Sexually Transmitted Diseases: What's Your Risk?

Summary & Participants

Among STDs, AIDS has occupied the spotlight for many years now, and for good reason. But other STDs -- like herpes, gonorrhea, and syphilis -- are still prevalent, and not to be taken lightly. What do you know about these diseases? How are they spread? What are the symptoms? And how do you keep yourself out of risk? Our panel of experts will answer these questions and more as they discuss the ever-present threat of STDs.

Host: David Folk Thomas
Fox News Channel
Participants:
Brian A. Boyle, MD
Assistant Professor of Medicine, Weill Medical College of Cornell University
Adam Stracher, MD:
Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital

Webcast Transcript

DAVID FOLK THOMAS: Welcome to our webcast. I'm David Folk Thomas. It's the downside of sex: sexually transmitted diseases, or STDs -- chlamydia, herpes, gonorrhea. If you're sexually active, you're at risk. It's important to know how to prevent getting infected with an STD and what to do if you should be infected by an STD. Joining us to discuss this topic are two experts. I'm joined by Dr. Adam Stracher -- he's sitting on my left -- and sitting next to Dr. Stracher is Dr. Brian Boyle. They are both attending physicians at New York Presbyterian Hospital, Cornell University Medical Center, and they are both assistant professors in the department of international medicine and infectious diseases at Cornell University Medical College. I need a drink of water. That's a mouthful. Gentlemen, doctors, thanks for joining us today.
We're talking about STDs. Let's just start with a general overview. Dr. Stracher, what is a sexually transmitted disease?

ADAM STRACHER, MD: Sexually transmitted diseases are basically exactly what they sound like.

DAVID FOLK THOMAS: I guess that's why they're called STDs.

ADAM STRACHER, MD: They're diseases that can be transmitted sexually, and they include bacterial and viral and fungal infections that can be transmitted in multiple different ways... from one partner who is infected to a partner who isn't infected.

DAVID FOLK THOMAS: Dr. Boyle, I mentioned a few of them, but if you could just tick off the more common ones. Of course, we know AIDS is the top most devastating one, but what are the other sexually transmitted diseases?

BRIAN BOYLE, MD: I think as you point out, AIDS is probably the most important sexually transmitted disease that we deal with today, and it's probably the most devastating, but there are many other sexually transmitted diseases: gonorrhea, chlamydia, syphilis. All, of course, are bacterial diseases that are spread from person to person. There are numerous fungal infections that can also be spread, and there are viral infections, some of which have lifelong consequences associated with them: herpes -- which, once you're infected with, you're infected for life, as is true of most of the viral infections. Other viral infections also occur, CMV -- cytomegalovirus -- is also a sexually transmitted disease. Epstein-Barr virus can be a sexually transmitted disease. While most of us associate hepatitis B virus or hepatitis C virus with the liver, it also can be effectively transmitted sexually and, in fact, the main way that hepatitis B is spread is sexually.

DAVID FOLK THOMAS: In layman's terms, bacterial or viral, what's the difference?

ADAM STRACHER, MD: I think that an important distinction is that, for the most part, viral -- AIDS is a viral infection -- those are much more difficult to treat. They tend to be lifelong infections in many situations. They tend to have no cures, their treatment tends to be less effective, whereas with bacterial infections like chlamydia and gonorrhea and syphilis, while they can be just as devastating, if they're caught in time they can be treated effectively with antibiotics.

DAVID FOLK THOMAS: AIDS, again -- everybody's been inundated with this, affected by it -- maybe personally, through friends. You read about it every day. Devastating. Has the fact that AIDS has just emerged in the past 20 years or so as such a devastating killer, has that had an effect on having people not take these other STDs seriously, Dr. Boyle?

BRIAN BOYLE, MD: Exactly the opposite, really. Not that they didn't take them seriously, but that they, as a result of the threat of AIDS and contracting HIV -- which is the virus that causes AIDS -- they have taken sexually transmitted diseases much more seriously. If you are at risk of getting HIV, you may be much more cautious about having unprotected sex than if you're not. The disease of the '80s, herpes simplex -- HSV, which is also a viral infection and also lifelong -- was really nothing compared to the consequences and the devastation caused by HIV. But what we saw initially was that we saw the numbers of STDs -- gonorrhea, syphilis, chlamydia -- decline as people were alerted by HIV and frightened by HIV into using safer sex and using condoms. But as we've seen recently, the numbers are starting to go back up. Many centers track syphilis, and the syphilis numbers and gonorrhea numbers tend to be going back up, which makes many of us worry that perhaps people are not taking the appropriate precautions, they're not taking these diseases seriously enough now.

DAVID FOLK THOMAS: Dr. Stracher, is there any rating system, can we put AIDS at the top, as far as the seriousness of the other STDs, whether it be gonorrhea, chlamydia, herpes. They're obviously all bad, but would you say this one's worse than that, et cetera?

ADAM STRACHER, MD: I think, as Brian pointed out, HIV, clearly, because of it is such a serious illness and so frequently results in death. Perhaps until recently, it is the number one most concerning and most serious. But I think that I would not rate the others. I think they all are serious infections. I think they all can cause serious disease -- life-threatening disease in some situations -- or have devastating consequences in some situations, so I don't think that I would rate them except to say that they're all serious and important to avoid.

DAVID FOLK THOMAS: How can they be prevented from spreading? Obviously, it's sexual contact. What different types of ways are they spread? Then we'll talk about prevention.

It only takes on time of unprotected sex and you can have a sexually transmitted disease like AIDS or herpes for life. How are STDs spread?

BRIAN BOYLE, MD: They can be spread through genital-to-genital contact, genital-anal contact or genital-oral contact. Any of those can spread disease and spread it very effectively, especially if there are other STDs or sores or problems present. So any of the ways that people commonly have sex can spread these diseases, which means, basically, that you have to use a condom or a dental dam or something else to protect yourself from having a mucous membrane contact -- your mouth or your genitals -- contacting someone else's genitals or mucous membranes.

DAVID FOLK THOMAS: Can you spread sexually transmitted diseases such as gonorrhea through kissing?

ADAM STRACHER, MD: Some of those infections can be spread from oral-genital infection for sure, and some can be spread from one person's mouth to another person's mouth -- certainly herpes can, certainly gonorrhea can -- and in rare situations they can be spread from one skin site to another skin site that is not a genital or an oral area.

DAVID FOLK THOMAS: What about sitting on a toilet seat?

BRIAN BOYLE, MD: Those are the stories that people hear about or that some people would like to be able to tell their partners, but that's generally not true and really doesn't occur.

DAVID FOLK THOMAS: As far as the different contacts -- you said genital-to-genital, oral, et cetera -- is there any one scenario that's more risky than the other?

ADAM STRACHER, MD: They're all risky and, again, it's very difficult to rank them. Genital-anal contact, anal intercourse, is particularly risky because of the conditions under which that occurs. Normal vaginal intercourse is a little less risky.

DAVID FOLK THOMAS: Can you go back? What conditions, because it's more likely to be unprotected?

ADAM STRACHER, MD: In particular, speaking of HIV, again, because that can lead to mucous membrane rupture that can make infection with HIV much more likely. So anal intercourse can make HIV spread much more likely because of the nature of it. Usual vaginal intercourse is a little less likely to spread disease, although it has spread HIV, although, as far as the other pathogens are concerned, it's equally likely.

BRIAN BOYLE, MD: And oral-genital, again, a little less likely to spread disease than the others, but still possible, and recent studies have shown that even HIV -- although many HIV specialists thought that oral sex was relatively safe -- recent studies are showing that, in fact, a significant number of infections of HIV have occurred through unprotected oral sex.

DAVID FOLK THOMAS: Dr. Stracher, do you have something to add?

ADAM STRACHER, MD: I don't have much to add. I think Brian covered it all. I think that in homosexual men, the risk of anal intercourse does increase the risk of infection, both because of the increased rate of infection and also because of occasional bleeding and that sort of thing that may increase the risk of developing infection or of spreading infection and, as Dr. Boyle pointed, that's true for HIV infection, but all of those intercourse methods may spread other infections equally.

DAVID FOLK THOMAS: Is there any way to tell -- say you have one partner who is infected, whether it be with HIV, herpes, gonorrhea, what have you -- they have unprotected sex with the other partner, who has a clean bill of health. Is there any way to determine the likelihood that they will pass the disease?

ADAM STRACHER, MD: We do have some estimates of what the rate is with each episode of intercourse or another contact for many types of illnesses. The rate varies. It depends on many factors, as Dr. Boyle mentioned, whether there are other sexually transmitted diseases and sores and the stage of infection that people have and whether they're symptomatic or asymptomatic infection, so there are estimates, and the range is from very common to very uncommon. I think that's probably enough.

BRIAN BOYLE, MD: It's sort of a crapshoot. It's Russian roulette. You may be infected, you may escape. It's not guaranteed.

ADAM STRACHER, MD: The risk may be 1 in 300 for episode, for instance. That means that you may just have sex once and spread the infection and develop the infection, so I think it's not fair to look at it and say, "I have a very low chance. I can do it and be risky and I'm probably not going to get infected," because it really only takes one episode.

BRIAN BOYLE, MD: We've had several patients who have come in with HIV who have been monogamous with one person who is not HIV infected and reported that years and years ago they had a single encounter -- perhaps when they were in college or in some other circumstance -- and yet they're infected with HIV. As Adam just pointed out -- and as you pointed out -- it's a crap shoot. You may get lucky and the odds may be 1 in 300. You may be that unlucky one where one encounter leads to your getting infected.

DAVID FOLK THOMAS: In a little bit I want to go back to the issue of being monogamous. But symptoms, we have some pictures next to you, I believe. What are these? Syphilis? To show sometimes you have no symptoms, but a lot of times you do. What have you got over there?

A person may not show physical symptoms of having an STD, but they can still spread it

ADAM STRACHER, MD: Sometimes you have absolutely no symptoms. I think that's an important thing for people to understand. These are some of the common infections that we tend to see. These, at the top, are some common presentations of herpes simplex. You can see the ulcerative nature of these lesions, which start as blisters, a blistering type condition, as reflected in these drawings, and then may progress to a frankly ulcerative disease, where you actually have a complete loss of the skin, which can be quite, quite painful. In the lower frame, here, you have lesions which are commonly associated with syphilis. This is a chancre. It generally has rolled edges. I'm not sure that's going to come across well on the camera.

DAVID FOLK THOMAS: Is that a medical term, chancre, or is that just a slang term?

ADAM STRACHER, MD: No, that's the medical term. It's actually called a chancre. It has rolled edges, which kind of define it. It generally is painless, though, so this occurs -- Unlike the herpes lesions that we saw at the top, this lesion tends to be painless and if left alone, it very frequently will heal on its own. That doesn't mean that the Syphilis is cured or gone. It simply means that they may progress to subsequent diseases, and these are some illustrations of secondary syphilis, where you end up with these lesions all over your body and perhaps on the palms of your hands and disseminated throughout your body. Then, again, many patients who have secondary syphilis may tend to get better from that condition despite the fact that the syphilis persists in their body. Then they may go on to have what's called tertiary syphilis, which has very serious neurologic conditions associated with it.

DAVID FOLK THOMAS: So syphilis can, untreated, go away on its own?

BRIAN BOYLE, MD: Absolutely, and it very frequently -- Again, I think this goes back to the concept of when you have a problem you need to go see your doctor and have him or her treat you, diagnose and treat the problem because these diseases may tend to go away on their own. That doesn't mean they've been cured. It doesn't mean you're better. It may mean that you're then at risk for passing it to other people and that you're at risk for very serious long-term complications.

DAVID FOLK THOMAS: Dr. Stracher, we were talking about being monogamous. You can be in what you feel is a monogamous relationship and you never necessarily have a guarantee that your partner's keeping their end of the bargain. What's your advice on that scenario?

ADAM STRACHER, MD: I could be a marriage counselor if I could give that sort of advice, but I think it's important that if you have any doubts at all that you use protection, that you wear condoms, that you are as faithful to your partner as you would want them to be to you, and that you take whatever precautions are necessary to protect yourself and to protect your partner. I think it's also important to point out that condoms, while they're helpful, are not always 100 percent. I have a patient who I saw today who is married and had one exposure to a prostitute, wore a condom, oral contact, and developed herpes. It can develop if a condom breaks. It can develop underneath or behind or below a condom, so I think it's important, while protective measures are helpful, monogamy or abstinence is clearly the best way to prevent or protect yourself.

DAVID FOLK THOMAS: Go ahead, Dr. Boyle.

BRIAN BOYLE, MD: I think that's one of the tragedies of people who treat HIV, as I do, on a frequent basis. Many of my patients are women who were infected by their husbands, who they thought were monogamous and were not, and did not disclose to them their HIV status. So, as you point out, your partner is not necessarily 100 percent reliable.

DAVID FOLK THOMAS: You mentioned before, a lot of these STDs, you do not have symptoms. How is that possible, and in that case, how do you know to get treatment?

ADAM STRACHER, MD: Again, it goes back to the importance of seeing your doctor on a frequent basis, especially if you're having unprotected sex, which is really a foolish thing to be doing in this day and age. It goes back to seeing your doctor and discussing that and getting advice from him or her about how to avoid that, as well as being screened. Women should follow up with their internist or, if they're sexually active, they should see a gynecologist every six months to a year to be evaluated by the gynecologist, and the gynecologist, as a part of his or her routine screening, will do the necessary testing to see if the person has been infected. The same thing is also true with a sexually active male. In addition, there are some things that you should do if you're sexually active, and as a standard part of vaccination of children now, children are given hepatitis B vaccine. Now, many of us were born in a time when that vaccine was not available and was not given. If you're sexually active, you ought to go get vaccinated for hepatitis B, because that is a lifelong infection that can lead to liver failure and disease and it is commonly spread sexually. You should go and get the vaccine and protect yourself from at least one viral pathogen that some protection is available for.

BRIAN BOYLE, MD: I think that's an important point, talking about the asymptomatic infection, that individuals may be asymptomatic with these infections, either for weeks or for many, many years. In the case of HIV infection or hepatitis B, individuals may be infected but be asymptomatic for 20 years and be able to spread to their partners.

DAVID FOLK THOMAS: Gentlemen, thank you very much. I say "gentlemen," I think should be saying "doctors," correct? We've been joined by Dr. Brian Boyle and Dr. Adam Stracher. We hope you've learned a lot about sexually transmitted diseases, STDs. You can never have enough information on this topic. Thanks for joining us on this webcast. I'm David Folk Thomas.