Tag Archives: Sexually transmitted disease

Straight, No Chaser: STDs – Syphilis, The Great Mimicker

November 19, 2014Genital/Urinary, Infectious Disease, Obstetrics and GynecologyConditions and Diseases, Disease, health, Infection, Men who have sex with men, MSM, Rash, Reproductive Health, Sexually transmitted disease, Symptom, Syphilis, TuskegeeJeffrey Sterling, MD

Today, Straight, No Chaser will present two phrases that you may not have previously heard: The Great Mimicker and MSM, and that means we’re discussing what has historically been a devastating disease: syphilis. Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease between the Americas and Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.

Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…

Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.

Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The microorganism causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
Prevention and Treatment Considerations: Advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. Remember that treating syphilis at any point can prevent the most severe complications that lead to death.
For a historical lesson on what happens with untreated syphilis, review this Straight, No Chaser post on The Tuskegee Experiments.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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The Straight, No Chaser Comprehensive Safe Sex Guide

November 18, 2014Genital/Urinary, Infectious Disease, Obstetrics and Gynecology, Health PreventionAnal sex, Condom, Dental dam, HIV, Human papillomavirus, National Institutes of Health, Safe sex, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This edition of Straight, No Chaser is a keepsake, whether for your own reference or as a conversation piece/teaching guide for others. I suspect that due to the volume and wealth of information contained within, you’ll refer to this post time and again (or so I hope). For additional information, refer to the U.S. Center for Disease Control and Prevention and/or the National Institutes of Health websites.

STAYING STD-FREE
The best ways to stay STI free is to confirm it and then avoid it. If you want to reduce your risk of acquiring HIV and other STIs (sexually transmitted infections) through sexual contact, here are your options.

Abstain from sex.
Be monogamous.
Prove both you and your partner(s) are negative. Get yourself and your partner(s) tested, preferably prior to engaging in sexual activity and subsequently every three to six months, especially if you and/or your partner have more than one sexual partner.
If and once you establish that you’re STI-free, learn how to use condoms and do so every time you have sex.

A special note about protecting yourself from HIV
HIV can be spread by having unprotected sexual contact with an HIV-positive person. “Unprotected” means any vaginal, anal or oral sex without barrier protection, like a condom or dental dam. Some of the ways to reduce your risk of getting HIV through sexual contact include the following:

Don’t have sex. Abstinence is the best way to be certain that you won’t contract HIV. Although HIV is occasionally transmitted in other ways, vaginal, anal and oral sex are the most common ways that HIV is transmitted.
Be monogamous. To be clear, this means you are in a sexual relationship with only one person and both of you are having sex only with each other. For the purposes of contracting HIV, sex includes vaginal, oral or anal sexual activity. Monogamy is optimally effective if you also confirm early and often that both you and your partner are not infected with HIV.
Get yourself and your sexual partner(s) tested: Knowing your own status is important for both your health and the health of your partner. Talking about your HIV status likely will be difficult and uncomfortable, but it’s important to start the discussion BEFORE you have sex.

FRANKLY, “DON’T ASK, DON’T TELL” IS JUST DUMB WHEN IT COMES TO STIs.
This is actually quite simple. No excuses. You need to ask your sexual partner(s) and any possible future partners the following questions.

Have you been tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
When was the last time you were tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
If you’ve been tested, what were the results of your tests?

SAFER-SEX ACTIVITIES
These activities carry no risk of HIV transmission:

Non-sexual massage
Casual or dry kissing
Masturbation (without your partner’s body fluids)
Frottage—also known as “dry humping” or body-to-body rubbing

You can still contract other STIs, like herpes, HPV, or pubic lice (“crabs”) if you have bare skin-to-skin contact with your partner.

CONDOM USE
Here are two questions for both males and females.

Have you ever learned how to safely and appropriately use condoms?
Do you use condoms consistently?

To maximally reduce your risk of getting HIV or other STIs, you must use a new condom with every act of vaginal, anal or oral sex. If you don’t use them for oral but do for vaginal and anal, you have still lowered your risk, just not as much as you could have. Also, you must use condoms correctly, as depicted in the above diagram, to appropriately reduce your risk. Learning correct usage also will keep condoms from breaking or slipping off, which reintroduces the risks.
I also want you to understand that all condoms are not created equal. Latex condoms are highly effective against HIV and other STIs. Do you or your partner have a latex allergy? If so, the next safest condom choice is a polyurethane or polyisoprene condom. Just tell your pharmacist at the drug store that you’re allergic to latex, and s/he’ll take it from there. On the other hand, lambskin condoms do NOT protect against HIV. The particle size of the virus allows it to maneuver and slip through lambskin.
Condoms alone have never been enough. Did you know that you should always use a water-based lubricant when you use a condom for either vaginal or anal sex? I want to restate this: that’s water, not petroleum jelly. Water-based lubricants reduce friction and help keep the condom from breaking. Do NOT use an oil-based lubricant (such as petroleum jelly, hand lotion or cooking oil). Oil-based lubricants can damage condoms, making them less effective.
Both male condoms and female condoms will help protect you against HIV and other STIs. If you’ve learned to enjoy sex with a male condom, you can learn to enjoy it with a female condom or a dental dam. Additionally, there are many of you who have contracted STIs. If you wish to continue to enjoy a variety of sexual activities, learning to use the full range of barrier protection may be a better option for you and your partner than abstaining.
Condoms do not provide 100% protection against all STIs, but you are always safer using a condom than not. You can get certain STIs, like herpes or HPV, from contact with your partner’s bare skin, even if one of you is wearing a condom, but condoms lessen the risk. Take the time to explore and inspect each other if you’re confused or concerned about the possibility of your partner having an STI.
Spermicides only serve the purpose of reducing the risk of becoming pregnant. They are ineffective in preventing contraction of HIV and other STIs. They actually irritate rectal and vaginal walls, in effect increasing the chances of HIV infection should infected fluids come into contact with these areas.

ABOUT SEX TOYS
This is pretty straightforward. Using sex toys can be safe, but think of staying clean and “not sharing.”

It is important that you use soap and water to clean your toys after each use. If the instructions allow for a stronger disinfectant, you may do so.
As a rule, don’t share your toys. The nature of how toys are typically used likely increases the risk of vaginal or anal irritation, which increases the risk for HIV or other STI transmission.
If you “must” share your toy with your partner while still trying to be safe, use a condom on the toy before you use it, and change the condom before your partner uses it.

CIRCUMCISION
We’ve discussed circumcision at length in Straight, No Chaser. (Click here for a dedicated post on circumcision.) There has been ongoing interest and research over the past few years about circumcision and its effect on preventing HIV infection. The bottom line? In 2007, the World Health Organization reported that male circumcision reduced the transmission of HIV by 60% from women to men in three randomized, controlled studies in Uganda, Kenya, and South Africa.
There is much less available data for men who have sex with men and how circumcision might affect HIV transmission through anal sex. In addition, recent studies show that circumcision does NOT protect women from contracting HIV from male partners.
Let’s be careful in interpreting the results of these findings.

Circumcision is only additionally effective when earlier preventative efforts have not been taken. Advocating circumcision is not an appropriate substitute for any of the numerous safety measures and habits previously discussed to reduce one’s risk for HIV and other STIs.
Failure to have a circumcision does NOT increase one’s HIV and other STI risk in the presence of appropriate safe-sex activities.

So there you have it. Knowledge is power. We appreciate that this posting was not balanced by the human decisions and passions that come into place with sexual activity. We recommend that you adopt a posture of “safety first” to create that balance! Good luck, and feel free to ask your SMA expert consultant any questions you may have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Bacterial Vaginosis – No, That's Not a STD

November 17, 2014Genital/Urinary, Obstetrics and Gynecology, Health PreventionBacteria, Bacterial vaginosis, Centers for Disease Control and Prevention, Conditions and Diseases, health, Human sexual activity, Infection, Microorganism, PH, Sexual partner, Sexuality, Sexually transmitted disease, Vagina, Vaginitis, Women's HealthJeffrey Sterling, MD

I try to give you straight talk but never crudely. As I’ve discussed conditions involving the genitalia, I’ve been mindful of the reality that large numbers of you have been affected by sexual transmitted diseases/infections (aka STDs/STIs), and I will always respectful of that consideration. That doesn’t mean I’m sugar-coating your information, it just means I am aware that you’re suffering and concerned by different scenarios.

One of those is bacterial vaginosis. There is an age after which women invariably start discovering that various things they do can disrupt the appearance, smell and content of their vaginal fluid. It’s certainly human nature to wonder if something has gone terribly wrong. Let’s pick up our Doctor-Couple conversation from earlier…
Patient: Yep! I have this grayish/whitish discharge that only happens after sex. And sometimes it itches around there. And it burns when I pee! No rashes or that other stuff, though.
Doctor: Ok. Let’s examine you…

All humans have various microorganisms that normally reside inside us at relatively low levels; different microorganisms inhabit different part of the body. They’ve set up a delicate balance (like an ecosystem, if you will) that, once settled doesn’t disturb us (their hosts) at all. If external or internal circumstances disturb that balance such that one set of organisms is disproportionately affected, overgrowth of the other organisms may occur. Many of you will recognize this as happening when you get a ‘yeast’ infection. It’s also what occurs when you develop bacterial vaginosis (BV). BV is the most common vaginal infection in the U.S. It’s more likely to be seen when you start having unprotected sex with a new partner, have multiple sex partners, are pregnant or douche (therefore, women who are not sexually active can have BV also). By the way, you don’t get BV from toilet seats or swimming pools.

The question everyone always has is “What’s the role of sex, especially sperm, in it?”. That’s asked because BV is often noticed after unprotected sex that includes ejaculation. Here’s where you learn the difference between ‘sexually transmitted’ and ‘sexually associated’. It is unclear what role sex has in the development of BV, but common thoughts include alterations in the pH of the vaginal fluid based on interactions with sperm/semen. It is known that the pH of women become more alkaline (less acidic) after exposure to semen, and that environment produces compounds causing the ‘fishy smell’. Yes, that’s real. We even have a real thing call a ‘whiff test’ as part of making the diagnosis.
The good news is BV is easily treated. The bad news is it needs to be treated, and it can recur even if it’s treated. Remember, it’s just an overgrowth syndrome. There are complications to not getting BV treated, especially if you’re pregnant. This makes it especially important that medication be taken to completion, even though you may feel better prior to that. Male partners do not need to be treated.
So this couple gets ‘off the hook’, even though they may decide to start using condoms. Next we will focus on the risks of various sexual activities. Stay tuned.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Public Health Has Saved More Lives Than Medical Care

April 8, 2014General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, asbestosis, black lung disease, Centers for Disease Control and Prevention, Conditions and Diseases, coronary heart disease, diphtheria, family planning, goiters, homophiles, immunizations, infant mortality, Influenza, measles, motor vehicle collision, pellagra, polio, rickets, rubella, Sexually transmitted disease, silicosis, smallpox, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stroke, tetanus, vaccinationsJeffrey Sterling, MD

When I tell most people I have a degree in public health, the typical response involves an assumption that public health involves caring exclusively for the indigent. I guess if you watched the news you could get that impression as well. Public health is the discipline dedicated to optimizing care for populations. Over the course of my career, I’ve cared for a lot of patients as a physicians, and I’ve actually saved a few lives. However, the work I’ve done as a public health professional has affected millions. The opportunity to work in public health is extremely gratifying.
In fact, according to the Centers for Disease Control and Prevention (CDC), the field of public health has been responsible for adding 25 years to the life expectancy of U.S. citizens over the 20^th century. In this post I’d like to share the “Ten Great Public Health Achievements in the 20^th Century.” Hopefully, this will cause you to reflect on how these discoveries, innovations and habit promotion affect your life and provide you opportunities to live a healthier life. These are being presented in no particular order.

Control of infectious diseases: The combination of hand washing, improved sanitation and appropriate use of antibiotics has saved untold millions. Examples of once prominent diseases being much better controlled include cholera, tuberculosis and even sexually transmitted infections.
Decrease in deaths from heart disease and stroke: The combination of risk modification, symptoms recognition and early treatment has contributed to a reduction in death rates by over 50% in the last four decades.
Family planning and contraceptive services: Innovations include barrier contraception to prevent pregnancy and transmission of HIV and other STDs, pre-pregnancy screening and counseling, promotion of smaller family size, longer intervals between children and the development of prenatal assessment.
Food safety and healthier food production: Food safety has involved reduction in contaminated food sources, better portion control, improvement of nutrition and appropriate components of meals. Fortification of foods has nearly eliminated once prominent diseases such as rickets, goiters and pellagra.
Fluoridation of drinking water: Multiple benefits exists including better infectious control and prevention of tooth decay. It’s estimated to have reduced tooth decay and loss by 40-70% since its inception in the 1940s.
Healthy mothers and babies: It is astounding that infant mortality rates dropped 90% and maternal mortality rates dropped 99% during the last century. The combination of better prenatal care, technological advances and better hygiene and nutrition all have played an important role.
Motor vehicle safety: Seat belts, child safety seats, motorcycle helmets, speed limits, air bags, safer highways and reduction in drinking and driving have all led to substantial reductions in deaths from motor vehicle crashes.
Recognition of tobacco as a health hazard: Today there are more former smokers than current smokers and untold million of lives have been saved since the 1964 Surgeon General’s report on the health risks of smoking.
Vaccinations: It wasn’t long ago in history when epidemics of measles, polio and influenza were killing tens of thousands of people annually. Rubella, tetanus, diphtheria, Hemophilus and other diseases have been brought under control. Smallpox has been eradicated as a disease due to immunizations.
Workplace safety: Elimination of workplace health hazards such as black lung (coal workers’ pneumoconiosis), silicosis, asbestos poisoning and reductions in injuries related to occupational hazards have reduced fatal occupational injuries by approximately 40% in the last 30 years.

These efforts don’t occur by accident and shouldn’t be taken for granted. Public health is a clear example of important, appropriate and effective societal collaboration for the betterment of us all. Next time you see a public health professional, give her or him a pat on the back. More importantly, take the time to review the above listing and be sure you’ve incorporated the items into your life.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

The Straight, No Chaser Comprehensive Safe Sex Guide

December 31, 2013Infectious Disease, Obstetrics and Gynecology, Health PreventionAnal sex, Condom, Dental dam, HIV, Human papillomavirus, National Institutes of Health, Safe sex, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Abstain from sex.
Be monogamous.
Prove both you and your partner(s) are negative. Get yourself and your partner(s) tested, preferably prior to engaging in sexual activity and subsequently every three to six months, especially if you and/or your partner have more than one sexual partner.
If and once you establish that you’re STI-free, learn how to use condoms and do so every time you have sex.

Don’t have sex. Abstinence is the best way to be certain that you won’t contract HIV. Although HIV is occasionally transmitted in other ways, vaginal, anal and oral sex are the most common ways that HIV is transmitted.
Be monogamous. To be clear, this means you are in a sexual relationship with only one person and both of you are having sex only with each other. For the purposes of contracting HIV, sex includes vaginal, oral or anal sex activity. Monogamy is optimally effective if you also confirm early and often that both you and your partner are not infected with HIV.
Get yourself and your sexual partner(s) tested: Knowing your own status is important for both your health and the health of your partner. Talking about your HIV status likely will be difficult and uncomfortable, but it’s important to start the discussion BEFORE you have sex.

Have you been tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
When was the last time you were tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
If you’ve been tested, what were the results of your tests?

SAFER-SEX ACTIVITIES
These activities carry no risk of HIV transmission:

Non-sexual massage
Casual or dry kissing
Masturbation (without your partner’s body fluids)
Frottage—also known as “dry humping” or body-to-body rubbing

Have you ever learned how to safely and appropriately use condoms?
Do you use condoms consistently?

It is important that you use soap and water to clean your toys after each use. If the instructions allow for a stronger disinfectant, you may do so.
As a rule, don’t share your toys. The nature of how toys are typically used likely increases the risk of vaginal or anal irritation, which increases the risk for HIV or other STI transmission.
If you “must” share your toy with your partner while still trying to be safe, use a condom on the toy before you use it, and change the condom before your partner uses it.

Circumcision is only additionally effective when earlier preventative efforts have not been taken. Advocating circumcision is not an appropriate substitute for any of the numerous safety measures and habits previously discussed to reduce one’s risk for HIV and other STIs.
Failure to have a circumcision does NOT increase one’s HIV and other STI risk in the presence of appropriate safe-sex activities.

So there you have it. Knowledge is power. We appreciate that this posting was not balanced by the human decisions and passions that come into place with sexual activity. We recommend that you adopt a posture of “safety first” to create that balance! Good luck, and feel free to ask your SMA expert consultant any questions you may have on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: The Medical Complications and Medication Treatment of Alcoholism

December 23, 2013Toxicology/DrugsAcamprosate, Alcoholic beverage, Alcoholism, Delirium tremens, health, Naltrexone, Neurological disorder, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

There are interesting commonalities of certain drugs like alcohol and cigarettes. One is users that really enjoy them are able to do so for a long time while being oblivious to the growing danger those activities pose. Another commonality is even more so than mentally, when things go wrong physiologically, they really go very wrong.
Possible Complications
Alcoholism and alcohol abuse pose threats to many aspects of your health, including the following.

Birth defects (fetal alcohol syndrome)
Bleeding throughout your digestive tract, including the esophagus (up to and including rupture), gastritis (inflammation of the stomach) and ulcer disease.
Brain cell damage
Brain disorder called Wernicke-Korsakoff syndrome (includes dementia, mental status changes)
Cancer of the esophagus, liver, colon, and other areas
Changes in the menstrual cycle (period)
Delirium tremens (DT’s)
Dementia and memory loss
Depression and suicide
Erectile dysfunction
Heart damage
High blood pressure
Increased risks for behavioral disorders including depression and suicide
Increased risks for sexually transmitted infections (STIs)
Increased risks for trauma, including motor vehicle collisions, violence and head injuries with intracranial bleeding
Inflammation of the pancreas (pancreatitis)
Insomnia
Liver disease, including alcoholic hepatitis, cirrhosis and cancer
Nerve damage
Nutritional deficiencies

Treatment
Medical goals and patient goals are often different and seem to depend on the extent of perceptible injury that has occurred at the time of the decision to quit drinking. Often, patients will want to reduce drinking instead of stopping completely. Continued drinking in moderation is only as viable an option as the patient’s level of alcohol-related level of disease and the patient’s ability to stay limited in consumption and focused toward that goal.
Ideally, abstinence (the complete stopping of alcohol intake) is the goal, and it needs to be the goal if and when the desire to stop drinking is coupled with the presence of significant alcohol-related disease.
As everyone knows, the management of alcoholism requires multiple simultaneous approaches, including family and social networks. It is often the family network that helps the alcoholic come to the understanding that alcohol intake has disrupted his or her ability to function normally. It is a most unfortunate occurrence when this has not occurred prior to the development of significant medical disease. Individuals with alcohol problems are more likely to take the steps necessary to successfully withdraw from alcohol use.
Regarding the medical aspects of alcohol cessation, withdrawal is a very important consideration and is best done in a controlled manner. Components of effective withdrawal address the various medical and mental health considerations reviewed earlier and medical avoidance treatment.
Medical avoidance treatment includes medicine that prevent relapse via various methods, and they include the following:

Antabuse (generic name: disulfiram) is a well known and commonly used medicine that works by producing very unpleasant side effects with virtually any alcohol intake within two weeks of taking the medicine.

Naltrexone (brand name: Vivitrol) is an injectable medicine that works to decrease alcohol cravings.
Acamprosate is a drug that has been shown to lower relapse rates in those who are dependent on alcohol.

This is part of an ongoing series on alcohol use and abuse.

Click here to review the symptoms suggestive of alcoholism.
Additional posts will review a severe form of alcohol withdrawal, delirium tremens (the DTs) and non-medical aspects of treatment.

Feel free to contact your SMA expert consultant if you have any questions on this topic.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Your HIV and STD Risks from Sexual Activities Other Than Intercourse

December 4, 2013Genital/Urinary, Infectious Disease, Obstetrics and Gynecology, Health PreventionAnilingus, Barrier contraception, Condom, Dental dam, HIV, Oral sex, Sexual intercourse, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Today, your sexual IQ goes up, and hopefully your risk for sexually transmitted infections (STIs), including HIV, goes down.
This is the fifth and last post in a series on HIV and AIDS.

For an explanation of what AIDS is, click here.
For an explanation of how HIV is contracted, click here.
For an explanation of the signs and symptoms of HIV/AIDS, click here.
For an explanation of the risk of contracting HIV from specific acts of sexual intercourse, click here.

Here are some terms you should understand.
Rimming: oral-anal contact
Fingering: digital sexual stimulation

Now let’s review.

Performing Oral Sex On A Man

You can get HIV by performing oral sex on your male partner. The risk is not as pronounced as it is with unprotected vaginal or anal sex, but oral sex clearly is a mode of transmitting HIV.
You are also at risk for getting other sexually transmitted infections (STIs), including herpes, syphilis, chlamydia and gonorrhea.
Using condoms during oral sex reduces the risk of contracting HIV and other STIs.
Your risk of contracting HIV from oral sex is reduced if your male partner does not ejaculate in your mouth.
Your risk of contracting HIV from oral sex is reduced if you do not have open sores or cuts in your mouth.

Receiving Oral Sex If You Are A Man

The risk of contracting HIV is less with receiving oral sex than many other sexual activities, but it is still present.
Your risk of contracting HIV from receiving oral sex is reduced if you do not have open sores or cuts on your penis.
Oral sex also presents a risk of contracting other STIs, most notably herpes.

Performing Oral Sex On A Woman

Significant levels of HIV have been found in vaginal secretions, so there is a risk of contracting HIV from this activity, although the risk is not a great with other sexual activities.
It is also possible to contract other STIs from performing oral sex on a woman.
There are effective barriers you can use to protect yourself from contact with your partner’s vaginal fluids. You can use dental dams or non-microwaveable plastic wrap to protect against HIV and other STIs. (According to the Centers for Disease Control and Prevention, plastic wrap that can be microwaved will not protect you—viruses are small enough to pass through that type of wrap.)

Receiving Oral Sex If You Are A Woman

The risk for contracting HIV while receiving oral sex is significantly lower than for unprotected vaginal sex, but it is still present.
It is also possible to contract other STIs while receiving oral sex.
There are effective barriers you can use (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over your vulva to protect yourself from STIs.

Oral-Anal Contact (Rimming)

The risk of contracting HIV by rimming is very low but comes with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming.
You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over the anus to protect against infection.

Digital Stimulation (Fingering)

There is a very small risk of getting HIV from fingering your partner if you have cuts or sores on your fingers and your partner has cuts or sores in the rectum or vagina.
The use medical-grade gloves and water-based lubricants can during fingering eliminates this risk.

If you have any additional questions, please feel free to ask questions or provide comments. I cannot more highly endorse the websites at cdc.gov and the US Department of Health and Human Services.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Your HIV and STD Risks From Specific Acts of Sexual Intercourse

December 3, 2013Genital/Urinary, Infectious Disease, Obstetrics and GynecologyAIDS, Anal sex, Female condom, HIV, Hiv And Aids, HIV/AIDS, Safe sex, Sexual intercourse, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

Let’s be clear that we’re explicitly discussing the types of sexual behaviors that will lead to transmitting HIV and other sexually transmitted infections (STIs). Over the next two days, we will run the gamut of sexual behavior and its implications.
This is the fourth in an ongoing series on HIV and AIDS.

For an explanation of what AIDS is, click here.
For an explanation of how HIV is contracted, click here.
For an explanation of the signs and symptoms of HIV/AIDS, click here.

What I hope to accomplish here is to identify those activities that place you at significant risk for contracting HIV and other sexually transmitted infections (STIs). The take-home message is you really should identify your partner’s health status before you begin sexual activity.
Today we will focus on four types of sexual activity and discuss the risks of each. Let’s start with some terminology.

Receptive sex risks speak to risks to the receiver.
Insertive sex risks speak to risks to the giver.
Bottoming is a way of describing receptive anal sex.
Topping is a way of describing insertive anal sex.

Now, let’s review.

Receptive Vaginal Sex

Vaginal sex without a condom is a high-risk behavior for HIV infection.
HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
If you currently have an STI or vaginal infection, your risk for contracting/transmitting HIV is increased because your tissue will be inflamed. This has nothing to do with the presence or absence of symptoms.
Female condoms protect HIV infection if used correctly. However, the risk still exists for any area exposed and infected (in the presence of an open sore or bleeding, for example).
Barrier birth control methods (such as diaphragms, IUDs and cervical caps) DO NOT protect against STIs or HIV infection. If infected semen or sperm contracts inflamed or otherwise injured vaginal tissue, the risk of transmission/contraction is present.
Birth control pills do not protect against HIV or other STIs.

Insertive Vaginal Sex

HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
Condom use is a critical means of protection against STIs that are present without obvious symptoms. Use condoms with a water-based lubricant every time you have insertive vaginal sex to prevent STIs, including HIV.

Receptive Anal Sex (Bottoming)

Bottoming without a condom provides the highest risk for contracting HIV, more so than any other sexual behavior.
HIV has been identified in pre-ejaculatory semen. “Pulling out” prior to ejaculation may not decrease your risk.
Rectal douching before anal sex can increase your HIV risk. Douching irritates the rectal tissue and can make you more receptive to contracting HIV. Soap and water in a non-abrasive manner are adequate means of cleanliness.
If bottoming, you will best minimize the risk of transmitting HIV and other STIs by always using a water-based lubricant with a latex, polyurethane, or polyisoprene condom. This will help to minimize irritation to the rectum during sex and subsequent transmission.

Insertive Anal Sex (Topping)

Topping without a condom is a high-risk behavior for transmission of HIV and other STIs. An infection may be present. If small sores, scratches or tears are also present, they would provide a ready path of entry and transmission of HIV.
Similarly, those same lesions in your partners rectum could harbor infected cells in blood, feces or other fluid, which, when contacted, could infect you through your penis.

Check back for the next post in this series on HIV/AIDS. It will focus on HIV and STD risks from sexual activities other than intercourse.
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From the Health Library of SterlingMedicalAdvice.com: "When should I be worried about a vaginal discharge?"

November 19, 2013Genital/Urinary, Obstetrics and GynecologyBacterial vaginosis, Facebook, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition), Twitter, WordPressJeffrey Sterling, MD

With the incidence of bacterial vaginosis and sexually transmitted infections, one would think the easy answer would be “always”, but it’s not quite that simple.
Some females normally have a discharge, and part of ‘being worried’ or not is knowing what’s normal for you. Discharges that are foul-smelling, colored, bloody, or accompanying genital rashes or sores should definitely be evaluated. Certainly, new discharges should be evaluated in an effort to help you understand if this is something physiologic or abnormal.
For the full blog on this topic, visit us at SterlingMedicalAdvice.com. Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

Straight, No Chaser: The Sexually Transmitted Cancer

October 18, 2013Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health PreventionAnal cancer, Cervarix, Cervical cancer, Food and Drug Administration, Gardasil, HPV, Human papillomavirus, Michael Douglas, Sexually transmitted disease, Sterling Medical Advice, WordPressJeffrey Sterling, MD

I want to thank my friend and colleague, Dr. Julius Ellis, noted Ob/Gyn physician for contributing to this post. Let’s start this with two simple statements:

Cervical cancer has basically been shown to be caused by an infection.
There soon will be no reason that anyone has to have cervical cancer.

The most common sexually transmitted infection is now caused by the human papillomavirus (HPV). Some of you will recognize HPV as a cause of genital warts. (Secondary syphilis is another cause. This means if you ever develop warts, go get checked immediately.)
Even more importantly, certain HPV strains have been shown to cause virtually all cervical and anal cancers. HPV also causes some cancers of the vagina, penis, and oropharynx (a certain part of the throat—and yes, this is what Michael Douglas was referencing about having obtained throat cancer by performing oral sex).
Let’s address this topic in Q&A format:
1) Am I at risk for HPV? How do you get this?
Everyone having sex or who has ever had sex is at risk for HPV. In fact, nearly all sexually active men and women get it at some point in their lives. HPV is passed on through genital contact, most often during vaginal and anal sex, but also through oral sex and genital-to-genital contact without intercourse. HPV can be passed on between straight and same-sex partners even if and when the infected person has no signs or symptoms.
2) If I get genital warts, will I get cancer?
Not necessarily, but the possibility is high enough that you need to get treated. Most HPV infections actually resolve on their own. It’s the ones that linger that are the concerns.
3) If I do have warts, what increases my risks for these cancers?
Smoking, a weakened immune system, having had many children (for increased risk of cervical cancer), long-term oral contraceptive use (for increased risk of cervical cancer), and poor oral hygiene (for increased risk of oropharyngeal cancer) all increase the risk for developing cancer after an HPV infection.
4) How do I get this and how do I prevent it?
The most reliable way to prevent infection with HPV is abstinence, avoiding any skin-to-skin oral, anal, or genital contact with another. If you are sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the strategy most likely to prevent HPV infection. However, because of the lack of symptoms, it’s hard to know whether a partner is currently infected with HPV. Use of condoms reduces the transmission of HPV between partners, although areas not covered by a condom can still be infected.
The Food and Drug Administration (FDA) has approved two HPV vaccines, branded as Gardasil (for the prevention of cervical, anal, vulvar, and vaginal cancer, precancerous lesions, and genital warts in these areas) and Cervarix (for the prevention of cervical cancer and precancerous cervical lesions caused by HPV). Both vaccines are highly effective, but neither has been approved for prevention of penile or oropharyngeal cancer. And yes, it’s safe and effective as young as age 9, although the Center for Disease Control and Prevention currently recommends vaccination between ages 11–14. You must contact your physician for additional details on these important medications.
5) How do I treat HPV infections?
There’s no treatment for HPV itself, but the problems HPV causes can be treated. We’ll address the two major ones:

Genital warts may be treated topically by you or a healthcare provider. If not treated, they may multiply, go away, or stay the same.
Cervical cancer may be treated by your gynecologist, but be warned: Prevention is best, and early detection gives you the best chance for the best outcomes. Continue those annual exams.

There will soon come a time when all boys and girls are receiving vaccinations at around ages 11–12, and cervical cancer (in particular) will become a rare entity. That only happens if you get your family immunized. The science is in. There’s no good reasons left to wait.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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Straight, No Chaser: The Sexually Transmitted Disease Summary and The Week In Review, Sept. 29th, 2013

September 29, 2013Infectious Disease, The Week In ReviewAIDS, Bacterial vaginosis, Chlamydia infection, Conditions and Diseases, Disease, Gonorrhea, health, Herpes, HIV, Safe sex, Sexually transmitted disease, Straight No Chaser (composition), SyphilisJeffrey Sterling, MD

Based on your responses to the pictures posted this week, I should have renamed the blog, Scared Straight, No Chaser. The irony of it all is without exception, those pictures were very typical representations of the various sexually transmitted infections (STIs). Some of you didn’t like it, but I do appreciate that large numbers of you read it all. I hope you learned a lot and even more importantly were moved into (in)action. In case you missed anything:

On Sunday, we began the week with a look at bacterial vaginosis (BV), which may be associated with sex but is not an STI. It’s important for women to take an active effort to learn their bodies and the effects various activities have. Remember, BV is easily treated, but it’s always fair to take the opportunity to ensure that STIs aren’t also present.

On Monday, we reviewed the most common bacterial STI, chlamydia. Chlamydia is a really typical disease in that it’s contagious, easily transmitted and has substantial complications if not treated.

On Tuesday, we reviewed gonorrhea, which very often occurs in tandem with Chlamydia. Like chlamydia, it’s contagious, easily transmitted and has substantial complications if not treated. Think of gonorrhea when copious discharge is present, and don’t forget this includes the eyes, throat and joints.

On Wednesday, we reviewed the various stages of syphilis. This easily treatable yet very dangerous disease has the nasty habits of mimicking many other disease and spontaneously disappearing – which is not the same as it being cured. Instead, it progresses to more harmful stages if not identified and treated. Remember the association of syphilis with rashes involving the palms and soles.

On Thursday, we reviewed the treatment of syphilis. It is so important to understand how easily this is treated, so get checked. We also reviewed the story of the Tuskegee Experiment of Untreated Syphilis and how that (unethically) led to the knowledge we have about syphilis and the mandatory protections now in place for humans participating in medical experiments.

On Friday, we reviewed herpes. Many were shocked to learn these groups of small blisters (vesicles) can be found wherever an infection occurs, including the fingers, eyes and mouth. Think of herpes when you get a painful genital ulcer, and get checked ASAP.

On Saturday, we discussed the cauliflower ear, a too common, very preventable and apparently sought after (by certain athletes) condition seen in those with trauma to the ear. The trauma results in the accumulation of blood and clots, which damages and deforms the ear into its prototypical appearance. This leads to a life of pain and deformity.

Here are three final considerations on sexually transmitted infections.

1. They all tend to coexist. Your exposure to one places you at risk for acquiring others, including HIV/AIDS. What you don’t know can hurt you; in fact it can kill you.

2. Remember that until your partner is treated, you’re not treated.

3. Most of these diseases lead to conditions that physiologically make acquiring HIV/AIDS more likely. I didn’t discuss HIV/AIDS this week because it’s involved enough that it is its own topic with several different considerations. We’ll address these another time.

If you’re not prudent enough to practice safe sex, please be diligent enough to get tested and treated based on any suspicion. Even better – do both. The life you save will be your own.

Straight, No Chaser: Syphilis Prevention, Treatment and the Tuskegee Experience

September 26, 2013Genital/Urinary, Medical Treatment, Obstetrics and Gynecology, Public Health, Health PreventionAfrican American, health, Human papillomavirus, Limited liability company, Monogamy, Penicillin, Powered, Sexual partner, Sexuality, Sexually transmitted disease, Sterling, Straight No Chaser (composition), Syphilis, Tuskegee, United States, United States Public Health Service, WordPressJeffrey Sterling, MD

Syphilis should be a word derived from something meaning horrible. In an earlier post, we reviewed the rather horrific progression of the symptoms of syphilis. An additionally horrible consideration is that treatment is so very easy once identified. Of course, that’s not the most horrific aspect of the disease. Read on.
Looking back retrospectively, advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. However, as discussed in the post discussing the symptoms of syphilis, remember that treating syphilis at any point can prevent the most severe complications that lead to death. Which brings us to Tuskegee – and keep in mind this is Straight, No Chaser.
In the early 1930s, the US Public Health Service working with the Tuskegee Institute in Alabama began a study to evaluate the effectiveness of current treatments for syphilis, which at the time, were thought to be at least as bad as the disease. The study was conducted on 600 Black men, who were convinced to participate in the study with the promise of free medical exams, meals and money for burial, ‘if’ it was necessary.
The study was initially meant to last 6 months, but at some point a governmental decision was made to continue the study and observe the natural progression of syphilis until all subjects died of the disease, with a commitment obtained from the subjects that they would be autopsied ‘if’ they died. There were several problems with this decision.

None of the patients participated under informed consent. They believed they were being treated as opposed to being observed and having medicine withheld while they were being allowed to die. In other words, the subjects were not aware of the purpose of the study.
Penicillin was established as a true, rapidly effective treatment for syphilis and the standard of care by 1947. The study continued 25 years beyond this treatment option being available.
Efforts by concerned individuals failed to end the study for 5 years prior to a whistleblower going to the press in 1972. The study was ended in a day.

The aftermath of the study includes the following:

Reparations averaging a mere $15,000 per individual were given ($9M total) as well as a formal apology, delivered by President Clinton. Yep, the victims received the equivalent of $15,000 per person on average for 40 years of carrying syphilis 25 years after there was a known cure, after infecting wives and unborn children in several documented cases.
Strict requirements for protocols for human study (i.e. Institutional Review Boards) were implemented for the first time.

It shouldn’t surprise anyone that many African-Americans remain distrustful of governmental public health efforts to this day; for many, this study continues to be the reason while vaccination isn’t optimally taken advantage of (e.g. HPV) and why organ donation rates are so relatively low in the African-American community. Even though this posture contributes to the adverse health outcomes that exist in the African-American community, it isn’t hard to see why the fear and distrust exists.
Let’s bring this full circle. When it comes to syphilis, prevention is best, and full treatment is available. At the very least, I certainly can say you’ve been warned. Folks have given their lives to make your warning possible. I welcome your questions and comments.
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Straight, No Chaser: Syphilis – The Great Mimicker

September 25, 2013Genital/Urinary, Obstetrics and GynecologyConditions and Diseases, Disease, health, Infection, Men who have sex with men, MSM, Rash, Reproductive Health, Sexually transmitted disease, Symptom, SyphilisJeffrey Sterling, MD

Today, you will learn two phrases that you may not have previously heard: The Great Mimicker and MSM. Regarding another word you definitely should know, I’ll touch on it and will save for a separate post: Tuskegee.
Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease from the Americas to Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In the first part of this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.

Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…

Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.

Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The bacteria causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
All of the pictures in this posts are typical representations of the various stages of syphilis, and I’ve seen them all. These are not meant to provide any shock value other than demonstrating what occurs with progression of the disease. Later, I will discuss treatment, risks and other considerations. I don’t think you’ll want to miss the rest of the story. That really is shocking – and horrible.
Feel free to offer comments or ask questions.
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Straight, No Chaser: Gonorrhea (No Clapping)

September 24, 2013General Health and Wellness, Genital/Urinary, Infectious Disease, Obstetrics and GynecologyCenter For Disease Control and Prevention, Chlamydia infection, Dysuria, Gonorrhea, Human sexual activity, Pelvic inflammatory disease, Sexually transmitted disease, WordPressJeffrey Sterling, MD

Some of you are old enough to remember when Gonorrhea was called ‘The Clap’, but do any of you know why it was called that? Read on for the answer. In the meantime, realize how disgusting a disease this is. The Center for Disease Control and Prevention (CDC) estimates that well over 800,000 cases of gonorrhea occur yearly. To make matters worse, have you heard about the new ‘Super Gonorrhea’? Don’t let this happen to you.

Here’s what I want you to know about Gonorrhea:

1. It’s a real good reason to wear condoms and a just as good of a reason to wash your hands. Gonorrhea most commonly presents with no symptoms (more often the case in women), but it has two symptoms that won’t let you forget it. It’s the STD that may present with burning upon urination so severe that you feel like you are peeing razor blades. It’s also defined by copious discharge. If you’re exuding white, yellow or green pus, think gonorrhea. As was the case with Chlamydia, it can affect the rectum (proctitis) or a portion of the testicles (epidydimitis), as well as the throat or eyes. Wash your hands after using the bathroom, gents.
2. It’s contagious. If you’re sexually active with someone infected, odds are you’ll get it. It can be acquired via oral, vaginal or anal sex, and ejaculation isn’t required for transmission. Even worse, that means you can pass it to your newborn child (There’s even a name for the condition: ophthalmia neonatorum, as seen in the lead picture.).
2. Treatment doesn’t prevent you from reacquiring it. If you don’t change the behavior, you won’t change the future risk.
3. If both partners aren’t treated, then neither is treated. This can just get passed back and forth like a ping-pong ball. If you have several sexual partners, you’ll manage to introduce a lot of drama into a lot of lives. If you are treated, you should not engage in sexual activity until one week after your partner has completed treatment.
4. It causes serious complications. PID (pelvic inflammatory disease – a complication of untreated Gonorrhea and Chlamydia) is a serious enough topic to warrant its own post, but untreated infections lead to infertility and an increased rate of tubal (ectopic) pregnancies. Gonorrhea also spreads through the blood and joints. Many of these complications are life-threatening.
5. STDs hang out together. Gonorrhea that goes untreated increases the chances of acquiring or transmitting HIV/AIDS. An infection with Gonorrhea should prompt treatment for other STDs and testing for HIV. It is generally assumed that if you have gonorrhea, you’ve likely been infected with Chlamydia.
6. It is easily prevented and treated. Wear condoms each time, every time. Get evaluated early with the development of signs or symptoms. Discuss the discovery of Gonorrhea with all sexual contacts from the last several months. This is an infection you don’t have to catch.
7. It is now super, but not in a good way. Due to antibiotic resistance, treatment of gonorrhea is becoming more complicated. We are seeing more patients who don’t respond to the first course of treatment. Consider antibiotic resistance if symptoms persists more than three days after completion of treatment.

Now, about The Clap.

Traditionally, there have been three theories about why gonorrhea is called the clap, only one of which sound legitimate to me.
1. Treatment (allegedly) used to involved ‘clapping’ a book together around the penis to expel the discharge. Not only does that not make sense, I can’t imagine men letting someone smash their penis in that manner, when you could just ‘milk’ the discharge out (no pun intended). This is a very common explanation, though…
2. The clap may be a mispronunciation of the phrase ‘the collapse’, which is what gonorrhea was called by medics when GIs were being infected with gonorrhea in WWII.
3. Finally, perhaps, clap is derived from the French word for brothel, ‘clapier’. Makes sense if you’re in Paris, but in NY, why wouldn’t it have been called ‘the broth’, because that’s kind of how it looks… Sorry if you’re reading this during lunch. Then again, I did spare you a picture of genital gonorrhea.
Let me know if you have any questions or comments.
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Straight, No Chaser: The Most Common STD – Chlamydia

September 23, 2013Genital/Urinary, Medical Treatment, Obstetrics and Gynecology, Health PreventionChlamydia infection, Dysuria, Gonorrhea, Human sexual activity, Infection, Non-gonococcal urethritis, Pelvic inflammatory disease, Sexually transmitted disease, WordPressJeffrey Sterling, MD

For most people, NGU isn’t a college in South Carolina. In fact, non-gonococcal urethritis isn’t really even that anymore, meaning it doesn’t need to be defined by the fact that it’s not gonorrhea. Chlamydia (the most common cause of NGU) by itself causes an estimated 3 million sexually transmitted infections a year. It is the most likely reason you’re coming into the emergency department when someone’s been behaving badly.
Here’s what I want you to know about Chlamydia:
1. It’s a real good reason to wear condoms. Chlamydia most commonly presents with no symptoms but may present with burning with urination, having to go more often (that’s the urethritis; the urethra is the tube through which urine flows) and a cloudy discharge. Less commonly, it can affect the rectum (proctitis) or a portion of the testicles (epidydimitis).
2. It’s contagious. If you’re sexually active with someone infected, odds are you’ll get it. It can be acquired via oral, vaginal or anal sex, and ejaculation isn’t required for transmission. Even worse, that means you can pass it to your newborn child (to disastrous effects to the baby, as noted in the lead picture of the newborn; Chlamydia has long been a significant cause of blindness worldwide, though thankfully the rate is decreasing).
2. Treatment doesn’t prevent you from reacquiring it. If you don’t change the behavior, you won’t change the future risk.
3. If both partners aren’t treated, then neither is treated. This can just get passed back and forth like a ping-pong ball. If you have several sexual partners, you’ll manage to introduce a lot of drama into a lot of lives. If you are treated, you should not engage in sexual activity until one week after your partner(s) have completed treatment.
4. It causes serious damage to females. PID (pelvic inflammatory disease – a complication of untreated Chlamydia) is a serious enough topic to warrant its own post, but untreated infections lead to infertility, an increased rate of tubal (ectopic) pregnancies and other complications. This needs to be identified and treated.
5. STDs hang out together. Chlamydia that goes untreated increases the chances of acquiring or transmitting HIV/AIDS. An infection with Chlamydia should prompt treatment for other STDs and testing for HIV.
6. It is easily prevented and treated. Wear condoms each time, every time. Get evaluated early with development of signs or symptoms. Discuss the discovery of Chlamydia with all sexual contacts from the last several months. This is an infection you don’t have to catch.
Let me know if you have any questions or comments.
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Straight, No Chaser: Bacterial Vaginosis – No, That's Not an STD

September 22, 2013Medical Treatment, Obstetrics and Gynecology, Public Health, Health PreventionBacteria, Bacterial vaginosis, Centers for Disease Control and Prevention, Conditions and Diseases, health, Human sexual activity, Infection, Microorganism, PH, Sexual partner, Sexuality, Sexually transmitted disease, Vagina, Vaginitis, Women's HealthJeffrey Sterling, MD

I try to give you straight talk but never crudely. Therefore as I wade into conditions involving the genitalia, I’ll be sure to respect various sensitivities. That doesn’t mean I’m sugar-coating your information, it just means I am aware that you’re suffering and concerned by different scenarios.
One of those is bacterial vaginosis. There is an age after which women invariably start discovering that various things they do can disrupt the appearance, smell and content of their vaginal fluid. It’s certainly human nature to wonder if something has gone terribly wrong. Let’s pick up our Doctor-Couple conversation from earlier…
Patient: Yep! I have this grayish/whitish discharge that only happens after sex. And sometimes it itches around there. And it burns when I pee! No rashes or that other stuff, though.
Doctor: Ok. Let’s examine you…
All humans have various microorganisms that normally reside inside us at relatively low levels; different microorganisms inhabit different part of the body. They’ve set up a delicate balance (like an ecosystem, if you will) that, once settled doesn’t disturb us (their hosts) at all. If external or internal circumstances disturb that balance such that one set of organisms is disproportionately affected, overgrowth of the other organisms may occur. Many of you will recognize this as happening when you get a ‘yeast’ infection. It’s also what occurs when you develop bacterial vaginosis (BV). BV is the most common vaginal infection in the U.S. It’s more likely to be seen when you start having unprotected sex with a new partner, have multiple sex partners, are pregnant or douche (therefore, women who are not sexually active can have BV also). By the way, you don’t get BV from toilet seats or swimming pools.
The question everyone always has is “What’s the role of sex, especially sperm, in it?”. That’s asked because BV is often noticed after unprotected sex that includes ejaculation. Here’s where you learn the difference between ‘sexually transmitted’ and ‘sexually associated’. It is unclear what role sex has in the development of BV, but common thoughts include alterations in the pH of the vaginal fluid based on interactions with sperm/semen. It is known that the pH of women become more alkaline (less acidic) after exposure to semen, and that environment produces compounds causing the ‘fishy smell’. Yes, that’s real. We even have a real thing call a ‘whiff test’ as part of making the diagnosis.
The good news is BV is easily treated. The bad news is it needs to be treated, and it can recur even if it’s treated. Remember, it’s just an overgrowth syndrome. There are complications to not getting BV treated, especially if you’re pregnant. This makes it especially important that medication be taken to completion, even though you may feel better prior to that. Male partners do not need to be treated.
So this couple gets ‘off the hook’, even though they may decide to start using condoms. Unfortunately, some of the next sets of couples aren’t so lucky.
I welcome any questions or comments.

Straight, No Chaser: The Doctor/Patient Sexually Transmitted Disease (STD) Talk

September 21, 2013Infectious Disease, Public Health, Health PreventionGonorrhea, health, Herpes simplex, Human papillomavirus, Human sexual activity, Safe sex, Sexuality, Sexually transmitted disease, Syphilis, VaginaJeffrey Sterling, MD

As an emergency physician, my first consideration is to eliminate life threats. Along the way, I cure disease and provide a ton of information. With all of these efforts, I provide a heavy dose of tough love and straight talk meant to empower (and hopefully never belittle). This is heavy on my mind because this week we’ll be discussing sex – not the pleasant aspects, but those instances when something has gone wrong as a result of sex.
I’ve been on the receiving end of hundreds (more likely thousands) of couples coming in, usually one dragging the other by the ear, attempting to determine if “something’s going on”, and yes, more than a few relationships have left the emergency room dissolved after such conversations. I would like to have the beginning of such a conversation with you much in the way that I might have with one of these couples. This is a very appropriate prelude to a conversation about sexuality transmitted infections (aka STIs aka STDs).
Patient: I have a foul smell coming from my vagina. I know he’s doing something!
Doctor: Can you tell me what it smells like? Is there any vaginal discharge, rash or other lesions that you’re seeing?
Male partner (who would have been better off saying nothing): It smells like fish!
Patient (after shooting eye lasers at her partner): I am not having sex with anyone but him, so I know he did something!
Male partner: Doc, I’m not doing anything. She’s the only one I’m with, and I don’t have any symptoms.
Doctor: So each of you only has each other as a partner?
Couple: <nods yes>
Doctor: Would you bet your lives on it?
Couple: <Stunned silence>
Doctor: Well that’s exactly what you’re doing every time you’re having unprotected sex. Now about that discharge…
This upcoming week we are going to address 5 of the 6 most common and/or most important STIs out there for you to know about.

Chlamydia

Gonorrhea

Syphilis

Herpes

HIV

Not talking about them, not protecting yourself from them, and not testing yourself for them is truly believing that ignorance is bliss. In this case, what you don’t know can kill you. No matter what you think about how ‘good’ it is, it’s not worth risking your life over. Also, as an additional conversation, I’ll discuss Bacterial Vaginosis.
While you’re waiting for the next post, go back and reread the other of the 6: this post on ‘The Sexually Transmitted Cancer’. It definitely should be considered requiring reading for everyone who is sexually active or about to become active, and I would have addressed it first had I not already covered it. Might I suggest you cover it as well?
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Straight, No Chaser: Circumcision – To Do or Not to Do?

August 23, 2013Genital/Urinary, Medical Treatment, Pediatrics/Kids Health, Public HealthAmerican Academy of Pediatric, American Academy of Pediatrics, Circumcision, Foreskin, health, medicine, National Center for Health Statistics, Sexually transmitted disease, Surgery, United StatesJeffrey Sterling, MD

As a medical professional, circumcision has long been one of those things that’s made me go hmmm…. If your religious beliefs include this as a ritual or ceremony, fine. I get it, and I have no criticism at all. No disrespect is intended. Otherwise, circumcision is largely a procedure looking for an indication. Quick, tell me what other elective surgical procedure or harmful activity of any type is allowed on children, much less newborns? While I’m waiting for you to think about an answer that doesn’t exist, let’s recap the procedure and the medical logic behind it.
As you know (and men are painfully aware – pun intended), circumcision is the surgical removal of the skin over the glans (tip) of the penis. Over the last 30 years, the rate of males receiving the procedure has dropped from 64.5% to 58.3%, according to the National Center for Health Statistics. Worldwide about 30% of males are circumcised, and of those receiving it, the religious influence is largely present. 69% of those being circumcised are Muslim and 1% are Jewish (Circumcision is part of religious rituals in both religions.).
Let’s cut to the chase (no pun intended): Here are the best arguments for circumcision.

It helps prevent certain infections (e.g. yeast and UTIs – which most males aren’t especially prone to anyway).
The cells of the inner surface of the foreskin may provide an optimal target for the HIV virus (This is theoretical and not conclusively decided in the medical literature. In any event, this is NOT the same as saying uncircumcised males do or are more likely to contract HIV.).
Circumcised males have a lower rate of penile cancer (which is very low under any circumstances).
Now, there are emergency indications for circumcision; the one I’ve had to address (once in twenty years) is an inability to readjust a foreskin that too tightly adhered to the shaft of the penis (paraphimosis). Obviously, that’s a medical emergency and not something frequently seen enough to justify universal circumcision any more than a much higher rate of appendicitis would warrant universal and elective removal of everyone’s appendix.

Here are criticisms of the decision to have circumcision.

Any surgical procedure has complications, and that should be taken seriously. That said, the complication rate for circumcision is very small and includes bleeding infection and pain.
Circumcision is a violation of a child’s body and is unnecessary and disfiguring. The foreskin might not be cut the appropriate length, might not heal properly and may require addition surgery because the remaining foreskin incorrectly attaches to the end of the penile shaft.

Honestly, both the risks and benefits are quite overstated. Circumcision doesn’t appear to be a medically necessary procedure, but it isn’t an especially dangerous one. Interestingly, the American Academy of Pediatrics’ latest comment on circumcision is that the benefits of circumcision outweigh the risks, which stops short of recommending routine circumcision for all. Even that equivocal smacks of conflict of interest, given who’s performing the procedure at a significant cost to the consumer. Again, this appears to be a procedure looking for an indication…
If I was having this conversation in Africa, where the sexually transmitted infection rate is substantially higher and can be significantly reduced by circumcision, we’d be having a different conversation. If my Jewish or Muslim friends and colleagues were asking my medical advice on the safety of getting the procedure done as part of their religious ceremonies, we’d be having a different conversation. However, we’re not, and for the population in general, it’s safe to say that – various preferences (for various reasons) aside – there’s no compelling reason to recommend circumcision on all newborn males. Make your judgment based on facts, not a whim. And that’s medical straight talk. Oh, and guys – sorry about the picture. That wasn’t a good day.

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