Testing, Testing, 1, 2, 3

Teens have MANY questions about Sexually Transmitted Infections (STI's). One of their most consistent themes is "do my parents have to know?" Typically, that is followed up with, "my mom would kill me if she found out..." Teens- rest assured, though your parents may not be thrilled, in 15 years of practice I have NEVER seen a truly bad outcome from a kid telling their parent that they are sexually active. Believe me, as a parent, we'd rather have the discussion about your sexual activity BEFORE you have a viral STD like HIV, herpes or warts, and BEFORE you get pregnant. So, back to the questions:

1. Do I have to tell my Mom if I had an STD? In the state of Texas, anyone can be tested & treated for STDs without parental consent. However, if your parent is paying the bill (using their insurance) the doctor cannot lie and say they are treating or testing for something else- that is fraud, and the doctor can lose their license. I would strongly encourage anyone living with their parents to share this information- your parents love you & you will get through this together.

2. Can I get tested without a doctor ordering the test, like from an online source? Yes, there are multiple labs that allow you to order STD tests yourself. You can typically choose a single test you might be worried about (like your new partner tells you they have genital herpes) or a panel, that includes multiple tests. The key here is this: if your test is POSITIVE, meaning that you do have an STD, that lab cannot treat you. You are instructed to take the results to your physician for further treatment.

3. How much does it cost to get tested for "everything" if I pay cash? This has a huge range of answers, depending on where you go for testing and how much income you have. Online tests average around $30 per test, with a full panel being roughly $200. Community clinics and Planned Parenthood offer reduced rate testing, and some places offer free HIV testing. Please do not let cost stop you from seeking testing or treatment- timing is critical!

BOTTOM LINE: There are multiple options for STD testing that will allow anonymity, and work with your financial situation. Get yourself tested!

PS. For more details, FAQ, answers & stories, check out Seductive Delusions

MORE Teen Sex Q&A

More questions I hear from teens...
Which Sexually Transmitted Diseases can be cured? Trichomonas (a parasite), crabs (public lice), gonorrhea & chlamydia (both bacteria) can all be completely CURED if caught early and treated. If gonorrhea & chlamydia sit around for months or years untreated, they can cause permanent damage that leads to infertility or pelvic pain- and though the infection can still be cured, the damage to the genital tract cannot.

Which STDs can NOT be cured? Right now, we have treatments but no cures for the viral diseases: HIV (which causes AIDS), HPV (the human papilloma virus), Herpes (both oral and genital) and Hepatitis A, B & C.

When should I get tested- after how many partners? In a perfect world, you really should be tested after intimacy with any new partner. Since most STDs are silent, the only way you can no for sure that you will not be giving a new partner disease is to go and get tested.

How do they test for these diseases? A simple urine test can be used for gonorrhea, chlamydia, and trichomonas. A blood test is required for HIV, syphilis, hepatitis, and herpes. Pap tests with DNA testing check for different strains of HPV. Pubic lice can be detected by simple visual inspection, sometimes aided with looking at a pubic hair under a microscope.

More on testing tomorrow...too many questions for one post!
BOTTOM LINE: Let's answer teen questions about sex and STDs!

PS. For more details, FAQ, answers & stories, check out Seductive Delusions

Teen Sex Questions

I really enjoy teenagers. NO, that is not sarcasm, and YES, we have our own at home! Pre-teens & teens have always been my favorite group to work with, as a physician or girl scout leader or school volunteer. I love seeing how much potential they have, and more importantly, seeing THEM recognize their own strengths, and figure out how to most effectively use those talents to ultimately shape their future career choices. I think many adults make the mistake of talking down to teens, dismissing their heartaches, homework loads and stresses as trivial in the scheme of life (which, in fairness, is often how they look from our vantage point.) The reality is that their stress level is enormous, and that even if it is "puppy love" or "just a middle school test", these challenges are the greatest they have faced so far in their young lives. I believe we as adults can give perspective, but it is important not to minimize what they are going through.

All that being said, one of my educator roles is talking to youth about sexually transmitted diseases. I have been speaking to teens on this topic for roughly three years, and every time, I require the participants to write down a question at the end of my talk. I give them index cards (so they all look the same) and have them directly hand me the cards, so no one sees what anyone else has written. Not surprisingly, there are some common themes, though it might surprise you that I am primarily talking to straight A, service-minded, "good kid" student leaders. I thought I would spend the next several blog entries sharing some of their questions (and my answers) so both teens and parents can see what is being discussed. I'll start today with some questions about pregnancy:

1. Does birth control work?
Yes, but it is not foolproof. Oral contraceptives (the pill) are 99% effective when they are taken correctly- at the SAME TIME, every day; no skipped pills. Combining the pill with condom use as well is highly recommended. Remember, condoms alone are only effective 11-20% of the time, but adding them to the pill decreases the chances of conceiving as well as offering some protection against STDs.

2. Is it better to use two condoms at the same time, “doubling up”, in case one breaks?
NO, absolutely not. Using two condoms at once actually decreases effectiveness (due to sliding and breakage.)

3. Can you get pregnant without intercourse?
Usually not, but if semen enters the vagina, which can happen with “outercourse” or in the process of anal sex, it is possible. Young girls are very fertile – that is the take home message.

BOTTOM LINE: Talk with your teens about STDs, LISTEN to their questions, and help them find the correct answers!
PS. For more details, FAQ, answers & stories, check out Seductive Delusions

GLAMOUR Reports $1.5 Million Lawsuit for STD!

Have you seen the September issue of GLAMOUR? Well, look closely at the article: "I Sued My Ex for Giving Me an STD- and I WON!" It's a fascinating case, actually. In short, a guy and gal got together. The girl had done "due diligence" in revealing her past sexual history, and had asked him about his. He reported NO history of STDs and said he, in fact, was in a "dry spell" and hadn't been with anyone in a long time. What's next?
Girl believes guy. Girl sadly develops genital warts AND abnormal Pap smears that are pre-cancerous. (To be clear, these are both caused by HPV, the Human Papilloma Virus, but represent infections by TWO DIFFERENT strains of HPV, as warts do not turn into cancer.) Back to the story- meanwhile, guy has-oops- impregnated another girl during the not-so- dry spell...
Now, the girl who caught the HPV is in law school, and not only knows her rights, but wants to be certain to protect any future women this guy chooses to be less than honest with, so...voila! Lawsuit.
Here is the best part: Girl WINS lawsuit, including an appeal, for $1.5 MILLION!
You can read part of my opinion about the case on page 338 of the magazine, but here are a few more thoughts:
1. People LIE about having STDs- it's embarrassing, they don't want to be rejected, and they think they wont get "caught."
2. Completely HONEST people may not actually KNOW that they have a disease, because so many are SILENT.
3. Perhaps we need some new media-worthy "catch phrase" for people to ask to see proof that their potential partner has been recently tested for ALL STDs- "Show me the papers"? "Papers before clothes?" "Proof, not promises?" "Reality before Romance?"
4. You cannot tell by LOOKING who has an STD. (This guy was a medical professional- a dentist- perfect case in point!)
5. IF you give someone else an STD, you CAN be found liable in a court of law. KNOW YOUR OWN STATUS as well as asking potential partners their status.
6. STDs are COMMON and cross all racial and socio-economic boundaries- don't be fooled into thinking that beautiful, rich, popular people are disease-free!

BOTTOM LINE: You CAN and WILL be held liable for giving someone a sexually transmitted disease. If you are not practicing abstinence, GET TESTED and swap results with any future partners BEFORE you are intimate.

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 #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 #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 #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".

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)