Have you been asked the Five P’s??? – April is STD Awareness Month

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Use protection

Let’s say you are going to Student Health or your private caregiver.  In most cases, they are going to ask you a few questions about your sexual health and sexual practices. These questions are very personal, but they are as important as the questions about other areas of physical and mental health. Your answers are kept in strict confidence. 

So, are you ready to talk about your five P’s?  The five “P”s stand for Partners, Practices, Protection from STDs, Past history of STDs, and Prevention of pregnancy.

Partners

  • Are you currently sexually active? (Are you having sex?)
  • In the past 12 months, how many sex partners have you had?
  • Are your sex partners men, women, or both?

Practices

  • What kind of sexual contact do you have or have you had?
  • Genital (penis in the vagina), Anal (penis in the anus), Oral (mouth on penis, vagina, or anus)?

Protection from STDs

  • Do you and your partner(s) use any protection against STDs? If not, why?  If so, what kind”
  • How often do you use this protection? If “sometimes,” in what situations or with whom do you use protection?
  • Are there other forms of protection that you would like to discuss today?

Past history of STD’s

  • Have you ever been diagnosed with an STD?
  • Have you had any recurring symptoms or diagnoses?
  • Have you ever been tested for HIV, or other STDs? Would you like to be tested?
  • Has your current partner or any former partners ever been diagnosed or treated for an STD?

Prevention of pregnancy (Based on partners noted earlier, conception and contraception questions may be appropriate)

  • Are you currently trying to conceive or father a child?
  • Are you concerned about getting pregnant or getting your partner pregnant?
  • Are you using contraception or practicing any form of birth control?
  • Do you need any information on birth control?

Finally, before you move on to discuss other things with your caregiver, consider:

  • Are there other things about your sexual health and sexual practices that you should discuss to help ensure your good health?
  • Any other concerns or questions regarding sexual health in general?

Student Health Services can offer you expert advice, all the current diagnostic and treatment options, and vaccinations that can protect you long term.  Come see us, and GET YOURSELF TESTED

Roger Miller, MD (OSU Student Health)

Can a wart on my finger spread to my genitals?

common wart

plantar wart

Q: Can a wart on my finger spread to my genital area?

A:  All warts (or “verrucae”) are caused by Human Papilloma Virus (HPV).  On the hands, they’re referred to as common warts; on the bottom of the feet they’re called plantar warts; around the fingernails they’re called periungual warts; on the genitals or around the anal area they’re called genital warts.

Take a deep breath… I know those 3 little letters strike fear in the hearts of all college and grad students, especially those who are sexually active, but there are over 150 distinct strains of HPV and they all prefer certain body parts and skin types.  For instance, HPV-1 has a foot fetish and causes plantar warts while HPV 6 and 11 prefer to hang out in the “junk yard” and cause genital warts. 

So while you technically have HPV on your finger – which I know is creepy to think about – it really likes the neighborhood and has no plans to move down to the “Short North” so to speak.  I know the blogosphere and wiki-land is ripe with people who swear that they got genital warts from fingers (either their own or someone else’s) – and while the mysterious nature of life (and fear of lawyers) preclude me from “never saying never” – the odds of that really happening are extremely small.

On the surface (ha ha) warts seem like a silly thing to worry about, but they can become a serious emotional issue – the thought of being “infected” by anything can make you feel gross and the fact that they are visible and are spread by skin-to-skin contact can make them especially embarrassing and even affect relationships.  But it’s very important to remember that besides the strains of HPV that cause cervical and some other extremely rare types of cancer, warts are only a cosmetic issue.  They are not a threat to your health or the health of your partners, and they almost all clear on their own within a year or two.

And the good news is that if you don’t want to wait that long, there are pretty good treatment options available at the Student Health Center to get rid of them quicker.  I’ll talk about them in my next post, but for now, rest assured that you don’t need to wear gloves every time you go to the bathroom!

All photos: UpToDate.com

John A. Vaughn, MD
Student Health Services
The Ohio State University

IUD Insertion Now Available at the Student Health Center!

managingcontraception.com

What is an IUD?

It is an intrauterine device, also called an IUS (intrauterine system).  It is a t-shaped flexible plastic device inserted into the uterus with 2 strings attached to the bottom of the device that hang into the vagina.

Why don’t more women use the IUD?

The intrauterine device (IUD) is highly effective and widely used by women throughout the world, except in the United States.  Here IUDs are used by fewer than 3% of reproductive-aged women. 

In the 1960s and 1970s the IUD was very popular in the United States.  Due to the defective construction of one IUD – the Dalkon Shield – that was introduced in 1970, there was a high incidence of pelvic infection.  Unfortunately, the Dalkon Shield problem tainted all IUDs and ever since, consumers in the United States have inappropriately regarded all IUDs as a cause of pelvic infection.

Recently there has been renewed interest in IUDs as a reversible, long-acting, and effective contraception.  And with careful screening and technique, the IUD is very safe.

I’ve heard that there are different kinds of IUDs?

There are three IUDs approved by the FDA: the copper IUD (Paragard) and two progestin-releasing IUDs (Mirena and Skyla).  IUDs depend for contraception on the general reaction of the uterus to a foreign object.  In addition, the copper of the Paragard is spermicidal, and the progesterone in the Mirena and Skyla IUDs change the cervical mucus and lining of the uterus.

Why would I choose one IUD rather than another?

The Paragard contains no hormones and lasts for 10 years.  For the first several months after insertion, periods may be longer, heavier or more uncomfortable.

The Mirena works for 5 years and is approved by the FDA to ease menstrual bleeding.  Periods become lighter and less regular and less painful.

The Skyla IUD, approved by the FDA in January 2013, works for three years.  It has a narrower inserter and slighter smaller body.  It may be more appropriate for a woman with a smaller uterus or one who has not had a child.

My friend said that the insertion of the IUD is painful.

You may have mild to moderate pain when the IUD is put in, especially if you have never been pregnant.  Talk to your health care provider about ways to make insertion more comfortable.  You can take Ibuprofen 30 minutes before your appointment to help with cramping.

How do I know if I’m a good candidate for the IUD?

Your health care provider will review your medical history and ask you to have a pelvic exam.  The exam will include tests to rule out cervical cancer and sexually transmitted infection.  This testing is done to lessen the chance of infection at the time of the IUD insertion.   You will want to limit sexual partners and use condoms consistently to avoid pelvic infection with the IUD. 

Are there serious complications with the IUD?

It is possible, although rare, that the IUD could pass through the wall of the uterus during insertion.  The health care provider will know this immediately if it happens. 

The IUD can slip out of the uterus.  Sometimes it comes out all the way and sometimes it comes out only part-way.  You may find the length of the strings becomes shorter or longer, or you feel the plastic of the IUD at the cervix.

And it is possible to develop a pelvic infection.  This is most common during the first three weeks after insertion.

How expensive is the IUD?

The IUD only costs money at the beginning and then you have a 3 or 5 or 10-year method.  You will need to check with your insurance company to see how much of the device and insertion are covered.  The cost is usually between $500 – $1,000.  If you have the comprehensive Student Health Insurance or the Wilce Care Supplemental Insurance, the IUD cost will come out of your $2,000 yearly allowance.

If you have any questions about birth control, come in and talk to the Women’s Services staff at the Student Health Center.  We will help you find the best one for your lifestyle.

Beth Askue, MS, CNP
Student Health Services
The Ohio State University

What STIs can I get tested for at Student Health and which ones are curable?

click to enlarge

Q: Which Sexually Transmitted Infections (STIs) can you test for at Student Health and which ones are curable?

A: If you come to the Student Health Center to get screened for STIs (meaning you don’t have any symptoms or worrisome exposures), we check for the following infections: HIV, Syphilis, Chlamydia, and Gonorrhea

How do we do it?  We draw some blood and have you pee in a cup – it’s as simple as that.  The blood test checks for HIV and syphilis, and the urine test checks for Gonorrhea and Chlamydia.  If you have the Comprehensive Student Health Insurance Plan, STI screening is covered once a year.  If you’re on another insurance plan, check with them about coverage.

There are other STIs out there that we can check for if you have specific symptoms or exposures. 

  • Herpes: The only way to confirm that someone has genital herpes is by taking a swab of an active sore. We can do a blood test for antibodies to the Herpes virus, but they aren’t very helpful; they only tell whether or not someone has been exposed to the virus, which doesn’t necessarily mean that they have (or ever will have) active disease.
  • Hepatitis B&C: We can do a blood test for antibodies to these viral infections if someone is at high risk for acquiring them or if they have been exposed to it, but their incidence is so low in the general population that screening for them isn’t useful or cost effective.
  • HPV: There is currently no screening test for HPV. The annual Pap smear that women receive is kind of an indirect test for HPV exposure since it screens for cervical cancer, which is caused by HPV infection, but in terms of checking for exposure to strains of HPV that cause genital warts, there are no tests. The only way to confirm if someone has HPV is if they develop a visible genital wart.
  • Trichomoniasis: Trich (sounds like “trick”) is caused by a protozoan microorganism called Trichomonas Vaginalis. The infection may not cause any symptoms, but since it’s not as common in the U.S. as other parts of the world, and because it usually does cause symptoms like discharge and itching, we don’t routinely screen for it. We can test for that infection by doing a swab and looking at it under the microscope or taking a culture.

In terms of “curing” STIs:

Trichomoniasis and STIs caused by bacteria – Syphilis, Chlamydia and Gonorrhea – are eradicated with antibiotics.   Once they are treated, they’re gone.

Those caused by viruses on the other hand – HIV, Herpes and Hepatitis – are a different story. There are no “cures” for any of these diseases; while antiviral medications can help manage flare-ups or delay the progression of the diseases they cause, once you’re infected with them they stay with you for life.  As they say in med school: What’s the difference between love and herpes? Herpes is forever!

HPV is a special case. The infection is caused by a virus, and can cause serious long term complications such as cervical, anal and throat cancer, but the majority of people infected with HPV clear the virus on their own and don’t suffer any serious health consequences as a result of having it.

If you have any questions or concerns about STI testing, please make an appointment with Student Health Services – we’re here to help!

John A. Vaughn, MD
Student Health Services
The Ohio State University

Photo: safesexnoregrets.nt.gov.au

Freaked out about cold sore giving girlfriend genital herpes

allsymptoms.info

I just learned about the potential of oral HSV-1 to spread to the genital region, and I feel a little freaked out and worried about my girlfriend of 3 years.  I don’t believe I’ve ever kissed her or performed oral sex anywhere near the time of a cold sore break out, as they are rather infrequent for me (once every 1-2 years), but I have performed oral sex on her several times without protection.  On top of that, she has never had an outbreak of HSV-1 anywhere as far as I know, but what are the chances that I have given it to her, either orally and/or genitally?

More generally, why is genital HSV-1 on the rise? I read that it’s because more college-aged people are performing oral sex these days, so the incidence is increasing. But does this mean that it has always carried the potential to spread to the genitals, or is this a mutation or a new strand of HSV-1? Last, when they say that HSV-1 can spread to the genitals, what sort of probability are they talking about? 

Please give me some more information to help put my mind to rest.

As we covered in a recent post, the old way of thinking about Herpes Simplex Virus – that type 1 (HSV-1) only causes cold sores on the lips while HSV-2 only infects the genitals – isn’t really applicable anymore.  While HSV-1 does prefer to live above the belt and HSV-2 below, both can infect the mouth or genitals.  So unfortunately, you’re right to be a little freaked out.  But let’s go through your questions to hopefully put you at ease.

Why is genital HSV-1 on the rise? Has it has always carried the potential to spread to the genitals, or is this a mutation or a new strand of HSV-1?

Genital HSV-1 is on the rise.  In fact, among sexually active adults, new genital HSV-1 infections are as common as new oral HSV-1 infections[1].  This is especially true for college aged people.  A study done at the University of Wisconsin in 2003 showed that the proportion of newly diagnosed genital herpes infections resulting from HSV-1 increased from 31% in 1993 to 78% in 2001 in college students[2].  A 2011 study involving college students showed that this trend continues; HSV-1 accounted for 78% of female and 85% of male genital herpes infections[3].

This is not because of any new strand of Super Herpes, but because of changing beliefs in what constitutes “safe” sex.  College students report having vaginal intercourse and oral sex at about the same frequency, but the problem is that because they assume oral sex is safer, they are much less likely to use a condom.  While it certainly eliminates the risk of pregnancy, oral sex doesn’t eliminate the risk of transmitting sexually transmitted infections and in fact, increases the risk of transmitting HSV-1 because it is spread by direct contact.  So HSV-1 has always had the ability to spread to the genitals, it’s just getting more of an opportunity nowadays. 

When they say that HSV-1 can spread to the genitals, what sort of probability are they talking about?  What are the chances that you have passed HSV-1 on to your girlfriend, either orally or genitally?

Unfortunately, it’s really impossible to say.  The closest thing to an answer that I could find came from a 2006 study that showed that transmission of HSV-2 can occur pretty quickly in new sexual relationships[4]. In 199 people who acquired HSV-2 genital infection after beginning a new relationship, the median length of the relationship was 3.5 months and the median number of sex acts before transmission was 40.  But the most important finding is that it took a lot longer for participants whose partners told them up front that they had genital herpes to acquire the infection compared with participants whose partners didn’t – 270 days vs. 60 days.  So even though it’s kind of an awkward conversation to have at the beginning of a new relationship, talk to your partner about this stuff – it’s the best way to keep you both as safe as possible.

If you have any questions about HSV or any other sexually transmitted infections, make an appointment to see us at the Student Health Center.  We can answer your questions, take a look at what’s worrying you and perform any necessary lab testing.

John A. Vaughn, MD
Student Health Services
The Ohio State University


[1] Langenberg AG et al. A prospective study of new infections with herpes simplex virus type 1 and type 2. N Engl J Med. 1999;341(19):1432.

[2] Roberts CM, Pfister JR, Spear SJ. Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sex Transm Dis. 2003;30(10):797.

[3] Horowitz , et al. Herpes simplex virus infection in a university health population: clinical manifestations, epidemiology, and implications. J Am Coll Health. 2011;59(2):69.

[4] Wald A et al. Knowledge of partners’ genital herpes protects against herpes simplex virus type 2 acquisition. J Infect Dis. 2006;194(1):42.

I get cold sores a lot. Does that mean I should worry about every little bump below the belt?

C

B

A

I get cold sores every month, which I suppress pretty well with medication.  My concern is that I may autoinoculate and spread it to my genitals; in fact, every time I have a pimple, ingrown hair or tear down there I panic!  How does the appearance of genital Herpes Simplex Virus Type 1 (HSV-1) differ from other more benign conditions? Is it unreasonable to end up at the gynecologist every time one of these other things appears? 

Great questions.  Let’s tackle them one by one.

Is it unreasonable to end up at the gynecologist every time something looks funny down there? 

Absolutely not.  The only way to truly find out what you’re dealing with in these situations is by consulting with an expert whose advice you trust.  Sometimes even your doctor won’t be able to tell by just looking – the same problem can look very different in different people, or even at different times in the same person – so she can do other tests to help you figure out what’s going on.

Can you autoinoculate yourself and spread HSV-1 it to your genitals?

Unfortunately, the answer to this one is yes.  People tend to think of Herpes Simplex Virus 1 (HSV-1) as the “cold sore” virus and HSV-2 as the “genital herpes” virus.  But both HSV-1 and HSV-2 are spread by direct skin-to-skin contact, and either can infect the mouth or genitals.  So if you were to touch a cold sore on your mouth and then touch your genitals, you could theoretically cause an outbreak down there.  The good news is that medication lessens the duration and severity of outbreaks (which tend to decrease in frequency and severity over time on their own anyway), so if you are staying on top of your cold sore outbreaks with suppressive medication, the odds of you doing this are very, very small. 

How does the appearance of genital Herpes Simplex Virus Type 1 (HSV-1) differ from other more benign conditions?

This is a tough one.  Like I said, many conditions that can affect the genitals look like Herpes and sorting them out isn’t always as easy as laying eyes on the situation.  That being said, some of the more common conditions do have typical characteristics.

Folliculitis: is inflammation of a hair follicle (“ingrown hair” or “shave bump”).  It happens when hair follicles are damaged by friction from clothing, a pimple or shaving and then get infected with Staphylococcus Bacteria (“Staph infection”).  They are red, inflamed areas that usually look like a pimple and have a hair in the center of it. They can be treated with anything from warm compresses to antibiotics.

Molluscum Contagiosum: are small, painless bumps that are flesh-colored and usually have a dimple in the center.  They may be red if they get irritated.  They’re caused by a poxvirus and are treated like genital warts caused by HPV.

Herpes: typically appears as a group of red blisters or ulcers.  Unlike molluscum, genital warts and (usually) folliculitis, these lesions are VERY painful and can be preceded by flu like symptoms.

There’s a picture of each of these conditions to the right.  Can you tell which one is which?  (Click to enlarge.  Answers below)

This list is far from complete, and again, no one can make a diagnosis from looking at a picture online, so if something doesn’t look right down there, be sure to see your women’s health care provider right away.  If you are a student at Ohio State, you can make an appointment with our Women’s Services Clinic; they’re always happy to help.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Answers: A = Molluscum Contagiosum, B = Herpes, C = Folliculitis

HIV/AIDS AWARENESS at OSU

http://www.itsyoursexlife.com/gyt/to

Order-It-Yourself Testing

September 27th is National Gay Men’s HIV/AIDS Awareness Day.  As we move into our fourth decade dealing with the HIV virus and the resulting diseases, It is important to consider that HIV is still having a major impact on people’s lives every day.  Gay men and other MSM have played a critical role in educating their community (and subsequently, the rest of the world) about the risks of HIV, ways to prevent transmission, and ways to reach out and assist those living with HIV every day.   

Nationally, there is an ongoing focus on reaching out to everyone at risk, including some who have not had the opportunity to hear the message, including many young people and people of color.  Dr. Kevin Fenton, Director of the National Center for HIV/AIDS at CDC, wrote this post from the White House Office of AIDS policy, and he references many groups that are empowering men to get tested regularly, encourage their partners to get tested, and think about ways to prevent new HIV infections.

Here at OSU, there are ongoing efforts to educate students and assist them with testing options.  The Student Wellness Center recognizes sexual health as one of the critical dimensions of wellness, and offers many resources.  Gustavo Carlos, who serves as a sexpert for the SWC outreach, meets with students weekly to discuss safer sex and answer questions. 

However, there is work still to do right here on campus.  Martez Smith, OSU social work major and member of the AIDS Resource Center Ohio, works with many MSM of color, and is concerned that sexual health and STI prevention messages are not reaching these students.  He is involved in community programs that are reaching out to OSU student organizations to help spread the word. 

Have you ever been tested?  Even if your risk is small, the CDC recommends testing for HIV AT LEAST ONCE.  If you have ongoing risk, then annual testing is in order.  Student Health Services can assist you in many ways, including access to testing, education materials, and access to medical professionals who can counsel you and answer your questions.  Check out our past GYT (Get Yourself Tested) blogs for other pointers.

Get tested.  Know your status.

Roger Miller, MD  (OSU Student Health Services)

 

 

IMPORTANT update for gonorrhea treatment – if you get the drip, you need a shot

As if you needed another reason to practice safe sex, the Centers for Disease Control and Prevention (CDC) just updated their guidelines for the treatment of gonorrhea, an sexually transmitted infection (STI) caused by a bacterium called Neisseria gonorrhoeae.  Gonorrhea is one of the most common STIs in the United States and we see it fairly regularly here at the Student Health Center. 

Gonorrhea is a really smart bug – it has become resistant to every medication we’ve ever used to treat it so we’ve had to keep coming up with new options.  Until now, we’ve been able to use oral antibiotic (one you take by mouth) to treat it, but sure enough, recent trends have shown that our latest option, Cefixime (Suprax), is starting to become less effective. 

So now we’re literally down to our last shot – an injectable antibiotic called Ceftriaxone (Rocephin).  According to the new guidelines, if you get gonorrhea you need to get a single shot of Ceftriaxone PLUS an oral antibiotic, either azithromycin (Zithromax) or doxycycline.

We can test and treat you for gonorrhea (along with other STI’s) at the Student Health Center, so if you are having any symptoms like burning when you pee, lower abdominal or pelvic pain, or a discharge from your penis or vagina, come in and see us ASAP.  

If gonorrhea goes untreated, it can cause serious health problems.  In women, it can lead to chronic pelvic pain, life-threatening ectopic pregnancy, and even infertility.  In men, it can cause epididymitis, a painful condition that may lead to infertility.  Infection also increases the risk of contracting and transmitting HIV.

Although some people have symptoms, most people do not so it is absolutely critical for you to protect yourself from gonorrhea.  If you’ve never had sex, then you’re in good shape.  If you are sexually active, there are some important things you should do to lower your risk of infection.

·         limit the number of people you have sex

·         always and correctly use a condom

·         get screening lab tests to check for STIs once a year (remember, they often don’t have symptoms)

But this (really very serious) public and potentially personal health issue isn’t just about sexual behavior, it’s about medication behavior.  The more we use antibiotics for any reason, the more opportunities bacteria have to adapt and become resistant to them.  So then we have to switch to another antibiotic, then another, then another, until – like we’re facing now with gonorrhea – we run out of options. 

So believe your health care provider when she tells you that you really don’t need an antibiotic for your cold or sore throat – she really does have your best interests at heart.  And if she does prescribe you an antibiotic, make sure you take it as prescribed and until it’s gone.  Leftover pizza can be a great thing; leftover antibiotics never are.

If you want more information about gonorrhea, you can check out the CDC fact sheet, or come in to see us at Student Health.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Get Your GYT On!

Click Picture to link

We use a lot of resources from the GYT (Get Yourself Tested) site, sponsored by MTV and CDC.  This is especially true during STD Awareness Month, which is rapidly coming to a close.  One fairly new item on the site is the GYT Party!   Rest assured, this is not a political party.  It is an interactive website, where you hang out, get some information, and listen in on some cool conversations.   You might even learn something!! 

So, come on, join us at the Party!

GYT PARTY

Good Health! 

Roger Miller, MD (OSU Student Health)

Q: I’ve been exposed! When should I get my STD test?

Get Yourself Tested

Use protection

APRIL is STD AWARENESS MONTH

Students come in on occasion with immediate concerns about STDs, especially after an unprotected sex act, or one in which the protection failed.  Their questions?

  • What STDs could I have gotten last night?
  • When would I get symptoms if infected?
  • How soon can I be tested to know that I’m ok?
  • Can I spread this to another sex partner?
  • When is Emergency Contraception needed, if there is a pregnancy risk?

These are excellent questions, and require some discussion with a healthcare provider.  The reason is that STDs can vary from a few days to several months or more in terms of INCUBATION.  INCUBATION means the time needed from exposure to infection.  Getting tested immediately (or the next morning) may be too early to find the bug when it is first growing, but can tell us about your past risks. 

While testing may need to be delayed or repeated, treatment is often given right after exposure, if a partner is known to be infected with an STD.  This is called EMPIRIC treatment for an exposed partner, and can prevent an STD before it starts.

Final points –

  • While we will strive to address all your concerns on the first visit, there will likely still be some unknowns at the end of your visit.  We will establish a treatment and testing plan that is best suited to your needs.
  • Protection is Prevention if used consistently and carefully.  Most condoms fail because of user errors. 
  • Student Health Services is your healthcare provider in the heart of campus.  Come see us for our caring and expertise.   

Good Health!

Roger Miller, MD  (OSU Student Health)