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HealthCheckUSA Health Alert: Oprah and Bioidentical Hormones FAQs

Wednesday, August 26th, 2009

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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.”

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HealthCheckUSA Health Alert: Most Important Lab Tests Women Should Have

Wednesday, August 26th, 2009

By Dr. Rwanda Campbell, August 6, 2009

1. A Pap Smear Test examines cells for any changes that may indicate the possibility of cervical cancer. Campbell recommended that the first test be conducted at the age of 20 or at the onset of sexual activity and continued annually until age 65 or 70. She said some insurance companies allow the test annually and others cover the test every three years if test results are normal. Even if the pap smear isn’t performed every year, Campbell said it is important for every woman to have an annual pelvic exam.

2. A cholesterol blood test is important because high cholesterol levels have no symptoms but can be deadly. Excess LDL, or bad cholesterol, can cause build-up in the arteries and interfere with blood flow. HDL, the good cholesterol, has protective qualities and can remove LDL from the blood. Some pediatricians now test cholesterol levels and Campbell said everyone should get a baseline test by the age of 20. The test should be repeated at least every five years until the age of 45. Anyone older than 45 with a family history of heart disease or high cholesterol levels should be screened annually. While medications are available to lower cholesterol levels, the physician said it is better to lower cholesterol through diet modification.

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3. Breast exams are recommended at age 30 and every three years after that while mammograms are recommended annually beginning at age 40. A clinical breast exam checks breast tissue for lumps, thickening or other changes that warrant follow-up. Mammograms are X-rays of the breast tissue that may find cancers when they are still too small to be felt. Breast cancer is most curable if it is found in its earliest stages. Campbell said genetic testing is available to women whose mothers or sisters have had breast cancer.

4. Skin cancer screenings should begin by the age of 30 and be conducted annually thereafter. A primary care provider or dermatologist may do head-to-toe screenings. Skin cancer is the second most common cancer in women and is curable if it is caught early. Women with fair skin, repeated sunburns, many moles and a family history of skin cancer are have the highest risk of developing skin cancer.
5. Thyroid lab tests are needed to make sure the gland is functioning properly. The thyroid gland regulates the way the body uses energy. If the thyroid gland is overactive, it may lead to rapid weight loss and nervousness. If it isn’t up to speed, a person may feel weak, fatigued, generally unwell, depressed and suffer from excessive vaginal bleeding. Early diagnosis can avoid more debilitating conditions like heart disease, high cholesterol and stroke, she said. Screenings should begin at the age of 35 and continue every five years, or more often if the woman experiences thyroid symptoms or has risk factors, such as a family history of thyroid problems. Thyroid problems may be adjusted with medication.

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6. Blood pressure levels are checked every time a person visits a doctor. High blood pressure levels can lead to heart attack, stroke, heart failure and kidney damage. High levels produce no symptoms. Campbell said high blood pressure is often weight related for women. Blood pressure readings should be below 140/90. High blood pressure, or hypertension, may be treated with lifestyle changes and/or medication.

7. Diabetes is a condition in which the body doesn’t make enough insulin or has a reduced response to insulin. It will cause blood sugar levels to be too high and increase the person’s risk of heart disease and stroke. It can also result in birth defects during pregnancy and premature menopause. Screening guidelines call for testing by the age of 45 or sooner if risk factors are present. Campbell recommended screenings before that and for any woman who is overweight.

8. Colonoscopies examine the large intestine for signs of colon cancer, which is 90 percent curable if found early. Growths and polyps may be removed and biopsied during the test. Preparation for the test (a bowel cleansing) is a bigger challenge than the test itself because patients are usually asleep during the procedure, the physician said. The first screening is usually done when the patient turns 50 and is repeated every 10 years if no polyps or risk factors exist. Higher-risk patients, such as those with a family history of colon cancer, should get their first test 10 years before the family member was first diagnosed and every five years after that.

9. Bone-density scans measure the mass of a patient’s bones and assess her risk of developing osteoporosis. Campbell said a broken hip could be a life-changing event; it can mean moving to a nursing home. Weight-bearing exercise, Vitamin D and calcium help build bone mass in younger patients, but medicines may be needed in older patients. Women may lose up to 20 percent of their bone density in the five to seven years after menopause. Campbell recommended women have their first bone-density screenings by age 65 and that they be repeated every five years. Doctors may suggest testing at an earlier age for patients who are underweight, have ever smoked, have a recent history of broken bones or a family member with osteoporosis.

10. Hormone Blood Tests that Assess your menstrual cycle is the last test for women and one that directly affects quality of life for many women. Campbell said she encounters patients who live in fear of having menstrual accidents and who won’t leave home because their flow is too heavy. “That is not normal,” she said. “There are many options available for women today.” Medications and ablation may both reduce the severity and length of periods. Hysterectomies, which used to be the only option, are now considered options of last resort.
- Women’s Comprehensive Blood Testing Profile

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

Wednesday, August 26th, 2009

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

Wednesday, August 26th, 2009

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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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HealthCheckUSA Health Alert: STD Testing Recommendations Part 2

Wednesday, August 26th, 2009

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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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HealthCheckUSA STD Alert: STDs and Common Symptoms

Tuesday, August 25th, 2009

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STD Testing Recommendations: 7 STDs and Common Symptoms

By Mayo Clinic staff

If you’re having sex, you may also be experiencing STD symptoms. STD symptoms can occur regardless of what type of sex — vaginal, oral or anal — you’re having, or whether you use condoms. Although condoms when correctly and consistently used are highly effective for reducing transmission of STDs, no method (other than abstinence) is 100 percent effective. This is particularly true with certain STDs, such as genital warts and genital herpes.

STD symptoms can range from subtle to obvious. If you think you’re experiencing STD symptoms, see a doctor to get tested for STDs. Some STD symptoms can be treated easily and eliminated. Other STD symptoms require more involved and long-term treatment.

Either way, it’s essential to be STD tested via blood or urine, and — if diagnosed with an STD — be treated. It’s also essential to inform any partners so that they can be evaluated and treated. If untreated, STDs can increase your risk of acquiring another STD such as HIV. This happens because an STD can stimulate an immune response in the genital area or cause sores, either of which might make HIV transmission more likely. Some untreated STDs can also lead to infertility.

Common STDs and their Symptoms

Chlamydia
Chlamydia is a bacterial infection of your genital tract. Chlamydia may be difficult for you to detect because early-stage infections often cause few or no signs and symptoms. When they do occur, they usually start one to three weeks after you’ve been exposed to Chlamydia. Even when signs and symptoms do occur, they’re often mild and passing, making them easy to overlook.

Gonorrhea
Gonorrhea is a bacterial infection of your genital tract. The first gonorrhea symptoms generally appear within two to 10 days after exposure. However, some people may be infected for months before signs or symptoms occur. Signs and symptoms of gonorrhea may include:
• Thick, cloudy or bloody discharge from the penis or vagina
• Pain or burning sensation when urinating
• Frequent urination
• Pain during sexual intercourse

HIV
HIV is an infection with the human immunodeficiency virus. HIV interferes with your body’s ability to effectively fight off viruses, bacteria and fungi that cause disease, and it can lead to AIDS, a chronic, life-threatening disease.

When first infected with HIV, you may have no symptoms at all. Some people develop a flu-like illness, usually two to six weeks after being infected. Early HIV symptoms may include:
• Fever
• Headache
• Fatigue
• Swollen lymph glands
• Rash

These early symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, you are very infectious. More persistent or severe symptoms of HIV infection may not appear for 10 years or more after the initial infection.

As the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic symptoms such as:
• Swollen lymph nodes — often one of the first signs of HIV infection
• Diarrhea
• Weight loss
• Fever
• Cough and shortness of breath

Signs and symptoms of later stage HIV infection include:
• Persistent, unexplained fatigue
• Soaking night sweats
• Shaking chills or fever higher than 100 F (38 C) for several weeks
• Swelling of lymph nodes for more than three months
• Chronic diarrhea
• Persistent headaches

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Genital herpes
Genital herpes is highly contagious and caused by a type of the herpes simplex virus (HSV). HSV enters your body through small breaks in your skin or mucous membranes. Most people with HSV never know they have it, because they have no signs or symptoms. The signs and symptoms of HSV can be so mild they go unnoticed. When signs and symptoms are noticeable, the first episode is generally the worst. Some people never experience a second episode. Other people, however, can experience episodes over a period of decades.

When present, genital herpes symptoms may include:
• Small, red bumps, blisters (vesicles) or open sores (ulcers) in the genital, anal and nearby areas
• Pain or itching around your genital area, buttocks or inner thighs

The initial symptom of genital herpes usually is pain or itching, beginning within a few weeks after exposure to an infected sexual partner. After several days, small, red bumps may appear. They then rupture, becoming ulcers that ooze or bleed. Eventually, scabs form and the ulcers heal.

In women, sores can erupt in the vaginal area, external genitals, buttocks, anus or cervix. In men, sores can appear on the penis, scrotum, buttocks, anus or thighs, or inside the urethra, the tube from the bladder through the penis.

While you have ulcers, it may be painful to urinate. You may also experience pain and tenderness in your genital area until the infection clears. During an initial episode, you may have flu-like signs and symptoms, such as headache, muscle aches and fever, as well as swollen lymph nodes in your groin.
In some cases, the infection can be active and contagious even when sores aren’t present.

Genital warts (HPV infection)
Genital warts, caused by the human papillomavirus (HPV), are one of the most common types of STDs. The signs and symptoms of genital warts include:
• Small, flesh-colored or gray swellings in your genital area
• Several warts close together that take on a cauliflower shape
• Itching or discomfort in your genital area
• Bleeding with intercourse
Often, however, genital warts cause no symptoms. Genital warts may be as small as 1 millimeter in diameter or may multiply into large clusters.
In women, genital warts can grow on the vulva, the walls of the vagina, the area between the external genitals and the anus, and the cervix. In men, they may occur on the tip or shaft of the penis, the scrotum or the anus. Genital warts can also develop in the mouth or throat of a person who has had oral sex with an infected person.

Hepatitis
Hepatitis A, hepatitis B and hepatitis C are all contagious viral infections that affect your liver. Hepatitis B and C are the most serious of the three, but each can cause your liver to become inflamed.

Some people never develop signs or symptoms. But for those who do, symptoms may occur after several weeks and may include:
• Fatigue
• Nausea and vomiting
• Abdominal pain or discomfort, especially in the area of your liver on your right side beneath your lower ribs
• Loss of appetite
• Fever
• Dark urine
• Muscle or joint pain
• Itching
• Yellowing of your skin and the whites of your eyes (jaundice)

Syphilis
Syphilis is a bacterial infection. The disease affects your genitals, skin and mucous membranes, but it may also involve many other parts of your body, including your brain and your heart.

The signs and symptoms of syphilis may occur in four stages — primary, secondary, latent and tertiary.

Primary
These signs may occur from 10 days to three months after exposure:
• A small, painless sore (chancre) on the part of your body where the infection was transmitted, usually your genitals, rectum, tongue or lips. A single chancre is typical, but there may be multiple sores.
• Enlarged lymph nodes.
Signs and symptoms of primary syphilis typically disappear without treatment, but the underlying disease remains and may reappear in the secondary or third (tertiary) stage.

Secondary
The signs and symptoms of secondary syphilis may begin two to 10 weeks after the chancre appears, and may include:
• Rash marked by red or reddish-brown, penny-sized sores over any area of your body, including your palms and soles
• Fever
• Fatigue and a vague feeling of discomfort
• Soreness and aching
These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.

Latent
In some people, a period called latent syphilis — in which no symptoms are present — may follow the secondary stage. Signs and symptoms may never return, or the disease may progress to the tertiary stage.

Tertiary
Without treatment, syphilis bacteria may spread, leading to serious internal organ damage and death years after the original infection.
Some of the signs and symptoms of tertiary syphilis include:
• Neurological problems. These may include stroke and infection and inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis). Other problems may include poor muscle coordination, numbness, paralysis, deafness or visual problems. Personality changes and dementia also are possible.
• Cardiovascular problems. These may include bulging (aneurysm) and inflammation of the aorta — your body’s major artery — and of other blood vessels. Syphilis may also cause valvular heart disease, such as aortic valve problems.
If you suspect you have an STD, see your doctor.

If you suspect you have these or other STDs or that you may have been exposed to one, see your doctor for STD testing. Timely diagnosis and treatment are important to avoid or delay more severe, potentially life-threatening health problems and to avoid infecting others.

HerpeSelect Herpes Simplex Virus 1 and 2 IgG Blood Test

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