Talk STDs with Sue

Last Editorial Review: 10/4/2004

WebMD Live Events Transcript

Usually you have to wait until Sunday night watch the popular Oxygen Network program, Talk Sex With Sue Johanson. But she joined us on April 14, 2004 as part of STD Awareness Month to share the results of a recent survey on genital herpes treatment and to answer questions about living and loving when you have an STD .

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:
Please tell us about the new survey commissioned by the National Women's Health Resource Center.

JOHANSON:
The survey which looked at patients managing long-term chronic conditions suggests that more than twice as many patients with asthma who are aware of suppressive therapy and use it on a regular basis to manage their condition, when compared to patients with genital herpes who are aware of suppressive therapy. This despite research that shows suppressive therapy can help reduce the frequency of recurrent genital herpes outbreaks for many patients.

In addition, of all the respondents, genital herpes patients had the highest incidence of not doing anything to manage their condition.

MODERATOR:
Why do you suppose that is?

JOHANSON:
There are probably quite a few reasons why. They are embarrassed; they are ashamed to admit they have this infection; some may feel it is punishment for their sexual behavior; some may not be aware there is treatment; some are afraid to ask questions because they don't want to know the answers. For example, "Can I ever have a baby the "normal" way?" Some feel guilty. Many feel extreme anger at the person who infected them. To be honest, some don't like the idea of taking medication every day and for others, the cost may be prohibitive.

MEMBER QUESTION:
But don't they have genital herpes every day? It isn't just when you have outbreaks. It is with you for life.

JOHANSON:
The virus is with you for life. It remains stored at the base of your spinal cord, but may not bother you at all, or you may experience infrequent outbreaks. Others may experience an outbreak with every menstrual period or whenever they are under stress, they have a fever or other illness, or are exposed to UV light or sunlight. Some have very little discomfort and others are decimated with every outbreak.

MODERATOR:
What surprised you most about the survey results?

JOHANSON:
I am most surprised by people's reluctance to acknowledge that it could recur at the wrong time and the wrong place; generally, before a big date, graduation dance, or your honeymoon.

MEMBER QUESTION:
Is stress a factor in outbreaks?

JOHANSON:
Stress is definitely a factor. Anxiety, fear, worry, an argument in the family, job loss, financial problems, can definitely trigger an outbreak of genital herpes.

MEMBER QUESTION:
Isn't genital herpes the most common STD?

JOHANSON:
No, genital herpes is not the most common. In all probability chlamydia is the most common, but it is the easiest to diagnose, to treat, and to cure. It is followed by human papillomavirus infection (HPV) or genital warts.

If it's wet and oozy, it's possibly herpes. If it's painful, it's possibly herpes. Dry, raised, painless bump, could possibly be warts. See your doctor and don't have sexual contact with anybody until it has been diagnosed and treated. For more information, go to genitalherpes.com.

MODERATOR:
You can also visit the WebMD message boards and our sexual health center.

MEMBER QUESTION:
How do you go about getting diagnosed and treated for an STD with no medical insurance?

JOHANSON:
Check with your local sexual health clinic or Planned Parenthood clinic. Both are minimal cost.

MEMBER QUESTION:
I thought there was no cure for genital herpes?

JOHANSON:
There is no cure for genital herpes, but there is suppressive medication, which can reduce the number and severity and duration of an outbreak.

MODERATOR:
What is involved in suppressive therapy?

JOHANSON:
Suppressive therapy is a prescribed medication taken daily by mouth, which curtails a flare-up of genital herpes. It is a prescription from your family doctor. If you have any concerns, please get it checked out immediately, and ask about suppressive therapy.

MEMBER QUESTION:
Hopefully you can answer this question for me: How much of a risk is my partner at even if I don't have an outbreak at the time?

JOHANSON:
That is something we really do not know. Some herpes patients are shedders. Even if they do not have an outbreak, old dead skin cells can slough off and in some cases contact could trigger an infection with your partner.

MEMBER QUESTION:
How do you know if you're a shedder?

JOHANSON:
At this point we have no guaranteed way to tell. So we go on the assumption that everybody could possibly be a shedder and must be aware of that.

MEMBER QUESTION:
Aside from the meds, what else should I be doing?

JOHANSON:
Be aware of the prodromal signs and symptoms, such as a painful bump that tingles, itches, or burns, followed by a lesion or blister that may be very painful. This will last up to 10 to 14 days, then will heal without leaving a scar.

Prevention is condoms, safer sex every time, all the time. Please do not use condoms lubricated with nonoxynol-9. Be open and honest with your partner if you suspect an outbreak is impending. Avoid any sexual contact at that time.

MEMBER QUESTION:
How do I get a potential lover to get tested before we do anything? Any advice?

JOHANSON:
Talk to your partner. Tell your partner you are concerned for their health and you are concerned for your health. So in both your interests, why don't we go together to see the family doctor or a sexual health clinic and be tested for the possibility of all sexually transmitted diseases (STDs) including genital herpes.

Talk to your partner openly and honestly. Tell them you enjoy being with them, you have great fun together, and you find this partner very attractive and interesting, and you hope that this might develop into an ongoing relationship.

If you have a history of diagnosed genital herpes, you wait until there is an opportune moment when you are alone, when there are no distractions, and you can talk on a personal level. Then you say, "I find this very embarrassing, but when I was in college, I picked up an infection. It does not bother me and I take medication so that it is pretty well under control."

Then go and say, "Do you know about cold sores, the ones you get on your lip? Instead of getting them on my lip, I get them below the waist."

At this point your partner will probably say, "What is it?" And you can say, "It's called herpes. I don't have an outbreak too often, and I take ongoing medication to help control it."

Then I would go on to say, "I promise you I would always tell you in advance whenever I feel I am aware of the prodromal symptoms, because I want to protect both of us."

MODERATOR:
You need to be honest about outbreaks not only to protect your partner, but also to protect yourself.

JOHANSON:
Because if you have a herpes lesion and your partner is HIV positive, you could be infected with the HIV virus through that open lesion. That is why suppressive medication is so beneficial.

MODERATOR:
And if you can't talk to a sexual partner about these things, maybe you shouldn't be having sex with them?

JOHANSON:
If you are too embarrassed or too ashamed to talk to your partner about the possibility of a transmission of any of the sexually transmitted diseases, then perhaps it would be advisable to postpone any sexual contact until the relationship is well established and the intimacy and trust level are at a level that you can be comfortable talking about the possibility of sexually transmitted diseases.

MEMBER QUESTION:
Can herpes of the mouth such as a cold sore be transmitted to the genitals?

JOHANSON:
Yes. Generally, herpes of the mouth is herpes simplex virus 1 (HSV-1), but with oral genital sex it could be transmitted to your partner's genitals.

Conversely, if your partner has genital herpes, (generally herpes simplex 2 or HSV-2)) it could be transmitted to you by oral genital sex. That's why it is essential that you talk to your partner well in advance about such intimate details.

MEMBER QUESTION:
Are there any side effects from taking the medications?

JOHANSON:
For some people on suppressive medication, there may be some side effects, such as nausea, vomiting, upset stomach, or diarrhea. Talk to your family physician.

MEMBER QUESTION:
What do you think of the attention HPV has received lately and how prevalent it seems to have become suddenly with new testing and such?

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.

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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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