Of greatest concern is the time it takes to get results. Please give me information for all the common STDs. Thanks.

A: Here are our best answers, broken down by disease.

> Chlamydia – standard used to be a bacterial culture (takes a few days to come back), but more common nowadays and more preferred for accuracy is a bacterial DNA PCR or SDA (both are types of NAAT). This can give results overnight. Both tests most commonly use urine samples. Window period is 2 days to 2 weeks.

> HPV – HPV testing done in the form of a visual inspection plus an application of acetic acid in a clinic can give you immediate results as to whether or not a lesion is HPV. This is the only way one can test for warts. Pap smears need to be read by a cytologist in a lab; depending on how busy your clinic’s lab is, this could take a few days or as long as two weeks to receive a result. Window period can be a few weeks to a few years; unfortunately, if someone gets an HPV outbreak or abnormal pap smear, it could be the result of HPV exposure from several years ago.

> Gonorrhea – same as Chlamydia. Time does not vary by specimen location per se; that said, some labs require a different collection tube for oral/throat specimens, and that can take a couple of extra days. Window period 2 days to 2 weeks.

> Herpes – visual inspection is the starting point, and suspicious lesions or rashes can be swabbed for viral culture. The culture takes a couple of days to grow in the lab, and may take an extra day for the lab to run typing on the viral DNA to distinguish between HSV I and HSV II. Blood Ab tests should take about a day to come back as reactive or not, and another day to run typing between HSV I and HSV II. Window period 2 days to 2 months; some people may contract HSV but never have obvious symptoms of an outbreak.

> HIV – we don’t have statistics about how many places use rapid tests vs. DNA tests; that said, in San Francisco, most clinics use rapid tests as a starting point to check for antibodies; any reactive test is confirmed with multiple Ab tests (Western blot and Elisa) and a PCR and/or a viral load. It is less common for clinics in this area to send tests to an outside lab for Ab. Ab and PCR tests should be available from a lab in a couple of days. Window period varies state-to-state; in California for antibody testing, it is 2 weeks to 6 months, with 98% of people developing antibodies 3 months after contracting HIV. DNA PCR tests are accurate 6 weeks after exposure.

> Syphilis – the blood test is an Ab test, either VDRL or RPR. Both of these take multiple steps: one to find an initial reactivity, and another to confirm that it is due to the syphilis bacterium. People with a history of syphilis infections will always test positive on the first step, so their specimens will always require multiple steps. The first step of this test can usually be completed in a day or two, with another day or two for subsequent steps on reactive specimens. Window period up to 2 months.

> Trichomoniasis – most clinics do not send specimens to outside labs for testing, though there is a culture available. Clinicians can diagnose trich off of a wet mount: a sample of discharge smeared onto a microscope slide examined in your doctor’s office. It is rare to test men for this infection, as they seldom have symptoms, but if a woman tests positive for trich she can request medication for her partners. Window period 1-2 weeks.

One thing we’d note about the more sensitive tests: they can sometimes be too sensitive and give false positive results. We have heard clients say that they test positive on a test, ask for a retest, and then show up negative. Also, depending on what lab your clinic or doctor’s office uses, test results may be delayed. We hear from local clinics that specimens they send to the local Department of Public Health Lab can take as long as 2 weeks to return results to them, but private labs may return results overnight. Your provider’s office may have either financial or contractual considerations as to which labs they use.

Reliable sources to get information about testing and window periods are:
http://www.labtestsonline.org/
http://www.ashastd.org/

A: It’s unlikely that you will transmit genital warts to anyone at this stage, although not impossible. There’s no way to tell for certain whether the virus is still in your system; there are currently no HPV tests for men. However, HPV infections often clear up on their own. Most healthy men will have no further health problems after an HPV infection, although it’s a good idea to regularly check the genital area for further signs of warts or other physical abnormalities. Given that it’s been so long since you were symptomatic and you have not had any recurrences, it’s a strong possibility that this has happened with you. To sum up, while there’s no guarantee, it’s unlikely that you can pass the HPV virus for genital warts on to your partners.

A: We know that some people drink blood directly from the body and some people drink blood that has been previously drawn. The risk of each may vary.

If it is your own blood there is no risk. However, if it is someone else’s blood than there is a risk and, if you are unsure of their status, that risk is higher.

The diseases that are of most concern would be HIV and Hepatitis B & C and there are lesser but varying risks for other STDs.

HIV is known as a dangerous virus but it is also a fairly fragile virus. If the blood was directly from the person it would be a higher risk if you have small cuts in your mouth, possibly from brushing or flossing your teeth, that you may be unaware of. It may also get into small cuts that are on your lips or hands if the blood gets in contact with those areas. If the blood was previously drawn and exposed to air for a period of time or stored refrigerated the risk would be reduced as the HIV virus would be less likely to survive in either environment. In addition the HIV virus does not survive long when it comes in contact with either saliva or the digestive acids in the stomach

The Hepatitis virus however is much more resilient and can survive much longer than the HIV virus. For this reason there is a high risk of contracting Hepatitis if you were exposed to and drink blood that was contaminated. There are vaccines for Hepatitis A & B you can get for protection.

Piercings, if they have healed, are not considered open wounds. They do however provide an area that is at increased risk for irritations and those irritations may allow a virus or disease to enter the body.

A: Condoms can greatly reduce the chance of transmission, but HPV can occur on skin surfaces in the genital regions not covered by a condom. Of the more than 100 types of HPV about 30 are sexually transmitted and only two are linked to cervical cancer.

An estimated 5.5 million new HPV infections occur each year in the US, accounting for about a third of all STD transmission. It’s a very communicable STD.

Recent studies show that about 70% of infected females will clear the infection in 12 months and 90% will clear within 2 years. The incubation period for the virus is 2 to 3 months. Many or most men may carry the virus and never present with symptoms.

With all that said – telling your other sexual partners is a good idea, if for nothing else to make sure the females in the group have their regular pap smears. The cervical cancer associated with HPV is very slow to develop and regular pap smears can lead to successful early intervention. How far back to go? Theoretically in a perfectly safe world, up to two years. Practically, probably less time. One thing we do find is that it’s quite common for men and women who practice swinging or open sexual relationships to go for regular check up or STD testing.

The good news is that there is not as much of a stigma attached to this virus because it’s quite common. It’s quite likely 25 million or more folks in the US currently have HPV.

Here is a great resource with info on HPV – hpvinfo.com. We use the site’s information while we work here at SFSI.

I recently had a normal pap smear, which included HPV testing. We rarely engaged in penile/vaginal sex, and only once (accidentally) without a condom. My primary exposure to his HPV was oral.

I have no health insurance, so I am being judicious about this — is it indicated I should go for testing of my throat? What is the name of the test I want?

A: The research on HPV is very new so there is a lot of information and studies that are still missing. What we do know is that cancer is only caused by a few of the hundreds of possible strains of HPV. A doctor or dentist can do a visual test to see if there are any HPV lesions in your throat. We recommend regular visits to the dentist because they are trained to detect any abnormalities in the mouth and throat, including those from sexually transmitted diseases. At this time there are only visual tests for HPV in the throat, and it is difficult to detect if there are no lesions present.

For more information on HPV you can call the American Social Health Association (ASHA) at 1 (800) 227-8922 Monday through Friday from 9am to 6pm EST or The Center for Disease Control’s STD 24 hour hotline at 1(800) 342-2437.

A:Herpes exists at the skin level, in the skin and nerve cells at the surface. The risk when there is no sore is close to zero. When Herpes goes active and creates a sore is the time of most contagiousness. There is also a phase of Herpes called Asymptomatic Shedding where virus cells come out in smaller numbers to the surface of the skin, without making a sore.

So what does this mean for female ejaculate? There is no Herpes virus in the fluid before it comes out. The only way Herpes virus cells would get into the fluid is if it flowed over a sore or picked up some virus from the surface of the skin on its way out. So if the woman has no visible sore then the chance of transmission is low. If you know for a fact she doesn’t have Herpes then the chance is zero.

As for other STDs it’s hard to say. There haven’t been a lot of studies done on the risk of female ejaculate as a carrier. It would be safe to say that if the woman has Chlamydia, Gonorrhea, or Syphilis then getting her fluids onto another person’s genitals, mouth, or throat would be risky. HIV transmission from female fluids is super low, unless she is bleeding in her urine or menstruating AND is also HIV positive.

A: The vaccination is given in a three shot series and it is recommended to complete the course within 6 months. Through our own contacts we are told that all three shots are needed to be 100% effective against Hepatitis B. You will not be 100% covered, even for a shorter time period, after only one or two of the three shots.

Most importantly, continue through the series of three shots to complete the vaccination. If you miss any, continue through to the third shot at the appropriate intervals, or as soon as possible. If there is a delay, depending on the length of time from the first to the final shot, you may need to check with a doctor and do the series again.

A: We’re going to assume for this question that you are asking about using the mouth to stimulate a partner’s genitals, and not their anus (a.k.a. rimming).

The safety of oral sex depends on whether either partner has a sexually transmitted disease (STD). The risk of HIV transmission is extremely low, but various other STD’s can be transmitted through oral sex. Some STD’s can be transmitted by skin-to-skin contact and others can be transmitted through mucus membranes or fluids, so the mouth and genitals are both areas of concern.

If neither partner has an STD, both giving and receiving oral sex is safe for men and women. A woman cannot get pregnant from giving or receiving oral sex. It’s not harmful to ingest either semen or vaginal fluid. As long as it is comfortable for both partners, oral sex can be a very enjoyable low risk activity.

The San Francisco City Clinic has a handy chart that shows STD risks by activity type.

A: Chlamydia is something you don’t want to “wait” on. It’s a bacterial infection easily spread from one sexual partner to another. If you have symptoms (discharge, bleeding, painful urination), seek treatment. Often there are no symptoms for up to 3 weeks, or never any at all. It can be diagnosed through a urine or swab test and if positive you’ll receive a treatment. If only one partner is getting treated the other can re-infect and cycle continues. That is why it is imperative that both partners take their entire treatments at the same time!

Even after a very long time of having an infection the treatment will clear it out. It’s never untreatable. However there can be some long term damage. As a man, untreated chlamydial infections can lead to prostatitis (inflammation of the prostate gland), urethral scarring, infertility, or epididymitis (inflammation of the cord-like structure at the back of the testes). There are as many health issues long-term untreated for women with chlamydia than for men, especially issues with their reproductive organs and fertility as a whole.