Booster Shots

Oddities, musings and news from the health world

Category: STDs

Take care. Viagra treats erectile dysfunction, not -- repeat, not -- STDs

July 6, 2010 | 12:48 pm

Viagra The benefits of erectile dysfunction drugs are well- documented. They may be double-edged as well.
 
In a study published Tuesday in Annals of Internal Medicine, researchers analyzed pharmacy data for men over 40 who had received a prescription for an erectile dysfunction drug. We'll let them sum it up:

"Men who use ED drugs have higher rates of STDs, particularly HIV infection, both in the year before and after use of these drugs."

Here's the abstract from the STD study, the journal's information for patients and the pertinent-facts WebMD story: Men on ED Drugs Get More STDs. (Reuters cast it this way: Viagra-popping seniors lead the pack for STDs. ... That's right: "Seniors.")

As for what erectile dysfunction drugs can -- and can't -- do, please refer to this Viagra (sildenafil) information from rxlist.com. It's quite blunt, stating near the top of the page:

"Use of this drug does not protect against sexually transmitted diseases (e.g., HIV, hepatitis B, gonorrhea, syphilis). Practice "safe sex" such as using latex condoms. Consult your doctor or pharmacist for more details."

The information on Levitra (vardenafil) and Cialis (tadalafil) say the same thing.

-- Tami Dennis

Photo credit: AFP/Getty Images


Genital herpes is widespread, CDC says

March 9, 2010 |  4:32 pm

Nearly one in every two African American women ages 14 to 49 has genital herpes, the Centers for Disease Control and Prevention said Tuesday. Overall, two out of every five blacks in that age group carry the virus, and one out of every six Americans, the agency announced at an STD Prevention Conference in Atlanta.  The proportions have not changed since the agency's last estimate for the period 1999 to 2004. About 80% of those who carry the virus do not know they are infected. Women appear to be particularly susceptible to infection, with 21% of women infected, compared with 11.5% of men.

"The message is herpes is quite common," Dr. John M. Douglas Jr. of the CDC's division of STD prevention said in a telephone news conference. "The symptoms can often be very innocuous," which explains why so many are unaware of their condition.

Genital herpes, known more precisely as herpes simplex virus type 2 or HSV-2, is the most common sexually transmitted disease in the country. It can cause recurrent and painful genital sores. The infections cannot be cured, but lesions can be controlled with antiviral drugs such as Zovirax, Zirgan and Valtrex, which halve the likelihood of transmission to a sexual partner. The virus is most commonly transmitted when sores are present in the genital area but can be transmitted even when they are not. "Many individuals are transmitting herpes to others without even knowing it," Douglas said. The agency does not recommend widespread screening for infections but does suggest that people with symptoms that might be caused by the virus be tested by their physicians. Surveys reported at the conference suggest that many people, especially women, are anxious or uncomfortable about seeking STD testing and are unwilling to have a positive result appear in their medical records.

Research has shown that people who are infected with HSV-2 are two to three times more likely than others to contract HIV. The virus can also render HIV-positive people more likely to transmit the virus to others. Dr. Kevin Fenton, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TM Prevention, noted in the conference that the wide dissemination of HSV-2 in the black community may be partialy responsible for the high incidence of HIV infections there. Although African Americans make up only 12% of the U.S. population, they account for 50% of all HIV infections.

The new data come from the CDC's National Health and Nutrition Examination Survey and cover the years 2005 to 2008. The prevalence is down slightly from the previous survey, but the difference is not statistically significant.

A different herpes virus, herpes simplex virus type 1, causes oral sores and is not considered to be as serious.

The CDC estimates that about 19 million new STD infections occur every year in the United States and that the infections cost the healthcare system $16 billion annually.

-- Thomas H. Maugh II


Let's not ignore these gems on self-control, table saws and HPV infection

January 16, 2010 |  8:00 am

Pity the diligent researchers who went up against the Big Medical News of the week. Their papers might not have gotten as much attention as studies about PTSD (quick administration of morphine after a traumatic event might preempt the condition) or the nation's weight (Americans have finally grown weary of the term "obesity epidemic" and started cutting back), but they caught our eye. So we're sharing...

Cookies - Rather than curse your lack of self-control -- too many chips, cigarettes or drinks, too few morning jogs, salads or normal portions -- maybe you should just get new friends. That's our conclusion anyway. What University of Georgia researchers found was that people with good self-control enhance our ability to practice the same. Similarly, the excess-prone can erode our self-control. Simply thinking about the respective types was enough to have an effect on behavior.
On second thought, maybe you should keep your fun friends and just think about your dour acquaintances when you're out having a good time. Here's the news release -- plus the abstract
from the series of studies, published in the Personality and Social Psychology Bulletin (this abstract's really only useful if you want to purchase a copy of the research).

- Table saws are a menace to fingers and thumbs -- and they're no less of a threat today than they were 18 years ago. Their nonoccupational (often translated as "amateur") use resulted in about 565,670 emergency room visits from 1990 through 2007, an average of about 31,000 a year. The total number of injuries rose 27%, but the rate of injuries, based on population, was pretty much the same.

Most injuries were, unsurprisingly, to the fingers and thumbs, and men accounted for 97% of the injuries. So say researchers from the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. Here's the abstract, published online in the Journal of Trauma, and the news release.

- Ah, young love. It rarely spares a thought for HPV infection. But it should -- 56% of young adults in a new sexual relationship have human papillomavirus; 44% have a type that can lead to cancer. New relationships are when HPV transmission is most likely.

Here's the abstract in the journal Sexually Transmitted Diseases, another one in Epidemiology and the news release from McGill University. Also of note: The name of the study is the HITCH Cohort. And condoms were found more likely to protect men than women.

(In case you missed the Big Medical News, here's a link to the PTSD story and the obesity story.)

-- Tami Dennis

Photo: How many you eat could depend on your companions. Choose wisely.

Credit: Los Angeles Times


More from the week: Chlamydia, breast cancer, Hispanics in nursing homes

January 9, 2010 |  8:01 am

They may not have made headlines this past week, but these research developments are worth noting. So consider them noted (if not thoroughly developed in this space).

-- One might think that frequently screening and treating teenage girls for chlamydia would cut back on just how common the disease is in that age group. Not so.

Turns out there are a lot of reinfections. Here's the abstract, published in the Journal of Infectious Diseases, and here's the news release from Indiana University.

-- We can talk about quality-of-care standards, but that doesn't mean doctors will follow them. When it comes to procedures to ensure coordinated cancer care, for example, most breast cancer surgeons might just go their own way.

So suggests a survey of surgeons in Detroit and Los Angeles. Here's the abstract, published in the January issue of Medical Care, and the news release from the University of Michigan Health System.

-- As for nursing home quality, elderly Hispanic people are more likely to live in not-so-good ones, at least as compared to their white counterparts. The findings come as the percentage of Hispanics in nursing homes increases.

Here's the abstract, published in Health Affairs, and the news release from Brown University.

-- Tami Dennis


STD screening should start early

December 7, 2009 |  1:00 pm

Young women should be screened for sexually transmitted diseases within a year of first intercourse and should be retested every three to four months if an infection is found, according to a study published today in the Archives of Pediatrics and Adolescent Medicine.

Researchers at Indiana University followed 386 urban women who were age 14 to 17 when the study began. They found that most participants had intercourse at a young age (between 13 and 15). By age 15, 25% of the women had acquired an STD, most often chlamydia. The average time between first intercourse and the first STD infection was two years. Repeated infections were common. Within six months, 25% of the women with prior chlamydia, gonorrhea or trichomoniasis were reinfected.

Many untreated STD infections carry serious health consequences, including raising the risk of developing a serious infection called pelvic inflammatory disease, HIV infection and later infertility, ectopic pregnancy and preterm birth. The U.S. Preventive Services Task Force and Centers for Disease Control and Prevention have recommendations for STD screening, but those documents are somewhat vaguely worded. "Neither group has made evidence-based recommendations on the most appropriate starting age and the most appropriate frequency of screening," the authors wrote in the paper. This study suggests that starting at a young age and conducting regular screening may prevent many health problems among women later.

-- Shari Roan


For mild dysplasia and cervical cancer, you can blame HPV

November 20, 2009 |  4:48 pm

Gardasil Mild cellular changes detected by Pap smears don't necessarily lead to cancer, a fact that played a role in the new pullback on cervical cancer screening, but both cell changes and cervical cancer can be traced to human papillomavirus.

As today's story noted: "Human papillomavirus, or HPV, which causes cervical cancer and infects half of all young women within a few years of sexual activity's start, also causes cell changes called dysplasia. Those abnormal cells are typically removed before they become cancerous. But such treatment may not be necessary."

Here's an overview of cervical dysplasia from the Women's Health Channel. It notes that up to 70% of mild cases resolve on their own.

The likelihood of progression depends on the amount of dysplasia. Here's what the site says about the stages.

And here are some questions and answers about human papillomaviruses, which have also been linked to cancers of the anus, penis, vulva and vagina -- and to genital warts. The information is from the National Cancer Institute. Of note: There are more than 100 types of HPV;  some are considerably more likely to cause cancer than others.

It states: "Both high-risk and low-risk types of HPV can cause the growth of abnormal cells, but only the high-risk types of HPV lead to cancer. Sexually transmitted, high-risk HPVs include types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 73. These high-risk types of HPV cause growths on the cervix that are usually flat and nearly invisible, as compared with the external warts caused by low-risk types HPV–6 and HPV–11. HPV types 16 and 18 together cause about 70% of cervical cancers."

The Gardasil vaccine can protect against some, including types 16 and 18, but not all.

-- Tami Dennis

Photo: The HPV vaccine protects against four strains.

Credit: European Pressphoto Agency


Girls and young women have higher rates of both chlamydia, gonorrhea

November 16, 2009 | 10:00 am

Today, we get new data on chlamydia, gonorrhea and syphilis infections in the United States. And it appears that girls and young women age 15 to 19 -- especially African American girls and women -- are at considerable risk; they have the highest number of cases of both chlamydia and gonorrhea. 

Increased screening may be responsible for some, but not all, of these numbers, the report says. Among the highlights of the 2008 data from the federal Centers for Disease Control and Prevention:

-- Chlamydia: 1.2 million total cases reported; 342,875 in the aforementioned age group. Women are more likely to be severely affected in the long term, experts say, but men and women likely have similar disease rates. Men just don't get tested as much.

-- Gonorrhea: 336,742 total cases reported, again with girls and young women having the highest rates. Experts believe the true number is almost twice this amount.

-- Syphilis: 13,500 total cases reported, most among men who have sex with men.

What's needed, the report says, is better screening and treatment -- and behavioral interventions (safe sex, among other things). And, it says, we must do something about the racial disparities. 

Here's the summary of the new data, with highlights. And here's the full report: Sexually Transmitted Disease Surveillance, 2008.

-- Tami Dennis


To reduce the risk of genital herpes, use a condom -- every time

July 13, 2009 |  4:22 pm

Condom We've assumed that condoms can reduce the spread of genital herpes -- but without complete, or at least well-quantified, confidence in the assumption.  

This fact sheet from the federal Centers for Disease Control and Prevention sums up the reason for such hesitation: "Genital ulcer diseases can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered."

Then there's the problem of transmission without visible signs of infection. As the National Institutes of Health states: "Most people get genital herpes by having sex with someone who is shedding the herpes virus either during an outbreak or an asymptomatic (without symptoms) period. People who do not know they have herpes play an important role in transmission because they are unaware they can infect a sexual partner."

Researchers at the University of Washington, the federal Centers for Disease Control and Prevention and elsewhere decided to try to clarify just how much condoms can reduce the spread of genital herpes, known medically as herpes simplex virus 2 (or HSV-2).
 
They analyzed six studies of various types, all of which featured data on individual condom use and on HSV-2 acquisition.

They found that people who always used condoms had a 30% decreased risk of acquiring genital herpes when compared with people who never used condoms.

In clarifying further, the researchers stated: "Risk of HSV-2 acquisition decreased by 7% for every additional 25% of the time that condoms were used during anal or vaginal sex. Risk of HSV-2 acquisition also rose steadily and significantly with increasing frequency of unprotected sex acts, and our findings were consistent throughout multiple analysis strategies."

The results were published today in the Archives of Internal Medicine. Here's the abstract.

The upshot of the study: "Although the magnitude of protection was not as large as has been observed with other STIs, we found that condoms offer moderate protection against HSV-2 acquisition in men and women."

Here's more information on genital herpes from the National Institutes of Health, including details on asymptomatic shedding:

"Sometimes, the virus can become active but not cause any visible sores or any symptoms. During these times, small amounts of the virus may be shed at or near places of the first infection, in fluids from the mouth, penis, or vagina, or from barely noticeable sores. This is called asymptomatic shedding. Even though you are not aware of the shedding, you can infect a sexual partner during this time. Asymptomatic shedding is an important factor in the spread of herpes."

And here's the aforementioned fact sheet on genital herpes from the CDC.

The key here is consistent use. Not sometime use, but consistent use.

-- Tami Dennis

Photo: A health worker in the Philippines conducts a seminar recently on the proper use of a condom.

Credit: Francis R. Malasig / EPA


For men, a not-very-persuasive argument for the HPV vaccine

June 3, 2009 |  7:13 am

Possibly contrary to common knowledge, human papilloma virus can and does affect men, leading to genital warts and, less often, cancer of the anus or penis. But it's best known for its role in causing cervical cancer. Men, lacking a cervix, are less concerned about this than women.

But maybe men don't know they can pass along the virus to women. Maybe they don't know that getting the vaccine could help protect current and future loved ones. Maybe if they did, they'd get the new vaccine that protects against some types of the virus. Maybe ...

It's not happening. In a study published this year in the journal Sexually Transmitted Diseases and now being touted by Florida State University, one group of male college students was told about the vaccine's potential benefits to them and another group was told about its potential benefits to them and their partners. Neither message had much effect.

The news release. The abstract from the journal.

These were college-age men, mind you. And it's possible that older men with longtime partners or wives might feel differently. But it also seems likely that women not inclined to get the vaccine wouldn't be swayed by the partner-protection message either. It's not just one shot -- it's three of them.

Other recent news on the HPV vaccine from the Los Angeles Times:

HPV vaccine may benefit older women

HPV: Men can get it too

And basic information on the virus from the CDC.

 --Tami Dennis


Rodent of the Week: Why herpes recurs

March 27, 2009 |  1:48 pm

Rodent_of_the_weekThe problem with herpes viruses is that one infection isn't enough. After the initial infection, the virus enters neurons and hides, occasionally escaping from this period of latency to cause a flare-up of the disease. Now, however, researchers have a good clue as to why the virus recurs.

In studies in mice, researchers identified a viral protein, called VP 16, that appears to be the key to the dormancy and reactivation of the virus. Researchers at Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine caused a high fever in a mouse with herpes. Certain triggers, such as fever, are known to cause herpes to reactivate. The researchers found that VP 16 must be produced before the virus can leave the neuron and reactivate. The study is published in the journal PLoS Pathogens.

"This completely changes our thinking about how this virus reactivates from latency," said Richard Thompson, a co-author of the paper and researcher at the University of Cincinnati, in a news release. "Instead of a simple positive switch that turns the virus on following stress, it appears instead to be a random de-repression of VP 16 gene that results in reactivation."

Knowing this should help researchers devise ways to prevent the virus. There is no treatment to eliminate herpes from the body or prevent it from reactivating although antiviral medications can help prevent outbreaks and stop the spread of the disease to some degree.

-- Shari Roan

Photo credit: Advanced Cell Technology Inc.



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