How Estrogen May Help Prevent Urinary Tract Infections After Menopause

Laboratory study suggests vaginal supplementation would benefit some women

By Serena Gordon

HealthDay Reporter

THURSDAY, June 20 (HealthDay News) -- Estrogen treatment delivered vaginally may help prevent repeat urinary tract infections in postmenopausal women, new laboratory research suggests.

Urinary tract infections are common among women, with one-quarter experiencing recurring infections. And age-related changes increase the likelihood of these infections developing after menopause, when estrogen production plummets.

Until now, taking antibiotics prophylactically -- to ward off recurrent urinary tract infections -- has been the gold standard for these women, said Thomas Hannan, a research instructor in pathology and immunology at Washington University School of Medicine in St. Louis. "But antibiotic resistance is increasing, and some women are resistant to everything we have," Hannan said. "We need other options. We need non-antibiotic options."

This study, published in the June 19 issue of the journal Science Translational Medicine, "suggests a more holistic approach by changing the way women respond to bacteria," said Hannan, co-author of an editorial accompanying the study in the journal.

The results support the use of vaginal estrogen as a preventive measure for postmenopausal women with recurrent urinary tract infections, he wrote in the editorial.

Working in the laboratory and with animal models, the researchers identified a number of ways that estrogen -- the female sex hormone -- helps keep recurrent urinary tract infections at bay.

"This study presents some underlying mechanisms for the beneficial effect of [topical estrogen formulations] after menopause and supports the application of estrogen in postmenopausal women suffering from recurrent UTIs," wrote the study's authors, from the Karolinska Institute in Stockholm, Sweden.

About half of all women will experience at least one urinary tract infection in their lifetime, according to the study. For about 25 percent of these women, the infection will come back again within six months.

Low estrogen levels have previously been linked to recurrent infections, and the new study sought to identify exactly how estrogen might affect a woman's risk of recurrent urinary tract infections.

For the study, the researchers used human cells from postmenopausal women who had used supplemental vaginal estrogen for two weeks. They also worked with mice that were given bacteria that would cause urinary tract infections like those in humans.

They found that estrogen encourages production of natural antimicrobial substances in the bladder. The hormone also makes the urinary tract tissue stronger by closing the gaps between cells that line the bladder. By gluing these gaps together, estrogen makes it harder for bacteria to penetrate the deeper layers of the bladder wall, the study authors said.

Estrogen also helps prevent too many cells from shedding from the top layers of the bladder wall.

"Normally, there's an innate response to infection and some cells die -- sort of taking one for the team -- and then these cells shed," Hannan said. "But shedding too much could allow bacteria to get into the deeper tissue, so this exfoliation is a double-edged sword."

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Should I take steroids for my chronic sinus infections?

Posted June 12, 2013, 2:00 am

I have chronic sinusitis and nasal polyps. My specialist suggested trying oral corticosteroids. What do you think?

“Steroids” is short for anti-inflammatory hormones called corticosteroids, and “oral” means steroids taken in pill form. I think a short course of five to seven days of oral steroids is worth a try. That’s particularly true if your sinusitis isn’t getting any better. My colleague, Neil Bhattacharyya, an ear, nose and throat doctor and professor at Harvard Medical School, agrees. Much of what I say below is based on his advice.

As you know, sinusitis is an inflammation of the mucous membranes that line the sinuses. It often causes headaches and an uncomfortable feeling of pressure in the face. (I’ve put an illustration of how sinusitis works below.)

Sinusitis is inflammation of the mucous membranes that line the sinuses.

Chronic inflammation in the membranes of your nose and sinuses can cause fleshy growths called polyps. Not all cases of chronic sinusitis result in polyps, but when they form, polyps can block your nasal passages and sinuses. This makes breathing more difficult and can diminish your sense of smell. Polyps also make it easier for infections to start in your sinuses.

I assume you’ve tried the usual techniques for dealing with sinusitis: inhaling steam, taking extra-long showers, drinking lots of water and sleeping with your head elevated. A course of antibiotics is also often appropriate if there are clear signs of bacterial infection in your sinuses (such as green or brown discharge when you blow your nose, a fever and a rotten feeling).

Once sinusitis becomes chronic, the inflammation can take on a life of its own. Corticosteroids become an important treatment option, as they have anti-inflammatory effects.

The first type of steroid to try is one that can be inhaled into the nose. Inhaled steroids deliver the medicine directly to the inflamed tissues that need to be quieted. However, polyps can block the passage of the inhaled steroids to some of the inflamed areas.

If inhaled steroids don’t do the job, it’s worth considering a brief course of steroids in pill form. Taking an oral steroid such as prednisone for a week or so reduces the size of the polyps a little and decreases overall inflammation in the nose. Shrinking polyps and reducing inflammation allow the topical steroid to reach its target and be more effective.

The reason I and many doctors hold off on using steroids in pill form is that the medicine travels in the blood, exposing the whole body to the medication. (In contrast, topical steroids expose only the nose and sinuses.) Side effects are more likely from oral steroids than from inhaled steroids; they may include elevated pressure in the eyes (glaucoma), increased blood pressure and mood swings. But in my experience, a short course of oral steroids, such as what I’m recommending here, rarely produces serious side effects.

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Men Face Higher Risk of Infections Related to Health Care

Extensive study found hospitalized men had 60 percent greater odds of bloodstream, surgical infections

By Mary Elizabeth Dallas

HealthDay Reporter

WEDNESDAY, June 5 (HealthDay News) -- Women are less likely to develop infections related to receiving health care than men, according to a large new study.

After examining thousands of cases involving hospitalized patients, researchers found that women were at much lower risk for bloodstream infection and surgical-site infection than men. The study authors suggested that their findings could help health care providers reduce men's risk of these infections.

"By understanding the factors that put patients at risk for infections, clinicians may be able to design targeted prevention and surveillance strategies to improve infection rates and outcomes," lead study author Bevin Cohen, program director at the Center for Interdisciplinary Research to Prevent Infections at Columbia University School of Nursing, said in a university news release.

The study, recently published online in the Journal of General Internal Medicine, revealed that the odds of developing a community-associated bloodstream infection were 30 percent higher among men. Meanwhile, the researchers found a 60 percent higher risk among men for health care-associated bloodstream infections as well as for surgical-site infections.

Biological differences between men and women's skin may play a role in men's increased risk for infection. Previous studies have shown there are more bacteria present at the insertion site of a central venous catheter on men than women.

These gender differences were less apparent in children younger than 12 and people older than 70, the study found.

"In addition to using enhanced infection risk profiles to improve infection rates, it may be sensible to conduct specialized preoperative skin decontamination procedures and postoperative wound care for men to further reduce the risk of infection," Cohen concluded.

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Steady Rise in Heart Valve Infections Noted in U.S.

Title: Steady Rise in Heart Valve Infections Noted in U.S.
Category: Health News
Created: 3/22/2013 2:35:00 PM
Last Editorial Review: 3/25/2013 12:00:00 AM

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Craze for Hairless Genitals Accompanies Rise in Infections

Shaving, clipping and waxing may raise risk of skin virus, study finds

By Alan Mozes

HealthDay Reporter

MONDAY, March 18 (HealthDay News) -- Here's a caution in the hairless-body craze. Pubic hair removal could boost your risk for a pox infection, French researchers say.

Skin irritation brought on by either shaving, clipping or waxing the genital area could explain the recent increase among healthy adults of a minor sexually transmitted virus called molluscum contagiosum, the researchers suggest.

"Genital hair removal has become a fashion phenomenon in the last decade," noted case study lead author Dr. Francois Desruelles, of the department of dermatology at Archet Hospital in Nice.

"At the same time, the number of cases of molluscum contagiosum has risen," he added.

This association needs to be confirmed by controlled studies, Desruelles said. But he believes the growing popularity of genital hair removal, seen in men as well as women, may raise the risk of molluscum contagiosum.

The practice may also increase the risk for developing genital warts due to infection with papillomavirus, he said.

Desruelles and his colleagues describe their observations in a letter published online March 19 in the journal Sexually Transmitted Infections.

The molluscum contagiosum rash is usually seen in children or people with impaired immune systems, but it is also sexually transmitted. To look into a possible link between the condition and hair removal, the authors studied 30 infected French patients who sought the services of a private skin care clinic in Nice in 2011 and 2012.

The average age of the patients was about 30 years, and 24 of them were men. To varying degrees, all displayed the telltale signs of infection: pearl-like, raised skin bumps. In four cases, the bumps had spread up the abdominal region; in one, they had moved down the thigh.

Almost all of the patients had undergone pubic hair removal, the investigators found. Shaving was the method of choice for 70 percent; 10 percent chose waxing and 13 percent chose clipping.

One-third of the patients suffered from an assortment of other skin issues, such as warts, bacterial skin infections, cysts, scars, and/or ingrown hairs. But the authors theorized that ultimately the pox virus may have spread through "self-infection," meaning scratching irritated skin, which was likely provoked by the hair removal process.

Genital shaving in particular appeared to elevate infection risk.

"Laser hair removal doesn't seem to be involved in this association," Desruelles said, "because there are no microscopic cuts or bleeding during the removal of hair. For the same reason, waxing could be less 'at risk' than shaving."

However, genital shaving may have some "positive aspects," Desruelles said, noting that the practice may help curb the spread of pubic lice. Bloomberg News recently reported that with 80 percent of American college students now waxing, clipping, and shaving away all or some of their genital hair, pubic lice cases have dramatically dropped.

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Flu Infections Continue to Decline

Title: Flu Infections Continue to Decline
Category: Health News
Created: 3/8/2013 4:35:00 PM
Last Editorial Review: 3/11/2013 12:00:00 AM

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Kids, Seniors Prone to MRSA Infections Depending on Season: Study

Title: Kids, Seniors Prone to MRSA Infections Depending on Season: Study
Category: Health News
Created: 3/1/2013 12:35:00 PM
Last Editorial Review: 3/4/2013 12:00:00 AM

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Multiple Tests Needed to Spot Infections in Newborns: Study

Title: Multiple Tests Needed to Spot Infections in Newborns: Study
Category: Health News
Created: 2/20/2013 6:36:00 PM
Last Editorial Review: 2/21/2013 12:00:00 AM

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Avoiding Injuries and Infections at the Gym

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WebMD Feature Reviewed byKimball Johnson, MD Risk: Unqualified Staff

Does your personal trainer have a degree or certificate? Or did he pay a nominal fee, take a brief online test, and, presto, became a fitness instructor?

"Yes, that can happen," says Sherri McMillan, spokeswoman for the IDEA Health and Fitness Association. "There are people out there who call themselves personal fitness trainers and instructors with minimal, outdated, or no qualifications."

Avoiding the Risk

Ask to see certificates and degrees and ensure they are current, McMillan advises. Certifying organizations include the American Council on Exercise, the American College of Sports Medicine, and the National Strength and Conditioning Association.

Specialists may have specific certificates, such as those offered by the Pilates Method Alliance for Pilates instructors. McMillan also recommends asking about recent workshops or conferences your fitness pro has attended to make sure they're staying current in the field.

It's also important to make sure team members are certified in CPR/fitness first aid and automated external defibrillator (AED), a portable electronic device that can treat sudden cardiac arrest. Make sure the gym staff knows where the first aid kit and AED are located, McMillan says.

Risk: Equipment Malfunction

Hundreds of people may use your gym's equipment every day. That can cause wear and tear to the equipment, which could lead to malfunction -- and risks to you.

Avoiding the Risk

Ask the gym staff how often equipment is assessed and repaired, and speak up if you see something that's broken. "If you notice cables starting to fray or any piece of equipment that doesn't seem to be operating correctly or effectively, stop using it and report the issue to a staff member," McMillan says.

Risk: Improper Exercise Selection or Form

Choosing the wrong exercises or using improper form is one of the most common hazards in the gym, says Neal I. Pire, spokesman for the American College of Sports Medicine. "Just because an exercise is 'Mr. Olympia's favorite' does not mean it is a good choice for you. Couple this with not asking for professional help from a personal trainer, and you are ripe for a mishap that will land you at the neighborhood orthopedist."

Avoiding the Risk

"Know your limits," McMillan says. "You know your body better than anyone." If you have special risks or conditions -- such as a bad back, high blood pressure, recent surgery -- tell your trainer so he or she can tailor your exercise program to your specific needs.

Risk: Falls

Jumping, running, and moving around various objects in the gym can increase your risk of tripping and falling.

Avoiding the Risk

Be aware of your surroundings, McMillan cautions. Watch for items that you might trip over -- such as a water bottle, hand weight, piece of equipment, sweatshirt, or even a loose set of keys. Then move them to a safer location. Be especially careful in wet areas around showers, pools, and hot tubs, where you're more likely to slip and fall.

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