Exactly Why STDs Are Bad

One of the hardest parts of my job is calling a patient to tell her that she has a sexually transmitted infection (STD/STI). Every woman receives this news differently--shock, anger, horror, depression, resignation--but it always ruins her day and often sends her to the internet to find out what it means.

But STDs are not all alike (even if it always sucks to get one). This news may mean you need to take a single dose of antibiotics to cure it...or it may mean that your life is forever changed (HIV). In general, there's two kinds of STDs. Bacterial and parasitic infections include gonorrhea, chlamydia, trichomonas, and syphilis; these can be treated, and often cured, with medication. Viral infections infections are most often the big three: HIV, HPV and herpes. These infections cannot be cured, though their symptoms may be controlled.

Most of us are aware of the dangers around the viral infections (the gifts that keep on giving). But sometimes my patients are unaware of what exactly the consequences are of contracting a bacterial or parasitic STD. "You can just treat it, right? So what's the big deal?"

Short-term misery.

• The infections themselves - while they may be silent, they can cause vaginal discharge, vulvar bumps, burning, and pain.
• Abscesses - when certain STIs make their way up to your tubes and ovaries, they can create a pocket of pus the size of a golf ball or larger, often leading to....
• Hospitalization, for both intravenous antibiotics and pain control. Sometimes time alone is enough to resolve an abscess, but sometimes you end up needing....
• Drainage or surgery. It can be a needle passed through the wall of your belly to drain the pus, or actual surgery to remove the mess--either way it's a nightmare.

Long-term consequences.

• The risk of surgical complications if surgery is needed--bleeding, further infection, damage to your bladder or bowels.
  
• Infertility, if your fallopian tubes are scarred. Even surgery is often not alone to repair such damaged tubes, and you're then facing in-vitro fertilization (IVF) if you want to get pregnant in the future.
• The "talk" with every future partner about your sexual history. First sexual encounters can be awkward enough, without having to talk about your herpes or HPV infection.
• Medical bills. Because these infections need to get treated, whether or not you've got insurance.

Finally, if you contract an infection from a partner and eventually sleep with someone else without treatment, you'll be spreading the STD wealth without knowing it. So if you're not in a monogamous relationship--or aren't sure if you are or not--please think twice about not wearing condoms. Use them for your health, both for now and for later.

Have any of you, or had someone close to you, had to deal with the consequences of an STD?

Photo credit: miszpinay

Oversleeping Plan B

Dr. Kate,

My boyfriend and I use condoms, but he also generally pulls out during sex. So we were having super hot sex and then he came inside me. Whenever this happens, I take the morning-after pill to be safe. But this time I was so tired that I took the second pill 21 hours later rather than 12 hours later. Because I slipped up taking the second pill does that increase my chance of getting pregnant?

Not 2 Late?

Dear Not 2 Late,

We don't know for sure what happens when you take the second pill of plan B late. My best guess is that it doesn't work as well, and perhaps not at all. So I'm glad you were using it as a back-up to your back-up method of birth control (withdrawal...yes, "pulling out" counts as birth control, albeit not a very effective one). Since you were using a condom, your chance of pregnancy from this one time is pretty low.The easiest way to prevent this very common plan B mistake is to take both pills at the same time. It's just as effective, and won't increase the chance of nausea or vomiting.

Using condoms + withdrawal each time you have intercourse? Not a bad combination if you can't get access to hormonal birth control or IUDs. But I'd encourage you to think about these other methods. They're much more effective, and certainly are easier to use than buying EC multiple times in a year.

Do any of you use condoms and withdrawal as your birth control combo?

Photo credit: evelynishere

Talking About HPV

Hi Dr. Kate,

Sadly, I went to my annual OB-GYN appointment 2 weeks ago and was told that HPV was present in the swab that was taken. My oh-so helpful doctor's office couldn't tell me which strain it was, only that it was present and that I needed to come back in 6 months for another checkup, so I'm guessing it's not the genital warts one, just the cancer causing one? It is really frustrating to me, as I've only been with two people in my whole life, and condoms were used both times. Plus, I've sat through the three Gardisil shots as well before I got busy with either one of my partners.

My main concern is the relationship I'm in now. We aren't seeing anyone else, and so far it's been going great, until now.... What is the protocol here? I understand with a regular STD you need to tell your partner and I'm prepared to fess up here as well, but it's hard to since I don't know what kind I have. Anyway, since my doctor isn't helpful, I was wondering what the correct behavior is here.

Tongue-Tied

Dear Tied,

Let's talk about you first. You've done all the right things to protect yourself, but as we know, nothing takes the risk away completely...which is why screening is so important. The majority of HPV testing looks only for high-risk strains. There are multiple versions of HPV that put you at risk for cervical cancer, but since they're all managed the same way, they're tested for in a batch. So unfortunately, yes, you've got a strain that puts you at risk. The Gardasil will still offer you protection from getting those strains in the future, though, so the shots weren't in vain. BTW, docs don't test for low-risk strains for two reasons: 1) we don't treat them directly unless warts appear, and 2) you don't need more frequent pap testing for the low-risk ones.

Now the tough question--if and how to discuss your diagnosis with your boyfriend. It's likely that he too has the virus, though you'll never know which one of you had it first. You can look at this situation in two ways:

• Since 80% of sexually-active adults have or will acquire HPV, your boyfriend likely had the virus (and gave it to you) or would have gotten it from someone else. Since the virus won't affect his health, there's no need to tell him about it while you're together. And if you break up, you can tell him then, so he'll know to warn future partners.
• HPV is still an STD, and most of us want to know about any infection that we've been exposed to, whether or not we can do anything about it.
  

Personally, I believe that the best course of action is generally openness and honesty. If you're close enough to someone to get naked and swap bodily fluids, you should be able to share bad news as well. You can bring it up when you're not in bed (or at least not post-coital), at a moment that you've got time to talk. And you can give him resources about where to go for more information, like here and here.

How have you handled a diagnosis of HPV? Have you told all to your partner? How did you do it?

Photo credit: kimberlyfaye

Lovely Lady Lumps?

Dr. Kate,

I had a baseline mammogram, and two lumps were found in my left breast, so I was sent to get an ultrasound. The doctor did not really say too much. She asked me if I had an infection in my breast, I said no and that was that. She said that she really couldn't tell anything else because this was my baseline and that I needed to come back in 6 months to see if the lumps have grown. Is this a normal answer? Do I wait 6 months to see if it is cancer? I had one lump removed from my right breast in 1993 which was not cancer but is that what you do? Should I go see another doctor?

Leery About Lumps

Dear Leery,

Breast lumps can be tricky to manage. There are several features of a lump that doctors consider in trying to figure out if a lump is benign (not cancerous) or not:

• Smooth or rough? A lump that's smooth like a marble is more likely to be benign thank one that is bumpy around the edges.
  
• Mobile or fixed? A lump that you can squish around between your fingers is more likely to be benign than one that feels cemented in place.
  
• Fluid-filled or solid? A cyst filled with fluid is 99% of the time benign.
  

Additionally, your medical history can provide clues. If you're a breast-feeding mom, a lump is more likely to be a blocked milk duct. Similarly, if you've got fibrocystic breast disease, a lump may be cyclical thickening of normal tissue. The radiologist, too, looks for features of the lump on the scan to give their best estimate of what the lump is.

But in the end, the only way to know that a lump is not cancer is to sample it--using a needle (with or without ultrasound or CT scan) to extract cells, then examine them under a microscope. No doctor can tell you with certainty that a lump is benign until you've had it biopsied. But if your doctor or the radiologist has a low suspicion that the lumps are cancer, waiting 3-6 months for another exam and mammo/ultrasound is reasonable.

Bottom line? Ask your doctor why she thinks it's okay to wait 6 months for another check. And if you're not reassured, seek a second opinion. It's your body, and you need to feel good about what's happening with it.

Have you ever had a breast lump? Did you have a biopsy, or did your doctor say it was okay to wait?

Photo credit: zpeckler

"Trust Women."

I have been trying to find words to write about the murder of Dr. George Tiller on Sunday. But the first words that spring to mind--outrage, devastation, fear, anger--don't begin to scratch the surface for me.

Dr. Tiller provided a service to women in need that few others have the courage to give. Had he died in a car accident, it would be a loss for women and their families. But murdered in his church? It's a loss for humanity.

I can't seem to find answers, or solace in the knowledge that there are other abortion providers who are bravely going to work this week to do the work that is so necessary. I'm only finding endless questions.

Where are we as a nation that anyone can see assassination as justifiable, for anything?

Why can't people trust women to make the best decision for themselves and their family?

Why does the provision of LEGAL medical care put a doctor's life at risk?

What happens to women if abortion providers stop practicing out of fear?

Since my words are inadequate, I'm linking to a site with women's stories, those who have experienced the worst news you can receive about a wanted pregnancy. Those who are making the toughest decision of their lives, and were lucky enough to find a doctor who could give them the care they needed. Activists on both sides of the issue--aided by the media--so often paint all women who receive 2nd- and 3rd- trimester abortions with the same brush. Let these women break out of the caricatures and become real to you.

And I'll end with words from Dr. Tiller, words that I wish everyone who is anti-choice could read and truly understand:

"Abortion is a matter of survival for women. It is a matter of the survival of their hopes, their dreams, their aspirations, and their potential. Abortion is not a cerebral or reproductive issue. Abortion is a matter of the heart. For until you understand the heart of a woman, nothing else about abortion makes any sense at all."

* If you want to give a donation, consider: Medical Students for Choice (helping to educate and train the next generation of doctors about reproductive health) and the National Network of Abortion Funds (who help poor women access abortion care).

Photo credit: qwrrty