[Question #3413] Followup

36 months ago
Hi Dr.  HH, thank you so much! You made me feel way better. I just wanted to clarify that you weren’t saying I should or need to ask another doctor about the Remicade stuff, but if I want more info I could? Also, I just wanted to confirm that even if someone is having symptoms them, or I touching their genitals and then touching mine is low risk for any STD? I couldn’t decipher if that question was answered. Sorry for my need for followup but thank you so much again for helping me return to my life! You guys provide such an invaluable service. 
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Welcome back to our Forum.  Today I happened to pick up your follow-up question and will be answering.  FYI, Dr. Handsfield and I have worked closely together  for over 35 years and while the words we use may vary, we always agree on the substance of our advice.  In your case it may be a good thing that I happened to pick up your question today as you will be hearing the same message that you received earlier from Dr. Handsfield from me, using slightly different words.  I have read through your earlier interaction with Dr. Handsfield and agree with his advice to you. 

Your follow-up questions seem to focus on two issues.  In the first instance, there is the issue of communication with your own or other doctors regarding how your Remicade might interact with your HPV or HSV-1 infections.  I agree with Dr. Handsfield that there is no need to interact further with your doctors regarding the questions you asked earlier regarding your vulnerability to infection.  On the other hand, there is no reason not to if you wish to.  Your Remicade should not increase your vulnerability to acquisition of new STIs although it could make your symptoms or signs of infection more apparent than if you were not taking the medication.  I would however, recommend against using the internet to look for answers.  All too much of what is said there is incorrect, taken out of context or misstated. 

Your second question related to transmission of STIs through hand to genital contact.  Here I agree with Dr. Handsfield as well.  HPV, HSV and other STIs are transmitted through direct sexual contact and person to person transmission through transfer of genital secretions on a persons hands does occur.  Thus there is no risk of you transmitting your HPV or genital HSV-1 to the children you care for in the course of your work with them, including giving them baths, changing diapers, etc.  Similarly, there is no risk of STI transmission or acquisition of infections through mutual masturbation in which you and a partner get your genital secretions on one another without penetration.

I hope this verification of what you have heard from Dr. Handsfield is helpful and will allow you to move forward.  EWH
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36 months ago
Hello, thank you for confirming that my Remicade doesn’t make me any more likely to get stds or to transfer them to others. If I got that wrong just let me know. To clarify I wasn’t re-asking because I didn’t believe Dr. HH I was asking to make sure I was understanding correctly. I have another question about your response. You wrote that transmission does happen from secretions without penetration but then wrote that hands don’t cause transmission. So again, just wanting clarification, if I am with a partner who has an std am I at risk of contracting it if they touch their genitals and then touch me, with or without secretions? I understand that if I go to the bathroom or something and wash my hands the kids I nanny for aren’t at risk even if I hand feed them or apply diaper cream or if they touch my mouth and then theirs. Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
 Sorry. On my earlier reply I left out the word NOT.    STDs are NOT transmitted by the transfer of genital secretions on a person's hands to another person's genitals.   Thus, if you are with a partner with an STD and that partner touches their genitals and then your genitals with their hands you are not at risk for acquiring that STD From the transfer of secretions on their hands.   Similarly, the kids you take care of are not at risk for any genital infection you have from touching your genitals and then going on to apply diaper cream or otherwise touch them. 

 Sorry for any confusion my typographical error made. EWH
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36 months ago
Great! Thank you, and to be clear I don’t touch my genitals and then change diapers directly after.  I think that would be strange/gross. I was more concerned about passive contact or anything remaining on my hands after handwashing, or virus living on my hands and coming in contact with their mouths or private areas when I take care of them. Or them touching my mouth and then theirs. But I understand now that I was worrying too much, and that stds are only transferred from vaginal or oral sex or direct genital to genital contact. Thank you so much!
35 months ago
Hello. Thank you. I think I have 1 or 2 followupsleft. Not sure if my last one counted since there weren’t any actual questions in it. Let me know please. So, I have a suspicious bump near my anus. It is smooth and soft and seems to move a little when I touch it. It’s reddish, and not really rough. All of these things make me think it’s not a wart. I had a dermatologist look at it who said she thought it was a hair follicle. I keep  worrying it’s a wart because I don’t recall having another bump like this and it’s not irritated like a hair follicle. I did get the vaccine which I know covers the vast majority of wart-causing strains, but I wasn’t able to get the vaccine before I was sexually active, although I’d had limited partners and I was around age 26. I’m 33 now. Wondering what is the best type of doctor to examine this? Also, from what I’ve read, a genital herpes symptom can be almost anything, not necessarily just a blister and then resulting open sore, so how do I know when I’m having an outbreak? Thank you. Also, how often do you see warts in the mouth/throat-it’s my understanding that these would be the only symptoms/way to diagnose oral hpv (besides cancer) as there is no test? is there a way to swab the mouth/throat to check for other stds? I’ve never had an actual cold sore (blister on or around my lips) to swab for hsv, only sores inside my mouth and tiny  cuts or cracks on my lips. Is it recommended only people with confirmed diagnoses (like oral hsv) disclose?
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
I will address these questions directly. 

The bump near your anus has been evaluated by the proper specialist-your dermatologist. From the sound of things this could be a hair follicle or a benign skin tag.  If it were a wart I think your dermatologist would have said so.  The fact that you took the HPV vaccine, even if it was after you became sexually active makes it unlikely that it is HPV and this certainly does not sound like HSV which you also asked about.

Oral HPV infections are much less common that genital infections, typically resolve on there own and like most genital infections do not represent a health risk for most people.  There is no recommended test for oral HPV and I urge you not to worry.  Dentists regularly inspect the enitre oral cavity for lesions and that is sufficient.

I see no reason for you to be worried about HSV of any sort- oral or genital and recommend against routine blood testing for this infection.  The test has problems with false positive results and is not recommended as a screening test. 

This will be your final follow-up.  Take care EWH---
35 months ago
Thank you! I actually have diagnosed hsv-1 genitally and high risk hpv on my cervix-hence my questions. Wanting to make sure this doesn’t change your answers, especially regarding oral infections. I shared this in my original post. I can pay more if needed. Thank you! 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago
I remember both of these facts and in fact, the 4th sentence of my original reply said "I have read through your earlier interaction with Dr. Handsfield and agree with his advice to you."  Thus this background in no way changes my assessment or recommendations 

Persons who have genital HSV-1 virtually never get oral HSV-1, rarely experience genital recurrence and genital HSV-1 is rarely transmitted. 

You seem very, perhaps overly concerned about STIs.  I hope the perspective offered through Dr. Handsfield's earlier interaction with you and in my comments above will help you to move on without continuing concern.  This thread was to be closed above and I chose to answer your follow-up but there will be no further answers.  I hope that you will have faith in your own doctors and be able to move forward.  EWH
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35 months ago
Thank you! Just wanted to clarify. I apologize for my anxiety and thank you very much for your help!