Amebiasis is a parasitic disease caused by organisms called protozoas. People can be infected but not have symptoms. Rarely, it can cause dysentery which includes stomach pain, bloody diarrhea, and fever, or it can invade other parts of the body such as the liver (causing abscesses), lungs, or brain.

Common symptoms include:

• Loose stools
• Stomach pain/cramping

For those who become sick, it can take about 2-4 weeks from the time of exposure to the time of illness. Without treatment a person can carry amebiasis for weeks up to years.

Amebiasis is spread through the fecal-oral route. A person needs to ingest the parasite which can occur from actions like diaper changing or sexual activity, or indirectly such as eating contaminated food or water.

Anyone can become infected with amebiasis. It is more common among:

• People living in areas with poor sanitary conditions (especially in tropical areas)
• Travelers and immigrants from these areas
• People in institutions with poor sanitary conditions
• Men who have sex with men

Contact your physician. The test for amebiasis is to look at stool under the microscope. Your physician may request several stool cultures because it can be hard to distinguish from another similar parasite.

Amebiasis can be treated with antibiotics.

There is no vaccine for amebiasis.

If you are traveling to an area where amebiasis is common, make sure to drink bottled water or boil the water and do not drink drinks with ice cubes. Also do not eat any unpasteurized dairy products, and food from street vendors, or any fruit you did not peel yourself.

Careful hand washing can help prevent amebiasis, especially after going to the bathroom and before preparing food.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book

Animals can inflict serious and even fatal injuries through their bite. An animal bite can result in a break in the skin, bruise, or puncture wound. It is important to seek prompt medical care when bitten. Even injuries that don't seem to be that serious can hide underlying damage to tissues or may get infected with germs or the rabies virus.

In addition to seeking medical treatment, you should notify the Division of Disease Control (DDC) at 215-685-6748 to report the incident. Once notified of the incident, DDC will evaluate whether you are at risk for rabies infection and whether you need to receive postexposure prophylaxis (PEP). Please refer to our rabies information page for more information on the rabies virus and protocol.

One of the best ways to prevent infection after a bite is to wash the area thoroughly with soap and water. If the site of the animal bite is infected there is a chance that the infection can travel to other places in the body if not treated. A healthcare provider can help determine whether treatment or vaccines such as tetanus or rabies are needed to prevent infection.

Symptoms of an infection that may result after a bite include the following:

• Fever
• Discomfort or tenderness at the site of the bite
• Redness or swelling at the site of the bite
• Pus or drainage at the site of the bite
• Improper healing time

A large majority of animal bite cases involve domesticated dogs. However, cat bites are more likely to cause infection. Animals can transmit several kinds of bacteria and viruses through their bite. These organisms are transferred from the animal's saliva, mouth, or teeth into the victims wound once the skin is broken. For this reason it is important to thoroughly wash the area bitten or scratched and seek medical care even if you do not think the wound is serious.

Two of the more serious infections that can be transmitted through an animal bite are rabies and tetanus. The likelihood of getting one of these diseases is less if the animal is domesticated, it is up to date on its shots, and if you are up to date on your tetanus vaccination. An infection known as cat-scratch disease may also result after a cat scratch.

There are several steps you can take to prevent animal bites. It is important to make sure that your pets are up to date on their vaccinations. For animals that you may find in your household it is important to take the following precautions:

• Evaluate what type of pet is appropriate for your household
• Do not engage in aggressive play with domesticated animals
• Make sure that children are supervised around animals in your household
• You may want to train animals to be around other people
• Do not startle or disturb sleeping or eating animals
• If approached by an aggressive dog, don't scream and/or run, try to remain motionless and avoid eye contact.

The following precautions will help prevent animal bites from stray or wild animals:

• You should not try to approach, pet, or capture stray or wild animals.
• If you see a stray dog you should contact the Philadelphia Animal Care and Control Team so they can come out and attempt to catch the dog.
• If you see sick, injured or aggressive wildlife you should contact the Philadelphia Animal Care and Control Team. Animal Control Officers will attempt to catch or trap the animal. Your assistance may be required to safely trap an animal, such as allowing a trap to be left on your property.
• Make sure to seal cracks and gaps in your home so that bats cannot enter. If bats are entering your home through gaps and cracks you should contact a licensed wildlife pest control company. They will repair the gaps and cracks, preventing bats from gaining entry. If you observe a bat in your home you should contact the Philadelphia Animal Care and Control Team so they can come out and attempt to remove the bat.

All animal bites, whether they are from stray, wild, or domesticated animals, should be reported right away. Call 215-685-6748.

Please use the resources below, talk with your doctor, or contact the Division of Disease Control.

• Learn About Dog Bites (CDC)
• Learn about Animal Bites and Scratches (CDC)
• First Aid for Animal Bites (Mayo Clinic)
• PDPH Rabies Information
• Philadelphia Animal Care and Control Team

Meningitis is a swelling of the membranes (“meninges”) that cover the brain and spinal cord. Aseptic or viral meningitis is a relatively common and rarely fatal illness with multiple viral causes such as enteroviruses, arboviruses, echovirus, and coxsackie viruses. This condition is called aseptic meningitis because tests for bacteria are negative. Viral meningitis occurs most commonly from June through October, when enteroviruses and arboviruses are circulating in the community.

Many people who are diagnosed with aseptic meningitis will experience symptoms of:

• Headache
• Fever
• Vomiting
• Nausea
• Photophobia (sensitivity to light)
• Rash
• Neck stiffness
• Confusion
• Respiratory symptoms
• Muscle weakness

Aseptic meningitis is usually diagnosed by looking at the symptoms that you have, or by finding a virus in your cerebral spinal fluid (CSF) located in your spinal column, or by the lack of bacterial growth in the CSF.

Usually people get enteroviruses, which are the most common cause of viral meningitis through direct contact with an infected person's stool. Small children that have not been toileted and the adults who have contact with them can receive and spread the virus through poor handwashing and personal hygiene practices.

Enteroviruses can also be spread through direct or indirect contact with respiratory secretions (saliva, sputum, or nasal mucus) of an infected person. Another leading cause of asceptic meningitis are arboviruses which are spread from the bite of infected mosquitoes and other insects.

Anyone can develop aseptic meningitis, however some situations may increase your risk of coming into contact with viruses that can lead to this condition. Some of these situations include being in contact with diapered children, poor hygiene, missed vaccinations, and being outside where infected mosquitoes and other insects are more likely to bite you. Individuals most at risk are small children who have not been toilet trained and the adults who have frequent contact with them.

Since the symptoms of viral meningitis are similar to those of bacterial meningitis, which is usually more severe and can be fatal, it is important for people suspected of having meningitis to seek medical care. Your healthcare provider will determine if your spinal fluid should be tested. There is no specific treatment for viral meningitis. Most patients completely recover on their own within 2 weeks. Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. Doctors often will recommend bed rest, plenty of fluids, and medicine to relieve fever and headache.

Following good hygiene practices such as washing your hands thoroughly and often, cleaning surfaces that have been contaminated with stool or respitory secretions, covering your cough, and avoiding contact with others' saliva through kissing or sharing utensils while they are sick can help avoid getting a virus.

Receiving vaccinations included in the childhood vaccination schedule can also reduce the spread of viruses.

To prevent viruses transmitted by mosquitoes, when you are outdoors use insect repellent that contains DEET or Picaridin. Many mosquitoes are most active in the evening and during early morning hours. Be sure to use insect repellent and wear long sleeves and pants at these times or consider staying indoors during these hours.

Please use the resources below, or contact your doctor or primary care physician.

• CDC Aseptic Meningitis Frequently Asked Questions
• MedlinePlus Aseptic Meningitis Page
• Mayo Clinic Aseptic Meningitis Page

Babesiosis is an infection of the red blood cells that are caused by microscopic parasites. Babesia microti is the main species that has been found in people in the United States.

Most people who have this infection do not have any signs or symptoms. However some people will develop flu-like symptoms. It may take from 1 to 3 weeks after a tick bite for symptoms to occur.

Symptoms include:

• Fever
• Chills
• Headache
• Loss of appetite
• Body Aches
• Nausea

Babesiosis can also cause hemolytic anemia, which is also known as the destruction of red blood cells.

Complications of babesiosis can include:

• Severe hemolytic anemia
• A low and unstable blood pressure
• Blood clots or bleeding
• Death
• Organ malfunction

Babesiosis is diagnosed by a blood test.

Typically, people become infected with babesiosis after being bit by an infected deer tick. However, in some situations people do become infected with babesiosis through blood transfusions from an infected donor. Babesiosis can also be contracted from an infected mother to her baby during pregnancy or delivery.

Anyone that goes outside in areas with infected deer ticks is at risk for getting this infection. However, certain people are at a higher risk for developing severe complications. These include:

• The elderly
• Those who do not have a functioning spleen
• Those that have a weak immune system because of other medical conditions such as cancer or AIDS.
• Those who have other serious health conditions such as liver or kidney disease

Contact your physician so that a blood test can be done to determine if you have babesiosis.

In general, babesiosis is treated for 7-10 days with a combination of two different prescription drugs.

Since avoiding exposure to tick habitats is not entirely possible, there are several things that people can do in order to reduce the chances of getting the disease. When people are in outdoor areas where ticks are present they can apply bug repellents that contain DEET. Also, wear light colored clothing so that you could easily spot a tick. Tucking your pants into your shoes keeps ticks from being able to attach to your legs.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• CDC Division of Parasitic Diseases
• National Institute of Allergy and Infectious Diseases

Botulism is a rare but serious illness that is caused by a nerve toxin produced by the bacterium Clostridium botulinum. There are seven types of botulism toxin but only types A, B, E, and F cause illness in humans. The botulism bacteria can also form into spores. There are three main kinds of botulism: foodborne, wound, and infant. Infant Botulism is the most commonly reported form of botulism in the United States.

• Double or blurred vision
• Drooping eyelids
• Slurred speech
• Difficulty swallowing
• Dry mouth
• Muscle weakness or paralysis

• Lethargy
• Feeding poorly
• Constipation
• Weak cry
• Poor muscle tone

If untreated these symptoms can progress to paralysis of the arms, legs, trunk, and respiratory muscles.

Botulism is difficult to diagnose. Physicians may consider the diagnosis if the patient's history and physical examination suggest botulism. A blood or stool sample will then be sent to a laboratory for testing.

Foodborne botulism most often develops after eating improperly processed home-canned foods or home-preserved meats.

Infants can get botulism by being fed food that contains botulism spores that enter the infant's intestine. Infant botulism is associated with feeding honey products to infants.

People get wound botulism when the botulism spore, typically found in soil or gravel, gets into an open wound.

Children who are younger than six months old and who eat foods that contain botulism spores, such as honey, are at risk for getting infant botulism.

Anyone who eats contaminated foods, usually foods that are not properly processed, are at risk for getting foodborne botulism.

Anyone who has an open would and is in areas with contaminated soil are at risk for getting wound botulism.

Contact your doctor right away. Untreated botulism can sometimes result in death.

Hospital care is necessary for all types of botulism. In most cases, an antitoxin medication is given for treatment. Antibiotics are sometimes given for wound botulism.

Prevention of botulism is based upon good food preparation practices. The toxin is destroyed by boiling foods at 185°F for 5 minutes or longer. The inactivation of spores requires temperatures of 248°F for 10 minutes or longer. Frozen foods should be thawed in the refrigerator, not at room temperature. Bulging containers should not be opened and foods with off-odors should not be eaten or even tasted. You should return cans with bulging lids to the place where you bought it.

To prevent infant botulism, do not feed your infant honey products.

Wound Botulism can be prevented by promptly seeking medical care for infected wounds and by not using injectable street drugs.

Please use the following resources, or contact your doctor or primary care physician.

• Botulism Fact Sheet (Pennsylvania Department of Health)
• Botulism Fact Sheet (CDC)

Campylobacteriosis is a bacterial illness that causes diarrhea. It is often called campylobacter.

Symptoms include:

• Diarrhea
• Abdominal pain/cramping
• Fever

People with campylobacter usually recover in 2-5 days, but it can be sick up to 10 days.

Rarely there are long-term problems, which range from arthritis to Guillain-Barré syndrome.

Most campylobacter infections occur from people eating undercooked or raw poultry or meat, or other food that has been contaminated by these meats. Other sources of campylobacter are raw or unpasteurized milk or contaminated water. It is not often spread from person to person.

Anyone can get campylobacter. Those most at risk are:

• Infants
• Young adults
• Males

If you think you have campylobacter, contact your physician.

The test for campylobacter requires a stool sample.

Campylobacter can be treated with antibiotics. Diarrhea can cause fluid loss and dehydration, so it is important to drink fluids.

There is no vaccine for campylobacter.

Careful hand washing can help prevent campylobacter, especially after going to the bathroom and before preparing food. Always cook meat and poultry to the correct temperature and use a meat thermometer to make sure it is the right temperature. The color of the meat does not ensure it is done cooking. Do not eat any unpasteurized dairy products or juices. Do not swallow water when swimming.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book
• Food Safety For You!

Chlamydia (cla-mid-ee-ah) is a sexually transmitted disease (STD) caused by a bacteria called Chlamydia trachomatis. It can spread from person to person during sexual intercourse (vaginal and anal) when a person's mucous membranes come into contact with the vaginal secretions or semen of an infected person. It can be transmitted without complete insertion of a penis into the vagina or anus. It is less likely, although possible, to be transmitted to the throat during oral sex. It can also be passed from mother to newborn during childbirth. Chlamydia infections are treatable and curable with antibiotics.

Untreated chlamydia can lead to severe reproductive health problems for women, including sterility. Pelvic inflammatory disease (PID) is a common result of untreated chlamydia infection. In PID, the bacteria move from the vagina up through the cervix and into the uterus, fallopian tubes and ovaries. Blockage and scarring can damage the tubes, causing women who conceive to be more likely to have "tubal pregnancies."

In men, untreated chlamydial infections can lead to prostatitis (inflammation of the prostate gland), urethral scarring, infertility, or epididymitis (inflammation of the cord-like structure at the back of the testes).

If you are HIV positive and have chlamydia, inflamed genital tissues contain highly concentrated amounts of the virus, causing 8-10 times more HIV to be shed in your semen or vaginal secretions. If you are HIV negative and have chlamydia, your immune cells are especially susceptible to HIV if your partner is carrying the virus. Rectal chlamydia may increase chances of getting HIV ten to twenty-fold.

Symptoms usually appear from one to three weeks after infection, but then go away, even if left untreated. Many people infected with chlamydia never have any symptoms at all.

Women may experience pain and itching of the vulva or vagina; vaginal discharge; unusual vaginal or anal bleeding; pain with urination; and/or pain when having sex. 80% of infected women have no symptoms.

Men may experience discharge from the head of the penis or the anus; pain or itching at the head of the penis; and/or pain with urination. 50% of infected men have no symptoms.

A complete examination for chlamydia includes taking a sexual history, examining any symptoms you might be having and testing a sample of your genital secretions with a swab. In addition, there is a chlamydia test that can be done on a urine sample. The exact test(s) done will depend on where you go for your exam.

Some providers recommend that you get tested for gonorrhea at the same time as your chlamydia test. Talk to your provider about the options available to you when you go to get tested.

Antibiotics cure chlamydia. It is very important to take all the pills you are given even if you feel better, so the bacteria is completely wiped out.

Your sex partner(s) must be examined and treated too, because otherwise they can give the infection back to you and/or infect others. You need to abstain from sex for one week from when the antibiotics were started. If you still have symptoms after you've completed the treatment, it's important to go back to your provider for a check-up.

Once you are treated and cured of chlamydia, you can be re-infected if you're exposed to the bacteria again.

Abstinence is the only way to completely avoid getting chlamydia or other STDs. If you're sexually active, using condoms consistently and correctly for oral, anal and vaginal sex is your best bet for staying sexually healthy. Since chlamydia can be passed even if the penis or tongue does not completely enter into the vagina or rectum, it's important to use a condom from the very beginning to end of sexual contact.

The risk for chlamydia is directly related to the number of sex partners you have: The more sex partners, the greater the risk of contracting it. Having more sex with fewer partners reduces your risk of getting chlamydia.

If you have a new partner with whom you intend to be monogamous, consider having full STD checkups together before you start having sex. If you're sexually active with more than one monogamous partner, regular STD checkups at least every six months is recommended. Chlamydia and other bacterial STDs are curable with proper diagnosis and treatment.

Find out more about STDs at STDPhilly.

Cholera is a diarrheal illness caused the bacteria Vibrio cholerae. People with cholera infection often do not have symptoms or have a mild gastroenteritis (irritation or inflammation of the stomach and intestines). If severe cholera is not treated, the dehydration can quickly lead to shock and death. Onset is often sudden, anywhere from hours to about 5 days.

Symptoms include:

• Watery stools often described as "rice-water stool"
• Vomiting
• Leg cramping
• Dehydration

Cholera can be spread a few different ways. The first is the fecal-oral route, meaning a person needs to ingest the parasite. This can occur from actions like diaper changing or sexual activity, or indirectly such as eating contaminated food or water. Poor sewage systems and drinking water can cause cholera to spread quickly.

The cholera bacteria also live in brackish (a mix of fresh and salt water) rivers and coastal waters, and can contaminate shellfish. Eating raw or undercooked shellfish from these areas can also cause infection.

Anyone can become infected with cholera. It is more common among these groups:

• Travelers to areas where cholera is common (especially countries with poor sewage systems)
• People who eat undercooked shellfish that are harvested from certain coastal areas or rivers

Contact your physician. Diagnosis is confirmed through a stool specimen. Rehydration is very important in treating people infected with cholera, and IV fluids may be needed for fluid replacement. Antibiotics can shorten the length of the illness.

There are oral vaccines available outside of the United States. The CDC does not recommend these vaccines for most travelers because of the low risk for US travelers and also because this vaccine does not offer full protection.

If you are traveling to an area where cholera is common, make sure to drink bottled water or boil the water and do not drink drinks with ice cubes. Also do not eat any unpasteurized dairy products, food from street vendors, or any raw fruit or vegetable (including salad). Avoid undercooked or raw fish, shellfish, and ceviche.

Please use the following resources, or contact your doctor or primary care physician.

CDC Disease Listing
• FDA Bad Bug Book

Cryptosporidiosis is a diarrheal illness caused by a parasite. It is often called crypto.

Symptoms include:

• Diarrhea
• Weight Loss
• Stomach cramps/pain
• Fever
• Nausea
• Vomiting

Symptoms can occur 1 to 12 days after becoming infected with crypto. Symptoms usually last up to several weeks, but the parasite can be shed in the stool for weeks after the symptoms have stopped. This is important because millions of parasites can be released in one bowel movement, making it very contagious.

The parasite that causes crypto lives in the intestine of humans and animals. The infection can be transmitted from drinking contaminated water or ice, which includes swallowing contaminated water while swimming. It can also be passed through contaminated food and touching surfaces that have been contaminated with fecal matter from an infected person.

Anyone can become infected with crypto. It is more common for these groups to get it:

• Travelers and immigrants from areas where crypto is common
• Diaper aged children, especially in child care settings
• Close contacts with someone who has crypto
• Swimmers who swallow contaminated water while swimming
• People exposed to fecal matter during sexual activities
• People who handle infected cattle

Contact your physician. The test for crypto is through a stool sample to look for the parasite. Your physician may request several stool cultures because it can be hard to distinguish from another similar parasite. Crypto can be treated with antibiotics. Diarrhea can cause fluid loss and dehydration, so it is important to drink fluids.

If you have a weakened immune system, it is very important to seek medical care. Crypto can be life threatening in people with weakened immune systems.

There is no vaccine for crypto.

If you are traveling to an area where crypto is common, make sure to drink bottled water or boil the water and do not drink drinks with ice cubes.

Careful hand washing can help prevent crypto, especially after going to the bathroom or changing diapers, and before preparing food.

If you are swimming, follow proper swimming hygiene. Do not swim until at least 7 days after your diarrhea has stopped and shower before swimming.

Please use the following resources, or contact your doctor or primary care physician.

CDC Disease Listing
• FDA Bad Bug Book

Cyclosporiasis is an intestinal infection caused by a parasite. It is commonly known as cyclospora.

Symptoms include:

• Watery diarrhea
• Frequent, sometimes explosive bowel movements
• Loss of appetite
• Weight loss
• Stomach cramps
• Bloating
• Increased gas
• Nausea
• Fatigue (tiredness)

It is usually one week between becoming infected and showing symptoms. Symptoms can last from a few days to over a month. People can have relapses where they feel better and then have symptoms again.

Eating or drinking food or water that has been infected with stool or feces that contained the parasite spreads cyclospora. It is not usually transmitted person to person. Fresh fruits and vegetables, especially berries, are often causes of cyclospora infections.

Anyone can become infected with cyclospora. It is more common for these groups to get it:

• Travelers and immigrants from areas where cyclospora is common (often tropical areas)

Contact your physician. The test for cyclospora is through a stool sample to look for the parasite. Your physician may request several stool cultures because it can be hard to distinguish from another similar parasite. Cyclospora can be treated with antibiotics. Diarrhea can cause fluid loss and dehydration, so it is important to drink fluids.

There is no vaccine for cyclosporiasis.

If you are traveling to an area where cyclospora is common, make sure to drink bottled water or boil the water and do not drink drinks with ice cubes. Always wash fresh produce carefully before eating it.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book

Dengue is a disease caused by any one of four closely related viruses. The virus is transmitted to humans by an infected mosquito. A more severe form of dengue is known as dengue hemorrhagic fever (DHF). DHF is an infection that is caused by the same viruses that cause dengue. Generally, younger children have a milder illness and symptoms than adults.

Symptoms include:

• High fever
• Severe headache
• Back aches
• Bloody stool
• Joint pain
• Nausea and vomiting
• Eye pain
• Rash
• Nausea or vomiting

Dengue symptoms will appear 3-14 days after being bitten by an infected mosquito.

Dengue hemorrhagic fever is characterized by a fever lasting 2-7 days with general symptoms that could come from any other illness. Hemorrhagic manifestations, the tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding follow the fever.

Dengue is diagnosed by a blood test.

The dengue virus is transmitted to people after an infected Aedes mosquito bites them. The mosquito becomes infected after biting an infected human. The mosquito can transmit the virus to humans 1 week after biting an infected person.

Anyone that travels to tropical areas that contain Aedes mosquitoes such as: the Caribbean, South America, South Central Asia, and Southeast Asia are at risk for getting dengue infection.

Contact your physician.

There is no specific medical treatment available for dengue infection. Persons who think they have dengue should use pain relievers with acetaminophen and should avoid those containing aspirin. Those persons with dengue should drink many fluids and rest so they do not become dehydrated.

When traveling to areas with infected mosquitoes, avoiding mosquito bites is the best way to prevent dengue infection. Aedes mosquitoes typically live outdoors in cold dark areas. Travelers should use insecticides to get rid of the mosquitoes.

When you are outdoors use insect repellent that has DEET in it. Mosquitoes are most active at dusk and dawn. Wear long sleeves and pants at these times or consider staying inside during these hours.

For long term travelers, eliminate the places where the mosquito could lay her eggs. This means getting rid of outdoor containers that hold water. Large items that can hold water such as garbage cans should be covered.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Dengue and Dengue Hemorrhagic Fever: Questions and Answers
• WHO Dengue page
• MedlinePlus Dengue page
• CDC Travelers' Health-Yellow Book

E. coli is a large group of bacteria with many different strains or types. Some of the strains are harmless and others can be life-threatening. Certain strains produce toxins, which are known as shiga toxin.

Symptoms include:

• Severe stomach cramping
• Diarrhea (often bloody)
• Vomiting
• Low grade fever

People usually become sick 3-4 days after exposure to E. coli, but it can range from 1-10 days. People will usually feel better within 5-7 days. A small number of people with E. coli (5-10%) will develop hemolytic uremic syndrome (HUS).

Symptoms of HUS include:

• Decreased frequency of urination (urinating less often)
• Feeling tired
• Losing color in the cheeks and inside of eyelids

HUS usually occurs around 7 days after the first symptoms, and usually when the diarrhea starts to improve. People with HUS should seek medical care and will often be hospitalized to prevent kidney failure.

E. coli is spread several ways. It is usually spread from people who are infected with this germ, who pass the bacteria in their bowel movements (stool). If infected persons do not wash their hands well, this germ can get into the food or drink they are handling, and others can then get sick by eating this food or drink. People can also get this germ on their hands when changing diapers or assisting a child with toileting.

Certain foods have greater risk of E. coli infection, such as unpasteurized or raw milk or cheeses, unpasteurized apple cider, and contaminated water. Others have gotten sick from contact with cattle or petting zoos.

Anyone can get E. coli. The people most at risk are:

• Very young children
• The elderly

If you think you have E. coli, you should contact your doctor and discuss your symptoms. A stool sample will be collected to determine the diagnosis. Supportive therapy, such as rehydration is important. Antibiotics are not helpful in treating E. coli, because they increase the risk of HUS. Anti-diarrheals are also not recommended because they increase the risk of HUS.

There is no vaccine for E. coli.

Careful hand washing can help prevent E. coli, especially after going to the bathroom or changing a diaper, before preparing food, or after petting animals. Always cook meat to the correct temperature and use a meat thermometer to make sure it is the right temperature. The color of the meat does not ensure it is done cooking. Do not eat any unpasteurized dairy products or juices. Do not swallow water when swimming.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book
  • Enterotoxigenic
  • Enteropathogenic
  • Escherichia
  • Enteroinvasive

Ehrlichiosis is the general name that describes several bacterial diseases that affect animals and humans. These diseases are caused by the organisms in the genus Ehrlichia. In the United States, there are two Ehrlichia species that are known to cause infection in humans.

Initial signs and symptoms include:

• Fever
• Headache
• Fatigue
• Muscle aches

Other signs and symptoms could include:

• Nausea
• Vomiting
• Diarrhea
• Joint Pain
• Occasionally a rash may form

Symptoms typically appear 5 to 10 days after being bitten by a tick. However it is possible that some people who become infected with ehrlichiae will not become sick or will only have very mild symptoms.

Ehrlichiosis is diagnosed through a combination of clinical signs and symptoms and lab tests, such as blood tests.

People can get ehrlichiosis if an infected tick bites them. The most commonly infected tick is known as the lone star tick.

Anyone can get this disease that lives in or travels to areas that have lone star ticks such as: southern, eastern, and south-central United States. However, certain people are at a higher risk of suffering from a more serious illness. These people include:

• The elderly
• People who have a weak immune system because of medical conditions such as cancer or AIDS.

Contact your doctor and explain the symptoms you have. If you are aware of a tick bite, notify your doctor. A blood test could be done to determine if you have ehrlichiosis.
Ehrlichiosis is treated with a course of antibiotics.

Since avoiding exposure to tick habitats is not entirely possible, there are several things that people can do in order to reduce the chances of getting the disease. When people are in outdoor areas where ticks are present they can apply bug repellants that contain DEET. Also, wear light colored clothing so that you could easily spot a tick. Tuck your pants into your shoes so that ticks cannot attach crawl up your pant legs.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• MedlinePlus page
• Mayo Clinic page

Giardiasis is a diarrheal illness caused by a parasite. It is often called giardia.

Symptoms include:

• Diarrhea
• Gas or flatulence
• Greasy stools
• Stomach or abdominal cramps
• Upset stomach
• Weight loss
• Dehydration

Symptoms will usually appear about 1 to 2 weeks after being infected with giardiasis. Symptoms can last 2 to 6 weeks on average.

The parasite that causes giardia lives in the intestine of humans and animals. The infection can be transmitted from drinking contaminated water or ice, which includes swallowing contaminated water while swimming. It can also be passed through contaminated food, touching surfaces that have been contaminated with fecal matter from an infected person.

Anyone can become infected with giardiasis. It is more common for these groups to get it:

• Travelers and immigrants from areas with a high incidence of giardia
• Diaper aged children, especially in child care settings
• Close contacts with someone who has giardia
• Swimmers who swallow contaminated water while swimming
• People exposed to fecal matter during sexual activity

Philadelphia has seen outbreak situations associated with swimming pools.

Contact your physician. The test for giardia is through a stool specimen to look for the parasite. Your physician may request several stool cultures because it can be hard to distinguish from another similar parasite. Giardia can be treated with antibiotics. Diarrhea can cause fluid loss and dehydration, so it is important to drink fluids.

There is no vaccine for giardia.

If you are traveling to an area where giardiasis is common, make sure to drink bottled water or boil the water and do not drink drinks with ice cubes.

Careful hand washing can help prevent giardia, especially after going to the bathroom and before preparing food.

If you are swimming, follow proper swimming hygiene. Do not swim until 7 days after your diarrhea has stopped and shower before swimming.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book

Gonorrhea (gon-or-e-uh) is a sexually transmitted disease (STD) caused by a type of bacteria called Neisseria gonorrhoea. Gonorrhea can be transmitted to both male and female partners during vaginal, anal and oral sex from a partner infected in his or her throat, vagina, urethra or anus. Gonorrheal infections are completely curable with antibiotics.

If you are HIV+ and have genital inflammation due to gonorrhea, the inflamed tissues contain highly concentrated amounts of the virus. If the gonorrheal infection is in your penis, you can shed 8-10 times more HIV in your semen.

If you are HIV- but have gonorrhea, the disease-fighting cells of your immune system are especially susceptible to HIV if you have unprotected sex with an HIV-infected partner. Rectal gonorrhea increases the risk of contracting HIV by ten to twenty times.

In about 1% of people with untreated gonorrhea, the infection can spread beyond the genital area to the bloodstream, skin, heart or joints. This is called Disseminated Gonococcal Infection (DGI). Symptoms include fever, multiple skin lesions, arthritis, infection of the inner lining of the heart, and meningitis. DGI can be treated with antibiotics.

PID (pelvic inflammatory disease), a serious pelvic infection in women, is a more common result of untreated gonorrhea. In PID, the bacteria move from the vagina up through the cervix and into the uterus, fallopian tubes and ovaries. Blockage and scarring can damage the tubes, making a woman who conceives more likely to have a tubal pregnancy. Left untreated, PID can cause infertility. Untreated gonorrhea can also cause chronic menstrual problems, postpartum endometritis, urinary tract infections, miscarriage, and cervical discharge.

Men with untreated gonorrhea can occasionally develop epididymitis, a painful infection of the testicles. Untreated gonorrheal infections can also cause inflammation of the prostate and urethral scarring, sometimes leading to infertility.

Most men develop symptoms of gonorrhea within two to five days after being exposed, with a possible range of one to thirty days. Although most women are asymptomatic (without symptoms), for those who do have symptoms, they usually appear within 10 days after being exposed.

Men who have gonorrhea in the penis or anal area may experience a discharge from the head of the penis or the anus; pain or itching of the head of the penis; swelling of the penis or testicles; pain and/or burning upon urination; frequent urination; anal or rectal itching; white anal discharge; and/or pain during bowel movements.

Women with gonorrhea may have a discharge from the vagina; lower abdominal pain, especially during or after sex; unusual bleeding with cramping; pain or burning with urination.

If you're infected with gonorrhea in the throat, there are usually no symptoms, except possibly a sore throat.

There are several different testing options for gonorrhea. Your medical provider will decide which one is best given your situation and the lab facilities available at the clinic or medical practice. Some tests are done on a urine sample, and some on a swab of the secretions from the infected area.

Your provider will give you antibiotics to kill the gonorrheal bacteria in your body. If you are prescribed antibiotics, take all of the pills, even if you feel better before you finish the dosage. Your sex partner(s) need to be examined and treated also, because if you have unprotected sex again, you can be re-infected. If you're non-monogamous, your partner is also capable of infecting others until he or she gets proper treatment.

It's important to talk to your partners to maintain your sexual health and that of our community. Also you must abstain from partner sex for one full week from when your antibiotic treatment is started.

The risk for gonorrhea is directly related to the number of sex partners you have: The more sex paartners, the greater the risk of contracting it. Having more sex with fewer partners reduces your risk of getting gonorrhea.

The only way to be 100% sure of eliminating your risk of contracting gonorrhea or other STDs is to abstain from sex. If you are sexually active, however, using condoms (male or female) for sexual activity is your best bet for protecting yourself. Since gonorrhea can be transmitted during oral sex, primarily mouth-to-penis or penis-to-mouth contact, it would be wise to use a condom when performing oral sex on a man or if you're a man, having oral sex performed on you. Also, we recommend regular STD checkups at least every six months if you're sexually active with more than one monogamous partner. Gonorrhea and other bacterial STDs are curable with proper diagnosis and treatment.

Find out more about STDs at STDPhilly.

Hepatitis is the name for inflammation of the liver caused by several different viruses. The viruses are classified by letters of the alphabet – with types A, B, and C being the most common. Each of these viruses can be transmitted in a number of ways, some sexually. Hepatitis B and C viruses can cause inflammation of the liver, liver failure, liver cancer, and death. Hepatitis B is the most common cause of liver cancer in the world. Chronic Hepatitis C (HCV) is the leading cause for liver transplants.

It is estimated that there are between 125,000 and 200,000 Hepatitis A infections (HAV) per year in the United States. Approximately 1.25 million people in the United States have chronic Hepatitis B virus (HBV), with an estimated 78,000 new HBV infections each year. HCV is the most common chronic blood borne infection in the United States. It is estimated that about 4 million Americans have been infected with HCV, of whom 2.7 million have chronic infections. There are approximately 25,000 new infections in the U.S. each year.

HAV usually runs its course without treatment. Once infected, you cannot be re-infected. Both HBV and HCV can attack in acute or chronic forms. The acute forms resemble a bad illness that can last for a few weeks, up to a few months. If the illness turns chronic (long-lasting), both Hepatitis B and C can ultimately lead to liver failure and death.

Important Note: Hepatitis B infection in someone who is HIV+ is more likely to turn into chronic HBV. It is estimated that 5,000 people die each year in the United States due to complications of cirrhosis and liver cancer as a result of HBV.

HAV is highly contagious and is spread from person to person via contaminated food, water or stool. A person is most infectious in the two weeks after exposure, but before symptoms show up – which means people can spread the virus without even knowing they have it.

Poor hand washing and contaminated water supplies can easily transmit HAV, as well as many types of anal sex such as rimming, fisting, fingering, and anal intercourse. Contact with something that's been in contact with the anus of an infected person can also transmit the virus. This means that sharing sex toys, kissing someone who's been rimming, and sucking someone who's just topped someone else can all be risky activities for transmitting HAV.

HBV is the most common sexually-transmitted type of viral hepatitis. People can be infected through anal and vaginal sex by sharing body fluids (blood, semen and vaginal fluids). It is possible, although rare, for Hepatitis B to be transmitted solely via oral sex. People who share or use needles with contaminated blood can be infected. Currently, blood transfusions are rarely the cause of HBV infections in the United States due to the improved screening of blood supplies. Although tattoo, body piercing, and acupuncture needles may transmit HBV, they account for only a small proportion of the total reported cases in the United States.

People who share or use needles or injection drug equipment (works, cotton, cookers, spoons) contaminated with blood can be infected with HCV. Most cases of HCV in the general population today have been the result of blood transfusions in the past. Currently, proper screening for Hepatitis B and C is being done on all blood supplies in the United States.

The risk of transmission via oral and anal sex is unknown, but likely to be very low.

Within all three types of hepatitis – A, B, C – the severity and type of symptoms vary greatly. Many people do not have symptoms at all. If you do have symptoms, they could include fatigue, stomach pain, yellowing of the skin or eyes (jaundice), dark urine, light colored stool and/or fever.

In Hepatitis A, symptoms usually appear 2-6 weeks after infection. In Hepatitis B, symptoms usually appear 6 weeks to 6 months after exposure, if at all. Hepatitis C symptoms, if any, will show up 2 weeks to 6 months after exposure. Symptoms may be brief or last several weeks.

Hepatitis is diagnosed via a blood test for hepatitis antibodies. HAV antibodies may be detected as early as the onset of symptoms. HBV usually takes between 3 weeks to 2 months to show up in the blood. The average time it takes for a person infected with Hepatitis C to develop antibodies is 8-9 weeks after exposure.

General treatment for all types of early hepatitis is bed rest and fluid intake. Fluid intake is important to prevent dehydration. Avoidance of alcohol is strongly encouraged to reduce further liver damage. Hepatitis A and acute forms of B and C will eventually run their course, although recovery may take several months.

Chronic HBV can be a fatal disease. There is no cure, although treatments are available to help stop virus replication. Interferon, an antiviral agent, has been 40 percent effective in eliminating chronic HBV infection. It is most effective for people who were infected as adults.

New prescription drugs are now also available including Lamivudine (Epivir) and Adefovir dipivoxil (Hepsera). Talk to your health care provider for more information and to see whether they may be right for you.

HCV is treatable. New studies have shown that up to nearly 50% of people who undergo one year of therapy can be cured. Treatment will differ depending on the stage of illness at the time you seek treatment. Your health care provider can help you make the best decisions about your treatment based on your personal needs and health status.

The most important thing is to avoid alcohol and other drugs like acetaminophen (the active ingredient in Tylenol and Vicodin) because it can further damage your liver. In general, you want to eat healthfully, get plenty of rest, and exercise moderately. You need to see your medical provider on a regular basis to work together on your treatment plan. Don't take any new medications, including herbal or over-the-counter drugs, without talking to your provider first.

If you know you have HBV, you can protect others by using condoms during sexual activity.

If you know you have HCV, you can protect others by not donating blood, body organs, tissue or semen; covering any cuts or sores you have to prevent spreading infectious blood or secretions; not sharing personal hygiene items such as razors or toothbrushes and not sharing needles or any other works. Currently there are no recommendations for condom use with HCV infected partners, however there are many other reasons to use condoms regularly for sexual activity.

Effective vaccinations are available to protect you against Hepatitis A and B. Both are recommended for those at high-risk of infection including men who have sex with men and health workers. Currently there are no shots to protect you against Hepatitis C.

A new combination vaccine called Twinrix has been approved for protection from both HAV and HBV in people who are 18 and older. It reduces the total number of injections for vaccination from both viruses from five to three.

If you have not yet been vaccinated and you engage in anal sex activities, using condoms for intercourse and cut-up non-lubricated condoms, household plastic wrap or dams (square pieces of latex) for oral-anal sex can significantly reduce your risk of contracting hepatitis. In addition, wash your hands and sex toys as soon as possible after anal contact.

Find out more about STDs at STDPhilly.

Hepatitis A is a liver disease caused by the hepatitis A virus, which can be spread from person to person. Children are less likely to show symptoms than adults.

Symptoms of hepatitis A include:

• Fever
• Fatigue (tiredness)
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored or pale stools (feces)
• Joint pain
• Jaundice (yellowing of eyes and skin)

Usually, symptoms last for less than 2 months, but in some cases people can be sick for up to 6 months. People with hepatitis A are contagious 1-2 weeks before they experience their first symptoms, and can remain contagious for up to a week after their first symptoms appear.

Most people who get hepatitis A feel sick for a few months, but they usually recover completely and do not have lasting liver damage. In some cases, hepatitis A can cause liver failure and death, but this is rare and happens more commonly in people older than 50 and people with other liver diseases.

The hepatitis A virus enters through the mouth, multiplies in the body, and is passed in the stool (feces). The virus is then carried on an infected person's hands. If the hands are not washed properly, the the virus can be spread to objects, food, or drink, which can come in contact with another person's mouth. Contaminated food and drink is one of the main ways that hepatitis A is spread. Sexual activities such as oral-anal contact with an infected person may result in person-to-person transmission.

The people most at risk for hepatitis A are those who:

• Travel to or live in countries where hepatitis A is common
• Have sexual contact with someone who has hepatitis A
• Are men who have sexual contact with other men (MSM)
• Use certain illegal drugs, whether injected or not
• Have clotting-factor disorders, such as hemophilia
• Are household members or caregivers of a person infected with hepatitis A

If you were recently exposed to hepatitis A and have not been vaccinated, you may benefit from a dose of vaccine or immune globulin (IG). Either must be given within two weeks of exposure to be effective. Your doctor can decide what is best for you based on your age and overall health.

If you think you have hepatitis A, you should contact your doctor and discuss your symptoms. Your doctor may then request a blood test to diagnose you with hepatitis A.

There is no specific treatment for hepatitis A. Doctors usually recommends rest, adequate nutrition, and fluids. Only very few cases will need to be hospitalized. It can take a few months before people begin to feel better.

There is a vaccine that prevents hepatitis A. The vaccine is now routinely recommended for all children over 1 year of age. The vaccine is also recommended for people in the following groups:

• Travelers
• Men who have sexual contact with other men (MSM)
• Users of injection and non-injection illegal drugs
• People with chronic (lifelong) liver disease such as hepatitis B or hepatitis C
• People who are treated with clotting-factor concentrates for blood disorders
• People who work with hepatitis A in a research laboratory

Proper hand-washing with soap and warm water after using the bathroom and before preparing or eating food is also a major way to prevent hepatitis A from spreading.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Division of Viral Hepatitis (DVH): Hepatitis A FAQs for the Public
• CDC Division of Viral Hepatitis (DVH): Hepatitis A Patient Education Resources
• CDC Vaccines & Immunizations: Hepatitis A Vaccination
• CDC Hepatitis A Vaccine Information Statement
• PDPH Immunization Program

Hepatitis B is a liver disease caused by the hepatitis B virus (HBV), which can be spread from person to person. Hepatitis B is spread through blood or body fluids of an infected person. Infection with HBV can be acute (short-term) or chronic (life-long).

The age at which a person is infected with HBV plays a major role in whether or not a person develops chronic hepatitis B. 5-10% of persons over 5 years of age that are infected with HBV develop chronic infection. 90% of infants infected with HBV develop chronic infection. 25-50% of children 1-5 years of age infected with HBV develop chronic infection.

Symptoms of hepatitis B include:

• Fever
• Fatigue (tiredness)
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored or pale stools (feces)
• Joint pain
• Jaundice (yellowing of eyes and skin)

Symptoms of acute hepatitis B usually last a few weeks, but can last as long as 6 months. Children under 5 are less likely to have symptoms when infected with HBV. Persons with chronic hepatitis B infection may not experience any symptoms at all, or may experience disease symptoms.

Persons with acute hepatitis B are contagious until the infection is resolved. Your doctor can tell you when an acute hepatitis B infection has been resolved. People with chronic hepatitis B can transmit the virus throughout their life, as chronic hepatitis B infection is life-long. Even if a person is not showing symptoms, they can still spread the virus as long as they are infected.

Chronic hepatitis B infection can lead to long-term health problems, and can eventually lead to liver damage, liver failure, liver cancer, and death.

HBV can survive outside the body for one week or more and still cause infection. Common disinfectants can kill the virus.

Hepatitis B is spread through blood or body fluids (including semen and vaginal fluids) of an infected person. It is not spread through food or water.

Ways in which hepatitis B can be spread include:

• Unprotected sexual activity
• Sharing injection drug equipment
• Tattooing or piercing if equipment is not cleaned properly
• During birth from an infected mother to baby
• Contact with open sores of an infected person
• Occupational exposure such as needle sticks
• Sharing personal items such as: razors, toothbrushes, nail clippers, etc.

The people most at risk for hepatitis B are:

• Sexual contacts of people infected with HBV
• People with multiple sex partners
• People who have a sexually transmitted disease (STD), or have had an STD in the past
• Men who have sex with men (MSM)
• People who share injection drug equipment
• Babies born to mothers infected with HBV
• People who work in settings where they may be exposed to blood or bodily fluids
• Hemodialysis patients
• People who travel to countries with intermediate to high rates of hepatitis B

If you think you may have been exposed to the hepatitis B virus, call your doctor or health professional. If you have been exposed to the hepatitis B virus, vaccine and/or a shot called “HBIG” (hepatitis B immunoglobulin) can be given to prevent hepatitis B infection. Hepatitis B vaccine and HBIG are most effective in preventing hepatitis B infection if they are given within 24 hours of exposure.

If you think you have hepatitis B or have been exposed to hepatitis B, you should contact your doctor, and discuss your symptoms. Your doctor may then request a group of blood tests to determine whether or not you have hepatitis B.

There is no specific treatment for acute hepatitis B. Doctors usually recommend rest, adequate nutrition, and fluids.

For chronic hepatitis B, there is treatment available. Not everyone who has chronic hepatitis B is recommended for treatment. Your doctor will take a number of factors into consideration when deciding whether or not you should be on treatment.

There are several ways to prevent the transmission of HBV. Vaccination with hepatitis B vaccine is the most effective way to prevent HBV transmission. The hepatitis B vaccine is highly effective and safe. It is recommended for all infants, children, and adolescents through 18 years of age. Infants should be immunized as part of the routine childhood immunization schedule. Hepatitis B vaccine can be given together with other vaccines

Other people who should be vaccinated for hepatitis B include:

• People whose sex partners have hepatitis B
• People with multiple sex partners
• People who currently have a sexually transmitted disease (STD), or have had an STD in the past
• Men who have sex with men (MSM)
• People who have close household contact with someone infected with the hepatitis B virus
• People who share injection drug equipment
• Healthcare and public safety workers at risk for exposure to blood or body fluids on the job
• Hemodialysis patients
• People that are incarcerated
• People working in correctional facilities
• People traveling to countries with moderate or high rates of HBV
• Residents and staff of facilities for developmentally disabled persons
• People with chronic liver disease, including hepatitis C
• People living with HIV infection

3-4 doses of hepatitis B vaccine are given, and the vaccine schedule may vary. Your doctor will be able to let you know when you will need to come in for vaccination.

Other ways to prevent transmission of hepatitis B include:

• Using condoms and having safe sex
• Not sharing injection drug equipment
• Not sharing personal items including razors, toothbrushes, blood glucose monitoring equipment, etc.
• Checking to see if tattoo/piercing equipment is clean
• Vaccinating exposed infants born to mothers who are positive for HBV

Please use the following resources, and contact your doctor or primary care physician.

• CDC Division of Viral Hepatitis (DVH): Hepatitis B FAQs for the Public
• CDC Division of Viral Hepatitis (DVH): Hepatitis B Patient Education Resources
• CDC Vaccines & Immunizations: Hepatitis B Vaccination
• CDC Hepatitis B Vaccine Information Statement
• PDPH Immunization Program

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which can be spread from person to person. Hepatitis C is spread through contact with blood of an infected person. Infection with HCV can be acute (short-term) or chronic (life-long).

Of people that are infected with HCV, 20% will have an acute infection, and clear the infection on their own. 80% of people infected with HCV will become chronically infected. If a person has an acute infection, and clears the infection, they can still become re-infected with HCV.

Symptoms of hepatitis C include:

• Fever
• Fatigue (tiredness)
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored or pale stools (feces)
• Joint pain
• Jaundice (yellowing of eyes and skin)

Of people infected with HCV, 20-30% will experience symptoms. Those people experiencing symptoms will usually develop symptoms anywhere from 2–24 weeks after being infected.

People with chronic hepatitis C may not experience any symptoms at all. Chronic infection with hepatitis C can lead to chronic liver disease, which can range from mild to severe, and can include cirrhosis (scarring of the liver) and liver cancer. Chronic liver disease as a result of chronic hepatitis C infection usually progresses slowly without any signs or symptoms for several decades.

People with chronic hepatitis C can transmit the virus throughout their life, as chronic hepatitis C infection is life-long. Even if a person is not showing symptoms, they can still spread the virus as long as they are infected.

Hepatitis C is transmitted through contact with blood of an infected person. Hepatitis C is not spread through food or water.

Ways in which hepatitis C can be spread include:

• Sharing needles, syringes, and other injection drug equipment
• Blood transfusions prior to 1992
• Small risk of being transmitted from mother to child at birth, but this risk increases if the mother has HIV too
• Tattooing or piercing if equipment is not clean
• Occupational exposure (needle sticks, etc.)
• Sex, specifically sexual behaviors that involve tearing and/or contact with blood
• Sex with multiple partners
• Sex when an individual has an active STD
• Sharing personal items including razors, toothbrushes, nail clippers, etc.

The people most at risk for hepatitis C are:

• Current and past injection drug users, including those who injected only one time or many years ago
• People who received donated blood, blood products, and organs prior to 1992
• People who received a blood product for clotting problems, made before 1987
• Hemodialysis patients
• People who received body piercing or tattoos done with non-sterile instruments
• People who work in settings where they may be exposed to blood
• HIV-infected persons
• Babies born to mothers infected with HCV

If you think you have hepatitis C or have been exposed to hepatitis C, you should contact your doctor, and discuss your symptoms and exposure. Your doctor may then request a blood test to determine whether or not you have hepatitis C.

If you have chronic hepatitis C, there are treatment options available. Not everyone who has chronic hepatitis C is recommended for treatment. Your doctor will take a number of factors into consideration when deciding whether or not you should be on treatment.

Currently, there is not a vaccine for hepatitis C. There are vaccines for hepatitis A and B. If you are at risk for hepatitis C, or have hepatitis C, getting vaccinated for hepatitis A and B is recommended in order to protect you from being infected with more than one type of hepatitis. Being infected with more than one type of hepatitis can be even more harmful to your liver.

Knowing your hepatitis C status is important. If you have hepatitis C, and you know your status, you can speak with your doctor about treatment options and lifestyle changes that can prevent further complications of hepatitis C infection. Knowing your status can also prevent you from transmitting hepatitis C to others.

Ways to prevent hepatitis C infection include:

• Not sharing injection drug equipment
• Using condoms and practicing safe sex
• Not sharing personal items, including razors, toothbrushes, blood glucose monitoring equipment, etc.
• Checking to see if tattoo/piercing equipment is clean

Please use the following resources, and contact your doctor or primary care physician.

• CDC Division of Viral Hepatitis (DVH): Hepatitis C FAQs for the Public
• CDC Division of Viral Hepatitis (DVH): Hepatitis C Patient Education Resources

AIDS stands for Acquired Immune Deficiency Syndrome and is a group of health problems caused by a virus called HIV, the Human Immunodeficiency Virus. HIV is transmitted from person to person via exchange of bodily fluids – semen, blood, and vaginal fluids – during anal, vaginal, and possibly oral sex, or when sharing needles during intravenous drug use.

People who test positive for HIV do not necessarily have AIDS. Many people are HIV+ but don't show symptoms of illness for years, if at all. People who do get AIDS can get very ill and die from infectious diseases and cancers that usually don't cause problems for other people. There is currently no cure for AIDS.

People with HIV show signs of AIDS when their immune system is seriously damaged. People with AIDS can suffer from what are called opportunistic infections, such as Kaposi's sarcoma (a skin cancer), PCP (a lung infection), CMV (a virus that infects the eyes), and candida (a fungal infection). AIDS-related diseases also include severe weight loss, brain tumors, and a myriad of other health problems.

AIDS shows up differently in every infected person. Some people die soon after getting infected, while others live fairly normal lives for many years after they are diagnosed with AIDS.

There are now treatments available that can slow down the replication of HIV in your body, along with any immune system damage. The treatment is called anti-retroviral therapy. However, there is currently no cure for AIDS.

You might not know if you are infected with HIV. Some people get flu-like symptoms such as fever, headache, sore muscles and joints, stomach ache, swollen lymph glands, or a skin rash four to six weeks after exposure to the virus. Most people have no symptoms at all.

If you get infected with HIV, your body tries to fight the infection. It makes antibodies, special molecules that are supposed to fight HIV. The most common HIV test is a blood test which looks for these antibodies. If you have them in your blood, it means that you are HIV positive.

If you become infected with HIV, it usually takes between three weeks and two to three months for your immune system to produce antibodies to HIV. If you think you were exposed to HIV, you should get tested. During your visit, speak to your doctor about the possibility of taking post-exposure prophylaxis or PEP.

Newer tests can detect HIV antibodies in saliva, a scraping from inside the cheek, or urine. A rapid HIV test was approved by the FDA in November 2002. Rapid test results are available within a half an hour after a blood sample is taken. The home test kits on the market are designed to help you collect your own blood sample. The sample is then sent to a lab where it is tested for HIV.

Clinics and medical providers will offer either confidential or anonymous HIV testing services. Confidential antibody testing means that you and the health care provider know your results, which may be recorded in your medical file. The health care provider and any other staff in the clinic or office are bound by confidentiality not to disclose the results of your test to anyone without your permission.

Anonymous testing means that your name is never associated with your test results. Current federal law requires all positive HIV tests to be reported. Reports can be made without using your name, but instead via a unique code. Currently, a person who gets either type of HIV test is asked to participate in pre- and post-test counseling.

As mentioned earlier, there is no cure for AIDS. There are anti-retroviral drugs now available that can slow down the virus, and slow down the damage to your immune system. These drugs have also helped reduce the overall rates of opportunistic infections in people with AIDS. The drug regime is severe however – many expensive pills have to be taken regularly on a daily basis – and there can be side effects when the pills are taken for a long period of time. Many people who are able to, though, choose to go on anti-retroviral therapy once they are diagnosed HIV+ to stem any potential illness and keep their quality of life high as long as possible. For more detailed and current information about treatment, visit www.hivinsite.org.

The best thing you can do is to stay healthy — keep your stress levels low, eat well, exercise regularly, get lots of rest, and if you're sexually active, have protected sex with your partners. You also need to work closely with a medical provider to monitor your health and determine the best course of continued treatment over time. There are resources available to help HIV+ people in the U.S. get treatment and regular medical services, sometimes at low-cost or reduced fees.

In order to avoid transmission of the virus to your sex partners, as well as to protect yourself from getting other bacterial and viral STDs, we advise discussing your HIV status with a prospective partner before having sex. Communication is one of the keys to keeping our community sexually healthy.

The only way to be 100% sure you won't get HIV/AIDS is to abstain from sex and intravenous drug use. If you're sexually active, using condoms correctly each and every time you have anal or vaginal sex provides the best protection against HIV transmission. While there is not enough scientific evidence available yet to be certain, there are many individuals who also state that they have gotten HIV from participating in oral sex (as givers to infected men). It is advisable to consider using condoms for oral sex as well, especially because other STDs like syphilis and gonorrhea, which can increase your risk of getting HIV, can be transmitted via oral sex.

Find out more about STDs at STDPhilly. Find an HIV test site near you.

Group A Streptococcus (GAS) is a type of bacteria that is commonly found in the throat and skin. Most infections caused by GAS such as “strep” throat are mild and non-life threatening. However, sometimes this type of bacteria can cause severe illness when it is found in the blood, muscles, or lungs. When GAS is found in these places, the infection is identified as invasive GAS disease.

Complications of invasive GAS infection include:

• Bacteremia
• Pneumonia
• Meningitis
• Endocarditis
• Septic Arthritis (Joint Infection)
• Cellulitis
• Pericarditis (infection of the sac covering the heart)
• Necrotizing fasciitis (an infection that destroys fat, muscle, and skin tissue)
• Streptococcal Toxic Shock Syndrome (an illness that causes a rapid drop in blood pressure and may lead to organ failure)

Group A Streptococci is spread by direct contact with secretions from an infected person's nose or throat. In addition, contact with infected wounds or skin may also increase a person's risk of getting the infection.

People most at risk for getting this disease are:

• People with chronic health conditions (diabetes, cancer, heart or lung disease)
• People with cuts, open wounds, or chickenpox
• Adults with a history of alcohol abuse or injection drug use
• People living in group settings

People with Invasive GAS disease are diagnosed by a healthcare provider typically within a hospital. The disease can be treated with antibiotics.

The best way to prevent this disease is by washing your hands thoroughly with soap and water or alcohol based gels after coughing and sneezing and before preparing and eating foods. Anyone who is diagnosed with this type of infection should not attend daycare, school, or work until they have completed 24 hours of antibiotic treatment. Individuals who have wounds should keep them clean and watch for signs of infection such as redness, swelling, and fever.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• E-medicine Group A Strep Information

Invasive Haemophilus influenzae disease is caused by the gram negative bacteria Haemophilus influenzae. Invasive disease is described as bacteria isolated from a normally sterile site such as blood, cerebrospinal fluid, pleural fluid, or joint fluid.

Infection with Haemophilus influenzae most often causes bacteremia (infection of the blood), meningitis, pneumonia, epiglottitis (an infection and swelling of tissue in the throat), arthritis, cellulitis, bone infections, and other infections. Haemophilus influenzae type b (Hib) is a vaccine-preventable disease. Other types of Haemophilus influenzae can cause similar illness and are not vaccine-preventable.

Invasive Haemophilus influenzae disease can be spread person to person by breathing in respiratory droplets which contain the bacteria. The time from exposure to the germ to development of the illness is not well known.

Haemophilus influenzae can only be found in humans. Unimmunized or underimmunized children younger than 5 years of age are at the greatest risk for invasive Hib disease.

People are at higher risk of infection if they:

• Live in crowded settings
• Attend child care settings
• Live with school-aged children
• Have chronic diseases such as sickle cell anemia, and antibody deficiency syndromes

People with Invasive Haemophilus influenzae disease are diagnosed by a healthcare provider typically within a hospital.

The disease can be treated with antibiotics.

A vaccine for Invasive Haemophilus influenzae type B (Hib) disease is available and is recommended for all children. Children should begin their primary series of Hib vaccine at 2 months of age and receive a booster dose at age 12-15 months.

Please use the following resources, or contact your doctor or primary care physician.

• American Academy of Pediatrics
• CDC Hib Vaccination Page
• Hib Vaccine Information Sheet
• Immunization Action Coalition

Listeriosis is caused by the bacteria Listeria monocytogenes and can present as a mild febrile illness or more serious disease. Listeria bacteria is commonly found in contaminated foods.

Symptoms of this illness include:

• Fever
• Muscle Aches
• Nausea
• Diarrhea
• Headache
• Stiff neck
• Confusion

Symptoms can begin 3-7 days after exposure to the bacteria, but typically occur for up to 3 weeks.

Listeriosis is diagnosed through clinical symptoms and laboratory testing. A blood or spinal fluid sample is collected and is sent to a laboratory for further identification of Listeria monocytogenes.

People get listeriosis by eating contaminated foods. Listeriosis is not spread from person to person except during pregnancy. A pregnant woman may pass the infection to her unborn child.

People most likely to get listeriosis are:

• Pregnant Women
• Newborns
• People with weakened immune systems
• People with chronic medical conditions (cancer, diabetes, or kidney disease)
• The elderly

Contact your physician immediately if you have symptoms of listeriosis, so that further testing and examination can be done to confirm your diagnosis. The medication that is used to treat listeriosis is a combination of antibiotics.

Listed below are several ways to prevent listeriosis:

• Eat ready to eat items as soon as possible
• Do not eat/drink unpasteurized foods or drink unpasteurized milk or juice
• Thoroughly cook all meat products, such as beef, pork, chicken, or hot dogs.
• Wash all raw vegetables before eating.
• Separate uncooked meats from vegetables and cooked meats
• Wash hands, knives, and cutting boards after handling uncooked foods

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Information Page
• FDA Consumer Page & Food Safety Site
• US Department of Agriculture Listeriosis Fact Sheet

Legionnaire's disease is caused by bacteria known as Legionella. People infected with Legionella bacteria may become ill with Legionnaire's disease or Pontiac fever. While oth of these conditions present with similar signs and symptoms, Legionnaires' disease commonly results in pneumonia and hospitalization while Pontiac fever is a milder illness that is defined by fever and muscle or head aches.

Symptoms of Legionnaire's disease include:

• Pneumonia
• Fever
• Fatigue
• Muscle aches
• Headache
• Cough
• Chills
• Abdominal pain
• Diarrhea

More severe complications from Legionnaire's disease include respiratory failure and death.

People who develop Legionnaire's disease will usually have symptoms 2-10 days after being exposed to Legionella. The disease can be diagnosed through a combination of clinical symptoms and laboratory tests.

Legionella bacteria are waterborne germs that have been found in showers, air conditioning cooling towers, humidifiers, whirlpool spas, respiratory therapy devices, and decorative fountains among other sources. Persons can be exposed to Legionella by breathing in water droplets containing the bacteria. Legionnaire's disease is not spread person to person. For most cases, the source of infection is usually not identified.

People above the age of 50 are more likely to get the disease. Other risk factors include cigarette smoking, chronic lung disease, diabetes, and any immunocompromising condition such as cancer, those receiving corticosteroids, or those who have had a recent organ transplant.

A healthcare provider can help diagnose Legionnaire's disease through physical examinations, chest x-rays or CT scans, and laboratory tests. Legionnaire's disease can be treated with intravenous and oral antibiotics.

It is important to educate yourself and your family about Legionnaire's disease. In addition, regular maintenance and improved designs of cooling towers and plumbing systems may help limit the growth and spread of Legionella.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Legionnaire's Disease Page

What is Lyme disease?

Lyme disease is an infection caused by the bacteria known as Borrelia burgdorferi. The bacteria can be spread to humans from infected blacklegged ticks (also known as a deer tick).

The Lyme disease bacterium can infect many different parts of the body that can result in different symptoms. Not all people with Lyme disease will have the same symptoms and some will not experience any symptoms for years after an infected tick bite.

Symptoms include:

• Circular rash (erythema migrans)
• Fatigue (tiredness)
• Chills and fever
• Headache
• Muscle and joint pain
• Swollen lymph nodes

The red circular rash can appear anywhere from 1 day to 3 months after the bite of an infected tick. The rash continues to grow and the center may clear up, giving it a bulls-eye like appearance.

If left untreated many people will begin to have short spells of arthritis, with severe joint pain and swelling, affecting the large joints mainly.

Many of the Lyme disease symptoms can be mistaken for another illness. Therefore diagnosis of Lyme disease includes the patient having:

• A history of possible exposure to ticks in areas where Lyme disease is known to occur.
• Signs and symptoms of the illness.
• Positive blood tests results detecting the patient has antibodies to the Lyme disease bacterium

People get Lyme disease after being bitten by an infected blacklegged tick. Once a tick feeds on an infected animal, the tick will carry the bacterium for life.

Anyone that goes outside in areas where deer ticks are known to live is at risk for getting it.

Contact your physician so that tick exposure and medical history can be collected. Your physician may also do a blood test if Lyme disease is suspected.

Lyme disease is treated with a course of oral antibiotics.

Avoiding tick bites can prevent Lyme disease. Ticks prefer wooded and bushy areas with high grass. These are areas to avoid especially during the months of May, June, and July when deer ticks are most active. When you are outdoors use insect repellent with 20% - 30% DEET on exposed skin and clothing to prevent tick bites. Wear long pants, long sleeves, and long socks to keep ticks off your skin.

Wearing light-colored clothing will help you see ticks more easily. Tucking your pant legs into socks or shoes and tucking your shirt into your pants helps to keep ticks on the outside of your clothing. Check yourself for ticks after being in tick-infested areas and monitor your health closely after being bitten by a tick.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Learn About Lyme Disease
• MedlinePlus page
• Mayo Clinic page

Malaria is a serious and sometimes fatal disease that is caused by a parasite that can be found in a certain type of mosquito. There are four different types of malaria.

Symptoms include:

• Headache
• Muscle Aches
• Tiredness
• Nausea
• Vomiting
• Diarrhea

Malaria is not spread from person to person. You cannot get malaria from casual contact with people who have malaria.

Depending on the type of malaria a patient has, symptoms could begin 10 days to 4 weeks after being bitten by an infected mosquito. However, a person may feel ill as early as 7 days after being bitten by an infected mosquito, or as late as 1 year later.

Malaria is diagnosed by a blood test.

People get malaria by being bitten by an infected female mosquito. Only Anopheles mosquitoes can spread malaria. The mosquito becomes infected with malaria after biting an infected human.

Malaria can also be spread through blood transfusions, organ transplants, or through sharing needles with someone who has malaria. Malaria could also be spread from a mother to her unborn child before or during birth.

Anyone can get malaria. However, most cases of malaria occur in people who live in countries where malaria is common. People from the United States can become infected when they travel to these countries.

People who have little or no protection against malaria, such as young children and pregnant women have a greater chance of becoming very ill. Travelers coming from countries where malaria is not present are more likely to become very sick.

You should contact your doctor right away and tell them if you have traveled to an area that has malaria, so that a blood test can be done.

Malaria can be treated with prescription drugs. The type of drugs and length of treatment will depend upon the type of malaria, where the person was infected, the person's age, whether or not they are pregnant, and how sick they are at the start of treatment.

How can I prevent Malaria?

If you are traveling to a malaria risk area there are many drugs that can help prevent you from getting malaria. You and your doctor can decide on the best drug for you based on where you plan to travel and your medical history. Taking precautions to avoid the bites of infected mosquitoes is also an effective means of prevention.

To allow enough time for the drugs to become effective visit your doctor 4-6 weeks before travel.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• World Health Organization Malaria page
• MedlinePlus Malaria page

Measles is a respiratory disease that is caused by a virus. Measles is a very contagious disease that can be particularly serious in children and adults.

Symptoms include:

• High fever
• Cough
• Runny nose
• Watery eyes
• Rash which typically begins a few days after the other symptoms

Symptoms usually appear 8 to 12 days after being exposed to measles. The average time from exposure to appearance of the rash is 14 days.

A person who has measles can spread measles to other people for three to five days before the rash appears and at least four days after the rash appears.

Measles typically only last one to two weeks, however there are some complications that are associated with this disease. These complications can include: ear infections, pneumonia, seizures, encephalitis (inflammation of the brain), and sometimes death.

Measles is usually diagnosed by a blood test.

Measles is a highly contagious disease. It is found in the mucus in nose and throat of infected people. When that person sneezes or coughs, droplets spray into the air. The infected mucus can land in other people's noses or throats when they breathe. Disease transmission can also occur after putting fingers in the mouth or nose after handling an infected surface.

The people most at risk for getting measles are:

• Children less than 15 months of age, who are too young to receive the vaccine
• People who are not vaccinated
• Children vaccinated before the age of one

Seek medical attention right away.

If you seek medical attention within 72 hours of exposure, live virus vaccine should be given to you. For household contacts that are at risk, people where measles vaccine is contraindicated, or others with high risk complications Immune Globulin (IG) should be used within 6 days of being exposed.

The measles, mumps, and rubella (MMR) vaccine is a live, weakened, combination vaccine that protects against the measles, mumps, and rubella viruses. After receiving the vaccine, the body develops an immunity that, in 95% of children, will last for a lifetime. The first dose is typically given on or after a child's first birthday (12-15 months). A second dose, usually given around age 4-6, is recommended to protect those who did not develop immunity with the first dose of the vaccine, and to act as a booster to those who did.

Receiving the measles vaccine can prevent this disease. If someone is exposed to measles, they can contact their doctor to see if they have received the vaccine. If you have measles you should avoid public settings such as: school, work, or daycare settings.

Please use the following resources, or contact your doctor or primary care physician.

• Pennsylvania Department of Public Health Measles Fact Sheet
• CDC About Measles Fact Sheet
• CDC Measles Vaccine

Meningitis or bacterial meningitis is inflammation of the areas that cover the brain and spinal cord. It is a severe infection and can cause many complications. Bacterial meningitis is caused by Haemophilus influenzae type b, Streptococcus pneumoniae, Listeria monocytogenes and Neisseria meningitidis.

Symptoms of this infection include:

• High fever
• Severe headache
• Stiff neck
• Increased sensitivity to light
• Nausea/Vomiting
• Tiredness
• Confusion
• Seizures
• Rash

Infants and newborn may not have the classic signs and symptoms of meningitis. Instead they may have the following: constant crying, irritability, poor feeding, increased tiredness, a bulge in the soft spot at the top of their head, and stiffness in the baby's body and neck.

Diagnosis of bacterial meningitis is done by identification of symptoms and collecting a sample of spinal fluid or blood. The sample is then grown to identify the type of bacteria that is causing the infection.

Bacterial meningitis is spread by the exchange of throat and respiratory secretions and extended contact with an infected individual. In addition, eating foods such as hot dogs, soft cheeses, and lunchmeats that are contaminated with Listeria monocytogenes can spread this type of infection. It is also important to note that wild and domesticated animals are carriers of Listeria monocytogenes.

People who have been in close contact with the infected person for long periods of time are at a higher risk for getting meningitis. Possible complications of this infection are: brain damage, hearing loss, learning disabilities, organ failure, coma, decreased blood pressure, shock, and death

People who are most likely to get meningitis are:

• Teenagers
• People living in close living spaces
• People exposed to active and passive tobacco smoke
• Pregnant women
• Immunocompromised Individuals
• Working with animals
• Microbiologists who work with isolates of Neisseria meningitidis

Contact your health care provider right away if you have any symptoms of meningitis. Bacterial meningitis can be treated with antibiotics, but it is important to start the medication in the early stages of the illness. This type of infection is commonly treated with vancomycin and ceftriaxone.

The best way to prevent meningitis is to receive the recommended vaccinations. Currently, there are vaccines for three types of bacteria that can cause meningitis: Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b (Hib). Read the current recommendations for preventing Neisseria meningitidis.

Please use the following resources, or contact your doctor or primary care physician.

• Pennsylvania Department of Health- Meningitis Disease Page
• CDC-Questions & Answers about Meningitis
• Mayo Clinic Meningitis Disease Information Page
• Medline- Meningitis Overview

What is Mumps?

Mumps is an acute disease that is caused by the mumps virus. It typically affects the salivary glands located within your cheek, near your jaw line, and below your ears.

Symptoms include:

• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of appetite
• Swelling of salivary glands

The symptoms can appear from 16 to 18 days after being exposed to mumps, although it may vary from 12 to 25 days.

A person who has mumps can spread the infection to a non-infected person 3 days before their symptoms appear to about 9 days after their symptoms appear.

Severe complications are rare, but some do occur. These complications can include: inflammation of the brain and/or tissue covering the brain and spinal cord (encephalitis/ meningitis), deafness, inflammation of the testes or ovaries, and inflammation of the breasts.

Mumps is diagnosed by the symptoms and a blood test. Further lab testing may be required.

Mumps is spread through the air by mucus or droplets from the nose or throat of an infected person, usually when a person coughs or sneezes. However, a person who is infected and does not have symptoms may also still spread the disease.

Although older people may get the disease, mumps usually occurs in children between the ages of 5 and 14.

Contact your doctor right away.

There is no specific treatment for mumps. Supportive care should be given as indicated.

The measles, mumps, and rubella (MMR) vaccine is a live, weakened, combination vaccine that protects against the measles, mumps, and rubella viruses. After receiving the vaccine, the body develops an immunity that in 95% of children will last for a lifetime. The first dose is given on or after a child's first birthday. A second dose, usually given around age 4-6, is recommended to protect those who did not develop immunity with the first dose of the vaccine, and to act as a booster to those who did.

The single most effective control measure is vaccination. Infected individuals should not attend school or work while they are still infected. Anyone who has not received 2 doses of mumps-containing vaccine should be vaccinated. Persons exposed to mumps should be educated on the signs and symptoms of the disease and should seek medical care if symptoms begin.

Please use the following resources, or contact your doctor or primary care physician.

• Pennsylvania Department of Public Health Mumps Fact Sheet
• CDC Mumps Fact Sheet
• CDC Mumps Vaccine

Norovirus is a virus that causes the “stomach flu” or gastroenteritis (irritation or inflammation of the stomach and intestines).

Symptoms include:

• Nausea
• Vomiting
• Stomach crams
• Diarrhea
• Low grade fever
• Headache
• Feeling of tiredness

The there is usually 1-2 days between the time of exposure to the time that symptoms appear, but this time can be as short as 12 hours. Illness typically lasts 12-60 hours and is self-limiting (it will resolve on its own). The virus can be shed in stool for up to two weeks and is also present in vomit.

Norovirus can be easily spread from person-to-person through direct contact, contact with contaminated surfaces, and consuming of contaminated food. The infectious dose is very low, meaning it only takes few virus particles to cause illness. The virus can survive on surfaces for weeks, and is fairly resistant to many disinfecting agents. Contamination of food and drink may occur when infected individuals handle food or beverages, leading to many infections among individuals who consume those products.

Anyone can get norovirus. Because it is so easily spread people in institutions such as long term care facilities and schools have more chance for exposure.

If you think you have norovirus, you should contact your doctor, and discuss your symptoms. There are no antibiotics to treat norovirus, but the symptoms can be treated through rehydration, rest, and antiemetics (a drug used to treat nausea and vomiting).

Stay home if you are ill, especially if you work in healthcare, as a food handler, or at a daycare. Commonly touched surfaces such as door knobs and railings should be frequently cleaned.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• FDA Bad Bug Book
• Norovirus Fact Sheet

Pertussis (whooping cough) is a very contagious respiratory disease. It is caused by bacteria (Bordetella pertussis) and lasts for many weeks. Pertussis is characterized by a severe cough, whooping and vomiting after cough in children, but the disease may be milder in vaccinated children and adults.

Pertussis symptoms develop in 3 stages:

• Catarrhal Stage (lasts 1 to 2 weeks)
• Runny nose
• Sneezing
• Low-grade fever
• Mild, occasional cough
• Infants may have gagging, gasping, or apnea (pauses in breathing)
• Paroxysmal Stage (last 1 to 6 weeks)
• Bursts of numerous, rapid coughs
• High-pitched whooping sound after coughing fits
• Turning blue
• Vomiting and exhaustion after cough fits
• Distress
• Between attacks the person appears fine
• Convalescent Stage (lasts weeks to months)
• Cough gradually disappears
• Coughing fits may recur for many months

Symptoms may begin 7-10 days after being exposed to pertussis. Adults and vaccinated children with pertussis may have milder symptoms or may not have any symptoms of illness (asymptomatic).

People with untreated pertussis are most contagious during the catarrhal stage of the illness until 2 weeks after the cough develops (i.e., approximately 21 days). People are no longer contagious after 5 days of appropriate antibiotic medications.

Pertussis symptoms can last 6-10 weeks or longer. Symptoms decrease gradually over weeks to months. Complications from pertussis among older children and adults may include fainting, sleep disturbance, incontinence (unintentional loss of urine), rib fractures, and pneumonia. Pertussis is most severe when it occurs to infants less than 6 months of age, particularly in preterm and unimmunized infants. Complications among infants can include pneumonia, seizures, encephalopathy (disease in the brain) and rarely, death.

Pertussis is diagnosed by a doctor based on the signs of illness (i.e., whooping, coughing fits, etc.) and/or laboratory tests. Laboratory tests may include blood tests or a nasal swab.

Pertussis is spread person to person by contact with airborne droplets from the nose and mouth of an infected person.

Anyone can get pertussis. People who are not vaccinated and people who have not had pertussis before are more likely to get pertussis. Also people who live in the same household with a person with pertussis are very likely to get the disease.

If you believe that you have pertussis, call your doctor immediately. Your doctor can diagnose you with pertussis based on your signs and symptoms of illness and often times a positive laboratory test.

Antibiotic medication prescribed by a doctor is used to treat pertussis and prevent the spread of disease. It is important that you take all the antibiotic medications prescribed to prevent spreading the illness to others.

Pertussis is very contagious in households, so your doctor may also prescribe antibiotic medication for your household members. It is important that your household members take all the antibiotic medication prescribed in order to prevent spreading the illness to others.

Your doctor may also administer vaccinations to children who have not completed their pertussis vaccinations.

Vaccination with a pertussis-containing vaccine (like DTaP for children or Tdap for adolescents and adults) is the best way to prevent illness. Pertussis vaccine is given to children in 4 doses at 2 months, 4 months, 6 months and 15-18 months of age. A booster dose of vaccine is given to children before school entry (4-6 years old). Adolescents 11-12 years of age are also recommended to receive a booster dose of vaccine.

Pertussis vaccine is also available for older adolescents and adults (younger than 65 years of age). Any person who wants to be protected against pertussis should speak to their doctor about vaccination. People who live or work with small children (<12 months) or who have direct patient care are especially encouraged to get a booster dose of pertussis vaccine.

• People with pertussis should stay at home and away from others until they have completed 5 days of their antibiotics. People with pertussis who do not want to take antibiotics should stay home and away from other for 21 days after cough onset.
• Always cover your mouth and nose with a tissue or your sleeve when you sneeze and cough.
• Wash your hands with soap or use alcohol-based hand sanitizers, especially before eating or touching your face.

For more information, use the resources listed below or contact your doctor or primary care physician.

• Pennsylvania Department of Public Health Pertussis Fact Sheet
• CDC Pertussis Disease Listing
• PDPH Immunization Program

Q Fever is a worldwide illness that is characterized by a sudden onset of fever. It is caused by an infection with a bacterium called Coxiella burnetii.

Only about half of people with Q fever actually show symptoms.

Symptoms include:

• High fevers(104-105 degrees Fahrenheit)
• Headache
• Confusion
• Non-productive cough
• Weakness
• Severe sweats
• Muscle pain
• Nausea/Vomiting
• Diarrhea

The symptoms typically appear two to three weeks after exposure to Coxiella burnetii. The fever usually lasts for 1 to 2 weeks. Weight loss can occur and persist for some time.

Thirty to fifty percent of patients with a symptomatic infection will develop pneumonia. Additionally, a majority of patients have abnormal results on liver function tests that can lead to hepatitis (liver inflammation). A serious complication of Q Fever is endocarditis, an inflammation of the heart valves.

Blood tests are used to diagnose Q Fever.

People get Q fever by breathing in dust spores contaminated with Coxiella burnetii. The dust comes from the bodily fluids of infected animals such as sheep, goats, and cattle. The bacteria can also be found in the placenta after animals give birth. Direct contact with infected animals or drinking contaminated milk can also cause infection. In rare situations people can become infected by tick bites.

Most of the outbreaks that have happened in the United States have been in people who work with animals, such as:

• Veterinarians
• Meat processing plant workers
• Sheep and dairy workers
• Livestock farmers
• Researchers at facilities housing sheep

Contact your doctor right away so that blood work can be done to determine if you have Q fever.

Acute Q fever can be treated with a course of antibiotics.

People who work with animals that may be infected need to know the signs and symptoms of Q fever and seek treatment if they feel they could be infected. If you work with pregnant animals, be sure to get rid of the placenta properly after they give birth. Individuals should be encouraged to use only pasteurized milk and milk products.

Other measures include the quarantine of imported animals, and ensuring that holding facilities for sheep are located away from populated areas.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• MedlinePlus Q Fever page
• Mayo Clinic Q Fever page

Rabies is a deadly but preventable virus that is spread primarily after the bite of an infected animal. In the US the virus is mainly found in wild animals such as bats, coyotes, foxes, raccoons, groundhogs, and skunks but has also been found in some domestic animals such as dogs, cats, and ferrets. Small mammals such as squirrels, rats, mice, hamsters, guinea pigs, gerbils, chipmunks, and rabbits are almost never found to be infected with rabies and are not known to cause rabies among humans in the US.

Initial symptoms of rabies infection in humans are usually vague and tend to increase in severity as the infection spreads to the brain. Once symptoms begin, survival is rare. Deaths that occur in the US are usually the result of people not knowing that they are infected with the virus and as a result treatment was never started. Rabies postexposure prophylaxis (PEP), which is a series of preventative shots, is nearly 100% effective in stopping the rabies virus from infecting you.

Early symptoms include irritability, headache, fever and sometimes itching or tingling pain at the site of exposure. The disease eventually progresses to paralysis, swallowing difficulties, excess salivation, convulsions, delirium and death.

Rabies virus is found in infected mammals' saliva. When the sick animal bites another animal or human the virus can be passed through broken skin. It is possible but rare for people to get rabies if an infected animal's saliva gets directly into their eyes, nose, mouth, or an open wound. The rabies virus is also present in an infected animal's brain tissue and exposure to these contents can result in infection as well.

Rabies is not spread person to person though there have been documented cases where transplanted tissues from infected people have caused rabies infection in the transplant recipients. Touching a person with rabies or other casual contact with non-infectious urine, blood, or feces does not result in rabies.

The period between exposure to rabies virus and the development of symptoms in humans is variable but is normally 3 to 8 weeks. Incubation periods up to several years have also been recorded.

Anyone can be at risk for rabies infection. However, if you work with animals, work in a laboratory that tests for rabies, or are traveling to a country where rabies is more common, the likelihood of exposure is greater. Activities that may put you in areas where contact with rabid animals is higher, such as exploring caves where bats may be present, can also increase your risk.

If you have been bitten by a stray/wild animal or have been exposed to other infectious material (e.g. brain matter) you should seek medial evaluation as soon as possible. In addition you should also notify the Division of Disease Control (DDC) of the incident by calling 215-685-6748. DDC and your healthcare provider will determine whether or not you need PEP based on the following factors:

• What kind of animal was involved in the incident
• The health status of the animal
• Whether or not the animal can be observed for 10 days if the animal is a domesticated dog, cat, or ferret

If you are not sure whether or not you have been bitten you should also seek medical attention or contact DDC. This situation may occur if you have been exposed to a bat. DDC will test any bat that has bitten you, or any bat that was present in a room where people were asleep or unconscious (because you often cannot feel a bat bite you or see the marks from a bite), or if that bat was in a room with a child or someone who is mentally/physically disabled or intoxicated.

There are several steps you can take to prevent infection from the rabies virus. It is important to make sure that your pets are up to date and vaccinated against the rabies virus. Pets should also be confined and supervised while outside so they will not come into contact with any wild animals. You should not try to approach, pet, or capture stray or wild animals.

If you see a stray animal or if a stray animal has bitten you, contact the Philadelphia Animal Care and Control Team so they can come out to trap the animal. To prevent exposures to bats, make sure to seal cracks and gaps in your home so that bats cannot enter. If a bat enters your home, contact the Philadelphia Animal Care and Control Team to have it removed.

If you are traveling to a country with high rates of rabies transmission, you can speak with your doctor about receiving the rabies pre-exposure vaccine.

If you have come into contact with an animal that is known to have rabies or if you were bitten by an animal that is unavailable for testing or observation for at least a 10-day period, you are a candidate for rabies post-exposure prophylaxis (PEP). PEP consists of one dose of rabies immune globulin and four doses of rabies vaccine given over a 14-day period. These shots are nearly 100% effective in preventing rabies infection, so it is important to seek consultation from a healthcare provider after an animal bite to see if you should receive the shots.

Please use the following resources, contact your doctor, or the Division of Disease Control.

• Learn About Rabies (CDC)
• Philadelphia Animal Care and Control Team
• PDPH Animal Bites Information

There are many bacterium, parasites, and viruses (germs) that can cause recreational water illnesses. The two most common recreational water illnesses are caused by parasites: Cryptosporidium (crypto) and Giardiasis (giardia).

Diarrhea is a frequent symptom of RWI caused by crypto, giardia, and other germs such as Norovirus, Shigella, and E. Coli.

RWI can also cause other illnesses, including swimmer's ear, hot tub rash, and chemical burns. All of these illnesses can result from an improperly maintained swimming pool.

There are many ways to prevent recreational water illnesses.

• Do not swim if you have diarrhea. Wait until at least 2 weeks after the diarrhea has stopped before swimming again.
• Before entering a pool or hot tub, look at the water to see if it looks clean and clear, observe that there are no strong chemical smells, observe that tiles are not sticky.
• Do not swallow pool water.
• Take regular bathroom breaks while swimming.
• Check and change diapers often, in a diaper changing area.
• Wash your hands well after going to the bathroom or changing diapers.
• Take a shower before getting in the pool. This will take off oils, sweat, lotion, hair products and feces on your bottom.
• Wash children and babies, especially their bottoms, before they get into the pool.
• If your child has a bowel movement in the pool, notify pool staff immediately.

Contact your healthcare provider and discuss your symptoms. Get healthcare if you have diarrhea that is bloody, you have a fever, or symptoms worsen. Dehydration can easily occur if you have diarrhea, so be sure to drink plenty of fluids. This is particularly important for children, pregnant women, and immunocompromised people. DO NOT swim until 2 weeks after your diarrhea has stopped.

The Philadelphia Department of Public Health's Division of Environmental Health, Environmental Engineering Unit, inspects and helps monitor water quality in recreational water facilities. Please call: 215-685-7342.

• CDC Healthy Swimming
• Pennsylvania Department of Health Pool Recommendations
• Pennsylvania Department of Health Public Swimming and Bathing Places Regulations
• PDPH Environmental Engineering Unit

• Healthy swimming poster #1
• Healthy swimming poster #2

Rocky Mountain Spotted Fever (RMSF) is caused by infection with the bacterial organism Rickettsia rickettsii. It is the most severe tick-borne rickettsial illness in the United States.

Initial symptoms include:

• Fever
• Nausea
• Vomiting
• Muscle pain
• Lack of appetite
• Severe headache

Later symptoms include:

• Rash
• Abdominal pain
• Joint pain
• Diarrhea

Symptoms will begin to appear 5 to 10 days after a tick bite. The early clinical presentation of Rocky Mountain Spotted Fever is often nonspecific and may resemble many other diseases. Rocky Mountain Spotted Fever can be fatal if not treated promptly.

A diagnosis of RMSF is based on a combination of clinical signs and symptoms and specialized confirmatory laboratory tests, such as liver enzyme tests or blood tests.

People get Rocky Mountain Spotted Fever after being bitten by an infected tick. The American dog tick and the Rocky Mountain wood tick are the main carriers of the bacterial organism Rickettsia rickettsii. There is no evidence of casual person-to-person transmission.

Anyone who is bitten by an infected tick which remains on the person for several hours can get Rocky Mountain Spotted Fever.

The disease is rarely seen in the Rocky Mountain region. Most cases are reported from south-Atlantic regions of the United States such as Delaware, Maryland, Washington D.C., Virginia, West Virginia, North Carolina, South Carolina, Georgia, and Florida.

Contact your doctor right away and explain your symptoms. If you are aware that a tick has bitten you tell your doctor so that a blood test can be done.

Rocky Mountain Spotted Fever is treated with antibiotics. Patients are treated for at least 3 days after the fever stops and until there is evidence of improvement. The standard duration of treatment is 5 to 10 days.

Avoiding ticks and tick bites is the best way to prevent RMSF. Ticks prefer wooded and bushy areas with high grass. These are areas to avoid especially during the warmer months. When you are outdoors adults should use insect repellent with 20% - 30% DEET on exposed skin and clothing to prevent tick bites.

While outdoors in wooded and bushy areas you should also wear long pants, long sleeves, and long socks to keep ticks off your skin. Wearing light-colored clothing will help you see ticks more easily. Tucking your pant legs into socks or shoes and tucking your shirt into your pants helps to keep ticks on the outside of your clothing. After you return from wooded and bushy areas check yourself for ticks.

Please use the following resources, or contact your doctor or primary care physician.

• Rocky Mountain Spotted Fever Disease Listing
• Mayo Clinic Rocky Mountain Spotted Fever Page
• MedlinePlus Rocky Mountain Spotted Fever Page

Rotavirus is a virus that infects the intestinal tract of children. Rotavirus is the most common cause of severe diarrhea in children worldwide. In the United States the rotavirus has winter seasonal patterns, with yearly outbreaks occurring from November to April.

Symptoms include:

• Vomiting
• Fever
• Diarrhea, usually watery
• Abdominal pain

Symptoms will begin approximately two days after being exposed to the virus. The symptoms can last anywhere from 3 to 8 days after onset.

With the combination of vomiting and diarrhea, the person with the virus is at risk for becoming severely dehydrated.

Rotavirus is diagnosed based on the symptoms and a physical exam. The virus is usually confirmed by testing a stool sample.

Most people get rotavirus by being in contact with the stool of an infected person, and then ingesting the virus in some way. People can get the virus through the ingestion of contaminated water or food or through contact with contaminated surfaces and then putting their hands in their mouths.

Children under 5 years of age, especially those that are between ages 6 months to two years, are the most susceptible to the disease.

Contact your doctor.

There is not a specific treatment for rotavirus. Children should be given plenty of fluids in order to prevent dehydration. Severe dehydration cases will be hospitalized and will receive intravenous (IV) fluids.

There are currently two types of the rotavirus vaccine. A baby should get either two or three doses depending upon which type of the vaccine is being used. The doses are recommended at these ages:

• First dose – 2 months of age
• Second dose – 4 months of age
• Third dose – 6 months of age (if needed)

The first dose could be given as early as 6 weeks of age, but it should be given by 14 weeks of age. The last dose should be given by 8 months of age. The vaccine can be given with other childhood vaccines.

One way to prevent the spread of the rotavirus is to get vaccinated. In addition, you can prevent the spread of rotavirus by washing your hands thoroughly and often, especially when coming into contact with stool.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Rotavirus Fact Sheet
• CDC Rotavirus Vaccination Fact Sheet

Rubella (German measles) is an acute viral disease that lasts approximately three days.

Symptoms include:

• Slight fever
• Rash lasting two to three days
• Temporary swelling and pain in the joints
• Headache
• Weakness
• Runny nose
• Red eyes

Symptoms may begin 14 – 17 days after being exposed to rubella.

Some children may not have any symptoms. Adults who contract the virus may feel sicker than a child would.

People infected with rubella are contagious up to one week before the onset of a rash, and 4 days after the rash first appears.

Rubella is usually a mild illness, however it can become very serious if a pregnant woman becomes infected. Rubella can cause Congenital Rubella Syndrome (CRS) to the fetus. CRS can cause deafness, blindness, heart damage, or mental disabilities to the baby. If the woman becomes infected within the first 11 weeks of pregnancy, the chance of giving birth to a child with CRS can increase.

Rubella is diagnosed by a blood test.

Rubella is spread by contact with an infected person, and through coughing and sneezing.

Although rubella is most common among children and young adults, people of all ages can develop the disease. Rubella is very dangerous in women who become infected during the first few months of pregnancy.

Call your doctor right away. If you are diagnosed with rubella, stay home for at least seven days after the start of your rash. Avoid all contact with unvaccinated people including infants less than one year of age and with pregnant women.

There is no specific treatment for rubella. Hospital care may be needed for severe infections but most people can recover at home.

The measles, mumps, and rubella (MMR) vaccine is a live, weakened, combination vaccine that protects against the measles, mumps, and rubella viruses. The vaccine is usually given in two doses. The first dose is given to children between 12-15 months of age. A second dose is recommended to children between 4-6 years of age. However, children can get the second dose at any age, as long as it is at least 28 days after the first dose.

Ensuring that all children are appropriately vaccinated can help to prevent rubella. Also, infected people should avoid contact with people who have not received the vaccine. This can help prevent the further spread of rubella. Good hand hygiene and cough etiquette can also decrease disease transmission.

Please use the following resources, or contact your doctor or prmary care physician.

• Pennsylvania Department of Public Health Rubella Fact Sheet
• CDC Rubella Disease Listing

Salmonellosis is an infection of the intestines caused by bacteria called salmonella.

Symptoms include:

• Diarrhea
• Stomach cramps
• Fever
• Nausea
• Vomiting

The symptoms most commonly appear 12-36 hours after exposure but it can be as long as 72 hours before symptoms show. A person infected with salmonella may begin spreading the infection as soon as they develop symptoms and in most cases, may continue to do so for several days to several weeks.

Salmonella can be found in foods including raw chicken, beef, turkey, pork, eggs, and unpasteurized milk products. It may also be found on some pets, especially reptiles and baby chicks. Infected humans can carry the bacteria in their feces (stool). Eating raw or undercooked foods, food that came in contact with contaminated raw food, eating food contaminated by a cook infected with salmonella, being in close contact with infected animals and humans or their feces can also spread the infection.

Anyone can get salmonellosis but the risk is highest in infants and children under 5 years of age. People who are on antacid therapy and those who have suppressed immune systems are also at higher risk.

If you think you have salmonella, you should contact your doctor, and discuss your symptoms. Several antibiotics may be used to treat this infection. Your doctor will prescribe the most appropriate antibiotic for this illness. Treatment with antibiotics will shorten the length of the illness and help to clear the germ from the stool.

There is no vaccine to prevent salmonellosis.

In order to prevent getting salmonellosis, you should avoid eating raw or undercooked eggs, poultry, and meat. Raw eggs can be found in many foods, so you should take caution in eating foods like raw cookie dough, homemade ice cream, etc. Meats should be well cooked all the way through. Produce should be washed.

People with salmonellosis should not prepare or serve food, or serve drinks to others until their diarrhea has gone away.

Frequent and careful hand washing is also an important way to prevent salmonella from spreading.

You should always wash your hands after handling reptiles (including turtles) or birds (including chicks and ducklings). Since children are at high-risk for salmonellosis, they should not handle reptiles or birds.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• USDA Fact Sheet

Shigellosis is a disease caused by the bacteria shigella. It causes diarrheal illness.

Symptoms include:

• Diarrhea
• Stomach cramps
• Fever
• Nausea
• Vomiting

Symptoms may start 1-7 days after being exposed to the germ. Most symptoms start within 2-4 days. A doctor can determine if someone has this infection by collecting a stool sample and seeing if the bacteria grows in the laboratory. This test may be called a stool culture, or a rectal swab culture.

Shigella is spread several ways. It is usually spread from people who are infected with this germ, who pass the bacteria in their bowel movements (stool). If infected persons do not wash their hands well, this germ can get into the food or drink they are handling, and others can then get sick by eating this food or drink. People can also get this germ on their hands when changing diapers or assisting a child with toileting. It only takes a few germs to cause infection, and the germ is easily spread.

Anyone can get this infection.

In Philadelphia, shigella has been associated with outbreaks involving homeless shelters and childcare facilities, along with a larger community-wide outbreak.

If you think you have shigella, you should contact your doctor, and discuss your symptoms. Several antibiotics may be used to treat this infection. Your doctor will prescribe the most appropriate antibiotic for this illness. Treatment with antibiotics will shorten the length of the illness and help to clear the germ from the stool.

There is no vaccine to prevent shigellosis.

Frequent and careful hand washing is an important way to prevent shigella from spreading.

People with shigellosis should not prepare or serve food, or serve drinks to others until they have shown that they are no longer carrying the bacteria, or until their diarrhea has been gone for at least 2 days.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing

Streptococcus pneumoniae is a bacterial infection that can cause mild infections such as an ear infection. However, this type of bacterial infection is more severe when it is found in the blood, muscles, lungs, and spinal fluid. When Streptococcus pneumoniae is found in these areas of the body the infection is classified as invasive. The most common invasive infections are meningitis (inflammation of the tissue around the brain and spinal cord), bacteremia (bacteria in the blood), and pneumonia.

Streptococcus pneumoniae is spread person to person through respiratory droplets from an infected person. This may occur when the person coughs or sneezes. You cannot get the disease from insects, animals, or from the environment.

Anyone is at risk for getting this type of infection. However, the following groups are most at risk:

• Infants
• Young children
• Elderly people
• People with chronic health conditions
• People with underlying medical conditions, such as HIV and sickle cell anemia

Contact your doctor right away if you have any symptoms of Streptococcus pneumoniae to make sure that you are not experiencing any complications related to the infection.

Invasive Streptococcus pneumoniae is diagnosed by getting a specimen from the blood, spinal fluid, lung fluid, or joint fluid. The specimen is then sent to a laboratory for further testing to confirm a diagnosis of Streptococcus pneumoniae. This type of infection is treated with antibiotics, such as penicillin.

Vaccination is best way to prevent invasive Streptococcal pneumonia. Vaccine is available and recommended for infants, adults 65 years of age and older, and children and adults with certain chronic medical problems or living in high-risk environments or social settings. Healthy people who are less than 65 years of age are not recommended to receive vaccine. Contact your health care provider to discuss your risk of invasive Streptococcal pneumoniae and your need for vaccination.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• National Network for Immunization Network-Vaccine Information

Syphilis is a sexually transmitted disease (STD) caused by a type of bacteria called T. Pallidum. It can spread from person to person by physical contact during vaginal, anal, or oral sex. Syphilis infections are treatable and curable with antibiotics.

Untreated syphilis can lead to organ damage, including brain damage, and in some cases death. In addition, syphilis infection makes HIV easier to catch or to give to sex partners. New data show that for people who have HIV, syphilis can dramatically increase their viral load and cause a drop in CD4 counts. This increase resolves with syphilis treatment.

Syphilis infection occurs in four stages, named primary, secondary, latent, and tertiary (late).

Symptoms usually show up 2-12 weeks after being exposed. The first sign is often a skin sore called a chancre (shank-er). You may have more than one, or you may have chancres and not notice them because they are inside your anus or vagina. Chancres can also appear on your scrotum, penis, vaginal lips, anus or in your mouth. They are usually not painful. The sores will go away after several weeks without treatment, but you would still be infected.

Most people who have secondary syphilis notice a skin rash covering their body 4 to 12 weeks after infection. The identifying feature of this rash is that it shows up on the palms of the hands and soles of the feet. Often it is not itchy. Other common symptoms of secondary syphilis are swollen glands in various areas of the body, fever, fatigue, patchy hair loss, weight loss, and headache. Since these symptoms are so similar to those of many other health problems, syphilis has sometimes been called “the great imitator.”

Additional symptoms during secondary syphilis that are particularly important are syphilis warts and white patches (condylomata lata and mucous patches, respectively). These warts and patches are highly infectious and can occur in moist areas of the body like the mouth, side of the tongue, anus, etc.

Secondary syphilis symptoms usually last anywhere from 1 to 3 months, but sometimes they last longer, and once in awhile the symptoms come and go over a year or two. But even after the symptoms of secondary syphilis clear up, if left untreated, the infection continues in your body.

Latent syphilis causes no symptoms. The infection can be detected only by a blood test. If not treated, latent syphilis continues for life. Many people with latent syphilis never have serious problems, but some progress to the final stage, called tertiary syphilis.

About one-third of untreated people with syphilis experience serious damage to various organs and body systems. Tertiary syphilis can appear any time from a year to 50 years after becoming infected; most cases occur within 20 years. The brain, heart, liver, and bones are the most commonly involved organs. Tertiary syphilis can cause paralysis, mental problems, blindness, deafness, heart failure, and death.

A complete examination for syphilis in a doctor's office or clinic includes taking a sexual history, examining any symptoms you might have (chancres, rash, etc.) and a blood test. There are special tests available at Philadelphia Health Care Center to diagnose syphilis from sores if they are present.

Penicillin shots cure syphilis. If you are allergic to penicillin, there are alternative antibiotics. One common alternative is called doxycycline. It is safe and effective.

Even though symptoms will clear up after treatment, sometimes the first treatment doesn't completely cure the infection. It is very important to have several repeat syphilis blood tests to be sure the treatment worked and the infection is completely gone. In most cases this means repeat blood tests one week after treatment, then every few months for the next year.

Your sex partner(s) must be examined and treated too. Otherwise they can give the infection back to you and/or infect others. It's important to talk to your partners to maintain the sexual health of our community. Once your treatment is completed, you will no longer be contagious and cannot spread syphilis to others. Until then, you need to abstain from sex or use condoms for anal, oral and/or vaginal sex.

The risk for syphilis is directly related to the number of sex partners you have: The more sex partners, the greater the risk on contracting it. Having more sex with fewer partners reduces your risk of getting syphilis.

Abstinence is the only surefire way to avoid getting syphilis or other STDs. If you're sexually active, using condoms consistently and correctly for oral, anal and vaginal sex is your best bet for staying sexually healthy. Also, regular STD checkups at least every six months if you're sexually active with more than one monogamous partner is recommended. Syphilis and other bacterial STDs are curable with proper diagnosis and treatment.

Find out more about STDs at STDPhilly.

Tetanus, sometimes referred to as lockjaw, is a bacterial disease that affects the nervous system. The Clostridium tetani bacterium causes tetanus.

Early symptoms include:

• Jaw muscle cramping or lockjaw
• Stiffness in the neck and abdomen
• Difficulty swallowing

Later symptoms include:

• Severe muscle spasms
• Seizure-like activity
• Autonomic nervous system disorders

Symptoms can begin anywhere from three days to three weeks after being exposed to tetanus.

There are some complications linked with tetanus. These complications include bone fractures, abnormal heart rhythms, pneumonia, and sometimes death.

Tetanus is diagnosed based on signs/symptoms and a physical exam.

People get tetanus when a wound, or break in the skin, has become contaminated with Clostridium tetani bacteria. Tetanus is not spread from person to person.

Anyone who is not adequately vaccinated is at risk for getting tetanus. The elderly and those with weak immune systems are at a higher risk for developing complications.

Contact your doctor and tell them your symptoms.

Wounds should be thoroughly cleaned. If the patient has not had a tetanus booster in the previous 10 years, a single booster injection should be administered on the day of injury.

There is a vaccine called tetanus toxoid that has been available for many years. Tetanus toxoid is a combination vaccine (DTaP) and is given at two, four, six, and 12-15 months of age, and between four and six years of age.

Children who are seven years of age or older should receive Td (tetanus and diphtheria) toxoid. A tetanus booster shot is recommended every 10 years.

The most effective way to prevent tetanus is to be adequately immunized.

Please use the following resources, or contact your doctor or primary care physician.

• Pennsylvania Department of Public Health Tetanus Fact Sheet
• CDC Tetanus Fact Sheet
• CDC Tetanus Vaccine

Tularemia is a potentially serious illness that occurs naturally throughout the United States. It is caused by the bacterium Francisella tularensis which is found in animals, especially rodents, rabbits, and hares.

Symptoms include:

• Sudden fever
• Chills
• Headache
• Diarrhea
• Muscle aches
• Joint pain
• Dry cough
• Progressive weakness

Symptoms may appear 3 to 5 days after exposure to the bacteria, but it could take as long as 14 days for symptoms to appear.

People with tularemia can also develop pneumonia with chest pain, cough, and difficultly breathing. Other symptoms of tularemia depend on how the person was exposed to the illness.

These symptoms include:

• Ulcers on the skin or mouth
• Swollen and painful lymph glands
• Swollen and painful eyes
• Sore throat

The disease can be fatal if it is not treated with the right antibiotics.

Tularemia is a rare disease and is difficult to diagnose. Blood tests and cultures as well as history of exposure to certain animals, ticks, or flies can help confirm the diagnosis.

People can get tularemia in different ways. These include: being bitten by an infected tick or deerfly, handling the bodies of dead infected animals, eating or drinking contaminated food or water, and breathing in the bacteria.

Anyone who spends time outdoors in areas where infected ticks or deerfly can be found is at risk. Animal hunters and trappers are at a higher risk of getting tularemia.

Contact your doctor at the first sign of illness. Make sure to let your doctor know if you are pregnant or have a weakened immune system. Since tularemia can be difficult to diagnose and its symptoms can be mistaken for other illnesses, it is important to share with your doctor any likely exposures, such as tick and deerfly bites, or contact with sick or dead animals.

Tularemia can be treated with a course of antibiotics.

There are multiple ways to prevent tularemia. When outside, use insect repellent containing DEET on your skin, to prevent bug bites. Use care and wear gloves when handling sick or dead animals. If you notice a change in behavior in livestock, contact your veterinarian. Be sure to cook your food thoroughly and that your water is from a safe source.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Tularemia Page
• MedlinePlus Tularemia Page
• Occupational Safety & Health Administration (OSHA) Tularemia Page
• University of Minnesota Center For Infectious Disease Research & Policy Tularemia Page

Typhoid fever is a bacterial illness caused by Salmonella typhi. While it can be a mild illness in endemic areas (countries where there typhoid is common), if untreated it can be life threatening.

Symptoms include:

• Fever
• Headache
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain/cramps
• Constipation
• Cough
• Diarrhea
• Fatigue
• Loss of appetite

Usually, symptoms appear 1 to 2 weeks after exposure, but can appear anywhere from 3 to 60 days after exposure, especially without treatment.

After the acute infection period, people can be carriers of typhoid, meaning they have no symptoms but continue to shed the bacteria in the stool and are infectious. A small percentage of people (less than 5%) will become permanent carriers of typhoid.

Typhoid fever is spread from eating or drinking food or water that has been contaminated by an infected person's feces or urine. Flies can also infect food. Although unusual, typhoid has been transmitted through sexual contact.

The people most at risk for typhoid are those who:

• Travel to or live in countries where typhoid is common
• Are household members or caregivers of a person infected with typhoid
• Have sexual contact with someone who has typhoid

In Philadelphia, typhoid is uncommon and has been associated with travelers and immigrants.

If you think you have typhoid, you should contact your doctor, and discuss your symptoms. A stool, urine or blood sample will be collected to determine the diagnosis.

Antibiotics can be used to treat typhoid. Your doctor will determine treatment based on drug sensitivity, or which drugs are resistant to typhoid.

Preventing transmission to others is very important. The best way to prevent typhoid transmission by an infected person is by careful hand washing, especially after using the bathroom and before preparing or eating food. There are typhoid vaccines available for people traveling to areas where typhoid is common.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Disease Listing
• CDC Typhoid Fact Sheet
• CDC Traveler's Health Yellow Book Chapter 4

West Nile virus (WNV) is a potentially serious illness that humans get after being bitten by an infected mosquito. WNV seen more in the summer and fall months.

Many people who are infected with WNV will not experience any symptoms.

Milder symptoms include:

• Fever
• Headache
• Body aches
• Nausea
• Skin rash on the chest, stomach and back

Severe symptoms include:

• High fever
• Headache
• Neck stiffness
• Disorientation
• Coma
• Muscle weakness
• Vision loss
• Numbness and paralysis
• Convulsions and tremors (seizures and shaking)

The milder symptoms can last as short as few days or can last up to several weeks. The severe symptoms can last several weeks and the neurological effects could be permanent.

People typically get sick 2-14 days after being bitten by an infected mosquito. However, some people may not feel sick for up to 21 days after being bitten.

WNV is usually diagnosed by looking at the symptoms that you have and by finding the virus in your blood or in your cerebral spinal fluid (CSF) located in your spinal column.

Usually, people get WNV after being bitten by an infected mosquito. However, in some cases people spread WNV through blood transfusions, organ donation, and during pregnancy from mother to child.

Being outside means that you are at risk for getting West Nile virus. However people over the age of 50 and people with weak immune systems are more likely to develop the severe symptoms of WNV if they become sick. It is important for these individuals and others to avoid being bitten by mosquitoes.

Milder WNV illness can improve by itself, and people do not necessarily need to seek medical attention for this infection though they may choose to do so.

If you develop symptoms of severe WNV illness, such as unusually severe headaches or confusion, seek medical attention right away. Severe WNV illness usually requires hospitalization.

Pregnant women and nursing mothers are encouraged to talk to their doctor if they develop symptoms that could be WNV.

There is no specific treatment for WNV infection. For more severe symptoms of WNV people usually need to go to the hospital where they can receive help with breathing, IV fluids, and nursing care.

When you are outdoors use insect repellent that contains DEET or Picaridin. Be sure to follow the directions on the insert package. Many mosquitoes are most active at dusk and dawn. Be sure to use insect repellent and wear long sleeves and pants at these times or consider staying indoors during these hours.

Make sure you have good screens on your windows and doors to keep mosquitoes out.

Get rid of mosquito breeding sites by emptying anything that contains standing water such as flowerpots, buckets, and barrels. Change the water in pet dishes and replace the water in birdbaths weekly. Drill holes in tire swings so water drains out. Keep children's wading pools empty and on their sides when they aren't being used.

Please use the following resources, or contact your doctor or primary care physician.

• CDC West Nile Virus Questions and Answers
• MedlinePlus West Nile Virus Page
• Mayo Clinic West Nile Virus Page
• National Biological Information Infrastructure (NBII) West Nile Virus Page

Yellow fever is caused by an infection with the yellow fever virus, which is transmitted from the bite of an infected mosquito. Yellow fever occurs in tropical regions of Africa and in parts of South America. Yellow fever is a very rare cause of illness in U.S. travelers.

Initial symptoms include:

• Fever and chills
• Severe headache
• Muscle aches
• Nausea
• Fatigue (tiredness)
• Weakness

Symptoms will typically appear 3 to 6 days after infection. In 15% of cases, their symptoms may stop briefly for a few hours up to a day and then they may progress to develop a more serious form of this disease. This form is characterized by these symptoms:

• Jaundice (yellowing of the skin)
• Nose bleeds
• Bleeding gums
• Bruising
• Black vomit
• Abnormal amount of protein in the urine

An initial diagnosis of yellow fever is usually based upon clinical symptoms, places and dates of travel activities, and the history of the location where the infection occurred. Yellow fever is then confirmed by laboratory testing.

People get yellow fever by being bitten by an infected mosquito in areas where yellow fever occurs. The tropics (sub-Saharan Africa and parts of South America) are the only areas that have yellow fever.

Anyone who travels to certain tropical areas and spends time outdoors is at risk for getting yellow fever.

Contact your doctor and explain your symptoms and history of travel.

There is not currently a treatment for yellow fever. You can treat the symptoms by resting, drinking plenty of fluids, and taking pain relievers, but avoid aspirin. Treatment should be made in consultation with your doctor.

Yellow fever can be prevented by receiving the vaccine. The vaccine is given only at designated yellow fever vaccination centers. Proof of yellow fever vaccination for travel to and from certain countries is required. Also note that the vaccine is to be given 10 days before travel to an area that has yellow fever.

Travelers should also take precautions against mosquito bites when in areas where yellow fever is common. When you are outdoors use insect repellent that has DEET in it. Mosquitoes are most active at dusk and dawn. Wear long sleeves and pants at these times or consider staying inside during these hours.

Please use the following resources, or contact your doctor or primary care physician.

• CDC Yellow Fever Page
• CDC Travelers' Health Yellow Book – Yellow Fever
• World Health Organization (WHO) Yellow Fever Page
• National Network for Immunization Information (NNii) Yellow Fever Page