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What is malaria?

Malaria is the most significant parasitic disease threat you will face in most tropical and subtropical countries. It is a microscopic blood- borne parasite transmitted to humans by the bites of infected mosquitoes.  There are 300 to 500 million cases a year of malaria worldwide —approximately 1000 a year are reported in U.S. travelers. 

Symptoms can include: fever and flu-like symptoms, chills, generalized muscle aches and pains, tiredness, headache, abdominal pain, and even diarrhea.  Symptoms usually begin 1 to 2 weeks after an infected bite, but onset can be as late as 4 or more weeks afterwards in some cases.  If left untreated, malaria can cause anemia, jaundice, kidney failure, coma, and death. 

Travelers can decrease the risk of malaria by taking certain drugs to prevent a malaria attack (malaria chemoprophylaxis) and by using measures to prevent mosquito bites.  However, in spite of all precautions, travelers occasionally might become infected with malaria.  Therefore, while traveling and up to five years after returning home, travelers should seek medical evaluation for any flu-like illness accompanied by fever.

If you have an extended period of travel or experience numerous mosquito bites in a malaria area, you may need additional anti-malarial medication after your return, to eradicate a possible asymptomatic incubating malaria infection.  If this situation applies to you, continue your prescribed malaria chemo-prophylaxis medication and seek care within two weeks after your return.

You are excluded from blood donation for 1 year after being in a malarious area.

Prevention

Travelers should limit their time outdoors in rural tropical areas between dusk and dawn, when the mosquitoes transmitting malaria are most likely to bite.  When outdoors, prevent mosquito bites by staying in screened areas as much as possible; wearing protective clothing that covers arms and legs; using an insect repellent on exposed skin areas when outdoors; and using a mosquito net where you sleep.  For more detailed information on procedures and products to prevent mosquito and other insect bites, see our health information article or brochure Avoiding Insects.

Drugs against malaria

No anti-malaria drug is 100% effective and drug resistant strains of malaria are being reported throughout the world.  Selection of the most effective regimen depends on itinerary, whether drug resistant malaria is reported at destination areas, age, health, allergies, and other factors. One of the following options may be selected.

1. Chloroquine Phosphate  (Aralen®)

Adult dosage: 500 mg orally once/week for use in areas with chloroquine-sensitive Plasmodium falciparum malaria. Take weekly dose starting 1 week before entering a malaria area, each week while there, and for 4 weeks after leaving the area.

Notes on Chloroquine:

  • Drug interactions can occur with Kaopectate®, methotrexate, metronidazole (Flagyl®), Phenergan®, and cimetidine.
  • Chloroquine can be used with caution in persons who have psoriasis, porphyria, or liver dysfunction, but not in those with retinal degeneration.
  • Chloroquine can decrease the effectiveness of the rabies vaccine given by intra-dermal administration, if taken sooner than 1 week following the last vaccine dose.
  • Chloroquine is considered safe in pregnancy.

2. Hydroxychloroquine Sulfate (Plaquenil®)

Adult dosage: 400 mg (2x 200 mg) orally once/ week—an alternative to chloroquine.

Notes on Hydroxychloroquine:

  • Drug interactions can occur with digoxin and rifampin and possibly with the drugs listed above under Chloroquine.
  • Hydroxychlorquine can be used with caution in persons who have psoriasis, porphyria, or liver dysfunction, but not in those with retinal degeneration.
  • Hydroxychloroquine can decrease the effectiveness of rabies vaccine given by intra-dermal administration, if taken sooner than 1 week following the last dose.

3. Malarone® (Atovaquone/Proguanil)

This drug is recommended for travelers going to areas of chloroquine-resistant Plasmodium falciparum malaria.

Dosing: 1 tab daily. Dose 1 day before through 7 days after leaving area of malaria risk.

Adult dosage: 250mg/100mg

Pediatric dosage: 62.5mg/25mg

Notes on Malarone:

  • Common side effects include mild stomach upset, headache, nausea and mouth ulcerations
  • Serous/rare side effects are hair loss, rash
  • Take with food or milky drink at same time each day
  • Do not take with tetracycline, rifampin, or metoclopramide

4. Doxycycline

Used for patients with intolerance to other antimalarials.

Adult dosage: Take 1 (100mg) tablet daily with evening meal starting 2 days before entering malarious area, each day while in the area and daily for an additional 4 weeks after leaving. Missing even one day's pill can result in malaria.

Notes on Doxycycline:

  • Doxycycline is not to be used by pregnant women or children under 9 years of age.
  • Due to increased sensitivity to the sun, wear a   sunscreen with a high SPF that covers both UVA and UVB.
  • Other potential side effects: vaginal yeast infections; erosion of esophagus if taken immediately before reclining without adequate liquids.
  • Pepto-Bismol® interferes with doxycycline absorption.

Treatment

If you have any of the aforementioned symptoms during or up to 3 years after leaving a malarious area, seek medical counseling. If a fever develops within 3 months after possible exposure, immediately seek medical help. Malaria can be treated if caught early enough, but delay in appropriate therapy can have serious or fatal consequences.

 

Authored by: Hall Health Center Travel Clinic staff

Reviewed by: Hall Health Center Travel Clinic staff (AT), May 2014


What is dengue (deng-gay) fever?

Dengue fever and dengue hemorrhagic fever are viral illnesses transmitted by the bite/sting of a mosquito. The mosquito species that carries dengue virus is active, biting during daylight hours, with a peak of activity just after daybreak, and then again for several hours before dark. These insects are often present indoors, and are common in areas of human habitation, including urban and rural areas throughout the tropical areas of the world.

Symptoms

Symptoms of dengue fever include:

  • Relatively sudden onset of high fever
  • Severe frontal headache
  • Muscle and joint pains
  • Nausea and/or vomiting
  • Rash

On the third or fourth day of the fever, many people will develop a rash on the torso, which then spreads to the arms and legs.

Usually the illness is "self-limited" in travelers and relatively mild, meaning it runs its course over a week or two, though in rare circumstances it can cause severe symptoms.

Another name for this illness is "break-bone fever" due to the extreme bone pain that can accompany this disease.

Treatment

There is no specific treatment for classic dengue fever, and most people recover within 2 weeks. To help with recovery:

  • Get plenty of bed rest
  • Drink lots of fluids
  • Take acetaminophen to reduce fever (not aspirin nor non-steroidal anti-inflammatory products such as aspirin or ibuprofen)

Risk to travelers

International travelers to areas where Dengue Fever occurs are at risk, more so if there is current epidemic activity underway at the time of the trip. Dengue is becoming an increasing health concern worldwide due to spread of significant disease in 2005-2007 in areas of the world without previous recent Dengue Fever.

Luckily, cases of severe Dengue Hemorrhagic Fever are rare, since this typically afflicts only those persons who reside in areas where dengue exists and are subject to repeated infections. Your travel health care adviser will let you know if dengue is a risk for you on your planned travel abroad.

Prevention of dengue fever

Since there is no vaccine against dengue at this time, the best prevention is to avoid getting bitten by mosquitoes in the first place. Follow these tips to prevent being bitten by mosquitoes:

  • Stay in screened or air-conditioned environments as much as possible
  • Use DEET-containing insect repellent on your skin

Your travel health adviser will discuss use of DEET in preventing dengue and other mosquito-borne diseases including malaria during your Travel Clinic visit.

If you have dengue fever

  • Avoid mosquito bites while you have a fever. Don't let mosquitoes bite you. They can infect other members of your family with dengue after biting you.
  • Use mosquito barriers until the fever subsides, to prevent day-biting mosquitoes from biting a sick person, becoming infected, and then biting someone else.
  • Rest in a screened room or under a bed net.
  • Use insect repellents and spray insecticide indoors if there are mosquitoes.

Additional resources

 

Authored by: Hall Health Center Travel Clinic staff

Reviewed by: Hall Health Center Travel Clinic staff (AT), May 2014


woman doctor.jpgWhat is PID?

Pelvic inflammatory disease or PID is a serious infection of the fallopian tubes and uterus.  This infection, which may result in blockage or scarring of the tubes, is the most common preventable cause of infertility in women.  It is estimated that over one million women in the U.S.


What is bacterial vaginosis?

Bacterial vaginosis (BV) is a common vaginal condition.  It is thought to be caused by an overgrowth of a bacterium called gardnerella vaginalis and certain other bacteria often found in the vaginal fluid.

What are the symptoms?

Symptoms may include:


What is a condom?

A condom (rubber, prophylactic) is a sheath worn over the penis. Condoms originally were designed to block the escape of sperm, but now have been shown to be effective in blocking entry and exit of bacteria and some viruses. Most condoms are made of latex but some, called "skin condoms," are made of sheep intestine. Only the latex condom should be used for disease protection because the AIDS virus, and possibly other disease agents, are able to penetrate the larger pores in the skin condom.


What are vaginal spermicides?

Vaginal spermicides are products such as foam, jelly, cream, suppositories or film that are inserted deep into the vagina on or near the cervix shortly before sexual intercourse.  Most of these products contain nonoxynol-9, a chemical that kills sperm on contact.  To be effective, a spermicide must be used every time intercourse occurs.

We recommend that vaginal spermicides always be used with condoms.


What is the HPV vaccine?

Two HPV vaccines (Gardasil and Cervarix) are approved to prevent cervical and other cancers.  Hall Health carries Gardasil, which prevents against the types of HPV that cause most cervical cancers.  It also protects you from the HPV strains that lead to mos


What every college student should know about HPV

  1. As many as 75% of sexually active people will have an HPV infection at some time in their lives.
  2. These HPV infections are usually asymptomatic and go away on their own.
  3. Some HPV infections are associated with abnormal Pap test results in women.
  4. Cervical cancer screening is recommended beginning at age 21.

What is emergency contraception?

Emergency contraception (also known as EC or the morning after pill) works to prevent pregnancy in the case of unprotected intercourse. For maximum effec­tiveness, EC should be taken as soon as possible after unprotected sex. However, EC may be taken within 72 hours (3 days) of unpro­tected intercourse.


What is Ortho Evra?

Ortho Evra or "the patch" is a birth-control patch. It contains the hor­mones norelgestromin and ethinyl estradiol, hormones similar to those used in birth control pills. Each contraceptive patch, which is thin, beige, flexible, and square, is worn on the body for 1 week at a time.

How does the contraceptive patch work?

Once applied to the body, the hormones are absorbed through the skin into the blood stream. Like the birth control pill, the patch works by suppressing ovulation.  It also causes changes to the cervical mucus and to the endometrium (lining of the uterus) that further reduce the chances of becoming pregnant.

How effective is the contraceptive patch?

Like the pill, the contraceptive patch is 99% effective when used correctly.

When do I start wearing the patch?

You may apply your first patch during the first 24 hours of your menstrual period.  No back-up birth control method is needed.

Or you may wait until the first Sunday after your period be­gins.  A non-hormonal method of birth control (such as con­doms or a diaphragm) is needed for the first 7 days. 

Where should the contraceptive patch be applied?

You can apply the patch to your abdomen, buttock, upper outer arm, or upper torso (but not the breasts).  You can wear it in the same location each week.  However, you should apply each new patch to a new spot on the skin.  To ensure effective­ness, you should not write on the patch or alter it in any way.

How should the contraceptive patch be applied?

You should apply the patch to clean, dry skin with no redness, irritation, or cuts. To make sure that the patch sticks properly, you should avoid using creams, lotions, oils, powder, or makeup on or near the site where the patch is to be applied.

Please refer to the patient package insert for specific instruc­tions in applying the patch.

Check the contraceptive patch every day to make sure that it is still sticking firmly.

How is the contraceptive patch removed?

To remove a used patch, simply lift one corner and quickly peel back. Because a used patch still contains some active hormones, you should fold the patch in half so that it sticks to itself before you throw it away.  If a small ring of adhesive is left on your skin (which may occur if certain clothing has rubbed against the patch), you can remove it by rubbing a small amount of baby oil on the area.

Will I be able to do all of the same activities I was doing before I began wearing the contraceptive patch?

Yes.  There is no need to alter daily activities while using the patch. Bathing, showering, swimming, exercising, or moisture due to wet or humid weather should not affect your contracep­tive patch.

What if I forget to change the contraceptive patch?

If you are more than one day late in putting on your first patch:

  • Apply the first patch of your new cycle as soon as you remember.
  • You will now have a new start day and a new Patch Change Day.
  • You must use backup birth control for one week to avoid becoming pregnant.

If you forget to change your patch during week 2 or 3:

  • And you are 1 or 2 days late, remove the used patch and apply a new one.
  • Apply your next patch on your normal Patch Change Day.
  • No back up birth control is needed.

If it has been more than 2 days past your last Patch Change Day:

  • Remove the used patch and apply a new patch as soon as you remember.
  • You will have a new Day 1 and a new Patch Change Day.
  • You must use back up birth control for 1 week to avoid becoming pregnant.

If you forget to take your patch off during week 4:

  • Take the patch off as soon as you remember.
  • Start your next cycle on your normal Patch Change Day.
  • No backup birth control is needed.

Can I change my Patch Change Day?

Yes. If you wish to alter the Patch Change Day,  follow these instructions:

  • Complete the current cycle.
  • Remove the third patch on the correct day.
  • Select a new Patch Change Day by applying a new patch on the desired day during the patch-free week.
  • Do not let more than 7 consecutive days go by without a new contraceptive patch.

Does the contraceptive patch cause side effects?

Except for possible minor skin reactions when the patch is placed, adverse events are similar to those associated with oral contraceptives.  The most common side effects are breast symptoms, headache, application-site reactions, nausea, cramps, and abdominal pain.  The patch is not associated with significant changes in weight.

Are there any risks associated with use of the contraceptive patch?

The patch contains hormones similar to those in birth-control pills.  Most side effects associated with the patch are not seri­ous, and those that are serious occur infrequently.  Serious risks, which can be life–threatening, include blood clots, stroke, and heart attack, and are increased if you smoke ciga­rettes. Cigarette smoking increases the risk of serious cardio­vascular side effects, especially if you are older than 35 years. Women who use hormonal contraceptives are strongly advised not to smoke. Some women should not use the patch, includ­ing those who have had blood clots (this does not mean blood clots in your menstrual flow), certain cancers, or a history of heart attack or stroke, as well as those who are or may become pregnant.

In November 2005, Ortho Women’s Health updated the information it provides to clinicians and patients.  The current patient information/warning states: “Hormones from patches applied to the skin get into the blood stream and are removed from the body differently than hormones from birth control pills taken by mouth. You will be exposed to about 60% more estrogen if you use ORTHO EVRA than if you use a typical birth control pill containing 35 micrograms of estrogen. In general increased estrogen exposure may increase the risk of side effects.  However, it is not known if there are differences in the risk of serious side effects based on the differences between ORTHO EVRA and a birth control pill containing 35 micrograms of estrogen.”

NOTE: The patch does not protect against HIV infection or AIDS or other sexually transmitted diseases.

What are the danger signs?

Call the clinic immediately or consult your private doctor or local Emergency Room if you experience ANY of the follow­ing:

  • Severe headache
  • Visual changes (flashing lights in the eyes, blurring and/ or partial loss of vision)
  • Numbness or tingling in the face, an arm, leg, hand or foot
  • Pain in the chest, shortness of breath, or coughing up blood (these symptoms may indicate possible clots in the lungs)
  • Severe leg pain (possible clot in the leg)
  • Crushing chest pain or heaviness
  • Severe abdominal pain

These symptoms may be warning signs of a blood clot, heart attack or stroke.

Who needs to know I am using Ortho Evra?

There are some drugs that may interact with Ortho Evra (and other hormonal birth control methods) possibly making the birth control method less effective in preventing pregnancy or causing an increase in breakthrough bleeding. If you are ill or need medical care, tell your health care practitioner that you are using Ortho Evra. If surgery is anticipated, it may be advisable to discontinue Ortho Evra one month before the surgery. Please discuss this with your surgeon and clinician.

Please note also that women who are using a hormonal method of birth control and also use some form of St. John’s Wort have reported pregnancies and breakthrough bleeding.

What if I want to become pregnant?

The contraceptive patch is a reversible form of birth control.  As with other forms of hormonal contraception, you may experience a delay in becoming pregnant after you stop using the patch, especially if you had irregular menstrual cycles before you used it.  Your clinician may advise you to postpone trying to get pregnant until you begin menstruating regularly on your own.

Other important information

Be sure you have available at all times a non-hormonal method of birth control such as condoms, diaphragm or spermicides.

If you do not know what to do about mistakes in using your patch, use a backup birth control method every time you have sex and contact your health care provider.

Individual replacement patches are available from your pharmacist.

For detailed information, read carefully the information sheet that is included with your prescription for Ortho Evra or you may access the web site for Ortho Evra at www.orthoevra.com

Additional resources

If you have any questions and are a UW student or established Hall Health patient, you may call one of our Consulting Nurses for further information.

 

Authored by: Hall Health Center Women's Health Clinic staff

Reviewed by: Hall Health Center Women's Health Clinic staff, January 2014


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