Tag Archives: Human papillomavirus

Straight, No Chaser: Cervical Cancer – The Sexually Transmitted Cancer

cervical-cancer-awareness

Let’s put this take home message up front: here’s a pretty good demonstration of the value of vaccines. I hope that each of you resolves to get any children you care for vaccinated before they become sexually active.

I want to thank my friend and colleague, Dr. Julius Ellis, noted Ob/Gyn physician for contributing to this post. Let’s start this with two simple statements:

  • Cervical cancer has basically been shown to be caused by an infection.
  • There soon will be no reason that anyone has to have cervical cancer.

female reproductive system

As a reminder, the cervix is the lower and narrow end of the uterus that connects the vagina to the upper part of the uterus (i.e. the womb). Cervical cancer used to be the leading cause of cancer death for women in the US.

In 2018, it is estimated that:

  • 13,240 women in the United States will be diagnosed with cervical cancer.
  • 4,170 women in the United States will die from cervical cancer.

Fortunately, over the last 40 years, the number of cases of cervical cancer and the number of deaths from cervical cancer have decreased significantly, largely due to Pap tests. The even better news is the opportunity exists to virtually eradicate the disease. Cervical cancer is highly preventable because screening tests and a vaccine to prevent human papillomavirus (HPV) infections are available. When cervical cancer is found early, it is highly treatable and associated with long survival and good quality of life.

HPV oral

Yes, cervical cancer is a sexually transmitted infection (STI), and the most common STI is now known to be caused by the human papillomavirus (HPV). Some of you will recognize HPV as a cause of genital warts. This means if you ever develop warts, go get checked immediately (another good reason to do this is because genital syphilis may also present as warts). Even more importantly, certain HPV strains have been shown to cause virtually all cervical and anal cancers. HPV also causes some cancers of the vagina, penis, and oropharynx (a certain part of the throat—and yes, this is what Michael Douglas was referencing about having obtained throat cancer by performing oral sex).

Early on, cervical cancer may not cause signs and symptoms, but advanced cervical cancer may cause bleeding or discharge from the vagina, either of which may be persistent or abnormal from similar episodes you’ve had in the past. If you have any of these signs, see your physician for an evaluation of this and other possible causes of these symptoms.

Am I at risk for HPV? How do you get this?

HPV STD

Everyone having sex or who has ever had sex is at risk for HPV. In fact, nearly all sexually active men and women get it at some point in their lives. HPV is passed on through genital contact, most often during vaginal and anal sex, but also through oral sex and genital-to-genital contact without intercourse. HPV can be passed on between straight and same-sex partners even if and when the infected person has no signs or symptoms. It’s important to know there’s a big difference between obtaining the HPV virus and obtaining cancer from having the HPV virus.

If I get genital warts, will I get cancer?

HPV genital warts

Not necessarily, but the possibility is high enough that you need to get treated. Most HPV infections actually resolve on their own. It’s the ones that linger that pose particular concern.

If I do have warts, what increases my risks for these cancers?

hpv risks

Smoking, a weakened immune system, having had many children (for increased risk of cervical cancer), long-term oral contraceptive use (for increased risk of cervical cancer), and poor oral hygiene (for increased risk of oropharyngeal cancer) all increase the risk for developing cancer after a HPV infection.

How do I get this and how do I prevent it?

HPV

The most reliable way to prevent infection with HPV is abstinence, avoiding any skin-to-skin oral, anal, or genital contact with another. If you are sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the strategy most likely to prevent HPV infection. However, because of the lack of symptoms, it’s hard to know whether a partner is currently infected with HPV. Use of condoms reduces the transmission of HPV between partners, although areas not covered by a condom can still be infected.

HPV vaccine

The Food and Drug Administration (FDA) has approved two HPV vaccines, branded as Gardasil (for the prevention of cervical, anal, vulvar, and vaginal cancer, precancerous lesions, and genital warts in these areas) and Cervarix (for the prevention of cervical cancer and precancerous cervical lesions caused by HPV). Both vaccines are highly effective, but neither has been approved for prevention of penile or oropharyngeal cancer. And yes, it’s safe and effective as young as age 9, although the Center for Disease Control and Prevention currently recommends vaccination between ages 11–14. You must contact your physician for additional details on these important medications.

How do I treat HPV infections?

There’s no treatment for HPV itself, but the problems HPV causes can be treated. We’ll address the two major ones:

  • Genital warts may be treated topically by you or a healthcare provider. If not treated, they may multiply, go away, or stay the same.
  • Cervical cancer may be treated by your gynecologist, but be warned: Prevention is best, and early detection gives you the best chance for the best outcomes. Continue those annual exams.

There will soon come a time when all boys and girls are receiving vaccinations at around ages 11–12, and cervical cancer (in particular) will become a rare entity. That only happens if you get your family immunized. The science is in. There’s no good reasons left to wait.

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.

Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

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Filed under Health Prevention, Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease, Obstetrics and Gynecology

The Straight, No Chaser Comprehensive Safe Sex Guide

safe-sex-no-regrets

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.

Talking_Partner_STD

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.

Repeal DADT logo-2

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?

STDlights

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.

howToUseCondoms

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.

sex-toys-300x285

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 None Required

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.

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.

Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

Comments Off on The Straight, No Chaser Comprehensive Safe Sex Guide

Filed under Genital/Urinary, Health Prevention, Infectious Disease, Obstetrics and Gynecology

Straight, No Chaser: Cervical Health Awareness

cervical_health_awareness_month

January is Cervical Health Awareness Month, and to that end, The Center for Disease Control and Prevention (CDC) boldly proclaims “No woman should die of cervical cancer.”

It’s cervical health month in the United States, and this point has a rather simple message: Cervical cancer is highly preventable and can be cured when discovered and treatment early. Here are some quick tips to help you check this off of your list of concerns.

  • Every child should get vaccinated at age 11 or 12. Even if you’ve reached age 26 and haven’t been vaccinated, you should discuss options with your physician.
  • The most important thing you can do to help prevent cervical cancer is to get screened regularly starting at age 21.

pap smear

  • The Pap test (or smear) should be performed regularly at age 21. It looks for precancerous changes to the cervix that identify the need for early treatment. In many cases a normal test will eliminate the need for another test for the next three years, but your physician will discuss your individual circumstances in this regard.
  • The HPV test looks for the virus that is now known to be the cause of cervical cancer. Furthermore, human papillomavirus (HPV) is sexually transmitted. The HPV test can be done at the same time as the Pap test from the same examination.

Hopefully knowing these simple tools will convince you to be attentive to preventing and managing your cervical health. This is a public health success story in that cervical cancer could be eliminated if everyone followed the above steps. The rest is up to you.

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.

Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

Comments Off on Straight, No Chaser: Cervical Health Awareness

Filed under Health Prevention, Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease, Obstetrics and Gynecology

Straight, No Chaser: Cervical Cancer – The Sexually Transmitted Cancer

cervical-cancer-awareness

Let’s put this take home message up front: here’s a pretty good demonstration of the value of vaccines. I hope that each of you resolves to get any children you care for vaccinated before they become sexually active.

I want to thank my friend and colleague, Dr. Julius Ellis, noted Ob/Gyn physician for contributing to this post. Let’s start this with two simple statements:

  • Cervical cancer has basically been shown to be caused by an infection.
  • There soon will be no reason that anyone has to have cervical cancer.

female reproductive system

As a reminder, the cervix is the lower and narrow end of the uterus that connects the vagina to the upper part of the uterus (i.e. the womb). Cervical cancer used to be the leading cause of cancer death for women in the US.

In 2011 (the most recent year numbers are available):

  • 12,109 women in the United States were diagnosed with cervical cancer.
  • 4,092 women in the United States died from cervical cancer.

Fortunately, over the last 40 years, the number of cases of cervical cancer and the number of deaths from cervical cancer have decreased significantly, largely due to Pap tests. The even better news is the opportunity exists to virtually eradicate the disease. Cervical cancer is highly preventable because screening tests and a vaccine to prevent human papillomavirus (HPV) infections are available. When cervical cancer is found early, it is highly treatable and associated with long survival and good quality of life.

HPV oral

Yes, cervical cancer is a sexually transmitted infection (STI), and the most common STI is now known to be caused by the human papillomavirus (HPV). Some of you will recognize HPV as a cause of genital warts. This means if you ever develop warts, go get checked immediately (another good reason to do this is because genital syphilis may also present as warts). Even more importantly, certain HPV strains have been shown to cause virtually all cervical and anal cancers. HPV also causes some cancers of the vagina, penis, and oropharynx (a certain part of the throat—and yes, this is what Michael Douglas was referencing about having obtained throat cancer by performing oral sex).

Early on, cervical cancer may not cause signs and symptoms, but advanced cervical cancer may cause bleeding or discharge from the vagina, either of which may be persistent or abnormal from similar episodes you’ve had in the past. If you have any of these signs, see your physician for an evaluation of this and other possible causes of these symptoms.

Am I at risk for HPV? How do you get this?

HPV STD

Everyone having sex or who has ever had sex is at risk for HPV. In fact, nearly all sexually active men and women get it at some point in their lives. HPV is passed on through genital contact, most often during vaginal and anal sex, but also through oral sex and genital-to-genital contact without intercourse. HPV can be passed on between straight and same-sex partners even if and when the infected person has no signs or symptoms. It’s important to know there’s a big difference between obtaining the HPV virus and obtaining cancer from having the HPV virus.

If I get genital warts, will I get cancer?

HPV genital warts

Not necessarily, but the possibility is high enough that you need to get treated. Most HPV infections actually resolve on their own. It’s the ones that linger that pose particular concern.

If I do have warts, what increases my risks for these cancers?

hpv risks

Smoking, a weakened immune system, having had many children (for increased risk of cervical cancer), long-term oral contraceptive use (for increased risk of cervical cancer), and poor oral hygiene (for increased risk of oropharyngeal cancer) all increase the risk for developing cancer after a HPV infection.

How do I get this and how do I prevent it?

HPV

The most reliable way to prevent infection with HPV is abstinence, avoiding any skin-to-skin oral, anal, or genital contact with another. If you are sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the strategy most likely to prevent HPV infection. However, because of the lack of symptoms, it’s hard to know whether a partner is currently infected with HPV. Use of condoms reduces the transmission of HPV between partners, although areas not covered by a condom can still be infected.

HPV vaccine

The Food and Drug Administration (FDA) has approved two HPV vaccines, branded as Gardasil (for the prevention of cervical, anal, vulvar, and vaginal cancer, precancerous lesions, and genital warts in these areas) and Cervarix (for the prevention of cervical cancer and precancerous cervical lesions caused by HPV). Both vaccines are highly effective, but neither has been approved for prevention of penile or oropharyngeal cancer. And yes, it’s safe and effective as young as age 9, although the Center for Disease Control and Prevention currently recommends vaccination between ages 11–14. You must contact your physician for additional details on these important medications.

How do I treat HPV infections?

There’s no treatment for HPV itself, but the problems HPV causes can be treated. We’ll address the two major ones:

  • Genital warts may be treated topically by you or a healthcare provider. If not treated, they may multiply, go away, or stay the same.
  • Cervical cancer may be treated by your gynecologist, but be warned: Prevention is best, and early detection gives you the best chance for the best outcomes. Continue those annual exams.

There will soon come a time when all boys and girls are receiving vaccinations at around ages 11–12, and cervical cancer (in particular) will become a rare entity. That only happens if you get your family immunized. The science is in. There’s no good reasons left to wait.

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.

Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Comments Off on Straight, No Chaser: Cervical Cancer – The Sexually Transmitted Cancer

Filed under Health Prevention, Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease, Obstetrics and Gynecology

Straight, No Chaser In The News: Success Eliminating Cervical Cancer with the HPV Vaccine

hpv-img-2-lg

In the news is information about the human papillomavirus (HPV) vaccine, used to prevent sexually transmitted infections causing genital warts, and more importantly, causing cervical, anal, penile, mouth and throat cancers. Of particular interest is information demonstrating the vaccine developed to prevent HPV infections is even more effective that thought.

Federal researchers from the US Centers for Disease Control and Prevention (CDC) note that existing use of the vaccine has reduced the presence of the virus in teenage girls by approximately two-thirds. This information is especially impressive given the relative novelty and limited use of the vaccine. Only about 40% of girls and 20% of boys between ages 13-17 have been vaccinated. The better news for the future is public health professionals are making a significant push for greater vaccine use at ages 11-12, when the vaccination rates for other childhood diseases exceed 80%.

hpv_vaccine_cancer_prevention

Here’s a public health message: taking the vaccine is about cancer prevention, not just preventing a sexually transmitted infection (genital warts). Unfortunately this message hasn’t fully penetrated the national dialogue: only the District of Columbia, Rhode Island and Virginia require the HPV vaccine, even though it is believed universal use of the vaccine would virtually eradicate cervical cancer. As a frame of reference, several other countries (e.g. Australia) in which HPV vaccine use is mandatory, has achieved over 90% vaccination rates over 90% reduction in rates of genital warts.

About 14 million Americans become infected with HPV each year, and approximately 27,000 people get cancer as a result of an infection from HPV. The American Cancer Society estimates that 4,120 women will die of cervical cancer this year.

If you have a child of either sex, have the conversation with your pediatrician or primary care physician about the HPV vaccine as early as age 10. If you’re a female into your mid-twenties and haven’t been vaccinated, you should also discuss this vaccine with your physician. You should be encouraged that a simple vaccine can eliminate cervical cancer.

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

Comments Off on Straight, No Chaser In The News: Success Eliminating Cervical Cancer with the HPV Vaccine

Filed under Health Prevention, Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease, Obstetrics and Gynecology, Pediatrics/Kids Health

The Straight, No Chaser Comprehensive Safe Sex Guide

safe-sex-no-regrets

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.

Talking_Partner_STD

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.

Repeal DADT logo-2

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?

STDlights

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.

howToUseCondoms

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.

sex-toys-300x285

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 None Required

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.

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Filed under Genital/Urinary, Health Prevention, Infectious Disease, Obstetrics and Gynecology

Straight, No Chaser: Cervical Health Awareness

cervical_health_awareness_month

January is Cervical Health Awareness Month, and to that end, The Center for Disease Control and Prevention (CDC) boldly proclaims “No woman should die of cervical cancer.”

It’s cervical health month in the United States, and this point has a rather simple message: Cervical cancer is highly preventable and can be cured when discovered and treatment early. Here are some quick tips to help you check this off of your list of concerns.

  • Every child should get vaccinated at age 11 or 12. Even if you’ve reached age 26 and haven’t been vaccinated, you should discuss options with your physician.
  • The most important thing you can do to help prevent cervical cancer is to get screened regularly starting at age 21.

pap smear

  • The Pap test (or smear) should be performed regularly at age 21. It looks for precancerous changes to the cervix that identify the need for early treatment. In many cases a normal test will eliminate the need for another test for the next three years, but your physician will discuss your individual circumstances in this regard.
  • The HPV test looks for the virus that is now known to be the cause of cervical cancer. Furthermore, human papillomavirus (HPV) is sexually transmitted. The HPV test can be done at the same time as the Pap test from the same examination.

Hopefully knowing these simple tools will convince you to be attentive to preventing and managing your cervical health. This is a public health success story in that cervical cancer could be eliminated if everyone followed the above steps. The rest is up to you.

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: Cervical Cancer – The Sexually Transmitted Cancer

cervical-cancer-awareness

Let’s put this take home message up front: here’s a pretty good demonstration of the value of vaccines. I hope that each of you resolves to get any children you care for vaccinated before they become sexually active.

I want to thank my friend and colleague, Dr. Julius Ellis, noted Ob/Gyn physician for contributing to this post. Let’s start this with two simple statements:

  • Cervical cancer has basically been shown to be caused by an infection.
  • There soon will be no reason that anyone has to have cervical cancer.

female reproductive system

As a reminder, the cervix is the lower and narrow end of the uterus that connects the vagina to the upper part of the uterus (i.e. the womb). Cervical cancer used to be the leading cause of cancer death for women in the US.

In 2011 (the most recent year numbers are available):

  • 12,109 women in the United States were diagnosed with cervical cancer.
  • 4,092 women in the United States died from cervical cancer.

Fortunately, over the last 40 years, the number of cases of cervical cancer and the number of deaths from cervical cancer have decreased significantly, largely due to Pap tests. The even better news is the opportunity exists to virtually eradicate the disease. Cervical cancer is highly preventable because screening tests and a vaccine to prevent human papillomavirus (HPV) infections are available. When cervical cancer is found early, it is highly treatable and associated with long survival and good quality of life.

HPV oral

Yes, cervical cancer is a sexually transmitted infection (STI), and the most common STI is now known to be caused by the human papillomavirus (HPV). Some of you will recognize HPV as a cause of genital warts. This means if you ever develop warts, go get checked immediately (another good reason to do this is because genital syphilis may also present as warts). Even more importantly, certain HPV strains have been shown to cause virtually all cervical and anal cancers. HPV also causes some cancers of the vagina, penis, and oropharynx (a certain part of the throat—and yes, this is what Michael Douglas was referencing about having obtained throat cancer by performing oral sex).

Early on, cervical cancer may not cause signs and symptoms, but advanced cervical cancer may cause bleeding or discharge from the vagina, either of which may be persistent or abnormal from similar episodes you’ve had in the past. If you have any of these signs, see your physician for an evaluation of this and other possible causes of these symptoms.

Am I at risk for HPV? How do you get this?

HPV STD

Everyone having sex or who has ever had sex is at risk for HPV. In fact, nearly all sexually active men and women get it at some point in their lives. HPV is passed on through genital contact, most often during vaginal and anal sex, but also through oral sex and genital-to-genital contact without intercourse. HPV can be passed on between straight and same-sex partners even if and when the infected person has no signs or symptoms. It’s important to know there’s a big difference between obtaining the HPV virus and obtaining cancer from having the HPV virus.

If I get genital warts, will I get cancer?

HPV genital warts

Not necessarily, but the possibility is high enough that you need to get treated. Most HPV infections actually resolve on their own. It’s the ones that linger that pose particular concern.

If I do have warts, what increases my risks for these cancers?

hpv risks

Smoking, a weakened immune system, having had many children (for increased risk of cervical cancer), long-term oral contraceptive use (for increased risk of cervical cancer), and poor oral hygiene (for increased risk of oropharyngeal cancer) all increase the risk for developing cancer after a HPV infection.

How do I get this and how do I prevent it?

HPV

The most reliable way to prevent infection with HPV is abstinence, avoiding any skin-to-skin oral, anal, or genital contact with another. If you are sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the strategy most likely to prevent HPV infection. However, because of the lack of symptoms, it’s hard to know whether a partner is currently infected with HPV. Use of condoms reduces the transmission of HPV between partners, although areas not covered by a condom can still be infected.

HPV vaccine

The Food and Drug Administration (FDA) has approved two HPV vaccines, branded as Gardasil (for the prevention of cervical, anal, vulvar, and vaginal cancer, precancerous lesions, and genital warts in these areas) and Cervarix (for the prevention of cervical cancer and precancerous cervical lesions caused by HPV). Both vaccines are highly effective, but neither has been approved for prevention of penile or oropharyngeal cancer. And yes, it’s safe and effective as young as age 9, although the Center for Disease Control and Prevention currently recommends vaccination between ages 11–14. You must contact your physician for additional details on these important medications.

How do I treat HPV infections?

There’s no treatment for HPV itself, but the problems HPV causes can be treated. We’ll address the two major ones:

  • Genital warts may be treated topically by you or a healthcare provider. If not treated, they may multiply, go away, or stay the same.
  • Cervical cancer may be treated by your gynecologist, but be warned: Prevention is best, and early detection gives you the best chance for the best outcomes. Continue those annual exams.

There will soon come a time when all boys and girls are receiving vaccinations at around ages 11–12, and cervical cancer (in particular) will become a rare entity. That only happens if you get your family immunized. The science is in. There’s no good reasons left to wait.

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: Syphilis Prevention, Treatment and the Tuskegee Experience

tuskegeesyphilis4

Syphilis should be a word derived from something meaning horrible. In an earlier post, we reviewed the rather horrific progression of the symptoms of syphilis. An additionally horrible consideration is that treatment is so very easy once identified. Of course, that’s not the most horrific aspect of the disease. Read on.

Looking back retrospectively, advanced syphilis is especially disheartening because it is so easily treated and prevented. Prevention is as simple as always wearing condoms, being in a monogamous relationship with someone confirmed not to have it, checking your sexual partner prior to sex and not engaging in sex if any type of sore/ulcer is in the mouth, genitalia or anal region. Regarding treatment, syphilis once upon a time was quite the plague until penicillin was discovered; treating syphilis is how penicillin ‘made a name’ for itself. Treatment with penicillin easily kills syphilis but unfortunately does nothing for damage that has already occurred. However, as discussed in the post discussing the symptoms of syphilis, remember that treating syphilis at any point can prevent the most severe complications that lead to death. Which brings us to Tuskegee – and keep in mind this is Straight, No Chaser.

tuskegee

In the early 1930s, the US Public Health Service working with the Tuskegee Institute in Alabama began a study to evaluate the effectiveness of current treatments for syphilis, which at the time, were thought to be at least as bad as the disease. The study was conducted on 600 Black men, who were convinced to participate in the study with the promise of free medical exams, meals and money for burial, ‘if’ it was necessary.

The study was initially meant to last 6 months, but at some point a governmental decision was made to continue the study and observe the natural progression of syphilis until all subjects died of the disease, with a commitment obtained from the subjects that they would be autopsied ‘if’ they died. There were several problems with this decision.

  • None of the patients participated under informed consent. They believed they were being treated as opposed to being observed and having medicine withheld while they were being allowed to die. In other words, the subjects were not aware of the purpose of the study.
  • Penicillin was established as a true, rapidly effective treatment for syphilis and the standard of care by 1947. The study continued 25 years beyond this treatment option being available.
  • Efforts by concerned individuals failed to end the study for 5 years prior to a whistleblower going to the press in 1972. The study was ended in a day.

The aftermath of the study includes the following:

  • Reparations averaging a mere $15,000 per individual were given ($9M total) as well as a formal apology, delivered by President Clinton. Yep, the victims received the equivalent of $15,000 per person on average for 40 years of carrying syphilis 25 years after there was a known cure, after infecting wives and unborn children in several documented cases.
  • Strict requirements for protocols for human study (i.e. Institutional Review Boards) were implemented for the first time.

It shouldn’t surprise anyone that many African-Americans remain distrustful of governmental public health efforts to this day; for many, this study continues to be the reason while vaccination isn’t optimally taken advantage of (e.g. HPV) and why organ donation rates are so relatively low in the African-American community. Even though this posture contributes to the adverse health outcomes that exist in the African-American community, it isn’t hard to see why the fear and distrust exists.

Let’s bring this full circle. When it comes to syphilis, prevention is best, and full treatment is available. At the very least, I certainly can say you’ve been warned. Folks have given their lives to make your warning possible. I welcome your questions and comments.

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: Success Eliminating Cervical Cancer with the HPV Vaccine

hpv-img-2-lg

In the news is information about the human papillomavirus (HPV) vaccine, used to prevent sexually transmitted infections causing genital warts, and more importantly, causing cervical, anal, penile, mouth and throat cancers. Of particular interest is information demonstrating the vaccine developed to prevent HPV infections is even more effective that thought.

Federal researchers from the US Centers for Disease Control and Prevention (CDC) note that existing use of the vaccine has reduced the presence of the virus in teenage girls by approximately two-thirds. This information is especially impressive given the relative novelty and limited use of the vaccine. Only about 40% of girls and 20% of boys between ages 13-17 have been vaccinated. The better news for the future is public health professionals are making a significant push for greater vaccine use at ages 11-12, when the vaccination rates for other childhood diseases exceed 80%.

hpv_vaccine_cancer_prevention

Here’s a public health message: taking the vaccine is about cancer prevention, not just preventing a sexually transmitted infection (genital warts). Unfortunately this message hasn’t fully penetrated the national dialogue: only the District of Columbia, Rhode Island and Virginia require the HPV vaccine, even though it is believed universal use of the vaccine would virtually eradicate cervical cancer. As a frame of reference, several other countries (e.g. Australia) in which HPV vaccine use is mandatory, has achieved over 90% vaccination rates over 90% reduction in rates of genital warts.

About 14 million Americans become infected with HPV each year, and approximately 27,000 people get cancer as a result of an infection from HPV. The American Cancer Society estimates that 4,120 women will die of cervical cancer this year.

If you have a child of either sex, have the conversation with your pediatrician or primary care physician about the HPV vaccine as early as age 10. If you’re a female into your mid-twenties and haven’t been vaccinated, you should also discuss this vaccine with your physician. You should be encouraged that a simple vaccine can eliminate cervical cancer.

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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Filed under Health Prevention, Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease, Obstetrics and Gynecology, Pediatrics/Kids Health