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Posted by David | Posted on 26-08-2009

HealthCheckUSA Health Alert: Oprah and Bioidentical Hormones FAQs

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By Miranda Hitti, WebMD Health News Reviewed by Louise Chang, MD

Jan. 15, 2009 — Oprah Winfrey says menopause caught her “off guard” and that she’s taking bioidentical hormones that have made a big improvement in how she feels.

Bioidentical hormones are one form of therapy for menopausal symptoms. Winfrey, who turns 55 this month, writes in February’s edition of O, The Oprah Magazine that she felt “out of kilter” and had “issues” for two years that she suspected were hormonal. Upon a friend’s recommendation, Winfrey went to a doctor who specializes in hormones.

Winfrey writes that the hormone specialist told her that her “hormonal tank was empty” and gave her a prescription for bioidentical estrogen.

“After one day on bioidentical estrogen, I felt the veil lift,” Winfrey writes. “After three days, the sky was bluer, my brain was no longer fuzzy, my memory was sharper. I was literally singing and had a skip in my step.”

Winfrey isn’t recommending bioidentical hormones for every menopausal woman. Instead, she urges women to “take charge of your health” and says it’s time to “start the conversation” about menopause and bioidentical hormones.

Oprah writes that bioidentical hormone therapy is controversial and confusing to many people.

What’s the controversy about? Are bioidentical hormones better or safer than other hormone therapy? WebMD has answers from experts.

What Are Bioidentical Hormones?
“There is enormous confusion about the meaning of the term ‘bioidentical,’” JoAnn Manson, MD, DrPH, tells WebMD via email.

“Bioidentical hormone preparations are medications that contain hormones that are an exact chemical match to those made naturally by humans,” says Manson, who is chief of preventive medicine at Brigham and Women’s Hospital in Boston and the Elizabeth F. Brigham Professor of Women’s Health at Harvard Medical School.

Some bioidentical hormones are made by drug companies, are approved by the FDA, and are sold in standard doses. Other bioidentical hormone preparations are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient. Those “custom-made” preparations aren’t approved by the FDA.

Why Aren’t Compounded Bioidentical Hormones FDA approved?
The FDA doesn’t approve any compounded products, for any condition, because those products aren’t standardized.

That doesn’t mean that compounding is bad. Compounding can be useful for patients who are allergic to an additive in an FDA-approved product, says Kathleen Uhl, MD, the FDA’s assistant commissioner for women’s health.

But “the purpose of compounding is to do it on a patient-by-patient basis, so there’s nothing that’s submitted to FDA to evaluate, so they’re not FDA approved,” Uhl explains.

And because compounded products don’t go through the FDA approval process, they don’t bear the same warnings as other hormone therapy.

A woman who gets a prescription for an FDA-approved hormone therapy for menopausal symptoms is “going to get a lot of warning information,” but if she gets a compounded product instead, “you don’t get any of those warnings,” Uhl says. “There’s no requirement for them to provide that because those products are not FDA approved.”

Why Aren’t Compounded Bioidentical Hormones FDA approved? continued…
L.D. King, executive director of the International Academy of Compounding Pharmacists, suggests that patients look for accredited compounding pharmacies listed on the web site of the Pharmaceutical Compounding Accreditation Board (PCAB).

“They make sure those accredited pharmacies are adhering to a very high level of practice, which would include pretty extensive quality control,” King tells WebMD. He also suggests that because there aren’t a lot of PCAB-accredited compounding pharmacies, patients should ask compounding pharmacies what types of quality assurance procedures are in place.

Manson points out that with FDA-approved “bioidentical” drugs available, “most women interested in bioidentical formulations do not need to take custom-compounded products (exceptions would be women with allergies to ingredients, or intolerances to doses, in commercially available products).”

Does That Mean Compounded Bioidentical Hormones Are Safer?
“There is no reason to think that these bioidentical compounded [products] would have a different safety profile than the FDA-approved ones,” Uhl says. She points out that some compounded pharmacies have gotten warning letters from the FDA for false and misleading claims about safety and other benefits.

Isaac Schiff, MD, chief of obstetrics and gynecology at Massachusetts General Hospital, agrees.

Schiff led an American College of Obstetrics and Gynecology (ACOG) committee that reviewed the scientific evidence on compounded bioidentical hormone therapy in 2005. That committee concluded that there wasn’t scientific evidence to support claims of increased efficacy or safety for compounded estrogen or progesterone regimens. The North American Menopause Society (NAMS) and the Endocrine Society have issued similar statements.

“It may be safer, but that study hasn’t been done yet,” Schiff tells WebMD. He says he would like to see a large, lengthy, rigorously designed study on the topic.

“I’m not inherently negative about it,” Schiff says. “I hope they’d be good … and if it turns out to be safer, fabulous. I would like, as a physician, to prescribe the safest hormones to my patients who want to be treated.”

Erika Schwartz, MD, a New York doctor who prescribes FDA-approved biodentical hormones and compounded bioidentical hormones, says there have been studies that support the safety of bioidentical hormones, compared to other hormone therapy.

Schwartz asks, “If NAMS or ACOG says there are not enough studies, well, why haven’t you done the studies if you think you need more? If this had been men’s health, would we be having this conversation, or would we have answers?”

Schwartz says she has long wanted to see large, government-sponsored studies compare bioidentical and other hormone therapies head to head.

“She’s allowed to have her opinions,” Uhl says. “The evidence that FDA has seen and what’s available in the medical literature leads us to believe that there are the same concerns” with bioidentical and other hormone therapy for menopausal symptoms.

Uhl adds that “the FDA is not prohibiting the compounding of bioidentical hormones. There is definitely a niche for them and certain patients do need this, but it’s not for everybody, and the people who are taking it need to realize that the risks are probably the same for the FDA-approved drugs as they are for the [compounded] bioidentical.”

Can You Take Bioidentical Hormones Indefinitely?
Hormone therapy has been linked to increased risk of breast cancer, so most health experts recommend that women take the lowest dose for the shortest time, if they need it.

That research wasn’t done on bioidentical hormones. But that doesn’t necessarily mean that it’s safe to take them for a longer time, Schiff says.

“If you have the exact same estrogen as one’s own body makes, it doesn’t mean it’s any safer,” says Schiff.

Schwartz counters that bioidentical hormones are chemically different from the hormone therapy drugs that were linked to health risks, saying “there is no reason to compare recommendations because they’re not the same product.”

Schwartz says she’s been prescribing bioidentical hormones for 14 years and takes them herself, having switched from other hormone therapy years ago. “I feel great and the women I work with feel great,” she says. “I have no complaints.”

Schiff doesn’t dismiss bioidentical hormones. “If I have a patient who says she wants a bioidentical … then I personally would prescribe a hormone like estradiol, which is what her ovaries made, and I would give it to her in a skin patch by one of the drug companies that I know; it has oversight by the FDA and it has the exact dose that I want her to have,” says Schiff, who has no ties to any drug companies. If a patient is already on a bioidentical hormone, “I try to find out exactly what she’s taking and try to make sure that it’s a safe dose and that she could be followed carefully,” Schiff says.

Schwartz says she gives her patients a choice between standardized bioidentical hormones or compounded products made by a lab she has vetted. She stresses the importance of doctors being trained about bioidentical hormones by other physicians who are knowledgeable about bioidenticals. “The physician has to work with the patient and the compounder,” Schwartz says.

Are Saliva and Blood Tests FDA Approved?
Yes, those tests are FDA approved for diagnostic purposes — but not to tailor hormone treatment.

“The tests are not approved for use to measure hormone levels to adjust hormone therapy,” says Uhl, who points out that hormone levels can fluctuate throughout the day.

Schwartz says she doesn’t believe saliva testing is appropriate and only uses blood tests with her patients.

What About Oprah’s Experience?
“I’m happy that Oprah feels better,” Schiff says. “Every experience is an important experience … but everybody’s individual and they have to work that out with their doctor.”

Some women, Schiff notes, feel better when they start hormone therapy, but he’s not sure if bioidentical hormone therapy would give them an additional boost.

Compounded or not, bioidentical hormones are only part of the picture, Schwartz says.

“A lot of people just want to follow the celebrity,” she says. “Sometimes people come in and what they really need is to address their diet, their exercise, their lifestyle.”

“I think bioidentical hormones are great,” Schwartz says. “But if you don’t address them in the context of the whole person — with her diet, her exercise, her lifestyle, with her relationships, with her stresses — and you don’t work with everything, you’re not really going to be able to come up with the results that women would like to see.”

Posted by David | Posted on 26-08-2009

HealthCheckUSA Health Test Education: Importance of Condoms in preventing STD’s

Category : std testing

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Importance of Condoms in preventing STD’s

By Mayo Clinic staff

A male condom is a thin sheath placed over the erect penis just before sexual intercourse. Condoms, commonly called rubbers, are a very effective way to protect yourself and your partner from sexually transmitted diseases (STDs) and to prevent pregnancy. Condoms are simple to use, inexpensive and widely available.
Condoms are usually made of latex, but some are made from polyurethane or lambskin. Latex and polyurethane condoms provide the most protection against sexually transmitted diseases. Condoms are available with or without a lubricant in a variety of lengths, shapes, widths and thicknesses — and even come in different colors. Some condoms are textured to enhance sensation.

Condoms can prevent both pregnancy and STDs
If you use them correctly every time you have sex, condoms are effective at preventing pregnancy and the transmission of the human immunodeficiency virus (HIV), the virus that causes AIDS. Condoms also reduce the risk of infection from other STDs, such as gonorrhea, Chlamydia, Herpes, Syphilis and Hepatitis.

Condoms don’t have the side effects found in some forms of female contraception, such as birth control pills or shots, or potential complications of an intrauterine device (IUD). They are available without a prescription, and are easy to obtain.

Risks of using Condoms to prevent STD’s
• Some people are allergic to latex, and if either partner is allergic, he or she may react to contact with a latex condom. Reactions to latex include rash, hives, runny nose, swelling and constriction of the airways and loss of blood pressure. In this case, a condom made from polyurethane or lambskin may be an option.
• While condoms are an effective way to prevent the transmission of STDs and to prevent pregnancy, they aren’t foolproof. While it’s rare, it’s still possible to get an STD or get pregnant when using a condom, especially if it breaks or comes off during sex. Even if you use condoms on a regular basis, it is still very important to get routine STD testing. Affordable, confidential STD testing is available from www.HealthCheckUSA.com

How you prepare to use a condom
Condoms are available without a prescription. They’re sold in many stores and from vending machines in some restrooms. Condoms may be less expensive at family planning clinics such as Planned Parenthood. They’re also usually available at university health centers.

Condoms come in a number of shapes, sizes and textures. Finding a condom that works well for you can take a little trial and error.
• Fit is important. If it’s too tight, a condom is more likely to break. If it’s too loose, it may slip off.
• Some men find that condoms decrease sensation or are uncomfortable to wear. You may find that a certain type of condom is more comfortable for you or provides greater sensation during sex.

Some condoms are lubricated with nonoxynol-9, a spermicide meant to help prevent pregnancy. However, condoms without spermicide appear to be a better option for several reasons:
• Spermicidal condoms don’t appear to be any more effective than other lubricated condoms at preventing pregnancy.
• Nonoxynol-9 may irritate or damage skin cells in the vagina and rectum. This could potentially increase the risk of getting an STD.
• Spermicide doesn’t help protect you or your partner against HIV/AIDS or other STDs.
• Spermicidal condoms cost more than other types of condoms and have a shorter shelf life.

Condom safety tips
• Store condoms in a cool, dry place. Exposure to air, heat and light increases the chance that a condom will break. Don’t keep condoms in a billfold, back pocket or glove compartment for an extended period of time. Friction, perspiration and changes in temperature can cause condoms to break down and become less reliable.
• Check the expiration date. Don’t use a condom after its expiration has passed.
• Check condoms for damage — brittleness, small tears or pinprick holes — before using.
• With latex condoms, be sure to use only water-based lubricants, such as K-Y jelly. Don’t use oil-based lubricants, such as petroleum jelly, baby oil, cooking oil or lotion. They can weaken a latex condom and cause it to break.
• Never reuse a condom. If a condom is inside out and does not unroll easily, don’t flip it over because there may be semen in it. Use another condom.
• If you’re concerned about preventing STDs, use a latex or polyurethane condom. Lambskin condoms don’t protect against STDs as well as latex or polyurethane condoms do. Read the label on the package to see what the condom is made of and whether it’s labeled for STD prevention.
• For the best protection from STDs, use a condom during any sexual activity, whether vaginal, oral or anal.

What you can expect from Condoms
It’s important to use condoms carefully, correctly and consistently.
• Open the package carefully. Don’t use teeth or fingernails.
• If you use condoms that aren’t already lubricated, apply lubricant inside and outside of the condom.
• If you’re not circumcised, make sure you pull your foreskin back before putting on the condom.
• Place the tip of the rolled-up condom over the erect penis. The rolled rim should be on the outside.
• Gently press the tip of the condom to remove air.
• Unless the condom has a reservoir tip, unroll the condom down over the entire penis while leaving room — a half-inch space — at the tip to collect the semen.
• Remove any air bubbles to make sure the condom fits correctly. An air bubble could cause the condom to tear or come off.
• After intercourse, withdraw the penis while holding the base of the condom so that the condom doesn’t come off. Then remove the condom and dispose of it in the trash. Don’t flush condoms down the toilet

Results of condom use
Condoms are an effective form of birth control. However, about 1 in 50 couples who use condoms correctly will get pregnant in a year. Chances of pregnancy increase if you don’t always wear a condom during intercourse, or you use condoms incorrectly.

Although there is still some risk for getting or transmitting STDs, condoms are very effective at preventing the transmission of most STDs. When used correctly, a condom creates a barrier that limits your exposure — and your partner’s exposure — to semen or other body fluids that can carry STDs.

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Posted by David | Posted on 26-08-2009

HealthCheckUSA News Alert: D.C. to Offer STD Tests In Every High School

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Written By Darryl Fears and Nelson Hernandez, Washington Post Staff Writers
Wednesday, August 5, 2009

D.C. school officials are planning to offer STD lab tests for sexually transmitted diseases to all high school students in the coming school year, expanding a pilot program that uncovered a significant number of infected children.

The program conducted last year at eight high schools found that 13 percent of about 3,000 students tested positive for an STD, mostly gonorrhea or chlamydia, according to the D.C. Department of Health.

The expansion places D.C. public schools in the vanguard of a growing number of urban school districts that test adolescents for STDs. About 12,000 students attend public high schools in the District.

STDs are of particular concern to AIDS activists because they increase the risk of contracting HIV. The testing program was hailed in a report being released Wednesday by the D.C. Appleseed Center for Law and Justice as a positive step in the city’s effort to arrest its growing AIDS rate, which is the highest in the nation and is considered an epidemic. Half of the city’s cases of chlamydia and gonorrhea are among adolescents.

The program, which has been discussed by the D.C. school board, requires students to attend a lecture about STDs, but they can opt out of providing a urine sample for the test. All 50 states and the District allow minors older than 12 to be screened for STDs without parental consent.

“The program tells us that a lot of students in the public school system are engaging in unsafe sex,” said Walter Smith, executive director of D.C. Appleseed, which advocates for more AIDS outreach and education in the schools. “If 13 percent of these students are testing positive for STDs, those same kids could get HIV. A lot needs to be done to get the message out to the schools . . . and this very high STD rate is an indication that what we’ve been doing is not effective.”

In a 2007 study by the D.C. public school system, 60 percent of high school students and 30 percent of middle school students reported having had intercourse. Twenty percent of the high school students said they had had sex with four or more partners, and 12 percent of the middle school students said they had had three or more partners.

The D.C. schools first offered the tests two years ago at two charter schools. Health department workers presented a lecture on STDs to groups of 20 to 30 students in grades 9 through 12; none of the students was younger than 15. After the lecture, students were invited to submit urine samples for chlamydia and gonorrhea testing at a health department laboratory.

Of 987 students who attended the lectures, 68 percent submitted urine specimens, according to a report. Of those students, 9 percent tested positive for at least one STD.

Test results were provided confidentially by telephone, and the city paid for treatment at the school or an STD clinic. Students who decided to be treated by a family physician were responsible for their own payments. Students were counseled about STDs and HIV prevention, were given notification cards to inform partners of the positive diagnosis and were encouraged to share the results with their parents.

In the past school year, the program was modified and expanded to eight high schools: Ballou, Banneker, Anacostia and Dunbar high schools, Moore Academy and Choice Academy, and two charter schools, Rock Creek Academy and High Road Academy. In those schools, a 45-minute lecture was given, followed by a question-and-answer period, officials said.

Chad Ferguson, deputy chief of youth engagement for the D.C. schools, said the tests are administered by taking groups of 15 to 20 students at a time to the restroom area. The students are given paper bags containing urine collection cups and enter bathroom stalls. Once they get in the stalls, they can choose whether or not to provide urine samples. All the students return the paper bags, so other students do not necessarily know who did or did not provide a sample. Students provide a password and then call in a week later to get their result and treatment, if necessary.

The D.C. STD testing program is a near copy of a Philadelphia program that began in 2002. In the 2004-05 school year, 30,000 students in 53 high schools attended presentations, and 16,000 submitted specimens for testing, according to a report by the Philadelphia Department of Health. More than 4 percent tested positive for chlamydia, gonorrhea or both.

School systems in New York, Chicago, New Orleans and Baltimore, among others, either perform screening for sexually transmitted diseases or are preparing to begin pilot programs. In Baltimore, no parental consent is required. In New York, parents can elect to not have their child tested. In New Orleans, a parent must give consent for a child to take the test.

“We have Third World statistics in terms of our HIV issues, and from the HIV perspective, we do need to find a way to identify students so that we can help them,” said William Lockridge, a member of the State Board of Education representing Ward 8.

But he said parents need to be involved. “Right now, if you play sports in a public school, you have to get permission from your parents. If you take a field trip, you have to get permission from your parents. Why would it be any less for this? . . . Only if the parent gives the consent upfront would I do this.”

D.C. Council member David A. Catania (I-At Large) offered a different viewpoint. “This isn’t necessarily intended to comfort adults,” said Catania, who chairs the health committee. “I don’t think you turn a blind eye and pretend these problems don’t exist.”

Catania said he has not heard much community opposition to the testing. “In this regard, I find our population to be extremely secure,” he said. “I’m not condoning this behavior. I don’t think young people are equipped for the consequences of engaging in sex, but the fact is that they do.”

Chlamydia is the most commonly reported disease in the United States, according to the Centers for Disease Control and Prevention. More than 1.1 million new cases were reported in 2007, up from 1 million the previous year.

Because the condition is mainly asymptomatic, most cases of chlamydia go undiagnosed. The CDC estimates that there are actually about 2.8 million new cases of chlamydia in the country each year, indicating that more than 1 million are undiagnosed. Symptoms include an inflamed pelvis and chronic pelvic pain, similar to symptoms for gonorrhea.

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Posted by David | Posted on 26-08-2009

HealthCheckUSA Health Alert: STD Testing Recommendations Part 2

Category : std testing

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STD Lab Testing Recommendations: Part 2

By Mayo Clinic staff

Testing for a disease in someone who doesn’t have symptoms is called screening. Most of the time, STD screening is not a routine part of health care. But there are exceptions:

Everyone:
The one STD screening test suggested for everyone between the ages of 13 and 65 is a blood test or saliva test for human immunodeficiency virus (HIV), the virus that causes AIDS. Most health care settings in the United States offer a rapid HIV test with same-day results.

STD Screening for HIV, hepatitis B, Chlamydia, gonorrhea and syphilis generally takes place at the first prenatal visit. A blood test to detect HSV type 2 infections is recommended for pregnant women with current or past partners who have genital herpes.

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Young Women who are Sexually Active:
All sexually active women under age 25 should be tested for Chlamydia infection. The Chlamydia STD test uses a sample of urine or vaginal fluid you can collect yourself. Some experts recommend repeating the Chlamydia STD test three months after you’ve had a positive test and been treated. The second STD test is needed to confirm that the infection is cured, as reinfection by an untreated or undertreated partner is common. A bout of Chlamydia doesn’t protect you from future exposures. You can catch the infection again and again, so you should get retested when you have a new partner.

Women ages 21 to 66:
The Pap test screens for cervical abnormalities, including inflammation, precancerous changes and cancer, which is caused by certain strains of human papillomavirus (HPV). From ages 21 to 66, women should have a Pap test at least every three years. Women who start having sex before age 21 should have a Pap test within three years of first intercourse.

Men who have sex with men:
Compared with other groups, men who have sex with men run a much higher risk of catching STDs. Many public health groups recommend annual or more frequent STD testing for these men. Regular tests for HIV, herpes, gonorrhea, Chlamydia and syphilis are particularly important.

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People with HIV:
If you have HIV, it dramatically raises your risk of catching other STDs. Experts recommend frequent syphilis, gonorrhea, Chlamydia and herpes STD tests for people with HIV. Women with HIV may develop aggressive cervical cancer, so they should have Pap tests twice a year to screen for HPV. Some experts also recommend regular HPV STD screening of HIV-infected men who risk anal cancer from HPV contracted anally.

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Vaccination for STDs
Vaccines are available to prevent two viral STDs that can cause cancer — human papillomavirus (HPV) and hepatitis B. The HPV vaccine is recommended for all girls between ages 9 and 26, and the hepatitis B vaccine is usually given to newborns.

Partner notification and preventive treatment
If STD lab tests show that you have an STD, your sex partners — including your current partners and any other partners you’ve had over the last three months to one year — need to be informed so that they can get STD lab tested and treated if infected. Public health regulations require doctors to report all cases of syphilis and HIV to the local or state health department, which employs trained disease intervention specialists who will work with you — and sometimes with your doctor — to identify your partners, inform them of their exposure and get them tested and treated. In some states and counties, the health department also notifies partners exposed to gonorrhea and Chlamydia.

Official, confidential partner notification effectively limits the spread of STDs, particularly syphilis and HIV. The practice also steers those at risk toward appropriate counseling and treatment. Finally, since you can contract some STDs more than once, partner notification reduces your risk of getting reinfected.

Depending on your circumstances, you might prefer to be the one who breaks the bad news to your partner, and that’s certainly an option. Your disease intervention specialist may help you prepare and make a contract with you to go through with the conversation within a set amount of time. If your partner hasn’t been treated by that time, the health department picks up with its usual partner notification procedure.

In an approach called expedited partner treatment, the staff at an STD clinic will treat an exposed partner without doing a full medical evaluation. When you’re diagnosed with Chlamydia, gonorrhea or trichomoniasis, your doctor may prescribe enough medication to treat both you and your partner. This approach is called patient-delivered partner treatment.

Safer sex
Thanks to improved STD lab testing and treatment, most people with access to health care no longer face all the dreadful consequences of STDs. Still, there is no room for complacency. One risky encounter is unlikely to cost you your life, but it could really mess up your future. These guidelines offer the greatest possible margin of safety.
• Don’t have sex in any way that puts you and your partner in direct contact with each other’s blood, semen or other body fluids.
• Avoid vaginal and anal intercourse with new partners until you have both been tested for STDs. Oral sex is less risky, but use a latex condom or dental dam to prevent direct contact between the oral and genital mucosa.
• Use a latex condom every time you have intercourse.
• Never use an oil-based lubricant, such as petroleum jelly, with a latex condom.
• Don’t drink alcohol or use drugs. If you’re under the influence, you’re more likely to take sexual risks.
• Don’t look for sex partners online or in bars or other pickup places.
• Before any serious sexual contact, communicate with your partner about practicing safer sex. Reach an explicit agreement about what activities will and won’t be OK.
• Stay with one sex partner who doesn’t have any STDs and who won’t have sex with anyone but you.

HealthCheckUSA offers many STD lab tests that are affordable and do not require a doctor’s prescription. We have over 5,000 lab locations throughout the United States.

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Posted by David | Posted on 19-08-2009

HealthCheckUSA Health Alert: STD Testing Recommendations

Category : Blood Testing, std testing

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STD Testing Recommendations: Part 1

By Mayo Clinic staff , Mary Gallenberg, M.D.

STD testing: What to know before your appointment
Not all doctors perform the same lab tests for sexually transmitted diseases, known as STD testing. Learn which STD lab tests you may need, which you might have to ask for and the limitations of STD testing.

If you’re sexually active, particularly with multiple partners, you’ve probably heard the following advice many times — use protection and make sure you and your partners receive routine STD testing. But what’s included in routine STD testing? Not all doctors test for the same STDs. And some STDs — some of which can’t be fully prevented by condom use — can’t be tested for. So even if you ask your doctor to test you for everything, this doesn’t mean that you or your partner will be screened for or clear of all STDs.

The only way to fully protect yourself against STDs is to abstain from sex. However, if you’ve decided to be sexually active, routine STD testing is important to managing your health. Mary Gallenberg, M.D., a specialist in obstetrics and gynecology at Mayo Clinic, Rochester, Minn., helps clarify what kinds of STD tests are important and how to ensure you get them.

If you’re sexually active, what routine STD lab tests are most important?

STD Lab Testing For Women:
At a minimum, get a Pap smear — a simple procedure that collects cells from your cervix to test for cancer or precancerous changes. This type of cancer can arise as a result of a human papillomavirus (HPV) infection — a common STD. Pap smears are recommended for women who are age 21 and older or no later than three years after a woman’s first intercourse. If you’re a woman between age 30 and 69, you may only need a Pap smear every two to three years if you’ve had three normal Pap smears in a row and have had no new sexual partners.

STD Lab Testing For Men:
Centers for Disease Control and Prevention (CDC) guidelines don’t suggest routine STD screening if you don’t have any symptoms, unless your sexual practices include having sex with men.

If you are a man who has sex with men, annual screening for HIV, syphilis, Chlamydia and gonorrhea is recommended. HIV and syphilis can be life-threatening if untreated, and Chlamydia and gonorrhea can put you at greater risk of acquiring HIV and other STDs.

STD Lab Testing For Men and Women:
Also see your doctor for STD testing if you have any signs such as genital sores, including fluid-filled blisters, ulcerations or warts, or if you have unusual discharge from your penis or vagina. If you’re a woman, abdominal pain or fever along with unusual discharge may indicate pelvic inflammatory disease (PID) — an STD-related condition that can cause infertility.

The CDC also encourages voluntary HIV testing, at least once, as a routine part of medical care if you are an adolescent or adult between the ages of 13 to 64. The CDC advises yearly HIV testing if you are at high risk of infection, for example if you’ve had unprotected sex with more than one sexual partner since your last screening.

What other STD testing do you recommend?
First, don’t assume that during an annual exam or Pap smear that you’re also receiving STD testing. This may not be the case. If you think you need STD testing, you must request it from your doctor. Talk to your doctor about your concerns and what tests you’d like or need.

Gonorrhea and Chlamydia STD Testing
If you are a sexually active girl or woman under age 24, or a woman older than 24 and at risk of STDs — for example you are having sex with a new partner or multiple partners — get screened annually for gonorrhea and Chlamydia. If untreated, these infections can cause PID in women. Gonorrhea and Chlamydia can also significantly increase your risk of acquiring other STDs like HIV. If you are a man who has sex with men, get tested for these infections at least annually.
Gonorrhea and Chlamydia screening is either done through a urine test or through a swab inside the penis in men or from the inside of the cervix in women. The sample is then analyzed in a laboratory. Screening is important, because you can be unaware that you have either infection. For example, approximately 80 percent of women and 50 percent of men diagnosed with Chlamydia don’t have symptoms at the time of diagnosis.

Syphilis, hepatitis and HIV STD Testing
If you test positive for gonorrhea or Chlamydia, you’re at greater risk of other STDs such as syphilis, HIV and hepatitis and should get tested for these infections.

In addition, request HIV, syphilis and hepatitis testing if you:
• Have had more than one sexual partner since your last screening
• Use IV drugs
• Are a man who has sex with men
• Are concerned you’ve been exposed

Your doctor tests you for syphilis by taking either a blood sample or a swab from any genital sores you might have. The sample is examined in a laboratory. A blood sample is taken to test for HIV and hepatitis A and B.

It’s possible that you may test negative for syphilis or HIV if you’ve only just recently acquired the infection. If you or your doctor suspects this is the case, you may need to be rescreened at a later date. Talk with your doctor if you have concerns about this.
Consider vaccination for hepatitis A and B. You can prevent these infections by receiving the vaccines.

What about other common STDs like genital herpes and human papillomavirus (HPV) infection?

Genital herpes and STD Testing
Unfortunately, no good screening STD test exists for herpes, a viral infection that can be transmitted even when a person doesn’t have symptoms. Your doctor may take a tissue scraping or culture of blisters or early ulcers, if you have them, for examination in a laboratory. But a negative test doesn’t rule out herpes as a cause for genital ulcerations.

A blood test may also help detect a herpes infection, but, again, results aren’t always conclusive, particularly if you’re not experiencing signs and symptoms of an active stage. Some blood tests don’t distinguish between types 1 and 2 of the herpes virus. Type 1 is the virus that more typically causes cold sores, although it can also cause genital sores. Type 2 is the virus that more typically causes genital sores. You may ask for a “type-specific” IgG blood test, which differentiates between the two, measuring antibodies to the viruses in your blood. Still, the results may not be totally clear, depending on the sensitivity of the test and the stage of the infection. False-positive and false-negative results are possible.

HPV STD Testing
HPV, an infection that can be transmitted even when a person doesn’t have symptoms, is a condition contracted from one of a group of more than 100 related human papillomaviruses (HPVs). Some of the viruses cause cervical cancer, others cause genital warts. Some never cause any problems. At least 50 percent of sexually active men and women will acquire an HPV infection within their lives, and that number jumps to 80 percent of women by age 50.

Being infected with certain types of HPV is the most important risk factor for developing cervical cancer. Women over age 30 may choose to receive a Pap test (to test for cervical cancer) every three years along with a human papillomavirus (HPV) DNA test. The HPV test is collected with a brushing from the cervical canal. Women with both a negative Pap test and a negative HPV DNA test are at low risk of developing significant precancerous changes of the cervix over the next three years. The combination of Pap smear and HPV DNA testing is not Food and Drug Administration (FDA) approved for screening women younger than 30 because HPV infections that will ultimately clear up on their own are more common in this age group, and a positive test result may lead to unnecessary additional testing and treatment.

The HPV DNA test can test for both low-risk types of HPV, which may cause genital warts, and high-risk types that may cause cervical cancer. Your doctor may recommend testing only for the high-risk types because of their threat to your health. Since no treatments exist for HPV itself — although treatments do exist for genital wart outbreaks caused by HPV — paying for a test to find the low-risk types may be of little use to you.

No HPV test is available for men with the exception of visual inspection or biopsy of genital warts if they are present.
Girls and women ages 9 to 26 can help prevent HPV infection by receiving the HPV vaccine. This vaccine protects against the two strains that cause 70 percent of cervical cancers and the two strains that cause 90 percent of genital warts.
STD testing: What to know before your appointment

Are all STD tests always done?
No, as mentioned earlier, men should receive STD testing if they have symptoms, have sex with other men, or if a partner tests positive for an STD. In women, HIV, syphilis and hepatitis testing may be done if other STDs are present. Testing for herpes is only usually done if symptoms are present. And HPV testing isn’t available for men, and only sometimes done for women older than 30.
Ask to be tested for other STDs if you’re concerned. Some tests may be expensive and your insurance may not cover them.

What STD tests are commonly covered by insurance?
Insurance companies differ in what services are covered. Check with your insurer, and if STD testing isn’t covered and you can’t afford to pay, consider testing through HealthCheckUSA. HealthCheckUSA provides affordable STD lab testing that is totally anonymous, confidential and convenient. HealthCheckUSA has over 5,000 locations nationwide for STD Lab Testing Services.

What do you suggest to someone considering having sex with a new partner or who may be at risk of an STD?
If you can’t trust a partner not to give you an STD, you may not want to have sex with that person. You can ask them to be tested for gonorrhea, Chlamydia, HIV, syphilis and hepatitis, but negative tests for these may mean the infection is just in too early of a stage to detect. Also, there are no good screening tests for herpes, and HPV testing is limited — men can’t be tested unless they have visible warts, and HPV testing generally isn’t recommended for women younger than 30.

If you decide to have sex, use condoms. Condoms help protect you against life-threatening infections like HIV. However, condoms don’t fully protect you against every STD. For example, condoms may not cover all of the skin that might contain an HPV or herpes virus, so the condoms may reduce, but not eliminate, the chance of such a virus being transmitted to you. In fact, you can be exposed to these viruses through genital to genital or mouth to genital contact, not just through intercourse.

If you have sex, you put yourself at some risk even with the most thorough STD testing and condom use, and you have to accept that risk.

If a person tests positive for an STD, what’s the next step?
If you test positive for an STD, the next step is to consider further testing and then to get treatment as recommended by your doctor. In addition, inform any partners. Your partners need to be evaluated and treated, because you can pass some infections back and forth.

Expect to feel various emotions. You may feel ashamed, angry or afraid. These are all normal feelings. Some STDs are very common so you aren’t alone. You’ve done the right thing by getting tested and you can now discuss treatment and how this might affect current or future relationships. Talk with your doctor about your concerns.

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Posted by David | Posted on 19-08-2009

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What you don’t know can hurt you. Ventura County’s lesser-known and most popular STDs

By Kit Stolz, 07/30/2009

The most feared of all sexually transmitted diseases (STDs) is the potentially deadly AIDS/HIV virus, which in 2005 struck 30 people in Ventura County, according to the Department of Public Health.

That, ironically, is the good news. The rate of AIDS/HIV infection has stabilized in recent years, and even declined slightly from that of five years ago.

The bad news is that more than 50 times as common as the HIV/AIDS virus is a sexually transmitted bacteriological disease called chlamydia. Chlamydia is epidemic in the United States, and the rate of infection in Ventura County has doubled in the last 10 years.

Chlamydia was diagnosed in 1,570 people in Ventura County in 2005, the most recent year for which there are official statistics. Most of those who contracted the disease were young. Nearly one-quarter of those who came down with the sexually transmitted disease (STD) were teenagers, and almost one-half of those who contracted the STD disease were between the ages of 20 and 24.

It’s the most frequently reported of all sexually transmitted diseases (STDs), both nationwide and in Ventura County. Although it’s not the most common of sexually transmitted diseases (STDs), it’s one of the most likely to cause problems if not treated.

The real hazard of chlamydia is not that so many people have it and know it, but that a far larger number of people have it and don’t know it.

“It’s one of the most common infections we see,” said Dr. Kirk Cook, who works as a family doctor and serves as a public information official for the county, “but the number of cases we see is just a fraction, because most people who contract this disease do not have symptoms.”

According to the U.S. Centers for Disease Control, about three-quarters of infected women and about one-half of infected men do not show signs of chlamydia.

If symptoms do appear, they show up within one to three weeks after infection.

In women, medical experts say that the most common symptom is a vaginal discharge, pain during urination, pelvic pain or pain during sex.

In men, the most likely symptom is a burning experienced during urination. Because men’s sexual organs are simpler, the disease is more likely to be seen, but symptoms can vary. One Ventura County patient, who wished to keep his identity private, found a sore on his penis after a sexual adventure overseas.

“It didn’t hurt, but it was gross,” he said. “I couldn’t believe it. I never saw anything like it. It looked like a crater on my dick. It just got bigger and bigger. I had to go to the doctor.”

Easy to cure and easy to contract, again Chlamydia is one of the easiest of all sexually transmitted diseases to treat. A single dose of an antibiotic pill named azithromycin can cure the disease, although doctors typically ask patients to return to take a second dose of the medicine, because one-quarter or more of those who are initially diagnosed with the disease are reinfected within months, usually by the same partner who passed on the disease in the first place.

“In California, the largest population affected by this disease are in the ages of 15-25,” said Cook. “I think that’s partly because these are people who are not mature adults, and also because chlamydia is not a disease that kills people, the way the HIV/AIDS virus can, so it’s easy to get complacent. But if this disease goes untreated in women, it can lead to pelvic inflammation and scarring of the fallopian tubes. This is a disease with bad long-term consequences for fertility.”

If a woman has no symptoms, or overlooks cramping, pain or a bloody discharge, the chlamydia infection can spread, often resulting in PID, or pelvic inflammatory disease, which can damage a woman’s reproductive organs. According to the Guttacher Institute, an international nonprofit organization focused on sexual health, about 20 percent of women who contract PID will lose their fertility permanently.

Why patients often don’t know who gave them the STD Disease
According to Dr. Adina Nack, a sexual health educator at Cal Lutheran University who published a book last year about women’s experiences with sexually transmitted diseases such as HPV, the human papillomavirus, STDs can remain hidden in the body and without symptoms for so long that a patient often isn’t sure who gave him or her the disease.

“One of my interviewees had been married once, gotten divorced, and then when she was with her second husband came down with symptoms of a sexually transmitted infection,” Nack said. “We tend to think that if we are exposed to one of these diseases, that we will get the symptoms within a short period of time, but it’s very possible to be exposed to an STD and not see your first symptoms for upwards of 18 months.”

This was the case of one young Ventura County woman, “Helen,” who had gotten engaged to be married when she suffered her first outbreak of genital herpes. She assumed at the time that her fiance had given her the disease, despite his denials, but now realizes that she probably picked it up when she was an undergraduate in college.

“It was horribly painful, and I blamed him,” she said. “I had no idea what was happening to me — I didn’t know anybody who had had herpes. It caused a lot of stress in the relationship, and we eventually broke up.”

Genital herpes is not on the list of sexually transmitted diseases reported to government medical authorities because, according to the Centers for Disease Control, blood tests for genital herpes can be “difficult to interpret.”

Blood tests can detect the presence of antibodies to herpes, but cannot reliably distinguish between herpes simplex type 1, which is more likely to cause fever blisters around the mouth, and herpes simplex type 2, the virus which usually causes genital herpes.

The virus is the most common sexually transmitted disease, infecting an estimated 45 million to 60 million Americans, according to the CDC.

Herpes can be passed on even if no symptoms are present. Although antiviral prescription drugs such as Valtrex can make the disease less painful and contagious, it’s still a disease profoundly damaging to what Nack, in her book Damaged

Goods, calls a woman’s “sexual self.”

An older woman in the San Fernando Valley, “Jamie,” wrote in an e-mail interview how she was devastated by a diagnosis of herpes simplex type 2 from a lover who died before she found out that he gave her the sexually transmitted disease.

“I was so wounded that I shut down socially. I had no social life for many years and did not even think about dating. I could not begin to imagine the misery and humiliation of having to have that infamous ‘talk’ that we, who know we have herpes, are supposed to have with a potential mate or lover. It is ironic because those who are spreading it are those who do not know they have it, which is most people with herpes,” she said.

Recovering from a sexually transmitted disease (STD)
According to Nack, the emotional devastation “Jamie” experienced when she caught a sexually transmitted disease is often what happens to women who contract STDs. Nack thinks this reflects the way we as a people have decided to look at sexual health.

“In this country, we consistently want to hold women responsible for sexual health, but not their male partners,” she said. “You can see this attitude play out with the Gardasil vaccine, which can protect against HPV (human papilloma virus, aka genital warts) in both men and women, but which has been marketed only to young women, and not as an HPV vaccine, but as a cancer vaccine. I don’t think we’re doing men any favors by letting them off the hook when it comes to taking care of their sexual health. They won’t get cervical cancer, but I have seen some seriously bad cases of genital warts on men.”

Nack points out that more than 6 million new cases of HPV are diagnosed each year, making it the second most common sexually transmitted disease after herpes. Complicating matters is the fact that the test for cervical cancer, the Pap smear, can detect the presence of abnormal HPV-altered cells around the cervix, but cannot detect the genital wart virus on external sex organs. A doctor who isn’t careful can give a patient the impression she doesn’t have HPV when she does, or can lead a patient to fear cervical cancer, when in fact she may only have contracted the virus that can sometimes develop years later into cervical cancer.

All too often, according to Nack’s research, doctors stumble over the complexities and uncertainties of diagnosis of sexually transmitted disease, especially in women. Two-thirds of the more than 40 women she interviewed at length complained that their doctors misdiagnosed their STDs, failed to explain them clearly, or even hurt them unnecessarily in treatment, adding to the pain and confusion.

Patients often go into “diagnostic shock” when they learn they have a sexually transmitted disease, Dr. Cook confirms.

“If a patient has symptoms, sometimes the diagnosis comes as a relief, especially with chlamydia, which is easy to treat,” he said. “But sometimes a patient will say, ‘I don’t even know what you’re talking about,’ or, ‘I never heard of it.’ Part of a doctor’s job is education, and with STDs, that means encouraging patients to contact sexual partners and encourage them to come in for treatment.”

Christine Lyon, of Planned Parenthood in Santa Barbara, points out that young patients are often reluctant to go to their family doctors for tests or treatments, knowing that this will likely spark questions from parents. She encourages young people who suspect they have an STD, or who want to know how to protect themselves, to visit Planned Parenthood or a county health clinic if a visit to a family doctor sounds intimidating.

“One in four young women in this country have an STD,” she said. “A lot of those cases are chlamydia. The known rate of chlamydia is higher in women than in men, but that’s probably because they are more likely to receive routine screening. Our goal is to treat anyone who comes through the door and wants reproductive health services.”

The good news about STDs
Contracting a sexually transmitted disease (STD) often turns out to be a strengthening experience in the long run, according to Dr. Nack. Many of the women she interviewed look back on themselves before they were infected as naive and passive, too compliant to the wishes of men.

“Once you decide you might want to be intimate with someone, you have to have ‘The Talk.’ You have to get your partner to be as honest as possible about their sexual health,” Nack said. “Because there’s a heavy moral stigma against being sexually active, it’s difficult for young girls to take an assertive role, but it’s really necessary. Condoms are great for preventing fluid-borne STDs, such as HIV, chlamydia, and gonorrhea, but skin-to-skin contact still takes place in sex, and that can pass other STDs, such as HPV and herpes.”

“Jamie” completely agrees that women must protect themselves, and objects fiercely to victims of sexually transmitted diseases being blamed for their misfortune.

“The herpes social stigma really makes me mad because it is the only serious harm it does to most people who contract, it,” she wrote. “It is not fair to make us lepers. I hate the stereotype ‘herpes whore.’ I got it while being faithful to a man I loved, a guy who should have gotten a special Oscar for Performance in a Personal Life. If you have sex with anyone — and at some point nearly everyone does — you risk contracting the herpes simplex virus. We are not bad people. We are unlucky.”

“Jamie” has taken to wearing confrontational T-shirts in public places, with slogans such as “VALTREX” or “HERPES DISCLOSURE.” She watches the expressions on the faces of people she passes, curious to see if they’re shocked, horrified or understanding, and gives out information on herpes if they’re curious.

She writes that she has mostly taken this one-woman personal sexual education campaign to places such as Venice Beach, but this summer plans to go to more conservative places.

If you see her, she hopes you will say “hi” and be accepting. She says she is only trying to protect you from the pain and heartbreak of coming down with an STD.

HealthCheckUSA offers many STD lab tests that are affordable and do not require a doctor’s prescription. We have over 5,000 lab locations throughout the United States.

Recommended STD Lab Tests

Comprehensive Sexually Transmitted Disease (STD) Panel