Myth #15- TALKING about STDs encourages SEX

Okay, my last myth for April's STD Awareness Month is one that I'm truly passionate about airing. Let me assure you, when I teach youth about sexually transmitted infections, no one leaves the room ready to jump in the sack! There is NOTHING SEXY about genital warts, infertility, and painful, recurring ulcers in your genitals. NOTHING!

When we teach kids that they shouldn't smoke, we do way more than say "don't smoke". We appropriately teach them that not only does nicotine cause yellow teeth and bad breath, but also leads to lung cancer (and bladder cancer and mouth/throat cancers!) Do pictures of black lungs and stained teeth encourage youth to go out and try smoking??

So, why not teach our kids about the real medical risks of physical intimacy? It's NOT ENOUGH to say "don't have sex". Believe me, that is why I wrote the book Seductive Delusions: how everyday people catch STDs! I wrote the book for every smart, educated, and yes, religious young person who ended up with a sexually transmitted disease because they did NOT understand all the facts.

BOTTOM LINE: Teaching kids about STDs does NOT encourage them to have sex- it helps them have all the information they need to make smart, safe choices.

STD Myth #14- Penicillin will cure it!

"Oh, it's nothing a shot of penicillin wont fix, right?" If you're over forty, you probably grew up hearing this one. In fairness, back then, it was kind of true! Unfortunately, now we only have ONE sexually transmitted disease that penicillin can still cure- syphilis. Amazingly enough, a shot of penicillin really will fix that one!

However, it's important to note that half of our STDs are viral (herpes, HPV, HIV, & hepatitis A, B, and C) and therefore NO antibiotic can cure them. We do have anti-viral medications that can help suppress these infections, but no cure yet.
Additionally, gonorrhea (which IS a bacterial infection) has become resistant to multiple different classes of antibiotics, so now there is only one type of antibiotic which is still effective.

BOTTOM LINE: Realize a simple dose of antibiotics will NOT always "fix" an STD.

Myth #13- AIDS is disappearing

HIV disease is far from disappearing. We have over a million Americans living with HIV disease or AIDS. (AIDS is more advanced disease, and many people with HIV disease have little or no symptoms.) When the AIDS epidemic erupted, it was depicted as a disease of the gay male population in San Francisco. Sadly, many people still believe the myth that only that group is at risk for HIV disease.
So what are the facts? Which Americans have HIV? An estimated 47% are black, 34% are white, and 17% are Hispanic. Roughly one in four people with HIV disease are unaware of their infection. 74% are male, and 26% are female. 45% of people with HIV are indeed men who have sex with men (gay or bisexual or on the "down low"), 27% are heterosexuals who had "high risk" contact, and 22% are intravenous drug users. By age, the majority are 25-44 years old at diagnosis.
BOTTOM LINE: HIV has infected over a million Americans, and one fourth of them are unaware- get tested and make sure you know your status.

Myth #12- Tricks are for Kids!

Okay, I'm spelling it differently to avoid brand recognition and association with STDs, but if you're over forty, you get it! The key is, if you are a legitimate grownup (over 35, or maybe 40, in my book) then the whole point is you DO NOT want to "get it", if IT is a sexually transmitted disease. We have fallen into the habit of worrying about our kids making poor choices so much that we are ignoring OUR generation's bad decisions. Whether it's the habit of having a couple glasses of wine out at meals before we drive our family home, or assuming the new partner we are dating wouldn't be the kind of guy/gal to have an STD, we need to realize that more life experience does not equal entitlement to ignore safety precautions.
BOTTOM LINE: Grown ups get STDs, too!

Myth #11- Symptoms Gone, Disease Gone?

Okay, this myth ties in with the earlier one that you'd KNOW if you had an STD. How many women out there have used an over-the-counter (OTC) product to treat a presumed yeast infection? Well, here's the thing. An itch, burn or discharge is NOT always a yeast infection, regardless of whether or not the symptoms go away when you use an OTC treatment.
Many sexually transmitted diseases have transient symptoms, causing an initial itch, burn, or discharge, but then those symptoms resolve on their own, although the infection is still there. This is not only true, but very common, especially with chlamydial infections. The problem is that even though now silent, this infection can be damaging your reproductive tract, possibly even leading to infertility.
So, when is a yeast infection "just" a yeast infection (which is really a yeast overgrowth, not a true infection)? Well, if you are taking an antibiotic (which kills off the good bacteria in your vagina along with the problem bacteria causing an infection elsewhere, like your sinuses), AND you have not ever had a sexual partner (or are in a long-standing monogamous relationship), it is likely yeast. If you have had a new sexual partner, however, I'd suggest you go to your doctor and be diagnosed accurately.
BOTTOM LINE: Don't assume that symptoms resolving with the use of a yeast medicine confirms that you "only" had yeast!

Myth #10- Vaccines prevent ALL STDs

Vaccines are wonderful. They save lives and prevent a tremendous amount of disease. A couple years ago, the first vaccine designed to prevent cancer was released on to the market- Gardasil, the HPV vaccine. This vaccine protects young women (and now young men) from four different strains of the human papilloma virus, which is the cause of cervical cancer. Specifically, two strains of HPV, types 16 and 18, cause 70% of cervical cancers. It turns out that these same strains cause other cancers as well, including penile, anal, and some head and neck cancers (which is one reason that males are now being vaccinated as well.)
Happily, the vaccine also protects people against the two types of HPV that cause 90% of genital warts.

Is it expensive? Yes, but if you ask anyone who has suffered through the experience of having genital warts (and having them treated), believe me, they'd tell you it's well worth it.
Is it safe? Yes, all the data shows that this is a safe vaccine, and given the population receiving the vaccine, it has been under tremendous scrutiny.
Does it protect you against ALL STDs? NO! While it would be terrific if a single vaccine made you bullet-proof, that is not the case. This vaccine only protects against genital warts and cervical cancer, and even that is not 100%.
BOTTOM LINE: HPV Vaccines protect against HPV ONLY, not gonorrhea, herpes, chlamydia, or any other sexually transmitted disease!

Myth #9- One Time Wont Hurt!

What's the big deal about "just once"? The big deal is that unless the person you are with has NEVER before been intimate with another partner, you are not exposing yourself to "just" one person. When you get together with "Justin" (insert the appropriate name here!), you are actually hooking up with all of Justin's former partners, AND everyone THOSE partners have been with, and SO ON, and SO ON! Think of it as a pyramid. This is the number one reason that you can catch an STD from "just once", because once might mean once, but usually means five, ten, fifty or a hundred.
I had a patient last year who had three direct contacts, but after we discovered she had positive tests for not only Chlamydia, but also HIV, we went back and did the math. Her first boyfriend had around ten previous partners, the second had closer to twenty, and the third was around twenty. Therefore, my patient had been exposed to at least FIFTY, and what are the odds that those fifty were all "virgins" (meaning no prior sexual contact of any type)? Gee, I'm guessing none! So, with only three partners, my patient had effectively been with over a hundred other people.
BOTTOM LINE: When you are sexually intimate with one person, you are exposed to everyone they have hooked up with in their past, AND those partners' former partners, AND so on!

Myth #8- Party in Pools!

Myth #8 about sexually transmitted diseases is that the chlorine in pools and hot tubs make any sexual activity in the water safe. Now, although it is true that you will NOT catch an STD from simply swimming or hanging out in a pool, there is NO PROTECTION from STDs if you are having sex in the water!
With apologies to Dr. Seuss...
If you have sex in a car, in a box,
or with a "fox",
In a tub, now here's the rub;
Being cool or while in pools-
you CAN catch STDs,
No "Fools"!

BOTTOM LINE: Hot tubs and pools do not cause STDs, nor do they offer protection.

Myth#7 - You'd KNOW if you had an STD

Why the heck would you NOT know if you caught an STD? Wouldn't you have SOME kind of symptom? Burning, itch, blisters, or discharge? Well...NO. The difficult thing about STDs is that most sexually transmitted infections are SILENT. Which ones?

Don't be fooled that the "beautiful people"- the smart, educated, wealthy, witty, or even "parent-approved" dates are automatically disease-free. STDs don't care how many years of school you've completed or how many bucks are in your wallet.
BOTTOM LINE: You cannot tell by looking (or feeling) who has an STD!

Myth#6 "Normal Pap" = Disease-Free

Okay, the next myth surrounding sexually transmitted infections is that a "normal" report after a Pap smear means you are disease-free. Pap smears are wonderful- we are detecting cervical cancer earlier and curing it more easily. BUT- a Pap smear ONLY TESTS for cervical cancer, and possibly HPV (the human papilloma virus, which is the cause of both cervical cancers and genital warts.) Pap smears do NOT test for gonorrhea, chlamydia, HIV, herpes, etc.
Many women believe that they are automatically tested for all STDs when they have their "annual" exam. Certainly, this is a terrific time to be tested, but it is not a given. If you have had a new sexual partner since you were last tested for sexually transmitted diseases, PLEASE ASK your doctor to test you for all STDs.
Guys, you're not off the hook here. When you have YOUR physical exams, a "normal" report does not mean you are disease-free either, UNLESS you have asked your doctor to test you for STDs. The good news is that blood and urine tests together will do the trick- no swabbing necessarily needed.
BOTTOM LINE: Don't ASSUME you're being tested for STDs unless you specifically ask- and even then, make sure you know exactly which diseases were checked.

Myth #5- Virgins can't have STDs

Ah, the devil is in the details, right? And didn't we have a President teach us that it depends how you define SEX? So...many youth today intend to maintain their virginity until marriage, and even wear wedding-style rings promoting their abstinence. However, many of those same youth believe that oral (and even anal) sex do not "count" towards virginity. In the last few months, I've made it a point to ask the groups of adolescents that I've been speaking to whether or not these two types of intimacy impact your virginity. I would estimate 95% have agreed that oral sex does NOT count, but only around 30% think that anal sex does not count.
Where does this leave us? This trend points out that when you are deciding whether or not to be physically intimate with someone, their self-described status of "virgin" is not necessarily a guarantee that they are disease-free. Every sexually transmitted disease except for trichomonas can be passed via oral or anal sex. Oh, and by the way, remember not everyone is honest...
As an aside, I am not intending to belittle the promise rings. I absolutely respect and admire the youth who are comfortable in their religious views and choose to respect their bodies and their faith in this manner.
BOTTOM LINE:"Virginity" does not equal disease-free. Ask more questions!

Myth #4- Condoms ="SAFE SEX"

Okay, we're on a roll. Myth #4 is that CONDOMS=SAFE SEX. Condoms absolutely DECREASE greatly your risk of both pregnancy and sexually transmitted infections, especially for the STDs transmitted via body fluids- gonorrhea, chlamydia, HIV and trichomonas. However, condoms can only cover ONE area- I don't think I need to spell out which one. Diseases that can be transmitted outside that area, by direct skin-to-skin contact, can still be spread despite proper condom use. Which diseases are these? Herpes, HPV (the wart virus), syphilis, and pubic lice (crabs).
Also, because there is a roughly 10% failure rate of condoms through breakage, there is still a chance (1 in 10) of being exposed to potential disease. Not to mention that in real life studies, condom failure rates are more like 20%, because they are simply not used consistently.
So what to do? GET TESTED-both you and your partner. Know that really SAFE SEX means both partners are tested and known to be free of disease.
BOTTOM LINE: Condoms are very helpful in decreasing disease transmission, but don't be fooled that simply using condoms guarantees "SAFE SEX".

Myth #3 Herpes Algebra

Same cookie, different crumble...Myth #3 is that you can only spread herpes when there are visible blisters. WRONG!

The herpes virus can be spread whether or not there are any visible sores. So, if parter A gets cold sores (meaning the blisters from herpes that occur outside the mouth, usually on or near the lips), he or she can pass this infection to partner B by kissing or oral-genital contact. Partner B could then develop oral or genital herpes, depending upon the site of contact. If, however, partner B already gets cold sores, then he/she will not get a new case of herpes (assuming both parties have herpes simplex type 1, which can be confirmed with a blood test.)

Confused? Let me say it differently. Once you have one type of herpes, you will not get that same type of herpes in a different spot on your body. You may, however, get a different type. The common example is that if you have cold sores, which are most often herpes simplex virus (HSV) type 1, you are still susceptible to getting genital herpes from HSV type 2.

The important point here, though, is that although herpes is thought to be most contagious immediately before, during and after blisters are present, the LACK of blisters (in between outbreaks) does NOT equal NOT contagious. A great reference book for herpes if you have further questions is: The Good News about the Bad News by Terri Warren.

BOTTOM LINE: Herpes is ALWAYS potentially contagious, whether or not you see blisters.
PS. Jump forward to the $7 Million Herpes Case!

STD AWARENESS MONTH! Myth #2 Tough cookies...

April is STD Awareness month, so I plan to blog about the common myths and misperceptions about sexually transmitted diseases. Myth #1 was addressed on April Fool's Day- STDs do NOT come from toilet seats.

Myth #2- Oral sex doesn't "count". Believe me, when it comes to passing disease, "ORAL" counts BIG time! I can't tell you how often I hear patients cry "But that's impossible, I haven't had sex yet!" when I diagnose them with genital herpes. Herpes is not the only disease you can pass via oral sex, but it certainly is the most common one that I see in my practice. In fact, trichomonas is the only sexually transmitted infection that is NOT passed via oral-genital contact.

So, realize that while oral sex by itself may not put you at risk for pregnancy, it absolutely carries with it the risk of infection.

BOTTOM LINE: Oral sex can and often DOES transmit infection- especially herpes.

Don't be April's FOOL! STD Myth #1

Toilet seats are the REAL cause of our STD (sexually transmitted disease) epidemic, right? APRIL FOOLS!!

Let me be perfectly clear- you can NOT catch sexually transmitted infections from a toilet seat! All that time our moms spent teaching us to either precariously hover over the seat or carefully plaster the seat with pieces of toilet paper was a waste. The majority of STDs are simply not that hearty! They die as soon as the fluid around them dries up. And "crabs" (pubic lice) can't grip on to the seat, so they slide off.

STDs are transmitted through SEX- oral, anal, and "old-fashioned" traditional sex. They require either a break in the skin or penetration through the mucus membranes. When you sit on a toilet seat, it's the back of your thighs. So, unless you've got cuts/scrapes there, you should be home free. Certainly, I wipe off a WET toilet seat with the handy toilet paper so I'm climbing on to a dry throne.

BOTTOM LINE: Don't be FOOLED into thinking you catch STDs from public toilets! Worry about who you kiss, not where you sit.

PS. It's a NEW MONTH, so change those air filters! (see 2/1/10 post)