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Need Advice
Hi, Thanks for taking my question. About 5 years ago I remember having a sore on the head of my penis. It was small, bubble like, but I do not remember it being painful. It healed shortly thereafter. I couldn't have been too concern with it otherwise I would have went to my MD. I believe at the time I thought it was herpes. I never had herpes before. I went to my md a few months later (for another reason) and mentioned it to him. The MD didn't seem too concern with it, he just said if it comes back to make an apt right away. I am a gay male and this dr is at a major health center that deals primarily with the gay community. I took his word for it, didn't have a need to question it. I have been tested for syphilis a few times thereafter and the results were negative. Recently I have been hearing about the increased incidence of syphilis in the gay community. I started to look on the internet and found the symptoms and of course the chancre sore symptoms made me recall the past situation. My question is...should I be concern with syphilis based on this past situation? I am in a monogomous committed relationship for the past 4 years. I have read that the RPR is not always accurate. Is this true? What can the MD do testwise to check me out? Lastly, why don't MD's suggest screening for STD's? Expecially in gay males?? I have never been asked to test (screening) for an STD in my life! This upsets me since I was a single young gay male who didn't know I should have been tested yearly for STD's. It gets me mad! I have been going to this MD who acutally specializes in STD's for the past 10 years. I have a feeling that unless "the patient asks", doctors in general do not push screening test(s). Maybe this is due to insurance regualations?? I forgot, I was in a research study (Explore!) which dealt with HIV in gay men who are negative and the effects of counseling in preventing HIV transmission. At the end of the study, the sponsors wanted to test all participants for the herpes virus. I don't know what test they used, but since it was for research purposes, I am assuming it was pretty thorough. The test came back negative, which I was surprised at since I thought I had herpes based on the situation I described above. Sorry for the long message, I hope it makes sense. Thanks for answering.
MEDICAL PROFESSIONAL
"I don't necessarily think gay men are more prone to stds than any other sexually active adult."
Actually that's not true. On average, gay men have far more partners than most straight men and wowomen (obviously there are many exceptions). Even for people with similar sexual lifestyles, anal sex is inherently riskier for transmission of HIV, and probably for other STDs, than vaginal sex; and more frequently practiced among gay men than among straight couples.
"They are just now recommending MD's to start asking patients to be tested for hiv. Why did it take so long for the medical community to do this??"
As I said above, we agree that the "medical community" can be faulted for not pulling its weight in STD/HIV prevention. (In quotes because there is no single "medical community" any more than a single "gay community".) However, one reason has political resistance from persons and agencies that claim to represent persons at risk for HIV, especially from rights-oriented gay groups. Some elements of the gay community have vigorously resisted every reasonable public health intervention, such as named HIV reporting and routine interviews for partner notification, and also were strongly resistant to the expanded HIV testing recommendations. By refusing to compromise on some major barriers to testing--such as the pre-test requirements for risk assessment, counseling, and written consent--those people and agencies bear a big portion of the responsibility.
The lack of a monolithic "gay community" is borne out by your obviously responsible attitude and understanding of these issues. In fact, there is evidence that your perspective is the more common one among gay men. The political pressures almost certainly represent a vocal minority.
HHH, MD
Actually that's not true. On average, gay men have far more partners than most straight men and wowomen (obviously there are many exceptions). Even for people with similar sexual lifestyles, anal sex is inherently riskier for transmission of HIV, and probably for other STDs, than vaginal sex; and more frequently practiced among gay men than among straight couples.
"They are just now recommending MD's to start asking patients to be tested for hiv. Why did it take so long for the medical community to do this??"
As I said above, we agree that the "medical community" can be faulted for not pulling its weight in STD/HIV prevention. (In quotes because there is no single "medical community" any more than a single "gay community".) However, one reason has political resistance from persons and agencies that claim to represent persons at risk for HIV, especially from rights-oriented gay groups. Some elements of the gay community have vigorously resisted every reasonable public health intervention, such as named HIV reporting and routine interviews for partner notification, and also were strongly resistant to the expanded HIV testing recommendations. By refusing to compromise on some major barriers to testing--such as the pre-test requirements for risk assessment, counseling, and written consent--those people and agencies bear a big portion of the responsibility.
The lack of a monolithic "gay community" is borne out by your obviously responsible attitude and understanding of these issues. In fact, there is evidence that your perspective is the more common one among gay men. The political pressures almost certainly represent a vocal minority.
HHH, MD
I do agree with you that doctors SHOULD recommend testing, but i think its like pulling teeth. Thats why i suggest we don't rely on them for suggesting it to us. There is so much out their on std's thats scary that we have to unfortunately take it upon ourselves to get the tests done. As far as testing for hiv, I heard it would soon be mandatory for one to be tested during there next Dr.'s appt, regardless of why are there. I don't know if there is any truth to that.
I don't necessarily think gay men are more prone to stds than any other sexually active adult. I do feel that MD's are more abt to check during a physical other test (ie lipids) and not suggest one gets an STD panel test for screening. Women go to the gynecologist and probably have more of an opportunity to be screened. Men do not. Many many people have an std and have no symptoms and did not think about ever having one (it certainly is possible). They are just now recommending MD's to start asking patients to be tested for hiv. Why did it take so long for the medical community to do this?? It certainly wasn't because of any confidentiality or fear of losing insurance. Legally we have protection for this (ie hippa etc). I feel most people seek STD testing when they have symptoms. If one has no symptoms then most don't necessarily worry (not all). Just imagine how many people would find out if they had an STD and could be treated and thus the spread would likely decrease. I know we are in charge of our health, but the MD's are the professionals and thus should guide their patients.
Just a comment, just b/c your gay doesn't mean the doctors have to push someone to test for std's. Since your bubble has not returned and the doctor didnt see it, he probably thought he didn't have a reason to test you. Everyone, gay or straight, is responsible for his or her health. Do not rely on other people to suggest you get tested. YOU suggest it to your health care provider. Anyway, best wishes and good health.
MEDICAL PROFESSIONAL
I agree the blister-like lesion sounds like it could have been herpes, but not syphilis. In any case, your negative tests for both infections proves it was neither one. False negative RPR and other syphilis tests are uncommon. It is theoretically possible you had syphilis and it cleared up, resulting in a negative RPR. But the negative result is 100% assurance that you do not now have active syphilis. Don't worry about it.
You are exactly right to be frustrated that more providers do not take the initiative to learn their patients' risks for HIV and other STDs and recommend STD and HIV screening routinely. CDC, professional societies, gay advocacy groups, etc routinely advise it. The reasons they don't do it are complex, but largely it's a matter of time, inertia, and habit. In particular, many docs simply aren't well trained or confident in raising issues of sex and drugs with their patients. Whatever the reasons, this has proved a tough nut to crack (no pun intended!). This is one the reason CDC recently came out with new recomendations to test all adults in the US for HIV, without taking a risk history. Dropping the requirement for risk history should result in more people being tested.
On behalf of all who care about HIV/STD prevention, thank you for participating in EXPLORE!. It was a very important study, even if the main results were negative. Contrary to expectations when the study was started, gay/bi men randomized to intensive counseling (10 sessions over a year or two, as I recall) did not have any lower rate of new HIV infections than those who didn't receive the intervention. Disappointing results, but very important ones. In fact, those results are partly behind the new CDC recommendations, especially the part that drops a requirement for routine pre-test or post-test counseling of HIV negative people, since EXPLORE! showed that it makes no difference.
EXPLORE! used accurate type-specific herpes antibody tests. You can rely on your negative result.
Best wishes-- HHH, MD
You are exactly right to be frustrated that more providers do not take the initiative to learn their patients' risks for HIV and other STDs and recommend STD and HIV screening routinely. CDC, professional societies, gay advocacy groups, etc routinely advise it. The reasons they don't do it are complex, but largely it's a matter of time, inertia, and habit. In particular, many docs simply aren't well trained or confident in raising issues of sex and drugs with their patients. Whatever the reasons, this has proved a tough nut to crack (no pun intended!). This is one the reason CDC recently came out with new recomendations to test all adults in the US for HIV, without taking a risk history. Dropping the requirement for risk history should result in more people being tested.
On behalf of all who care about HIV/STD prevention, thank you for participating in EXPLORE!. It was a very important study, even if the main results were negative. Contrary to expectations when the study was started, gay/bi men randomized to intensive counseling (10 sessions over a year or two, as I recall) did not have any lower rate of new HIV infections than those who didn't receive the intervention. Disappointing results, but very important ones. In fact, those results are partly behind the new CDC recommendations, especially the part that drops a requirement for routine pre-test or post-test counseling of HIV negative people, since EXPLORE! showed that it makes no difference.
EXPLORE! used accurate type-specific herpes antibody tests. You can rely on your negative result.
Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
