STDs: Talk STDs with Sue (cont.)

JOHANSON:
Human papillomavirus has reached almost epidemic proportions and is insidious. Males, because their genitals are external, would in all probability, be aware of the presence of genital warts. They check their penis on a regular basis and if anything is amiss, they seek medical attention immediately.

Females, on the other hand, may be totally unaware of the presence of warts because much of our genitals are internal, not visible. Many females would have warts on their external genitals (labia, clitoris, vaginal opening) but most females do not look at their genitals on a regular basis.

Most females will feel this unusual painless bump on their genitals when inserting a tampon during their menstrual period. Internal genital warts in females will be diagnosed when she has an annual pelvic examination including Pap smear.

Many doctors are unaware of the prevalence of anal sexual activity amongst their patients so they may neglect to check the rectum during a physical examination. For this reason, patients should be honest with their family physician and ask the doctor to check for anal warts.

MEMBER QUESTION:
Isn't it the case that most men who are carrying HPV are unaware ... especially the types that cause cervical abnormalities? Women really have no way of knowing if their male partners have these types or not?

JOHANSON:
Most males are aware if they have genital warts, unless the warts are up in their urethra. In which case, he might experience difficulty urinating or discomfort urinating and would go to a physician quickly.

Females, on the other hand, may not know they are infected and because human papillomavirus in females is a precursor to cancer of the cervix, diagnosis and treatment is essential.

Research is underway because there is some indication that genital warts, in a male urethra, MAY BE precursor to prostate cancer. That has not been verified by the American Medical Association (AMA).

MEMBER QUESTION:
I'm not talking about the types that cause warts. I'm talking about high-risk strains that lead to cervical dysplasia and cervical cancer.

JOHANSON:
There are 57 different varieties of the human papillomavirus, of which two are known to be high risk for cancer.

MEMBER QUESTION:
Are some sex practices more likely to spread STDs than others? Or does the use of condoms and medications make them all pretty much the same risk?

JOHANSON:
Condoms and practicing safer sex provide excellent protection against Chlamydia and gonorrhea, but because warts may be located anywhere on the genitals, areas not covered by the condom, the partner could be exposed to a herpes lesion during an outbreak.

MEMBER QUESTION:
We have a problem. How do you keep a condom from tearing during anal sex?

JOHANSON:
Used properly, condoms very seldom tear. When they tear, it is generally because the male did not leave a space at the tip of the condom when he was rolling it down to the base of his penis; so that with pressure of anal intercourse, the condom may tear. Always leave a space at the tip of the condom to allow room for ejaculate to be stored and for stretchability.

MEMBER QUESTION:
Can I take meds for herpes while pregnant? What about delivery?

JOHANSON:
When a female is pregnant, she should tell her doctor immediately that she has genital herpes. If she has been taking suppressive therapy, the doctor will take her off the medication because insufficient research has been done to prove prenatal safety.

If a patient is near her due date, she must tell her doctor immediately if she becomes aware of the prodromal symptoms, so that the baby may safely be delivered by cesarean section. This will protect the baby from possible exposure to the herpes virus.

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

JOHANSON:
I've had this wonderful opportunity to help increase awareness of genital herpes on an STD awareness campaign. If you want more information about herpes, visit genitalherpes.com, or alksexwithsue.com, and watch Talk Sex With Sue Johanson on Oxygen every Sunday and I'll be there talking about sex.

MODERATOR:
We are out of time. Thanks to Sue Johanson, RN, for sharing her expertise with us today. For more information, please be sure to visit the WebMD message boards , where you can post your questions and comments for our in-house experts and your fellow WebMD members. It's a great community and you will be welcomed warmly!

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