STD Awareness Month 2016 "Talk. Test. Treat"

"TALK. TEST. TREAT."

Perfect theme for the CDC's 2016 STD Awareness Month! We can't have AWARENESS if no one is talking about these diseases. And because these diseases are mostly SILENT, you can't have AWARENESS that you have an STD unless you TEST for it.

The Bad News: 

• Sexually transmitted infections affect over 20 MILLION Americans every year, and young people ages 15-24 make up over HALF of these cases. 
• Chlamydia, gonorrhea and syphilis are on the rise for the first time in a decade.
• Gonorrhea is more difficult to treat because it has become very resistant to antibiotics
• Curable bacterial STDs, if not diagnosed and treated in a timely fashion, can have lasting impact by causing chronic pelvic pain or even infertility. 
• Young people are the least likely to get tested and treated for numerous reasons, including ignorance that their non-intercourse sexual activities can transmit STDs, fear and embarrassment of telling their parents, inability to pay for or access healthcare on their own.

The GOOD News:

• Many of these infections are preventable, and testing is easier than ever (no pelvic exam required in most cases- only a urine test for gonorrhea and chlamydia, and a blood test for HIV and syphilis). 
• Gardasil vaccine prevents the vast majority of genital warts and HPV-related cancers.
• Hepatitis B vaccine prevents Hep-B related cirrhosis and liver cancer.
• Proper and consistent condom use greatly reduces transmission of most STDs.

I have found that sharing stories (with accurate medical information) is a powerful tool for teaching about sexually transmitted infections. Check out the newly released second edition of Seductive Delusions: how everyday people catch STIs.

BOTTOM LINE: TALK.TEST.TREAT  and learn how you can help spread KNOWLEDGE and stop the spread of DISEASE.

Planning International Travel? Check out the CDC!

I am  so excited to be heading to El Salvador today with Austin Smiles, a wonderful organization that gives the gift of a beautiful smile to people born with cleft lips or palates. Check out our blog and Facebook page!

If you are planning to international travel, start your medical planning for the trip well in advance- ideally six months ahead, and check out the CDC Traveler's Advice page.  Simply select your destination country, and you will see all the current medical recommendations for your travel. Please note that often vaccinations are recommended that may require more than one dose, so you may need to get started on your shots 4-6 months before you leave! For example, if you are headed to Central America and have not been immunized against Hepatitis A, this vaccine is given in two doses, six months apart.

In addition to vaccine recommendations, the CDC also gives you a handy medical check list that includes site specific prevention for issues such as travelers diarrhea, malaria, and altitude sickness. Advice for lodging and general safety issues (depending on the political climate, etc.) are also included.

Remember to see your family doctor well in advance of your trip, so you can have plenty of time to get any prescriptions you might need- whether it's medication for motion sickness, flight anxiety, or traveler's diarrhea. Think about the timing of your regular prescriptions, especially if you have medications that are filled monthly at your local pharmacy. Especially in summertime (on Fridays, at 4:59pm!) primary care doctors are swamped with panicked phone calls from patients requesting medications to be called in urgently to pharmacies, from birth control to blood pressure to actual travel destination-related antibiotics or other drugs...and that doesn't work well for anyone. Medical planning should happen at the same time you secure your passport, because neither of these processes can or should be rushed in the final hours.

BOTTOM LINE: For international travel, START EARLY with planning your medical prevention!

Cigarettes- the Good News & the Bad News

Let's start off with the GOOD news- the CDC's anti-smoking TIPS campaign has turned out to be far more successful than they had dared to hope! Over 1.6 million smokers had a quitting attempt, and at least 200,000 smokers DID QUIT as a direct result of the shocking pictures and stories featured in this unique national program. The Lancet published a wonderful article this week summarizing all the findings: Effect of the First Federally Funded U.S. Antismoking National Media Campaign.

I have always maintained that stories are more powerful than statistics. Sure enough, this campaign is chock-full of stories from former smokers- people sharing extremely painful negative consequences from their nicotine addiction. Virtually every complication from smoking is shared: heart surgery scars, asthma, artificial limbs (from damage to blood vessels), artificial voice boxes (from throat cancer), COPD (chronic obstructive pulmonary disease) and of course, lung cancer, to name a few. Hearing from Terrie- a former cheerleader, points out the dangers of "social smoking" in college. Likewise with Michael, who smoked in the military. Click on the TIPS from Former Smokers 2013 to hear and see more...and share with any of your friends or family or co-workers who still smoke.

The campaign goals are to increase public awareness of both immediate and long term health risks of smoking- both first-hand, and from inhaling second-hand smoke. Note that for every person who dies from smoking, 20 more Americans are LIVING with a smoking-related illness. The CDC wants to encourage and support smokers who are ready to quit, as well as encourage them to limit other people's exposure to their second-hand smoke. 

So that was the good news...now the bad. Just last week, Notes from the Field: Electronic Cigarette Use Among Middle and High School Students- United States, 2011-2012 was published in the CDC's Morbidity and Mortality Weekly Report. E-cigarettes are not a new cell phone app, they are true electronic cigarettes that are battery powered and deliver nicotine and other byproducts via an aerosol. Worse yet, they can add sweet "childhood" flavors- fruit, mint or chocolate. Really??? Does the industry have NO conscience???? Not surprisingly, they are portrayed as "safe smoking" (anyone else reminded of "safe sex" campaigns?) and teens are jumping on board. E-cig use doubled in this time period, yielding nearly 2 million (1.78, lest I exaggerate) students trying out nicotine in this delivery system last year. Please note that although we do not yet have long-term studies on the "pure" damage of these e-cigarettes, we know that nicotine is damaging to adolescent brain development and, hello- nicotine is ADDICTIVE. If you get addicted via e-cigs vs. dipping vs. "regular" cigarettes- the outcome is the SAME. You are ADDICTED to NICOTINE.

BOTTOM LINE: There is still NO AMOUNT of smoking that is GOOD for you, so please, help encourage your friends who are already smoking to QUIT, and parents, please warn your kids that e-cigarettes are NOT SAFE. NICOTINE is ADDICTIVE in ANY FORM.

Flu Vaccine- It's Not Too Late!

Okay, it's January, and now EVERYONE you know is getting the flu! Is it too late for you to get vaccinated? ABSOLUTELY NOT! The truth is that now that we're all scared, it's tough to find somewhere that has the flu vaccine in stock! Call your doctor or your pharmacy and find out how many they have left, then jump in your car and head over.

This year is another one of those "really bad" flu years. Yes, if you are vaccinated today, you have to wait a couple weeks for your shot to protect you. BUT...the flu season is just catching its stride, so all you have to lose is a temporarily sore shoulder.

This year's flu seems to be bringing with it the added bonus of nausea and vomiting, as if muscles that feel like a Mack truck hit you were not enough. The flu is NOT just a stuffy or runny nose and cough- that's a cold. The flu is OMG, I can NOT get out of bed and function, because my head is splitting, my muscles are screaming, and yes, this year's bonus is the vomiting and diarrhea. Believe me, a sore arm for a few days is a happy trade for the flu.

Who should be vaccinated? Hello, it's EVERYONE. The CDC (Center for Disease Control and Prevention) recommends that everyone over the age of 6 MONTHS get a flu vaccine each year.

Wash hands, wash hands, and oh yes, wash your hands...for 20 full seconds! When you dash them under the water or take 5 seconds to apply hand sanitizer, you are nicely moving your germs around, so spend the extra 15 seconds and scrub a bit to be more effective.

BOTTOM LINE: FLU SEASON is in FULL SWING- Strike back by getting your FLU VACCINE and WASHING YOUR HANDS...for a full 20 seconds!

For more info, check out the current stats on this year's flu at the CDC at: 
http://www.cdc.gov/flu/about/season/flu-season-2012-2013.htm

Flu Season 2012- Ready or Not!

While we are rushing around in December, take a moment to think about whether or not your family has received the flu vaccine this year. The CDC reports show that unfortunately, we are jumping into the season early this year, especially in TEXAS, Alabama, Louisiana, Mississippi, and Tennessee. In fact, this is the earliest in the flu season to reach this level in almost a decade (since 2003-2004). The good news is that the viruses identified with testing DO largely match the strains that are included in this year's vaccine. More good news is that they are susceptible to our antiviral medications, although I am not a huge fan of these drugs in otherwise healthy individuals.
Both types of influenza- A and B- are being documented, with the usual ratio of nearly 3:1 from A:B.

What is FLU? Influenza is not a simple cold, nor is it a twenty four hour stomach virus. The flu causes fever, chills, cough, runny/stuffy nose, muscle aches, headaches, fatigue, and sometimes involves vomiting and diarrhea (more often in kids). Colds and allergies tend to bother you from the neck up- stuffy, sore throat, headache- but don't knock you down for the count, and coughs are generally less bothersome.

How is the FLU spread? This virus is spread from infected people when the cough, sneeze or talk, via tiny respiratory droplets, and the scary part is that you are contagious a full day BEFORE you develop symptoms (as well as for about a week after you feel sick.)

How can you prevent the FLU? Get vaccinated. Get vaccinated. Get vaccinated. It's not too late for this year- get vaccinated. The flu vaccine is indicated for EVERYONE over the age of 6 months, EVERY YEAR.

Who should NOT get vaccinated? Those with severe chicken egg allergies; bad reactions to vaccine in the past; younger than 6 months; history of an uncommon disease called Guillain-Barre. If you are sick with a fever, wait till this illness is over before getting the vaccine.

BOTTOM LINE: It's FLU SEASON again- get vaccinated!

WORLD AIDS DAY- Does It Affect YOU?

Today, December 1, 2012, is World AIDS Day. Hopefully you will see some red ribbons around that reflect more than Christmas cheer- they are symbols of AIDS awareness. Many Americans are unaware that HIV disease is still a concern, since it is no longer a common lead story on the nightly news. Ironically, our capitol, Washington D.C., has the highest prevalence of HIV disease within our country.  There are now over 1.1 million Americans living with HIV disease. The good news is that with the tremendous advances with antiviral therapy in the last decade, most people with HIV infection are able to continue to lead productive lives, although they must be extremely vigilant about their health maintenance. The Center for Disease Control (CDC) estimates that one in four new HIV infections occur in young people ages 13-24, with over 12,000 new infections in this age group each year.

Perhaps the most frightening issue with HIV disease today is that a significant portion of these infected individuals- up to an estimated 60% of infected youth- have no idea they are infected, and therefore can be unknowingly spreading this disease. The current recommendations are for EVERYONE aged 13-65 and living in the United States to be tested, regardless of perceived risk. With this universal directive, we will be able to identify all those with silent disease, and initiate early treatment that will improve and prolong their health.

BOTTOM LINE: Current guidelines encourage all Americans aged 13-65 to have at least one HIV test. Talk with your doctor today and GET TESTED. 

Gardasil- Not for the FAINT,,,

Continuing my discussion this week about the HPV vaccine, Gardasil, I'd like to address side effects. At this point in the United States, there have been over 46 million doses of HPV vaccine administered (the vast majority Gardasil), which implies over 15 million people (since a series includes three shots.)
Unfortunately, when you start involving a population this large, within that group there will be uncommon diseases that occur in the general population. For example, a disease that occurs in only one out of 500,000 will have 30 cases in this group. Sorting out which of these rare occurrences are random and which are linked to a cause such as a vaccine can be challenging.

We have multiple organizations that closely follow adverse reactions to vaccines. The VAERS (Vaccine Adverse Event Reporting System) accepts reports from anyone- patients, family members, clinicians, etc. The Vaccine Safety Datalink coordinates the CDC- Center for Disease Control and Prevention- with managed care systems through electronic medical records. The Clinical Immunization Safety Assessment (CISA) network hooks up the CDC with our academic medical centers. All of these organizations collect and analyze adverse reactions to vaccines, from minor issues like transient pain, redness, swelling or headache, to fainting, blood clots and even death. What have they discovered from Gardasil?

Let's address what was not found first. Although there have been over forty deaths reported, there is no common pattern in these tragic events to link the cause to this vaccine. Some causes of death included diabetes, illicit drug use, heart failure and viral infections (not HPV).

There is an increased incidence of serious blood clots in this group, but only 10% did not have other obvious identifiable risk factors for clotting (such as obesity, smoking, or oral contraceptive use.)

FAINTING (medical term, syncope) IS a real possible side effect of this drug. The numbers are not staggering, but they are significant. Although fainting after vaccination is reported in significantly less than 1% of Gardasil recipients, Gardasil is the most frequently reported vaccine to cause fainting (as a single vaccine), accounting for over half of vaccine-related fainting episodes reported. The good news is that half of the fainting episodes occur within 5 minutes of receiving the shot, and 80% occur within 15 minutes.

BOTTOM LINE: Make sure to wait the full recommended 15 minutes after injection to minimize the risk of fainting, but be assured that Gardasil is a safe vaccine.

What's YOUR Blood Pressure?

Today the Center for Disease Control and Protection (CDC) released their report "Vital Signs: Awareness and Treatment of Uncontrolled Hypertension Among Adults- United States, 2003-2010), and what did they find?

• 30.4% of American Adults have high blood pressure - over 66.9 MILLION of us!!!
• 14.1 million people HAVE high blood pressure, but do not KNOW it
• 
  Of those that have high blood pressure, over HALF are NOT CONTROLLED.
• 5.7 million people KNOW they have HBP but don't take medicine
• Of the 35.8 million people who have UNCONTROLLED high blood pressure, the VAST MAJORITY (89.4%) have a usual source of health care & (85.2%) have health insurance

The media is all abuzz with this information, and with good reason. Hypertension (high blood pressure) is a disease that is easily diagnosed- just a blood pressure cuff is needed. We have a plethora of medications that treat hypertension, the mainstay of which are older, effective drugs that should not be expensive. High blood pressure, however, is a silent disease- potentially no symptoms until that big heart attack, stroke, kidney or heart failure. It is challenging to convince patients to take a medication when they have no obvious symptoms that will improve by taking the medications. 

With one in three Americans being obese, it should come as no surprise that roughly that same number of Americans have high blood pressure. As a nation, we have got to start reversing these trends, and MEDICATIONS ARE NOT THE ANSWER. Yes, we need them to control pressures (and some hypertension exists in skinny, fit bodies, independent of weight), but the real focus should be on improving our exercise and food choices. The good news is that with even very modest weight loss (of as little as 5-10 pounds), much of high blood pressure resolves! So, back to M.O.R.E. on nutrition!

BOTTOM LINE: High blood pressure is a SILENT disease that will cause serious damage if not discovered and treated, so CHECK YOUR BLOOD PRESSURE today!

Hepatitis C Testing- the Fine Print

Yesterday's blog focused on the CDC's new recommendation for ALL BABY BOOMERS to be tested for Hepatitis C, regardless of their other risk factors. The rational is to diagnose this often silent disease early, while treatment can make the most impact saving lives and improving quality of lives. While hepatitis C is largely transmitted via IV drug abuse (which obviously people can identify as a risk factor), there is a significant chunk- usually quoted around 10%- of people who have NO KNOWN risk factors.

So what's the fine print about the testing? First of all, the Hep C test is a blood test (just a heads up for the needle-phobics out there.) Mainly, however, the issues about testing surround the results.

A negative result is wonderful- there is extremely low chance that you have the disease and the test missed it, because this is a very sensitive test.

A positive result, however, leads to a much longer discussion. A positive Hep C Antibody test (the screening test) cannot tell you how long you have been infected. More testing is now required. The next step will be to have a different blood test that measures "viral load"- actually looking for the amount of Hep C virus present in your system. Other blood tests will measure your liver "function" to see if it looks inflamed.  Your doctor may also test to determine the subtype of Hep C in order to better advise you regarding the potential response to therapy. By the way, All positive tests for Hep C will be reported to the health department. This should not to make you paranoid, as your insurance company will obviously know as well, but simply something to note.

If your screening test was positive but your viral load does NOT show any current presence of Hep C, and your liver enzymes are normal- you will be considered to have recovered from a prior Hep C infection, and part of the lucky 15-25% who do not progress to chronic disease.

 If your screening test is positive, your viral load is elevated, but your liver enzymes are normal and you feel fine- you may be a Hep C Carrier, and most people in this category do not require immediate treatment. Carriers are followed closely to be sure they are not having silent worsening of disease (as measured by deteriorating blood tests or symptoms), holding off on treatment until there has been a change.

If your screening test is positive, your viral load is high, and your liver enzymes are abnormal or you have significant symptoms, then you will be heading to a liver specialist to discuss treatments. Though the treatment for Hep C can be challenging, between 50-80% of patients have sustained (successful) responses to treatment, depending on their subtype and how long the disease has been present.

BOTTOM LINE: Baby Boomers should talk with their doctors about getting tested for Hepatitis C, but recognize the results may initially create more additional questions than answers. 

Baby Boomers & Hepatitis C- Are You at Risk?

Yesterday the Center for Disease Control (CDC) announced that all baby boomers (adults born in 1945-1965) should be tested for Hepatitis C in order to increase earlier detection of this often silent disease. The CDC predicts that one in thirty Baby Boomers is infected with Hep C, and that close to a million people will be newly diagnosed if all in this age category are tested. The hope is that this strategy will save over 100,000 lives.

What is hepatitis C? Hep C is a viral infection that primarily targets the liver, and can potentially lead to severe liver damage, cancer and death. The good news is that 15-25% of people infected will "fight off" the disease and not become chronically ill with this disease.

How does someone catch Hep C? This infection is blood-born, so it is transmitted when there is direct blood-to-blood contact such as when people share needles for drug use. Baby boomers who received blood transfusions before 1992 could have been infected then and harbored silent disease for several decades. (Blood transfusions after that time were able to be screened and are safe.) Hep C can also be spread through sex with an infected person, but the transmission rates are very low (as measured in monogamous couples where one partner has hep C and the other does not.) Tattoos are another potential source of transmission. Unfortunately, most studies show that 10% of people with hepatitis C have no identifiable risk factors,  so that is why everyone should be screened regardless of their behavioral risk factors. 


Isn't there a vaccine for hepatitis? For Hepatitis A and Hepatitis B- YES, but not yet for Hep C.

What is the treatment? Unfortunately, the treatment for hep C is not as simple as taking an antibiotic for a bacterial infection, but it is very effective. Hep C treatment typically lasts a year and requires weekly injections, and the medications can have marked and serious side effects (especially fatigue, flu-like symptoms and depression.) Newer medications may offer shorter treatment courses and will be much better tolerated.

How do I get tested? Schedule an appointment to talk with your doctor about getting a blood test for Hepatitis C. The results are not exactly black and white, so you will want to learn more details before you decide...more on this tomorrow.

BOTTOM LINE: New recommendations suggest ALL BABY BOOMERS should get tested for Hepatitis C.

Traveling Out of the Country?

If your approaching Spring Break plans include traveling out of the country, NOW is the time to check in with your doctor to see whether or not you need any special vaccines or preventative medications before your trip. Immunizations take at least a few weeks to "kick in" and protect you, so start thinking about these shots at least a month (or preferably, two months) in advance of your trip. Additionally, there are some medications, such as those for prevention of malaria, that you need to start taking a couple weeks before your trip in order to be effective.

A great resource for medical travel planning can be found through the Center for Disease Control (CDC) at http://wwwnc.cdc.gov/travel/. Simply enter in your planned destinations, and a list of recommended vaccines as well as a plethora of extra information is readily available.

For example, let's take Mexico (think sunshine, beaches and...mosquitoes?) Of course, your routine vaccinations such as measles, tetanus and polio should be current. In addition, both Hepatitis A & B vaccines are recommended, as well as the typhoid vaccine- especially if you are visiting smaller or more rural areas. Rabies vaccine is only recommended for travelers who plan to be very involved with wild or stray animals, such as researchers, vets, or "high adventure" seekers. Besides the shots, travelers need to consider medications to prevent malaria, a serious blood-borne illness that is transmitted by mosquitoes. While not all regions of Mexico are at risk for malaria, people touring Chiapas, Oaxaca, Nayarit, and Sinoloa will need to discuss anti-malaria drugs with their doctors.

BOTTOM LINE: When your travel plans extend beyond our country's borders, check with your family doctor a couple months in ADVANCE of your trip to see if you need updated or additional immunizations or preventative medications.

CDC Now On Board for GARDASIL for BOYS

This week the Advisory Committee on Immunization Practices (ACIP) unanimously voted to recommend that 11-12 year old boys be vaccinated against HPV (the Human Papilloma Virus)- hooray! Girls have NO monopoly on genital warts, which affect over one million Americans each year. They are COMMON. Sadly, in my clinical experience, little harms self-image like a young person developing these genital lesions, especially because we cannot simply cure them and make them go away forever.

Genital warts are transmitted by direct skin-to-skin contact, and though this usually occurs during sex, actual intercourse is certainly not required to pass them on. They are very contagious, with transmission rate of up to 65%. Warts typically recur despite treatment, and frankly, the treatment is unpleasant at best- we burn the warts chemically or with liquid nitrogen. If you've ever had a wart frozen/burned off your knee, you know what that feels like, and the genital area has more nerve endings. Enough said!

The Gardasil vaccine immunizes recipients against the two strains of HPV (6& 11) that cause 90% of genital warts. Additionally, Gardasil protects against the two strains of HPV that cause the majority of cervical cancers. While males don't have a cervix to get cancer, they do have other parts that get HPV-related cancers (anal & penile, as well as some head and neck cancers,) although certainly these cancers are less common.

Gardasil was approved for use in males over two years ago, but the public has mainly been aware of the use in females. I'm glad the CDC and ACIP are on board, and hope that with increased education, we can help protect the next generation against HPV-related diseases.
BOTTOM LINE: Gardasil- it's not just for girls! Talk to your family doctor about immunizing ALL your kids.

PS. I am NOT on anyone's payroll for this vaccine- but I absolutely do recommend it.

Teen Pregnancy- New CDC Report has Good News & Bad News

The CDC released "Vital Signs: Teen Pregnancy" this week, which looks at teenage pregnancy statistics over the last two decades. On the plus side, the total national teen birth rate in the United States was the lowest we have recorded, down, in fact, by 37% from 1991. Unfortunately, we still had over 400,000 teenage births, which is 4% of female teens aged 15-19, and the annual estimated cost of teen childbearing is- gulp- over $9 BILLION. The USA birth rate is up to 9 times higher than most other developed countries.

Please note, my fellow southerners (Texas, Oklahoma, Arkansas, New Mexico and Mississippi), that we have the very WORST rates of teenage pregnancy in the country: >60/1000 females vs. <20/1000 for the best states, up in New England. Not something to boast about...

Today, and every day, 1,100 teenage girls will give birth in the US. That's 1 out of 10 new mothers. The cycle continues as 1/3 of kids born to teenage moms become teenage parents themselves. Not surprising, only half of teenage moms earn their high school diplomas- even by age 22.

The media is still portraying teen motherhood and sex in general as glamorous, fun, and enticing, which is far from the truth. Unpaid bills, screaming kids and exhausted parents are more the rule. We are slowly creeping in the right direction, but we've got much work to do to effectively educate our kids.

BOTTOM LINE: America has embarrassingly high rates of teenage pregnancy, costing our nation billions of dollars and heartache. We can do better.