SYPHILIS

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidium. The infection is usually sexually transmitted, in which case it is called venereal syphilis. It may also be passed from an infected mother to her unborn child, in which case it is known as congenital syphilis.

Syphilis has been uncommon since penicillin become widely available in the 1950s, although global syphilis statistics show that in recent years the number of cases has been rising. The World Health Organisation estimates that 12 million new cases of venereal syphilis occurred in 1999.¹

“The past decade has seen a rise in new cases of the almost forgotten ‘historic disease’ syphilis, particularly in certain risk groups.” - Alexandra Geusau and Stefan Wöhrl, Medical University of Vienna ²

Syphilis symptoms

The symptoms of syphilis are the same in men and women. They can be mild and difficult to recognise or distinguish from other STDs. Symptoms may take up to 3 months to appear after initial infection. Syphilis is a slowly progressing disease that has several stages. The primary and secondary stages are very infectious.

Primary stage

One or more painless ulcers (know as chancres) appear at the place where the syphilis bacteria entered the body. On average, this will be 21 days after sexual contact with an infected person. Chancres may be difficult to notice and are highly infectious. The usual locations for chancres are:

• on the vulva (outside the vagina) or on the cervix (neck of the womb) in women.
• on the penis in men.
• around the anus and mouth (both sexes).

The ulcers take between 2 and 6 weeks to heal.

If the infection is not treated at this point then it will progress to the secondary stage.

Secondary stage

If the infection has not been treated, the secondary stage will usually occur from 3 to 6 weeks after the appearance of chancres. The symptoms often include:

• a flu-like illness, a feeling of tiredness and loss of appetite, accompanied by swollen glands (this can last for weeks or months).
• a non-itchy rash covering the whole body or appearing in patches.
• flat, warty-looking growths on the vulva in women and around the anus in both sexes.
• white patches on the tongue or roof of the mouth.
• patchy hair loss.

During this stage syphilis is very infectious and may be sexually transmitted to a partner. These symptoms will usually clear up within a few weeks, but may re-occur for years.

Treatment at any time during the first two stages of syphilis will cure the infection.

Latent and tertiary stages

If a person infected with syphilis has not received treatment during the first two stages of the disease then it will progress to the latent stage. The person will no longer experience any symptoms of the earlier stages, but their infection can still be diagnosed with a blood test.

If left untreated, the infection may develop into symptomatic late syphilis, also known as the tertiary stage. This usually develops after more than 10 years and is often very serious. It is at this stage that syphilis can affect the heart and possibly the nervous system.

If treatment for syphilis is given during the latent stage then the infection can be cured. However, any heart or nervous-system damage that occurred before the start of treatment may be irreversible.

How syphilis is passed on

Syphilis can be transmitted through direct contact with a syphilis sore. The methods of transmission are:

• by having vaginal, anal or oral sex with someone who has the infection.
• from a mother to her unborn baby.

Syphilis cannot be passed on by sharing baths, toilets, towels or eating utensils.

Where to go for help

If you have any symptoms or you are worried you may have been infected with syphilis, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can.

Some countries have specific sexual health clinics that can help you directly. Check AVERT's help and advice page or your local telephone directory to see if you have a clinic near you.

The diagnosis of syphilis

To find out if someone has syphilis, a doctor will usually carry out the following examinations and tests:

• a blood sample is taken and sent to an STD testing laboratory.
• a specimen of fluid is taken from all sores using a cotton swab and examined under a microscope.
• the genital area is examined for any primary signs of syphilis. The rest of the body is also checked.
• women are given an internal examination to check for sores.
• a sample of urine is taken.

None of the examinations should be painful, but they may be slightly uncomfortable. The blood samples taken by the doctor are examined in a laboratory under a microscope to confirm a diagnosis. Various tests can be used on the blood sample. The most common and least expensive looks for antibodies.

The examinations and tests can be done as soon as a person thinks they might have been in contact with syphilis. However, if the result is negative then it is usually recommended that the person retests at a later time, as it can take up to 3 months for the immune system to produce the antibodies that are detected by the test.

Treatment

If the patient has syphilis, the doctor or sexual health adviser will talk about the STD and answer any questions. The patient will be asked about their sexual partners as it is important they are informed and tested as soon as possible.

It is strongly advisable to avoid any oral, vaginal or anal sex whilst having treatment, especially if the patient is in the early infectious stages of syphilis. Contact with any sores or rashes carries a risk of syphilis transmission.

Treatment of syphilis usually consists of a two-week course of intramuscular penicillin injections or, in some cases, antibiotic tablets or capsules. If the patient has had syphilis for less than a year then fewer doses will be needed.

If the patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, then the doctor should be informed so that alternate medication can be prescribed.

It is important that the full course of treatment be completed. If treatment is interrupted then it may be necessary to start again from the beginning.

After the treatment is completed, the patient will be asked to attend the clinic at regular intervals for blood tests to check that the syphilis has gone.

Once a person has been treated and confirmed cleared of syphilis, any future blood tests (e.g. for immigration reasons) will still be positive, because the body retains antibodies against the bacteria. Doctors can give the person a certificate explaining that they have been treated and no longer have syphilis.

Treatment is only capable of killing the syphilis bacteria and preventing further damage. It cannot repair damage already done to organs, or prevent re-infection if the person is exposed to the bacteria again.

Prevention

Although using a condom reduces the chances of becoming infected with syphilis, it is not entirely effective. A condom may not cover all of the sores or rashes in the affected areas, and direct skin contact may result in transmission.

If a person has sex regularly with multiple partners, then it is advisable for them to get frequent STD check-ups.

A person can become re-infected with syphilis even if they have had effective treatment for a previous infection. Past infection with syphilis does not make a person immune.

Congenital syphilis

Syphilis can infect a baby in the womb if the mother's infection is not treated. This is know as congenital syphilis. If a baby becomes infected then there is a high risk of stillbirth or miscarriage.

A newborn baby may not display any obvious symptoms of syphilis, but may develop serious complications within weeks if the disease is not treated.

In many countries, blood tests for syphilis are given to all pregnant women when they visit antenatal clinics. Women may also be offered other tests for other STDs, such as an HIV test when pregnant.

If a woman is found to be infected with syphilis, treatment can safely be given during pregnancy with no risk to the unborn baby.

Chlamydia: symptoms, treatment & prevention

Chlamydia is one of the most commonly reported bacterial sexually transmitted diseases (STDs). It is caused by the Chlamydia trachomatis bacterium, which may infect the urethra and rectum in both sexes and the cervix in women. Occasionally chlamydia can also affect other parts of the body, including the throat, lungs, liver and eyes.

Global chlamydia statistics show that an estimated 92 million new chlamydia infections occur each year, affecting more women (50 million) than men (42 million). Chlamydia can cause serious problems later in life if left untreated.

Chlamydia symptoms and signs

Symptoms usually appear between 1 and 3 weeks after exposure but may not emerge until much later. Chlamydia is known as the ‘silent’ disease as in many people it produces no symptoms. It is estimated that 70-75% of women infected with chlamydia are asymptomatic (have no symptoms) and a significant proportion of men also have no symptoms. Those who do have symptoms may experience:

• Women

• a minor increase in vaginal discharge caused by an inflamed cervix.
• cystitis (an inflammation of the lining of the bladder).
• the need to urinate more frequently, or pain whilst passing urine.
• pain during sexual intercourse or bleeding after sex.
• mild lower abdominal pains.
• irregular menstrual bleeding.
• a painful swelling and irritation in the eyes (if they become infected).

• Men

• Men are more likely to notice symptoms than women, though they too may be asymptomatic.
• a white/cloudy and watery discharge from the penis that may stain underwear.
• a burning sensation and/or pain when passing urine.
• a painful swelling and irritation in the eyes (if they become infected).

In both men and women a chlamydia infection in the rectum will rarely cause symptoms.

How is chlamydia passed on?

Chlamydia can be transmitted:

• by having unprotected vaginal, anal or oral sex with someone who is infected.
• from a mother to her baby during vaginal childbirth.
• by transferring the infection on fingers from the genitals to the eyes, although it is rare for this to happen.

Where to go for help

If you have any symptoms or you are worried you may have been infected with chlamydia, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can.

In some countries, local pharmacies and chemists may offer chlamydia testing kits that allow a person to take a sample themselves for analysis by the pharmacy.

Some countries also have specific sexual health clinics that can help you directly. Check our help and advice page or your local telephone directory to see if you have a clinic near you.

The diagnosis of chlamydia

To find out if someone has chlamydia, a doctor or nurse will usually carry out the following examinations and tests:

• an examination will be done of a patient’s genital area.
• a urine sample may be taken.
• samples will be taken from any possibly infected areas, using a cotton wool or spongy swab.
• women will usually be given an internal pelvic examination, similar to a smear test, where a swab sample is taken from the cervix.
• men will be given an external examination of their testicles to check that these are healthy.

The examinations may be uncomfortable but they are unlikely to cause any pain.

Chlamydia will be detectable a few days after being infected, often before any symptoms have appeared.

Samples taken during the examinations are sent to a laboratory for testing. The result is usually available within one week, though this may vary depending on location.

Treatment of chlamydia

The treatment of chlamydia is simple and effective once the infection has been diagnosed, consisting of a short course of antibiotic tablets.

If a patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, it is important that the doctor is informed as this may affect which antibiotics are prescribed. Treatment must not be interrupted once a course of antibiotics has been started; otherwise it may be necessary to start again from the beginning.

The doctor or health advisor will discuss the chlamydia infection and answer any questions. They will also want to know about any partners the patient has had sexual contact with in the past six months, as they will also be at risk of having chlamydia and should be tested.

The infected patient should not have penetrative sex until treatment has finished and the doctor has confirmed they no longer have chlamydia by re-testing.

Follow-up

It is important that the patient returns for a check-up once the treatment has been completed to make sure they are well and have no recurring infection.

Complications

If chlamydia is left undiagnosed and untreated then it is more difficult to deal with. Early diagnosis and treatment means that chlamydial infection can be cleared up easily, but if it is left unchecked then other problems can arise.

• Women

• Pelvic Inflammatory Disease (PID) - an inflammation of the fallopian tubes (the tubes along which an egg passes to get to the womb). PID increases the future risk of ectopic pregnancy (a pregnancy outside the womb) or premature birth. If the fallopian tubes are scarred, it can also lead to problems with fertility. Female infertility can often be traced back to infection with chlamydia.
• Mother-to-child-transmission (MTCT) - during pregnancy chlamydia can potentially be passed on to the baby, giving it an eye or lung infection. Chlamydia can be safely treated during pregnancy provided the correct antibiotics are prescribed.
• Cervicitis - symptoms include a yellowish vaginal discharge and pain during sex. In long-term cervicitis the cervix becomes very inflammed and cysts can develop and become infected. This can lead to deep pelvic pain and backache.

• Men

• Complications caused by chlamydia in men are uncommon, but if left untreated a long-term infection may lead to:
• Epididymitis - painful inflammation of the tube system that is part of the testicles, which can lead to infertility.
• Urethritis - inflammation of the urine tube (urethra), causing a yellow or clear pus-like discharge to collect at the tip of the penis. Left untreated it can lead to a narrowing of the urethra, which can affect the ability to urinate easily and can potentially cause kidney problems.

• Men and women

• Complications that can occur in both sexes are:
• Reiters syndrome - can cause inflammation of the eyes and joints and sometimes a rash on the genitals and soles of the feet.
• Appendicitis (inflammation of the appendix).

Chlamydia prevention

Using condoms greatly reduces the risk of chlamydia being passed on during sex. Getting tested for STIs at a sexual health clinic, and encouraging new partners to get tested before having sexual intercourse, also helps to prevent transmission.

If you think you may have any of the symptoms listed above then getting tested is highly recommended. Visit the nearest G.U.M. (Genito-Urinary Medicine) clinic, sexual health clinic or doctor as soon as possible to avoid complications. In countries such as the USA and UK, all pregnant women are offered a test for STDs such as chlamydia, and it is recommended that all sexually active women under the age of 25 get screened for STDs at least once a year.

When should sex education start?

Sex education that works starts early, before young people reach puberty, and before they have developed established patterns of behaviour.^{15 16 17} The precise age at which information should be provided depends on the physical, emotional and intellectual development of the young people as well as their level of understanding. What is covered and also how, depends on who is providing the sex education, when they are providing it, and in what context, as well as what the individual young person wants to know about.

It is important not to delay providing information to young people but to begin when they are young. Providing basic information provides the foundation on which more complex knowledge is built up over time. This also means that sex education has to be sustained. For example, when they are very young, children can be informed about how people grow and change over time, and how babies become children and then adults, and this provides the basis on which they understand more detailed information about puberty provided in the pre-teenage years. They can also when they are young, be provided with information about viruses and germs that attack the body. This provides the basis for talking to them later about infections that can be caught through sexual contact.

Providing basic information provides the foundation on which more complex knowledge is built up over time.

Some people are concerned that providing information about sex and sexuality arouses curiosity and can lead to sexual experimentation. There is no evidence that this happens.^{18 19} It is important to remember that young people can store up information provided at any time, for a time when they need it later on.

Sometimes it can difficult for adults to know when to raise issues, but the important thing is to maintain an open relationship with children which provides them with opportunities to ask questions when they have them. Parents and carers can also be proactive and engage young people in discussions about sex, sexuality and relationships. Naturally, many parents and their children feel embarrassed about talking about some aspects of sex and sexuality. Viewing sex education as an on-going conversation about values, attitudes and issues as well as providing facts can be helpful. The best basis to proceed on is a sound relationship in which a young person feels able to ask a question or raise an issue if they feel they need to. It has been shown that in countries like The Netherlands, where many families regard it as an important responsibility to talk openly with children about sex and sexuality, this contributes to greater cultural openness about sex and sexuality and improved sexual health among young people.²⁰

The role of many parents and carers as sex educators changes as young people get older and young people are provided with more opportunities to receive formal sex education through schools and community-settings. However, it doesn't get any less important. Because sex education in school tends to take place in blocks of time, it can't always address issues relevant to young people at a particular time, and parents can fulfill a particularly important role in providing information and opportunities to discuss things as they arise.²¹

Who should provide sex education?

Different settings provide different contexts and opportunities for sex education. At home, young people can easily have one-to-one discussions with parents or carers which focus on specific issues, questions or concerns. They can have a dialogue about their attitudes and views. Sex education at home also tends to take place over a long time, and involve lots of short interactions between parents and children. There may be times when young people seem reluctant to talk, but it is important not to interpret any diffidence as meaning that there is nothing left to talk about. As young people get older advantage can be taken of opportunities provided by things seen on television for example, as an opportunity to initiate conversation. It is also important not to defer dealing with a question or issue for too long as it can suggest that you are unwilling to talk about it.

In school the interaction between the teacher and young people takes a different form and is often provided in organised blocks of lessons. It is not as well suited to advising the individual as it is to providing information from an impartial point of view. The most effective sex education acknowledges the different contributions each setting can make. Schools programmes which involve parents, notifying them what is being taught and when, can support the initiation of dialogue at home. Parents and schools both need to engage with young people about the messages that they get from the media, and give them opportunities for discussion.

In some countries, the involvement of young people themselves in developing and providing sex education has increased as a means of ensuring the relevance and accessibility of provision. Consultation with young people at the point when programmes are designed, helps ensure that they relevant and the involvement of young people in delivering programmes may reinforce messages as they model attitudes and behaviour to their peers.^{22 23 24}

Effective school-based sex education

School-based sex education can be an important and effective way of enhancing young people's knowledge, attitudes and behaviour. There is widespread agreement that formal education should include sex education and what works has been well-researched. Evidence suggests that effective school programmes will include the following elements:

• A focus on reducing specific risky behaviours;
• A basis in theories which explain what influences people's sexual choices and behaviour;
• A clear, and continuously reinforced message about sexual behaviour and risk reduction;
• Providing accurate information about, the risks associated with sexual activity, about contraception and birth control, and about methods of avoiding or deferring intercourse;
• Dealing with peer and other social pressures on young people; Providing opportunities to practise communication, negotiation and assertion skills;
• Uses a variety of approaches to teaching and learning that involve and engage young people and help them to personalise the information;
• Uses approaches to teaching and learning which are appropriate to young people's age, experience and cultural background;
• Is provided by people who believe in what they are saying and have access to support in the form of training or consultation with other sex educators.

Formal programmes with these elements have been shown to increase young people's levels of knowledge about sex and sexuality, put back the average age at which they first have sexual intercourse and decrease risk when they do have sex . All the elements are important and inter-related, and sex education needs to be supported by links to sexual health services, otherwise it is not going to be so effective . It also takes into account the messages about sexual values and behaviour young people get from other sources, like friends and the media. It is also responsive to the needs of the young people themselves - whether they are girls or boys, on their own or in a single sex or mixed sex group, and what they know already, their age and experiences.

Taking Sex Education Forward

Providing effective sex education can seem daunting because it means tackling potentially sensitive issues. However, because sex education comprises many individual activities, which take place across a wide range of settings and periods of time, there are lots of opportunities to contribute.

The nature of a person's contribution depends on their relationship, role and expertise in relation to young people. For example, parents are best placed in relation to young people to provide continuity of individual support and education starting from early in their lives. School-based education programmes are particularly good at providing information and opportunities for skills development and attitude clarification in more formal ways, through lessons within a curriculum. Community-based projects provide opportunities for young people to access advice and information in less formal ways. Sexual health and other health and welfare services can provide access to specific information, support and advice. Sex education through the mass media, often supported by local, regional or national Government and non-governmental agencies and departments, can help to raise public awareness of sex health issues.

Because sex education can take place across a wide range of settings, there are lots of opportunities to contribute.

Further development of sex education partly depends on joining up these elements in a coherent way to meet the needs of young people. There is also a need to pay more attention to the needs of specific groups of young people like young parents, young lesbian, gay and bisexual people, as well as those who may be out of touch with services and schools and socially vulnerable, like young refugees and asylum-seekers, young people in care, young people in prisons, and also those living on the street.

The circumstances and context available to parents and other sex educators are different from place to place. Practical or political realities in a particular country may limit people's ability to provide young people with comprehensive sex education combining all the elements in the best way possible. But the basic principles outlined here apply everywhere. By making our own contribution and valuing that made by others, and by being guided by these principles, we can provide more sex education that works and improve the support we offer to young people.

What is sex education?

Sex education, which is sometimes called sexuality education or sex and relationships education, is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy. Sex education is also about developing young people's skills so that they make informed choices about their behaviour, and feel confident and competent about acting on these choices. It is widely accepted that young people have a right to sex education, partly because it is a means by which they are helped to protect themselves against abuse, exploitation, unintended pregnancies, sexually transmitted diseases and HIV/AIDS.^{1 2 3 4 5}

What are the aims of sex education?

Sex education seeks both to reduce the risks of potentially negative outcomes from sexual behaviour like unwanted or unplanned pregnancies and infection with sexually transmitted diseases, and to enhance the quality of relationships. It is also about developing young people's ability to make decisions over their entire lifetime. Sex education that works, by which we mean that it is effective, is sex education that contributes to this overall aim.

What skills should sex education develop?

If sex education is going to be effective it needs to include opportunities for young people to develop skills, as it can hard for them to act on the basis of only having information.^{6 7} The kinds of skills young people develop as part of sex education are linked to more general life-skills. For example, being able to communicate, listen, negotiate, ask for and identify sources of help and advice, are useful life-skills and can be applied in terms of sexual relationships. Effective sex education develops young people's skills in negotiation, decision-making, assertion and listening. Other important skills include being able to recognise pressures from other people and to resist them, deal with and challenge prejudice, seek help from adults - including parents, carers and professionals - through the family, community and health and welfare services. Sex education that works, also helps equip young people with the skills to be able to differentiate between accurate and inaccurate information, discuss a range of moral and social issues and perspectives on sex and sexuality, including different cultural attitudes and sensitive issues like sexuality, abortion and contraception.^{8 9 10}

Forming attitudes and beliefs

Young people can be exposed to a wide range of attitudes and beliefs in relation to sex and sexuality. These sometimes appear contradictory and confusing. For example, some health messages emphasis the risks and dangers associated with sexual activity and some media coverage promotes the idea that being sexually active makes a person more attractive and mature. Because sex and sexuality are sensitive subjects, young people and sex educators can have strong views on what attitudes people should hold, and what moral framework should govern people's behaviour - these too can sometimes seem to be at odds. Young people are very interested in the moral and cultural frameworks that binds sex and sexuality. They often welcome opportunities to talk about issues where people have strong views, like abortion, sex before marriage, lesbian and gay issues and contraception and birth control. It is important to remember that talking in a balanced way about differences in opinion does not promote one set of views over another, or mean that one agrees with a particular view. Part of exploring and understanding cultural, religious and moral views is finding out that you can agree to disagree.

Attempts to impose narrow moralistic views about sex and sexuality on young people through sex education have failed.

People providing sex education have attitudes and beliefs of their own about sex and sexuality and it is important not to let these influence negatively the sex education that they provide. For example, even if a person believes that young people should not have sex until they are married, this does not imply withholding important information about safer sex and contraception. Attempts to impose narrow moralistic views about sex and sexuality on young people through sex education have failed.^{11 12} Rather than trying to deter or frighten young people away from having sex, effective sex education includes work on attitudes and beliefs, coupled with skills development, that enables young people to choose whether or not to have a sexual relationship taking into account the potential risks of any sexual activity.

Effective sex education also provides young people with an opportunity to explore the reasons why people have sex, and to think about how it involves emotions, respect for one self and other people and their feelings, decisions and bodies. Young people should have the chance to explore gender differences and how ethnicity and sexuality can influence people's feelings and options.^{13 14} They should be able to decide for themselves what the positive qualities of relationships are. It is important that they understand how bullying, stereotyping, abuse and exploitation can negatively influence relationships.

So what information should be given to young people?

Young people get information about sex and sexuality from a wide range of sources including each other, through the media including advertising, television and magazines, as well as leaflets, books and websites (such as www.avert.org) which are intended to be sources of information about sex and sexuality. Some of this will be accurate and some inaccurate. Providing information through sex education is therefore about finding out what young people already know and adding to their existing knowledge and correcting any misinformation they may have. For example, young people may have heard that condoms are not effective against HIV/AIDS or that there is a cure for AIDS. It is important to provide information which corrects mistaken beliefs. Without correct information young people can put themselves at greater risk.

Information is also important as the basis on young people can developed well- informed attitudes and views about sex and sexuality. Young people need to have information on all the following topics:

• Sexual development
• Reproduction
• Contraception
• Relationships

They need to have information about the physical and emotional changes associated with puberty and sexual reproduction, including fertilisation and conception and about sexually transmitted diseases, including HIV/AIDS. They also need to know about contraception and birth control including what contraceptives there are, how they work, how people use them, how they decide what to use or not, and how they can be obtained. In terms of information about relationships they need to know about what kinds of relationships there are, about love and commitment, marriage and partnership and the law relating to sexual behaviour and relationships as well as the range of religious and cultural views on sex and sexuality and sexual diversity. In addition, young people should be provided with information about abortion, sexuality, and confidentiality, as well as about the range of sources of advice and support that is available in the community and nationally.

Heaviest Bird Ever Alive - 2 candidates

(contribution by Christoph Kulmann)

Elephant BirdThe Elephant Bird (shown above under biggest eggs) is thought to have been the inspiration for the Roc (or Ruhk) made famous in the stories of Sinbad and the accounts of Marco Polo. While Aepyornis was by no means as large and terrible as the elephant-eating Roc, it WAS one of the largest birds that ever lived. The flightless bird grew to around ten or eleven feet tall, and is estimated to have weighed up to 1100 pounds. By comparison, a BIG Ostrich will go eight feet and 300 pounds. The home of the Elephant Bird was the island of Madagascar, off the eastern coast of Africa. The island was first populated by African and Indonesian peoples that are thought to have arrived around the time of Christ, about 2000 years ago. They were, in turn, visited by Muslim traders from East Africa and the Comoro Islands in the ninth century. The first Europeans to visit the island were the Portuguese in 1500, but Europeans didn’t really establish a foothold on the island until the French settled there beginning in 1642. The Elephant Bird was probably still around at that time but it had already become very rare. One of the only contemporary European accounts of the bird was written by the first French Governor of Madagascar, Étienne de Flacourt, who wrote, in 1658, "vouropatra - a large bird which haunts the Ampatres and lays eggs like the ostriches; so that the people of these places may not take it, it seeks the most lonely places." The natives’ histories of the Elephant Bird, however, rarely describe it as an aggressive bird, and more often portray it as a shy, peaceful giant. Most likely the Vouron Patra was driven to extinction by people raiding their nests. The eggs and egg shells were both very important items to the tribal Malagasy, who used them for food and all kinds of stuff. The fossil record shows that maximus was not the only species of Aepyornis that ever lived. It is thought that between three and seven different types of Elephant Bird have lived since the Pleistocene although only one, the smaller Aepyornis mullerornis is thought to have survived into historic times along with the Elephant Bird. Only the giant is known to have co-existed with humans, and by 1700, it too was gone.

Only the largest of the New Zealand Moas were taller, some reaching thirteen feet, but they weren’t as massively built. Moa were large flightless birds that went extinct in the late 1700’s or early 1800’s. These huge, bulky birds lived in lowland forests on the islands of New Zealand. The word moa comes from the Maori language, in which the plural of moa is moa (we are using that convention). The oldest-known moa fossils date from 2.4 million years ago. The last of the moa (the smaller species) lived on the South Island of New Zealand until the 1700’s. On its native New Zealand, there were no large mammals to prey on the moa or its eggs; its only predators large birds, like the Haast eagle (which is now extinct). When the Maori people moved to New Zealand over 1,000 years ago, they destroyed much of the moa’s lowland forest habitat and introduced mammals, including dogs and rats. These mammals ate the moa’s eggs. The Maori people also hunted and ate the moa. These forces probably contributed to the extinction of the moa. The moa had a large body, a small head, a long neck, short, thick legs, and a large beak. There were 11 species of moa. The largest was almost 11.5 feet (3.5 m) tall and weighed perhaps 700 pounds (320 kg); the smallest of the moa were turkey-sized. The moa’s nest was located on the ground (leaving the eggs vulnerable to predators). The moa was an herbivore (plant-eater); it ate fruit and some plant material (like leaves). These birds swallowed stones (which went into gizzard) that helped digest the food. Classification: Kingdom Animalia (animals), phylum Chordata, subphylum Vertebrata (vertebrates), class Aves (birds), order Dinornithiformes, family Anomalopterygidae (the lesser moa) and family Dinornithidae (the greater moa). There were 11 (or possibly 13) different species of moa, including Dinornis, the biggest moa and the biggest bird that ever lived.

In ancient Australia, until 50,000 years ago, there was a group of birds called the Dromornithids. By far the largest of them was "Dromornis stirtoni", a massive creature that stood 3 meters tall and must have weighed more than half a ton. They disappeared rather abruptly, and there is still much debate about the reasons. But the Australians seem to have kept a memory of these giant birds. In some legends, there is a creature called "mihirung", and most likely this means a dromornithid bird.

Smelliest Bird

The south American hoatzin (Opisthocomus hoazin) has an odor similar to cow manure. Colombians call it pava hedionda ("stinking pheasant"). The cause of the smell is believed to be a combination of its diet of green leaves and its specialized digestive system, which involves a kind of foregut fermentation.

Large Flocks

Flamingoes, with their long necks and legs, have a height range of 3-5 feet and are the biggest bird to form large flocks. Of the four species, the lesser flamingo (Phoeniconaias minor) of eastern and southern Africa has been seen in flocks of several million birds, particularly in the Great Lakes of eastern Africa.

Biggest Bird

The largest and strongest living bird is the North African ostrich (Struthio camelus . Males can be up to 9 feet tall and weigh 345 pounds, and when fully grown the have one of the most advanced immune systems of any animal. South Africa was the first country to see the commercial potential of ostrich products - the creature are prized not only for their large soft white feathers and their meat but also for their skins, which are made into the strongest commercially available leather in the world. Ostrich farming is believed to have begun in the Karoo and Eastern Cape c. 1863. By 1910 there were more than 20,000 domesticated ostriches in the country, and by 1913 ostrich feathers were the fourth most important south African export product. Demand began to dry up soon afterwards, but there was an ostrich revival in the 1920’s when farmers started to produce biltong ( dry strips of ostrich meat) commercially.

Heaviest Parrot

Flightless Kakapo around 7lbs in weight; New Zealand [contributed by Harold Armitage, Wild Macaws Wild Macaws]

SinbadA flightless nocturnal bird, which was described by early European settlers as " the most wonderful bird on Earth, " the Kakapo parrot was once endemic throughout New Zealand. Today only 50 birds remain, some of which live on Little Barrier Island (Hauturu) as part of a Department of Conservation endangered species recovery programme.

The name "Kakapo" is Polynesian (Maori) for "parrot of the night." Moss green, like Kakapo "Suzanne’s" foster brood, Codfish Island, 2002. Photo by Don Merton/DOC.the foliage of the native trees and grasses in which it evolved, funny and cuddly, with a wonderful spicy fragrance, this unique bird has small wings, useless for flight but handy to steer with when you’re jumping down a bank, and a rudimentary keel in its sternum. It browses forest trees, ferns, herbs, moss and lichen and grinds its food between a powerful lower mandible and a grooved pad in the upper mandible, a method of mastication which is thought to be unique.

Tallest Flying Birdscrane

The largest cranes (family Gruidae) can be almost 6 ft. 6 in. tall.
Heaviest Flying Birds

The Kori Bustard or paauw (Ardeotis Kori) of northeast and southern Africa and the great bustard (Otis tarda) of Europe and Asia weigh about 40-42 pounds. There is a report of a 46 lb. 4 oz. male great bustard shot in northeastern China. It was too heavy to fly.

Largest Carnivorous Bird

(contribution by Christoph Kulmann)

Titanis Walleri. This bird is known from the early Pleistocene (Ice Age) of Florida. It is the last known member of the family Phorusrhacidae, a group of large, flightless birds which evolved in South America. This creature had an estimated body height of 3 meters (if it stood fully erect, and 2.5 meters in more normal situations). Titanis really had arms instead of wings.

Fastest Swimming BirdGentoo Penguin

Gentoo Penguin found on the Antarctic Islands can swim 40 km per hour. Large populations are found at South Georgia, Falkland Islands, and Iles Kerguelen although their breeding distribution is circumpolar. An orange bill and a white stroke behind its eye distinguish the black and white gentoos from the smaller adelie and chinstrap species. Long stiff tail feathers stick out behind as they walk, often cocked up in the water, no other penguin has such a prominent tail. They breed in winter at the more northerly sub-Antarctic islands, laying two eggs as early as July. Can dive over 300’ though most prey dives are shallower. Most dives last only half a minute.

Smallest Parrot

[contributed by Harold Armitage, Wild Macaws Wild Macaws]

The Pygmy parrots of Papua and nearby islands. Genus Micropsitta. There’s six different sorts - Yellow-capped, Buff-faced, Finsch’s, Geelvink, Meek’s, Red-breasted - all around 3" long (8cm). Thought to eat lichens and mosses but not much is known about their lifestyles.

Smallest Bird of Prey

The black-legged falconet ( Micrphierax fringlius ) of southeast Asia and the white-fronted or Bornean falconet ( M. latifrons ) of northwestern Borneo both have an average length of 5.5-6 inches, including a 2 inch tail, and weigh approximately 1.25 ounces.

Smallest Bird

Male bee hummingbirds (mellisuga helenae), which live in Cuba, weigh 0.056 ounces and are 2.75 inches in length. The bill and tail account for half of this length.

Biggest Fish Ever Found" Unearthed in U.K.

James Owen in England
for National Geographic News

October 1, 2003

Fish tend to inspire exaggerated tales, as anglers know all too well. But paleontologists digging up a giant fossilized fish in England have plenty of bones to back their claim that this really was one heck of a whopper. First, however, they've got to piece all the evidence together.

Discovered by two paleontology students in clay pits near Peterborough, the fossil is the largest known fish ever recorded. Identified by experts from the universities of Portsmouth and Glasgow, Leedsichthys problematicus swam the world's oceans some 155 million years ago.

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"It's by far the biggest and most complete Leedsichthys ever found, which makes it the biggest fish ever found," said Mike Barker, head of paleobiology at Portsmouth University.

Equipped with massive, teeth-lined gills, experts say the creature was probably one the first giant planktivores. A Jurassic version of the baleen whale or basking shark, it would have filtered out huge quantities of tiny shrimp and other marine organisms while cruising over what is now central England.

The Peterborough specimen's estimated length is 22 meters (72 feet)—almost twice as long as a whale shark, the largest fish swimming today. Those working on the fossil reckon the species may have reached sizes to rival the blue whale.

Named after Alfred Leeds, an English farmer who first discovered Leedsichthys problematicus in the late 1800s, "problematicus"reflects difficulties paleontologists had in classifying the species, eventually linking it to an extinct group of bony fishes called pachycormids which had sickle-shaped pectoral fins and forked tails.

Problem Fish

Leedsichthys is proving equally problematical for today's fossil experts. The Peterborough site contains a tangled mass of thousands of fractured bones, making the task of excavation akin to tackling a gargantuan, mud-caked jigsaw puzzle.

"It's far more complicated than digging up a large reptile or a dinosaur," said dig leader Jeff Liston, vertebrate researcher at Glasgow University's Hunterian Museum in Scotland. "Its bones are exceptionally thin, and are crushed by the weight of clay over millions of years. Another problem is that many fish from this family had only limited calcification of their skeleton, so many parts simply do not preserve."

He added: "There's still a stupendous quantity of bones we're trying to get out. The previous biggest specimen, called Big Meg, filled about 20 museum drawers. We've already got almost 120 drawers of material."

In fact, Liston says he felt relieved when his team discovered the fish's tail section was missing, having been quarried out during clay extraction work in the late 1980s. "The last time someone tried to excavate the tail of this animal it came out in just under 10,000 fragments," he said.

Liston and his team estimated the fish's age by examining other fossils and the sediment containing its remains. Tests showed this comprised eight to 10 percent organic material, such as algae and plankton.

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Liver Function Test

Liver disease refers to any disease or disorder that causes the liver to stop functioning as it should, examples of liver disease are cirrhosis . and hepatitis. For more information on the liver click here. This liver test detects abnormal levels of bilirubin and urobilinogen in urine, raised levels can indicate liver disease. It is recommended that you take this test if you are feeling generally unwell or are experiencing any of the following: Nausea Fatigue Lack of appetite Yellowing of the skin and eyes

Cirrhosis of the Liver

What is the liver? The liver is by far the largest organ in the body, it is situated in the upper abdomen and is protected from injury by the rib cage. The liver has many important functions. For more information on the liver click here. What is cirrhosis of the liver? Cirrhosis is a medical term and means hardening of an organ or scarring. This basically means that healthy tissue has been destroyed leaving scar tissue which can block the flow of blood through an organ. Cirrhosis is a serious condition, when it occurs the liver stops working properly and so will fail to control infection, blood clotting and prevents bile from transferring to the small intestine. What causes cirrhosis of the liver? A number of conditions can lead to cirrhosis. Drinking excess alcohol is the most common cause of cirrhosis and many people associate the disease with alcoholism. Other causes of cirrhosis include: Chronic Viral Hepatitis - the 2 most important are Hepatitis B or C. Non alcoholic fatty liver disease Autoimmune chronic active hepatitis Primary biliary cirrhosis which is uncommon and other conditions that results in the bile ducts becoming blocked. Inherited diseases, such as the rare disorder Wilson's disease. Prolonged exposure to some drugs Alcohol and cirrhosis While almost everyone who drinks excessive amounts of alcohol will develop some kind of liver damage, this does not always develop into cirrhosis. Once alcohol has damaged the liver, then the liver cells become vulnerable to even small amounts of alcohol and so you must stop drinking all alcohol immediately. Drinking within sensible limits can minimise the risk of you developing alcoholic liver disease. Please see our page on alcohol for more information about sensible limits and what a unit of alcohol refers to. How do I know if I have cirrhosis of the liver? Like most liver disease it is symptomless in the early stages and when there are symptoms they are often vague. Most people are only aware they have cirrhosis from a physical examination or laboratory tests performed for another illness. However, as the disease progresses and the liver is unable to perform its functions you may feel generally unwell as well as experiencing any of the following: Loss of appetite. Tiredness and lack of energy. Weight Loss Jaundice Itching Nausea and sickness Easy bruising and nosebleeds Enlargement of breasts in men - this is due to a build up of female hormones which the liver would normally destroy. In the later stages more serious symptoms may occur. Swelling of the abdomen - due to a build up of fluid. This could cause a dramatic increase in body weight. Vomiting of blood Dark, black stools Fever and shivering attacks Episodes of confusion The above symptoms are ones you should particularly watch out for especially if you have been recently diagnosed with cirrhosis. How is cirrhosis diagnosed? Your doctor may have a feel of your liver from a physical examination and may also carry out a urine test which among other things looks for bilirubin and urobilinogen, if these levels are raised this could indicate the liver is damaged and a sign of liver disease (eg hepatitis,cirrhosis). If these levels are raised and/or the liver feels larger or harder than it should then your doctor may recommend a LFT (Liver Function Test) for more detailed results and looks at the following: Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) - these are enzymes that help to process proteins and may be raised if your liver is inflamed or injured. Bilirubin - This is a chemical in bile, a damaged liver cannot process bilirubin and so levels can build causing the skin and/or eyes to look yellow (jaundice). An increase in bilirubin is suggestive of liver disease. Alkaline Phosphatase (ALP) and Gamma-Glutamyl Transferase- these are enzymes and might be raised when there is a blockage in your liver or bile duct. Albumin - This is a protein and may be low in some cancers or if you have been eating little and are malnourished. Your doctor may also carry out a x-ray, ultrasound, CT or MRI scan and a biopsy may be taken. We have a liver function test on this website, for more information on this test click here. How is cirrhosis treated? Liver damage from cirrhosis cannot be reversed and so treatment will aim at reducing the complications of the disease and slowing or stopping its progress. The destruction of the liver can be stopped if the cause is removed, so if alcohol is the cause you must stop drinking alcohol and also be aware of alcohol contents within foods. If hepatitis is causing cirrhosis then medications can be given to treat the type of hepatitis such as interferon. If long term cirrhosis causes the liver to be extremely damaged then it may cease to function. In this situation the only option is to have a liver transplant.

Alcoholic Liver Disease

What is the liver? The liver is by far the largest organ in the body, it is situated in the upper abdomen and is protected from injury by the rib cage. The liver has many important functions. For more information on the liver click here. Alcohol and the liver Most people in the UK drink alcohol and in the last decade there has been a marked increase in the amount that people drink. Drinking excessive amounts of alcohol can cause liver disease. Alcohol is quickly absorbed into the bloodstream from the stomach and upper part of the small intestine, this then passes through the liver. When in the bloodstream alcohol reaches all the organs in the body but it is the liver that sees the highest concentrations and so it is the liver that is most prone to alcohol related problems. The amount of alcohol that causes liver damages seems to vary widely between individuals. There appears to be a genetic susceptibility to the harmful effects of alcohol and women tend to be more sensitive than men. However, it goes without saying the more you drink the more likely you are to develop the more advanced forms of the disease. For more detailed information on alcohol, the units and what the recommended consumption of alcohol is click here. How does alcoholic liver disease progress? There are 3 main stages of liver disease though the progression through these stages is variable. Stage 1 - Minimal change, almost all heavy drinkers will develop this stage known as fatty liver. This is not linked to deterioration of liver function but abnormalities may be seen in some blood tests. A fatty liver is reversible if alcohol is given up completely. Stage 2 - Alcoholic Hepatitis, the effects of this condition can be mild but also be life threatening. The results of a liver function test will almost always be abnormal and jaundice may develop. Again if alcohol is given up at this time the effects can be reversed but if you continue to drink heavily you will have a high risk of developing cirrhosis. Stage 3 - Cirrhosis, this is the final stage and is irreversible. Cirrhosis means that the healthy tissue has been destroyed leaving scar tissue which can block the flow of blood through an organ. For more information on cirrhosis of the liver click here. What are the symptoms? Unfortunately, like most liver disease it is symptom less in the early stages and when there are symptoms they are often vague. You may experience fatigue, nausea, vomiting (especially in the morning), diarrhoea or abdominal pains. However, as the disease progresses and the liver is unable to perform its functions you may develop more specific liver related symptoms such as jaundice. For more information on symptoms please click here. How is alcoholic liver disease diagnosed? If you have a history of drinking excess alcohol then your doctor may recommend a liver function test or scans to establish the presence and/or severity of liver damage. For more detailed information on alcohol, the units and what the recommended consumption of alcohol is click here. What is the treatment for alcoholic liver disease? The most important thing you can do is stop drinking, cutting down will only reduce the rate of damage. For people with advanced alcoholic hepatitis admission to hospital may be required. For more information on the treatment please read our page on cirrhosis of the liver.

What is the liver?

The liver is the largest organ in the body, it is situated in the upper abdomen and is protected from injury by the rib cage. The liver has many important functions some of which include:

• The production of bile.
• Helps the body to digest fats.
• Stores vitamins, iron and other essential nutrients until the body needs them.
• Converts the food you eat into energy needed for daily life.
• Aids in the removal of toxic substances (e.g. drugs and alcohol) from the bloodstream.

The liver can repair itself quite easily and can usually function with only a small portion of it working.

What is liver cancer?

Liver cancer happens when cells begin to multiply at a faster rate than they should and the unwanted cells form a growth. There are 2 main types of liver cancer and these are:

• Primary cancer - this means the cancer started in the liver. This type of cancer is quite rare in the U.K.
• Secondary cancer - this means the cancer developed in another part of the body and has spread to the liver. The most common cancers that may spread to the liver are cancers of the stomach, lung, colon and breast.

There are 2 main types of primary liver cancer. The most common type is known as a hepatoma, it starts in the cells, which perform the major tasks of the liver, called hepatocytes. The second type of cancer is known as cholangiocarcinomas and it starts in the cells that line the bile ducts of the liver.

What causes primary liver cancer?

Although nobody is exactly sure what causes primary liver cancer, it does tend to arise in those people whose liver has been severely damaged by a condition called cirrhosis (scarring of the liver). Any disease that causes cirrhosis of the liver will increase the risk of you developing liver cancer. Cirrhosis of the liver can be caused by infection with the hepatitis B or C virus and drinking excess alcohol. Hepatitis A does not cause cirrhosis or primary liver cancer.

However, only a small minority of people with cirrhosis of the liver will go on to develop primary liver cancer.

Primary liver cancer tends to affect the middle aged and elderly, but very rarely it can affect children. It is also a lot more common in men than it is in women.

What causes secondary liver cancer?

A primary cancer situated elsewhere in the body always causes secondary liver cancer. If cancer cells from the primary cancer escape into the bloodstream the liver is the most likely place for them to embed and grow, as all blood in the body passes through the liver.

What are the symptoms of liver cancer?

The symptoms for both primary and secondary cancer are similar though in the early stages you may have no symptoms. Secondary liver cancer tends to be found when the primary cancer is diagnosed. When symptoms are present they may include any of the following:

• Pain or discomfort in the upper abdomen.
• Loss of appetite.
• Weight loss.
• Nausea and occasionally vomiting.
• High temperature.
• Jaundice - a yellow colouring of the skin and eyes, darkened urine and a pale colour to the stools.

These symptoms can be common to many other non-serious conditions, so always have any symptoms you are experiencing checked by your doctor.

Is there anything I can do to prevent liver cancer?

To avoid liver cancer you should stop smoking, as this will greatly reduce your risk of developing lung and stomach cancer. Try to maintain a healthy balanced diet and reduce your consumption of alcohol - a major cause of cirrhosis of the liver. Protect yourself against the hepatitis virus by practicing safe sex and avoid sharing needles.

If you have cirrhosis of the liver your doctor should regularly test you for the presence of a hepatoma. The test may involve regular blood tests, which looks for the presence of alpha-feta protein (A.F.P.), a substance found in abnormal amounts in those with a hepatoma.

How is liver cancer diagnosed?

Your doctor may have a feel of your liver from a physical examination and may also carry out a urine test which among other things looks for bilirubin and urobilinogen, if these levels are raised this could indicate the liver is damaged. If these levels are raised and/or the liver feels larger or harder than it should then your doctor may recommend a LFT (Liver Function Test) for more detailed results and looks at the following:

• Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) - these are enzymes that help to process proteins and may be raised if your liver is inflamed or injured.
• Bilirubin - This is a chemical in bile, a damaged liver cannot process bilirubin and so levels can build causing the skin and/or eyes to look yellow (jaundice). An increase in bilirubin is suggestive of liver disease.
• Alkaline Phosphatase (ALP) and Gamma-Glutamyl Transferase- these are enzymes and might be raised when there is a blockage in your liver or bile duct.
• Albumin - This is a protein and may be low in some cancers or if you have been eating little and are malnourished.

A cancer of the liver might be suspected when an abnormality is seen in ‘liver blood tests’. This blood test detects there is something wrong in the liver but this may not necessarily be because of cancer.
If the liver cancer type is a hepatoma it normally produces abnormal amounts of a substance called alpha-feta protein, which can be detected in the blood.

To diagnose liver cancer you will have a scan of the liver with an ultrasound, CT scan or a M.R.I. (Magnetic Resonance Imaging). These tests build up a picture of the liver and show the exact location of the tumour, though they cannot usually tell, if it is a primary or secondary cancer. For a final diagnosis you will usually have a biopsy, which involves the doctor taking a small sample of liver cells, for examination under a microscope. A biopsy will tell the doctor what type of cell is causing the cancer to develop.

How is liver cancer treated?

The type of treatment available will depend on the size and type of the cancer. The treatment of secondary liver cancer depends on where the primary cancer is.

If you have a hepatoma there are a number of treatments available. If the cancer is small it may be removed by an operation. Even if you need to have the majority of the liver removed, it will start to regrow very quickly and could be back to normal size within a month.

If cirrhosis has seriously affected the liver, a liver transplant may be considered. Chemotherapy may be used in the treatment of primary and secondary cancer but it is unlikely that radiotherapy will be used.

If the cause of primary liver cancer is cholangiocarcinomas then it can be very difficult to treat. The first stage of treating this type of cancer is to relieve the jaundice, caused by blocked bile ducts (where this type of cancer forms). Once this has been carried out, the doctor can assess the size and position of the tumour and will hopefully be able to perform surgery. Radiotherapy may also be used to treat this type of cancer.

HEPATITIS A, B AND C.

What is hepatitis?

Hepatitis is an inflammation (being swollen and/or painful) of the liver, an organ which is essential to life. If the liver does not function properly, it can cause serious illness. Hepatitis is usually caused by a virus, but other factors like drugs, alcohol and medications may play a role.

There are several viruses which can cause hepatitis. Letters of the alphabet identify these viruses. The 3 most common types of Hepatitis are Hepatitis A, Hepatitis B and Hepatitis C. All these viruses cause similar problems and have similar symptoms but are spread in different ways and have different effects on your health.

HEPATITIS A

What is hepatitis A?(back to top)

Hepatitis A is a disease of the liver, caused by the hepatitis A virus. Hepatitis A is fortunately quite rare in the U.K. It tends to be more common in countries with poor personal hygiene.

What causes hepatitis A?

It is possible to become infected with hepatitis A through eating or drinking contaminated food or water. The virus spreads easily within families and places where people live in close contact e.g. school institutions. The virus is found in faeces and can be passed on even if a tiny amount of virus comes into contact with a person’s mouth. It is therefore always very important to wash your hands after going to the toilet and before eating. The virus may also be passed on through sexual activity.

Am I at risk from hepatitis A?

The following are factors that could put you at risk of getting hepatitis A: -

• Poor personal hygiene.
• Close personal contact with someone with hepatitis A.
• Swimming in water that may be contaminated.
• Eating food that has been washed in contaminated water e.g. fruit.
• Eating shellfish from seawater that is contaminated.
• Travelling to countries with a high rate of hepatitis A.

What are the symptoms of hepatitis A?

People with hepatitis A may have no symptoms depending on the severity of infection, but can still pass the virus on to others. Possible symptoms may include: -

• Flu-like symptoms (fever).
• Nausea and vomiting.
• Diarrhoea.
• Fatigue.
• Loss of appetite and weight loss.
• Abdominal pain.
• Itchy skin.
• Jaundice (a yellow discolouration in the skin and eyes).

How is hepatitis A diagnosed?

Your doctor may have a feel of your liver from a physical examination and may also carry out a urine test which among other things looks for bilirubin and urobilinogen, if these levels are raised this could indicate the liver is damaged and a sign of liver disease (eg hepatitis,cirrhosis). If these levels are raised and/or the liver feels larger or harder than it should then your doctor may recommend a LFT (Liver Function Test) for more detailed results. A simple blood test is usually carried out to confirm the presence of the hepatitis virus.

Can hepatitis A be prevented?

There is a vaccination available to protect you from hepatitis A for 1 year, a booster can then be given to protect you for up to 10 years. It is important to have the vaccination if you are travelling to parts of the world with a high level of hepatitis A (usually less developed areas such as Africa).
Ask your doctor for advice if you are at all worried about the virus. Once you have had hepatitis A you will develop an immunity to the infection for the rest of your life.

Can hepatitis A be treated?

Hepatitis A usually runs its course within 2-8 weeks, although some people can be ill for up to 6 months. The length of infection is influenced by the age and general health of the affected person. There is no specific treatment for hepatitis A, and it will usually resolve itself. Bed rest, proper nutrition and avoiding alcohol are usually recommended to relieve the symptoms.

What are the long-term effects of hepatitis A?

Most patients make a full recovery from hepatitis A, this type of hepatitis virus is not a serious long-term health problem. There is however, a small chance that hepatitis A will cause long-term damage to your liver, but this is very rare. Once you have had hepatitis A you will not be able to donate blood.

HEPATITIS B (back to top)

What is hepatitis B?

Hepatitis B is very common worldwide and is a very infectious virus, that causes inflammation of the liver.

What causes hepatitis B?

Hepatitis B is usually passed on through unprotected penetrative sex, (where the penis enters the vagina, anus or mouth) or through sex which draws blood. It can also be passed on through sharing contaminated needles, from an infected mother to her baby or from a blood transfusion.

What are the symptoms of hepatitis B?

Hepatitis B can be a silent infection with no symptoms, or it can result in acute hepatitis or chronic hepatitis. Acute means the illness usually only lasts a few weeks, and the liver normally returns to normal. Chronic hepatitis B is a more serious illness and it may last for the rest of your life and cause permanent liver damage. Hepatitis B is called chronic when the illness has lasted longer than 6 months.

The symptoms of acute hepatitis may include: -

• Fatigue.
• Loss of appetite.
• Flu like symptoms (headache and fever).
• Nausea and vomiting.
• Diarrhoea.
• Weight loss.
• Jaundice (dark urine and a yellowish tint to the skin and eyes).
• Itchy skin.

Only a small percentage of people will go on to develop chronic hepatitis and it can have a broad range of symptoms or remain asymptomatic, while other people may become extremely ill. Symptoms of chronic hepatitis B may include: -

• Fatigue.
• Jaundice.
• Gastrointestinal bleeding (stomach and intestines).

How is hepatitis B diagnosed?

Your doctor may have a feel of your liver from a physical examination and may also carry out a urine test which among other things looks for bilirubin and urobilinogen, if these levels are raised this could indicate the liver is damaged and a sign of liver disease (eg hepatitis,cirrhosis). If these levels are raised and/or the liver feels larger or harder than it should then your doctor may recommend a LFT (Liver Function Test) for more detailed results. Hepatitis B can be diagnosed with a simple blood test. The blood test looks for the presence of the hepatitis B virus. If the result of your blood test is positive, you may be referred to a specialist for further tests. These tests are to find out how much hepatitis is affecting your liver.

Can hepatitis B be prevented?

If your partner has hepatitis B a condom should always be used when having sex to prevent them passing the virus on. There is a vaccine available for people who are at a high risk of catching hepatitis B.

Can hepatitis B be treated?

Most people with acute hepatitis will recover and will require no specific treatment, though bed rest and a good diet is recommended. Those people who go on to develop chronic hepatitis are more difficult to treat though some may benefit from a drug called interferon. They will also need to be monitored regularly to detect if any damage is occurring to their liver. If you have signs of severe liver damage you may need to have a liver transplant.

If you are diagnosed as having hepatitis B you should try to limit the amount of alcohol you drink and avoid fatty foods. Most adults once recovered from the hepatitis B virus will develop a life long immunity.

What are the long-term effects of hepatitis B?

In severe cases if a person remains infected with the hepatitis B virus (chronic hepatitis) they may develop complications such as liver cirrhosis (scarring, damage of the liver) or liver cancer.

HEPATITIS C (back to top)

What is hepatitis C?

Hepatitis C as the other 2 viruses is inflammation of the liver. Symptoms of hepatitis C can be easily confused with less serious illnesses. Unfortunately the signs of liver damage may not occur for a couple of decades and by the time the disease becomes apparent liver damage can be considerable and even irreversible.

What causes hepatitis C?

Hepatitis C is present in the blood of an infected person. If infected blood enters another person’s blood stream, that person may then catch the virus. The most common spread of hepatitis C is through sharing needles and syringes. It may also be passed on through sharing razor blades or from an infected person's blood coming into contact with open cuts on another person. There is a very small risk of catching hepatitis C during sex, the risk is greater during menstruation. Another way of catching hepatitis C is through a blood transfusion in a country where blood is not tested for the hepatitis C virus. All blood in the U.K. is tested. On rare occasions hepatitis C can be passed on from a infected mother to her baby at the time of birth.

What are the symptoms of hepatitis C?

Ther are 2 phases of hepatitis C infection, known as acute and chronic. In many cases people infected with acute hepatitis C may not become ill, others may experience the following symptoms: -

• Flu like symptoms (fever).
• Poor appetite.
• Diarrhoea.
• Mild jaundice (dark urine,yellow skin).

When liver inflammation lasts more than 6 months the illness is called chronic hepatitis C. The symptoms of chronic hepatitis C may include: -

• Fatigue.
• Loss of appetite.
• Nausea and vomiting.
• Soreness in the abdomen (under the ribs).
• Pain in the joints.
• Fever.

How is hepatitis C diagnosed?

A simple blood test will confirm if you are infected with the hepatitis C virus. If the blood test is positive you may be referred to a specialist for further tests. These tests are to find out how the hepatitis virus is affecting your liver and could include, a liver scan or liver biopsy.

Can hepatitis C be prevented?

At present there is no vaccine available to stop infection with hepatitis C, though research is being carried out to develop one. However, you can prevent infection with hepatitis C in the following ways:-

• If you inject drugs, always use clean, sterile needles and never share.
• Never share personal items, such as toothbrushes, razors and nail scissors as these can all punture the skin and become contaminated.
• Always clean blood up with bleach and using waterproof gloves.
• Practice safe sex - always use condoms.

Can hepatitis C be treated?

Some people with hepatitis C will get better on their own. However, if you experience recurrent attacks you may be referred to a specialist who will run a number of liver function tests. From the results of these investigations the specialist can decide if you would benefit from treatment. The majority of people with hepatitis C will not require treatment.

What are the long-term effects of hepatitis C?

People who have been infected may continue to carry the virus in their blood and become long term or chronic carriers. It is believed a low percentage of people will develop cirrhosis, which is scarring of the liver, then after a few years some people with cirrhosis may then go on to develop liver cancer.

It is believed that carriers of hepatitis C remain infectious throughout their lives and may be capable of spreading the virus to others.

Because drinking makes hepatitis C worse, people with hepatitis C should either seriously cut down on drinking alcohol or avoid alcohol entirely.

IF YOU ARE WORRIED THAT YOU MAY HAVE A HEPATITIS VIRUS YOU SHOULD VISIT YOUR LOCAL G.U.M. CLINIC OR DOCTOR FOR ADVICE AND IF NECESSARY FOR TREATMENT