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Doctors' Answers to "Frequently Asked Questions" - Sexually Transmitted Diseases

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 07/11/2000]
Question: will sulfamethoxazole/tmp treat sexually transmitted disease

Answer: Some, but not most. Ok for gonorrhea, syphilis etc. But not for most of them. Biaxcin would be the drug of choice.

[posted 02/8/2000]
Question: Hi, I have had white/transparent semen with bits of yellow gelatinous substance, solid.I have had it for 3 or 4 years, and I am 20 now. I have heard that it is abnormal, so I wish you could help me.I have not had any other problem I think.Thanks.

Answer: Probably normal, but a semen analysis and culture would determine this-available at any md office. If there is a problem it is a low grade infection, probably a normal variant.

[posted 08/17/1999]
Question: what is an over the counter treatment available for genital warts, and where can i buy it. also if you know where in northern alabama can i get proper treatment and removal for these. Or at least to get this diagnosed

very frustrated

Answer: I'm not aware of any OTC that would be effective. As to treatment, a urologist, dermatologist or internist could do this effectively. A sexually transmitted disease clinic would also be a good site. If you are male, you should see a urologist for an examination of your penis to ensure that there is no early signs of penile cancer, one of the risks of HPV.

Sores in Nose [posted 1/14/99]
Question: For about the last 7 years I have been experiencing painful sores on the inside of my nose. I can usually pinpoint my period by three to four days by the arrival of these awful sores each month. Lately however, they have started to come and go as they please. They are on the inside walls of my nose and cannot be seen by looking at me. I mentioned this to my doctor and he said they might be caused by hormones, because while I was pregnant with my daughter I did not get them. I am beginning to wonder since the symptoms are occurring now without any relationship to my cycle. The sores are filled with fluid and will dry up scab and then heal. This is usually a one week cycle. Any ideas? They are annoying me.

Answer: Sounds like herpes, I'd get them cultured.

Lip sores/Blisters [posted 1/14/99]
Question: I am curious as to the cause and reason for my outbreaks of entire lip blistering. I have had an outbreak twice now. The first time was a little over a year ago and the recent one started about 3 weeks ago. They itch, burn, seep, peel, and take forever to go away. I went to the doctor during the first outbreak, and he thought it was Herpes. He gave me an oral medication that I had to take five times a day, and it didn't help at all. He tried taking a culture of it, but it wasn't moist at the time of my visit. I don't remember what he gave me, but I ended up stopping it since it wasn't helping me at all. Eventually it went away. Now, with my recent outbreak, I went to the doctor and he gave me a prescription of cortisone cream (2.5%). It is supposed to help with the itching. It does, and it looked like my blisters were on the mend. Now they are breaking out again. They itch, and are beginning to seep again. When I was told it could be herpes I began taking Lysine. I don't know if that helped. I stopped after my lips appeared to be getting better. I use petroleum jelly, lip balm, and the cortisone cream. Is there anything else I can do to minimize the length of these outbreaks? Is there something stronger to help with the itching and seeping? When I wake up in the morning, sometimes my lips are swollen and crusted over with dried puss. The doctor didn't mention anything about Herpes this time around. When I finally went in, my lips were getting better. I know stress can be a factor, and I have a two year old. But if she was my stress causing factor, then I would have outbreaks all the time. My job is good. There has been nothing that I have dealt with in the last five years that would cause extra stress. Any insight to why I break out and how to help ease the duration of these outbreaks would be so welcomed.

Answer: Certainly sounds like herpes, but I'd get it cultured during an outbreak. Lysine can be helpful and small daily doses of acylovir or equivalent is very helpful.

NSU: Non-Specific Urethritis [posted 12/02/98]
Question: My partner was prescribed to take Floxin 400mg., and was was being treated for Gonorrhea, but the doctor has checked off Urethritis Non-Gonococcal. Does this mean Gonorrhea? I was told to get checked out myself. What does this really mean. That my partner was being treated for STD or is it just an infection. I noticed pus with a ring and brown spots.

Answer: Usually NSU(non-specific Urethritis) is due to chlymdia and treated with this class of drugs. It is sexually transmitted and you should be evaluated/treated. Treatment should be concurrent with your partner so you don't "ping pong" the infection back and forth between treatments. Most physicians would treat both sexual partners concurrently to expect success.

  Contracting Genital Herpes & Medicating with Famvir [posted 11/3/98]
Question: I recently contracted genital herpes. I have several concerns regarding how this is possible. First, I've never had intercourse, and I've only had one "real" relationship: a long-term, monagomous one with my current boyfriend. We've been together for nearly a year, and our genitalia have never come in contact, although we have had oral sex on a few occasions. During our entire relationship, he's never had a cold sore, and he's never been intimate with anyone else. (ie: nothing but kissing in his prior relationships, the last of which ended 5 years ago.) Are there other ways I could have caught this? I was also diagnosed with mononucleosis about six months ago, and I've also heard that mono is a form of the herpes virus. Could it mutate or spread, especially through saliva somehow contacting the genitalia? And, since I live in a dorm with community bathrooms, is it possible that someone with active lesions could have left the virus on the shower wall, and I could have contracted it? Other than that, my doctor originally put me on Valtrex, but I've read some studies show that people who take Famvir have fewer recurrences. TMy doctor hadn't heard of this, but was willing to switch me over immediately. She said it wouldn't do any harm, and could, possibly, do some good. What are the benefits of Famvir over Valtrex, then? Are there any problems associated with Famvir that aren't associated with Valtrex? And, I'm taking acetaminophen with codeine 3 for pain relief. What are the health risks associated with this drug? Thank you.

Answer: Probably the oral contact, the virus can be transmitted prior to actual ulcers breaking out-although some think it can be transmitted vertically from mother to child in the birth canal(this is more controversial). I would prefer the Famvir, more effective and less toxic. I have seen a report of l-tryptophan being used to decrease outbreaks as well. Whether this works or not, I don't have any experience to tell. As to the tyl # 3, high doses could be physically addicting and you should avoid long drives, machinery or alcohol. But, it is often necessary due to the discomfort.

Herpes Zoster or Something Else [posted 10/29/98]
Question: I have what I think is Herpes Zoster, what other condition could i have that re-occurs every 3-6 months for the last 8 years? Description: red inflamed area on one side of my face and on areas of my back. Resembles ringworm. itching, light pain. starts like bug bite then enlarges over a period of 10+ days. Rings on back will increse in size. It started about 6 months after lower back surgery done 8 years ago, re-ocurring every 3-6 months. Is there any other drug i can try? Famvir does not work very well.

Answer: Has this been cultured? Doesn't sound like typical herpes unless there are associated little blisters. If Famvir isn't working, ensure the diagnosis. Maybe an Infectious Disease consultant might be helpful. I suspect you are treating the wrong problem.

Herpes Simplex Virus II [posted 8/13/98]
Question: If a person has Herpes Simplex Virus II, occurring in the genital area, what are her chances of having a healthy baby? Should she forget the idea of having a baby? I know one of the side effects is blindness. How can this be prevented and how can a baby be born healthy with the mother having this STD.

Answer: There are two methods of delivery and many women have this problem and deliver healthy, unaffected children. Surveillance cultures are performed to ensure that the virus is in a dormant state or not actively infective. Secondly, cesarean delivery is performed if there is any possibility of active infection during delivery, this effectively eliminates the problem.

Condoms in School
Question: This is a major topic at my school. What is your opinion on condoms being handed out upon request. Do you think it would help reduce sexually transmitted diseases in our area?

Answer: I'm all for it. You have to understand that most physicians are basically pragmatists. We see simple practical solutions as best and tend to see sexually transmitted diseases as merely another infection to treat. We tend not to have the social emotional baggage due to our overall training. However, to function in social context one needs to consider these political and social ramifications. Many parents/teachers are unwilling to acknowledge the sexual freedom and sexual expression necessary to young adults. I think this is important, but would rather that my patients wouldn't contract incurable diseases or become functionally sterilized (fallopian tube disease due to STDs). Hence, I'm all for free access to condoms. I'm also for open and free discussion of the impact of intercourse on young adults and other aspects of sexual education. Access without education doesn't make a lot of sense to me.

Medications for Herpes
Question: I'm Bipolar and after 3 years of trials with good psychiatrists, I take 60 mg Parnate, 7.5 mg Dexedrine, 200 mg Lamictal(Mood Stabilizer), 10 mg Ativan daily. In addition, I have genital herpes and found that I am more susceptible to breakouts since I began the medications, and getting the illnesses. I take Acyclovir 400 mg day to prevent sores. This works only marginally. I wish to try some herbal/vitamin sources to help decrease the virus' activity in addition to other stress reducers. I've read that Amino Acid Lysine helps, and Amino Acid arginine hurts. Echinacea helps for immune building. Do any of these therapies play havoc with my neurotransmitters and nervous system/psychotropic drugs and the balance I've maintained with these drugs? Do Acyclovir and the new one, Valtrex, have chemical structures that may depress me or counteract the drugs? I have found that Zantac, Advil, and fluconozale seem to depress me. My psychiatrist told me Zantac was a sort of an antihistamine, which is a known depressant. I truly want to try alternative remedies on herpes, which is there for good, but very stress related. Unfortunately, my depression would not budge without the drugs. I tried for years.

Answer: In spite of lots of claims, no one clearly knows the effect of these drugs on your body. They don't seem to cause any harm, but haven't been impressed by my patients on these drugs. I know of no alternative treatments for herpes that have any promise.

Genital Herpes
Question: I was exposed by a girlfriend numerous times. I have no symptoms. I will be tested next month when my insurance kicks in. How can I keep from getting this disease?

Answer: Exposure to genital herpes is common. After several weeks, if you are to develop the disease, it will occur in small-- usually clustered-- small blister like eruptions. They are usually fairly painful. Taking acylovir after exposure might be of help. However, using condoms is the only sure fire way. Some recommend double condoms since there is about a 5-10% break rate with condoms.

Genital Herpes
Question: I have seen commercials on this new drug called Valtrex. What is the difference between Valtrex and Zovirax that I am taking now.

Answer: Valtrex belongs to the same group of anti-biotics as Zovirax. The major difference is that Zovirax is 4-5 times a day and Valtrex is 3 times a day. They both work. Valtrex is similar in price in most pharmacies.

Question: I have constant pain in my lower testicles and I urinate frequently. I had been taking 250 mg of Keflex and then I was switched to 100 mg Doxtciline. I feel heated flare from my prostate area during ejaculation and during intercourse.

Answer: It sounds to me like you have a Sexually Transmitted Disease like chlymdia or neiserria gonorrhea. You need to discuss this with your physician.

Genital Herpes
Question: Can a person who has genital herpes donate blood?

Answer: Usually, if there are no other infections or risk factors.

Question: I have a yellowish puss-like discharge coming out of my penis, but it is only in my semen. Could this be an STD or a problem with my prostate? I am 23 years old.

Answer: This most likely is a sexually transmitted infection. Gonorrhea, etc. I would immediately proceed to the sexually transmitted disease clinic or your physician.

Molluscum contagiosum
Question: Recently I was diagnosed with molluscum contagiosum lesions on my penis. I have never had intercourse or sexual contact and I am curious if (after the lesions disappear or are treated) this disease is contagious or even present after the lesions are gone. Also, I don't understand how I contracted the disease without having sex. How is this possible?

Answer: Molluscum contagiosum is spread by contact. However, this particular organism is tough to kill and may be spread by towels, commonly worn clothing, etc. It can be endemic on children’s athletic teams if they switch articles of clothing or equipment. It can also be easily spread by using a towel which was not sufficiently heated in washings.

Question: Are there any protease inhibitors being used against the herpes virus?

Answer: I haven’t seen any research. These are different enzymes, so I suspect they would be less effective. Also, since resistance develops easily, I doubt that much research will be focused here.

Question: What are the two most popular treatments or contraceptives for gonorrhea?

Answer: Treatment of gonorrhea and prevention are two different problems. In general, gonorrhea is fairly penicillin sensitive, although resistant strains are beginning to emerge. In 1986, the CDC changed its recommendations from penicillin only, to include this information also. Since then, treatment has been tetracycline or equivalent plus a cephalosporin. This is to treat gonorrhea and the common chylamydia co-infections. Many STD clinics treat patients with one dose of IM antibiotics like claritomycin or spectinomycin due to the traditional non- compliance with one week of antibiotics. Prevention is best performed by condoms.

Herpes Simplex
Question: If one partner has genital herpes, it can be transmitted to the other partner. Once this partner has it, can it be re-transmitted back and forth over and over again, or, once you have it in your system, is it there and no further transmission between two partners would matter? Also, is there any relationship between genital herpes and herpes zoster? Can the two different herpes viruses be "intermingled"?

Answer: Herpes Simplex can be classified as Herpes simplex 1 or 2. This is a DNA virus that in general affects mucosal surfaces. Once an individual has herpes infection anti-bodies develop that effectively prevent repeat infections. However, the primary infection tends to break out at random times. There have been some reported cases of an individual having separate infections to Herpes 1 and 2. However, in general one primary infection is all that is seen. Consequently, once an individual has an infection he/she cannot be reinfected. They may however, transmit an infection to a previously uninfected individual.
Herpes Zoster is a related but different virus. Consequently, infection from Herpes Simplex does not protect from Zoster and vice versa. Zoster is usually seen as common "chicken pox". Like Simplex, once an individual is infected they will not be re-infected. However, the Zoster may reemerge as "shingles". It is very rare to have concomitant infections with Simplex and Zoster.

Herpes Simplex
Question: Many years ago (3 years) I had sex at a young age. I was healthy up until that point. I have had headaches everyday for 2 years, my joints are constantly burning, my kidneys burn and my urethra feels sharp hits of pain. I know something is wrong and I would like a game plan. It also seems that my heart has been affected and my spine burns.

Answer: The act of intercourse inself would not produce the symptoms that you are having. However, there are different sexually transmitted infections which may produce many or all of the symptoms. Chylmadia, syphilis and other organisms can produce different well known syndromes post intercourse. I would contact a physician specializing in sexually transmitted diseases. Also, this may have nothing to do with intercourse in which case an Arthritis specialist would be the best person to contact.

Genital Herpes
Question: Are there therapies for genital herpes, other than, aclyvoir? Can such things as the heart, blood vessels, etc. be scarred as a result of genital herpes; is there a reason that blood thinners etc., could aid for declined cognitive skills.

Answer: Although there are some newer drugs for the treatment of genital herpes, they generally fall into the same class as acyclovir. The major advantage of these drugs is in frequency and a little bit in terms of nausea. I don't think that my patients have noticed a major advantage in the newer drugs, but I'm sure some patients will benefit from taking the drug less often. Herpes infections usually aren't involved a great deal in the heart and blood vessels. Systemic herpes infections can be quite severe and involve any organ system. However, once the inital infection is defeated by one's immune system, the long-term effects of Herpes on different organs are pretty minimal. Consequently, long-term therapy with blood thinners, etc. is rarely a problem.

Detection Through PapSmear
Question: Can a doctor detect VD in a women if you go for a her pap smear test ?

Answer: Venereal warts can be seen, gonorrhea and other infections are rarely seen on a pap smear.

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