Guest: Dr. Ted Rosen
Presenter: Neal Howard
Guest Bio: Dr. Ted Rosen, Professor of Dermatology at Baylor College of Medicine in Houston, TX, Chief of Dermatology at the Houston VA Medical Center and an expert in the treatment and diagnosis of both STD and non-STD genital lesions, including external genital warts (EGW) reminds us there is a great need for increased awareness when it comes to STDs and sexual health. He advises people to establish an open and honest relationship with their physicians in order to prevent STDs or to seek treatment immediately, if necessary. For more information on external genital warts and treatment options like VEREGEN, visit www.veregen.com
Segment overview: Dr. Ted Rosen, MD, shares some insight on how to talk to a partner about STD’s.
Health Professional Radio – Partner and STD (Sexually Transmitted Diseases)
Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you so much for joining us today. Approximately 79 million Americans are currently infected with HPV which can lead to genital warts. Our guest in studio today is an expert in the diagnosis and treatment of STD and non-STD genital lesions and he’s in studio today with us to talk about, not only some of the treatments for HPV but also how to talk to your physician about sexually transmitted diseases, how to prevent them and how to talk about them to your partner. Our guest in studio is Dr. Ted Rosen, Professor of Dermatology at Baylor College of Medicine, also Chief of Dermatology Services at Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas. Some STDs are more well-known than others but all of them are serious and require medical attention. Dr. Rosen reminds us that there’s a great need for increase awareness when it comes to STDs and sexual health and advises people to establish an open and honest relationship with their physicians in order to prevent STDs or to seek treatment immediately if necessary. If you like some more information on external genital warts and treatment options like ViroGen, visit www.virogen.com. Welcome to Health Professional Radio Dr. Rosen.
Dr. Ted Rosen Good afternoon, glad to be here.
N: Now you’re an expert in the treatment of some of the most common forms of HPV. First tell our listeners what exactly HPV is.
R: Well HPV stands for human papilloma virus so there’s a family of viruses that belong there. There are about a hundred plus that have been identified, new ones are constantly being identified and all those roughly 40 can cause sexually transmitted disease, they can infect the skin on and around the genitalia as well as the mucosa of the genital organs, so those cause external genital warts and then the low risk varieties can cause genital warts, the high risk varieties can cause genital cancer.
N: So it’s a pretty high priority once you know that you’ve been exposed. How does one know that they’ve been exposed to any of these varieties of HPV?
R: Unfortunately, there’s no blood test that’s readily available and very sophisticated swabs looking for DNA are available but they’re not commercially, it’s more of a research thing. So number one would be to try and prevent infection by using barrier protection or being abstinent or only having sex with one partner monogamous who has no infection, sort of that. The way one knows that there’s a problem is the lesions, so for external genital warts it would be small bumps sometimes flat, sometimes looking like cauliflower of various sizes in the genital region or the upper inner thighs, the skin above the genitalia and for women, they can occur inside the vagina which would be seen during a well-woman exam for example and for the men actually occasionally they can get inside the penis, so they might be peeking out the end of the urethra but it’s finding a bump usually asymptomatic but sometimes they hurt, sometimes they bleed, sometimes they itch, if you see something that doesn’t belong there you need to be concerned.
N: Now we’re not talking about run in the mill herpes, right? We’re talking about something more on a much more devastating level?
R: Herpes is a devastating disease for the people who have it because it’s recurrent, it hurt, it causes unsightly blisters and the blisters may break and then cause painful, small shallow erosions but HPV is probably even worst because the lesions can get to be ultimately without treatment, actually quite large, they’re relatively easy to transmit if a woman has genital wart, gives birth to a baby through an infected birth canal, those can sometimes lead to laryngeal papilloma which are similar lesions on the larynx, on the vocal chords of the baby. So this is a major problem, it’s not just a cosmetic nuisance and then the psychic overlay of this whole thing is important because people are ashamed, they’re embarrassed, they’re concerned where did I get this? Who might I have given it to? So yeah it’s a really big problem.
N: Now there is a vaccine for at least one type of HPV, am I correct on that in that statement?
R: Well there two different, there’s actually three vaccines available, two of which will be available at the end of the year 2016. They protect against most but not all of the HPV types that cause genital cancer and one of them that’s got nine different HPV types in it out of those 40 that can affect the genitalia, helps to protect against external genital wart but here in the US we’re not doing a terribly good job at vaccinating the population. So it’s different from state to state but we clearly not doing a wonderful job. The vaccines optimally given early, age 10, 11 it can be given as early as age 9. It can be given as late at age 26 but it’s best given before sexual activity even starts but it’s not a hundred percent protect.
N: So the vaccine has been missed and the person is, well they’re doing what they do and they contract HPV. Is it a done deal, is it recurrent like herpes or is it treatable and you can learn a lesson from it and go on about your business? What are some of the treatments for the most common forms of HPV?
R: Well let’s talk about external genital warts, the oncogenic or cancer inducing one, that’s a much more complicated thing but I think everybody should understand that genital warts are imminently treatable. And there are variety of different treatments that can be done, some are used by the patients in the privacy of their own home at their convenience, some are done by the healthcare provider in the office, those include freezing with liquid nitrogen and various surgical and laser interventions that are destructive. In all instances the treatments are reasonably effective if done properly and so there’s real hope for people who have external genital warts related to human papilloma virus.
N: Are any of these treatments more, I guess invasive or intrusive or uncomfortable in any way as far as treating them?
R: Well certainly all the provider applied treatment, surgical burning, freezing, cutting would be considered perhaps more invasive and a little more uncomfortable. The patient applied treatments that are done at home are generally well tolerated, one of the newest ones for example is a green tea derivative, it’s called Sinecatechins 15% ointment and that’s a very interesting treatment, it’s one of the newer ones that’s been approved and the patient applies that 3 times a day at their convenience, their home for up to 16 weeks or less if the lesions go away and it’s very well tolerated with a very good complete cure rate, 53.6% complete cure rate and patients who are cured have been followed over a long period of time like three months is kind of our standard follow up after a treatment and over 93% of patients remain clear. So without having to go through cutting, burning, freezing and other somewhat uncomfortable interventions.
N: Does HPV cause these lesions and warts 100% of the time whether treatment or not? Is that what’s going to happen? Is that the only thing that you gonna know or do they sometimes not cause these lesions and there some other manifestation that tips you off?
R: Well let me answer that in two different ways. First or all, many people become infected with HPV. In fact it probably is nearly every single sexually active adult at one time or another their skin encounter human papilloma virus but you keep in mind that the majority of individuals, their own immune system will rid the virus, it will get rid of the virus and so they don’t end up with manifestations that relate to the infection. Some people become infected and the virus lays dormant in the skin, it isn’t gone but it’s there but it doesn’t cause any problems and for some other people, the different HPV viruses can lay dormant for a long time and then at some future point, suddenly activate for reasons we don’t entirely understand and then cause things like genital warts or if they’re the bad type the oncogenic viruses lead to genital cancer long after the infection was acquired.
N: Okay, so I suppose like any other detection, I guess the amount of virus that a person has become in contact with that hasn’t been dispelled, does that determine whether or not they’re gonna be 16 weeks or 3 weeks or, how does that actually, it seems like every case is different for every type of person and every type of skin to skin contact encounter?
R: Well, that’s the case so we don’t know. It depends how susceptible the person is, it depends on the number of virus particles that they come in contact with which is hard to predict even based on the lesion of the person who is infected. It depends how long their contact with it, are there already small breaks in the skin that allow the virus to penetrate? It’s very difficult to predict who will infect another person and it’s even harder to predict who is susceptible to infection. So think you have to consider every single person who’s doing things, unprotected sexual intercourse, by doing that is at risk for acquiring a sexually transmitted disease from the great many that are prevalent in the society.
N: You talked about the psychological aspect of a person being ashamed or maybe even fearful to reveal that they’ve been infected or come in contact. What tips or advice do you have on talking to your partner, your sexual partner about sexually transmitted diseases whether you’ve come in contact and you need to warn him/her or maybe talking to your physician about prevention or treatment? How do you get the ball rolling with such a stigma attached to it?
R: I think Neal that the best thing to do is just be upfront, honest and very matter of fact and I advise my patients to ask me for my advice that whenever you’re starting a new relationship think about it in this way, “I want to protect you, my new partner as well as protect myself. So before we start having sexual contact, let’s talk about our past, let’s talk about what we’ve had, what we’ve been treated or maybe we should go get tested for the things that can be tested for in advance.” And I think that shows concern and care and I realized that in the heat of the moment, the passions are high and sometimes that’s a little hard to do but it’s really an important thing and if people think about protecting not only themselves, it’s not a selfish thing, it’s protecting your partner then you can approach it that way. As far as health care providers talking to their patients, I think the patients shouldn’t hesitate to talk to any of the healthcare providers about these issues and healthcare providers should not be embarrassed or ashamed to talk about them, this is an integral part of a person’s general health and so you just bring it up. “Look I’m now sexually active and I need to know what I need to worry about and what I should be protected about and how do I protect myself and my new partner.” And with about a 50% divorced rate here in the United States, even adults, even adults who were older need to consider this, even if they’re dating people their own age. So it’s not just the young people even though the majority of sexually transmitted diseases occur in that 15-24 age group, it’s everybody needs to consider this as a possibility.
N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’ve been in studio with Dr. Ted Rosen, Professor of Dermatology at Balor College of Medicine, also Chief of Dermatology at Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas and we’ve been in studio talking about some of the ways that we can get the conversation started even though there’s a lot of stigma associated with sexually transmitted diseases. Some STDs are more well-known than others but all of them are serious and require medical attention. Dr. Rosen reminds us that there’s a great need for increased awareness when it comes to STDs and sexual health and advises people to establish an open and honest relationship with their physicians in order to prevent STDs or to seek treatment immediately if necessary. If you like some more information on external genital warts and treatment options like ViroGen visit www.virogen.com. It’s been great having you here with us today Dr. Rosen.
R: Thank you for having me.
N: Thank you. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can also subscribe through our podcast on iTunes.