Tag Archives: Infection

Straight, No Chaser: MRSA, the Big, Bad Staph Infection

September 28, 2016Infectious Disease, Skin/Dermatology844-SMA-TALK, Antibiotic resistance, Behind the Curtain, Infection, Methicillin-resistant Staphylococcus aureus, MRSA, Spider bite, Staphylococcus, Staphylococcus aureus, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

One of the things that’s changed a lot from when I first started practicing medicine is people show up every day to the emergency room for mosquito and spider bites. The local news has done a number on you, as now everyone is afraid of MRSA.
Methicillin-resistant Staph Aureus (MRSA) is a bacterial infection that’s resistant to the penicillin family of drugs that we used for decades to treat many infections. Staph Aureus itself is a bacteria akin to flipping a light switch. Normally, it resides within us (approximately 30% of us have it in our nostrils but only 2% of us carry the MRSA variety), not causing any problems, but it is also the source of many dangerous and life-threatening illnesses if it enters your bloodstream.
Over the last 50 years of treating Staph infections, resistance to many different antibiotics has occurred, meaning that when a serious infection occurs, it’s potentially very harmful. The emphasis there should be on potentially. Most MRSA infections are community-acquired skin infections that resemble a spider or other insect bite but are still mild and are treatable with different antibiotics than historically used. Regular Staph and MRSA infections are even more likely to occur in those institutionalized (i.e. in hospitals, nursing homes, etc.) and have tubes and wounds. Consider and discuss the risk with your physician when you see someone on a breathing device, a urinary catheter, needing gauze for surgical wounds or on feeding tubes. Amazingly, MRSA causes approximately 60% of hospital-acquired Staph infections now.
My primary goal today is to inform you of what you need to know to prevent obtaining these infections and when to be especially diligent in seeking treatment. It’s really a simple task of maintaining hygiene. Just prevent that ‘light-switch’ from flipping to the on position and most times you’ll be ok.
1. Staph is everywhere. You can best protect yourself by simply practicing good hygiene. Wash your hands early and often.
2. MRSA is spread by contact. Don’t be so quick to feel and squeeze on someone’s (or your own) boil. Wash your hands before and after such contact. Don’t share towels or razors.
3. Keep any cuts, scratches, nicks or scrapes covered until healed.
If you do see or develop signs of a skin infection (redness, warmth, tenderness, pain and possibly discharge from the wound site), it’s worth contacting your physician to see if s/he’d like to start antibiotics or drain a possible abscess.
So… don’t be afraid, be smart. Prevention is key.

Feel free to ask 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 Questions About Human Bites

July 26, 2016Infectious Disease, Medical Treatment, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Bite, Bite marks, Bites and Stings, Boxer's fracture, cat bite, Conditions and Diseases, Dracula, health, human bite, Infection, laceration repair, metacarpal bone, pinky finger, puncture wound, Snake bite, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Wound, Wounds and InjuriesJeffrey Sterling, MD

The votes are in, and it appears that Jaws (from James Bond fame) found the previous post, well… biting. Here’s your questions and answers about human bites:
1) If human bites are so dangerous, why do women love Dracula so much?

Seriously? Let’s just ascribe it to the neck being an erogenous zone and move on…

2) What’s a Boxer’s Fracture?

A boxer’s fracture is a misnomer because boxers don’t get them. This describes a fracture at the base of the small finger (5^th metacarpal), often caused from poor form throwing a punch. If you take one hand and move the pinky finger portion of the palm (the metacarpal bone), you’ll notice how movable it is (i.e. unstable) compared with the same efforts on the index and middle fingers at the level of the palm, which is what should deliver the blow. A boxer’s fracture and a human bite together makes for a very bad day.

3) Is a human’s mouth really dirtier than a goat’s mouth?

It’s correct to say the bacteria in a human’s mouth cause more disease.

4) Is a bite the same as a puncture wound

The difference between a puncture wound and a laceration is you can identify the bottom (base) of the wound in a laceration, and you can’t in a puncture wound. Regarding bites: cats, snakes and the aforementioned Dracula are more likely to cause puncture wounds. Puncture wounds may or may not be caused by a bite (e.g. knife wounds are punctures).

5) I received a bite and didn’t get stitched up. Why?

This could be for several reasons. Puncture wounds don’t receive stitches because you don’t want to seal off the infection. That’s a really good way to develop an abscess.
Sometimes we will opt for ‘delayed closure’, waiting 3-5 days to ensure no infection has occurred before placing stitches.
It’s really about the risk/benefit ratio. A laceration to a face is more likely to be repaired because of the risk of disfigurement and scarring, plus the face is a relatively low infection area anyway.

6) Why didn’t Dracula ever get Hepatitis or HIV?

Even though Dracula’s the undead, one would think he’d be the world’s single greatest transmitter of both HIV and the blood transmitted forms of Hepatitis. HIV is viable for awhile in dead tissue, but it can’t multiply, which would explain why Dracula doesn’t show signs of the diseases. On that note, I’m done.

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: Human Bites

July 25, 2016Infectious Disease, Skin/Dermatology844-SMA-TALK, Behind the Curtain, Bite, Bites and Stings, Biting, Cellulitis, Conditions and Diseases, Hangnails, health, human bite, Infection, Mike Tyson, Open wound, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Tetanus shot, Wound, Wounds and InjuriesJeffrey Sterling, MD

Maybe it’s where I’m located, but I tend to see way more “fight bites” than anything else; these specifically refer to someone getting hit in the mouth. It’s always interesting to see the guy who “won” the fight being the one who has to come in for medical treatment. He cut his hand on someone’s tooth and really doesn’t think much of it. He just wants the laceration sewn. Little does he realize, the structures in the hand (tendons, blood vessels, muscles, and bones) are highly concentrated. He also doesn’t know that they are confined to a very limited space and seeding an infection in that tight space makes things really bad really quick. This guy is very dangerous because he tends to deny ever getting into the fight, ascribing the injury to something else (like punching a tree)—at least until I ask him why a tooth is inside his hand.

Then there’s the “Yes, he bit me” variety, where the teeth were the aggressor that engaged the victim instead of the fist engaging the tooth. Think of the Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears, and other unmentionables)! Children, as another example, sometimes bite and need to learn to stop that behavior. Biting is sometimes seen in sexual assault, physical abuse, self-mutilation, or with mentally handicapped individuals.

A third type is the ‘We love too much!’ variety of bites. These may include hickeys that actually break the skin. Other examples of “friendly” bites are folks biting off their hangnails, fingernails, and toenails and create skin infections. Yes, it happens more than you’d think, and no, you don’t have to be a vampire.
The commonality to all of these scenarios is saliva that found its way through the skin. Because of the virulence of the bacteria contained within the saliva, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness, fever, and possible pus from the wound develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, get evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop. In fact, these bites require immunization for tetanus.
Bottom line: There’s no reason not to get evaluated if you develop those signs of infection, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.

So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies like peroxide, alcohol, and anything else that burns. Those agents make things worse by damaging the skin more than they “clean” the area.
2) Apply ice—never directly to the wound—but in a towel. Use for 15 minutes on and then 15 minutes off.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
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: Bacterial Vaginosis – No, That’s Not a STD

May 3, 2016Genital/Urinary, Obstetrics and GynecologyBacteria, Bacterial vaginosis, Behind the Curtain, Centers for Disease Control and Prevention, Conditions and Diseases, health, Human sexual activity, Infection, Microorganism, PH, Sexual partner, Sexuality, Sexually transmitted disease, Vagina, Vaginitis, Women's HealthJeffrey Sterling, MD

I try to give you straight talk but never crudely. As I’ve discussed conditions involving the genitalia, I’ve been mindful of the reality that large numbers of you have been affected by sexual transmitted diseases/infections (aka STDs/STIs), and I will always respectful of that consideration. That doesn’t mean I’m sugar-coating your information, it just means I am aware that you’re suffering and concerned by different scenarios.

One of those is bacterial vaginosis. There is an age after which women invariably start discovering that various things they do can disrupt the appearance, smell and content of their vaginal fluid. It’s certainly human nature to wonder if something has gone terribly wrong. Let’s pick up our Doctor-Couple conversation from earlier…
Patient: Yep! I have this grayish/whitish discharge that only happens after sex. And sometimes it itches around there. And it burns when I pee! No rashes or that other stuff, though.
Doctor: Ok. Let’s examine you…

All humans have various microorganisms that normally reside inside us at relatively low levels; different microorganisms inhabit different part of the body. They’ve set up a delicate balance (like an ecosystem, if you will) that, once settled doesn’t disturb us (their hosts) at all. If external or internal circumstances disturb that balance such that one set of organisms is disproportionately affected, overgrowth of the other organisms may occur. Many of you will recognize this as happening when you get a ‘yeast’ infection. It’s also what occurs when you develop bacterial vaginosis (BV). BV is the most common vaginal infection in the U.S. It’s more likely to be seen when you start having unprotected sex with a new partner, have multiple sex partners, are pregnant or douche (therefore, women who are not sexually active can have BV also). By the way, you don’t get BV from toilet seats or swimming pools.

The question everyone always has is “What’s the role of sex, especially sperm, in it?”. That’s asked because BV is often noticed after unprotected sex that includes ejaculation. Here’s where you learn the difference between ‘sexually transmitted’ and ‘sexually associated’. It is unclear what role sex has in the development of BV, but common thoughts include alterations in the pH of the vaginal fluid based on interactions with sperm/semen. It is known that the pH of women become more alkaline (less acidic) after exposure to semen, and that environment produces compounds causing the ‘fishy smell’. Yes, that’s real. We even have a real thing call a ‘whiff test’ as part of making the diagnosis.
The good news is BV is easily treated. The bad news is it needs to be treated, and it can recur even if it’s treated. Remember, it’s just an overgrowth syndrome. There are complications to not getting BV treated, especially if you’re pregnant. This makes it especially important that medication be taken to completion, even though you may feel better prior to that. Male partners do not need to be treated.
So this couple gets ‘off the hook’, even though they may decide to start using condoms. Next we will focus on the risks of various sexual activities. Stay tuned.
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: STDs – Syphilis, The Great Mimicker

April 30, 2016Genital/Urinary, Infectious Disease, Obstetrics and GynecologyBehind the Curtain, Conditions and Diseases, Disease, health, Infection, Men who have sex with men, MSM, Rash, Reproductive Health, Sexually transmitted disease, Symptom, Syphilis, TuskegeeJeffrey Sterling, MD

Today, Straight, No Chaser will present two phrases that you may not have previously heard: The Great Mimicker and MSM, and that means we’re discussing what has historically been a devastating disease: syphilis. Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease between the Americas and Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.

Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…

Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.

Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The microorganism causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
Prevention and Treatment Considerations: 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. Remember that treating syphilis at any point can prevent the most severe complications that lead to death.
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 Questions About Human Bites

June 9, 2015Infectious Disease, Medical Treatment, Skin/DermatologyBite, Bite marks, Bites and Stings, Boxer's fracture, cat bite, Conditions and Diseases, Dracula, health, human bite, Infection, laceration repair, metacarpal bone, pinky finger, puncture wound, Snake bite, Wound, Wounds and InjuriesJeffrey Sterling, MD

Seriously? Let’s just ascribe it to the neck being an erogenous zone and move on…

2) What’s a Boxer’s Fracture?

A boxer’s fracture is a misnomer because boxers don’t get them. This describes a fracture at the base of the small finger (5^th metacarpal), often caused from poor form throwing a punch. If you take one hand and move the pinky finger portion of the palm (the metacarpal bone), you’ll notice how movable it is (i.e. unstable) compared with the same efforts on the index and middle fingers at the level of the palm, which is what should deliver the blow. A boxer’s fracture and a human bite together makes for a very bad day.

3) Is a human’s mouth really dirtier than a goat’s mouth?

It’s correct to say the bacteria in a human’s mouth cause more disease.

4) Is a bite the same as a puncture wound

The difference between a puncture wound and a laceration is you can identify the bottom (base) of the wound in a laceration, and you can’t in a puncture wound. Regarding bites: cats, snakes and the aforementioned Dracula are more likely to cause puncture wounds. Puncture wounds may or may not be caused by a bite (e.g. knife wounds are punctures).

5) I received a bite and didn’t get stitched up. Why?

This could be for several reasons. Puncture wounds don’t receive stitches because you don’t want to seal off the infection. That’s a really good way to develop an abscess.
Sometimes we will opt for ‘delayed closure’, waiting 3-5 days to ensure no infection has occurred before placing stitches.
It’s really about the risk/benefit ratio. A laceration to a face is more likely to be repaired because of the risk of disfigurement and scarring, plus the face is a relatively low infection area anyway.

6) Why didn’t Dracula ever get Hepatitis or HIV?

Even though Dracula’s the undead, one would think he’d be the world’s single greatest transmitter of both HIV and the blood transmitted forms of Hepatitis. HIV is viable for awhile in dead tissue, but it can’t multiply, which would explain why Dracula doesn’t show signs of the diseases. On that note, I’m done.

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: Human Bites

June 1, 2015General Health and WellnessBite, Bites and Stings, Biting, Cellulitis, Conditions and Diseases, Hangnails, health, human bite, Infection, Mike Tyson, Open wound, Tetanus shot, Wound, Wounds and InjuriesJeffrey Sterling, MD

A third type is the ‘We love too much!’ variety of bites. These may include hickeys that actually break the skin. Other examples of “friendly” bites are folks biting off their hangnails, fingernails, and toenails and create skin infections. Yes, it happens more than you’d think, and no, you don’t have to be a vampire.
The commonality to all of these scenarios is saliva that found its way through the skin. Because of the virulence of the bacteria contained within the saliva, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness, fever, and possible pus from the wound develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, get evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop. In fact, these bites require immunization for tetanus. Bottom line: There’s no reason not to get evaluated if you develop those signs of infection, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.

So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies like peroxide, alcohol, and anything else that burns. Those agents make things worse by damaging the skin more than they “clean” the area.
2) Apply ice—never directly to the wound—but in a towel. Use for 15 minutes on and then 15 minutes off.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
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 © 2015 · Sterling Initiatives, LLC

Straight, No Chaser: STDs – Syphilis, The Great Mimicker

November 19, 2014Genital/Urinary, Infectious Disease, Obstetrics and GynecologyConditions and Diseases, Disease, health, Infection, Men who have sex with men, MSM, Rash, Reproductive Health, Sexually transmitted disease, Symptom, Syphilis, TuskegeeJeffrey Sterling, MD

Today, Straight, No Chaser will present two phrases that you may not have previously heard: The Great Mimicker and MSM, and that means we’re discussing what has historically been a devastating disease: syphilis. Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease between the Americas and Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.

Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…

Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.

Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The microorganism causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
Prevention and Treatment Considerations: 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. Remember that treating syphilis at any point can prevent the most severe complications that lead to death.
For a historical lesson on what happens with untreated syphilis, review this Straight, No Chaser post on The Tuskegee Experiments.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Bacterial Vaginosis – No, That's Not a STD

November 17, 2014Genital/Urinary, Obstetrics and Gynecology, Health PreventionBacteria, Bacterial vaginosis, Centers for Disease Control and Prevention, Conditions and Diseases, health, Human sexual activity, Infection, Microorganism, PH, Sexual partner, Sexuality, Sexually transmitted disease, Vagina, Vaginitis, Women's HealthJeffrey Sterling, MD

The question everyone always has is “What’s the role of sex, especially sperm, in it?”. That’s asked because BV is often noticed after unprotected sex that includes ejaculation. Here’s where you learn the difference between ‘sexually transmitted’ and ‘sexually associated’. It is unclear what role sex has in the development of BV, but common thoughts include alterations in the pH of the vaginal fluid based on interactions with sperm/semen. It is known that the pH of women become more alkaline (less acidic) after exposure to semen, and that environment produces compounds causing the ‘fishy smell’. Yes, that’s real. We even have a real thing call a ‘whiff test’ as part of making the diagnosis.
The good news is BV is easily treated. The bad news is it needs to be treated, and it can recur even if it’s treated. Remember, it’s just an overgrowth syndrome. There are complications to not getting BV treated, especially if you’re pregnant. This makes it especially important that medication be taken to completion, even though you may feel better prior to that. Male partners do not need to be treated.
So this couple gets ‘off the hook’, even though they may decide to start using condoms. Next we will focus on the risks of various sexual activities. Stay tuned.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Fifteen Tips to Care for Diabetic Skin

December 20, 2013Endocrine/Metabolic, Health PreventionAntibacterial, Blood sugar, Diabetes mellitus, health, Infection, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Twitter, WordPress, WoundJeffrey Sterling, MD

In this previous post, we discussed the frailty of the diabetic skin and discussed how that sets one up for skin infections, abscesses, ulcers, amputations and even death. Your best defense from these set of illnesses and tragedies is knowledge, prevention and prompt action. Here are some concern steps you can take to better care for the diabetic in your life. In the event you know a diabetic who appears healthy, I want you to pay special attention to him/her. Diabetes is a chronic and insidious disease. These changes occur over years, and your challenge is to slow the process down as long as possible.
If you have diabetes, these tips may help prevent skin damage and infections:

Do the best to can to control your blood glucose levels. The more out of control it is, the most damage it causes.
You must check your feet every single day for the rest of your life. Diabetes develop decreased sensitivity to their feet. It is extremely common to step on a sharp object and not realize that you’ve done so. A splinter or nail is an excellent medium for an infection.
Eat fruits and vegetables. Your skin needs all the nourishment it can get.
Develop better hygiene. Wash and dry your skin often and thoroughly; this will keep you less exposed to infections.
Make a point of keeping your groin, armpits and other areas prone to heavy sweat dry. Those moist areas in particular are most prone to becoming infected. Talcum powder is a good choice to use.
Stay hydrated. It’s an uphill battle with the frequent urination and high blood sugar (glucose) levels. Dehydration causes your skin to be more brittle and prone to infections.
Stay moisturized! Apply lotion early and often, especially after baths. Note those dry, cracked feet and get ahead of that happening if possible.
Remember: if you’re diabetic, at some point your hands will retain sensation longer than your finger. It’s common to see scald injuries from stepping in water hot enough to burn you without you feeling it initially. Check the water with your hands before stepping into a tub.
Use a milder, less irritating soaps that include moisturizer. Speaking of tubs, avoid bubble baths. Sorry.
Consider investing in a humidifier to prevent skin drying, especially in dry or cold climates.
Always take any skin wounds seriously, especially those on your feet. Avoid placing alcohol on any of your wounds.
Invest in some sterile gauze. If you develop a scratch or other wound, control the wound with it after cleaning.
Limit your self-help to cleaning and gauze wrapping. Only place topical antibiotics or take antibiotics for a skin infection under your physician’s supervision.
Always ask your physician to check your skin during an examination and ask him/her to teach you what to look for.
Immediately consult your physician or access the local emergency room if you have a burn, scratch, abscess (boil) or laceration that seems serious.

Feel free to contact your SMA expert consultant if you have any questions on this topic.
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Straight, No Chaser: The Skin Problems of Diabetics, Part 1

December 19, 2013Endocrine/Metabolic, Health PreventionBlood flow, Blood sugar, Conditions and Diseases, Diabetes mellitus, diabetic foot ulcers, Endocrine Disorders, health, Infection, Pancreas, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

If you are diabetic or caring for a diabetic, one of the things you’ve likely noticed is that the skin doesn’t always seem to look, feel or perform normally. Perhaps the first thing I’d want you to know as a means of understanding what’s going on is this combination of facts: the skin is the body’s largest organ and diabetics have issues with blood flow. Given all the area needing blood flow, it stands to reason that diabetics invariably would have skin problems.
On a practical level, appreciate that infections are the most common cause of death in diabetics. Even a small cut or scratch in this population can lead to loss of a limb if unrecognized and left untreated. Unfortunately, amputations among diabetics happens all too often. Is it preventable? With 100% confidence, yes. You can sufficiently reduce your risk of this ever happening. That said, there’s a reality that approximately 1/3 of all diabetes will have some type of skin problem, ranging from eczema and other localized itching problems to infections, abscesses, and gangrene.
By now you are likely wondering two things: How does this happen, and how can I prevent/help this?
First, diabetics suffer from frequent and excessive urination from those high blood glucose levels. This can lead to dehydration. Dehydrated skin is dry, red and has a waxy appearance. It becomes cracked, itchy, easily injured, harder to heal and easier to infect. Remember how diabetics have problems with poor blood circulation? That reduces the bodies’ ability to fight infections. So the first course of action for diabetics (beyond understanding the risks) is to be diligent in preventing infection.
I will dedicate a separate post to give you all the knowledge you need to prevent diabetic cuts, scratches and skin infections or to have them treated. In the meantime, the same rules apply to diabetics as they do to everyone else: an ounce of prevention is worth a pound of care. Diet and exercise can stave off the day when you’re fighting for your life because of a diabetic foot ulcer.
Click here for an explanation of basic facts about diabetes.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: What is AIDS?

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

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

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

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

November 15, 2013General Health and Wellness, Head/Eyes/Ears/Nose/ThroatBody, Facebook, Infection, Lymph node, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition), Twitter, WordPressJeffrey Sterling, MD

First of all, thank you for the continued reader submissions.
Cervical (that is, neck) lymph nodes (small oval organs located in various parts of the body that help the body fight infections; aka ‘swollen glands’) are the topic of the day. Cervical adenopathy (aka lymphadenopathy) is the presence of swollen, tender lymph nodes in the neck. They can represent the following:

The body’s response to a primary infection in the neck;
The body’s response to a local infection around the neck (such as the ears or throat); and/or
The body’s response to diseases widespread throughout the body (such as with mononucleosis, tuberculosis, and other diseases, such as HIV).

Just remember that infections are by far the most common cause of tender lymph nodes in the neck and get them checked if your other symptoms are concerning enough to you. Of course, you could always contact your personalized health consultant at www.SterlingMedicalAdvice.com as well, and we’ll help you work through your concerns.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

Straight, No Chaser: Human Bites

October 27, 2013Infectious Disease, Skin/DermatologyFacebook, Infection, Limited liability company, Sterling, Sterling Medical Advice, Straight No Chaser, Twitter, WordPress, WoundJeffrey Sterling, MD

I have had weird experiences with humans biting humans, as have most physicians. There are several different types of human bites, which can range from harmless to surgically serious. However, as an emergency physician, knowing the dangers of the bacteria inhabiting your mouth, I tend to assume the worst until proven otherwise. Your first quick tip is to do the same.
Maybe it’s where I’m located, but I tend to see way more “fight bites” than anything else; these specifically refer to someone getting hit in the mouth. It’s always interesting to see the guy who “won” the fight being the one who has to come in for medical treatment. He cut his hand on someone’s tooth and really doesn’t think much of it. He just wants the laceration sewn. Little does he realize, the structures in the hand (tendons, blood vessels, muscles, and bones) are highly concentrated. He also doesn’t know that they are confined to a very limited space and seeding an infection in that tight space makes things really bad really quick. This guy is very dangerous because he tends to deny ever getting into the fight, ascribing the injury to something else (like punching a tree)—at least until I ask him why a tooth is inside his hand.
Then there’s the “Yes, he bit me” variety, where the teeth were the agressor that engaged the victim instead of the fist engaging the tooth. Think of the Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears, and other unmentionables)! Children, as another example, sometimes bite and need to learn to stop that behavior. Biting is sometimes seen in sexual assault, physical abuse, self-mutilation, or with mentally handicapped individuals.
A third type is the ‘We love too much!’ variety of bites. These may include hickeys that actually break the skin. Other examples of “friendly” bites are folks biting off their hangnails, fingernails, and toenails and create skin infections. Yes, it happens more than you’d think.
The commonality to all of these scenarios is saliva that found its way through the skin. Because of the virulence of the bacteria contained within the saliva, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness, fever, and possible pus from the wound develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, get evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop. In fact, these bites require immunization for tetanus. Bottom line: There’s no reason not to get evaluated if you develop those signs of infection, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.
So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies like peroxide, alcohol, and anything else that burns. Those agents make things worse by damaging the skin more than they “clean” the area.
2) Apply ice—never directly to the wound—but in a towel. Use for 15 minutes on and then 15 minutes off.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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From the Health Library of SterlingMedicalAdvice.com: "Is It OK to Take Leftover Antibiotics to Treat a Current Infection?"

October 21, 2013General Health and Wellness, Health PreventionAntibacterial, Antibiotic resistance, Facebook, health, Infection, Pharmacy, Sterling Medical Advice, Twitter, WordPressJeffrey Sterling, MD

You should never use any leftover antibiotics to treat a current infection. The various antibiotics that are available are effective only against specific bacteria, so do not assume that the old medication will take care of your current infection. Your physician should determine the cause of your infection and prescribe appropriate treatment.
It also is important to note that any time your doctor prescribes an antibiotic, you should take all the medicine you are given on the schedule your doctor provides—even when you start to feel better. Unless your doctor tells you to discontinue the antibiotic, you should not have any left over. Not finishing the prescription means some bacteria could survive and possibly come back even stronger. The surviving bacteria can then become resistant to the antibiotic, make the infection worse, and make it harder to treat.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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Straight, No Chaser: Emergency Room Adventures – The Cauliflower Ear

September 28, 2013Head/Eyes/Ears/Nose/Throat, Medical Treatment, TraumaCauliflower ear, Conditions and Diseases, Ear, health, Hematoma, Infection, Otitis, Otitis externa, Otitis media, Randy Couture, WordPressJeffrey Sterling, MD

So here I am again waiting for something interesting to walk in worthy of me telling you about, and lo and behold, a behemoth of a guy walks by. You know, one of those guys who works out way too much for it to be just about health. In any event, the nurse tells me the gentleman has ear pain, and she thinks it’s an infection. Well, that’s odd. Otitis media (middle ear infections) and otitis externa (external ear infections) usually happen in kids. So I get up to see him, and I see something that looks like an early version of Randy Couture’s ear… …and I immediately think of you.
A ‘cauliflower ear’ is something you should be aware of because it’s easily obtained, and it has very bad consequences if not addressed in a timely manner. It’s a deformity of the ear (usually the upper outer portion) mostly caused by blunt trauma. It happens a lot to wrestlers, boxers, MMA fighters and rugby players, but it’s also seen in those with infected high ear-piercings. It occurs when the ear gets hit, causing a hematoma (collection of clotting blood) to form. The hematoma prevents normal flow of blood through the ear. The problem with this is the ear is made of cartilage (a less sturdy form of tissue) than bone. No blood flow and the presence of clots cause the cartilage to wilt and deform, giving the lumpy appearance shown in the picture. This can be treated with drainage of the blood and clot from the ear, but if it’s not done early enough, the ear will become permanently deformed.
If you have trauma or infection to the upper ear, be on the lookout for redness or swelling. Don’t ignore it like you might be inclined to do elsewhere. Get it evaluated promptly, even if it seems minor because… Time is tissue.
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Straight, No Chaser: Syphilis – The Great Mimicker

September 25, 2013Genital/Urinary, Obstetrics and GynecologyConditions and Diseases, Disease, health, Infection, Men who have sex with men, MSM, Rash, Reproductive Health, Sexually transmitted disease, Symptom, SyphilisJeffrey Sterling, MD

Today, you will learn two phrases that you may not have previously heard: The Great Mimicker and MSM. Regarding another word you definitely should know, I’ll touch on it and will save for a separate post: Tuskegee.
Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease from the Americas to Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In the first part of this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.

Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…

Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.

Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The bacteria causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
All of the pictures in this posts are typical representations of the various stages of syphilis, and I’ve seen them all. These are not meant to provide any shock value other than demonstrating what occurs with progression of the disease. Later, I will discuss treatment, risks and other considerations. I don’t think you’ll want to miss the rest of the story. That really is shocking – and horrible.
Feel free to offer comments or ask questions.
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Straight, No Chaser: The Most Common STD – Chlamydia

September 23, 2013Genital/Urinary, Medical Treatment, Obstetrics and Gynecology, Health PreventionChlamydia infection, Dysuria, Gonorrhea, Human sexual activity, Infection, Non-gonococcal urethritis, Pelvic inflammatory disease, Sexually transmitted disease, WordPressJeffrey Sterling, MD

For most people, NGU isn’t a college in South Carolina. In fact, non-gonococcal urethritis isn’t really even that anymore, meaning it doesn’t need to be defined by the fact that it’s not gonorrhea. Chlamydia (the most common cause of NGU) by itself causes an estimated 3 million sexually transmitted infections a year. It is the most likely reason you’re coming into the emergency department when someone’s been behaving badly.
Here’s what I want you to know about Chlamydia:
1. It’s a real good reason to wear condoms. Chlamydia most commonly presents with no symptoms but may present with burning with urination, having to go more often (that’s the urethritis; the urethra is the tube through which urine flows) and a cloudy discharge. Less commonly, it can affect the rectum (proctitis) or a portion of the testicles (epidydimitis).
2. It’s contagious. If you’re sexually active with someone infected, odds are you’ll get it. It can be acquired via oral, vaginal or anal sex, and ejaculation isn’t required for transmission. Even worse, that means you can pass it to your newborn child (to disastrous effects to the baby, as noted in the lead picture of the newborn; Chlamydia has long been a significant cause of blindness worldwide, though thankfully the rate is decreasing).
2. Treatment doesn’t prevent you from reacquiring it. If you don’t change the behavior, you won’t change the future risk.
3. If both partners aren’t treated, then neither is treated. This can just get passed back and forth like a ping-pong ball. If you have several sexual partners, you’ll manage to introduce a lot of drama into a lot of lives. If you are treated, you should not engage in sexual activity until one week after your partner(s) have completed treatment.
4. It causes serious damage to females. PID (pelvic inflammatory disease – a complication of untreated Chlamydia) is a serious enough topic to warrant its own post, but untreated infections lead to infertility, an increased rate of tubal (ectopic) pregnancies and other complications. This needs to be identified and treated.
5. STDs hang out together. Chlamydia that goes untreated increases the chances of acquiring or transmitting HIV/AIDS. An infection with Chlamydia should prompt treatment for other STDs and testing for HIV.
6. It is easily prevented and treated. Wear condoms each time, every time. Get evaluated early with development of signs or symptoms. Discuss the discovery of Chlamydia with all sexual contacts from the last several months. This is an infection you don’t have to catch.
Let me know if you have any questions or comments.
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Straight, No Chaser: Bacterial Vaginosis – No, That's Not an STD

September 22, 2013Medical Treatment, Obstetrics and Gynecology, Public Health, Health PreventionBacteria, Bacterial vaginosis, Centers for Disease Control and Prevention, Conditions and Diseases, health, Human sexual activity, Infection, Microorganism, PH, Sexual partner, Sexuality, Sexually transmitted disease, Vagina, Vaginitis, Women's HealthJeffrey Sterling, MD

I try to give you straight talk but never crudely. Therefore as I wade into conditions involving the genitalia, I’ll be sure to respect various sensitivities. That doesn’t mean I’m sugar-coating your information, it just means I am aware that you’re suffering and concerned by different scenarios.
One of those is bacterial vaginosis. There is an age after which women invariably start discovering that various things they do can disrupt the appearance, smell and content of their vaginal fluid. It’s certainly human nature to wonder if something has gone terribly wrong. Let’s pick up our Doctor-Couple conversation from earlier…
Patient: Yep! I have this grayish/whitish discharge that only happens after sex. And sometimes it itches around there. And it burns when I pee! No rashes or that other stuff, though.
Doctor: Ok. Let’s examine you…
All humans have various microorganisms that normally reside inside us at relatively low levels; different microorganisms inhabit different part of the body. They’ve set up a delicate balance (like an ecosystem, if you will) that, once settled doesn’t disturb us (their hosts) at all. If external or internal circumstances disturb that balance such that one set of organisms is disproportionately affected, overgrowth of the other organisms may occur. Many of you will recognize this as happening when you get a ‘yeast’ infection. It’s also what occurs when you develop bacterial vaginosis (BV). BV is the most common vaginal infection in the U.S. It’s more likely to be seen when you start having unprotected sex with a new partner, have multiple sex partners, are pregnant or douche (therefore, women who are not sexually active can have BV also). By the way, you don’t get BV from toilet seats or swimming pools.
The question everyone always has is “What’s the role of sex, especially sperm, in it?”. That’s asked because BV is often noticed after unprotected sex that includes ejaculation. Here’s where you learn the difference between ‘sexually transmitted’ and ‘sexually associated’. It is unclear what role sex has in the development of BV, but common thoughts include alterations in the pH of the vaginal fluid based on interactions with sperm/semen. It is known that the pH of women become more alkaline (less acidic) after exposure to semen, and that environment produces compounds causing the ‘fishy smell’. Yes, that’s real. We even have a real thing call a ‘whiff test’ as part of making the diagnosis.
The good news is BV is easily treated. The bad news is it needs to be treated, and it can recur even if it’s treated. Remember, it’s just an overgrowth syndrome. There are complications to not getting BV treated, especially if you’re pregnant. This makes it especially important that medication be taken to completion, even though you may feel better prior to that. Male partners do not need to be treated.
So this couple gets ‘off the hook’, even though they may decide to start using condoms. Unfortunately, some of the next sets of couples aren’t so lucky.
I welcome any questions or comments.

Straight, No Chaser: MRSA, the Big, Bad Staph Infection

September 8, 2013Infectious Disease, Skin/DermatologyAntibiotic resistance, Infection, Methicillin-resistant Staphylococcus aureus, MRSA, Spider bite, Staphylococcus, Staphylococcus aureusJeffrey Sterling, MD

One of the things that’s changed a lot from when I first started practicing medicine is people show up every day to the emergency room for mosquito and spider bites. The local news has done a number on you, as now everyone is afraid of MRSA.
Methicillin-resistant Staph Aureus (MRSA) is a bacterial infection that’s resistant to the penicillin family of drugs that we used for decades to treat many infections. Staph Aureus itself is a bacteria akin to flipping a light switch. Normally, it resides within us (approximately 30% of us have it in our nostrils but only 2% of us carry the MRSA variety), not causing any problems, but it is also the source of many dangerous and life-threatening illnesses if it enters your bloodstream.
Over the last 50 years of treating Staph infections, resistance to many different antibiotics has occurred, meaning that when a serious infection occurs, it’s potentially very harmful. The emphasis there should be on potentially. Most MRSA infections are community-acquired skin infections that resemble a spider or other insect bite but are still mild and are treatable with different antibiotics than historically used. Regular Staph and MRSA infections are even more likely to occur in those institutionalized (i.e. in hospitals, nursing homes, etc.) and have tubes and wounds. Consider and discuss the risk with your physician when you see someone on a breathing device, a urinary catheter, needing gauze for surgical wounds or on feeding tubes. Amazingly, MRSA causes approximately 60% of hospital-acquired Staph infections now.
My primary goal today is to inform you of what you need to know to prevent obtaining these infections and when to be especially diligent in seeking treatment. It’s really a simple task of maintaining hygiene. Just prevent that ‘light-switch’ from flipping to the on position and most times you’ll be ok.
1. Staph is everywhere. You can best protect yourself by simply practicing good hygiene. Wash your hands early and often.
2. MRSA is spread by contact. Don’t be so quick to feel and squeeze on someone’s (or your own) boil. Wash your hands before and after such contact. Don’t share towels or razors.
3. Keep any cuts, scratches, nicks or scrapes covered until healed.
If you do see or develop signs of a skin infection (redness, warmth, tenderness, pain and possibly discharge from the wound site), it’s worth contacting your physician to see if s/he’d like to start antibiotics or drain a possible abscess.
So… don’t be afraid, be smart. Prevention is key.

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