Sexually Transmitted Diseases:
What's Your Risk?

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

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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?

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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.

Next: Additional details about each STD - symptoms, diagnosis, treatment and prevention.

Last updated: 6/2000.  Last reviewed: 10/05

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