FDA recommends the HPV vaccine for men!

Q: My girlfriend just got the HPV vaccine.  Can I get it too?

A: Not yet, but hopefully soon.

Gardisil, the vaccine against HPV (human papilloma virus) that is given to women to prevent certain types of cervical cancer, has been under extensive testing for use in men since it first came out in 2006.  So far, it has been demonstrated to be safe and about 90% effective at preventing genital warts.  Scientists and medical professionals have the hopes that it will also reduce the incidence of anal, penile and throat cancers and help further reduce the incidence of cervical cancer.  Merck & Co, the company which manufactures Gardisil, just met with a panel of experts in the US Food and Drug Administration (FDA) this week and the panel made a recommendation tht the vaccine be administered to males aged 9-26 years.  All that remains now is for the FDA to officially approve their panel’s recommendation.  We’ll keep you posted.

Remember, the only way to prevent HPV infection entirely is by remaining abstinent.  If you are having sex you are at high risk for contracting HPV sometime during your life.  You can lower that risk (but not totally eliminate it) by limiting the number of sexual partners you have and by properly using condoms (and dental dams as appropriate) every time you have sex.  

David Lehnus, CNP (OSU SHS)  

What exactly is vaginal discharge and is it normal?

Q: What exactly is vaginal discharge?

A: Having a small amount of vaginal discharge is normal, especially for young women of childbearing age. Regular everyday vaginal discharge is made up of normal vaginal secretions, skin cells and cervical mucous. The amount of discharge tends to vary with age, menstrual cycle, pregnancy and use of oral contraceptives.  Antibiotics, contraceptives, intercourse, douching and stress can change the quality of vaginal secretions and set you up for a variety of problems. Let’s talk about a couple of causes of abnormal vaginal secretions. Remember, this is just a general discussion; if you have any specific questions or symptoms, be sure to contact your health care provider.  

Yeast Infection (Vulvovaginal Candidiasis)

A yeast infection happens when the normal yeast that lives in the vagina overgrows. Some women get frequent yeast infections for no apparent reason, but it is more likely to happen if you are taking antibiotics, are pregnant, diabetic or stay hot and sweaty for a long time. The discharge caused by a yeast infection is typically white and has the consistency of cottage cheese. Other symptoms include itching, pain, swelling of the vulva or painful intercourse. Some yeast infections can be treated with over the counter medications, but they often require prescription medication for treatment.

Bacterial Vaginosis

This is a very common cause of vaginal discharge. It is usually caused by bacteria called Gardnerella vaginalis. There is some debate about whether or not this infection is sexually transmitted. While women with multiple sexual partners develop it at higher rate, women who aren’t sexually active may also develop the infection. The discharge of Bacterial Vaginosis is typically white, gray or yellow and is associated with a “fishy” odor that is worse after sex.  It too is associated with itching or burning, and a redness or swelling of the vagina or vulva. Bacterial vaginosis is treated with antibiotics.

Chlamydia

This is the most common sexually transmitted infection in the US. Symptoms include vaginal discharge that may be clear or cloudy, burning during urination, pain during sex, fever or pain in the abdomen. Unfortunately only about 30% of women with Chlamydia have symptoms. Untreated Chlamydia can cause scarring of the fallopian tubes which can lead to infertility or ectopic pregnancy in the future. Because so few infected women have symptoms, sexually active women are typically screened with their annual pap smear. Chlamydia infection is easily treated with antibiotics and it is also important that your sexual partners be treated as well. 

Gonorrhea

This is another very common sexually transmitted infection. Gonorrhea can infect the vagina, cervix, fallopian tubes, mouth, throat and even the eyes. Gonorrhea can also spread throughout the body and cause arthritis. Symptoms can include vaginal discharge that is typically colored and thick, burning during urination, fever, sore throat, abdominal pain and joint pains. Like Chlamydia, it can cause scarring of the fallopian tubes and lead to infertility or ectopic pregnancy.  It is also easily treated with antibiotics. Again, your partner must be treated to prevent you from getting re-infected. 

Trichomonas

This infection is caused by the parasite Trichomonas vaginalis. It is spread by unprotected sex with an infected partner. Symptoms may include a watery, greenish or yellowish bubbly discharge, an unpleasant odor, vaginal itching or swelling and burning during urination. This also can be treated with antibiotics and like other STIs your partner must be treated to prevent re-infection. 

So… a vaginal discharge can be completely normal, or a sign of a serious problem.  As you can see, the different causes of discharge will often look the same and cause similar symptoms.  If you develop a new discharge, or if you’ve always had one but it changes in any way, be sure to see your health care provider right away.  The staff at Student Health Services is always happy to help!

Angela Walker, Med IV (OSU COM)

Sheila Westendorf, MD (OSU SHS)

News You Can’t Use – Killer Coconuts and Falling Squirrels

This squirrel could've saved a life!

This is the first in what we hope are many installments of BuckMD’s latest online offering – News You Can’t Use!  We will scour the medical literature to bring you the latest (or completely out of date) medical news that has very little relevance to your life but is interesting, funny, weird and hopefully all of the above.  Today’s topic – killer cocunuts!

In 1984, scientists discovered that falling coconuts in the Pacific Islands accounted for 2.5% of admissions to the hospital in Papua, New Guinea. Said coconuts can weigh up to 10 pounds unhusked and can fall from a perch of up to 115 feet. Four cases of head injury secondary to deadly falling coconuts were described in an article in the Journal of Trauma (1984 Nov;24(11):990-1) including two instant fatalities. Recall from your physics class that momentum is conserved. These researchers have confirmed one of life’s inexorable truths – it is very bad for the momentum of a flying nut to be conserved in your head. 

Thankfully, closer to home here at The Ohio State University falling coconuts aren’t much of a threat.  Falling squirrels, however, are a fairly common event.  We at Student Health Services have managed more than our share of “Rodentia Gravitas” cases, and thankfully they rarely involve anything more serious than a few scratches on the arms and face.  While the injured students often report that they “did not see the squirrel coming,” they quickly get into the habit of searching the skies for signs of falling rodents.

Victoria Rentel, MD (Ohio State Student Health Services)

Are we all drug addicts?

As I grabbed the Dispatch off my front porch yesterday, I was greeted by an interesting headline.  Pfizer, the world’s largest pharmaceutical company, was fined $2.3 billion because of “unlawful prescription-drug promotions.”  Apparently, the corporate giant encouraged its employees to shower doctors with financial perks and other incentives to get them to prescribe their medications for “off-label” indications.  Many medicines are used to treat conditions for which they were not specifically approved by the FDA, but it is illegal for drug companies to market them as such. 

The idea that what medicine we’re prescribed can be determined by something other than pure medical science – especially when that other something looks an awful lot like corporate greed – is infuriating and scary.  But what really struck me about this story is what was behind it… literally.  The entire back page of the front section of the paper was covered with a color advertisement taken out by a local grocery chain who – for a limited time! – is offering FREE 14-day supplies of antibiotics because they “Care About Your Health.”

Free prescriptions!?  How does a store make money by giving away antibiotics?  I’m no marketing guru, but I believe the term is “loss leader”: if you come in for the free antibiotics, the theory goes, you’ll also pick up some laundry detergent or beer or kitty litter and they’ll make a tidy profit.  So why aren’t they giving away free milk, or Oreos (besides the obvious safety concerns over the stampede that would surely ensue)? 

Maybe it’s because you can’t buy antibiotics without a prescription so they don’t have to worry about losing too much money.  Or maybe it’s because the psychological associations we make with medicines are more powerful than the ones we make with Oreos (albeit not by much): on some level we’re all worried that we won’t be able to afford health care when we need it nowadays so the idea of getting vital medication for free really strikes a nerve. 

You could argue that getting people to choose one pharmacy over another isn’t quite the same as promoting the use of a medication in a way it wasn’t intended, but you could also argue that it isn’t all that different either.  Maybe you’re going on vacation next week and you’re already in your doctor’s office for a check-up and hey, it’s free, so you ask for a script “just in case.”  Or you’re prone to urinary tract infections and money is tight this month so you want to get some antibiotics now while they’re free.  Or your doctor tells you that you have a cold and you don’t really need an antibiotic but gives you a script for one to fill now in case it doesn’t get better by next week.  In a real sense, these are all “off label” uses of antibiotics that occur all the time and that can have a negative impact on your health and the health of the community.

My point is this: the grocery store is doing exactly what Pfizer got in trouble for – using financial incentives to influence the behavior of health care consumers in a way that is more about profit than good medicine.  The only difference (besides a few billion bucks, give or take) is that the people getting the perks are the prescribe-ees (i.e. us) as opposed to the prescribers.  Whether that’s a good thing or not is up to you to decide, but either way, a big part of being an educated health care consumer is recognizing that when it comes to your health, there are often forces at work that you may not even be aware of.

John A. Vaughn, MD (OSU SHS)

WOMAN + WOMAN SEX ? SAFE SEX

Many women enter college knowing if they are straight or lesbians, while others may be questioning and enjoy the chance to explore and experiment. Young lesbian, bisexual, and questioning women often assume that sexual activity between two women holds no risk of disease or STI’s. However, there are risks that need to be considered, depending on what you do.

ORAL – Oral-genital sex can put one at risk of Chlamydia, Syphilis, Gonorrhea, HPV, Herpes, and in some cases HIV. Dental dams or cut open condoms can be used as a protective barrier during oral sex. Even household plastic wrap can work, but use a couple layers. (BTW, for the guys reading this, plastic wrap is not recommended for penile sex.  Get a condom.)

ANAL – Oral-anal sex can put the “giver” at risk of Hepatitis A and intestinal parasites, along with the STI’s just mentioned. Latex or plastic barriers are a good idea here, too, along with cleaning the area before you start.

FINGERS AND TOYS – Penetrative sex can include the use of fingers or sex toys, and when used on both the vagina and the anus, can result in bacteria passing from anus to vagina, which can cause a vaginal infection.  This can also spread STI’s . So, wear latex gloves, and cover up your toys with latex gloves or condoms and change to fresh ones when moving from the anus to the vagina, or when sharing between partners.

So have fun, but don’t assume that lesbian sex is equal to safer sex. Take some precautions!

Alison Sauers, BA

Roger Miller, MD for BuckMD

 

Will shaving my head make me bald?

Britney recovered - and so will you!

Q: I lost a bet with some friends and now I have to shave my head. Is it true that it can cause a bald spot?

A: There are lots of rumors surrounding shaving your head. I’ve heard the permanent baldness rumor, as well as the rumor that shaved hair grows back thicker and darker. One look at Britney can tell you that these rumors are both false!

For those of you that need further proof, let’s take a look at the anatomy of hair. Hair grows from the follicle, which resides in the deep dermis. This means that hair must grow several millimeters through the dermis and epidermis to get to the outside of the skin. When you shave, you lop off the hair at the skin surface, leaving several millimeters of hair growing through the dermis. The hair follicle doesn’t even know that the hair has been cut.

Some other hair removal methods can cause hair thinning or baldness. There is some evidence that repetitive plucking or waxing of hair can cause damage to the follicle, which could cause hair loss. In addition, a medical procedure called electrolysis – in which the hair follicle is actually zapped with a small electrical current – can destroy the hair follicle, resulting in permanent baldness. Shaving, however, will not turn you into Mr. Clean for the rest of your life.

Adam Brandeberry, Med IV (OSU COM)

John A. Vaughn, MD (OSU SHS)