Health Chats
Living with STDs - Diagnosis, Symptoms, and Treatments
Wednesday Apr 01, 2009, 03:00PM - 04:00PM (EST)
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:
Other STDs are not known to increase susceptibility to yeast or BV.
I have HPV (genital warts) and was wondering if it can delay seroconversion of other diseases like HIV.  I am wondering because i had blood work and urine test and the results showed a slightly low WBC of 3.7 and trace of blood in urine (hiv was negative).  If the answer is no such that HPV cannot delay HIV seroconversion then could you please explain to me how experts know this kind of information given it would be hard to find patients to experiment on?
Would quitting smoking reduce the recurrence of outbreaks of HPV?
H. Hunter Handsfield, MD:
Smoking is associated with an increased risk of cervical cancer or precancerous changes caused by HPV, but is not known to have any other effect.  Stopping smoking is of course a very important health measure in its own right, and if you are a smoker I strongly encourage you to try hard to stop.  But it probably won't make any difference in your HPV.
Some of the most frequent questions we get in the STD forums is the risk from mutual masturbation (ie hand jobs, etc) and oral sex.  Can you go over the risks of those activities?
H. Hunter Handsfield, MD:
Thanks for your excellent work on the STD comunity forum, antiejessi.  Good show.
H. Hunter Handsfield, MD:
I meant to also add that this was partly addressed above.  As  you understand, this is a bit more complex than is possible to address very briefly.  I'll just say that the STDs evolved, simultaneously with human evolution, as sexually transmitted precisely because the germs are not easily transmitted except by exchange of substantial amounts of genital secretions or direct contact between susceptible genital tissues.  Any bug that can easily be transmitted by hand contact would be common in nonsexual situations and not classified as an STD.  For these reasons, things like gonorrhea, chlamydia, herpes, syphilis, HIV, etc simply are not transmitted with any measurable frequency by hand-genital contact.
Hello Dr.Handsfield. I was diagnosed with HSV-1 My Igg levels were 5.00 BIA Value. Can you tell me what that means? Also is it true that about 100 million americans have HSV-1?
H. Hunter Handsfield, MD:
You are infected with HSV-1.  Probably 100 million is too low an estimate; it's about half the adult population of the US.  Most infections were acquired orally during childhood.  Some such persons have recurrent oral herpes (cold sores), but the large majority do not.  This should not be a significant health issue for you any time in your life.
Hey everyone, please keep your questions short and succinct. If your question is too long (requires more than one submission of 1000 characters), it may not be answered here and a better place for it might be in the STDs forum. Or you can feel free to re-submit your question in a shorter format now.
What exactly is herpes? How does it differ from cold sores or canker sores?
H. Hunter Handsfield, MD:
That's much too complex a question in this sort of setting.  Herpes and canker sores are entirely different health problems.  The most obvious difference is that recurrent oral herpes (cold sores) almost always are on the outside of the lips or on the face, whereas canker sores are within the mouth.
Do you not think that HPV testing alone could replace Paps in females under 30 if costs are too prohibitive for both, giving the ability to sort out those with benign HPV from others with possibly life threatening HPVs?  
H. Hunter Handsfield, MD:
That's an excellent question but a very complex one, and it is a matter for extensive research into the pros and cons of various approaches to preventing cervical cancer.  For now, in the US and other industrialized countries, I definitely would not recommend abandoning pap smears in favor of testing only for HPV.  However, in developing countries without the infrastructure required for regular pap smears, the mainstays of cervical cancer prevention in the future probably will be a combination of cervical/vaginal HPV testing and HPV vaccination.
i just recently took 1 g of azithromycin and 400 g of cefixime. Then about 3 hours later i had very bad diarrhea. Do you think i have to take them again because they weren't absorbed or is it just a side effect of the antibiotics and they did get absorbed.l am currently living in Mexico and access to get tested isn't as easy.
H. Hunter Handsfield, MD:
Rapid onset of abdominal cramping and/or diarrhea is a common side effect of azithromycin.  t does not reduce the effectiveness of treatment.
Are there any new drugs in the pipeline for herpes? Does it look like their could be a cure in our lifetime?
H. Hunter Handsfield, MD:
There are some products in early stage of research, i.e. laboratory and perhaps animal research.  Nothing new is likely to be available for routine clinical use in less than 10 years, and even that might be optimistic.  Most researchers in this field do not expect to ever have a drug that provides a true cure, i.e. eradicates HSV from the body in the foreseeable future.  Sorry I don't have better news for your.
Without HPV tests for men with genital warts available, would you reconsider recommendation to allow for at least a 2 year abstinence period for men (too), to help with clearance times known to be usually needed for high grade HPV clearance, since so many high grade HPVs seem to accompany low grade wart infections?
H. Hunter Handsfield, MD:
I'm not sure I follow the reasoning.  I would not recommend anybody abstain from sex for 2 years because of HPV or fear of catching or transmitting it.  Genital HPV, including infection with the high-risk types most prone to cause genital cancers, should be viewed as an inevitable consequence of human sexuality (i.e., getting these strains is normal) and, in general, an inconvenience more than a serious health threat.  Certainly not worth a couple years of inability to pursue sexual and romantic instincts.
I get canker sores all the time, sometimes even 3 or 4 at a time. Is it an STD? Are they contagious?
H. Hunter Handsfield, MD:
Canker sores are not an STD.  They are not contagious.
As stated before I have genial warts...after using the bathroom I use hand sanitizer and wash my hands with soap and water if available. Is using hand sanitizer or washing with soap and water enough on their own enough to reduce the risk of transmission to others through say, shaking hands?
H. Hunter Handsfield, MD:
It's an STD and cannot be transmitted as easily as you assume.  No household contacts ever catch it (assuming they aren't also the sex partners of infected people) despite sharing towels, eating utensils, toilets, etc.  Your compulsive hygiene isn't protecting anybody against HPV and is unnecessary.
I went to two doctors with different diagnoses. What is the more reliable diagnosis: visual inspection by a GYN (who diagnosed me with GWs) or visual inspection and biopsy by a dermatologist, who declared that I had skin tags?
H. Hunter Handsfield, MD:
I can't compare the diagnostic capabiliteis of one doc versus anohter.  But in general dermatologists are the wart experts, and even without a biopsy I would generally trust a dermatologist's diagnosis in this situation.  In any case, the biopsy is proof:  no warts (at least no wart in the tissue snipped for biopsy).
When is a syphillis test is conclusive?  Is 6 weeks sufficient?
H. Hunter Handsfield, MD:
Six weeks is plenty of time.
Does erythromycin get rid of chlamydia?
H. Hunter Handsfield, MD:
Erythromycin is usually effective, but not quite as reliable as azithromycin or a tetracycline (i.e., doxycycline and related drugs).  This is both because the drug isn't quite as active and because gastrointestinal upset is common with erythromycin, so many people end up not taking the entire course of treatment.
People visit the STD community all of the time and say they have gotten Trich from other means then sex. Do you have any information on other ways Trich is aquired?
H. Hunter Handsfield, MD:
Trich is virtually always sexually acquired; if there are valid exceptions, they are very rare.  However, trich can be carried for several years, for sure in the vagina and perhaps in the male genital tract.  Also, standard diagnostic tests often miss the infection.  Therefore, it's very common for an apparently new trich infection to appear in someone without apparent STD risks, e.g. in woman who has had normal paps and pelvic exams for many years. But that doesn't mean it wasn't sexually acquired.