Tag Archives: AIDS

Straight, No Chaser: The Day You Get Diagnosed With HIV

November 4, 2016Infectious Disease, Health Prevention844-SMA-TALK, AIDS, Behind the Curtain, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

I’ve had many occasions to tell a patient they were HIV(+). Over the last 20 years of my doing so, that message has changed from a death sentence to the acknowledgement of a chronic disease that will need to be battled for a lifetime. That said, the responses still haven’t changed much. There are differences in those for whom the diagnosis is a complete surprise (such as those who would have received it from a blood transfusion) versus those who suspect they’ve been infected (e.g. through IV drug use or risky sexual practices).
I’d imagine that the response is much like it was for an earlier generation when news was received that they’d contracted “The Big C (Cancer).”

As I walk into the room, the patient is already in complete shock. It’s as if they’re thinking about the error of their ways and simultaneously not thinking at all.
The moment requires finesse. It’s easy to blow in and out of a room and drop this bomb of news; after all, it’s a busy emergency room. However, this is important. This is a moment when someone’s life will irreparably change. It will either be the first day of the rest of their life or the beginning of the end of their life.
Patients tend to want this information in private, although to a physician, this is a big red flag. This isn’t private information. Everyone in his/her life will be affected, and furthermore it’s important to start lining up one’s support from the very beginning. I want the patient to have loved ones around to hear this information if they will consent.
“I need you to pay attention, and stay with me.” I’ll tell them this regardless of the outcome, because the fact that this information is being provided in an ER instead of a primary care physician’s office usually means there is some behavior modification that’s going to be needed regardless of the verdict.
Let’s get this out-of-the-way, because that’s what he or she wants to know. “You’re HIV(+).” Again: “I need you to pay attention, and stay with me.”

There are different topics that need to be discussed.

What it means to be HIV(+).
What it means to have AIDS.
How the rest of one’s life is going to look with and without treatment.
What this will mean to one’s family, friends and other loved ones.
How to give the patient the best opportunity for success.

The conversation can be devastating or empowering. You may find this surprising, but a significant number of patients take this news as a rallying cry. In the same way a smoker is suddenly able to stop smoking cold turkey on the day of a heart attack, newly HIV(+) patients find the strength to stop IV drug abuse and alter other high risk activities.

Here’s a bit of a disclaimer. It’s really not all about friends/family support. Friends and family need to be protected. These are the very people who immediately become at risk once a significant other becomes HIV(+), and they deserve to know they are at risk. In many ways it’s easiest to inform them from the very beginning, and it’s certainly in their best interest to know as soon as possible.

Back to you and your diagnosis: you may have noticed I haven’t given you much time to breathe or grieve. There will be plenty of time for you to experience denial, anger, bargaining, depression and acceptance after you leave the emergency room. In real-time, the virus is here, and the risk for risk management begins immediately, especially given it likely wasn’t being handled previously. The most important purpose of your visit wasn’t the launching of your grieving process but the mobilization of resources to treat you and protect others.
A final point: you really don’t want to go through this. Seeing the utter despair, fear and depression indicates that life at best will be very challenging to live. The steps to minimize your risks are so straightforward. It’s agonizing to see those newly diagnosed mentally retracing their steps, knowing that wearing condoms or not being promiscuous or not engaging in needle use was within their control. Make better choices on the front end. After all, you probably wouldn’t knowingly step in front of a moving truck.

Please get tested.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Your HIV and STD Risks From Sexual Activities Other Than Intercourse

November 3, 2016Genital/Urinary, Infectious Disease, Obstetrics and GynecologyAIDS, Anal sex, Behind the Curtain, Female condom, HIV, Hiv And Aids, HIV/AIDS, Safe sex, Sexual intercourse, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Today, your sexual IQ goes up, and hopefully your risk for sexually transmitted infections (STIs), including HIV, goes down.
This is the fifth and last post in a series on HIV and AIDS.

For an explanation of what AIDS is, click here.
For an explanation of how HIV is contracted, click here.
For an explanation of the signs and symptoms of HIV/AIDS, click here.
For an explanation of the risk of contracting HIV from specific acts of sexual intercourse, click here.

Here are some terms you should understand.
Rimming: oral-anal contact
Fingering: digital sexual stimulation
Now let’s review.

Performing Oral Sex On A Man

You can get HIV by performing oral sex on your male partner. The risk is not as pronounced as it is with unprotected vaginal or anal sex, but oral sex clearly is a mode of transmitting HIV.
You are also at risk for getting other sexually transmitted infections (STIs), including herpes, syphilis, chlamydia and gonorrhea.
Using condoms during oral sex reduces the risk of contracting HIV and other STIs.
Your risk of contracting HIV from oral sex is reduced if your male partner does not ejaculate in your mouth.
Your risk of contracting HIV from oral sex is reduced if you do not have open sores or cuts in your mouth.

Receiving Oral Sex If You Are A Man

The risk of contracting HIV is less with receiving oral sex than many other sexual activities, but it is still present.
Your risk of contracting HIV from receiving oral sex is reduced if you do not have open sores or cuts on your penis.
Oral sex also presents a risk of contracting other STIs, most notably herpes.

Performing Oral Sex On A Woman

Significant levels of HIV have been found in vaginal secretions, so there is a risk of contracting HIV from this activity, although the risk is not a great with other sexual activities.
It is also possible to contract other STIs from performing oral sex on a woman.
There are effective barriers you can use to protect yourself from contact with your partner’s vaginal fluids. You can use dental dams or non-microwaveable plastic wrap to protect against HIV and other STIs. (According to the Centers for Disease Control and Prevention, plastic wrap that can be microwaved will not protect you—viruses are small enough to pass through that type of wrap.)

Receiving Oral Sex If You Are A Woman

The risk for contracting HIV while receiving oral sex is significantly lower than for unprotected vaginal sex, but it is still present.
It is also possible to contract other STIs while receiving oral sex.
There are effective barriers you can use (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over your vulva to protect yourself from STIs.

Oral-Anal Contact (Rimming)

The risk of contracting HIV by rimming is very low but comes with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming.
You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over the anus to protect against infection.

Digital Stimulation (Fingering)

There is a very small risk of getting HIV from fingering your partner if you have cuts or sores on your fingers and your partner has cuts or sores in the rectum or vagina.
The use medical-grade gloves and water-based lubricants can during fingering eliminates this risk.

If you have any additional questions, please feel free to ask questions or provide comments. I cannot more highly endorse the websites at cdc.gov and the US Department of Health and Human Services.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Your HIV and STD Risks From Specific Acts of Sexual Intercourse

November 2, 2016Genital/Urinary, Infectious Disease, Obstetrics and GynecologyAIDS, Anal sex, Behind the Curtain, Female condom, HIV, Hiv And Aids, HIV/AIDS, Safe sex, Sexual intercourse, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Let’s be clear that we’re explicitly discussing the types of sexual behaviors that will lead to transmitting HIV and other sexually transmitted infections (STIs). Over the next two days, we will run the gamut of sexual behavior and its implications.
This is the fourth in an ongoing series on HIV and AIDS.

For an explanation of what AIDS is, click here.
For an explanation of how HIV is contracted, click here.
For an explanation of the signs and symptoms of HIV/AIDS, click here.

What I hope to accomplish here is to identify those activities that place you at significant risk for contracting HIV and other sexually transmitted infections (STIs). The take-home message is you really should identify your partner’s health status before you begin sexual activity.
Today we will focus on four types of sexual activity and discuss the risks of each. Let’s start with some terminology.

Receptive sex risks speak to risks to the receiver.
Insertive sex risks speak to risks to the giver.
Bottoming is a way of describing receptive anal sex.
Topping is a way of describing insertive anal sex.

Now, let’s review.

Receptive Vaginal Sex

Vaginal sex without a condom is a high-risk behavior for HIV infection.
HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
If you currently have an STI or vaginal infection, your risk for contracting/transmitting HIV is increased because your tissue will be inflamed. This has nothing to do with the presence or absence of symptoms.
Female condoms protect HIV infection if used correctly. However, the risk still exists for any area exposed and infected (in the presence of an open sore or bleeding, for example).
Barrier birth control methods (such as diaphragms, IUDs and cervical caps) DO NOT protect against STIs or HIV infection. If infected semen or sperm contracts inflamed or otherwise injured vaginal tissue, the risk of transmission/contraction is present.
Birth control pills do not protect against HIV or other STIs.

Insertive Vaginal Sex

HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
Condom use is a critical means of protection against STIs that are present without obvious symptoms. Use condoms with a water-based lubricant every time you have insertive vaginal sex to prevent STIs, including HIV.

Receptive Anal Sex (Bottoming)

Bottoming without a condom provides the highest risk for contracting HIV, more so than any other sexual behavior.
HIV has been identified in pre-ejaculatory semen. “Pulling out” prior to ejaculation may not decrease your risk.
Rectal douching before anal sex can increase your HIV risk. Douching irritates the rectal tissue and can make you more receptive to contracting HIV. Soap and water in a non-abrasive manner are adequate means of cleanliness.
If bottoming, you will best minimize the risk of transmitting HIV and other STIs by always using a water-based lubricant with a latex, polyurethane, or polyisoprene condom. This will help to minimize irritation to the rectum during sex and subsequent transmission.

Insertive Anal Sex (Topping)

Topping without a condom is a high-risk behavior for transmission of HIV and other STIs. An infection may be present. If small sores, scratches or tears are also present, they would provide a ready path of entry and transmission of HIV.
Similarly, those same lesions in your partners rectum could harbor infected cells in blood, feces or other fluid, which, when contacted, could infect you through your penis.

Check back for the next post in this series on HIV/AIDS. It will focus on HIV and STD risks from sexual activities other than intercourse.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: What Are The Symptoms of HIV and AIDS?

November 1, 2016Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease844-SMA-TALK, Acquired Immunodeficiency Syndrome, AIDS, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is the third in an ongoing series on HIV and AIDS.

For an explanation of what AIDS is, click here.
For an explanation of how HIV is contracted, click here.

The National Institutes of Health has a nice method of categorizing HIV signs and symptoms, which I’ll replicate here. There are several take home messages, and I’ll use the pictures to communicate them.

HIV Positive Without Symptoms
Many people who are HIV-positive do not have symptoms of HIV infection, and symptoms only evolve as their condition deteriorates toward AIDS (Acquired Immunodeficiency Syndrome). Sometimes people living with HIV go through periods of being sick and then feel fine.

Signs and Symptoms of Early HIV
As early as two–four weeks after exposure to HIV (but sometimes as far out as three months later), people can experience an acute illness, often described as “the worst flu ever.” This is called acute retrovirus syndrome (ARS) or primary HIV infection. This represents the body’s natural response to HIV infection. During primary HIV infection, there are higher levels of virus circulating in the blood, which means that people can more easily transmit the virus to others.
Symptoms resemble a flu-like syndrome, including fever, chills, nights sweats, muscle aches and fatigue. Other symptoms may include a rash, sore throat, swollen lymph nodes and ulcers in mouth. It is important to state that not everyone gets ARS when they become infected with HIV.

Signs and Symptoms of Chronic or Latent Phase HIV
After the initial infection and seroconversion, the virus becomes less active in the body, although it is still present. During this period, many people do not have any symptoms of HIV infection. This period is called the ‘chronic’ or ‘latency’ phase. This period can last up to 10 years—sometimes longer.

Signs and Symptoms of AIDS
While the virus itself can sometimes cause people to feel sick, most of the severe symptoms and illnesses of HIV disease come from the opportunistic infections that attack the infected individual’s compromised immune system.
When HIV infection progresses to AIDS, many people begin to suffer from fatigue, diarrhea, nausea, vomiting, fever, chills, night sweats, and even wasting syndrome at late stages.
Unless symptoms are discovered late, HIV/AIDS is much better being diagnosed early based on risk factors and exposures. That said, use the knowledge provided to prompt evaluation and testing.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: How Do You Contract HIV/AIDS?

October 28, 2016Genital/Urinary, Infectious DiseaseAIDS, Blood, Blood transfusion, Body fluid, HIV, HIV-AIDS, HIV/AIDS, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This isn’t 1983. The mystery of how HIV infection is contracted has come and gone. Yet HIV and AIDS awareness are still critical. You need to be knowledgable to be empowered.

This is the first blog in an ongoing series on HIV and AIDS.

For an explanation of what AIDS is, click here.
For an explanation of the signs and symptoms of HIV/AIDS is, click here.

First, let’s address a simple principle. The HIV virus can live and reproduce in high levels in blood other body fluids, including breast milk, rectal mucus, semen (and pre-semen) and vaginal fluids. If any of those fluids are infected and are transmitted to another’s body, that individual can become infected with HIV. In special circumstances (such as healthcare workers), individuals may become exposed to other areas that may contain high levels of HIV, including amniotic fluid (in pregnancy women), cerebrospinal fluid (from the brain and spinal cord) and synovial fluid (from various joints).
Now please take a moment and look at the lead picture. In addition to those circumstances listed, you should know that fluids such as feces, nasal fluid, saliva, sweat, tears, urine or vomit don’t by themselves contain high enough levels to transmit HIV. However, if those fluids are mixed with blood and you have contact with both fluids, you may become infected via these routes.
HIV is transmitted through body fluids in very specific ways:

During anal, oral or vaginal sex: When you have anal, oral, or vaginal sex with a partner, you will have contact with your partner’s body fluids in areas very likely to be high in HIV viral load if your partner is infected. HIV gets transmitted in these instances through small breaks in the surfaces of the mouth, penis, rectum, vagina or vulva. One of the reasons HIV infection rates are higher in individuals with herpes and syphilis is because those diseases cause open sores, creating additional opportunities for HIV-infected body fluids to enter the body.
During pregnancy, childbirth or breastfeeding: Babies have constant contact with their mother’s potentially infected body fluids. Means of transmitting HIV from mother to child include through amniotic fluid, blood and infected breast milk.
As a result of injection drug use: Injecting drugs puts you in contact with blood. If those needles and their contents are contaminated, you can be directly delivering HIV into your bloodstream.
As a result of occupational exposure: Healthcare workers must be constantly diligent against this method of transmission. Risks of HIV transmission to healthcare workers occur through blood transferred from needlesticks and cuts, and less commonly through contact of infected body fluids splashed into the eyes, mouth or into an open sore or cut.
As a result of a blood transfusion or organ transplant: Fortunately, these days, this is very rare given the stringency of screening requirements in the United States, but it is possible to transmit HIV through blood transfusions or organ transplants from infected donors.

How does one get AIDS?
AIDS is a progression of HIV into its later stages and occurs after one’s immune system is severely damaged. You don’t “get AIDS” as much as HIV progresses to AIDS in certain circumstances. Many of us recall that HIV could progress in this way to AIDS in a matter of a few years a few decades ago. Fortunately, with the development of specialized medications in the 1990s, people with HIV are living much longer with HIV before they develop AIDS.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: What Exactly Is AIDS?

October 27, 2016Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease844-SMA-TALK, Acquired Immunodeficiency Syndrome, AIDS, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is the second blog in an ongoing series on HIV and AIDS.
After all these years, it’s still an interesting and important enough question to ask and to know how to answer. Most know that AIDS is a devastating disease caused by the HIV virus. However, courtesy of the National Institutes of Health, consider the following:
A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.
I – Immuno – Your body’s immune system includes all the organs and cells that work to fight off infection or disease.
D – Deficiency – You get AIDS when your immune system is “deficient,” or isn’t working the way it should.
S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.

Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (meaning infections not typically present in persons with normal immunity).
You will be diagnosed with AIDS if you have one or more specific opportunistic infections, certain cancers (such as Kaposi’s sarcoma) or a very low number of CD4 cells (a measure of the strength of your immune systems function). If you have AIDS, you will need medical intervention and treatment to prevent death.
Check back to Straight, No Chaser for additional posts on HIV/AIDS, including risk factors and symptoms, progression/complications and treatment.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight No Chaser: HIV Awareness Month – Can HIV Be Eliminated From the Body?

October 26, 2016Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease844-SMA-TALK, AIDS, Blood transfusion, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

It’s HIV Awareness Month. Have you noticed there’s a lot less chatter about HIV lately? Don’t be lulled into a sense of false security; no, it hasn’t been eradicated. It is still being contracted and is still causing death. Straight, No Chaser will review the latest on HIV in the next few posts.

Looking at the above picture, you would think it shows Ervin “Magic” Johnson donating blood. As most everyone knows, Magic famously retired from the NBA after contracting HIV. As we delve into this Straight, No Chaser, remember two important points.

He never contracted AIDS (we’ll get into the difference between HIV and AIDS in an upcoming post).
He is said to no longer have a detectable viral load of HIV. To paraphrase his words, “I’m cured of HIV.”

So does this mean it’s safe for certain “former” HIV(+) patients to donate blood and engage in activities others who are not HIV(+) can? HIV is a fascinating virus, and the more you know about it, the better off you are, particularly when it comes to protecting yourself from contracting the virus. Several Straight, No Chaser posts have addressed HIV/AIDS, and links are provided below.
In the meantime, consider the following. You’ve had many diseases over your life.

For those of you who have had pneumonia or the flu, did you forever stop kissing once you recovered?
For those of you who have had gonorrhea, syphilis or chlamydia, did you forever stop having sex once you were treated?
For those of you who have had chickenpox, did you forever stop hugging once the virus and rash disappeared?

I bring this points up to point out that at some point, once we truly discover a cure for HIV and actually are successful at eliminating the virus from the body of those infected, it makes sense that you could see someone who was HIV positive donating blood.
However…
That is not a picture of Magic Johnson donating blood. It could be him having blood drawn, or it could be a picture of someone else donating blood with Magic’s head photoshopped on the picture. How do I know this, even without going directly to the source?
In the news…
A case study exists that is about as close to this scenario as it gets. A baby thought to have been “cured” of HIV last year has now been diagnosed with the virus. After being born to a HIV(+) mother, a baby in Mississippi was pre-emptively treated with three antiretroviral drugs for 18 months. Doctors lost track of the infant until she was brought to a clinic for a visit after 10 months of receiving no HIV medication. The team involved found no evidence of the virus in her blood, and declared the girl “functionally cured.” Unfortunately, the virus has now returned. The child, now nearly 4, was recently found to have high levels of HIV in her blood during a routine visit to the University of Mississippi Medical Center, where she was originally discovered to be HIV(-). Decreased levels of CD4+ cells, the white blood cells targeted by HIV, along with the appearance of antibodies against the virus in her blood, suggest that her remission had come to an end, and that traces of virus remaining in her body had escaped from immune control.
There have now been several cases of cures and relapses. Here’s a bottom line consideration: the earlier that drugs are given, the easier it is for the body to keep the virus in check. However, one should not expect early treatment to completely eliminate HIV.

You may wonder how it’s possible for HIV to become undetectable or to relapse once seemingly “eradicated.” We know the HIV virus can hide away in tissues such as lymphoid and gut cells, as noted in the above picture. Medicines can only reach the virus located in the blood, and if therapy is halted, the virus can emerge from these other locations and relaunch its attack. This explains why most HIV patients need to take antiretroviral drugs daily over the course of their lives,.
The biggest hope for tackling the problem is to find drugs that flush latent HIV out of its hiding places in the body, so all the virus can be eliminated, effectively curing the patient so they don’t have to take more antiviral drugs.
This isn’t much of a surprise. Unlike the examples of disease being fully cured as in the scenarios listed above, other diseases simply go dormant inside the body. The classic example of this is the family of herpes viruses. Many of you are aware that a herpes simplex virus can reappear after decades of being absent. Similarly, chicken pox and shingles – diseases caused by the herpes zoster virus – can reappear after having run their course during the initial infection. At this point it appears that HIV appears to be more like the herpes viruses in this regard than examples of other infections and disease that can be completely eradicated.

Despite theoretically reasonable possibilities about the prospect of receiving blood from someone who had been HIV-positive, it is currently not prudent to do so, even as we know HIV loads can be completely eliminated from the blood of patients. That is not the same as eliminating HIV from the body. Thus, the American Red Cross and other blood donations involved in blood transfusions will not accept donations from anyone ever having been HIV(+).
For those in need of a life-saving blood transfusion, having individuals step up to donate is vitally important. Please consider doing so.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Living With An Incurable Sexually Transmitted Infection

May 9, 2016Genital/Urinary, Infectious Disease, Obstetrics and GynecologyAIDS, Anal sex, Behind the Curtain, Female condom, Herpes, HIV, Hiv And Aids, HIV/AIDS, HPV, Safe sex, Sexual intercourse, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

You’ve requested it, and it’s only fair. We’ve spent a lot of time discussing sexually transmitted diseases and infections (STDs, STIs). It’s reasonable to discuss living with an STD. The first point to appreciate is most STDs can be treated; that’s been discussed at length in several previous posts. Next you should understand that those that can’t be treated don’t represent a death sentence. STDs are simply diseases. To be clear you will need to make adjustments to you life, and this Straight, No Chaser will discuss those.
Even if you were irresponsible in acquiring an STD, you must be learn to be responsible in managing it once it’s known that you have an incurable STD such as HPV or HIV/AIDS. Refer back to the Straight, No Chaser Comprehensive Safe Sex Guide for details.

There are important differences between managing different diseases. Putting HIV/AIDS aside momentarily, consider the following general considerations regarding herpes or HPV.

You can live a mostly normal life with these conditions. Unless you’re in the midst of a herpes outbreak or are showing the warts of HPV, you will appear normal. Every other positive attribute you possess will still be intact. Use that positivity to help you through.
It’s only fair and reasonable to have a conversation with existing and/or new sexual partners about your condition. You and your partner should meet with your physician to discuss risks and possibilities. You will want this information to make informed decisions about what you choose to do moving forward.
If you are showing symptoms or in the midst of an outbreak, you should avoid any sexual activity.
Unless you’re in the midst of an outbreak, you can have sex. Remember that these STDs can be transmitted even in the absence of symptoms, so please protect yourself and your partner.

A really reasonable way to think about having sex with an incurable STD is to think about kissing someone with a cold or the flu. You could still do it, but you’re likely to be at risk. When the symptoms aren’t there, your partner could still be a carrier of the disease and could still give you the disease. Your better course of action is to wait until all symptoms are gone and then still be careful.

You have to simultaneously appreciate that your life will be approximately normal, even as you’ve had a significant change. Even as you get about living the rest of your life, you should be aware of risks that can cause an outbreak.

Of course intercourse is a very risky activity. Couples who have been exposed to one STD are likely to have been exposed to multiple. You don’t want to “ping-pong” diseases between you and your partner. Follow the recommended guidelines for having and avoiding sex based on your symptoms.
Surgery, trauma or any cause of a reduced immune system can produce an outbreak. If you’re diabetic, on steroids, have lupus or other conditions that affect the immune system, have a conversation with your physician.

At some point, you’ll get over the guilt and shame associated with having an untreatable STD and start focusing on the rest of your life. Be sure to live that life so it’s not causing more damage along the way; out of sight can’t be out of mind with an incurable STD. Be especially mindful of your risks of giving your partner your disease, both from specific acts of intercourse and from other sexual activities besides intercourse. Remember, these diseases all affect more than sex; managing these diseases is managing your health.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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Straight, No Chaser: Living With An Incurable Sexually Transmitted Infection

December 9, 2014Genital/Urinary, Infectious Disease, Obstetrics and GynecologyAIDS, Anal sex, Female condom, Herpes, HIV, Hiv And Aids, HIV/AIDS, HPV, Safe sex, Sexual intercourse, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

You’ve requested it, and it’s only fair. We’ve spent a lot of time discussing sexually transmitted diseases and infections (STDs, STIs). It’s reasonable to discuss living with an STD. The first point to appreciate is most STDs can be treated; that’s been discussed at length in several previous posts. Next you should understand that those that can’t be treated don’t represent a death sentence. STDs are simply diseases. To be clear you will need to make adjustments to you life, and this Straight, No Chaser will discuss those.
Even if you were irresponsible in acquiring an STD, you must be learn to be responsible in managing it once it’s known that you have an incurable STD such as herpes, HPV or HIV/AIDS. Refer back to the Straight, No Chaser Comprehensive Safe Sex Guide for details.

There are important differences between managing different diseases. Putting HIV/AIDS aside momentarily, consider the following general considerations regarding herpes or HPV.

You can live a mostly normal life with these conditions. Unless you’re in the midst of a herpes outbreak or are showing the warts of HPV, you will appear normal. Every other positive attribute you possess will still be intact. Use that positivity to help you through.
It’s only fair and reasonable to have a conversation with existing and/or new sexual partners about your condition. You and your partner should meet with your physician to discuss risks and possibilities. You will want this information to make informed decisions about what you choose to do moving forward.
If you are showing symptoms or in the midst of an outbreak, you should avoid any sexual activity.
Unless you’re in the midst of an outbreak, you can have sex. Remember that these STDs can be transmitted even in the absence of symptoms, so please protect yourself and your partner.

Of course intercourse is a very risky activity. Couples who have been exposed to one STD are likely to have been exposed to multiple. You don’t want to “ping-pong” diseases between you and your partner. Follow the recommended guidelines for having and avoiding sex based on your symptoms.
Surgery, trauma or any cause of a reduced immune system can produce an outbreak. If you’re diabetic, on steroids, have lupus or other conditions that affect the immune system, have a conversation with your physician.

At some point, you’ll get over the guilt and shame associated with having an untreatable STD and start focusing on the rest of your life. Be sure to live that life so it’s not causing more damage along the way; out of sight can’t be out of mind with an incurable STD. Be especially mindful of your risks of giving your partner your disease, both from specific acts of intercourse and from other sexual activities besides intercourse. Remember, these diseases all affect more than sex; managing these diseases is managing your health.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Your HIV and STD Risks From Sexual Activities Other Than Intercourse

December 5, 2014Genital/Urinary, Infectious Disease, Obstetrics and GynecologyAIDS, Anal sex, Female condom, HIV, Hiv And Aids, HIV/AIDS, Safe sex, Sexual intercourse, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

Today, your sexual IQ goes up, and hopefully your risk for sexually transmitted infections (STIs), including HIV, goes down.
This is the fifth and last post in a series on HIV and AIDS.

For an explanation of what AIDS is, click here.
For an explanation of how HIV is contracted, click here.
For an explanation of the signs and symptoms of HIV/AIDS, click here.
For an explanation of the risk of contracting HIV from specific acts of sexual intercourse, click here.

Here are some terms you should understand.
Rimming: oral-anal contact
Fingering: digital sexual stimulation
Now let’s review.
Performing Oral Sex On A Man

You can get HIV by performing oral sex on your male partner. The risk is not as pronounced as it is with unprotected vaginal or anal sex, but oral sex clearly is a mode of transmitting HIV.
You are also at risk for getting other sexually transmitted infections (STIs), including herpes, syphilis, chlamydia and gonorrhea.
Using condoms during oral sex reduces the risk of contracting HIV and other STIs.
Your risk of contracting HIV from oral sex is reduced if your male partner does not ejaculate in your mouth.
Your risk of contracting HIV from oral sex is reduced if you do not have open sores or cuts in your mouth.

Receiving Oral Sex If You Are A Man

The risk of contracting HIV is less with receiving oral sex than many other sexual activities, but it is still present.
Your risk of contracting HIV from receiving oral sex is reduced if you do not have open sores or cuts on your penis.
Oral sex also presents a risk of contracting other STIs, most notably herpes.

Performing Oral Sex On A Woman

Significant levels of HIV have been found in vaginal secretions, so there is a risk of contracting HIV from this activity, although the risk is not a great with other sexual activities.
It is also possible to contract other STIs from performing oral sex on a woman.
There are effective barriers you can use to protect yourself from contact with your partner’s vaginal fluids. You can use dental dams or non-microwaveable plastic wrap to protect against HIV and other STIs. (According to the Centers for Disease Control and Prevention, plastic wrap that can be microwaved will not protect you—viruses are small enough to pass through that type of wrap.)

Receiving Oral Sex If You Are A Woman

The risk for contracting HIV while receiving oral sex is significantly lower than for unprotected vaginal sex, but it is still present.
It is also possible to contract other STIs while receiving oral sex.
There are effective barriers you can use (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over your vulva to protect yourself from STIs.

Oral-Anal Contact (Rimming)

The risk of contracting HIV by rimming is very low but comes with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming.
You should use a barrier method (cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap) over the anus to protect against infection.

Digital Stimulation (Fingering)

There is a very small risk of getting HIV from fingering your partner if you have cuts or sores on your fingers and your partner has cuts or sores in the rectum or vagina.
The use medical-grade gloves and water-based lubricants can during fingering eliminates this risk.

If you have any additional questions, please feel free to ask questions or provide comments. I cannot more highly endorse the websites at cdc.gov and the US Department of Health and Human Services.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Your HIV and STD Risks From Specific Acts of Sexual Intercourse

December 4, 2014Genital/Urinary, Infectious Disease, Obstetrics and GynecologyAIDS, Anal sex, Female condom, HIV, Hiv And Aids, HIV/AIDS, Safe sex, Sexual intercourse, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

For an explanation of what AIDS is, click here.
For an explanation of how HIV is contracted, click here.
For an explanation of the signs and symptoms of HIV/AIDS, click here.

Receptive sex risks speak to risks to the receiver.
Insertive sex risks speak to risks to the giver.
Bottoming is a way of describing receptive anal sex.
Topping is a way of describing insertive anal sex.

Now, let’s review.

Receptive Vaginal Sex

Vaginal sex without a condom is a high-risk behavior for HIV infection.
HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
If you currently have an STI or vaginal infection, your risk for contracting/transmitting HIV is increased because your tissue will be inflamed. This has nothing to do with the presence or absence of symptoms.
Female condoms protect HIV infection if used correctly. However, the risk still exists for any area exposed and infected (in the presence of an open sore or bleeding, for example).
Barrier birth control methods (such as diaphragms, IUDs and cervical caps) DO NOT protect against STIs or HIV infection. If infected semen or sperm contracts inflamed or otherwise injured vaginal tissue, the risk of transmission/contraction is present.
Birth control pills do not protect against HIV or other STIs.

Insertive Vaginal Sex

HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
Condom use is a critical means of protection against STIs that are present without obvious symptoms. Use condoms with a water-based lubricant every time you have insertive vaginal sex to prevent STIs, including HIV.

Receptive Anal Sex (Bottoming)

Bottoming without a condom provides the highest risk for contracting HIV, more so than any other sexual behavior.
HIV has been identified in pre-ejaculatory semen. “Pulling out” prior to ejaculation may not decrease your risk.
Rectal douching before anal sex can increase your HIV risk. Douching irritates the rectal tissue and can make you more receptive to contracting HIV. Soap and water in a non-abrasive manner are adequate means of cleanliness.
If bottoming, you will best minimize the risk of transmitting HIV and other STIs by always using a water-based lubricant with a latex, polyurethane, or polyisoprene condom. This will help to minimize irritation to the rectum during sex and subsequent transmission.

Insertive Anal Sex (Topping)

Topping without a condom is a high-risk behavior for transmission of HIV and other STIs. An infection may be present. If small sores, scratches or tears are also present, they would provide a ready path of entry and transmission of HIV.
Similarly, those same lesions in your partners rectum could harbor infected cells in blood, feces or other fluid, which, when contacted, could infect you through your penis.

Check back for the next post in this series on HIV/AIDS. It will focus on HIV and STD risks from sexual activities other than intercourse.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: What Are The Symptoms of HIV and AIDS?

December 3, 2014Infectious Disease844-SMA-TALK, Acquired Immunodeficiency Syndrome, AIDS, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is the third in an ongoing series on HIV and AIDS.

For an explanation of what AIDS is, click here.
For an explanation of how HIV is contracted, click here.

Signs and Symptoms of AIDS
While the virus itself can sometimes cause people to feel sick, most of the severe symptoms and illnesses of HIV disease come from the opportunistic infections that attack the infected individual’s compromised immune system.
When HIV infection progresses to AIDS, many people begin to suffer from fatigue, diarrhea, nausea, vomiting, fever, chills, night sweats, and even wasting syndrome at late stages.
Unless symptoms are discovered late, HIV/AIDS is much better being diagnosed early based on risk factors and exposures. That said, use the knowledge provided to prompt evaluation and testing.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: What Exactly Is AIDS?

December 2, 2014Infectious Disease844-SMA-TALK, Acquired Immunodeficiency Syndrome, AIDS, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (meaning infections not typically present in persons with normal immunity).
You will be diagnosed with AIDS if you have one or more specific opportunistic infections, certain cancers (such as Kaposi’s sarcoma) or a very low number of CD4 cells (a measure of the strength of your immune systems function). If you have AIDS, you will need medical intervention and treatment to prevent death.
Check back to Straight, No Chaser for additional posts on HIV/AIDS, including risk factors and symptoms, progression/complications and treatment.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: World AIDS Day

December 1, 2014Genital/Urinary, Infectious Disease, Obstetrics and Gynecology844-SMA-TALK, Acquired Immunodeficiency Syndrome, AIDS, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Today is World AIDS day. This isn’t 1983. The mystery of how HIV infection is contracted has come and gone. You need to be knowledgable to be empowered.
This is the first blog in an ongoing series on HIV and AIDS.

For an explanation of what AIDS is, click here.
For an explanation of the signs and symptoms of HIV/AIDS is, click here.

Now please take a moment and look at the above picture. In addition to those circumstances listed, you should know that fluids such as feces, nasal fluid, saliva, sweat, tears, urine or vomit don’t by themselves contain high enough levels to transmit HIV. However, if those fluids are mixed with blood and you have contact with both fluids, you may become infected via these routes.
HIV is transmitted through body fluids in very specific ways:

During anal, oral or vaginal sex: When you have anal, oral, or vaginal sex with a partner, you will have contact with your partner’s body fluids in areas very likely to be high in HIV viral load if your partner is infected. HIV gets transmitted in these instances through small breaks in the surfaces of the mouth, penis, rectum, vagina or vulva. One of the reasons HIV infection rates are higher in individuals with herpes and syphilis is because those diseases cause open sores, creating additional opportunities for HIV-infected body fluids to enter the body.
During pregnancy, childbirth or breastfeeding: Babies have constant contact with their mother’s potentially infected body fluids. Means of transmitting HIV from mother to child include through amniotic fluid, blood and infected breast milk.
As a result of injection drug use: Injecting drugs puts you in contact with blood. If those needles and their contents are contaminated, you can be directly delivering HIV into your bloodstream.
As a result of occupational exposure: Healthcare workers must be constantly diligent against this method of transmission. Risks of HIV transmission to healthcare workers occur through blood transferred from needlesticks and cuts, and less commonly through contact of infected body fluids splashed into the eyes, mouth or into an open sore or cut.
As a result of a blood transfusion or organ transplant: Fortunately, these days, this is very rare given the stringency of screening requirements in the United States, but it is possible to transmit HIV through blood transfusions or organ transplants from infected donors.

Straight No Chaser: Can HIV Be Eliminated From the Body?

September 7, 2014Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease844-SMA-TALK, AIDS, Blood transfusion, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Looking at the above picture, you would think it shows Ervin “Magic” Johnson donating blood. This is a topic begging to be discussed. As most everyone knows, Magic famously retired from the NBA after contracting HIV. As we delve into this Straight, No Chaser, remember two important points.

He never contracted AIDS.
He is said to no longer have a detectable viral load of HIV. To paraphrase his words, “I’m cured of HIV.”

For those of you who have had pneumonia or the flu, did you forever stop kissing once you recovered?
For those of you who have had gonorrhea, syphilis or chlamydia, did you forever stop having sex once you were treated?
For those of you who have had chickenpox, did you forever stop hugging once the virus and rash disappeared?

I bring this points up to point out that at some point, once we truly discover a cure for HIV and actually are successful at eliminating the virus from the body of those infected, it makes sense that you could see someone who was HIV positive donating blood.
However…
That is not a picture of Magic Johnson donating blood. It could be him having blood drawn, or it could be a picture of someone else donating blood with Magic’s head photoshopped on the picture. How do I know this, even without going directly to the source?
In the news…
A case study exists that is about as close to this scenario as it gets. A baby thought to have been “cured” of HIV last year has now been diagnosed with the virus. After being born to a HIV(+) mother, a baby in Mississippi was pre-emptively treated with three antiretroviral drugs for 18 months. Doctors lost track of the infant until she was brought to a clinic for a visit after 10 months of receiving no HIV medication. The team involved found no evidence of the virus in her blood, and declared the girl “functionally cured.” Unfortunately, the virus has now returned. The child, now nearly 4, was recently found to have high levels of HIV in her blood during a routine visit to the University of Mississippi Medical Center, where she was originally discovered to be HIV(-). Decreased levels of CD4+ cells, the white blood cells targeted by HIV, along with the appearance of antibodies against the virus in her blood, suggest that her remission had come to an end, and that traces of virus remaining in her body had escaped from immune control.
The report of the baby’s relapse follows other similar news. Last March, two men in Boston were considered “cured” but were later found to have relapsed.
Research this year in monkeys showed that the earlier that drugs are given, the easier it is for the body to keep the virus in check. But the early treatment didn’t completely eliminate the HIV.

How is this possible, you may ask? We know the HIV virus can hide away in tissues such as lymphoid and gut cells, as noted in the above picture. Medicines can only reach the virus located in the blood, and if therapy is halted, the virus can emerge from these other locations and relaunch its attack. This explains why most HIV patients need to take antiretroviral drugs daily over the course of their lives,.
The biggest hope for tackling the problem is to find drugs that flush latent HIV out of its hiding places in the body, so all the virus can be eliminated, effectively curing the patient so they don’t have to take more antiviral drugs.
This isn’t much of a surprise. Unlike the examples of disease being fully cured as in the scenarios listed above, other diseases simply go dormant inside the body. The classic example of this is the family of herpes viruses. Many of you are aware that a herpes simplex virus can reappear after decades of being absent. Similarly, chicken pox and shingles – diseases caused by the herpes zoster virus – can reappear after having run their course during the initial infection. At this point it appears that HIV appears to be more like the herpes viruses in this regard than examples of other infections and disease that can be completely eradicated.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress.

Straight, No Chaser: Your HIV and STD Risks From Specific Acts of Sexual Intercourse

December 3, 2013Genital/Urinary, Infectious Disease, Obstetrics and GynecologyAIDS, Anal sex, Female condom, HIV, Hiv And Aids, HIV/AIDS, Safe sex, Sexual intercourse, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

For an explanation of what AIDS is, click here.
For an explanation of how HIV is contracted, click here.
For an explanation of the signs and symptoms of HIV/AIDS, click here.

Receptive sex risks speak to risks to the receiver.
Insertive sex risks speak to risks to the giver.
Bottoming is a way of describing receptive anal sex.
Topping is a way of describing insertive anal sex.

Now, let’s review.

Receptive Vaginal Sex

Vaginal sex without a condom is a high-risk behavior for HIV infection.
HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
If you currently have an STI or vaginal infection, your risk for contracting/transmitting HIV is increased because your tissue will be inflamed. This has nothing to do with the presence or absence of symptoms.
Female condoms protect HIV infection if used correctly. However, the risk still exists for any area exposed and infected (in the presence of an open sore or bleeding, for example).
Barrier birth control methods (such as diaphragms, IUDs and cervical caps) DO NOT protect against STIs or HIV infection. If infected semen or sperm contracts inflamed or otherwise injured vaginal tissue, the risk of transmission/contraction is present.
Birth control pills do not protect against HIV or other STIs.

Insertive Vaginal Sex

HIV is transmitted from men to women much more easily than from women to men during vaginal sex, but the risks are significant for both.
Condom use is a critical means of protection against STIs that are present without obvious symptoms. Use condoms with a water-based lubricant every time you have insertive vaginal sex to prevent STIs, including HIV.

Receptive Anal Sex (Bottoming)

Bottoming without a condom provides the highest risk for contracting HIV, more so than any other sexual behavior.
HIV has been identified in pre-ejaculatory semen. “Pulling out” prior to ejaculation may not decrease your risk.
Rectal douching before anal sex can increase your HIV risk. Douching irritates the rectal tissue and can make you more receptive to contracting HIV. Soap and water in a non-abrasive manner are adequate means of cleanliness.
If bottoming, you will best minimize the risk of transmitting HIV and other STIs by always using a water-based lubricant with a latex, polyurethane, or polyisoprene condom. This will help to minimize irritation to the rectum during sex and subsequent transmission.

Insertive Anal Sex (Topping)

Topping without a condom is a high-risk behavior for transmission of HIV and other STIs. An infection may be present. If small sores, scratches or tears are also present, they would provide a ready path of entry and transmission of HIV.
Similarly, those same lesions in your partners rectum could harbor infected cells in blood, feces or other fluid, which, when contacted, could infect you through your penis.

Check back for the next post in this series on HIV/AIDS. It will focus on HIV and STD risks from sexual activities other than intercourse.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: What are the Symptoms of HIV and AIDS?

December 2, 2013Infectious DiseaseAIDS, Disease, HIV, Hiv And Aids, HIV-positive people, HIV/AIDS, National Institutes of Health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

This is the third in an ongoing series on HIV and AIDS.

For an explanation of what AIDS is, click here.
For an explanation of how HIV is contracted, click here.

Signs and Symptoms of AIDS
While the virus itself can sometimes cause people to feel sick, most of the severe symptoms and illnesses of HIV disease come from the opportunistic infections that attack the infected individual’s compromised immune system.
When HIV infection progresses to AIDS, many people begin to suffer from fatigue, diarrhea, nausea, vomiting, fever, chills, night sweats, and even wasting syndrome at late stages.
Unless symptoms are discovered late, HIV/AIDS is much better being diagnosed early based on risk factors and exposures. That said, use the knowledge provided to prompt evaluation and testing.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: How Do You Contract HIV/AIDS?

December 1, 2013Genital/Urinary, Infectious DiseaseAIDS, Blood, Blood transfusion, Body fluid, HIV, HIV-AIDS, HIV/AIDS, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, United States, WordPressJeffrey Sterling, MD

For an explanation of what AIDS is, click here.
For an explanation of the signs and symptoms of HIV/AIDS is, click here.

During anal, oral or vaginal sex: When you have anal, oral, or vaginal sex with a partner, you will have contact with your partner’s body fluids in areas very likely to be high in HIV viral load if your partner is infected. HIV gets transmitted in these instances through small breaks in the surfaces of the mouth, penis, rectum, vagina or vulva. One of the reasons HIV infection rates are higher in individuals with herpes and syphilis is because those diseases cause open sores, creating additional opportunities for HIV-infected body fluids to enter the body.
During pregnancy, childbirth or breastfeeding: Babies have constant contact with their mother’s potentially infected body fluids. Means of transmitting HIV from mother to child include through amniotic fluid, blood and infected breast milk.
As a result of injection drug use: Injecting drugs puts you in contact with blood. If those needles and their contents are contaminated, you can be directly delivering HIV into your bloodstream.
As a result of occupational exposure: Healthcare workers must be constantly diligent against this method of transmission. Risks of HIV transmission to healthcare workers occur through blood transferred from needlesticks and cuts, and less commonly through contact of infected body fluids splashed into the eyes, mouth or into an open sore or cut.
As a result of a blood transfusion or organ transplant: Fortunately, these days, this is very rare given the stringency of screening requirements in the United States, but it is possible to transmit HIV through blood transfusions or organ transplants from infected donors.

Straight, No Chaser: What is AIDS?

November 24, 2013General Health and Wellness, Infectious DiseaseAIDS, Disease, HIV, HIV/AIDS, Immune system, Infection, National Institutes of Health, Sarcoma Kaposi, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is the first blog in an ongoing series on HIV and AIDS.

For an explanation of how HIV is contracted, click here.
For an explanation of the signs and symptoms of HIV/AIDS is, click here.

After all these years, it’s still an interesting and important enough question to ask and to know how to answer. Most know that AIDS is a devastating disease caused by the HIV virus. However, courtesy of the National Institutes of Health, consider the following:
A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.
I – Immuno – Your body’s immune system includes all the organs and cells that work to fight off infection or disease.
D – Deficiency – You get AIDS when your immune system is “deficient,” or isn’t working the way it should.
S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.
Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections.
You will be diagnosed with AIDS if you have one or more specific opportunistic infections, certain cancers (such as Kaposi’s sarcoma) or a very low number of CD4 cells (a measure of the strength of your immune systems function). If you have AIDS, you will need medical intervention and treatment to prevent death.
Check back to Straight, No Chaser for additional posts on HIV/AIDS, including risk factors and symptoms, progression/complications and treatment.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: The Sexually Transmitted Disease Summary and The Week In Review, Sept. 29th, 2013

September 29, 2013Infectious Disease, The Week In ReviewAIDS, Bacterial vaginosis, Chlamydia infection, Conditions and Diseases, Disease, Gonorrhea, health, Herpes, HIV, Safe sex, Sexually transmitted disease, Straight No Chaser (composition), SyphilisJeffrey Sterling, MD

Based on your responses to the pictures posted this week, I should have renamed the blog, Scared Straight, No Chaser. The irony of it all is without exception, those pictures were very typical representations of the various sexually transmitted infections (STIs). Some of you didn’t like it, but I do appreciate that large numbers of you read it all. I hope you learned a lot and even more importantly were moved into (in)action. In case you missed anything:

On Sunday, we began the week with a look at bacterial vaginosis (BV), which may be associated with sex but is not an STI. It’s important for women to take an active effort to learn their bodies and the effects various activities have. Remember, BV is easily treated, but it’s always fair to take the opportunity to ensure that STIs aren’t also present.

On Monday, we reviewed the most common bacterial STI, chlamydia. Chlamydia is a really typical disease in that it’s contagious, easily transmitted and has substantial complications if not treated.

On Tuesday, we reviewed gonorrhea, which very often occurs in tandem with Chlamydia. Like chlamydia, it’s contagious, easily transmitted and has substantial complications if not treated. Think of gonorrhea when copious discharge is present, and don’t forget this includes the eyes, throat and joints.

On Wednesday, we reviewed the various stages of syphilis. This easily treatable yet very dangerous disease has the nasty habits of mimicking many other disease and spontaneously disappearing – which is not the same as it being cured. Instead, it progresses to more harmful stages if not identified and treated. Remember the association of syphilis with rashes involving the palms and soles.

On Thursday, we reviewed the treatment of syphilis. It is so important to understand how easily this is treated, so get checked. We also reviewed the story of the Tuskegee Experiment of Untreated Syphilis and how that (unethically) led to the knowledge we have about syphilis and the mandatory protections now in place for humans participating in medical experiments.

On Friday, we reviewed herpes. Many were shocked to learn these groups of small blisters (vesicles) can be found wherever an infection occurs, including the fingers, eyes and mouth. Think of herpes when you get a painful genital ulcer, and get checked ASAP.

On Saturday, we discussed the cauliflower ear, a too common, very preventable and apparently sought after (by certain athletes) condition seen in those with trauma to the ear. The trauma results in the accumulation of blood and clots, which damages and deforms the ear into its prototypical appearance. This leads to a life of pain and deformity.

Here are three final considerations on sexually transmitted infections.

1. They all tend to coexist. Your exposure to one places you at risk for acquiring others, including HIV/AIDS. What you don’t know can hurt you; in fact it can kill you.

2. Remember that until your partner is treated, you’re not treated.

3. Most of these diseases lead to conditions that physiologically make acquiring HIV/AIDS more likely. I didn’t discuss HIV/AIDS this week because it’s involved enough that it is its own topic with several different considerations. We’ll address these another time.

If you’re not prudent enough to practice safe sex, please be diligent enough to get tested and treated based on any suspicion. Even better – do both. The life you save will be your own.