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Student Health Service

illnesses

Common Illness Issues

> The Common Cold - The Flu
> Glandular Fever - Infectious Mononucleosis
> Diarrhoea and Vomiting
> Itchy, Painful and Bleeding Bottoms
> Backache
> Acute Soft-tissue Injuries
> Acne
> Warts
> Fungal Infections of the Skin
> Headaches
> Irregular or Absent Periods
> Period Pain
> Vaginal Irritation and Discharge
> Urine Infections
> Sexually Transmitted Diseases
> Acquired Immune Deficiency Syndrome (AIDS)
> Anxiety and Depression
> Sleep Disturbance


The Common Cold - The Flu
There are over 200 varieties of virus which cause the symptoms of a cold and colds come in many different forms. Common symptoms are a running or blocked nose, sore throat, headache and nagging night-time cough. Many patients present the sore throat as the main complaint. In medical jargon, sore throats, colds, flu's and so on have come to be lumped together as 'upper respiratory tract infections' (URTI), with the usual implication that a virus is the cause.

Most people are aware these days that there is no specific treatment for virus infections and there is very little justification for prescribing antibiotics for them in case a secondary bacterial infection occurs. This only seems to ensure that if such a secondary infection happens, it is with a resistant bacterium.

This is not to say that unpleasant symptoms cannot be relieved to some extent. Soluble aspirin (disprin) or paracetamol for pain and fever and a simple decongestant spray or tablet remain very useful. Throat lozenges or gargle can help a sore throat and a dry nagging cough may be improved with a cough syrup. A day or two in bed if you are feeling very much under the weather can help to make you feel more comfortable, but prolonged periods in bed are on the whole of little benefit. URTI generally lasts about 4 days, with the vast majority falling into the range of 2 to 8 days. The dreaded glandular fever (see next section) is only one form of URTI which received perhaps more attention than it deserves.

We occasionally do see complications of URTI such as genuine sinusitis (infection of the air spaces in the bones of the face), middle ear and chest infections, but the vast majority of URTIs can be managed quite happily with a box of tissues, simple remedies and common sense. Most of the time you do not need to visit the Student Health Service.

Glandular Fever - Infectious Mononucleosis
This condition has an undeservedly bad reputation among student sand some information may help to redress the balance. Basically, it is a flu-like illness in which sore throat and enlargement of the lymph nodes in the neck and elsewhere are prominent features. It can vary in severity from mild illness to one which lays you low for many days, even weeks.

A specific virus, the Epstein-Barr virus, is known to be responsible for the illness and, unlike most flu-like illnesses, there is an easily performed specific blood test to confirm the diagnosis. However, confirming the diagnosis is not usually of much help as there is no specific treatment for this or other virus illnesses; and the best that can be done is to relieve some of the symptoms. Regular doses of Disprin or paracetamol are as good as anything else. Antibiotics are of no use in the treatment or glandular fever. Bed rest beyond a few days is not often necessary and being up and about if you feel like it does not harm. It is almost certainly spread in the same way as other respiratory tract infections: by droplets and personal contact.

Unfortunately, in the past the medical profession has managed to convince itself and sufferers in their turn that prolonged fatigue and debility are the norm after an attack of glandular fever. In fact fewer than 1 in 20 people have these symptoms beyond 3 weeks.

Finally, it is best to avoid body contact sports for about six weeks after an attack to avoid damage to the enlarged spleen (an organ tucked up under the left ribs at the side.) Avoidance of alcohol is probably desirable during the acute phase of the illness. Thankfully glandular fever recurs only very rarely (contrary to common belief).

Diarrhoea and Vomiting
If you have never had these symptoms, separately or combined, you must be a rarity. Most of the attacks are probably caused by viruses a sort of intestinal flu-but occasionally they are caused by food poisoning. For practical purposes, cholera and typhoid don't occur in this country, but if you have been overseas shortly before an attack begins, you should tell the doctor in case she or he forgets to ask.

When caused by food poisoning, the common culprits are inadequately cooked sausages and frozen chicken which is not properly thawed before cooking.  These items often contain bacteria and if the core of the sausage or chicken doesn't reach a high temperature for long enough, you may get a dose of food poisoning with your delicious meal. Boiled rice is an excellent culture medium for bacteria and you should think twice about reheating or frying yesterday's rice to have with the leftovers of chicken.

If you do start to vomit, stop everything by mouth for about four hours.No sips of water, no nothing. A previously fit adult will not become seriously dehydrated in this time. Nearly always the vomiting stops during this time as the body rids itself of the offending matter. Then start to have small quantities of water little and often, about 2 tablespoonfuls (30 mls) every 10 minutes or so until your thirst is satisfied.

If this stays down, you can increase the quantities after a few hours and start to eat when you are free of nausea and feel like eating.

If you have diarrhoea alone, stop all solid food, milk and milky drinks and stick to clear fluids such as dilute cordial or flat lemonade, little and often, to satisfy your thirst. Diarrhoea often takes longer to settle and you should stay off solid food until it does. Though you can introduce a bit of variety into the types of fluids you drink, it is generally best to keep to cool clear fluids rather than ice cold or hot drinks.

Vomiting and diarrhea combined are dealt with as for vomiting at first and as the vomiting settles, continue as for diarrhea. If the symptoms last for more than 24 hours in spite of following the above advice, seek medical help.

Itchy, Painful and Bleeding Bottoms
Ive got piles, doctor! may mean that the patient thinks he/she has enlarged bleeding veins in the anal canal (haemorrhoids), but it more usually means I've got something wrong with my backside and can't quite see what it is.  Bleeding, often just blood on the toilet paper, usually means there is a crack in the skin in the anal canal.  Haemorrhoids comes second on the list.  In the student age group it almost never means anything more serious.  The crack or, in medical jargon, fissure, is often painful.  We can often make it less painful while natural hearing occurs.

Much, much more common is itching of the skin surrounding the anus and I am sure we see only a small proportion of all the people with this annoying problem.  The majority are probably too shy or embarrassed to ask us for help. 

For all those embarrassed people, here is what to do. First, get a small mirror and have a look. If you have a red or purplish rash of the skin around the anus (sometimes it extends well onto the skin between the buttocks) you probably have a fungus infection (similar to jock itch at the front).  You will need to see a doctor to get an effective anti-fungal cream.  Not all rashes are caused by fungi so let a doctor have a look at it.  Most people haven't got a rash and the  itching seems to be related to sweat, chafing and poor hygiene.    Cycling adds insult to injury.   Tiny cracks form in the soggy, swollen skin and irritant particles of faeces get trapped.  Then you get into a vicious itch/scratch/itch circle.

Wear loose fitting cotton underwear and avoid tight trousers or jeans. After going to the toilet wipe gently with toilet paper and avoid the temptation to scrub. Follow-up with a wipe using either moist cotton wool or a 'Wet One'.  Pat dry with more toilet paper and follow-up with a very thin smear of a barrier ointment such as Vaseline. Avoid washing with soap. It makes things sting and the perfume often irritates the already inflamed skin. The secret of cure and prevention is meticulous anal hygiene and an appreciation of causes.

This routine does help in the majority of cases.  If you are not in that majority, see the doctor.

Backache
Despite what is often written, the human back is well adapted to an upright posture, but it is not well adapted to lifting heavy weights, being scrunched up in a rugby scrum, being repetitively shock-loaded for mile after marathon mile or being hunched up over a desk for hours on end.

Whatever the cause of a backache, few of them are serious in the student age group. If you do a lot of unfamiliar bending, stooping or heavy lifting, as for example in gardening or furniture moving, you may expect your back muscles to ache for a few days, just like any other overworked muscles. The usual remedies like soaking in a hot bath, lying in a comfortable position and taking a couple of simple pain-killing tablets give a lot of relief.

Unfortunately, study has to go on while the backache gets better, if indeed it is not the cause of the aching in the first place. As exams get closer, tension is added, by the feeling that the aching is making study quite impossible. No permanent damage is done however, so persistence with the study is still the best course.

Prevention is better than cure. Get help when lifting heavy weights and expect trouble if your athletic activities involve bending, stooping, heavy lifting and repetitive loading of the back. When studying, get your bottom right against the back of the chair and sit upright, with a small cushion just above the level of the belt-line to maintain the hollow of the back (it feels strange at first).Get your chair right in under the desk. You can read quite comfortably like this, holding the book upright or propping it up on a heap of other books. You can write with the forearm or elbow comfortably supported and move the paper up the desk as you write, rather than hunching over it.

If you do get backache and simple remedies don?t help, you may have some sort of structural problem, but in your age group, such problems are not very common and you will always be encouraged to try simple things first. X-Ray examination and blood tests are expensive and usually unhelpful. Physiotherapy only directly helps a minority of people with backache. If you do get backache, look on it as a transient nuisance. If it doesn?t get better come and get it looked at.

Acute Soft-tissue Injuries
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We cannot discuss specific injuries in detail here, but there are some general points worth making about soft-tissue injuries such as muscle strains, bruising and ligament strains. Any obviously serious injury should receive expert care as soon as possible, but many less serious ones, can be treated without medical advice or you can start treatment for yourself pending such advice.

The mnemonic is RICE: rest, ice, compression and elevation. Prompt application of ice reduces local swelling and inflammation while the cooling may also allow muscle relaxation and increased range of movement. Ice is best used crushed or flaked and moulded around the part in a thin towel. Alternatively, the part can be immersed in a bucket of iced water. Application of a compression bandage and elevation of the part between icing further discourages swelling.

We would suggest the following routine:

First 24 hours:
Ice for 15 to 20 minutes every three to four hours with gentle stretching provided it does not make the pain worse. Bandage and elevate between icing.

24 to 72:
Ice three times a day with gradually increasing exercise within the limits of pain. Continue bandage and elevation.

After 72 hours
Gradual increase in exercise and stretching, again only within the limits imposed by pain.

Acne
Acne is probably the commonest skin condition seen at the Student Health Service.  The majority of people will have grown out of their acne by their late teens so that on the whole we see only the more severe and persistent cases.  In the past, diet, dirt and grime have been blamed for the condition but it is now known that these have little or nothing to do with its cause.

The primary defect seems to be an inherited tendency for the cells which line the duct carrying oils from the sebaceous glands to the surface of the skin to thicken, thus blocking the duct. There is then a build up of oils which are broken down by bacteria into fatty acids which then irritate the surrounding tissues. There is also a tendency for the oil glands to over produce oil.

 Modern treatment is safe and effective.  It is not necessary to avoid any particular item in the diet nor is it necessary to spend hours scrubbing at the face to remove blackheads.

Treatment is aimed at unblocking the ducts of the sebaceous glands and dealing with infection by the bacteria which invades the oily build-up.

The two main agents applied to the skin to unblock the ducts are benzoyl peroxide and retinoic acid, used alone in mild acne. They may also be used in combination with oral antibiotics in moderate to severe acne. Antibiotics applied to the skin in various preparations are also available.

For exceptionally severe acne which does not respond to any other form of treatment there is available a tablet treatment called Isoretinion which can be highly effective, but has important possible side effects and is only available from skin specialists.

Warts
Warts are caused by a particular virus which stimulates the cells of the surface layers of the skin to divide rapidly.  The appearance of the resulting wart varies depending partly on its location on the body surface.  The most familiar variety of wart is the common wart which is the rough surfaced lump so often found on the hands.  The plane wart is flatter, smoother and only slightly elevated and is most often found on the face.  Plantar warts are found on the sole of the foot and occasionally the palm of the hand and are tender roughened areas often forming a slight pit rather than a lump.  Genital warts are rather different in appearance being softer and forming little cauliflower like lumps.  They will be discussed separately in the section on Sexually Transmissible Diseases.

 As warts are caused by an infective viral agent they can be passed on to other people usually as a result of direct contact.  People's susceptibility to wart virus infection varies considerably however, and many people will never develop warts despite undoubted exposure.  This fact plus the essentially minor nature of the problem makes it unnecessary to take excessive precautions against spread between individuals except in the case of genital warts.

There is a number of wart treatments available but none offer an instant cure and often a few months are required to eradicate a wart. A variety of wart paints can be purchased or prescribed, but in many instances freezing with liquid Nitrogen is the most convenient and effective treatment. At the Student Health Service, liquid Nitrogen is available every Tuesday and no appointment is necessary to see the nurse about this.

Fungal Infections of the Skin
Fungal micro-organisms are present all round us in the natural environment and as normal inhabitants on the skin, but only a few of the thousands of species cause disease in humans. The commonest diseases caused by such fungi are skin infections. These infections have a certain nuisance value but they are certainly not serious.

The most common fungal skin infections go under the general term ?tinea?. A variety of related fungal micro-organisms cause tinea infections in various locations around the body.

1.   Feet ('Athletes foot')
This is the itchy scaly condition so common between the toes, although the sole and sides of the feet may also be affected.

2. Groin ('Jock itch')
This is the itchy scaly rash spreading down the upper inner thigh, well known to most males.

3.   General skin surfaces ('ringworm')
This has a characteristic circular shape with a definite scaly red edge.

4. Hands
This is an itchy dry scaling condition.

5. Scalp
This produces scaly areas of hair loss.

6. Nails
This produces thickening and discolouration of the nail.

Each of these conditions can be relatively easily identified and treated by your doctor using a cream or occasionally tablets.

These fungal infections are mildly infectious and can thus be passed on to other people but this is of little practical concern as it is difficult to control such spread and the conditions are so easily treated.

A less common fungal skin infection is that due to a micro-organism with the exotic name of Candida albicans. This is in fact the ?thrush? organism which so commonly causes minor vaginal infections in women. It can also produce itchy inflammation of the skin usually in sweaty areas such as groin or armpit. Again this minor infection is easily treated.

Headaches
Headache is the commonest symptom of all and almost never has serious causes when it is an isolated symptom though people often have an unspoken worry that it may be a symptom of a brain tumour or some other dreadful disease.

The common causes are having an infection of some sort, migraine and tension. With infections the cause of the headache is usually obvious. With tension, there are usually no other symptoms apart from unpleasant aching in the back of the neck and in the brow, often with a sensation of pressure or squeezing on the top of the head. Coffee, tea and cigarettes make matters worse.

Migraines however, come in all shapes and sizes and sometimes have quite bizarre symptoms. The classical (about 30 percent) type has visual disturbance to begin with, as blurred patches, flashing lights or zig-zag lines, followed by a thumping headache, often one-sided and nausea or vomiting. Sometimes there can be numbness or tingling of the face or limbs, clumsiness, stiff neck, etc. etc.

Many sufferers have close relatives with this condition, recognize it for what it is and suffer in silence. As implied above, there are many atypical forms of migraine and it takes a bit of experience to sort them out. We can often prevent or reduce the number and severity of attacks by appropriate advice and treatment.

What about all the other causes of headaches? Serious diseases such as brain tumours and meningitis are thankfully very rare and most GPs would only see one or two cases in a working lifetime. Nevertheless, it is never a waste of time to have severe and/or persistent headaches assessed medically.

Irregular or Absent Periods
Menstruation begins on average at age 13 but can begin as early as age 9 or as late as age 15. Failure of periods to begin by age 16 is unusual and requires investigation. The average length of the menstrual cycle (the time from the beginning of one period until the beginning of the next) is 28 days but many women regularly have shorter or longer cycles (20-40 days). The average duration of bleeding is 5 days but again women vary greatly in the length and heaviness of their menstruation. Irregularity may have been present since the periods started or may develop later on after years of regular periods. On occasions the periods may stop altogether for months or even longer and this again is usually of no concern, although if the period disappears for more than six months it is usual to perform some screening investigations to exclude a number of rare hormone disorders which can produce this effect on the periods. A not so rare cause of period disappearance is, of course, pregnancy, but this diagnosis should not escape your attention.

Clearly the range of normal menstrual function is very wide and the reason why so many women experience patterns other than the regular monthly cycle is that the hormone balance required to produce regular ovulation and thus regular menstruation is very precise and is very easily upset by a wide variety of extraneous factors. The ultimate control of the hormone levels lies in the hypothalmus of the brain and that part of the brain is itself subject to many influences. Thus emotional stress, changes in daily schedule, changes in environment, and loss of body fat may all affect the hypothalamus and in turn affect the hormone levels controlling the menstrual cycle, producing irregularity or absence of ovulation and thus of a period. A lot of exercise, especially when combined with dieting is the commonest cause among university students.

In summary then, just about anything is possible when it comes to menstrual function and most patterns will fall within the range of normal. If however, periods have not started by age 16 or stop for six months or longer, assessment by your doctor is necessary.

Period Pain
Period pain is an experience common to almost all women. In the vast majority of cases the pain is just the normal consequence of the changes occurring in the uterus (womb) at the time of the month. The pain is typically in the lower abdomen or back and normally starts at or just before the start of the period and continues for 1-2 days. The severity of the pain varies between women and between different periods in the same woman. Those unfortunates who have very painful periods each month appear to produce much more of the prostaglandin hormone which is responsible for the increased activity of uterus during the period. In these women there may also be associated nausea, diarrhea, headaches, and exhaustion.

In a small number of cases, period pain may be due to other causes. A condition called endometriosis is the commonest of these and women with this will usually have painful periods as well as possibly bladder and bowel symptoms with their periods, Painful intercourse can also occur. Endometriosis is important as it can cause damage to the fallopian tubes so you should come and discuss this possibility if you are worried. Such things as an IUD (loop) and infections of the uterus and many rarer diseases can also produce unusually bad period pain, but the cause of such pain will usually be obvious from other associated symptoms of these diseases.

The type of treatment used for period pain will depend on the severity of the symptoms. Most women have relatively mild discomfort and are able to put up with it. More significant pain will often be relieved by a couple of panadol, a hot water bottle, and a rest. When the pain is a real nuisance and a regular event there are now very effective medications available on prescription which prevent the worst of the problem. These medications are taken from the beginning of the period for 2-3 days and act by counteracting the production of the prostaglandin hormone which cause the problem. They are not themselves hormonal. Using the contraceptive pill also usually diminishes period pain, but it isn?t usually used for this purpose alone nowadays.

So the message is don?t put up with bad period pain thinking that it is just a disadvantage of being female, as effective treatment is available.

Vaginal Irritation and Discharge
Vaginal irritation and excessive vaginal discharge are common occasional symptoms for most women. Irritation is always abnormal and denotes the presence of inflammation. Minor vaginal discharge is normal and is part of the self cleansing activity of the vagina. This normal discharge varies in quantity and quality through the menstrual cycle. An excessive discharge may, however, be abnormal and indicate the presence of inflammation.

The most common cause of inflammation within the vagina is infection.  The vagina normally possesses a range of bacterial inhabitants.  These bacteria live in balance with each other and harmony with their human host.  Other micro-organisms, however, can invade the vagina under certain circumstances and provoke an inflammatory response with its resultant irritation and discharge.  Most of the offending micro-organisms are of nuisance value only, but some can cause more serious infection.  Micro-organisms which cause minor infection are Candida albicans (the 'thrush' organism),  Trichomonas vaginalis, and Gardenerella vaginalis.  These infections are very common, not necessarily spread by sexual contact and easily treated.  The more serious infections are those caused by the gonorrhoea bacteria, herpes virus, and Chlamydia organism.  These are relatively uncommon, usually spread by sexual contact, and sometimes more difficult to treat.  They are considered in more detail in the section of Sexually Transmitted Diseases.

For most women it is the thrush organism Candida albicans which is the common problem. This is a yeast which is normally present in the bowel but sometimes invades the vagina. Some women have many episodes of ?thrush? each year, others only one every couple of years, but few are spared altogether. Various factors seem to encourage infection and these include the use of the contraceptive pill and the use of antibiotics. Infection is seldom if ever transmitted sexually although it is commonest in the sexually active. It is easily treated using creams or pessaries.

Finally it is worth noting the non-infective causes of vaginal irritation and/or excessive discharge. Occasionally the cause will be found to be a tampon mistakenly left in the vagina. Excessive attention to hygiene with overuse of strong soaps can set up a chemical irritation. Intercourse can also sometimes provoke inflammation without any infection being present.

Urine Infections
Urine in the bladder is normally sterile, in other words free of any bacterial organisms. Infections with bacteria, when it does occur, inflames the bladder and may on occasions also inflame the kidneys. In young adults urine infection is largely a female problem for the very simple reasons that the female urethra (the passage linking the bladder with the outside world) is considerably shorter than in the male and thus provides easier access for bacteria. There is also no doubt that urine infections become more common for women in their late teens and early twenties and part of the reason for this is that sexual activity does seem to encourage bacteria to migrate up the urethra. In very rare instances there may be more serious underlying reasons why urine infections develop, such as a congenital abnormality of the kidney/bladder system or the presence of a kidney stone.

The symptoms vary depending on whether it is just a bladder infection or a more serious kidney infection. A bladder infection will make you want to pass urine much more frequently than usual although you may struggle to pass more than a drop at a time. Typically there will be a burning sensation at the urethral opening when you do pass urine. There may also be an abdominal ache afterwards. The urine will sometimes contain obvious blood indicating severe bladder inflammation. Very occasionally none of these symptoms occur and the urine is just cloudy with a strong odour.

Kidney infections usually start as a bladder infection so all the above symptoms may be present. In addition, however, there will be backache on one or both sides, a fever and often vomiting.

Bladder and kidney infections are very easily treated by your doctor with antibiotics. There is no point in relying on any home remedies as antibiotic treatment is safe and effective and prevents the occasional serious effects on the kidney of untreated infection.

You can help, however, by increasing your fluid intake and the symptoms may be relieved a little by using bicarbonate of soda to reduce the acidity of the urine and help diminish the stinging. A teaspoon of bicarbonate of soda dissolved in 500 mls of water and taken as a drink hourly for three hours is reasonable. Panadol and a hot water bottle on the tummy may help with any abdominal discomfort

Sexually Transmitted Diseases
These are diseases which are almost exclusively spread by sexual contact. The greater the number of sexual partners you have, the greater will be your chances of acquiring one of these diseases and this should be a powerful disincentive to sleeping around especially as there are no satisfactory treatments for the ?new? diseases such as AIDS and genital herpes.

(1) Gonorrhoea is a bacterial infection. The man usually has a yellow discharge from the penis and burning on passing urine beginning about a week after sexual contact with an infected person. Often the woman has no symptoms, but usually there is an offensive discharge and frequent painful urination. There are many other causes of these symptoms in women but they should be checked, especially if there was a new sexual contact about a week previously. Many cases of infertility can be traced to untreated attacks of gonorrhoea. Treatment of the patient and contacts with antibiotics is effective and simple.

(2) Chlamydia is a common bacterial infection. The symptoms in men are similar to those of gonorrhoea but there are often no symptoms at all in women. Again, many instances of infertility in women are thought to be due to Chlamydia infection so treatment with antibiotics of the patient and partners is necessary.

(3) Genital herpes is a virus infection causing ulcers on the penis or vulva and in the vagina. It is relatively common and is an uncomfortable nuisance rather than a serious problem. It is spread by contact with an ulcer during sexual activity. Between attacks the virus lies dormant in the nerve endings and the disease is not then catching. Unfortunately, attacks recur but seem to get less severe and less frequent as time goes on. There is no effective curative treatment as yet, but the condition gets better on its own over 7 to 10 days, so no sex until the ulcers have completely healed. For those people who get very frequent attacks an anti-viral drug is available which does reduce the attack rate significantly.

(4) Genital warts are usually spread by sexual contact but not always. Again caused by a virus, they have a great nuisance value and, while treatment for them is available, it can be a little tricky to administer. Women who have had genital warts should make sure they have regular cervical smear tests, as some strains of wart virus are strongly associated with abnormalities of the cervix cells which, if untreated, might lead to cervical cancer.

(5)   Public lice (Crabs) cause itching in the pubic region. The lice are often visible, looking like miniature crabs, and the eggs are tiny pearly ovals attached to the hair shafts. Treatment is easy and effective with a special cream or shampoo. As they are caught from the pubic hair of a sexual partner, other STD?s are often caught at the same time and should certainly be looked for.

(6)   AIDS ? see next section

The best prevention for STD is having only one sexual partner. Using a condom during sexual activity is a good second best. Condoms are available by requesting a prescription from the Student Health Service and you do not need to see the doctor to get a prescription.

Acquired Immune Deficiency Syndrome (AIDS)
What it is
Aids is an illness caused by a specific virus.  It is known as human immunodeficiency virus or HIV.  It is not known whether it is a new mutation or whether the virus has been in existence in isolated areas of the world without coming to medical attention.  AIDS was first described in the early 1980's and since then there has been a rapid increase in the number of cases in the western world and a recognition that it is common in other parts of the world, especially sub-Saharan Africa where it is often known as 'Slim'.  It is known that the virus attacks cells in the immune system of the body, causing a breakdown in the body's immunity to otherwise very unusual infections and cancers.  Typically, the body mounts an immune response to the virus which holds it in check for a few years, during which time the patient is often unaware of there being anything amiss though blood tests can show its presence within a few months of infection. 

After a few years, the body's immune system becomes hopelessly weak and the body becomes overwhelmed by infections or unusual cancers. Drugs are now available which suppress the virus, but do not eradicate it. There is no cure for AIDS and no vaccine yet available to prevent it.

 For every person with fully developed AIDS, there are many others who have been infected with the virus and feel perfectly well or who have 'AIDS-related complex (ARC), a stage of relatively minor unwellness on the road to fully developed AIDS.  From what we know at the moment, probably everyone whose immune system gets invaded by the virus will eventually develop the later stages of the disease.  The long period free from symptoms and the slow progression of AIDS makes it a difficult disease to control, as infected 'antibody-positive' people can pass the virus on to others years before becoming aware of their own infection. 

Spread of Aids
HIV has been isolated from practically all body fluids, but the important ones for passing on infection are semen, vaginal secretions and blood. If the infected fluids come into contact with a broken body surface of another person, transmission of the virus may occur. Thus, transfusion of infected blood or blood products, sharing of needles and syringes by infected drug users and sexual activity may all result in the virus passing from one person to another. Because anal intercourse often damages anal and rectal tissue it is very common for HIV to be transmitted this way, but it is still relatively easy to acquire during normal intercourse.

Close to half of all patients in the medical wards of some hospitals in central Africa are infected with AIDS and nearly all got their disease by normal, heterosexual intercourse. While the majority of known cases in the western world at the moment are in homosexuals, many intravenous drug users in Australasia are antibody positive. Roughly half of the intravenous drug users finance their habit by prostitution (male and female) and it is inevitable that the number of infections in ?straight?, non-drug using people will rise in New Zealand. There is no evidence to suggest that AIDS can be spread by normal social activities such as shaking hands, hugging, sharing drinking glasses, or toilet facilities, having someone cough or sneeze in your face or kissing.

Size of Problem
The number of fully developed AIDS cases in the more prosperous countries of the western world is known fairly accurately, but figures for Africa are unreliable. In New Zealand 1,500 cases had occurred by the end of 2000. The World Health Organisation estimates that there are millions of cases in central Africa alone. The number of people who are known to be antibody positive without full-developed AIDS is of course much greater, five to fifty times greater, but only a small proportion of those infected will have yet come forward for testing.

What does this mean for someone living in New Zealand?
If one assumes there are 2000 or more antibody positive cases in four million people, the chances of having a sexual relationship with such a person may seem slight, but if children and other people who are not sexually active are excluded, together with the over-45s in whom AIDS has not yet been reported (over sixty-five percent of the population), then the chances are about 1 in 1000.  Affected people are predominantly young and sexually active.  If you have sex with someone, you put yourself at risk of getting any sexually transmitted disease (including AIDS) that any of his/her partners may have had and that those partners may have had. 

It is quite common, when tracing sexual contacts, to establish a 'family tree' of twenty or more people, and sometimes as many as sixty. 

If you are part of a chain of twenty people, the risk that one of them may be antibody positive of course rises to one in fifty.

Prevention of Spread
It is now no longer possible to be infected with HIV by transfusion of blood or blood products as all donated blood is tested for the virus. Intravenous drug users can protect themselves by not sharing needles and syringes.

Sexual spread can be minimized by limiting the number of sexual partners one has.  The ideal is for both partners never to have had any previous sexual relationship.  Then, as long as HIV hasn't been acquired any other way, both are totally safe, irrespective of what sexual practices are used. 

Condoms provide good but not absolute protection against HIV transmission during vaginal intercourse and should be used if either partner thinks there may be a significant chance of either having an infection. This is not any easy assessment to make, especially in a casual relationship, when judgement is often blurred by alcohol. In any event, people often lie or distort the truth about previous relationships, so the counsel of perfection is to avoid sex or use condoms irrespective of the need for contraception until you are absolutely sure that your new partner?s past has been free from risk.

If you ever have unprotected casual sex, either at a party or with a prostitute, escort girl, masseuse etc.; if you or any of your previous partners have had multiple sexual partners; if you have a partner from another country; if you are homosexual or bisexual practicing anal intercourse, you are at significant risk of acquiring AIDS. It cannot be cured. You can prevent it by following safe sexual practices. You must avoid casual sexual encounters. You need to know about the sexual past of a partner before deciding on a sexual relationship; you can no longer just let it happen.

You should use condoms, irrespective of a need for contraception. If you are not sure whether you have been at risk in the past, discuss it with a doctor who can, if necessary, arrange for confidential blood testing.

Anxiety and Depression
Everyone gets anxious from time to time. Quite a good way to get anxious is to attend lectures and labs, make notes and then not look at them again until a couple of days before an exam, or to do the work for an assignment the night before it is due in. Usually, all this just results in a nasty fright and, if you are a quick learner, a change in study habits.

However, long continued anxiety often leads to an exhaustion of coping power and a constant feeling of tension. Lots of tea, coffee and cigarettes makes matters worse and lots of booze to unwind leads to problems of a different kind. Sooner or later, the constantly anxious person becomes depressed.

Depression can be roughly divided into two kinds. There is the sort where you have an obvious reason to be depressed e.g. a family member has died or you have lost a winning Lotto ticket or smashed your mother?s car. The other type seems to arise from within the person, the co-called endogenous depression. It seems likely that it is due to a specific, imbalance in brain chemistry. Life becomes uninteresting and unstimulating, sleep is fitful and you feel tired and gloomy on waking though things may improve slightly as the day goes on. Appetite is poor. Everything seems too much trouble. You may burst into tears for no reason at all, or at least feel tearful.

 If you feel like this for more than a few days in a row, especially if there doesn't seem to be any cause for it, then seek help, either from a doctor or a member of the Student Counselling Service.  For mild, short-lived depression, simply discussing it with a neutral, uninvolved person may help, particularly if there has been a long-standing anxiety-causing problem in the background.   We may know the ropes much better than you and be able quickly to reach a practical solution to your difficulties.  With a true-blue endogenous depression, however, talk seems to be much less effective and certainly less speedy at bringing about improvement than is medical treatment. This takes the form of anti-depressant tablets. These are not sedatives (though some have sedative side-effects) nor do they lead to addiction. Modern anti-depressant medication usually has few if any side effects.

Sleep Disturbance
Insufficient or poor sleep can be disabling when you need to concentrate during day-time work. The most common problem occurs during exam preparation or during other high-pressure work. Studying late into the evening keeps the mind in high gear, making getting off to sleep difficult. Worry about a forthcoming exam can also make sleep elusive and fitful when it does come.

A vicious circle can easily be established, with poor sleep resulting in poor daytime concentration leading to increasing anxiety which further upsets sleep. Performance and confidence can quickly be reduced.

It pays to stop studying half to one hour before going to bed, using that time to do something relaxing and mentally undemanding . A warm drink may help, but tea, coffee and cocoa contain mild stimulants and should be avoided in the mid to late evening. Relaxing for a few minutes under a warm shower or in a warm bath often helps.

A comfortable bed and well ventilated room are helpful. An alcoholic 'nightcap' is probably best avoided if a hangover is not to be added to your problems. Despite doing all the right things you can still have resistant sleep problems and, while it is not the end of the world, we are in a good position to help people with short-term problems with highly effective modern short-acting sleeping tablets. Intermittent use of such medication seems to be safe and we have little reluctance in helping out occasionally in this way.

Long-term insomnia is more difficult because we accept that medication is not the answer to long-term problems. There are, however, other approaches to such problems and each case has to be assessed individually if the sleep disturbance that often accompanies real depression is to be dealt with appropriately. Coping with long-term problems will often involve the help of the Counselling Service in teaching specific relaxation techniques

Page Content: Bethea Weir