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pubic hair removal and std risk

Mar 19, 2013 - 0 comments

Brazilian waxes may increase risk of viral infection
By Meghan Holohan

Put down that razor. Step away from the wax. That Brazilian might be causing the spread of a sexually transmitted infection, according to a new study.  

A dermatologist in Nice, France, observed more and more patients coming to his office with molluscum contagiosum virus (MCV) outbreaks in their nether regions (molluscum contagiosum, incidentally, sounds more like a “Harry Potter” spell than a virus). About 93 percent of these 30 patients, both male and female, shaved, waxed, or clipped their pubic hair. This made Dr. Francois Desruelles, MD, wonder about the relationship between grooming downstairs and the spread of MCV.  

“Pubic hair removal is a body modification for the sake of fashion, especially in young women and adolescents, but also growing among men,” writes Desruelles in a letter published online in the British Medical Journal. “Anyway, pubic hair removal may be a risk factor for STMC [sexually transmitted MCV] or perhaps other STIs …”

MCV, a pox virus, spreads by skin-to-skin contact, from sharing items such as towels or clothes, or sexual contact. It causes pearly papules with dimples in the middle. While MCV looks unsightly, it is not painful and often goes away without treatment. Although a few bumps might be an inconvenience, some people develop hundreds of these papules, which can be embarrassing and disfiguring.

After looking at cases of sexually transmitted MCV, Desruelles believes that people are self-inoculating, meaning they are giving themselves pubic MCV from grooming. A person might shave a papule on her leg, for example, and the virus remains on the blade, which transfers it to her lady parts.

This is a common way to spread bacteria or viruses, explains Dr. Robert T. Brodell, MD, a professor and chief of the division of dermatology at the University of Mississippi Medical Center. People often spread warts this way.  

“You cut through a wart … and pull [the HPV] along a line so you end up with warts in a line. You have the original wart and nine more.”

Brodell, who did not participate in the study, believes there are a few other reasons why pubic hair grooming might cause the spread of MCV. People may share razors—so one person with MCV might pass it onto his roommate because they used the same razor (ew, people, get your own razors, especially if you are using it to trim your business). Or tiny abrasions from shaving makes it easier to contract MCV from a paramour.  

“You have sexual contact with someone who has it and it is easier to pick up the virus,” Brodell says. He recommends that people abstain from sex with someone who has an outbreak of MCV. If people suspect they have MCV or warts they should shave around the bumps, not through them, he adds.

While grooming likely increases the spread of sexually transmitted MCV, it doesn’t mean we must go au naturel. Brodell notes there is nothing inherent about pubic hair that protects people from MCV or STIs. “The hair itself is not a defensive barrier.”    

herpes testing in pregnancy

Mar 01, 2013 - 0 comments

Herpes Testing



who should get tested for herpes? Every pregnant woman and her partner and as early into pregnancy as possible!! The further into pregnancy you go, the less reliable the testing is for the mother and you want to know your status and also your partner's status so you can protect your unborn baby! 1 out of every 2-3 people in the US alone has hsv1 and 1 out of every 4-5 has hsv2. It's not likely that both partners are completely hsv free so knowing who has what is important.  

  type specific herpes igg blood testing typically is not a part of routine std testing nor is it a part of routine pregnancy testing unfortunately. Be sure to talk to your obgyn about what testing is being done at your first prenatal appointment and make sure herpes is part of that testing. You don't want to have symptoms during the last few weeks of pregnancy and not have any idea if they could be herpes related or not and be worrying at a time you should be anticipating the arrival of your new baby!   Make sure that your partner also seeks out testing too to know their status. You can transmit hsv1 to the genital area during oral sex as well as hsv2 can be transmitted during sex too.  Since studies have confirmed over and over again that over 90% of people who have hsv2 have no idea they have it until they are tested, neither you nor your partner should assume anything about status.   the two of you can't make educated decisions about what precautions to take until you know who has what.  It's also important to your obgyn to know if this was a newly acquired herpes infection or not too during pregnancy so getting tested prior to pregnancy or early into it, helps determine that too. About 1/2 of all presumed newly acquired herpes infections actually aren't so having baseline test results is helpful to your provider.

so how should you get tested? type specific herpes igg blood testing is the best way to test. Make sure it's the right testing.   ( )  You don't want herpes igm blood testing done and you don't want non-type specific igg blood testing done either.  A lesion culture when you have no symptoms genitally also isn't helpful.   If you  had symptoms that were cultured but came back negative, make sure that you follow up with type specific blood testing to confirm your status. Lesion cultures in general have a high false negative rate so appropriate follow up is important.

why is it important to get tested early into pregnancy?  The longer you wait, the less likely it is your testing will be accurate due to the normal hemodilution of your blood from pregnancy.  Blood testing during the last trimester especially is least accurate so you want it done long before that point.  

so what if you have symptoms during pregnancy that you think are herpes related? Be seen asap!!  You need a lesion culture and typing done of symptoms as early as possible - within 48 hours of symptoms appearing if at all possible.  There is about a 5% risk of herpes being transmitted to your unborn child if you are infected during pregnancy so  knowing for sure if you are newly infected during pregnancy is important so your obgyn can do the appropriate follow up for you ( additional ultrasounds to check on the baby ).  

If you have questions, post them on the herpes forum -

antibiotic resistance

Nov 23, 2012 - 4 comments

really important reading to properly understand why just throwing antibiotics at people isn't in their best interest.  


anal sex, oral sex and mutual masturbation risks

Oct 20, 2012 - 1 comments

Anal Sex


oral sex


mutual masturbation


ABSTRACT: Noncoital sexual behaviors, which include mutual masturbation, oral sex, and anal sex, are common expressions of human sexuality. Couples may engage in noncoital sexual activity instead of penile–vaginal intercourse hoping to reduce the risk of sexually transmitted diseases and unintended pregnancy. Although these behaviors carry little or no risk of pregnancy, women engaging in noncoital behaviors may be at risk of acquiring sexually transmitted diseases. Practitioners can assist by assessing patient risk and providing risk reduction counseling for those participating in noncoital sexual activities.

Noncoital sexual activities are common in both adults and adolescents. The 2002 National Survey of Family Growth found that 88% of females and 90% of males aged 25–44 years, and 55% of males and 54% of females aged 15–19 years, have had oral sex with an opposite-sex partner (1). Anal sex is less common than oral or vaginal sex and is commonly initiated at a later age; 35% of females and 40% of males aged 25–44 years and 11% of male and female adolescents aged 15–19 years reported anal sex with an opposite-sex partner (1). Comparison of data on oral sex from the 2002 National Survey of Family Growth with data from three national surveys from the early and mid 1990s (the 1991 National Survey of Men, the 1992 National Health and Social Life Survey, and the 1995 National Survey of Adolescent Men) provides no evidence for a recent increase in oral sex prevalence among adolescents and young adults despite concerns expressed in the popular media (1).

Noncoital behaviors commonly co-occur with coital behaviors. Both oral sex and anal sex are much more common among adolescents who have already had vaginal intercourse as compared with those who have not (2). Likewise, the prevalence of oral sex among adolescents jumps dramatically in the first 6 months after initiation of vaginal intercourse, suggesting that both are often initiated at the same time and with the same partner. Initiation of anal sex before initiation of coitus is rare, and the prevalence of anal sex increases slowly after initiation of coitus. When engaging in oral sex, most individuals, including adolescents, are unlikely to use barrier protection for a variety of reasons, including a greater perceived safety of noncoital sexual activity compared with vaginal sex (3, 4). In the 2002 National Survey of Family Growth, only 11% of females and 15% of males aged 15–17 years who had ever engaged in oral sex reported using a condom the most recent time that they had engaged in oral sex (5).

Some sexually transmitted diseases (STDs) may be transmitted during noncoital sexual activity. Infections can be spread through saliva, blood, vaginal secretions, semen, and fecal material. Preexisting infections, open sores, abrasions, or any compromise of the epithelial tissue can increase the risk of transmission. Transmission of STDs is organism specific, with certain infections commonly infecting the oral or rectal cavity, and many rarely doing so or causing infection without sequelae.

Human Immunodeficiency Virus Table 1: Risk of HIV Transmission

Human immunodeficiency virus (HIV) transmission is highly correlated with the HIV viral load of the infected partner. In addition, the risk of acquiring HIV varies dramatically according to the specific sexual behavior, especially whether it is insertive or receptive. The U.S. Centers for Disease Control and Prevention (CDC) estimates a 100-fold increase in risk from the safest to the least safe behavior (Table 1). Human immunodeficiency virus is most readily transmitted through anal sex. Receptive anal sex with a partner who is infected with HIV is the sexual behavior associated with the greatest risk of HIV transmission. Condom use reduces HIV transmission by approximately 80% in HIV-serodiscordant couples (6). Although saliva appears to have components that inactivate HIV, there are case reports of HIV acquisition in men who engaged only in oral sex with other men (7).

Herpes Simplex Virus

Herpes infection is commonly transmitted through kissing and via oral, vaginal, and anal sex. Typically, herpes simplex virus type 1 (HSV-1) is associated with oral lesions, whereas herpes simplex virus type 2 (HSV-2) is associated with genital lesions. However, both HSV-1 and HSV-2 are capable of infecting oral, anal, and genital sites. A study of university students seeking treatment for herpes found the percentage of HSV-1 genital herpes infections increased from 31% in 1993 to 78% in 2001 (8). Therefore, older studies that based their results solely on the presence of HSV-2 have underestimated the prevalence of genital herpes infections (9, 10).

Human Papillomavirus

Human papillomavirus (HPV) is a very common sexually transmitted virus that causes anogenital and oral cancers as well as the benign genital warts. There are more than 100 strains of HPV, 40 of which selectively infect the anogenital and oral areas. More than 90% of the HPV infections resolve spontaneously without sequelae; however, persistent infection in the anogenital area or oral cavity may cause cancer. Although the most efficient means of transmission appear to be penile–vaginal sex or penile–anal sex, oral transmission appears to occur as well. However, data currently suggest that transmission is less efficient to the oral cavity than to the genital area. The digital spread of HPV is theoretically possible because genital HPV DNA has been detected on the hand. However, because this is only detection of DNA, it is not proved that this DNA is infectious.

Hepatitis Viruses

Hepatitis B virus can be found in semen, saliva, and feces and is commonly spread through sexual contact. Hepatitis A is transmitted from fecal contamination of the oral cavity, thus explaining the higher incidence of infection in homosexual men who engage in oral–anal contact. Sexual transmission of hepatitis C is uncommon but has been associated with both preexisting hepatitis B and HIV infection and with oral–genital contact (7).

Nonviral Sexually Transmitted Diseases

A substantial number of recent primary and secondary cases of syphilis reported in Chicago were attributable to oral sex, with 86 of 627 (13.7%) individuals with syphilis reporting oral sex as the only sexual exposure that could account for their infection (11).

Most gonorrheal infections are sexually transmitted and involve the urethra, cervix, rectum, or mouth (12). Disseminated disease after oral–genital contact has been documented. Although only 10% of isolated pharyngeal gonorrheal infections are symptomatic, pharyngitis, with or without fever or lymphadenopathy, should raise suspicion for gonorrheal infection when all other etiologies have been ruled out.

Chlamydia has been isolated from throat cultures in both men and women. In women, pharyngeal infection is associated with performing oral sex on men (12, 13). Chancroid, shigellosis, salmonellosis, and other enteric infections have been linked to oral–genital or oral–anal sex in a few case reports but appear to be relatively uncommon. The role of noncoital sexual activity in the transmission of other nonviral infections, such as vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis remains unclear (12).

Patient Counseling

Noncoital sexual activity is not necessarily "safe sex." Because people define sexuality in a variety of ways, it is important that practitioners ask direct questions regarding sexual activity, including questions about oral or anal sex and mutual masturbation, and questions about sexual partners, including whether the patient has sex with men, women, or both men and women.

A positive response to these questions indicates the need for counseling regarding infection prevention strategies specific to noncoital sexual activity. To individualize counseling, the clinician must consider the woman's infection risk from partner factors (number of sexual partners and her partners' sexual behaviors, particularly multiple sexual partnerships) and the community prevalence of STDs. Because most women who engage in noncoital sexual activity also are engaging in penile–vaginal intercourse, the clinician needs to consider whether noncoital behaviors add any additional risks to those already posed by sexual intercourse. When a young person engages in only oral or anal sex, the likelihood of encountering a partner infected with an STD should be considered. Correct and consistent condom use should be encouraged, especially for anal sex and vaginal sex. Practitioners also should consider the patient's history of STDs and patterns of barrier method use with each partner. In brief, practitioners need to consider the totality of the patient's STD risk.

Counseling should focus on reducing STD risk factors such as multiple partners. This may be more effective than discouraging oral or anal sex. Risk-reduction strategies may include engaging in safer behaviors (eg, oral sex often is safer than vaginal intercourse, anal sex often is riskier than penile–vaginal sex), abstinence, mutual monogamy, limiting the number of partners, STD testing before engaging in sexual activity with a new partner, and correct and consistent use of condoms, particularly for vaginal and anal sex. Sex toys should be cleaned between uses. Couples counseling may be helpful for STD-serodiscordant couples.

Routine screening for chlamydia is recommended annually for all sexually active women aged 25 years or younger, and routine screening for gonorrhea is recommended for all sexually active adolescents. Although the 2006 CDC STD Treatment Guidelines recommend behavioral screening for anal and oral sex, they do not make specific recommendations for routine oral or anal STD laboratory screening (14). Selected laboratory testing for oral and anal STDs should be based on clinical symptoms and behavioral risks.

Lesbians and bisexual women should be screened for STDs based on the same risk factors as other women. Because most lesbians have been sexually active with men at some point in their lives and because some STDs also can be transmitted by sexual activity exclusively among lesbians, it should not be assumed that STD screening is unnecessary.


Great efforts are needed to educate health care practitioners and the public regarding the potential health risks of noncoital sexual activities and the importance of risk reduction and barrier methods of protection. Practitioners can assist by assessing patient risk and providing risk reduction counseling for those participating in noncoital sexual activities. Ultimately, additional research is needed to determine the full impact of noncoital sexual activity on the health of patients.