The Doctor Is In
Gail Hacker, MD
As February, the month of love, comes to a close it seemed appropriate to discuss some of the more commonly seen sexually transmitted infections (STI) we tend to see around here. Human Papilloma Virus (HPV) has been addressed in an earlier edition, and will not be reviewed again here. The 4 other bugs we will discuss will be Chlamydia, Gonorrhea, Herpes, and Syphilis. HIV/AIDS deserves an edition all its own and will be addressed at a later date. Hepatitis B and C, although transmitted via sexual contact, are much more likely to be spread by IV drug use, and will be addressed at another time.
Chlamydia: Chlamydia continues to be the most commonly reported STI, with over 10,000 cases reported to state authorities in 2008, about 1200 of which were right here in Lane County. Chlamydia infections are often symptom free, but can lead to significant illness and are one of the most common causes of female infertility. In men, Chlamydia can attack the tubes that lead from the testes out and can also cause infertility. When people do have symptoms they are usually painful urination, discharge from the penis or vagina, and pelvic or testicular pain. If a pregnant woman has untreated Chlamydia, the baby can suffer from serious eye infections and pneumonia. Women with Chlamydia are also at higher risk of getting HIV than healthier women.
Chlamydia is most common in sexually active folks between the ages of 15 and 24, and authorities recommend all sexually active people under the age of 26 be screened regularly to detect asymptomatic disease. If you or a recent partner (within the past 6 months) is diagnosed with Chlamydia it is very important that both of you get treated with antibiotics and abstain from sexual relations for at least a week after you have completed the treatment. It is also recommended that you get tested again about 2 months after treatment to make sure you haven't gotten re-infected. The most commonly prescribed antibiotic is azithromycin and you can take the entire treatment in one dose. This disease is so common that the Oregon state legislature voted last year to make it permissible for a health care provider to treat partners of infected patients even if the partner is not a patient of the provider (although it is recommended that all potentially infected people see a provider, sometimes this just isn't feasible). Chlamydia can be diagnosed from a urine specimen or at the time of a pap smear, and costs about $30.
Gonorrhea: After a drop in cases in the early 1990s we are seeing a resurgence of this nasty bug. There were about 100 cases in Lane County in 2008. Gonorrhea usually causes symptoms like discharge from the penis or vagina, and can cause pelvic infections, like Chlamydia, that can lead to abscesses (pus pockets) in the tubes and infertility. Pregnant women can pass the infection to their babies, leading to eye infections/possible blindness, joint infections, and life threatening blood infections. Gonorrhea and Chlamydia are often diagnosed at the same time, so if you are diagnosed with gonorrhea you will also be treated for Chlamydia at the same time. Treatment is fairly simple and no longer requires a big needle in both cheeks like it did when I was a resident.
Syphilis: Syphilis, the great imitator, is not seen very often around here, except in one particular group. Men who have sex with men are much more likely to transmit syphilis than other couples. It is more common in bigger urban areas, like Portland, and is still fairly common in the southeastern US. There are 3 stages to syphilis infection. Stage 1 is the initial stage and usually presents with a painless genital or oral ulcer called a chancre. This skin lesion is teaming with syphilitic bacteria.
Stage 2 is associated with a rash, and stage 3, or latent syphilis, is when the bug attacks the neurologic system and other internal organs. This is the deadly stage of the disease. If a person does not get treatment in the first stage of illness, the bacterium lies dormant for a while, then resurfaces, and marches onward. Treatment still involves big doses of penicillin.
Herpes: Unlike the above infections, which are bacterial, herpes is a virus. Once you are infected with it, you usually do not get rid of it. Some people get one outbreak, some get a few and some get them very frequently. There are 2 types of Herpes Simples virus: type 1 typically causes cold sores on the mouth, and type 2 usually affects the genitals, but there is significant crossover. As opposed to the painless ulcer of syphilis, herpes causes very painful blisters and is usually pretty evident, but can cause little or no symptoms or a generalized illness that feels like the flu on the initial infection. The most serious complication of herpes is when a woman gets infected late in pregnancy. The baby can develop herpes and get very sick if the mother delivers normally. A c-section is usually performed, for this reason, on all women with active lesions at the time of delivery. Herpes can be spread both when a person has a lesion and when they don't. There is medication that can be used to decrease the severity of individual outbreaks or that can be taken every day to prevent outbreaks in individuals that get frequent outbreaks.
What do these 4 infections have in common?
They are all transmitted through sexual contact, which means they can be prevented. Condoms offer some protection against all of these, although syphilitic chancres can appear on the testicles or labia and not be covered. Regardless, barrier methods protect against most STIs and should be used regularly in addition to any other form of contraception. If there is any question about a sore, discharge or other symptoms, abstinence is 100% effective. Just say no to a partner that has anything funny down there until they get checked. If they aren't willing to get taken care of, you shouldn't be willing to engage in sexual relations with them. All of these infections can cause significant illness in infants, can lead to infertility, and can increase the risk of HIV infection. Ask yourself the obvious question: will I die if I don't have sex right now? The answer is a resounding no. Might I die if I do have sex right now? Likely not, but is the risk for you, your partner, or an unborn child worth it? Probably not. Be safe, not sorry.
Supporting you in good health,
Gail Hacker, MD