Stinky Pee

Early in my career, I was preparing to see a patient whose complaint was “strong urine.” What could it mean, I wondered as I stood outside the exam room? Smelly? Dark? Painful? Able to leap tall buildings in a single bound? Strong urine and I have since done battle many times. While primary care providers hear a number of common urinary complaints – pain, weird color and frequency, to name but a few – in my experience, “strong” combined with some variation of “urine” almost always means stinky pee.

What does stinky pee mean? Often nothing major. Let’s start with the benign causes:

  • Foods like asparagus can make urine smell. People who eat mostly vegetables can have a grassy odor to their urine.
  • Vitamins in general can make urine a little stinky (and colorful). B vitamins especially can impart a peculiar odor.
  • Dehydration can make urine smell more strongly of ammonia.
  • Certain medications can give urine a different odor and, like vitamins can cause a change in color. Many commonly used antibiotics change the odor of urine as well.

Certain persistent stinky pee issues might be more serious and require the attention of your primary care provider.

  • Foul-smelling urine, especially when it is associated with pain, frequency, urgency, fever, back pain, or an odd color (rusty, red, pink, purple) should be evaluated. All of these things suggest a bacterial infection somewhere in the upper or lower urinary tract.
  • Musty-smelling urine is quite unusual and can be associated with metabolic and liver diseases.
  • Sweet-smelling urine is sometimes associated with diabetes.
  • Urine with a scent of maple syrup can be associated with a serious metabolic disease with a yummy-sounding name: Maple Syrup Disease. Pancakes anyone?
  • Urine that smells like feces could mean that there’s a connection (called a “fistula”) between the rectum and the bladder or urethra.
  • Some vaginal infections have an odd odor that women tend to notice when they urinate.

Many of these more serious issues have symptoms besides stinky pee, but if you have any questions or concerns, make a “pit stop” at Student Health Services!

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

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:

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

IUD Insertion Now Available at the Student Health Center!

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?

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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


Don’t Drop the Ball this New Year!

Happy New Year’s from Ohio State Student Health Services!

We know many of you probably have big plans for tonight, and those plans probably include alcohol.  While it’s fun to ring in the New Year with a toast or 2, things can get a little dangerous when you overdo it with the booze, especially when you don’t normally drink a lot.

A lot of emphasis is put on the dangers of drinking and driving on New Year’s Eve – which is obviously extremely important – but getting drunk can lead to other kinds of accidents too.  Like having unplanned sex with inadaquate protection, or leaving drunk voice-mails on your ex-boyfriend’s phone, or posting photos on your Facebook page that you really DON”T want your boss/professor to see tomorrow. 

But don’t take it from me, take it from the ultimate authority – Grandma!  On New Year’s Eve, don’t drunk-text your grandma, have a designated driver you can trust, log off of Facebook and back up your birth control!

Student Health Services wishes you a safe and happy 2013!!

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

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




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

Is 5-hour Energy safe in Pregnancy?

5-Hour Energy

wikimedia commons

A sharp-eyed BuckMD reader read our original post on 5-Hour Energy and sent us the following note:

If 5-Hour Energy drinks are no more harmful than coffee, what are the risks of drinking less than a bottle daily during pregnancy?  I have read your site and found nothing specific on risks/side effects during pregnancy.  Are there any risks to the baby?

Good question.  The short answer comes straight from the horse’s mouth.  From the 5-Hour Energy website:

Who should not take 5-hour ENERGY®?

  • Women who are pregnant or nursing.
  • Children under 12 years of age.
  • People diagnosed with phenylketonuria (PKU)

So even though (or more accurately, because) the 5-Hour Energy folks have never had to concern themselves with ensuring that any of the ingredients in their product are safe or actually do anything, they draw the line at selling it to people who are pregnant. 

Like we said in our last post, despite 5-Hour Energy’s promotion of its B Vitamins and medical-yet-natural sounding “energy blend,” the only thing in it that has ever been proven to improve mental alertness is caffeine.  So the question really is, “is caffeine safe in pregnancy?”  And the answer to that question is… maybe.

Some studies have reported an association between caffeine intake and adverse pregnancy outcomes while others haven’t.  These studies are inconsistent because it’s very difficult to control for all the factors that affect a pregnancy, not to mention accurately measure how much caffeine research participants really consumed.  The best we can say is that women who are pregnant or trying to become so should probably limit caffeine consumption to less than 200 to 300 mg per day to reduce their risk of possible adverse reproductive effects

The problem is that because 5-Hour Energy is sold as a supplement and not a medication, the company is not required to disclose their products’ caffeine content.  All it says on its website is that it “contains about as much caffeine as a cup of premium coffee.”  So what does that mean?  According to Energy Fiend, a 12oz Starbucks coffee has 260mg of caffeine while a 10oz Tim Horton’s coffee has 100mg.  So sometimes a cup is more than a cup.

What about the excess of B Vitamins in 5-Hour Energy?  Are they safe in pregnancy?

A can of 5-Hour Energy contains 30mg of B3 (Niacin), 40mg of B6 and 500mcg of B12.  The recommended daily allowance of these vitamins in pregnancy is 18mg of B3, 1.9mg of B6 and 2.6mcg of B12, so one can of 5-Hour Energy gives you way more than you need, especially since you’re more than likely getting enough from your diet anyway.  In general, B Vitamins aren’t dangerous in large amounts because they’re water soluble – once your body has enough, the extra is just excreted in your urine – so other than making your pee more expensive, 5-Hour Energy is unlikely to be dangerous.  However, an excess of Vitamin B3 (Niacin) can produce an uncomfortable flushing sensation.  

When in doubt, talk to your health care provider about anything you’re putting into your body when you’re pregnant or nursing.  If you are a student at Ohio State and have questions about pregnancy planning or other issues related to your reproductive health, you can make an appointment with our women’s services department; they are always happy to help you. 

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

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!


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


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)