STD Awareness

WebMD Live Events Transcript

April is National STD Awareness Month, making now the time to get informed about protecting yourself and your partner. WebMD's sexual health expert, Terri Warren, RN, ANP, joined us on April 14, 2004 to discuss prevention, symptoms, and treatment options.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Which STDs are most prevalent these days?

WARREN:
The most prevalent STD in the U.S. is genital herpes, followed by genital wart virus. Other common STDs include gonorrhea, Chlamydia, and trichimonis. Diseases we don't commonly think about as being sexually transmitted also include hepatitis B and C and of course, HIV.

MEMBER QUESTION:
What do you think of using miconazole to help minimize the discomfort of genital wart outbreaks? My husband used it (thinking he might have jock itch) before we realized it was genital warts from HPV (human papillomavirus). Are there any other meds that may help more effectively?

WARREN:
Miconazole is a treatment for fungal infections, not wart infections. Treatments for genital wart virus include liquid nitrogen, certain dilute acids, Aldara, and sometimes laser surgery. I have never heard of using antifungal medicine to treat wart virus, and would be surprised if it really did anything to treat warts.

MEMBER QUESTION:
There are several blood tests for herpes: Western Blot, HerpeSelect IgG EIA, HerpeSelect Immunoblot IgG, POCkit. What are the differences between the tests and when would you choose one over the other?

WARREN:
The POCkit test is no longer available. The Immunoblot and ELISA are both made by HerpeSelect, but are simply different methods of doing the same test. Both look for IgG antibodies. The Western Blot, done only at the University of Washington, looks at the bands that make up the antibody to herpes and this test is considered to be the gold standard, against which other tests are compared.

However, the HerpeSelect test can sometimes pick up antibody earlier than the Western Blot. We use Western Blot in our clinic, mostly to confirm questionable results on the HerpeSelect test or for research purposes.

"I think most people are looking for dramatic and painful sores, but in reality, many herpes symptoms are subtle, painless, and easily missed."

MEMBER QUESTION:
You indicate that Western Blot is used when HerpeSelect results are questionable. Can you please say more about what "questionable" means? Thanks.

WARREN:
For example, we run the Immunoblot in our clinic, and with the Immunoblot we look the presence or absence of bands of color on a strip to tell us if someone is or is not infected. If these bands are difficult to interpret, we might send a Western Blot.

With the ELISA, the patient gets an index value number that determines whether the test is considered positive or negative. For example, any value over 1.1 is considered positive. If someone has a value just over 1.1, and has had no symptoms associated with herpes and has had no recent exposures, I might choose to confirm that positive with a Western Blot in certain circumstances, particularly if the patient is also positive for HSV-1.

MEMBER QUESTION:
I'm kind of worried. A couple of months ago I got a little ... I want to say gray or brown bumps in my genital area ... I wanted to get your opinion on what it is? I don't have medical insurance and if it is serious then I want to go and get checked out but I don't want to spend the money if it could be nothing. They don't itch or burn; they are just there.

WARREN:
I would say that clearly we cannot make a diagnosis over the computer, and the bumps could be any number of things, from normal bumps to viral bumps. I would recommend, if you have no money, to seek out a county STD clinic. Most all counties are mandated to offer STD services on a sliding scale, and often Planned Parenthood clinics see patients on a sliding scale.

MEMBER QUESTION:
My boyfriend has genital herpes. Before an outbreak, his personality will undergo dramatic changes. He becomes distant, easily frustrated, moody, depressed. It is miserable. But he refuses to go on any type of suppressive medicine. Are personality changes before an outbreak normal?

WARREN:
I have not heard of that before. I have heard of people becoming sort of depressed during an outbreak, but have not heard of the personality changes prior to the outbreak. I have heard of people getting headachy and feeling generally a bit unwell prior to an outbreak, however, and maybe his personality changes are in response to those kinds of physical sensations.

MEMBER QUESTION:
Is there any way to tell if you have Chlamydia? And what is the treatment? I heard it could make you unable to have children.

WARREN:
Chlamydia, if left untreated, can make you sterile. The treatment does not make you sterile. Chlamydia is easy to test for and can be treated with a single-dose therapy. Both are very simple, not very expensive, and important in terms of preserving fertility. Azithromycin is the single-dose treatment.

Many women infected with Chlamydia do not have symptoms until the infection is more advanced, and probably a third of men with Chlamydia also have no symptoms, so the infection can be doing its negative work without people being aware it's even there.

MEMBER QUESTION:
I am worried about exposure to HIV. The last time I experienced sex was a year ago. Recently, I had an ELISA test and the result was non-reactive. Can I trust the result?

WARREN:
Yes, I would trust an ELISA done one year after potential exposure. In fact, the new tests for HIV infection pick up almost everyone who might be infected by three months after exposure.

I highly recommend the new Oraquick blood or saliva test, as you can get results within 20 minutes of the test being initiated. This prevents the painful waiting time that occurred with the old test and the new test is just as accurate.

MEMBER QUESTION:
Can you give me in-depth information on herpes symptoms? I have flu like symptoms and any sores heal much slower than ever.

WARREN:
The slow healing of sores may have nothing whatsoever to do with herpes. It depends on where the sores are on your body. You might be getting mixed up between herpes sores and other sores. Flu symptoms, by themselves, do not indicate having herpes. Some people who get herpes also get flu symptoms, and that might be what you're thinking of.

People who have genital herpes will intermittently get breaks in the skin of one kind or another in the area covered by a pair of boxer shorts. These breaks in the skin are often sores, but may start out as a bump and progress to being a more open sore, a blister, an ulcer, or a lesion. They can come on the buttocks, the thigh, the lower abdomen, around the rectum, at the base of the spine, or in the genital area -- the labia, the shaft of the penis, etc.

However, most people who have genital herpes, 90%, do not know that they are infected. This is probably not because they don't have symptoms, but rather, because they don't recognize their symptoms as being associated with herpes.

I think most people are looking for dramatic and painful sores, but in reality, many herpes symptoms are subtle, painless, and easily missed.

MEMBER QUESTION:
Can you discuss more on the painless and easily missed symptoms of herpes?

WARREN:
For example, I think many women have itching as their only symptom of herpes. They may attribute this itching to yeast or sensitivities to condoms or lubricants, when indeed; this may be a herpes symptom.

Men may attribute small breaks in the genital skin to friction burns from inadequately lubricated intercourse. When indeed, these are subtle herpes lesions.

People may think red areas in the genital area are simply irritations from things like bike riding or tight jeans or too much sex or masturbation.

Lesions on the buttocks are often misinterpreted as bug bites or poison ivy or poison oak. Or sometimes they can be described as recurrent shingles (which almost never happens).

"Choosing a partner based on whether they have herpes or not is probably one of the worst section criteria I can think of. With everything that people bring to a relationship that can cause trouble -- sex, money, kids -- herpes, in the big picture, is a drop in the bucket."

MEMBER QUESTION:
Do condoms protect against most STDs? Which STDs aren't prevented by condoms? And which condoms are best?

WARREN:
Condoms protect very well against infections that enter or exit through the male urethra; for example, gonorrhea, Chlamydia, and HIV. They protect less well against infections that are spread from skin-to-skin contact, like herpes and genital wart virus. Those infections can be spread from areas not covered by condoms or to areas not covered by condoms.

Probably the best condoms are latex, as opposed to animal skin. Female condoms are also good because they cover a greater area than do male condoms.

MEMBER QUESTION:
I have just been diagnosed with Chlamydia and PID. Can I give either of these to my boyfriend? I know he can't get PID but could the bacteria that causes PID in me do him harm?

WARREN:
Yes. Your pelvic inflammatory disease has most likely been caused by Chlamydia that has ascended into your upper reproductive tract, which would include fallopian tubes and uterus.

Your boyfriend can certainly get Chlamydia from you and should be treated as a contact to you. In fact, he may have infected you with Chlamydia, unless you have had a different partner.

He would get Chlamydia that then could be straightforward and cause a urethral infection in him, or it could become more complicated and cause an infection called epididymitis.

MEMBER QUESTION:
Can you explain more about HPV and any treatment or cure?

WARREN:
HPV stands for human papillomavirus. There are over 100 kinds of HPV, about 35 of which can infect the genital tracts. These viruses can cause infections ranging from external genital warts, which are aesthetically unpleasing but not dangerous, to strains that can cause cervical and rectal cancers.

The great news about HPV is that there are at least two vaccines to prevent HPV infection getting close to being available to the public. They are very effective, and I would guess they might be available in four to five years, to prevent infections to those who are not yet infected.

Right now, what we have for treatment is focused on eliminating infected tissue, rather than preventing infection from ever occurring.

MEMBER QUESTION:
How do you tell if the bumps are herpes or genital warts? What does each of them look like?

WARREN:
You would need to go to a doctor to have that sorted out. However, herpes bumps do not come and stay, they come and go. Warts are more likely to stick around, and not all bumps in the genital area are warts, either. They could be normal bumps, hair follicles, mollescum, or any other number of things.

MEMBER QUESTION:
If the tissue infected by HPV is removed, does that mean you no longer have the virus and will not spread it to your partner?

WARREN:
Most people actually do clear HPV over time, most within eight to 12 months, probably. However, it's possible to have no visible warts and still have virus present that could infect another person.

We don't know for sure who has cleared virus and who has simply had their apparent symptoms go away but still have HPV present on the skin. That's a difficult thing to sort out.

MEMBER QUESTION:
My boyfriend tested negative for HSV-1, HerpeSelect AB and positive for HSV-2 same test (index 2.72). I have tested negative for both. Is there a way for us to be fully intimate and for me not to contract HSV-2? Or should I take the mindset that I will contract it and need to factor that into my decision to be fully intimate? He has never had a classic outbreak.

WARREN:
There are things that the two of you can do to reduce the likelihood of transmission, but before I even go there, I will tell you that none of these tools to reduce transmission are perfect. At some point I think you need to make a decision in your head there is a chance, in spite of your best efforts, you could get HSV-2 genitally.

The tools that you can use to reduce transmission include him taking daily antiviral therapy which will reduce your risk by about half. In addition, if he uses condoms regularly, this will also offer significant protection against transmission of HSV. His developing an awareness of symptoms will also be helpful.

Think about it this way: You could decide that you don't want to take the risk of getting genital herpes, and so you move on and find a new partner. You ask this partner, do you have genital herpes? But because 90% of those who are infected don't know they are infected, you may end up having sex with someone with herpes anyway. In that situation, because he doesn't know he's infected, none of the transmission reduction tools will be used and your chances of getting infected are much higher.

I think choosing a partner based on whether they have herpes or not is probably one of the worst section criteria I can think of. With everything that people bring to a relationship that can cause trouble -- sex, money, kids -- herpes, in the big picture, is a drop in the bucket.

We're not talking about a disease that will kill you, or has long-term health effects, like HPV can. The main risk with herpes is the infection of a neonate and the increased risk of HIV acquisition. But if you take care of both of those issues, then you're left with a disease that I would describe as more annoying than anything else. So choose your partners based on bigger picture qualities, in my humble opinion.

"Chlamydia is easy to test for and can be treated with a single-dose therapy. Both are very simple, not very expensive, and important in terms of preserving fertility."

MEMBER QUESTION:
Can you get more STDs from anal sex than regular sex? My girlfriend refuses anal sex because of fears of disease.

WARREN:
I can't give you exact numbers, but I believe the risk of an STD from vaginal-penile sex is pretty similar to that of penile-anal sex. Your girlfriend may be declining anal sex for reasons other than infection.

MEMBER QUESTION:
Except when someone has a cold sore, you can't get a disease from oral sex, can you?

WARREN:
Unfortunately, you can. There are many STDs that can be spread from mouths to genitals. You raise specifically the issue of cold sores, so I will address that one.

The person who has recurrent cold sores also gives off virus from their mouth on days when they have no cold sores. Likely about one out of every six symptomatic days that person is giving off cold sore virus from their mouth when they have no symptoms.

So oral sex is not safe sex. And it would be useful if somebody in particular taught teenagers about those risks.

MEMBER QUESTION:
I am concerned about the type of HPV that causes cervical cancer.

WARREN:
The type of wart virus that causes cervical cancer is now being identified more often by liquid-based Pap smears. When a Pap smear is done now and found to be abnormal, further testing is most often done to determine which category of virus -- high- or low-risk types -- are found in the Pap. This allows clinicians to make decisions about how aggressive to be in terms of additional diagnostic tests or procedures. High-risk type would necessarily be pursued more aggressively, when identified in a Pap smear.

MEMBER QUESTION:
I have one kidney. Many of the antivirals indicate issues with kidney disease. Does this mean I cannot/should not take the drugs?

WARREN:
You may take the antivirals like anybody else, unless your creatinine clearance is less than 30. However, I would probably discuss this further with your nephrologist.

MODERATOR:
We are almost out of time. Do you have any final words for us?

WARREN:
I would recommend testing for STDs prior to sexual contact, so everyone knows where they stand and proper precautions and/or treatments can be instituted. Besides, sex can be much more fun when one isn't worrying about STDs.

MODERATOR:
We are out of time. Thanks Teri Warren, RN, ANP, for sharing her expertise with us today.



©1996-2005 WebMD Inc. All rights reserved.