Posts Tagged ‘hepatitis A’

Viral STI (Sexually Transmitted Infection) Update

January 27, 2018

Andrew Siegel MD   1/27/2018

Sadly, there exist many “creatures” out there that enjoy cohabiting our genitals and bodies. Today’s entry is on the topic of viral STIs– an important subject, since several viral STIs are highly prevalent and many of those who are infected are unaware that they are infected. Viral STIs consist of the four “H’s”: HPV, HIV, herpes and hepatitis as opposed to bacterial STIs (gonorrhea, syphilis, chlamydia), protozoan STIs (trichomoniasis) and other-organism STIs (pubic lice and scabies). This is the 4-H club that you would rather not be a member of. 


The format of today’s entry will be a 10-question multiple-choice quiz to test your basic knowledge.  Please try to answer all questions before proceeding to the answers and explanations at the end.

Abbreviation Glossary:

STI: sexually transmitted infections

HAV: hepatitis A virus

HBV: hepatitis B virus

HPV: human papilloma virus

HSV-1: herpes simplex 1

HSV-2: herpes simplex 2

HIV: human immunodeficiency virus

AIDS: acquired immune deficiency syndrome

  1. Which of the following STIs can be prevented by means of vaccination?

a) hepatitis A virus

b) hepatitis B virus

c) human papilloma virus (HPV)

d) all of the above

  1. Natural membrane condoms (lambskins) are effective in preventing STIs.

a) true

b) false

  1. Which of the following is the most common ulcerative STI?

a) genital herpes

b) chancroid

c) syphilis

d) lymphogranuloma venereum

  1. Most genital herpes infections are transmitted by people who are unaware they are infected.

a) true

b) false

  1. What is the most common STI in the United States?

a) chlamydia

b) HPV

c) herpes

d) gonorrhea

  1. Most cases of HPV infections are characterized by which of the following?

a) self-limited

b) asymptomatic

c) unrecognized

d) all of the above

  1.   What areas of the body may HPV infect?

a) genital and anal areas

b) mouth and throat

c) respiratory tract

d) all of the above

  1. Hepatitis B infections can cause which the following problems?

a) permanent liver scarring

b) liver failure

c) liver cancer

d) all of the above

  1. Hepatitis A infections, although usually spread by contaminated food or water can also be spread sexually by the following means:

a) oral-anal contact

b) digital-anal contact

c) penetrative anal sex

d) all of the above

  1. Approximately what percent of persons living with HIV are unaware of their infection?

a) 15%

b) 25%

c) 35%

d) 45%


  1. All of the above. There are effective vaccinations available for hepatitis A virus, hepatitis B virus and human papilloma virus (HPV).  These are the only STIs for which vaccination is available for prevention.
  2. False. Natural membrane condoms (lambskins) are NOT effective in preventing STIs. They are made from lamb intestine and have pores that block passage of sperm, but the pores are more than 10 times the diameter of HIV and 25 times the diameter of HBV. Sexual transmission of hepatitis B, HIV and herpes simplex can occur with natural membrane condoms. However, latex condoms are capable of preventing the transmission of these viruses
  3. Genital herpes is the most common STI that can cause ulcerations.  When symptomatic it causes painful, watery blisters that usually erode to form ulcers.
  4. True. Most genital herpes infections are transmitted by people who are unaware that they are infected. In the USA, one in six persons age 15-50 is infected with HSV-2. Most people infected have not been diagnosed and as such, most genital herpes infections are transmitted by people who are unaware they are infected or are asymptomatic. Lesions recur in 80% of those with HSV-2 and 50% of those with HSV-1.
  5. The most common STI in the United States is HPV. The prevalence of genital HPV in adults is approximately 45% in men and 40% in women. All boys and girls 11 to 12 years of age are currently recommended to receive HPV vaccines, prior to the onset of sexual activity and initial exposure to the virus.
  6. All of the above. Most cases of HPV infections are self-limited, asymptomatic and go unrecognized.  When symptomatic, HPV is characterized by genital warts (condyloma) in the anogenital regions.
  7. All of the above. HPV can infect the genital and anal areas, the mouth and throat, and even the respiratory tract.
  8.  All of the above. Hepatitis B infections if left untreated can cause serious liver diseases: permanent liver scarring (cirrhosis), liver failure, liver cancer and death.  HBV is transmitted by exposure to infected blood or body fluids.
  9. All of the above. Hepatitis A infections, although usually spread by contaminated food or water, can also be spread sexually by oral-anal contact, digital-anal contact, and penetrative anal sex. A combined HAV/HBV vaccine is available.
  10. About 15% percent of persons living with HIV are unaware of their infection. It is estimated that in the United States about 1.2 million individuals are living with HIV or acquired immune deficiency syndrome (AIDS). Fortunately, there are effective medications utilized for prevention of HIV infection as well as treatment of HIV infection.  

Bottom Line:  Be smart when choosing your sex partner and practice safe sex. There are many infections that are caused by pathogens (bacteria, viruses, protozoa, etc.) spread person to person by intimate contact. Although some are merely annoying and are easily treated, others can cause significant morbidity; some are associated with the development of cancer, and others, including HIV, are responsible for an epidemic of death. The viral STIs are the 4 “H’s”: HPV (human papilloma virus, responsible for genital warts), HIV (human immunodeficiency virus), hepatitis, and herpes.  Latex condoms are the only widely available proven method for reducing the risk of transmission of HIV and other STIs, but they are certainly not infallible. Strongly consider getting vaccinated to protect against HPV and hepatitis.

Wishing you the best of health!

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food


These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx





Vaccinations Are Not Just For Kids

February 16, 2013

Andrew Siegel, M.D.  Blog #94

Vaccinations are not just for kids! Vaccinations are as equally important for “grownups” as they are for children.   Many assume—mistakenly so—that vaccinations are only administered by pediatricians or that the vaccinations they received as children provide indefinite protection.  That stated, most adults are aware of the importance of obtaining an annual flu vaccine, particularly in light of the severe flu season we’ve experienced this year.  This is one vaccine that needs to be updated and modified annually because of the dynamic nature of influenza viruses, and is typically effective for only a several-month period of time.

As much as I am not a “pill-prescribing”-oriented physician and believe in lifestyle management as a first-line therapy for many medical issues, I strongly believe in vaccines.  Vaccines are exceptions because they don’t treat disease but actually prevent disease before it has an opportunity to arise. Vaccines contain the very same microorganisms that cause disease, although they are weakened to the extent that they do not actually incite the infection. This small dose of attenuated microorganisms stimulates one’s immune system to produce antibodies, resulting in immunity to the disease without having to suffer through the actual disease.

As a result of vaccinations, certain infectious diseases have become extraordinarily rare.  Polio is a prime example of this. So why is it important to continue vaccinating for a disease that has become so rare?   To help explain this, I borrow an analogy from the CDC  (Center for Disease Control). The vaccine situation is analogous to bailing out a boat that has a slow leak. When beginning the bailing process, the boat is quite filled with water. After laborious bailing, the boat eventually becomes near dry. We could be complacent and stop the bailing process and rest on our laurels and enjoy the almost dry boat.  However, the root cause–the leak–is still present.  Eventually, water would seep in to the extent that it would be up to the same level as when we first began bailing.   Until we can stop the leak (i.e., completely eliminate the disease), it is important to keep bailing (i.e., immunizing).   Even if there are only sporadic cases of a particular disease today, if we eliminate the protection afforded by vaccination, more and more people will ultimately be infected and spread the disease to others; as a result, the progress that has been made over the years will be for naught.

With respect to smallpox, we were able to stop the “leak in the boat” completely, eradicating the disease. Smallpox vaccinations are no longer necessary because the disease no longer exists at all. If we keep aggressively vaccinating, hopefully other diseases including polio and meningitis will no longer be around to infect, maim, or kill children.  Thus, the goal of vaccinations is not only to preempt the disease in an individual but also to eventually wholly eliminate the disease for the benefit of the society at large.

In 1974, Japan had a successful vaccination program for whooping cough (pertussis) with nearly 80% of children vaccinated. That year, only about 400 cases of whooping cough were reported in the entire country and there were no deaths. For some mysterious reason, rumors abounded that the vaccine was no longer needed nor was it safe, and by 1976 only one of 10 infants was getting vaccinated. Subsequently, in 1979, Japan suffered a major pertussis epidemic with more than 13,000 cases and over 40 deaths. Ultimately, the government resumed their aggressive vaccinating program and the number of cases dropped significantly, once again.  The point is that if we stopped vaccinating, diseases that have seemingly been abolished would resurface. More people will get ill and some of them will die.

Thus, we vaccinate not only for the individual, but to protect the future of our community.  This concept is referred to as “herd immunity,” the protection against disease that occurs when the vaccination of a significant portion of a population provides a measure of security for those who have not developed immunity.   When large numbers of the population are immune to a disease, the probability that a susceptible individual will come into contact with one who is infected is diminished. Vaccination acts as a “firewall” in disease spread, slowing or preventing transmission of the infectious disease to unvaccinated individuals who are indirectly protected by vaccinated individuals.  In order for herd immunity to be effective, it is advantageous that only a small fraction of the “herd” is left unvaccinated.   This population should be those who cannot safely receive vaccines because of medical conditions such as immune disorders, organ transplants, or certain allergies.

Vaccines for pneumonia, influenza, hepatitis, HPV (human papillomavirus) and the combined tetanus, diphtheria, and pertussis vaccine are available for adults. The recent resurging incidence of pertussis has led to an update of the traditional booster.  Pneumonia vaccine is recommended for adults 65 and older, particularly those with asthma, diabetes, cardiac disease, and in any other situation that compromises the immune system and places individuals at a higher risk for pneumonia.  Additionally, the vaccine is recommended for those who are in close contact with high-risk individuals. The hepatitis A vaccine is recommended particularly for those who travel to Third World countries. The hepatitis B vaccine is recommended for those with diabetes and those who are otherwise at risk, such as healthcare workers. The HPV vaccine is recommended for adolescents and young adults up to the age of 26.

Shingles—aka herpes zoster—results from the same virus that causes chickenpox. After exposure to chickenpox, the virus never quite completely leaves one’s system, living dormant in nerve endings.   For most people, the antibodies manufactured by the body keep the virus in check for many, many years. However, when our immunity becomes compromised by age or other factors, the virus can be re-activated in the form of a painful skin rash known as shingles. A one-time vaccination for shingles can prevent the occurrence of this painful condition.  The FDA has approved the vaccine for adults 50 or older, although some insurance companies will not cover it until age 60.

Bottom line:  Staying up-to-date with adult immunizations provides important protection for ourselves as well as our loved ones and other members of our “herd.”

For the CDC recommended vaccination schedule for adults, go to the following site:


Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

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