STD Awareness -- Terri Warren, RN, ANP -- 04/15/03
By Terri Warren
For National STD Awareness Month, we got informed about protecting our partners and ourselves. We discussed prevention, symptoms, and treatment options with WebMD's sexual health expert, Terri Warren, RN, ANP.
The opinions expressed herein are the guest's 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: Hello Terri. Welcome to WebMD Live. Let's get to our member questions.
Member: Is it true that one in five people in the U.S. are infected with herpes?
Warren: It's true that one in five people over the age of 12 in the U.S. are infected with HSV-2 and many more are infected with HSV-1. And 90% of those infected with HSV-2 don't know it.
Member: For those who acquire chlamydia, what is the statistical likelihood of also getting HIV?
Warren: I don't have that exact number, but the risk of getting HIV is greater when one has another STD. We do know if a person has HSV-2 that the risk of getting HIV is two to six times greater, with the average being two times greater.
Member: What about when you add in HPV and other diseases?
Warren: That's a difficult question to answer, because some are curable and some are not. In terms of HPV, it is felt that by the time someone has had five sexual partners, they are likely to have at least one type of genital wart virus.
Moderator: Can you explain the symptoms of genital warts?
Warren: Yes. The reality is that most people who are infected with genital wart virus have no symptoms that are recognizable. However, if people are going to have symptoms, warts will present most often as flesh-colored growths in the genital area.
Member: How can I get a blood test to determine if I have herpes and what type? What type test should I have?
Warren: That's a very good question and a complicated one. There are both accurate and inaccurate tests for herpes antibody on the market at this time. The trick is figuring out how to get the accurate test. One way to get the accurate test is to go to healthcheckusa.com and order this test yourself online. The web site will offer you laboratories in your area where you can have your blood drawn.
The tests that are best for herpes antibody are the Western blot, done only at the University of Washington, and blood samples can be sent there from anywhere. Another good test is the POCkit test. They have a web site called diagnology.com that lists healthcare providers who do this test and their addresses.
The other two good tests are made by a company called Focus Technology, and the test itself is called HerpeSelect. It is an IgG test. You do not want IgM tests, as they are not accurate.
Member: Can touching be done without being paranoid about contracting or spreading herpes? And is oral sex out of the question for either partner?
Warren: Good question. Touching genitals with hands that have intact skin, that is, no breaks in the skin, is very safe, because hand skin is thick, unlike the skin around the genitalia.
In terms of oral sex, that's more complicated. If a person has oral herpes, that is cold sores or fever blisters, even if they have no sore present, and they give oral sex to someone else, they can transmit the virus from their mouth to the genitals to their partner by giving oral sex. If virus is transmitted in this way, then the receiving partner will get genital herpes that is caused by HSV-1. HSV-1 genital infection is much less likely to recur or to be spread to another partner.
If a person gives oral sex to someone who has HSV-2 genital infection, it is possible that they could get HSV-2 on their mouth. However, this is not likely because many people already have HSV-1 oral infection and are, therefore, less likely to get a new type at the same site. If they did get HSV-2 orally, it would likely not recur in their lifetime.
Member: Is it safe for a man to perform oral sex on a woman who has had an outbreak in genital area, but not on labia or clitoral area?
Warren: When you ask about "safe," I believe you are asking for transmission to occur under those circumstances. The answer is that no, it is not impossible to contract herpes orally given the circumstances that you describe. We know that when people are shedding the virus from one area innervated by the sacral ganglia, that they might be also shedding from other locations within the ganglia without symptoms. However, if a person has HSV-1 genital infection and the person giving them oral sex has HSV-1 oral infection, then that is a safe practice.
Member: Oral sex is so popular with teens, even very young teens. They don't even consider it "sex." While they can't get pregnant, what STDs can be spread via oral sex -- mouth to penis, and mouth to vagina?
Warren: It is true that oral sex is incredibly common among teens. After all, our former president told us oral sex is not sex. However, oral sex can certainly transmit STDs, including herpes, HIV, chlamydia, gonorrhea, and hepatitis, and genital warts.
Teens are also having anal sex not infrequently, both to preserve their virginity and avoid pregnancy. Both oral and anal sex pose clear risks for STD transmissions. In addition, I think the common practice of oral sex in some way reduces the specialness of this kind of sexual contact between people in a loving relationship.
Member: Do men have to use a plastic cover of some kind to perform oral sex on a woman with genital herpes to avoid the risk of transmission? It sounds horrible and not appealing for anyone involved.
Warren: For maximum protection, yes, a plastic barrier, either dental dams or something like Saran wrap, provides good protection against transmission of organisms that cause STD. However, I agree that their use sounds pretty yucky. If it were me, I would make sure that both parties were tested for all STDs, including herpes, and if one person is infected with something that is not curable, that the other person does not have, then decisions about risk of transmission can be made within the context of the relationship.
For example, if one member of the couple has oral HSV-1 and the other member has neither HSV-1 nor 2, then the person who is infected with HSV-1 may choose to take daily antiviral medicines to try to reduce the risk of transmitting this virus.
Member: Exactly how quickly will the herpes simplex virus die once it leaves the vagina?
Warren: It depends on where the virus goes.
So we don't worry about things like toilet seats, but we do urge people to use their own towels for drying genitalia.
Member: Can genital herpes be contracted through blood transfusions or contact with blood from someone who is infected?
Warren: We do not believe that herpes can be contracted through a blood transfusion, because herpes is a disease that affects nerves, not blood. If someone had sex with someone during her period, transmission would be possible, but it wouldn't be through menstrual blood, but rather the skin-to-skin contact. I'm not saying it's completely impossible to contract herpes through blood, but extremely unlikely.
Member: Every time my husband performs oral sex on me, his mouth breaks out in these painful, white blisters. Does this mean I may have an STD?
Warren: That's difficult to say. It would be good for him to visit the dentist when these sores are present to figure out what they are.
Member: Ms. Warren, have you noticed any noticeable rise of women who break out with herpes while menopausal, who have not had a chance to be recently infected? Do you think that hormonal changes might cause herpes outbreak?
Warren: It's interesting that you ask that. We actually have seen a number of women that are older, by that I mean late 60s, early 70s, who are recognizing their first outbreak of genital herpes. And they have not had sex in many years. We believe there may be some relationship between declining immune function and the outbreak of herpes. The infection likely occurred years previously, but the immune system kept outbreaks under control. As we age, our immune function is less hardy, if you will. This is why we see reactivation of the chicken pox virus, which is also known as shingles.
Member: Terri, I have a question about bacterial infections. I just went to the doctor and I have another bacterial infection (I had one in February) and I want to know if it is sexually transmitted or what? I am freaking out because I don't know what is causing it. I don't want to go and accuse my boyfriend of cheating but how else could I be getting them? My doctor says that my boyfriend doesn't need to be treated for a bacterial infection. True?
Warren: First of all, I think you're talking about bacterial vaginosis. Technically, BV is not considered an STD. However, we don't see BV in women who do not have sex. So it is not related to a specific person or event, but somehow being sexual changes the environment of the vagina such that BV is more likely to occur and recur in the sexually active female.
And, yes, I agree that your partner does not need treatment. However, if you continue to have episodes of BV, then treating your partner would be one strategy that may show limited success. I would not blame your partner for this infection, though there may be some relationship between having sex with him and having BV, though it is not a direct cause and effect relationship.
Member: Can BV be caused because he is having sex with someone else and passing it to me?
Warren: I suppose that's a possibility, but just one possibility, not necessarily what's going on.
Member: Can BV go away on its own without medication?
Member: Well, he was treated the first time and now they are saying that he doesn't need to be treated again.
Warren: Well, that's why treatment is not recommended, because it doesn't make much impact on the recurrence rate if you treat men. Are you taking oral or vaginal medication?
Member: The first time they gave me oral and now they are going to give me vaginal medication.
Warren: OK, let's see how that goes for you. The truth is that for some women, once they get BV once, it can be something that recurs fairly often, but eventually will go away. I hope this works for you.
Member: How do you know which infection you have between gonorrhea, chlamydia, or just a regular yeast infection? The symptoms all seem the same. You see, my girlfriend said she gets discharge and also has a foul odor, and sometimes it burns when she urinates. She had a yeast infection before. This only happens when we have sex quite often. She is fine when we stop for a while. Could it be possible her yeast infection could be acting up?
Warren: Gonorrhea and chlamydia can be diagnosed by specifically testing for each. Neither gonorrhea nor chlamydia usually presents with malodorous discharge, nor does yeast. The things that cause malodorous discharge are most often BV and trich (trichomoniasis). Your girlfriend should be evaluated by a healthcare provider to see specifically what is going on. Some infections, if left untreated, can cause sterility. Please have her follow up with someone as soon as she can.
Member: Terri, if I was going to have a baby and I wanted to have it natural without a C-section, could the genital herpes cause my baby to be blind?
Warren: If you got pregnant, it would be wise for you to take antiviral medicine for the last four weeks of your pregnancy to try to avoid asymptomatic shedding at the time of delivery, which could make your baby ill. If you had an outbreak at the time of delivery, a C-section would be performed to try to protect your baby.
Member: I have dry flaky skin on my penis. I have tried lotion to no avail. I have no discharge or any type of pain except where the skin has flaked off. I am concerned this might be an STD due to the fact it only affects my penis.
Warren: Although I cannot be certain, of course, from your description, your symptoms suggest a fungal infection. Fungal infections sometimes require lengthy treatment with over-the-counter lotions, such as Lotrimin, and the continued use of an antifungal powder. However, again, I can't be sure this is what is going on.
Member: If it is true that HPV causes cervical cancer? In your opinion, why aren't women being more vocal about it?
Warren: I would most certainly agree that certain types of HPV cause cervical cancer. It is not the types of HPV that cause visible external genital warts. The types of HPV that cause cervical cancer are not apparent to women who have them, but instead are detected with the new Pap smears. You asked why women are not more vocal. First of all, I don't think that most women still know that HPV causes cervical cancer, and I'm not sure that when they do now, they will necessarily be more vocal. We, as a society, tend not to talk much about STDs in an open way, which I feel is unfortunate.
Member: Can a severe bladder infection produce bacteria similar to chlamydia?
Warren: Yes. Chlamydia can cause urinary tract infections.
Member: What is your general opinion about the potential effectiveness of the pending vaccines for HPV?
Warren: I think that the HPV vaccines will be incredibly effective in protecting unaffected women.
I am very optimistic about these vaccines.
Moderator: Terri, can you tell us about what research you are involved in these days?
Warren: Yes. We are involved in the herpes vaccine trial right now; the HPV vaccine trial. We are involved in a therapeutic vaccine trial for herpes, which will be a much bigger study in the fall. We are involved in a study looking at depression and sexual functioning as it relates to antidepressant medicine. We are involved in a new Famvir study, and also a new Valtrex short course therapy study.
Member: I have HSV-2 and have had it for two years, every outbreak I have I get really sick with flu symptoms, body aches, fever, etc. My doctor tells me that it can't happen still because it only happens on the first outbreak. Why do I still feel it then? Also everyone says that it gets better after the years, well how many years would that be?
Warren: Though most people only have systemic symptoms with their first outbreak, many people continue to get some level of systemic symptoms with recurrences. I would strongly suggest for you that you consider daily suppressant therapy to try to avoid outbreaks and thus these systemic symptoms.
Moderator: Terri, we are almost out of time. Before we wrap up for today, do you have any final comments for us?
Warren: I would just like to remind people that it's important to view sexuality as a very special gift and somehow incorporate that belief, if they can, into their practice. I think that by believing that more, we will see fewer STDs. Though most STDs are curable, many are not, like HPV, HSV and HIV, and hepatitis C, and their consequences can be very serious. If I had an ideal world, couples, before becoming sexual, would be tested for STDs to at least know where they stand and make choices about taking risks to become infected. So keep the condoms coming out there, folks.
Moderator: We are out of time. I'm sorry we couldn't get to all of your great questions. Our thanks to Terri Warren, RN, ANP, and thank you members for joining us today.
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