The Right Test
A recent study published in the journal Clinical Infectious Diseases found that many doctors do not have access to the appropriate tests for primary syphilis. Although the syphilis blood tests are capable of detecting an infection that has been going on for a while,doctors need to swab a chancre and examine the sample under a special type of microscope to confidently detect an early syphilis infection . The blood test alone can miss up to 30 percent of new syphilis infections, thus leaving newly infected people falsely confident of their negative status and more likely to pass on the disease.
Debunking the Down Low?
There was a great story on NPR last week that was designed to debunk the popular belief that the down low is a major contributor to the HIV epidemic among African American women. The reasoning didn't come as much of surprise to me, but I was really fascinated to hear some of Dr. Kevin Fenton's ideas about the actual explanation for the fact that although African Americans make up less than 15% of the population, African American women make up more than 65% of new female HIV cases in the U.S. I highly recommend taking a few minutes to take a listen to the story on the NPR webpage. Dr. Fenton is the director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention and he knows of what he speaks.
Condoms : On the Rise
An ongoing series of British surveys have found that the use of condoms by British women has been steadily increasing over time. In 2009, for the first time, they were used by similar numbers of women as were using the birth control pill. Although I think that the rise in the number of women who are protecting themselves from not just pregnancy but STDs is great, the accompanying TimesOnline editorial does make an excellent point. If your major goal is to protect against pregnancy, it's worth considering other options in addition to condom use. Condoms are fabulous, but they do occaisionally fail - particularly if they're not used correctly - so it's important to have other tools in your arsenal, including emergency contraception.
- Condoms 101
- The Top
10STDs - How to Use a Male Condom
- Emergency Contraception - From the Guide to Contraception.
Care More
Want to know what has been pinging my radar lately? The fact that so many people have bad experiences getting care for sexual health. The first thing that brought it to mind was a conversation with a woman who utterly refused to get a Pap smear because she equated it to sexual assault, but it just came to my attention again with this article about how overzealous and somewhat insensitive health care workers are scaring patients away from STD testing in DC.
It's easy for doctors and scientists to forget how many people associate sexual health with shame. Although talking about sex and dealing with sexual issues may be a regular part of our lives, doing so can be a source of immense stress, and even trauma, for our patients and subjects. It's therefore important for us to remember that to give better care, we need to care more - about privacy, about reducing feelings of shame, and even about finding non-threatening ways to educate people about sensitive issues. Sexual health care, and health care in general, is a difficult business, but a little patience, kindness, and consideration (from both patients and doctors) can make it easier on everyone.
Barrier Barriers
A research group at the Kinsey institute was recently awarded a grant to study barriers to condom use among college age men. I think that this sounds like an absolutely fascinating study, since it focuses both on men's intellectual experience with condoms and their physical reactions to condom use. I look forward to seeing the results when they're finally published, and would like to thank for the study's authors for reminding me to remind you that which condom you choose really does make a difference in your safe sex experience. Finding a condom that fits well and is comfortable will not only make sex more pleasurable, it will make it safer - since you'll be more likely to use a condom every time you have sex and use it correctly. It's worth comparison shopping. Think about how much fun you'll be able to have figuring out which one you like best...
PSA: Plastic Service Announcement
I have a secret army of minions who scour the news for me and send me articles they think might be of interest. (For some unknown reason, most of said minions are Canadian. Maybe they just read more news?) They're a great resource for staying on top of STD news I might otherwise have missed, and they are also skilled at finding the more obscure stories about safe sex that tend to slide under my radar. Case in point - a piece entitled "Plastic Wrap is Not a Condom" which linked me to this video about STD myths compiled by a commercial STD screening service. Most of the items on the list are closely related to the ones I talk about in my STD misconceptions article, but the list did contain a doozy of a myth that was new to me - the aforementioned plastic wrap story.
Let me clearly state for the record: plastic wrap is not a condom. You may be able to use it, with reasonable success, as a dental dam (advice varies) to make oral sex safer, but in general it's a better idea to leave it in the kitchen. Plastic wrap is designed to help food stay fresh... not to help people get fresh.
A Different Caliber Shot
On October 16, in addition to approving Gardasil for boys, the FDA approved an alternative HPV vaccine, Cervarix, for young women between the ages of 10 and 25 (Press Release). Cervarix, which has been available overseas for some time, is designed to protect against the two most common cancer-causing varieties of HPV, and may also have some cross-reactivity against another of the major cancer causing strains.
Several people have already asked me why they would choose a vaccine that only protects against two strains of HPV when there is one that protects against four available. Personally, I think it's good to have options, but there is also some evidence that Cervarix may stimulate a stronger immune response against HPV than Gardasil, although both are effective against the virus. Cervarix is the first vaccine containing the adjuvant monophosphoryl lipid A (MPL) to be licensed by the FDA.
Oh Boy!
Last Friday, which is the day the government prefers to use for news it hopes will get lost in the weekend lack-of-news cycle, the FDA approved the use of Gardasil in 9 to 26 year old men for the prevention of genital warts. The stealth tactics worked. Somehow it took me three days to find the press release, and it still hasn't hit most of the major media outlets that the HPV vaccine has been approved in men.
This is a very exciting development, although I'm really curious about how many young men will actually take this opportunity to get the HPV jab. It's been hard enough to interest parents in getting the vaccine for young women, and in girls Merck can talk about The Big C and cancer prevention. When all they'll be able to advertise is a possible reduction in an unpleasant, but far from fatal, sexually transmitted disease, it might be harder to get families and politicians on board.
It is worth noting that other HPV diseases do affect men, including several types of cancer, but they're not currently on the approved indications list... and I suspect they are unlikely to end up there due to their relatively low incidence and the resulting difficulty of studying them.
Political Cover-Up
The other day, while walking through Times Square with a rainbow-headed girlfriend, I heard a voice cry out "Obama condoms! Now specially packaged for girls with multi-colored hair." When I turned to see where the voice was coming from, I saw a young man in love beads selling these "Hope is Not a Form of Protection" condoms:
He also had Sarah Palin "When Abortion Isn't an Option" condoms, and the combination made me laugh so hard that I had to acquire one to talk about here on this blog.
Recent issues surrounding abortion and conscience clauses in the health care reform debate may mean that I am no longer be as thrilled with President Obama as I was when he was first elected, but I still find products like this to be a great marketing tool. Anything that makes people talk about safe sex, and laugh about safe sex, is a good idea in my book. Particularly if it also inspires them to carry a condom.
HIV Vaccine? Well, Maybe Not
I wish I could say that I was surprised that additional data about the new HIV vacine is less positive than what was implied at the original press conference, but I'm not. Although I think that the scientists had good reasons for using an intent to treat style of analysis for their original results, this once again shows the problem with a press release before publication model. As more and more data is coming out, the study results are seeming less and less significant. I still look forward to seeing the full results when they are published, including detailed analysis of the data, but it would have been a lot more realistic, and sensible, to do the analysis first... and have the party later.