sexually transmitted diseases

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New Normal In Age Of Hookup Apps? Rhode Island Rises In Syphilis, Gonorrhea, HIV

(Rhode Island Department of Health)

(Rhode Island Department of Health)

By Marina Renton
CommonHealth intern

The numbers are striking: Recent double-digit rises around the country in long-familiar sexually transmitted diseases — gonorrhea, HIV, even the old scourge of syphilis.

Perhaps even more striking is what Thomas Bertrand of the Rhode Island Department of Health said recently about the rising numbers on Here & Now: “I would not call it a crisis, I’d call it a new normal right now, and we need to push against it.”

Last month, the Rhode Island Department of Health put out a press release with its data from 2013 to 2014: Reported cases of infectious syphilis increased 79 percent, gonorrhea cases increased 30 percent, and newly diagnosed HIV cases increased 33 percent.

While these figures are dramatic, particularly the increase in syphilis, it’s important to remember that year-to-year changes aren’t always the best data to look at, said Bertrand, who is chief of the office of HIV, STDs, Viral Hepatitis, and Tuberculosis for the state Department of Health. It’s better to examine a period of five to 10 years, he says.

But those numbers don’t look good either: Since 2009, Rhode Island, along with the rest of the country, has seen increases in chlamydia, gonorrhea and syphilis, Bertrand said in a phone interview. “We mirror the national trends in general.”

“The acceleration or the increase may be a little bit steeper in Rhode Island than the rest of the country, but just a little bit,” he added.

Can swiping right lead to STDs?

The Rhode Island Department of Health’s statement mentions the use of hookup apps as a “high-risk behavior” that could be associated with the increase in STDs. However: “We don’t have data to say that the use of social media or the people who use it are more infectious or transmitting disease more than people who don’t,” Bertrand said.

But the apps do add to tracking problems: When people use social media such as Tinder and Grindr to arrange hookups, the encounter can be casual and brief, so people don’t share much information, Bertrand said. So, when someone is diagnosed with an STD, he or she might not be able to provide contact information for his or her sexual partners, making it harder to curb the spread of the disease.

Given the use of social media to arrange sexual encounters, there is opportunity for the health department to move online, Bertrand said. Continue reading

Hard Call: Your Girlfriend Has Chlamydia, May I Phone In Your Prescription?

(tbone_sandwich/Flickr Creative Commons via Compfight)

(tbone_sandwich/Flickr Creative Commons via Compfight)

By Dr. Myechia Minter-Jordan
Guest contributor

Eighteen-year-old Eva had recently had unprotected sex with her boyfriend and came into my office for an urgent appointment to get “checked out.”

While I performed my usual cervical exam and testing, I used my 20-minute visit to talk with Eva (not her real name) about self-empowerment and the importance of protecting herself from disease: 
“I am really glad that you’re here with me today. This is an important first step in taking charge of your health and learning how to take care of yourself…”

The next day I found out that unfortunately, Eva had contracted chlamydia, the most common sexually transmitted disease in the country and the state. My next moves were clear: The job of informing my young patient of her infection is one that I am used to, but never look forward to. What is even less comfortable is the task of informing and treating the partner, an individual who is most likely not my patient, and with whom I do not have a relationship.

However, because of state legislation passed in 2011, I now have the ability to prescribe or dispense antibiotics to treat chlamydia in the sex partner of patients with diagnosed infection. “Expedited Partner Therapy” does not require a provider to examine the partner prior to treatment. Research studies have shown that the treatment is safe and effective in reducing chlamydia infection compared to the traditional practice of just notifying — but not treating — the partner. Additionally, in several other states that have Partner Therapy programs, there have been no reports of adverse events.

Eva and I made this difficult call together. We weathered the denial, shock and anger from her boyfriend. It took a minute to shift the conversation from blame to education, then learning and most importantly, assurance. I assured Eva’s boyfriend that this disease was treatable and this was an opportunity to get treatment and get better.

Yes, such calls are hard, but necessary. Over the last ten years, cases of chlamydia in Massachusetts have more than doubled from 8,725 in 1999 to 18,811 in 2009, according to the Massachusetts Department of Public Health.

This disease is overwhelmingly a scourge of the young. Continue reading

What Teens Say Teens Should Know About Sexually Transmitted Diseases

(Planned Parenthood)

(Planned Parenthood League of Massachusetts)

By Joey Boots-Ebenfield
Guest contributor

I’ve gotten used to hearing myths and misinformation when I talk about sex with fellow teens.

And I talk about sex often in my role as an 17-year-old peer educator with the Planned Parenthood Get Real Teen Council (GRTC) — a year-long high school sexual health program for 10th-12th graders who are trained to facilitate sex education workshops and serve as resources for peers, families and communities.

If teens are uncomfortable talking about topics related to sex and sexuality, or don’t have a trusted source of information about their health, it’s easy for all kinds of misinformation to spread. And of course, there’s the Internet, where bad information is often rampant, so it’s not always a reliable place to find accurate health information.

The subject of sexually transmitted diseases (STDs) is no exception. I’ve heard some pretty interesting misconceptions about what STDs are and what it’s like to get tested. One myth is that STDs have obvious symptoms, like localized pain or some other physical sign.

In fact, this is quite the opposite! STDs often show NO symptoms. This myth is especially dangerous because it means that someone can have an STD and not even know it. As a result, many STDs go untreated, which can cause cause some pretty nasty complications. Continue reading

Why Safe Sex Is Easier Said Than Done

I scrolled through my contacts, found his name, took a deep breath, and pressed call. Pacing on the sidewalk, my palms getting sweatier by the minute, I rehearsed what I wanted to say, but it was useless by this point because he was going to pick up any sec—

“Hi.”

I struggled through mundane small talk, but finally broke out with the real reason for my call: to talk about sex, or more specifically, sexual history.

Sure, it’d been a few months since we’d slept together, but, at the time, neither of us had initiated that conversation — you know, the one about past partners, risky behavior, condom use, and sexually transmitted infections (STIs). It’s the conversation we all should be having but rarely do. Not only did we not talk about these things, but we didn’t use protection either. I know, I know.

I figured it was time I owned up to my mistake. Continue reading

Highlighting The Health Benefits Of Circumcision

The Circumcision by Tintoretto

A team of infectious disease experts wander into delicate political and parenting territory in the current Journal of the American Medical Association in their defense of male circumcision.

The three Johns Hopkins doctors argue that circumcising newborns and young boys offers clear medical benefits, and that political attempts to cut off public funding for the procedure are potentially dangerous, particularly to minorities and the poor.

Here’s much of the press release from Johns Hopkins:

Critics of infant or childhood circumcision claim, among other things, that the procedure should not be considered until males can give legal informed consent at age 18.

In an editorial to be published in the Journal of the American Medical Association online Oct. 5, Johns Hopkins health epidemiologist and pathologist Aaron Tobian, M.D., Ph.D., and health epidemiologist Ronald Gray, M.D., highlight the most recent medical research showing the considerable life-long health benefits of circumcision performed during infancy and the potential disadvantages associated with waiting until adulthood before undergoing the procedure. The experts point out that there are medical benefits during childhood, as many young men are already sexually active before age 18, and at greater risk of infection from sexually transmitted infections. Circumcision at older ages is also associated with more complications and cost than having the minimal surgery in infancy.

“Our goal is to encourage all parents to make fully informed decisions on whether to circumcise their infant boys based on medical evidence and not conjecture or misinformation put out by anti-circumcision advocates,” says Tobian, an assistant professor at the Johns Hopkins University School of Medicine. Continue reading

One Reader’s Response On Herpes: ‘Not Necessarily A Big Deal’

Boone historic archives

Please tune in to Radio Boston at 3 p.m. today to hear Dr. Lydia Shrier of Children’s Hospital Boston (and yours truly) talk about this recent post on how easily genital herpes can be spread.

During the taping, I found myself saying that I thought the takeaway message was double: “Be very, very careful, there’s a lot of this going around,” and also, “If you do catch it, you have a whole lot of company.”

One reader responded to the post with a consoling message that went one step further: If you do catch herpes, it’s not necessarily a big deal. At least, not for everyone.

True, herpes can cause pain, make people more susceptible to HIV and in rare cases, cause dangerous infections in newborns. Some people suffer through several outbreaks a year. But still, I thought the message-writer, Jeffrey Hunter, was making important points that are relevant to millions of people with herpes — and that might help offset the initial emotional pain that some may feel when first diagnosed. (And yes, he gave me permission to use his name.) Here’s his eloquent message in full:

I recently came across your article titled “Why You Should Assume Everyone Has Herpes” from a link on the npr.org website. I first off want to say thank you for bringing up the issue of how widespread herpes is. I don’t think most people are aware enough of just how common it is, how it is transmitted, or what the symptoms are.

There are a couple common assumptions about herpes, however, that I think we should be doing more to challenge. The first is that there is an automatic assumption that herpes is something really horrible to be avoided. I certainly won’t argue that herpes is good, but I felt your article was written from the point of view that contracting herpes must definitely be avoided, without actually examining that assumption. If in fact the prevalence among unmarried women between 45 and 50 is more than 50% in the country, at some point we have to ask, just how dire is this?

I myself tested positive for HSV-2 a little over a year ago. As you might imagine, that was a bit devastating to see on a test result, but after talking to my doctor about it and learning more about herpes I eventually found myself saying, if I have a virus which poses no long-term health risks and whose symptoms are so mild and infrequent that I would never have noticed them without a blood test to detect the virus, then just how serious is this? For myself I have to say, not very. Sure, it would be nice if I didn’t have the virus, and I certainly inform my partners about my status, but there are plenty of much more important health issues for me to spend my time worrying about (like, say, making sure my cholesterol levels remain healthy). Continue reading

Why You Should Assume Everyone Has Herpes

A lab image of herpes virus

I’m sure my boyfriend doesn’t have herpes, a patient recently told Dr. Lydia Shrier, an adolescent medicine specialist at Children’s Hospital Boston.

How could she be so sure? Dr. Shrier asked. Because, the patient replied, she had scoped out his body and “there’s nothing irregular about him.”

Dr. Shrier, a researcher on sexually transmitted infections, goes through this kind of conversation all the time. Patients tell her that they’ve never had blisters or lesions or sores, and so cannot possibly have genital herpes. The same for their sexual partners.

It falls to her to disabuse them of these notions, saying: “You can have lesions or not, you can have symptoms or not, you should basically be operating the same way, which is to assume that everyone has herpes.” That means taking precautions, from limiting sexual contact to using condoms.

Dr. Lydia Shrier

Though this is her longstanding message, she now has better evidence to back it up than ever before. Last week, a pre-eminent researcher on the genital herpes virus, known as Herpes Simplex Virus 2 or HSV-2, published a landmark paper documenting the striking rate at which people with no herpes symptoms can nonetheless “shed virus,” potentially infecting partners.

The study, led by Dr. Anna Wald of the University of Washington, found that people who’d had symptoms of herpes shed virus on about 20 percent of days, while people who test positive for herpes antibodies but have never had symptoms shed virus on only about 10 percent of days.

But here’s the kicker: When they’re shedding, people who’ve never had symptoms shed roughly the same amount of virus as people who’ve had symptoms. So it’s clearer than ever that lack of symptoms is no guarantee against infection. And in fact, Dr. Wald said, “Asymptomatic shedding may be the central phenomenon of transmission.”

In the old days, doctors would warn herpes patients to avoid sexual contact mainly when they had active lesions, believing that was the only time they were really contagious.

But evidence has long been growing that herpes can be transmitted even when no lesions are visible. The new study, by quantifying how much virus is shed even in the absence of symptoms, “is a real ‘aha!’ moment,” said Fred Wyand, spokesman for the American Social Health Association. “It’s really robust in terms of the number of subjects they enrolled and the length of time they were followed,” he said.

The study also helps explain how genital herpes has become so wildly common, infecting nearly one-fifth of the American adult population, given that it’s hard to imagine many people would want sex while they had the painful nether-regions equivalent of cold sores. Consider this stunning fact from the American Social Health Association:

In the United States, more people have genital herpes than all other sexually transmitted infections combined -– 50 million people in total.

There are more mind-boggling statistics. Continue reading