Health Chats
Living with STDs - Diagnosis, Symptoms, and Treatments
Wednesday Apr 01, 2009, 03:00PM - 04:00PM (EST)
H. Hunter Handsfield, M.D.Blank
University of Washington
, Seattle, WA
Sexually Transmitted Diseases (STDs) are often difficult for patients to discuss with their family and friends, their partner, and even their doctor. The stigma associated with having an STD can prevent patients from getting vital answers to their questions. If either you or your partner has been recently diagnosed with an STD or has been living with it for years and you have unaswered questions, join Dr. H. Hunter Handsfield for an hour-long chat covering the diagnosis, symptoms and treatments related to STDS.<br><br> As the Director of the STD Control Program for Public Health and on the Board of Directors of the International Union against Sexually Transmitted Infections and American Social Health Association, Dr. Handsfield is a renowned expert in the study of STDs. In this live health chat, Dr. Handsfield will answer your questions about syphilis, chlamydia, gonorrhea, herpes, hepatitis, genital warts/human papillomavirus (HPV), chancroid, pubic lice and scabies, trichomoniasis, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, pelvic inflammatory disease (PID), other vaginal infections and less common STDs.<br><br> Note: Questions about HIV will not be permitted during this chat. If you have a question about HIV prevention, please join Dr. Handsfield on April 7th for an <a href="/health_chats/register/9">HIV Prevention Live Chat</a>.
H. Hunter Handsfield, MD:
Greetings, everyone.  Thank you for joining the STD chat.  A few ground rules:  There are more of you, and more questions than can be answered; apologies for those we don't get to.  I will try to select questions that have educational value for many users and will deemphasize the ones that seem pertinent only to the questioner.  This will be an inexact process and I'll probably get it wrong sometimes.  Apologies again.  Finally, I will try to keep my replies quite brief, to maximize the number of questions accepted.  Those who desire more detail are welcome to post their questions in the STD Forum.
MedHelp:
Hello, everyone. The chat isn't scheduled to start for another 5 minutes. You can begin submitting questions now, and we'll start promptly at 3 PM Eastern / 12 PM Pacific.  
davetee:
My wife and i have different doctors. We share herpes. My doctor says to only treat the affliction when it appears. Her doctor says to take Valtrex 500mg daily. Is there consensus on which approach is more effective?
MedHelp:
Welcome, everyone. The chat is now live. Please submit your questions relating to STDs. Please do not submit any question related to HIV Prevention or HIV in general. HIV Prevention will be covered in next week's chat with Dr. Handsfield.
H. Hunter Handsfield, MD:
The two kinds of treatment have different purposes.  Continuing suppressive therapy helps prevent outbreaks, whereas episodic treatment -- ie therapy for each outbreak -- is intended to speed healing.  It's a personal choice, usually based on frequency and severity of outbreaks and desire to prevent transmission (which is not an issue in your case).
marlyn75:
I got HPV virus from my husband. I want to know if oral sex can cause oral HPV.
H. Hunter Handsfield, MD:
The mouth is not highly susceptible to HPV.  The actual transmission rate isn't known, but most people who perform oral sex on persons with genital warts do not get oral warts.  I wouldn't worry about it.  Anyway, once your husband's HPV clears up -- which most infections do in a few months -- he will be immune to catching the same strain again.
leefam:
If you were diagnosed with herpes 20 years ago and don't get outbreaks anymore, do you still have it? Sometimes a bump may appear on the hip area or pelvic hair area that is very sore like a hair bump. Could this be a herpes outbreak? Do frequent UTIs have anything to do with Herpes if they occur after sex?
H. Hunter Handsfield, MD:
Excellent question.  HSV infections last a lifetime, so for sure you "still have it".  But the frequency of recurrent outbreaks tends to decline with time, and probably asymptomatic viral shedding does as well.  At 20 years without a recurrence, it's a good bet your genital infection was due to HSV-1, not HSV-2; and even with HSV-2, you probably won't start to have outbreaks again.  However, you may have asymptomatic shedding and might still transmit the infection if you have sex with an uninfected partner.
diovisi:
Is it at all possible to get any STD from a strip club? Without warning a stripper reached inside my pants and grabbed my penis. It's been about 4 days since, I have had no symptoms, but i am worried. My wife and I will be having sex and I don't want to risk infecting her at all.  Anything to worry about here?
H. Hunter Handsfield, MD:
STDs are rarely if ever transmitted by hand-genital contact or by sex that doesn't involve genital, anal, or oral sex.  The only way you can get an STD in a strip club is to have unprotected intercourse while there.
kriskent:
Hi Dr Handsfield. I am allergic to Cephalexin. When I was diagnosed with gonorrhea recently my Dr put me on Cipro. However, I understand that Cipro is no longer recommended due to resistance. As cephalosphorins are the mainstay for many STDs, what treatment alternatives are available for patients allergic to cephalosphorins?
H. Hunter Handsfield, MD:
It is true that cipro is no longer recommended as primary therapy, due to rising resistance.  However, in heterosexual men and women, probalby around 90% of cases still are susceptible to cipro, so it probably will work just fine.  However, it is important you have a repeat test ("test of cure") in a couple of weeks to make sure treatment was effective.  (This is a bigger problem in men who have sex with men, in whom up to 30-40% of gonorrhea is now cipro-resistant.)
bluesharpie:
Dr. Handsfield, I have genital warts on my penis and around my anus. I am concerned I may have itched some of the infected area around my genitals with my bare hands in my sleep, and then touched my mouth. Should I be concerned with HPV being spread to my mouth, and should I be concerned with spreading HPV to others through kissing?
H. Hunter Handsfield, MD:
As I commented in response to another question above, oral HPV is uncommon.  And everybody touches their genitals and then their mouth -- it hapens all the time, usually without our even being aware of it.  So probably everybody with genital HPV carries the virus to their mouths -- yet almost nobody gets oral warts.  It's not an issue.
marlyn75:
Other than through sexual contact, how can the HPV virus be transmitted?
H. Hunter Handsfield, MD:
As far as is known, genital HPV is only transmitted sexually.  There are a few people who show up with genital HPV despite denying the possibility of sexual acquisition.  Many of them are not being truthful, but their might be a tiny percentage of infections that are acquired by unknown, nonsexual means.
gene1782:
I'm a little concerned with genital fordyce spots. Is there any direct relation between genital warts and genital fodyces spots?
H. Hunter Handsfield, MD:
No.  Fordyce spots are entirely normal,
ntdc:
I contracted hsv in January. My attacks are very bad with a lot of pain and sick feeling (like having the flu). I am on famvir and it gives me some relief but as soon as I finish the course 3 days later, the symptoms start coming back. I have not seroconverted yet  (my igg levels are very low, around .1 or less), I am wondering will the severity/frequency of outbreaks go down once that happens?
H. Hunter Handsfield, MD:
It is unlikely your symptoms are due to herpes.  I'm not saying you don't have genital herpes, but if you do, it is not the cause of symptoms that reappear so soon after treatment.  Even without treatment, recurrent genital herpes outbreaks never are more often than once a month or so, always clear up in 1-2 weeks, and there are no symptoms at all between outbreaks. Work with your provider to look into other causes for many (all?) of your symptoms.
H. Hunter Handsfield, MD:
Sorry, an additional comment:  I failed to note you only acquired your herpes a couple of months ago.  The initial outbreak sometimes lasts as long as 6 weeks, with a "stuttering" on and off course.  I suppose it could go even up to 8 weeks.  So maybe your symptoms are mostly herpes after all.  Still, tell your provider my concern about this and still pay attention to my reply above.  If it really is herpes, you might need a higher dose of Famvir or switch to valacyclovir (Valtrex) in a fairly high dose.  Discuss the details with your provider.
marlyn75:
Is there an HPV test for oral?
H. Hunter Handsfield, MD:
Researchers are trying to figure out the best way to test for oral HPV, and also to decide whether oral testing ever should be done.  If done, maybe as simple as a swab of the throat, or perhaps gargle and spit, then test the fluid for the virus.  But for now, I would say there is no reason to test for oral HPV.  See my replies to questions above about the infrequency of oral HPV infections.
ntdc:
Is famvir or acyclovir as effective as valtrex for supression of hsv? They are cheaper.
H. Hunter Handsfield, MD:
The only research study was done with valacyclovir (Valtrex).  The others also suppress asymptomatic viral shedding, and probably therefore help prevent transmission.  However, fanciclovir (Famvir) doesn't suppress shedding quite as well as acyclovior or valacyclovir do.  Valacyclovir is now (or about to become) available generically and the price should drop.  For now, I only prescribe valacyclovir to prevent transmssion or, if cost is critical, acyclovir.
orange_tire:
I recently took a urine test and tested negative for chlamydia and gonorrhea. I'm wondering if i should get tested again though. When I was peeing into the cup I accidentally went over the line so i poured some out. Now I'm afraid i may have poured out some of that "initial first catch urine" they were asking me for. How conclusive are my results?
H. Hunter Handsfield, MD:
The urine-based tests for gonorrhea and chlamydia are very forgiving.  Providing a little too much urine doesn't matter.  Your negative test resuls are valid.
sznbnz:
Hello Dr. Handsfield, I would like to know if it is possible to get gonorrhea on the throat.
H. Hunter Handsfield, MD:
Yes, by performing oral sex on a partner with genital gonorrhea.  Transmission is quite easy by fellatio (mouth-penis) and difficult by cunnilingus (mouth-vulva).  Therefore, gonorrhea of the throat is most common in men who have sex with men, less common but not rare in women, and quite rare in heterosexual men.
marlyn75:
Which treatment is the best for HPV virus, CIN II loop or laser?
H. Hunter Handsfield, MD:
STD specialists don't treat cervical HPV -- that's a gyn issue.  (We refer such patients from our STD clinic to their gynecologists.)  The best treatment varies from one patient to another, and I do not believe there is a single answer to this. Sorry.