infectious disease

Can a wart on my finger spread to my genitals?

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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

Take a trip with SHS

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Gorakhpur, India

Surfer on the Beach

 

Take a trip with SHS!

Student Health Services sees a lot of students with plans to travel internationally, either as part of one of the many OSU Study Abroad opportunities, other travel associated with academic programs, or recreational travel.  Before you grab that passport and head for the airport, here are some healthy pointers:

  • Plan ahead – Most students plan for months or even years to get ready for international travel. Don’t forget to include health matters in those plans. Some vaccines are given in series over months, so start those early.
  • Get your shot records – Updating any incomplete or expired vaccinations from your childhood is an important part of travel preparation.
  • Talk to your health care provider about your trip – This is especially important for those students with chronic illnesses or prescriptions that they plan to continue while traveling.
  • Do your health insurance homework – Are you covered in Caracas? What is your deductible in Denmark? Is there a co-pay for Tetracycline in Timbuktu? Find out how your travel plans will impact your coverage.
  • Visit a travel expert – Our Student Health Services travel providers are ready to address your needs comprehensively, and offer an extensive selection of travel vaccines and medications. If you plan to visit someone else, make sure they are up to date on the changing health situations around the globe. (BTW, SHS is an Ohio Department of Health-certified Yellow Fever Vaccine clinic)
  • Be Patient! – Travel visits usually take a bit longer than a typical visit to the doctor, as each visit includes a thorough review of your health history, a discussion of your destination country’s or countries’ current health and safety conditions, and orders for all necessary medications and shots. Many students also start their vaccines at that same visit, so we would expect that you would be with us 40-60 minutes at a minimum. (All vaccines are recorded on an official International Vaccine Certificate for your convenience.)

Keep in mind, disease exposures can occur on a 3 month excursion across a continent or during a 5 day trip to a beach resort.  So, come see us before you order your Spring Break airline tickets.  Reduce the risk of having your trip to Cabo result in spending the first weeks of Spring Quarter sick from a preventable illness.

Healthy Travels!

Roger Miller, MD and Pat Balassone, CNP (OSU Student Health Services)

 

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

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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

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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.

Can I get the flu from a flu shot?

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fluvaccine.com

Fall Colors

Q: I don’t want the flu shot because it always gives me the flu.  Is it okay not to get vaccinated?

A: Here are a facts to consider:

1. Injected influenza vaccine is an inactivated viral vaccine, meaning that there is no living influenza in the injection.  Therefore, you cannot get influenza from the vaccine.   This is a commonly held misbelief, in part because people commonly get upper respiratory illnesses in the winter months that they attribute to the vaccine.

2. The influenza vaccine is designed to protect against the most likely flu strains to appear in the upcoming season.  Against those strains, the vaccine is 70-90% effective in prevent infection.  If a different strain appears in the community, which is possible, then the vaccine may not protect against that one.

3. Nearly all vaccines can cause a brief period of low grade fever and body aches in the 1-2 days following vaccination, along with some discomfort in the injection site.  The fever and aches are due to your immune system responding to the vaccine (although the absence of these symptoms doesn’t mean the vaccine didn’t work), so in essence, this is a good thing.

All in all, the benefits of this vaccine greatly outweigh the risks.  Come see us if you have more questions, or are interested in getting the flu vaccine.   It is fully covered for those of you on the Comprehensive Student Health Insurance Plan, and several other insurance plans are covering it, too.  

Check out our Events Calendar for upcoming walk-in flu vaccine programs. 

Good Health!

Roger Miller, MD (OSU Student Health Services)

 

Questions about Meningitis Outbreak

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Image of Fungus

Q: I keep hearing about a big meningitis outbreak that has something to do with getting injections at a doctor’s office.  Is this the same as the meningitis we heard about when coming to campus? Does my vaccination protect me?

A: That is a great question.  “Mening”-“itis” refers to inflammation of the meninges, which is the tissue that forms a protective covering for your brain and the nerves in your spine. 

Meningitis is mostly caused by infections.

  • Viral – caused by several types of viruses, is usually less severe, and resolves without antibiotics.
  • Bacterial – caused by a few bacteria, most notably Neisseria mengitidis, which can cause a rapidly progressive and dangerous infection.
  • Parasitic – caused by parasites growing in contaminated water.
  • Fungal – caused by fungus, usually associated with a suppressed immunity.

There are also non-infectious types of meningitis, caused by cancer cells, chemicals, or trauma.

The one on the news lately is fungal meningitis, which was discovered in a number of people who had recently received spinal injections of a particular type of medicine.  The investigation so far is suggesting that the vials containing the medicine were contaminated. 

Fungal meningitis is not transmitted from person to person.  In this outbreak, the only people suspected to be at risk are those who received contaminated injections. 

There are two vaccines that protect us from bacterial meningitis.  Those are the HIB vaccine, which is received by small children, and the Meningococcal vaccine, usually received as a teen or just before college. 

Meningitis starts with a fever and headache, but can progress into severe symptoms including confusion or coma, and can be deadly, depending on the cause. 

If you have concerns about meningitis, or are having symptoms that worry you, come see us for assistance.

Good Health!

Roger Miller, MD (OSU Student Health Services)

 

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

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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

I saw a mouse in my apartment!!

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Mouse Hunter

As fall and winter approach, critters will be looking for food and warmth, and they may end up in our homes.  This might not be so bad, if it was a peaceful coexistence, but mice and rats like to chew holes in your cereal boxes, leave their feces on the floor, and raise their little furry families under your bed. 

So maybe you are an animal lover, and willing to clean up after your new companions.  The other drawback of these uninvited guests is the range of infectious diseases they can carry:

  • Hantavirus
  • Rat-bite fever
  • Leptospirosis
  • And others

Hantavirus is an infection you may have heard about this summer, when 9 cases were discovered among campers at Yosemite National Park in California.  3 of those persons died.  Exposure occurs from exposure to  droppings, urine or saliva.  The illness starts with fever and muscle aches, but can develop into a severe pneumonia. 

SO, what to do?  The CDC offers us some timely advice about rodent-proofing our living environments.

Of course, if you do not own the place you are living, you need to consult with the owners about the ways to keep rodents out. 

Ok, once you are rodent-proof, it is time to clean up their mess.  Cleaning up droppings, urine, and dead rodents requires some special handling:

  • Ventilate the area for at least 30 minutes before you start
  • Use a disinfectant or bleach solution
  • Spray the area involved thoroughly
  • Wipe up with paper towels
  • Wear disposable gloves
  • Place waste in sealed plastic bags and remove to an outdoors garbage can or dumpster

More tips are available at Cleaning Up After Rodents (CDC Website) 

Good Health!

Roger Miller, MD (OSU Student Health Services)

Our flu vaccine has arrived!!

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fluvaccine.com

Don't get lost in the crowd!

Fall Colors

Hey Buckeye students!  Our stock of flu vaccine has arrived and we are all ready to get this vaccine to you conveniently and efficiently.

Remember, Flu shots are very important to prepare you for a Buckeye Winter!  WHY? 

  • Flu season in Ohio usually is from December to April
  • Getting vaccinated any time this fall will help protect you throughout the flu season
  • CDC now recommends EVERYONE over the age of 6 months get a flu shot yearly
  • Have asthma, other lung diseases, or any other chronic illness? Then you have DOUBLE the reason to get this done!

Flu vaccines are designed to match as closely as possible to the strains of flu expected each winter, so the vaccine usually arrives in the community in the late summer/early flu. 

Walk-in (no appointment needed) programs will be held from 2-5:30 PM on our Ground Floor on:

  • October 1, 11, 18, 25, 30
  • November 7, 15

SHS Pharmacy also gives walk-in flu shots from 8:30 – 4:30 Monday through Friday.  No appointment needed!

Scheduled appointments for flu shots are also available by calling 614-292-4321 or online through My BuckMD (requires enrollment at the Health Center).

Our EVENTS Calendar also gives you access to forms that you can review and complete prior to your Health Center visit.

Our Flu Shot program price has been steady at $25 for over 5 years in a row, and have been covered in full by the Comprehensive Student Health Insurance Plan.  This year, other insurance plans may cover this vaccine in full as well. 

  • CHECK WITH YOUR INSURANCE COMPANY TO LEARN ABOUT YOUR COVERAGE

Roger Miller, MD (OSU Student Health Services)

 

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

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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