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Hi, I'm Dr. Edwin Thorpe, an OB-GYN with UT Medical Group. Thanks for joining us today and I'm ready to take your questions. Our topic today is Sexually Transmitted Diseases. Teens and young women are most at risk for the silent epidemic of STDs, such as chlamydia. This infection is particularly devastating for women because of its reproductive consequences.

Q: What are the signs of an STD?

Dr Thorpe: Unfortunately, many STDs have no signs or symptoms. In particular, chlamydia, herpes simplex, hepatitis B infection, and HIV. Therefore, screening becomes important. However, for females, common signs include an abnormal vaginal discharge or the presence of a sore on the genital region or possibly pain the lower pelvis.

For men, a penile discharge, with or without pain, or a sore or bump in the genital area would be the most common signs.

People who should request screening would include sexually active women between the ages of 15 and 25 or young men with symptoms. Screening involves a variety of tests that can be done in a doctor's office or clinic, including evaluation of the vaginal discharge, cervix, and sometimes a pap smear.

Q: I was wondering if it's dangerous to have a lot of partners. How much would my likelihood of getting an STD increase?

Dr. Thorpe: Certainly the more partners one has the more likely one can be exposed to an STD that has no symptoms. Particularly, if no condoms or barriers are used. Some experts estimate that with each new sex partner, your risk for an STD can increase by as much as 50 percent.

Q: When I get antibiotics for a bronchial infection won't that take care of an STDs I might have?

Dr. Thorpe: Not necessarily. Many antibiotics for respiratory infections have little or no activity against a variety of STDs. For instance, antibiotics are not effective for herpes, hepatitis B, or a variety of viral STDs.

Q: How can I tell if a girl has a disease?

Dr. Thorpe: As I mentioned before, an abnormal vaginal discharge or the presence of a sore on the genital region or pain the girl's lower pelvis are common signs.

However, if one suspects that you may have a disease, you should immediately go to see a doctor or health practitioner who can do a variety of evaluations to look for a variety of STDs. This can include an HIV test which is recommended for anyone who suspects they may have an STD.

Because they involve the cervix, uterus, and fallopian tubes, chlamydia infections can cause inflammation that can result in pelvic inflammatory disease and subsequently, infertility because of blocked fallopian tubes. Also women who are able to coneceive after chlamydia infections will often have a pregnancy in the fallopian tube, called ectopic pregnancy, because of the scarring left over from the chlamydia infection.

This type of scarring and inflammation is known to occur without signs or symptoms.

This is why regular checkups for sexually active young women is so important. These checkups should include a pap smear as well as a screening test for chlamydia. Safe sex practices clearly help to prevent these types of infections. Limiting the number of sex partners, preferably monogamous relationships or abstinence, have shown to be very effective.

Q:What is endometriosis? Is that a sexually transmitted disease?

Dr. Thorpe: Endometriosis is not a sexually transmitted disease and has no relationship with infections of any kind. Endometriosis is a condition in which tissue normally found in the uterine cavity is implanted outside the uterus on the fallopian tubes, ovaries, and other structures, that results in inflammation and pain over time.

Q I'm afraid to talk to my doctor about this and my mother will probably be with me. How can I get treated without her finding out? At my last checkup the doctor didn't even ask me if I was having sex.

Dr. Thorpe: This is a tough situation. Sometimes changing doctors may help. Some doctors will ask parents to leave so they can talk to the patients by themselves. That's something I do routinely. And that allows me to ask the important questions that need to be asked about sex, sexuality, disease, and pregnancy prevention. May I ask how old you are?

Comment: I am 16, I have been having sex for two year now.

Dr. Thorpe: There are limitations to how effective screening can be. Certain types of infections, for instance, herpes simplex, can't readily be diagnosed unless there is a sign. For instance, a sore on the genital area. Blood tests that are available are not always reliable.

You can try to talk to your doctor or possibly a nurse practitioner in their practice. If you could somehow indicate that you would like to be seen alone, that would be best. Maybe you could call the doctor's office before you come and tell the nurse you'd like to talk with the doctor privately.

Q: My fiance and I have a question. What causes water-like blisters on the bottom of your feet? We both get them on the right foot.

Dr. Thorpe: While I'm not a dermatologist, I believe this condition is called "hyperhydrosis" which is related to excessive perspiration in a specific area. I would recommend that you see a dermatologist if this is a problem.

Q: Is there a test to check for all STDs, or does one have to check for each one individually?

Dr. Thorpe: That's a good question. Most STDs have to be diagnosed individually. Some can be diagnosed using a blood test, and therefore, several diseases can be diagnosed that way. For instance, HIV, hepatitis B, hepatitis C, syphillis. Other diseases require an examination or a test from a specific genital site.

Q: Are home hiv tests reliable?

Dr. Thorpe: Home HIV tests are not considered to be the definite answer for the diagnosis of HIV. It is recommended that any positive home test be confirmed by a standard HIV blood test. HIV tests are available at no charge through the Shelby County Health Department. Any test result at some point should be supplemented with a standard HIV test because false negatives and false positives can occur.

Q: Does your doctor screen for STDs every time you go to him or do you have to ask for it?

Dr. Thorpe: No. Screening for STDs is usually based on a risk factor assessment. In other words, asking about what things may make someone more likely to have an STD. For instance, more than one sex partner, having sex without protection, having had an STD in the past.

Q: Don't they screen for all of them when you get married?

Dr. Thorpe: Not necessarily. Some states require a negative blood test for syphillis before a marriage license will be issued. However, screening for all STDs before a marriage license can be issued is not mandatory.

Q: My girlfriend says if you smell bad you have a disease, but I dont' know what it should smell like. can you explain?

Dr. Thorpe: Frankly I am confused by the question. Bad odors can result from a variety of things, including bad body hygiene and other diseases that cause odors to be produced in sweat. If you have a discharge that has a bad odor, that may indicate that there is an STD or some other infection and should be evaluated by a health practitioner.

Comment: Thanks very much. This has been fun and informative!

Dr. Thorpe: I'm glad you gained some additional information. And I'm curious about the smelling bad issue because many women will douche because they have odors. This is a practice where women use various types of solutions to rinse their vagina for cleanliness. This is really bad as a practice because it can lead to infections and other problems.

Q: I am on the pill, but I have missed a couple of days because I couldn't get a new pack right away. Will that get me pregnant?

Dr. Thorpe: Missing pills won't get you pregnant. Having sex will. Seriously, anytime you miss pills and continue to have unprotected sex, you run the risk of getting pregnant. That's why it's so important to not only take pills as directed but also to use condoms as a pregnancy backup and principally, to prevent STD’s.

Q: How can I tell if my (male) partner has an STD?

Dr. Thorpe: Thanks for asking. The fact is that most men with STD’s do not have symptoms. In contrast to women who may have a discharge, pain, etc., that can indicate a problem. For most men, a discharge from the penis with or without pain is the most common sign of chlamydia or gonorrhea. However, many other STD’s, including papilloma virus, herpes, often have no symptoms or signs.

Q: I heard a former partner has herpes. We were together for about two months. When would it show up in me or is there a possibility I won't get it?

Dr. Thorpe: How certain are you that he has herpes? And how do you know that he had the disease when you were together? That's why it may be difficult to know if you have it without a fairly sophisticated blood test for herpes. If it were positive for herpes, that still would not indicate that he was the source of the infection. After exposure to herpes, it usually takes anywhere from 1-3 weeks before signs show up. But remember most people with herpes have no signs or symptoms.

Q: Is shingles herpes?

Dr. Thorpe: Shingles is not herpes. It is chickenpox that has become re-activated in very specific areas of the body. The virus that causes chickenpox is part of the herpes virus family of viruses. This is why the treatment of shingles utilizes the same medications that are used for genital herpes.

Q: How long is it possible to have herpes without symptoms?

Dr. Thorpe: some individuals may have infection with herpes virus and never have symptoms. The virus is shed from the skin without visible lesions or lesions can be in concealed places like the vagina or cervix or the penile urethra without any signs.

Genital herpes infections are not curable but are controllable if outbreaks are frequent and painful, or both.

Q: Can you tell me the difference between a bladder infection and an STD?

Dr. Thorpe: Good question. Because some symptoms of a bladder infection--for instance, pain with urination--may not be due to a bladder infection but an infection of the urethra with chlamydia or gonorrhea. A check up in which the urine is tested for infection and a pelvic exam with a proper testing for STD’s should help to distinguish the two.

You can reach me at UT Medical Group at 880 Madison at 448-6632.

Moderator: Thanks for your questions everyone. We appreciate you participating.

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