In part two of our three-part series into the wider research behind STDs (and the truth about superbugs), Dr. Evan Goldstein discusses herpes, HPV, and the important role pap smears play in mitigating risk for patients (especially bottoms).
(Check out Part I in our series to read about Gonorrhea, Syphilis and Preventative Care.)
Adam Baran: Let’s talk herpes. What are the symptoms?
Dr. Evan Goldstein: Pain. You'll know. It depends on what people are doing, whether it’s external or internal penetration. I find that people get these little cuts, which some people confuse with the cuts they get from wet wipes or baby wipes, since that can also cause the same type of irritation.
But it’s a similar type of situation back there, which makes the skin very raw with these small serrations. And then from the bottom’s perspective, it's such a painful thing. That's where a suppressive treatment like Valtrex is effective, especially if you know you're positive from HSV or if you’ve had two to three episodes in a year. You can take preventative measures as well, though it's not as defined.
I've actually hooked up with somebody who told me the next day that they’re getting an outbreak. They suggested getting Valtrex.
Yeah, the seven-day course of treatment is standard, a thousand milligrams twice a day or 500 milligrams as the suppressive. Even at the dentist, sometimes you get a cold sore and then you take just a very small amount of Valtrex, and then boom, you're off to the races. Also, don't give oral or rim someone if you have a cold sore.
Let's talk warts and HPV pap smears. When should a person have one? What are the warning signs of HPV?
Well, we all have HPV, right? From licking, rubbing and playing–we're almost all positive for HPV. Everyone should get a pap smear every year, especially bottoms. I always say that pap smears lead to better sexual questions and better sexual examinations, even if it's just a swab. The practitioner has to look at your ass and if something seems abnormal, hopefully the practitioner will say something. It creates an opportunity to treat anything out of the ordinary and offers an educational moment.
I always say that pap smears lead to better sexual questions and better sexual examinations, even if it's just a swab.
With warts, some people have a lot of itchiness and some people are able to tell when something is just “off.” With HPV, I find that it's also associated with HSV, which is herpes. We almost all have type one—especially people that love to rim—but with that said, HPV and HSV are both very immune. Your body learns to fight them, but they're always there. If I can’t treat warts, because they don’t respond well to that treatment, I actually put them on an HSV treatment and then all of a sudden it gets better.
The other is HIV management, where we see a warts outbreak as the first sign a medication isn’t as effective to control your HIV. You may get outbreaks even though your T-cell counts are good, but your ratios can be off. I see a lot of people on an HIV med called Genvoya and they see recurrent anal warts, so I’ll switch them to a different medication to see if that helps. So all this to say that pap smears are really important, in addition to having your butt actually examined because there are so many things we can detect.
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With a visual examination, I can tell when there are issues or when things are looking normal. And then patients can talk with me about their love lives, and we start that dialogue. If I catch something early on a pap smear, I can examine it before it becomes more serious.
How can someone mitigate or prevent themselves from getting warts after exposure?
First is the vaccine. We all should get it, meaning anyone that is engaging sexually, and especially those who are bottoming. People think: well don't I already have that? Yes, maybe some types, but not all nine types in the vaccine and the other immune responses that a vaccine can help create.
Second is, like we discussed before, gargling with Listerine and showering post-play helps rinse off things like HPV.
Obviously condom usage is still important, along with regular checkups and understanding what your status is now.
Obviously condom usage is still important, along with regular checkups and understanding what your status is now. If someone calls you and they say that they have anal warts, I think depending upon how involved you are sexually, you should get a full evaluation and try not to blame whoever you think passed them on.
When should you disclose and what is good practice for disclosing something serious like HPV or herpes?
Honesty is always the hardest, but it's the right thing to do–being fully evaluated frequently, getting the vaccine, and making sure that you are completely rid of active issues. If I do a full exam and see no evidence of HPV active wart issues, then you’re no different than anyone else in the world.
With that said, when you test via pap smear, if you're high-risk positive, then you need to ethically figure out what you disclose and what you don’t. With friends with benefits, partners, someone that's taking a relationship to the next level–a lot of people stop using condoms or come off PrEP.
At that point, I think it behooves everybody to have a discussion about STD issues and history, even if you had something in the past or got a vaccine. From there, you can decide together to get checked periodically to ensure there are no issues. It’s especially important if you're bringing other people in or if it's an open world.