Sunday, January 11, 2015

Have you ever had a Toilet Seat transmitted disease ( T-STD) ?


No. No one has. It's not a thing.


To be blunt, it is called a sexually transmitted disease or infection ( STD/STI) for a reason. It happens by way of a sexual encounter. The toilet seat, short of a bad case of back splash, can't be blamed. Nor can you acquire a STI from shared towels or clothing ( unless you are getting very creative, in which case anything is possible, I suppose).


This means, if you test positive for an STI, your partner and you are both infected. You both need to be tested for confirmation. You both need to be treated. You both need to abstain from sex until the treatment is complete. You both should probably be retested to confirm the treatment worked. Oh, and there probably should be a discussion about safe sexual practices.


I can't begin to tell you how much I dread making the phone call when a patient of mine tests positive for an STI. Most commonly, it is Chlamydia. Occasionally, Gonorrhea. And ever so often, making a ratchet mess of all things good, Syphilis. I dislike these calls for no other reason than the utter shock and confusion I am usually greeted with on the other end of the line. Followed by denial. " How is it possible, my partner and I have only been with each other!" If I wait long enough with a suggestive silence in response to the question ...they eventually reach the right conclusions.


If you have not had sex with anyone else, your partner has. Infections such as the ones I mentioned above are acute infections. And though they can have long lasting, or chronic effects, they typically are a real time reflection of your sexual partner history.


One of my patients came to me bawling because her husband threatened to leave her after she tested positive for the big C. " I just don't understand, how could this happen, I haven't been with anyone else since " she said.  " It must be the infection I got from my boyfriend from two years ago happening again I guess" she said.  Fortunately, she was pretty meticulous about her follow up and had been seen in my practice for all of her care for the past 5 years. That meant I had access to all her results, treatments, and retesting. She had been appropriately treated ( confirmed by a negative follow up test). This wasn't chlamydia by miraculous infection. She had gotten re-exposed. After reviewing it over with her, she realized that her husband was not being as honest as she had hoped. " That M#$!^*F@#$%*! A$$!" she said.


Again, the above anecdote is only applicable for STI's such as Chlamydia, Gonorrhea, Trichomonas, and crab louse. There are, however, STI's that can't be directly linked to your current partner for time of exposure. These include Herpes ( the gift that keeps on giving),  HPV ( commonly known for genital warts, but more morbidly associated with cervical cancer), and Syphilis. These infections have a dormant phase and can demonstrate recurrent cycles of outbreaks ( Herpes), or gradual progression with worsening outcome if left untreated ( HPV and Syphilis). So please abstain from chasing your significant other with a golf club because your pap smear came back HPV (+). At least in this scenario, it would not be appropriate.


In addition to being able to figure out where you acquired the aforementioned infections, it is also critical to focus on  1. Avoiding acquiring them 2. Being able to identify when you have been exposed 3. Ensuring the right treatment and follow up as soon as possible.


1. Beyond the baseline unpleasant symptoms of an STI, there are some important reasons to avoid it in the long term as well. Primarily, fertility. That's right, you might not be thinking about it in your teens or even in your twenties ( or as in the case of yours truly, even in her 30's) but the ability to become pregnant sharply declines after having a single infection. In fact, it can go to as high as 50% reduction after 3 infections. It can also lead to pelvic inflammatory disease ( PID) - a fabulously painful consequence of STI's that can leave your pelvic anatomy looking like a grenade went off from the inside with the scarring that can develop after ( not a gynecologist's dream surgery, let me tell you). Prevention can only be guaranteed by either abstinence or consistent use of condoms. Birth control pills do not protect against STI's. I repeat, pills prevent pregnancy, condoms prevent chlamydia. Got it?


2. Identifying when you have been exposed can be, well, trichy. ( see what i did there?). Women don't always show symptoms ( neither do men, another reason why prevention is key). However, common symptoms can range from spotting and no pain to purulent discharge, odor...oh, and agonizing " my uterus is on fire" sort of pain. With infections such as trichomonas, you might have itching, a fishy odor and a grayish discharge. See references for more detailed lists. And pictures. Ahh the pictures.


3. The right treatment, at the right time- a single oral dose of azithromycin as soon as you become aware of your infection. Its a simple as that!  ( for chlamydia and gonorrhea that is). But persistent infection is common so it is important to complete treatment and not engage in intercourse during the treatment period. Also, if you don't feel comfortable contacting your partner(s) about your (shared) infection, your physician will be happy to do it. It is important to ensure everyone gets treated to ensure your partners health and yours ( nothing like karmic chlamydia coming back at you for round 2!) and we are trained in making those kinds of calls.


Here is my go to patient information source for STI (D)'s.

http://www.cdc.gov/std/default.htm

Feel free to contact me for any questions or concerns.


Be happy, be healthy!


ObGynKanobi OUT!


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