Tag Archives: HIV

Straight, No Chaser In The News: HIV Vaccine Awareness and Update

May 18, 2017Infectious Disease, Public Health, Health Prevention844-SMA-TALK, Behind the Curtain, HIV, HIV vaccine, National Institutes of Health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

The first (and at that point only) vaccine developed to date that has shown any significant effectiveness was demonstrated to be so in Thailand back in 2009. It was shown to cut the rate of HIV infection by 31% over 3.5 years, with most of the effect seen in its first year. This study was followed by a small-scale study in South Africa. The trial study involved 252 South Africans, and its positive results have set the stage for a much larger study, and it is generating a lot of excitement among the world’s top HIV vaccine scientists.

The U.S. National Institutes of Health is following up with a trial of an experimental vaccine in South Africa later this year on 5,400 healthy, at risk volunteers from ages 18-35, pending regulatory approval. The vaccine is a combination of a canarypox-based vaccine and another that enhances the body’s immune response to a vaccine. Results from the study will be available in 2020.
In case you’re wondering why the trial is occurring in South Africa, HIV is more pervasive in southern Africa that anywhere else in the world. According to the United Nations, it is estimated that 12.2 percent of the South African population (6.4 million persons) are HIV positive.

New HIV infections have fallen by 35% globally since 2000 but still ravages millions worldwide. The opportunity to offer an effective HIV would be welcomed everywhere.
If you’re interested in learning more about HIV/AIDS, just type HIV or AIDS into the search engine on the right.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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 8, 2017Genital/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 Chaser, There are 72 Hours in a DayJeffrey 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.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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: Healthcare Disparities

April 23, 2017General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, Behind the Curtain, colorectal cancer, Conditions and Diseases, death rates, Diabetes, healthcare disparities, HIV, Hypertension, immunizations, infant mortality, Influenza, life expectancy, Obesity, periodontitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

In large part, this blog exists to inform individuals of all backgrounds about the risks that lead to abnormal health outcomes. Our hope is that once you discover the risks, you’ll be sufficiently equipped and incentivized to take the simple steps provided to improve your health.
Disparities are abnormal outcomes of a different variety. Disparities in healthcare lead to premature development of disease and death. The culprits are often insufficient access to care, culture barriers, habits and even discriminatory practices. It is critical for all involved, i.e., individuals, healthcare planners and practitioners, to understand these causes so that everyone can adjust habits and apply resources to combat this health hazard affecting both individuals and communities.
For the last 25 years of my career, I’ve had the unfortunate privilege of addressing this topic in national forums, including before the National Urban League, before the National Medical Association, recently, in the NAACP’s The Crisis magazine and in Straight, No Chaser to extent that our service provides you with the information that can make a difference in your lives. Unfortunately for some, it’s almost never that easy.

As a statement of fact, according to the Center for Disease Control and Prevention (CDC) Health Disparities & Inequalities Report  of 2013, African-Americans suffer global health disparities that result in the following outcomes.

Life expectancy: In 2011, the average American could expect to live 78.7 years. The average African-American could only expect to live 75.3 years, compared with 78.8 years for the average White American.
Death rates: In 2009, African-Americans had the highest death rates from homicide among all racial and ethnic populations. Rates among African-American males were the highest for males across all age groups.
Infant mortality rates: In 2008, infants of African-American women had the highest death rate among American infants with a rate more than twice as high as infants of white women.

The following disparities were also reported:

Heart disease and stroke: In 2009, African-Americans had the largest death rates from heart disease and stroke compared with other racial and ethnic populations, with disparities across all age groups younger than 85 years of age.
High blood pressure: From 2007-2010, the prevalence of hypertension was among adults aged 65 years and older, African-American adults, US-born adults, adults with less than a college education, adults who received public health insurance (18-64 years old) and those with diabetes, obesity or a disability compared with their counterparts. The percentages of African-Americans and Hispanics who had control of high blood pressure were lower compared to white adults.
Obesity: From 2007-2010, the prevalence of obesity among adults was highest among African-American women compared with white and Mexican American women and men. Obesity prevalence among African-American adults was the largest compared to other race ethnicity groups.
Diabetes: In 2010, the prevalence of diabetes among African-American adults was nearly twice as large as that for white adults.
Activity limitations caused by chronic conditions: From 1999-2008, the number of years of expected life free of activity limitations caused by chronic conditions is disproportionately higher for African-American adults than whites.
Periodontitis: In 2009-2010, the prevalence of periodontitis (a form of dental disease) was greatest among African-American and Mexican American adults compared with white adults.
HIV: In 2010, African-American adults had the largest HIV infection rate compared with rates among other racial and ethnic populations. Prescribed HIV treatment among African-American adults living with HIV was less than among white adults.
Access to care: In 2010, Hispanic and African-American adults aged 18-64 years had larger percentages without health insurance compared with white and Asian/Pacific Islander counterparts.
Colorectal cancer: In 2008, African-Americans had the largest incidence and death rates from colorectal cancer of all racial and ethnic populations despite similar colorectal screening rates compared to white adults.
Influenza vaccination: During the 2010-11 influenza season, influenza vaccination coverage was similar for African-American and white children aged six months to 17 years but lower among African-American adults compared with white adults.
Socioeconomic factors: In 2011, similar to other minority adults aged 25 years or older, a larger percentage of African-American adults did not complete high school compared with white adults. A larger percentage of African-American adults also lived below the poverty level and were unemployed (adults aged 18-64 years) compared with white adults of the same age.

Identifying disparities is a good start. However, to reduce them it is necessary to identify and implement solutions, both individually and institutionally. To this end, we will explore best practices in future Straight, No Chaser posts. Feel free to ask any questions you have on this topic.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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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The Straight, No Chaser Comprehensive Safe Sex Guide

February 13, 2017Genital/Urinary, Infectious Disease, Obstetrics and Gynecology, Health PreventionAnal sex, Behind the Curtain, Condom, Dental dam, HIV, Human papillomavirus, National Institutes of Health, Safe sex, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This edition of Straight, No Chaser is a keepsake, whether for your own reference or as a conversation piece/teaching guide for others. I suspect that due to the volume and wealth of information contained within, you’ll refer to this post time and again (or so I hope). For additional information, refer to the U.S. Center for Disease Control and Prevention and/or the National Institutes of Health websites.

STAYING STD-FREE
The best ways to stay STI free is to confirm it and then avoid it. If you want to reduce your risk of acquiring HIV and other STIs (sexually transmitted infections) through sexual contact, here are your options.

Abstain from sex.
Be monogamous.
Prove both you and your partner(s) are negative. Get yourself and your partner(s) tested, preferably prior to engaging in sexual activity and subsequently every three to six months, especially if you and/or your partner have more than one sexual partner.
If and once you establish that you’re STI-free, learn how to use condoms and do so every time you have sex.

A special note about protecting yourself from HIV
HIV can be spread by having unprotected sexual contact with an HIV-positive person. “Unprotected” means any vaginal, anal or oral sex without barrier protection, like a condom or dental dam. Some of the ways to reduce your risk of getting HIV through sexual contact include the following:

Don’t have sex. Abstinence is the best way to be certain that you won’t contract HIV. Although HIV is occasionally transmitted in other ways, vaginal, anal and oral sex are the most common ways that HIV is transmitted.
Be monogamous. To be clear, this means you are in a sexual relationship with only one person and both of you are having sex only with each other. For the purposes of contracting HIV, sex includes vaginal, oral or anal sexual activity. Monogamy is optimally effective if you also confirm early and often that both you and your partner are not infected with HIV.
Get yourself and your sexual partner(s) tested: Knowing your own status is important for both your health and the health of your partner. Talking about your HIV status likely will be difficult and uncomfortable, but it’s important to start the discussion BEFORE you have sex.

FRANKLY, “DON’T ASK, DON’T TELL” IS JUST DUMB WHEN IT COMES TO STIs.
This is actually quite simple. No excuses. You need to ask your sexual partner(s) and any possible future partners the following questions.

Have you been tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
When was the last time you were tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
If you’ve been tested, what were the results of your tests?

SAFER-SEX ACTIVITIES
These activities carry no risk of HIV transmission:

Non-sexual massage
Casual or dry kissing
Masturbation (without your partner’s body fluids)
Frottage—also known as “dry humping” or body-to-body rubbing

You can still contract other STIs, like herpes, HPV, or pubic lice (“crabs”) if you have bare skin-to-skin contact with your partner.

CONDOM USE
Here are two questions for both males and females.

Have you ever learned how to safely and appropriately use condoms?
Do you use condoms consistently?

To maximally reduce your risk of getting HIV or other STIs, you must use a new condom with every act of vaginal, anal or oral sex. If you don’t use them for oral but do for vaginal and anal, you have still lowered your risk, just not as much as you could have. Also, you must use condoms correctly, as depicted in the above diagram, to appropriately reduce your risk. Learning correct usage also will keep condoms from breaking or slipping off, which reintroduces the risks.
I also want you to understand that all condoms are not created equal. Latex condoms are highly effective against HIV and other STIs. Do you or your partner have a latex allergy? If so, the next safest condom choice is a polyurethane or polyisoprene condom. Just tell your pharmacist at the drug store that you’re allergic to latex, and s/he’ll take it from there. On the other hand, lambskin condoms do NOT protect against HIV. The particle size of the virus allows it to maneuver and slip through lambskin.
Condoms alone have never been enough. Did you know that you should always use a water-based lubricant when you use a condom for either vaginal or anal sex? I want to restate this: that’s water, not petroleum jelly. Water-based lubricants reduce friction and help keep the condom from breaking. Do NOT use an oil-based lubricant (such as petroleum jelly, hand lotion or cooking oil). Oil-based lubricants can damage condoms, making them less effective.
Both male condoms and female condoms will help protect you against HIV and other STIs. If you’ve learned to enjoy sex with a male condom, you can learn to enjoy it with a female condom or a dental dam. Additionally, there are many of you who have contracted STIs. If you wish to continue to enjoy a variety of sexual activities, learning to use the full range of barrier protection may be a better option for you and your partner than abstaining.
Condoms do not provide 100% protection against all STIs, but you are always safer using a condom than not. You can get certain STIs, like herpes or HPV, from contact with your partner’s bare skin, even if one of you is wearing a condom, but condoms lessen the risk. Take the time to explore and inspect each other if you’re confused or concerned about the possibility of your partner having an STI.
Spermicides only serve the purpose of reducing the risk of becoming pregnant. They are ineffective in preventing contraction of HIV and other STIs. They actually irritate rectal and vaginal walls, in effect increasing the chances of HIV infection, should infected fluids come into contact with these areas.

ABOUT SEX TOYS
This is pretty straightforward. Using sex toys can be safe, but think of staying clean and “not sharing.”

It is important that you use soap and water to clean your toys after each use. If the instructions allow for a stronger disinfectant, you may do so.
As a rule, don’t share your toys. The nature of how toys are typically used likely increases the risk of vaginal or anal irritation, which increases the risk for HIV or other STI transmission.
If you “must” share your toy with your partner while still trying to be safe, use a condom on the toy before you use it, and change the condom before your partner uses it.

CIRCUMCISION
We’ve discussed circumcision at length in Straight, No Chaser. (Click here for a dedicated post on circumcision.) There has been ongoing interest and research over the past few years about circumcision and its effect on preventing HIV infection. The bottom line? In 2007, the World Health Organization reported that male circumcision reduced the transmission of HIV by 60% from women to men in three randomized, controlled studies in Uganda, Kenya, and South Africa.
There is much less available data for men who have sex with men and how circumcision might affect HIV transmission through anal sex. In addition, recent studies show that circumcision does NOT protect women from contracting HIV from male partners.
Let’s be careful in interpreting the results of these findings.

Circumcision is only additionally effective when earlier preventative efforts have not been taken. Advocating circumcision is not an appropriate substitute for any of the numerous safety measures and habits previously discussed to reduce one’s risk for HIV and other STIs.
Failure to have a circumcision does NOT increase one’s HIV and other STI risk in the presence of appropriate safe-sex activities.

So there you have it. Knowledge is power. We appreciate that this posting was not balanced by the human decisions and passions that come into place with sexual activity. We recommend that you adopt a posture of “safety first” to create that balance! Good luck, and feel free to ask your SMA expert consultant any questions you may have on this topic.
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 © 2017 · Sterling Initiatives, LLC · Powered by WordPress

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.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

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.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

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.
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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 In The News: HIV Vaccine Awareness and Update

May 25, 2016Infectious Disease, Public Health, Health Prevention844-SMA-TALK, Behind the Curtain, HIV, HIV vaccine, National Institutes of Health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

The search for an effective HIV vaccine continues. Let’s take this space to bring you up to date.

New HIV infections have fallen by 35% globally since 2000 but still ravages millions worldwide. The opportunity to offer an effective HIV would be welcomed everywhere.
If you’re interested in learning more about HIV/AIDS, just type HIV or AIDS into the search engine on the right.
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.

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.
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: STDs – Multidrug Resistant Gonorrhea

April 28, 2016Genital/Urinary, Infectious Disease, Obstetrics and Gynecology844-SMA-TALK, Behind the Curtain, Conditions and Diseases, ectopic pregnancy, healthcare disparities, HIV, human immunodeficiency, infertility, multidrug resistant gonorrhea, neisseria gonorrhea, Pelvic inflammatory disease, PID, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This post is the second of two discussing gonorrhea. Today we discuss multidrug resistant gonorrhea. That’s right. There are new strains of gonorrhea emerging and spreading, as if the existing strains weren’t devastating enough already.
The development of multidrug resistant gonorrhea has occurred. Gonorrhea has affected humans for centuries, and the organism causing it has been identified for over one hundred years. According to the Center for Disease Control and Prevention (CDC), there were over 300,000 cases of gonorrhea in the U.S. alone in 2011. It is estimated that over 800,000 infections are currently present (On a tangential note, this represents another significant cause of health care disparities; Blacks are 17 times more likely to be affected that Whites. This isn’t just due to behavioral patterns. In fact, it’s largely due to the asymptomatic nature of gonorrhea and the relative lack of access to care among Blacks, impacting ability to get treated).
Gonorrhea has proven itself to be especially wily. We’ve had access to effective antibiotics against it since the 1930s. Still, it continues to plague us. In the 1940s, the 1970s, and again in the 1990s, gonorrhea mutated and developed immunity to treatments that had been effective. In addition most cases of gonorrhea don’t cause symptoms, allowing itself to be spread in a “stealth” manner (Read: get checked).

Even more so than other instances of gonorrhea resistance, this instance poses especially concerning dangers. Treatment of multidrug resistant gonorrhea infections (particularly those resistant to the standard of care medicine ceftriaxone) will be much more complicated that it had been previously. Specifically, there is no ready replacement on standby that can be administered in emergency rooms, offices and clinics as easily as a simple shot of ceftriaxone is. Our most recent magic bullet is going by the wayside. Other available treatments also have varying degrees of emerging resistance and thus are likely to be sporadically ineffective. Until on-site testing is put in place that allows determination of susceptibility to various treatment regimens, patients infected with gonorrhea will run the risk of receiving medicines that are no longer effective. Current and future treatment regimens will involve the use of more than one medicine and higher doses of medicine than had previously been effective.

This brings to mind two important points. Gonorrhea is not just an infection that affects sexual organs. It produces devastating consequences throughout the body, including the facilitation of human immunodeficiency virus (HIV) transmission (i.e. the presence of gonorrhea makes acquiring HIV easier). It also causes serious reproductive complications in women, such as pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. It causes eye infections in newborns (they pick it up from mom) and infected persons who rub their eyes or otherwise place their fingers in their eyes without appropriate hand washing. Either failure to get treated or receiving ineffective treatment is a precarious situation.

Of course, this also creates and reinforces the urgency of practicing safe sexual behaviors. Straight, No Chaser has multiple postings on safe sex and best practices of preventing sexually transmitted infections. Here is a summary post for your review. Of course you can type any topic in the search engine for greater ability to explore these topics.
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: Healthcare Disparities

April 17, 2016General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, Behind the Curtain, colorectal cancer, Conditions and Diseases, death rates, Diabetes, healthcare disparities, HIV, Hypertension, immunizations, infant mortality, Influenza, life expectancy, Obesity, periodontitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Life expectancy: In 2011, the average American could expect to live 78.7 years. The average African-American could only expect to live 75.3 years, compared with 78.8 years for the average White American.
Death rates: In 2009, African-Americans had the highest death rates from homicide among all racial and ethnic populations. Rates among African-American males were the highest for males across all age groups.
Infant mortality rates: In 2008, infants of African-American women had the highest death rate among American infants with a rate more than twice as high as infants of white women.

The following disparities were also reported:

Heart disease and stroke: In 2009, African-Americans had the largest death rates from heart disease and stroke compared with other racial and ethnic populations, with disparities across all age groups younger than 85 years of age.
High blood pressure: From 2007-2010, the prevalence of hypertension was among adults aged 65 years and older, African-American adults, US-born adults, adults with less than a college education, adults who received public health insurance (18-64 years old) and those with diabetes, obesity or a disability compared with their counterparts. The percentages of African-Americans and Hispanics who had control of high blood pressure were lower compared to white adults.
Obesity: From 2007-2010, the prevalence of obesity among adults was highest among African-American women compared with white and Mexican American women and men. Obesity prevalence among African-American adults was the largest compared to other race ethnicity groups.
Diabetes: In 2010, the prevalence of diabetes among African-American adults was nearly twice as large as that for white adults.
Activity limitations caused by chronic conditions: From 1999-2008, the number of years of expected life free of activity limitations caused by chronic conditions is disproportionately higher for African-American adults than whites.
Periodontitis: In 2009-2010, the prevalence of periodontitis (a form of dental disease) was greatest among African-American and Mexican American adults compared with white adults.
HIV: In 2010, African-American adults had the largest HIV infection rate compared with rates among other racial and ethnic populations. Prescribed HIV treatment among African-American adults living with HIV was less than among white adults.
Access to care: In 2010, Hispanic and African-American adults aged 18-64 years had larger percentages without health insurance compared with white and Asian/Pacific Islander counterparts.
Colorectal cancer: In 2008, African-Americans had the largest incidence and death rates from colorectal cancer of all racial and ethnic populations despite similar colorectal screening rates compared to white adults.
Influenza vaccination: During the 2010-11 influenza season, influenza vaccination coverage was similar for African-American and white children aged six months to 17 years but lower among African-American adults compared with white adults.
Socioeconomic factors: In 2011, similar to other minority adults aged 25 years or older, a larger percentage of African-American adults did not complete high school compared with white adults. A larger percentage of African-American adults also lived below the poverty level and were unemployed (adults aged 18-64 years) compared with white adults of the same age.

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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The Straight, No Chaser Comprehensive Safe Sex Guide

February 14, 2016Genital/Urinary, Infectious Disease, Obstetrics and Gynecology, Health PreventionAnal sex, Behind the Curtain, Condom, Dental dam, HIV, Human papillomavirus, National Institutes of Health, Safe sex, Sexually transmitted disease, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Abstain from sex.
Be monogamous.
Prove both you and your partner(s) are negative. Get yourself and your partner(s) tested, preferably prior to engaging in sexual activity and subsequently every three to six months, especially if you and/or your partner have more than one sexual partner.
If and once you establish that you’re STI-free, learn how to use condoms and do so every time you have sex.

Don’t have sex. Abstinence is the best way to be certain that you won’t contract HIV. Although HIV is occasionally transmitted in other ways, vaginal, anal and oral sex are the most common ways that HIV is transmitted.
Be monogamous. To be clear, this means you are in a sexual relationship with only one person and both of you are having sex only with each other. For the purposes of contracting HIV, sex includes vaginal, oral or anal sexual activity. Monogamy is optimally effective if you also confirm early and often that both you and your partner are not infected with HIV.
Get yourself and your sexual partner(s) tested: Knowing your own status is important for both your health and the health of your partner. Talking about your HIV status likely will be difficult and uncomfortable, but it’s important to start the discussion BEFORE you have sex.

Have you been tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
When was the last time you were tested for HIV, herpes, gonorrhea, syphilis and/or chlamydia?
If you’ve been tested, what were the results of your tests?

SAFER-SEX ACTIVITIES
These activities carry no risk of HIV transmission:

Non-sexual massage
Casual or dry kissing
Masturbation (without your partner’s body fluids)
Frottage—also known as “dry humping” or body-to-body rubbing

Have you ever learned how to safely and appropriately use condoms?
Do you use condoms consistently?

It is important that you use soap and water to clean your toys after each use. If the instructions allow for a stronger disinfectant, you may do so.
As a rule, don’t share your toys. The nature of how toys are typically used likely increases the risk of vaginal or anal irritation, which increases the risk for HIV or other STI transmission.
If you “must” share your toy with your partner while still trying to be safe, use a condom on the toy before you use it, and change the condom before your partner uses it.

Circumcision is only additionally effective when earlier preventative efforts have not been taken. Advocating circumcision is not an appropriate substitute for any of the numerous safety measures and habits previously discussed to reduce one’s risk for HIV and other STIs.
Failure to have a circumcision does NOT increase one’s HIV and other STI risk in the presence of appropriate safe-sex activities.

So there you have it. Knowledge is power. We appreciate that this posting was not balanced by the human decisions and passions that come into place with sexual activity. We recommend that you adopt a posture of “safety first” to create that balance! Good luck, and feel free to ask your SMA expert consultant any questions you may have on this topic.
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: HIV's Sweet Tooth May Reveal the Ultimate Key to Its Defeat

June 5, 2015General Health and Wellness844-SMA-TALK, Behind the Curtain, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

There have been very impressive advances in the understanding and treatment of HIV that have led to impressive lengthening of lifespans and the quality of life in those infected. Researchers from Northwestern University and Vanderbilt University appear to have come across yet another such discovery.

In simple terms, HIV appears to be similar to a voracious monster with a large sweet tooth. After the virus invades an activated immune cell (CD4+, T cell), it hijacks sugar and nutrients from the cell to replicate and fuel its wild growth throughout the body. It is the fact that HIV is attacking and damaging our immune cells that leads to the devastating effects seen in HIV.
The new initiative appears to be based on an ability to turn off the switch within our immune systems that controls the sugar and nutrient pipeline. In effect, this starves HIV to death. The inability to replicate throughout the body renders the infection less powerful.

Prior drugs that have attempted to cut off HIV’s nutrient supply have had the undesirable effects of killing healthy cells, thus producing undesirable side effects. That does not appear to be the case in this recent study, the details of which can be read in the May 28 issue of PLOS Pathogens.
If these finding remain true in human studies, this will have proven to be an amazing accomplishment. The scientists involved in the study are also looking to apply this research to cancer treatment, based on cancer cells operating under similar energy demands.
Stay tuned for more information as news develops.

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. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.

Straight, No Chaser: Healthcare Disparities

April 24, 2015General Health and Wellness, Public Health, Health Prevention844-SMA-TALK, colorectal cancer, Conditions and Diseases, death rates, Diabetes, healthcare disparities, HIV, Hypertension, immunizations, infant mortality, Influenza, life expectancy, Obesity, periodontitis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Life expectancy: In 2011, the average American could expect to live 78.7 years. The average African-American could only expect to live 75.3 years, compared with 78.8 years for the average White American.
Death rates: In 2009, African-Americans had the highest death rates from homicide among all racial and ethnic populations. Rates among African-American males were the highest for males across all age groups.
Infant mortality rates: In 2008, infants of African-American women had the highest death rate among American infants with a rate more than twice as high as infants of white women.

The following disparities were also reported:

Heart disease and stroke: In 2009, African-Americans had the largest death rates from heart disease and stroke compared with other racial and ethnic populations, with disparities across all age groups younger than 85 years of age.
High blood pressure: From 2007-2010, the prevalence of hypertension was among adults aged 65 years and older, African-American adults, US-born adults, adults with less than a college education, adults who received public health insurance (18-64 years old) and those with diabetes, obesity or a disability compared with their counterparts. The percentages of African-Americans and Hispanics who had control of high blood pressure were lower compared to white adults.
Obesity: From 2007-2010, the prevalence of obesity among adults was highest among African-American women compared with white and Mexican American women and men. Obesity prevalence among African-American adults was the largest compared to other race ethnicity groups.
Diabetes: In 2010, the prevalence of diabetes among African-American adults was nearly twice as large as that for white adults.
Activity limitations caused by chronic conditions: From 1999-2008, the number of years of expected life free of activity limitations caused by chronic conditions is disproportionately higher for African-American adults than whites.
Periodontitis: In 2009-2010, the prevalence of periodontitis (a form of dental disease) was greatest among African-American and Mexican American adults compared with white adults.
HIV: In 2010, African-American adults had the largest HIV infection rate compared with rates among other racial and ethnic populations. Prescribed HIV treatment among African-American adults living with HIV was less than among white adults.
Access to care: In 2010, Hispanic and African-American adults aged 18-64 years had larger percentages without health insurance compared with white and Asian/Pacific Islander counterparts.
Colorectal cancer: In 2008, African Americans had the largest incidence and death rates from colorectal cancer of all racial and ethnic populations despite similar colorectal screening rates compared to white adults.
Influenza vaccination: During the 2010-11 influenza season, influenza vaccination coverage was similar for African-American and white children aged six months to 17 years but lower among African-American adults compared with white adults.
Socioeconomic factors: In 2011, similar to other minority adults aged 25 years or older, a larger percentage of African-American adults did not complete high school compared with white adults. A larger percentage of African American adults also lived below the poverty level and were unemployed (adults aged 18-64 years) compared with white adults of the same age.

This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK (844-762-8255) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd. Please like and share our blog with your family and friends. We’re here for you 24/7 with immediate, personalized information and advice. Contact your Personal Healthcare Consultant at http://www.SterlingMedicalAdvice.com or 1-844-SMA-TALK.

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.

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.

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