Hi doc

Well, ... had sex with an ex girlfriend - we both cheated on our spouses. Horrible affair. It was kind of a drunken quicky, vaginal, nothing extraordinary - not even very pleasant. In fact, the self loathing started before the sex...
She of course swears that this event was the only sex she ever had outside her marriage. However, I cannot account for her general faithfulness and I know she was quite experimental when we dated some 15 years back.

I'm avoiding sex with my wife at all costs but have not had the courage to break the news to her.

After the..., you know, event.... I had 5 days of combivir PEP, antibiotic PEP (three white tablets, one of one kind and two of another which was explained to me as the standard prophylaxis) as well as Hep A&B innoculation some 17 hrs (but no immunoglobulin) after the event.

Guilt and anxiety ridden, I then started on a series of tests. Most of these were apparently taken before appropriate elapsing of window periods. Two doctors attended to me during this time, however neither one claims to be an expert in this field. Their general attitude is friendly but dismissive of my overt concerns and due to the "low risk exposure" they are apparently not overly concerned with testing window periods, which in my opinion defeats the purpose of getting peace of mind.

The schedule below sets out the general gist of test, times and results.

I'm going for a final HIV PCR next week - about 6 weeks PE - (and knowing myself, I'll probably find myself taking an Elisa at 3 or 4 months as well...)

Within the first two weeks, I had a lot of discomfort in the perineum and surrounding areas. I eventually developed a dull pain in my testicles (like an unwelcome but gentle squeeze) that radiates up thhrough my pelvis and stomach cramps about 2 weeks+ into this mess. I went to our regualar GP, whom I obviously told nothing about the sexcapades. He treated me for stress induced Colon infection/ IBS with some antispasmodics?, anti anxiety goodies and antibiotics (I think a 1 a day for 3 days regime of Ciprobay XR). Things got better for a while, but I have since developed some musculo-skeletal pains, nausea, dry burning eyes and leg pains that come and go, which I ascribe to anxiety and stress. (I even use some fancy names such as "sciatica", "fibromyalgia", "pelvic floor dysfunction" and such, but I also understand that I don't fit the clinical criteria for most of these) I find however that some excercise works for most of my symptoms. Otherwise I get the odd itch in the crotch and some of those, Oh-no-its-a-burning-sensation!! moments on my penis. Hard to tell what is real, what is different and what is just, well, an itch. Nothing lasts for more than a minute or two, but tomorrow is the same thing...
Still, many of my current symptoms are "flu-like" - and we know what happens if you type "flu-like" and "std" in the Google search engine... Then again I'm better today - and no fever so far! Not that I know of - damnit! Keep on double guessing myself, and well, there is the dull pain on the right of my penis agian like clockwork. I cannot keep this up - if you'll pardon the pun.

Could you please give me some guidance on the following -

1) Does it appear that my antibiotic treatment would prevent most if not all bacterial risks of my exposure?

2) I think the Hep B Surface antigen test at 17 days was a waste of money. However, do I need to do more Hep B testing in view of my innoculation after the event and the 24 day qualitative PCR?

3) Should Hep C be a concern to me at all?

4) I'm happy about the positive HSV1 IgG, as I understand it may provide some limited protection against subsequent HSV2 exposure. I know (was told...) the IgG is prone to "cross-reactions" and false positives, but in view of the negative result I guess I got the better roll of the dice. There is however conflicting reports on the reliability of the HSV2 IgM at 9 days. Some even say a 4-6week window applies (and a 6-8 for the IgG), although my doctors seem quite happy with that result. Dr. Hunter of www.medhelp.org is particularly unhappy with the IgM. I qoute: "You are right about the "suspect nature" of IgM antibody for HSV infection, but the test is even worse than you might know. HSV IgM antibody testing is basically useless, except perhaps in diagnosing HSV in newborns....The basic problems are that for HSV in adults, IgM antibody often doesn't appear earlier than IgG, even with initial herpes"

Am I at the right place, or is it time to move on to a psychiatrist?

Thanking you in advance with much appreciation.

Regards

Hi, I wanted to know if I should get tested. I never had vaginal sex before but I have performed oral sex and I have received oral sex. The last time I was intimate was August 2004. However, in 2006 or 07I learned that my ex (whom I performed oral on) had unprotected sex with a man before he met me and he said he got tested and he was clear or whatever. But I never got my self tested to make sure and I read that you can't always go by somebody else results. I think about it all the time and wonder if I could have contracted a STD from him. I have no symptoms but I rather be safe than sorry. I was thinking about ordering the "STD Panel 4 Remote Exposure" from your website just to clear the air and prevent me from possibly exposing another man in the future, just in case. What's your opinion? Thanks in advance.

Hi,

Action is always betters tha worrying. Since your exposure was in 2004 a negative resulta in tte Complete Remote panel would clear the air.

In good health

Dr. Gian

Hello Dr G,

I couldn't agree more with your statement about despair, anxiety and resentment when it comes to this virus! After much research & consulting with Dr.'s, we're still left with many questions & doubts. Forgive the long email but, we need as much information as possible in order to make informed decisions.

I am 49 yr. old male...(excellent health) dating a 49 yr. old woman(excellent health) for the past 8 mos. A few weeks ago, she noticed a few blemishes in the pelvic area & was dx with Molluscum by her Gyno. Topical treatment resolved them..( I only wish I could say the same for our relationship).. Her gyno feels it was sexually transmitted. I have NEVER been with anyone else during our relationship. She claims the same & I believe her based on what I know of her morals & family values etc.. The Last sexual contact with others was virtually the same for both of us..about 1-2 Mos..prior to us meeting. P.s. I've never had ANY noticeable bumps/pimples in that area ...altho' a week after her diag. my dermatologist removed One, tiny ..flat, red spot from there...which turned out to me the 'M'. Also, about midway thru the relationship I was tested for all STD's with Negative results. Naturally, doubt has crept in to the relationship as we both try to find 'explanations' for other than it being sexually transmitted. Note: we have ALWAYS had protected sex.

As she is an Elementary school teacher (& its prevalence in children) I theorized that she may have touched a contaminated surface and contracted it that way..

Question 1.? If so, would she have had to touch the area (pelvic) the lesions showed up? need clarification as Ive learned that when Adults get it..it tends to settle in that area..but, not sure if it can enter one area...and show up in another WITHOUT touching that area.

Question 2 ? Being familiar with the stated incubation period, Is it possible...lets say, I contracted from my previous partner BUT...it had a long incubation & therefore I wasn't contagious until 4 - 6 mos? THEN, if transmitted to her...it didnt appear for a few months ..thereby explaining the lengthy period for it to appear?

Question 3 ? Do the 'lesions' ALWAYS follow the same development cycle? e.g. Over time do they always grow larger ? OR could they just appear as small ..red blemishes and stay that way for a long period where I may not have noticed? (or her on herself) As I say, Ive never had anything resembling the example photos Ive seen online... but, like most...have had little dots or tiny 'bumps' ( no head) in that area. Ive learned that the lesions can last for 1-2 yrs avg...and wondered if thats a possibility or would they DEFINITELY be noticed.

A few other notes... we've traveled quite a bit...various locales and hotel rooms ...and I've read where items such as clothing, bedding, toys, towels and other surfaces can be contaminated & wondered about that probability. Is there ANY other probable scenario which you can think of that would explain (other than sexual) our situation? I am beside myself & very anxious about the possible damage to our trust & relationship this can cause. I dont' blame her as she was deceived in a past relationship & has to be cautious. Its killing me that Im innocent of any wrong doing & can't seem to come up with info to prove otherwise.

Thank you in advance for any help/ advice you can offer... I know you must be very busy & receive loads of emails... Please answer at your earliest convenience....

Best regards,

Hi,

Molluscum is an innocent virus, easily spread, slightly on the rise in the US, of little health concern and rather than “blamishes” it shows up as small, waxy, round, raised polyp-like growths (often with a tiny depression in the middle) which may be single at first, but can multiply into clusters and contain a firm, waxy, white/yellowish substance. http://dermatlas.med.jhmi.edu/derm/result.cfm?OutputSet=2&BO=AND&Diagnosis=39

The infections source is usually skin to skin contact especially when present in the genital aerea but many other sources of infection are known such as contaminated towels, clothing, toys, benches and exercise equipment and even contaminated bedspread in a hotel. Molluscum spreading is made easier in the presence of stressed out skin areas i.e. sunburn, burns from too much chlorine in a swimming pool, eczema, scrapes, rug and razor burns, etc.

And…like the herpes virus, spreading to different parts of their body may occur due to autoinoculation by touching or scratching a bump and then touching another part of the body.

The manifestation of any infection and also for molluscim is always a transaction between the charge of the infective agent and your immune system modulation. Therefore several scenarios of clinical manifestation are possible within the congruity of certain ranges.

http://www.lib.uiowa.edu/hARDIN/MD/molluscum.html

http://www.cdc.gov/ncidod/dvrd/molluscum/overview.htm

I hope this information help giving an answer to your “questions and doubts” although, it seems to me. that the fundamental questions and doubts have to do with the presence of a breakdown in reciprocal trust rather than a health concern and “informed decisions” in such a situation need to come more from a reciprocal sharing of personal integrity rather than arguments based on statistical or scientific information.

Stay Well

Dr. Gian

From:
To: Dr.Gian
Subject: Pregnancy

Hi Dr.Gian

Well I have been reading a lot of articles on herpes and pregnancy and genital warts and pregnancy. Well my issue is that I have both. I have only had 1 herpes outbreak, which was my first, and got put on Valtrex. Currently I am taking one pill daily for prevention and have not had any second episodes. As for my warts I had my first out break and got some treatment for them and I really haven’t had any problems since just 1 or to small ones and they disappear. I am now planning to have a baby and I want to know how can that effect me and my baby as well my delivery choices other options I might have or if even I should have a baby.

Thank you I will appreciate your help and honesty!!

Hi,

First let me say that your ultimate reference about how to manage the herpes infection and minimize the risk to your baby is… a talk to your obstetrician or midwife. However, I have good news for you. Having herpes does not mean having hard choices in having a baby.
First element in your favor: You acquired herpes before getting pregnant and not during pregnancy, especially during the last part of pregnancy. Transmission rates are lowest for women who acquire herpes before pregnancy.
Second, herpes of the newborn is remarkably rare and while it is estimated that 20-25% of pregnant women have genital herpes only less than 0.1% of babies contract an infection. Compared to other risk of pregnancy, neonatal herpes is very small especially when the Mom does not have an active outbreak. Neonatal herpes occurs mostly from asymptomatic shedding (when the virus reactivates without causing any symptoms) especially.
Third: herpes antibodies in the mother's blood cross the placenta to the fetus and babies of mothers with long-standing herpes infections have a natural protection against the virus. Even women who acquire genital herpes during the first two trimesters of pregnancy are usually able to supply sufficient antibody to help protect the fetus. The higher rate of asymptomatic shedding, plus the lack of antibodies, create a greater risk for babies whose mothers become infected in the last trimester.
Only if a woman has a herpes lesion at delivery or complaints and symptoms which are called pro-dromal and occur immediately preceding the herpes, the OB-GYN may recommend a cesarean delivery to prevent the baby from coming into contact with active virus. Between 10% and 14% of women with genital herpes have an active lesion during delivery. The odds are higher for women who acquire herpes during pregnancy, and lower for women who have had herpes for more than six years.
Although some mothers, even without herpes lesions at the time of delivery, do request a C-section and put them selves at an higher delivery risk because they want to do everything possible to avoid infecting their babies. the standard of care recommended by the American College of Obstetrics and Gynecology (ACOG) is vaginal delivery. In your case, since you do not seem to have large and vaginal obstructing and/or bleeding vaginal warts, vaginal delivery would be also recommendable for your warts concern.

From:
To: Dr. Gian
Subject: Testing procedures

Dear Dr. Gian:

My girlfriend and I will be using on of your test centers for std testing. She insists that the only

conclusive way to properly test males for certain stds is by obtaining a sample from inserting a collection instrument into the urethra in the penis. Do you do this form of sample collection? Is this true, over just blood samples?

Thanks, Chris

Hi Chris,

I believe you are referring as " certain stds" the following : Chlamydia, Gonorrhea and Trichomonas. These are the ones where we use a swab inserted into the urethra. However today we have also a urine test available for Chlamydia and Gonorrhea which is widely used and very accurate. It is called the PCR test and it is done both in males and females. This is what we do. And we also, of course, do many other tests for STD, such as HIV, Syphilis, Herpes, Hepatitis etc. which require instead the taking of blood samples.

Thank for using our testing centers.

Dr. Gian

From: anonymous
To: dr.gian
Subject: Help please

Good Evening Dr Gian

I have a problem and it is getting me down.I had flu last week and i got my tablets, after my tablets were finished i got a burning and itchy feeling by my vagina.

My husband went to the chemist and got me the yeast infection cream I started using that but does not seem to take the itchy burning away. this morning when I got back from town I went to the toilet to discover that my vagina is swollen and itchy, painful and burning.

I looked closer and it had tiny spots on the vagina it looked like a scab that came of (its usely wet) but mine isn't it is dry but painful. on my lips I have spots it looks like pimples but they are itchy. Is this STD or Bacterial infection?

I can sleep at night as it is really sore please help me

(I know my partner hasn't been anywhere because he is always by my side)

Please reply soon

Please keep me anonymous

Regards

My dear,

I think you should get tested for Herpes 1 and Herpes 2 antibodies and repeat the test in 3 months if you are negative. Your symptoms are highly suggestive (almost a textbook description) of a Herpes Genitalis infection and you also should see a Doctor if things do not improve. Treatment is available and is very effective. Discuss this with your husband and have him tested too.

Stay well

Dr. Gian

From: Anonymous
To: Dr.Gian
Subject: Sex with sexual Workers

Hi Dr Gian.

I have had several encounters with prostitutes over the last 18 months. 8 to be exact. I know this was not the best idea and i do regret it after the encounters but drink has made me think its a good idea at the time! I now see sence and do not wont to go down that road again! I just want to put it behind me and to relax my mind that i havent caught an STI off one. I used a condom on every ocassion and i dont see any symptoms. My genitals do ach but i thought that was just through the sex i had recently with one. but i just wanted to know is there a high risk of me getting an STI? I hear that prostitues are very careful and are checked out regualry to be safe.

Hi,

Sex with sexual workers exposes you to a high risk of contracting a sexually transmitted disease and leaves you emotionally empty because of lack of intimacy. You do not seem to have symptoms and I hear a concern and a desire to make changes. So my advice is to get a panel of STD after you allow enough time from last exposure (so that you do not have to repeat some of the test) and before you act next time stop and observe what is that triggers your unwanted behavior, usually an unrecognized emotional state. If you do so you may find out that you do have a choice.

Stay well

Dr. Gian

From:
To: Dr.Gian

Subject: genital warts

Dr. Gian,

Just recently I found a few small genital warts on the shaft of my penis. I went to a urologist for some prostate pain and had him diagnose those as well. He was not 100% sure that this is what I had, but he did prescribe some cream to be applied directly to the warts for the 3 days on/ 4 days off treatment. I am on round one of the treatment and it appears to be working. A couple few questions for you:

I am recently divorced and would eventually like to date and have kids. How do I best ensure that I don’t transmit the HPV virus for a pregnancy? While the virus does not go away, it is less virulent when there are no warts present? In other words, is it ever safe to have unprotected sex with a new monogamous partner again?
Have you ever recommended the various herbal remedies that claim to rid your body of both the warts and HPV..such as Goodbye Wart? How effective do you think these really are?

I have had no other systems of any other STDs...no pain, no discharges, no fevers,sweats, weight loss, etc. Would you still recommend a full panel test?

Hi,

HPV cells become part of you once you get them. In man this is not a major problem ad exception for the cosmetics of the warts themselves. The cream used is Aldara which is indicated for the treatment of warts/condyloma acuminata in the external genital and in the area around the anus in individuals 12 years and older. It is quite effective although I personally have more experience and I have preferred more Condylox 0.5% solution especially for larger warts. The usual length of a treatment is about a month and, at times, one may need a second cycle of treatment.

You may be aware that is now available a vaccine to prevent HPV infections in young women, Gardasil, and is the only vaccine that may help guard against diseases that are caused by human papillomavirus (HPV) Types 6, 11, 16, and 18, the one associated with cervical cancer.

There are some herbal extract which are immune modulators and immune-response modifiers with high concentration of polyphenolic compounds (strong antioxidant) and I do not hesitate to recommend those in addition to other modalities of immune strengthening such as good nutrition in general, exercise and peace of mind.

I certainly would recommend a full, comprehensive panel of STD test using the time of exposure as the criterion upon which to base your choice.

In good health

Dr. Gian

From: Anonymous
To: Dr.gian
Subject: Herpes

Dr Gian,

Hello, I am a 22 year old female who is feeling quite scared at the moment. I have what feels like a cut, or small sore on the outer labia of my vagina and am afraid that it's Herpes. I have been with the same boyfriend for a little over a year now, with neither of us having outside partners, and we have both previously tested negative for the STI. Logically, I don't see how I could have gotten Herpes so long ago, evading blood tests, and then showing up a year later, but since I have been feeling run down and sick lately, and I take sexual health seriously, I am quite anxious. I first noticed it the morning after having particularly rough sex, and was considering the possibility of the sore being just an aggravated cut or scrape. I plan on getting to a doctor as soon as possible, but today is a Sunday and tomorrow is a holiday. Is there any advice you could give me to ease my mind until then??

Thank you very much,

Hi,

If Herpes is the question you should try to get a culture right away when the ulcer is still fresh. The chances of a false negative, however, are high (over 50%). Serology (blood test for antibodies) is the best choice for you. Ask for IgG type specific antibodies and remember that they may appear in one's blood anywhere from 2 weeks (a minority) to 3 months. Otherwise you need to retest if negative. This issue of time is valid also for the test you did before. The possibility you mention, however, cannot be excluded.

Wish you well

Dr. Gian

From: Anonymous
To: Dr.gian
Subject: Exposure

Hello

I went to Las Vegas and got drunk and did the most stupid thing a person of my age and stature could do. I am very worried now with reason. I am married and have a very loving and understanding wife. I cannot tell you how helpless it feels. I would like to know what tests should be done at this time. It would have been nice if someone could of reminded me that when this is done it not only affects your life but the life of everyone around you and of the things that you can get.
I recently had prostatitis and was treated for a month with sulfa drugs.
I had an uncomfortable feeling in my penis the next day. I would also take a cranberry and acidolphys herb for symptoms from prostatitis.
I went to the hospital and they took a sample for Chlamydia, and Herpes. They gave me 500 Mg Levaguin 1 tablet and Doxycylene 100 mg 2 x day for 7 days. I am lost. This is nothing you can fix or undo. This may have very well ruined my life. People should know this.

I didn't know what to do. I see on the STD Web side you have special panels.
What should I get? I also see that there is a panel for after 4 months. If I come out of this with nothing or something that is treatable it would be a blessing from god. I am such an ASS. I have a business and know a lot of people in this area. My wife doesn't want me to communicate to our local physician.
What is the best course to take?

Thank You I'm Lost

Hi,

Let me tell you few biological reasons as to why people are willing to forgive a mistake which is always an afterwards, and not in the moment, realization. The reasons are that, although we always talk about a firm, undisputed reality over there, independent of us, we all know that in truth we cannot trust our perceptions 100%. This, at least is true for me. In addition to that, we are historical being since we change our biology moment by moment and so when we encounter a new experience we are never the same. And to top this picture off we, especially men, are blind to our emotions which, when we are willing to suspend our rationalizations, we can see as being pure biological happenings. However they, invariably and unknowingly, guide our actions.

OK I said it..... nothing new for you since I see that you have already acknowledged the "mistake" .
Now, in practical terms, if your sexual encounter occurred just recently, days or 1-3 weeks ago, I would suggest the complete recent exposure panel with a retest only for HIV, Hepatitis and Herpes 4-12 weeks later. If all is negative then you can close the case which, not only brought forward your commitments, but also gave you an opportunity to put a correction for a newer you..

Be well.

Dr. Gian

From: Anonymous
To: Dr.gian