Giovanni A. Pupillo,  M.D

    Ask Dr. Gian   ....but read this first
 

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No other issue in the public health discourse is so loaded  with despair, anxiety and resentment. The involved know that guilt, emotions and  worries do not make any difference. What counts is getting tested and diagnosed early and, if needed, getting treated accurately and completely. When this occurs with confidentiality, understanding and compassion then, and only then, this personal health crisis can become an opportunity for education, self-knowledge and behavioral change.   

Dr. Gian 

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

Hi, 

I don’t know if you are thinking about a relationship between a sexually transmitted disease and what has been happening to your son but I doubt this is the case. Your information are  not enough to allow me to say much. The TORCH tests  is a serologic tests for Toxoplasmosis, syphilis, rubella, cytomegalovirus, and herpes simplex (TORCH tests).  The test name comes from the initial letters of the five disease categories. The presence of IgG antibodies to CMV, Rubella and Herpes simplex is not an uncommon finding in people in general and being positive in the mother does not necessarily means that she will infect the baby during delivery.  Let me point to you to this page http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/torch_test.jsp

Since your son was negative to the TORCH screening test, this indicated that antibodies of the IgM type, which would occur soon after the infection of these infective agents, were not present in your son’s blood. I am sure you are in good hands with your Doctors there in the hospital and ask you trust their good work and wish you well for your son.

Dr. Gian

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

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.

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

From:
Sent:
To: drgian@stdweb.com
Subject: Herpes versus Yeast Infection?

I am an uncircumcised 43-year-old man and, to my surprise, was diagnosed with both oral and genitall Herpes a few years ago during a blood test. I say "surprise," because I have never, to my knowledge, had a genital outbreak & only rare and mild outbreaks on my inner lip. I do have, however, two or three times a year a yeast infection at exactly the same spot under my foreskin, and invariably think that this must now be an outbreak. But my doctor says it is a yeast infection and has given me Triamcinolone Acetonide. Both with and without the medication, the light stinging/burning sensation usually lasts a few days.
I know that my first girlfriend when I was 17 had Herpes, and we had unprotected sex. I also had unprotected sex with the girlfriend I had throughout my 2Os (she is Herpes free). For the past 15 years I have only had protected sex--(though we'd do a lot of fooling around before the condom went on)--and none of my partners have had Herpes. Anyway, I do have Herpes, and I was told that it was quite high and "virulent" in my system, if that is the right term.
So, doctor, does this make sense? Can one have a high dosage of Herpes inside one's system without outbreaks? Can the yeast infection (which I understand from your column many uncircumcised men mistake for Herpes) appear always, for years now, at roughly the same spot?
I would be grateful if you could shed light on this worrying mystery.
 

Hi,
what you define "yeast infection' is most likely a Herpes flare up and, in that case, you may want to consider to be treated with one of the three standard antiviral we use: Zovirax, Valtrex and Famvir. This treatment will abort the flare up symptoms and should be considered also for suppressing recurrences and shedding of the virus without symptoms. I would also recommend you communicate your positive serology to your partners. Your question about " virulence " has no scientific basis. The virus travels along the nerve pathway from the epithelial cells of your skin and rests inactive in the ganglions along the spinal cord. I invite you to read more about Herpes behavior in emails shared by others with me.

Thanks.

Dr. Gian
 

Hello doctor,

I would like to share my expierence and worries with you.I had a unprotected sex, 12 years before,now my age is 29 yrs.I am planning to get married now, till now i didn't have any fever,weight loss etc,but i have a skin probelm with some rashes for past 6 yrs,i am getting the treatment now for that.I consulted with my skin doctor,she told it is a kind of virus,no need to worry much,i took Hepatis b,c,a surface antigen testing,all the results came up with non-reactive.
i am bit worried whether i will have aids.Whether i need to get tested?
Please advise.


Hi,
you probably don't, but since you have done testing for hepatitis may be you want to consider to be tested also fir HIV antibodies and move on with life.

Stay well.

Dr. Gian

hello,
about 2 years ago i felt i started to get symptoms of herpes, which is fine water like bumps by the genitle area. i got nervous, so i went in for a pap smear test as well as a blood test for herpes and all STD's. I came out negative for everything, including herpes. but now to years later i am getting the same symptom all over again. is it possible for a blood test for herpes to come out wrong? During the that time when i started noticing symptoms, i waited about 3-4 months before i went in for a blood test. which came out negative. again is it possible for test to come out wrong??? i am going to get tested again for herpes.

Hi,

with today high sensitivity and specificity of Herpes serology results of testing done 3-4 months from the date of symptoms are usually conclusive. The question arises if your Doctor tested only for Herpes type 2 antibodies since 30% of genital herpes is due to the type 1 virus. However, I think it would be advisable to retest with both type 1 and 2 specific antibodies,

Be well,

Dr. Gian

Hi Dr. Gian,

I have a skin problem that i can't find an answer to, any where on the internet.
I have these boils or pimple type stuff on the skin of my testacles.
They are not painful at all, they are just bumps that are white or a little red in color. They have thick skin on top of these bumps. I am not sure what are those, any information would be greatly appreciated.

Hi,

you probably have small genital warts. See you doctor. An effective treatment is available for genital warts.

In good health,

Dr. Gian
 

Hi,

So you are concerned that your 17 young and sexually active daughter might have had exposure to HPV and that the lesion on her tonsils could be not a benign growth.
I understand your concern. In fact this is shared by several researchers on oral cancers. Once upon a time tobacco and alcohol were responsible for most oral cancers until researchers start reporting an increase in the disease in patients with little or no history of smoking or drinking.   Scientists still do not fully understand the natural history of the disease and the transmission routes of HPV and oral cancer. For example, HPV 16 is found in pre-cancerous lesions in the cervix, but rarely in a condition called oral dysplasia, a precursor to oral cancer.
As far as HPV infection location, ano-genital HPV is believed to be the most common sexually transmitted infection in the United States. An estimated 20 million persons are currently infected, and an estimated 6.2 million new HPV infections occur annually.
HPV infection is common among adolescents and young adults. it seems to be prevalent among adolescent girls (as high as 64%) .Up to 75% of new infections occur among persons 15–24 years of age.
A review of HPV and tonsillary cancers indeed shows an increased social concern for this possibility, given the increase behavior, especially in young couples, for genito-oral sex. However other risk factors for HPV oral infection are related to the number of sex partners, lifetime history of sex partners, and the partners’ sexual history.
I would definitely bring this concern on the table with your daughter and with the Doctor so that an HPV test can be run on the surgical specimen and also have your daughter be tested for genital HPV and PAP test.

I wish you well.

Dr. Gian
 

Greetings,

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


 

Hi Dr. Gian,
I'm VERY worried about my friend...
I visited your web site but was unsure how to post a question in there so I just got your e-mail address and decided to send you an e-mail...
You see, my sister was hospitalized this past May with flu like symptoms and serious vomiting... While there they said she tested positive for acute Hepatitis C Virus.
Now just recently she came to town and i introduced her to some of my friends (who are VERY promiscuous) and knowing that both they and she are VERY promiscuous and that she fails to tell people that she tested positive for it, in order to protect my friends I told 3 of them that I was VERY close to about her positive results before she even met them.
My one friend who's got a brain like a pea and friskier then a jack rabbit got drunk and slept with her (unprotected sex) despite the warning. After less then a week she moved in with him.
A few of our friends got on his case about it out of concern for him catching this virus from her and finally he asked her about having it (as she never told him a word about it).
She told him that she honestly didn't know if she had it or not... she admitted to him that her results in May came back positive for the virus but she also said that she had a new test in August that apparently came back non-reactive; This is very confusing since her 1st results said she tested positive for it... I guess her doctor told her that she didn't have the virus at that point but that she remained a carrier for it.
What's that mean??? I know if one is a carrier of the flu virus they can spread it without actually having the flu themselves.... Does this mean that she is carrying the Hepatitis C virus and can spread it to other people even though she herself isnt testing positive for it herself at the moment?
My friend refuses to be tested because he's insisting that my sister doesn't have it since she showed him the non reactive results; despite the fact that she admitted that her first test was positive.
My sister is also bi sexual and she and my friend are not afraid or ashamed to gather multiple partners from the bar that we frequently hang out at and take them home for "GROUP FUN" if you know what I mean.
Now I don't want to ruin their reps if there is no reason or need to cause alarm however I know MANY people who hang out down there and I just think if it's a dangerous situation then they need to be educated and know what they could be getting themselves into. I know for a fact that they don't tell anybody... As I said my sister tested positive in May and had several partners without telling them. And since the non reactive results my friend is in shear denial.
Please tell me if There is any reason for alarm!
Thank You
~HUGS~FROM~ANGEL~

Dr. Gian

I have never tested positive for any STI's but it has been at least a year since my last test and I have had this happen before I was last tested, I'm just concerned now. I recently had sex with my boyfriend and during intercourse noticed that the condom was rubbing me almost raw. Since then I noticed something resembling a sore which is very uncomfortable, and burns when anything touches it. It's right around the area the condom kept rubbing and I'm wondering if it's not just from the condom and maybe a form of herpes. There's 2 or 3 spots around the base of my vagina and they aren't blistered they just look like something rubbed and irritated the area. I've had something similar that lasted less than a week and just figured it was the condom because the sex was rough. I live in Florida and am having financial problems so getting tested is going to be tough on my budget. Please let me know if I'm overreacting or should get tested right away. I also get similar reactions when I wipe with toilet paper too much in that area. It gets really sore and irritated.

Have a wonderful day!

Hi,

the description of your symptoms is highly suggestive of a Vaginitis secondary to  Herpes infection. I would see a local physician for an exam  and have am antibody Herpes test done.

In good health,

Dr. Gian

Hi Dr.

Thanks for your help

Hi,

well....a little confusing, isn't it? So what do we have as the main components of the story? 1) A risky sexual encounter, 2) a tingling and later a itching skin sensation 3) a bunch (five) type specific Herpes tests of which only one positive for type 2.

I am willing to bet you are negative and you are still concerned about the "risky" kind of encounter and your skin sensations are somewhat magnified by that concern.  As per your Herpes test one can occasionally find a HerpeSelect(R) test giving low positive results or other unexpected results.  What I usually do  in situation like yours, I ask the Lab to perform a special test called a "Positive Inhibition Elisa test. This is a test also formulated by Focus Technologies, the maker of HerpeSelect to further characterize those "iffy" results. This test refines the specificity and sensitivity of HerpeSelect and must be specifically requested by the physician when ordering the test as e reflex to the HerpeSelect. A POSITIVE inhibition test indicates that the HSV-2 specific reactivity of HerpeSelect was true, whereas a  NEGATIVE inhibition test indicates that the positive screening index of HerpeSelect was falsely positive.

Dear Dr. Gian,

I had a herpes-like outbreak 2 week ago. My doctor ordered a blood test. The test came back negative. The test was a DNA PCR test by Quest Diagnostics Nichols Institute.

I have no ideas why the doctor didn't just order regular antibodies test. I had an antibodies Igg and Igm test done a year ago, and it was negative. Perhaps that's why he ordered the DNA PCR test this time.

Questions:

1. Most importantly, is this DNA PCR test close to 100% in accuracy?

2. My symptoms on my penis look very similar to Herpes, but the doctor said it was yeast infection and he prescribed me "Nystatin and Triamcinolone Acetonide Cream." I used the cream for almost 3 weeks to clear up the "rashes" on my penis. I am uncircumcised. Even so, if the rash were due to yeast, then why would it take 3 weeks to clear up the rash?

3. Do I need to re-do another Herpes test like Western Blot to re-confirm?

Thanks a million.

Hi,

If you have blisters a swab for a Viral Culture with typology would be the first choice. HSV-1 & HSV-2 grow in what is called tissue culture cells or "cell culture." When changes in the cell culture are seen under a microscope, the laboratory does further tests to show that the changes are due to HSV and to find out if the virus is HSV-1 or HSV-2. In this test the incidence of false negative is somewhat high because it is difficult to keep the virus alive by the time it reaches the lab.. The specimen is best collected within the first 3 days following the appearance of a lesion but no more than 7 days.

The HSV Viral PCR or "polymerase chain reaction" tests are the most accurate tests for herpes. The indication for a viral PCR is usually as a supports to a diagnosis of herpes simplex encephalitis and herpes simplex meningitis and it is performed on a spinal fluid sample. PCR It is not commonly done on urine, blood or saliva specimen because it is not cost effective and the antibodies test we use now are highly sensitive and specific. A type-specific PCR and a distinction between HSV-1 and HSV-2.can also be performed from the extracted sample. 
PCR techniques are used also on tissue swabs on suspicious blister or sore.. PCR. make many copies of the viral genetic material (DNA) in a short time so that even tiny amounts of virus are sufficient for positive test. Only about 4 hours is needed once the specimen arrives in the lab.  PCR is more expensive than culture but may be the only test sensitive enough to find herpes in a lesion that does not contain much virus.
Herpes PCR sensitivity and specificity is close to 100% but is very expensive. A type specific serology blood test is a good alternative to see if you have been infected with HSV.
As far as the possibility of a yeast infection, lesions sometime may take several days to disappear.

Given what you say I do not think a Western Blot is necessary.

In good health,

Dr. Gian

Well now moving on, after my boyfriend disclosed this news to me and after I did some research on this I told him that he absolutely needs to get tested. I also told him that it is highly likely that he has contracted this Herpes 2 from her during all of those years. He was just tested a week ago and about four days ago his test results came back positive for both Herpes 1 & 2. Now I was furious, extremely furious and hurt. My boyfriend has put me at risk for a lifetime infection and I blame him and I blame his ex-wife for misleading him to believe he couldn't get it. I immediately paid to have this test done and I am still awaiting the results. I don't know what to do or how to feel right now. I don't know what to do if I turn out positive now or how I will react. I don't know what I will do if I turn out negative as he has it. I told my boyfriend that had he informed me that his ex-wife had Genital Herpes back when I first asked him over a year ago I never would have had sexual contact with him until he was tested and that if he was positive back at that time I would have probably walked away as at that time I was not in Love with him. Now I am in love with him but I feel betrayed by both him and his ex wife. This isn't the only concerns I have either. I told him that his older children that grew up in this household were at risk for contracting this virus from their mother all of these years. From what I have read it is possible for the virus to survive on plastic surfaces around spa's etc. and that even a damp shared towel could carry this virus. This is information I have found on this virus. His ex-wife had never disclosed this to the children. Two of which are a male 21 and female 18 along with the youngest now being 10. I honestly feel that these older children should be informed of this and should get tested being that they have been exposed to the possibility all of these years. I don't' know your opinion on this but frankly his ex-wife did not use discretion in all of her contact with her children. She did not disinfect things, etc. Can you please tell me what you think the responsible thing would be to do here. I doubt the mother will tell the children this but I do believe that my boyfriend the children's father would if he is advised that they have been put at some kind of a risk for contracting this. Most all of the years this family shared a pool, hot tub and more and I know if it was my children I would tell them and inform them that they should get tested to ascertain that they do not have this virus in which they could unknowingly spread to their intimate partners. I'll await your input on this one.

    First off I hope your test results are negative for Herpes antibodies and I wish you well for your future.
   Your email is really a compendium of all the concerns, the emotions, the considerations, the social acceptability, the ethical questions raised by this breakdown in living which is a Herpes infection. In one word the "Pathos of Herpes". Yes because, if we are really honest with ourselves we cannot escape but recognize that although we claim to be rational beings, all of our thinking and doing is based on emotions. 
   What I am going to say is meant to provoke reflection about this "Herpes Pathos". About one year ago I was called to testify in a criminal case where a man had allegedly killed his wife. According to the prosecutor's construction of the case the murder occurred only a few hours upon finding out from a test taken in my Clinic that he was positive for......Herpes type 1. This happened in spite of the counseling and the information given to him about the epidemiology of this widespread, ubiquitous and mild infection present in 75-80% of the population.
     Herpes type 1, the fever blister kind. We all have seen many times in our life people walking around with sores and clusters of blister along the vermilion border of their lips. We all have seen those small dark crusty spots on people's mouths, we have never given any attention to them, they were part of our social living together...we even joked and smiled about them. But now we find them very so often in the genitals, up to 30% of cultures and the the whole thing gets reorganized, the meaning changes, the context is transformed....and someone may even....murder someone else because of them!!!
     What is going on? What is it about us that we let locations of our anatomy take the lead in the meaning we give to things. What is it about us that we do not communicate things which could make a difference in the quality of our relationships and in the wellbeing of others?
What is it about us that we always face the truth about this second class virus with resignation, resentment and despair and than we frame it with in authenticity and look around for agreements which support our limited thinking?
    What is it that we give away our vitality and aliveness of our relationships, the vigor of our immune system and the commitment of being in good health? What is it that we take these positions and unworkable realities about Herpes that disempower us. What is it that we are full of cynicism, guilt and callousness about our own sexual health?

     Remember that an infection is always the following transaction

OK............. I said it!. Let's reflect on this... at least the two of us...and without looking for a quick answer.     

Dr. Gian,

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