlife consulting company, are running in wild kaoalas may offer valuable clues for researchers who are developing a human vaccine.

Chlamydia is the most common sexually transmitted infection worldwide, with 131 million new cases reported each year. In the U.S., 1 in 10 sexually active teenagers is infected, said Dr. Toni Darville, chief of the division of pediatric infectious diseases at the University of North Carolina.

Antibiotics exist, but they are not enough to solve the problem, Darville said. That's because chlamydia is a "stealth organism," producing few symptoms and often going undetected for years.

In 2019, Darville and her colleagues received a multiyear, $10.7 million grant from the National Institute of Allergy and Infectious Diseases to develop a vaccine. The ideal package would combine a chlamydia and gonorrhea vaccine with the HPV vaccine already given to most preteenagers.

Chlamydia's stealth and ubiquity — the name means "cloaklike mantle" — owes to its two-stage life cycle. It starts out as an elementary body, a sporelike structure that sneaks into cells and hides from the body's immune system. Once inside, it wraps itself in a membrane envelope, hijacks the host cell's machinery and starts pumping out copies of itself. These copies either burst out of the cell or are released into the bloodstream to continue their journey.

"Chlamydia is pretty unique in that regard," said Ken Beagley, a professor of immunology at Queensland University of Technology and a former colleague of Timms. "It's evolved to survive incredibly well in a particular niche, it doesn't kill its host, and the damage it causes occurs over quite a long time."

The bacterium can hang out in the genital tract for months or years, wreaking reproductive havoc. Scarring and chronic inflammation can lead to infertility, ectopic pregnancy or pelvic inflammatory disease. Evidence also is mounting that chlamydia harms male fertility as well.

No one knows how or when koalas first got chlamydia. But the curse is at least centuries old. In the late 19th century, Australian naturalist Ellis Troughton noted that the "quaint and lovable koala" was also susceptible to disease.

The animals suffered from an eye ailment similar to pink eye, which he blamed for waves of koala die-offs in the 1890s and 1900s. At the same time, anatomist J.P. Hill found that koalas from Queensland and New South Wales often had ovaries and uteruses riddled with cysts. Many modern scientists now believe those koalas were probably afflicted with the same scourge: chlamydia.

Koalas today have even more to worry about. Dogs, careless drivers and, recently, rampant bush fires have driven their numbers down so far that conservation groups are calling for koalas to be listed as endangered. But chlamydia still reigns supreme: In parts of Queensland, the heart of the epidemic, the disease helped fuel an 80% decline over two decades.

The disease is also the one that most often sends koalas to the Australia Zoo Wildlife Hospital, the country's busiest wildlife hospital. "The figures are 40% chlamydia, 30% cars, 10% dogs," said Dr. Rosemary Booth, the hospital's director. "And then the rest is an interesting assortment of what trouble you can get into when you have a small brain and your habitat's been fragmented."

Booth's team treats "chlamydia koalas" with an amped-up regimen of the same antibiotics used on humans. "I get all of my chlamydia information from the CDC," she said, referring to the Centers for Disease Control and Prevention, "because America is the great center for chlamydia."

But the cure can be as deadly as the disease. Deep inside a koala's intestines, an army of bacteria helps the animal subsist off eucalyptus, a plant toxic to every other animal. "These are the ultimate example of an animal that's completely dependent on a population of bacteria," Booth said. Antibiotics extinguish that crucial gut flora, leaving a koala unable to gain nutrients from its food.

For the past decade, Timms has worked to perfect a vaccine. His formula, developed with Beagley, appears to work well: Trials have shown that it is safe to use and takes effect within 60 days and that animals show immune responses that span their entire reproductive lives. The next step is optimizing it for use in the field.

Wasn't it unusual to have an animal that gets such humanlike diseases: diabetes, cancer and sexually transmitted infections? "We are but an animal," Booth said, throwing her hands up in a gesture of unity with the world. "We didn't think of it first."

Sexually Transmitted Diseases - Your Guide to STDs - WebMD

Posted: 12 Nov 2019 05:05 PM PST

Sexually transmitted diseases, commonly called STDs, are diseases that are spread by having sex with someone who has an STD. You can get a sexually transmitted disease from sexual activity that involves the mouth, anus, vagina, or penis.

According to the American Social Health Organization, one out of four teens in the United States becomes infected with an STD each year. By the age of 25, half of all sexually active young adults will get an STD.

STDs are serious illnesses that require treatment. Some STDs, like HIV, cannot be cured and are deadly. By learning more, you can find out ways to protect yourself from the following STDs.

What Are the Symptoms of STDs?

Sometimes, there are no symptoms of STDs. If symptoms are present, they may include one or more of the following:

Bumps, sores, or warts near the mouth, anus, penis, or vagina.
Swelling or redness near the penis or vagina.
Skin rash.
Painful urination.
Weight loss, loose stools, night sweats.
Aches, pains, fever, and chills.
Yellowing of the skin (jaundice).
Discharge from the penis or vagina. Vaginal discharge may have an odor.
Bleeding from the vagina other than during a monthly period.
Painful sex.
Severe itching near the penis or vagina.

How Do I Know If I Have an STD?

Talk to your doctor. He or she can examine you and perform tests to determine if you have an STD. Treatment can:

Cure many STDs
Lessen the symptoms of STDs
Make it less likely that you will spread the disease
Help you to get healthy and stay healthy

How Are STDs Treated?

Many STDs are treated with antibiotics.

If you are given an antibiotic to treat an STD, it's important that you take all of the drug, even if the symptoms go away. Also, never take someone else's medicine to treat your illness. By doing so, you may make it more difficult to diagnose and treat the infection. Likewise, you should not share your medicine with others. Some doctors, however, may provide additional antibiotics to be given to your partner so that you can be treated at the same time.

Continued

How Can I Protect Myself From STDs?

Here are some basic steps that you can take to protect yourself from STDs:

Consider that not having sex or sexual relations (abstinence) is the only sure way to prevent STDs.
Use a latex condom every time you have sex. (If you use a lubricant, make sure it is water-based.)
Limit your number of sexual partners. The more partners you have, the more likely you are to catch an STD.
Practice monogamy. This means having sex with only one person. That person must also have sex with only you to reduce your risk.
Choose your sex partners with care. Don't have sex with someone whom you suspect may have an STD. And keep in mind that you can't always tell by looking if your partner has an STD.
Get checked for STDs. Don't risk giving the infection to someone else.
Don't use alcohol or drugs before you have sex. You may be less likely to use a condom if you are drunk or high.
Know the signs and symptoms of STDs. Look for them in yourself and your sex partners.
Learn about STDs. The more you know, the better you can protect yourself.

How Can I Avoid Spreading an STD?

If you have an STD, stop having sex until you see a doctor and are treated.
Follow your doctor's instructions for treatment.
Use condoms whenever you have sex, especially with new partners.
Don't resume having sex unless your doctor says it's okay.
Return to your doctor to get rechecked.
Be sure your sex partner or partners also are treated.

Lack of darker skin in textbooks, journals harms patients of color - STAT

Posted: 21 Jul 2020 12:00 AM PDT

When dermatologist Jenna Lester learned that rashes on skin and toes were a symptom of Covid-19, she started searching the medical literature for images of what the rashes looked like on Black skin so she'd recognize it in her Black patients. She couldn't find a single picture.

"I was frustrated because we know Covid-19 is disproportionately impacting communities of color," said Lester, an assistant professor of dermatology at the University of California, San Francisco who recently published her analysis. "I felt like I was seeing a disparity being built right before my eyes."

The dearth of images in the Covid-19 literature is just the newest example of the glaring lack of representation of Black and brown skin that has persisted in dermatology research journals and textbooks for decades. The issue is coming under closer scrutiny now as dermatologists, like many physicians, grapple more openly with systemic racism and the health disparities it is causing in their field.

"Black Lives Matter is forcing a lot of people to look inward and say, 'Where are our shortcomings?'" said Nada Elbuluk, an associate professor of clinical dermatology at the University of Southern California and the founder of a diversity and inclusion program in her department. "Dermatology is no different."

The discrimination in her specialty extends beyond images and gaps in training, to restrictive insurance coverage for skin conditions that affect people with heavily pigmented skin, and to the many dermatologists who don't accept patients with Medicaid.

It may be no surprise that a field that focuses on skin is now reckoning with skin color. In dermatology, where images are critical for diagnoses, the lack of images of darker skin poses a roadblock to proper treatment and medical education. Skin conditions that involve redness or pinkness in light skin can be subtler or harder to see in dark skin, and physicians who haven't been adequately trained with such images are prone to misdiagnose people of color. "We absolutely need a diversity of images," said Elbuluk.

An analysis of textbooks by Jules Lipoff, an assistant professor of clinical dermatology at the University of Pennsylvania, showed the percentage of images of dark skin ranged from 4% to 18%. "We are not teaching (and possibly not learning) skin of color," Lester wrote in a separate analysis she conducted. Many worry the field's shift toward using artificial intelligence to aid diagnosis of disease will further deepen the divide, because the machine learning algorithms are trained with datasets consisting primarily of fair-skinned images.

Dr. Jenna Lester w/ patient — Dermatologist Jenna Lester treats Geoffry Blair Hutto at the UCSF skin of color clinic. Courtesy Barbara Ries, UCSF

It gets worse. While many textbooks depict the vast majority of skin diseases using light skin, there is one notable exception: Black skin is more often used to depict sexually transmitted diseases, a glaring example of stereotyping that is all the more painful given the U.S. government's complicity in the notorious Tuskegee experiments that left syphilis untreated for decades in a group of poor, Black men.

Lipoff's analysis, published this year, showed many dermatology textbooks had zero images of dark skin with acne, psoriasis, or dermatitis. When it came to syphilis, however, many books relied heavily on images of dark skin. Lester's analysis found that while 28% of images of infectious diseases used images of darker skin, the number of depictions of dark skin was twice as high for infections that were sexually transmitted.

"In the textbooks I used in medical school, every penis was a Black penis showing an STD. We've got to stop that," said Susan Taylor, a pioneer in the push for better dermatologic care for patients with dark skin and the Sandra Lazarus professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania.

Considered a trailblazer in the field of dermatology, Taylor established the nation's first "Skin of Color" dermatology clinic at Mount Sinai in New York in the late 1990s. In 2004, she founded the Skin of Color Society to help educate fellow dermatologists about how to treat patients of color, push for research and clinical trials to include people with darker skin, and mentor and encourage medical students of color to enter dermatology, where only 3% of practitioners are Black and 4% are Hispanic. "These are really abysmal numbers," Taylor said. "That's got to change."

Taylor is also the lead author of the textbook Dermatology for Skin of Color, a guide considered invaluable by many dermatologists. But even those who rely on the book say it's frustrating that a separate book on dark skin is still required — when as a nation we are just a few decades away from a majority of residents having skin of color.

"This is the white patient treated as the default and the Black patient as the asterisk," said Lipoff. "You can't make skin of color a lecture that students get once a year. It can't be 'otherized' or put in a separate textbook."

Taylor agrees. "Nothing would make me happier than to not have to publish another edition of that book," she said.

Dermatologists say the lack of images is one reason why many conditions, including Lyme disease, spider bites, and cancers can go misdiagnosed or underdiagnosed in darker skinned patients, sometimes with dangerous results. The five-year melanoma survival rate for Black patients is just 70% compared with 94% for white patients.

The mother of a mixed-race 13-year-old from Connecticut said she was told by her child's pediatrician when she was 8 that the white patches on her skin were pityriasis alba, a skin rash that's usually not considered a serious condition. She was given a lotion, but the skin patches never went away. "I kept going online and looking at things but I couldn't see anyone with issues that looked like hers," said the mother, who didn't want her name used to protect the girl's privacy. "And the doctor was casual about it."

Partly because of insurance issues, and partly because the mother thought there was nothing to worry about, it took five years before her daughter's white patches were properly diagnosed: She had T-cell lymphoma, a cancer. While she will require maintenance light therapy for life, her overall prognosis is good. But her case highlights the difficult and sometimes frightening challenge many patients of color face to get a proper dermatologic diagnosis.

"Black Lives Matter is forcing a lot of people to look inward and say, 'Where are our shortcomings?' Dermatology is no different."

Nada Elbuluk, associate professor of clinical dermatology at USC

When Ellen Buchanan Weiss noticed patches on the dark brown skin of her toddler son, she wondered if it was eczema, or something more serious. "I Googled it and noticed immediately the pictures were all of white skin," she said. "I Googled other conditions and it was the same. No matter what I searched, there were almost no images of dark skin."

The patches did turn out to be eczema and were easily treated. Still, the disparity bothered her for months. About a year ago, Weiss, a stay-at-home mom in Raleigh, N.C., decided to create an Instagram account called "Brown Skin Matters." She posted images of skin conditions in darker skin next to images of the same condition in white skin and asked followers to send in more photos. The account exploded almost immediately.

"I've had tons of medical schools, physicians, nurses, and pharmacists all contact me saying this was useful," she said. "I never thought this was going to become a diagnostic tool."

Instagram is not exactly the best platform for making medical diagnoses, so Weiss is now working with medical experts to help create a more rigorous and searchable web-based tool for diagnosis of skin diseases in darker skin. It still floors Weiss that she, a person with no medical background, is at the center of it. "It's curious to me, and troubling, that this is 2020 and this gap is still here," she said. "Some large medical institution should have been taking care of this, not me."

The issue of textbooks failing to adequately represent skin of color is not a new one. Yet Lipoff's study compared today's textbooks with those of 15 years ago and found little has changed. Jean Bolognia, a professor of dermatology at the Yale School of Medicine, has spent more than two decades editing the widely used textbook, Dermatology; she said providing a wide spectrum of skin tones is critical and something she's worked hard to include, though she acknowledged there's more work to do.

"I'm not saying it's perfect, but we've been working really hard for over 15 years to show the whole spectrum," said Bolognia, who is now working on the fifth edition of the textbook. "I feel you can always do better and I realize I don't have enough images of Asian skin, so that is something I'm addressing."

Bolognia said she tries to include photos of the same condition in darkly pigmented and lightly pigmented skin, cropped exactly the same way and side-by-side for comparison so readers can see how the same condition can appear significantly different on darker skin. She also includes many more images of dark skin of conditions, like cutaneous lupus or scarring folliculitis, that are more likely to affect Black people.

Comparison of atopic dermatitis in infants with darkly pigmented versus lightly pigmented skin, from the widely used textbook, Dermatology. Courtesy Bolognia JL, Schaffer JV, and Cerroni L, eds. Dermatology. 4th ed. Elsevier

Bolognia said she is extremely sensitive about not stigmatizing people of color by using only images of darkly pigmented skin to illustrate sexually transmitted diseases or drug users. "I noticed this as a student, the images of STDs were nearly all of patients with darkly pigmented skin, but the people I saw with syphilis were often fair-skinned," she said. "I wondered about the possibility that pictures were being taken of individuals who were less likely to say no."

The field's other widely used textbook is Andrews' Diseases of the Skin. That book's lead author, William James, is a longtime champion of diversity in dermatology, according to his colleagues at Penn, who include Taylor and Lipoff. James said representing a variety of skin tones was an important issue, but said authors were challenged by limits placed on the number of photos by textbook publishers and because findings of redness or pinkness can be hard to see in images of darker skin. "Deciding if an entity is represented at all, or more than once, is always difficult," he said in an email.

James said his textbook includes more photos of Black skin than white skin in conditions that are more common in Black patients, and noted that eight of 14 photos of syphilis are in lighter skin.

Agrowing number of dermatologists are following Taylor's lead and opening skin of color clinics that provide care for darker-skinned patients. Lester opened one at UCSF last year. Elbuluk has worked at or founded three skin of color clinics throughout her training and early career, including at Penn, NYU Medical School, and, in 2018, at USC, where she hopes to also spur much-needed clinical research on darker skin. "It's surprising to me when large cities don't have these," Elbuluk said.

There are many reasons why people of color, particularly those who do not have private health insurance, lack access to dermatologists. Lipoff, who has examined the issue, said many dermatologists do not take Medicaid. Racial bias that discourages the treatment of Black patients, he said, is literally built into the physician reimbursement system. Many conditions that affect darker skin are often not covered by insurance because they are considered cosmetic.

Meanwhile, the highest revenue procedures, Lipoff said, include those for the diagnosis and treatment of skin cancer, which is more likely to occur in white patients. This difference in how procedures are valued and reimbursed, he said, is a perfect example of structural racism that drives practices to directly and indirectly focus on white patients and marginalize Black patients. "If Black patients earned practices three times the revenue," he said, "the disparity would disappear overnight."

"It's curious to me, and troubling, that this is 2020 and this gap is still here. Some large medical institution should have been taking care of this, not me."

Ellen Buchanan Weiss, Raleigh resident who created the "Brown Skin Matters" Instagram account

Until it does, physicians who run skin of color clinics are hoping to address the lack of care, and poor care, Black and brown patients have received. The clinics are a welcome addition to people like Dar Bray, a 45-year-old behavioral therapist and darker-skinned Black man from Los Angeles.

Bray had dealt for years with deep and persistent scars caused by acne, trying bleaching creams and expensive cosmetic products, all with no success. "I went to so many doctors who didn't know what to do with my skin. All the pictures they had on their wall were fair-skinned people," Bray said. "It didn't feel like racism, it felt like just plain ignorance."

Seeing Elbuluk, he said, was immediately different. Bray is now undergoing chemical peels to remove scarring and using simple (and inexpensive) cleansers and moisturizers, and says he sees a huge improvement in his skin. He's also wearing sunscreen, something no physician had ever told him was necessary; like many, he had believed the myth "Black don't crack." "When I went to the beach, I never wore sunscreen," he said. "Now I have years of sun damage."

Mistrust of white physicians led Gregory Hines, a 63-year-old longshoreman who lives in Oakland, to go years without seeing a doctor about growths under his arm, on his back, and on his neck, even as they puffed up and became, in his words "kind of weird and ugly."

"I experience it a lot, going to doctors — especially white, male doctors — they assume they know more than you. They assume they already know what your problem is the minute you walk through the door," he said.

When he heard UCSF's Skin of Color clinic had opened, he was willing to give it a try. "When Dr. Lester walked in, I said, 'Whoa, this is great,'" he said. "I wanted a Black doctor who understands Black skin."

Lester ended up removing the masses, one of which was nearly as large as a golf ball, and sent them for tests to see if they were cancerous. Fortunately, they were not.

Lester is the only Black dermatologist in San Francisco. She's hoping that will change after her current crop of residents decides where they will establish their practices. Her Black patients, she said, are often shocked when she walks in the door.

"I've had patients ask if they can take a picture with me to show their grandkids," she said. "They want to talk all about me and how I got here, and I have to say, 'No, this time is for you.'"

Koalas With STDs Could Actually Prove Beneficial to Humans, Here's How - Nature World News

Posted: 15 Jul 2020 12:00 AM PDT

Koalas infected with chlamydia may be able to help us produce a vaccine from this widespread STD (or sexually transmitted disease). Chlamydia is a bacterium that is acting like a virus, and it has infected many vertebrates, including frogs, parakeets, fish, and yes, even koalas and humans.

Such a shared susceptibility to chlamydia led researchers to consider saving and studying koalas to develop a cure for people.

University of the Sunshine Coast Queensland microbiologist Peter Timms says researchers can give koalas a chlamydia vaccine and observe if it works under actual conditions. Timms has worked for a decade on developing a vaccine for the disease for koalas. He is currently conducting trials on wild specimens and hopes that the vaccine will be ready for widespread use soon.

Chlamydia in koalas can cause severe inflammation, scarring, and massive cysts in their reproductive tract. The chlamydia bacteria in koalas is remarkably similar to human chlamydia, because of their highly conserved and tiny genome, with active genes numbering only 900. This is a lot fewer than most infectious species of bacteria.

The vaccine being developed by Dr. Timms and his team may provide insights on the development of a human vaccine. Chlamydia is the most common STD in humans, having 131 million new infections every year. It can stay in the reproductive tract for years, and infections can cause ectopic pregnancy, inflammatory disease in the pelvis, and infertility. Chlamydia may affect male fertility as well, damaging sperm and causing congenital disabilities.

These clinical signs are seen in chlamydial infections both in koalas and humans. In koalas, however, it is more severe, with the infection rapidly ascending the animal's urogenital tract and even going to its bladder. Timms says the koala can be the ideal animal model for researching chlamydia and chlamydia vaccine development.

Dr. Timms said that instead of treating sick koalas, a vaccine would protect them from future infections and prevent the mother from passing it to her newborn. The vaccine trials developed by Dr. Timms and Queensland University of Technology immunology professor Dr. Kenneth Beagley showed that it takes effect in two months and is safe.

Furthermore, one-shot immunizes the koalas for their whole reproductive life. Optimizing it for field use is their next step. And after the trial, Timms hopes for the approval for mass vaccinations by the government in the northern part of Australia.

Timms' work with koalas made him realize that they are so much like us, in the sense that they can also be naturally infected by several chlamydia strains and have the same reproductive symptoms, such as infertility. This makes the koala, he says, be the ideal model animal.

University of North Carolina Pediatric Infectious Diseases Division chief Dr. Toni Darville and colleagues got a 10.7-million dollar grant to develop a chlamydia vaccine for humans. It was awarded by the National Institute of Allergy and Infectious Diseases. It is not yet certain how koala chlamydia research and vaccine will contribute to human chlamydia vaccine development, but human chlamydia research has already certainly benefited koalas.

Search This Blog

Signs of STD