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Reproductive Science Helps Women With HIV-Positive Partners Give Birth

Thursday, July 4th, 2013

Although sexually transmitted diseases are a very serious matter no matter what an individual is facing, HIV is perhaps the most frightening diagnosis for many individuals. Even with vastly improved life-expectancy rates, there are a number of concerns that individuals and those who have HIV-positive partners face throughout their lives. One of the biggest concerns for those who have HIV is whether or not they will have the opportunity to conceive children.

It is absolutely imperative that among couples in which one partner is infected with HIV and the other is not that protection is used whenever intercourse occurs. This means that a couple in which one partner has HIV cannot conceive naturally—at least, not in a responsible manner. However, studies in reproductive medicine have investigated whether or not the sperm of men that have been infected with HIV can successfully impregnate women while still leaving both mother and child HIV-free.

It sounds like a scary and risky procedure, and there has certainly been a lot of debate over whether these kinds of studies are wise. However, this study has shown that there does not seem to be a risk of infection in cases where the male sperm has been “washed” and the woman has been artificially impregnated. This is intriguing news not only for researchers that study the mechanics of HIV, but also for doctors who specialize in reproductive help. It means that there seem to be more options for couples in which at least one partner is infected. Unfortunately, pregnancy among HIV-infected women can still be dangerous, as the virus can transmit to the infant either during pregnancy or childbirth, and much more needs to be done to determine the possibilities for couples during these cases.

Overall, it is intriguing news and it will certainly continue to raise a lot of questions for those that specialize in women’s health and reproductive medicine. However, it is imperative for any couples in which one partner is infected with HIV to realize that it is necessary to seek medical advice when the issue of conception comes up. Even if the possibility for a safe pregnancy is there, it is better to seek the advice of professionals and to avoid any potential infection. Childbirth is a wonderful and a beautiful experience, but currently the best option for these couples is still to seek alternate methods to become parents.

– Yvonne S. Thornton, M. D., M. P. H.

Why getting the HPV vaccine (Gardasil®) makes sense

Friday, October 30th, 2009

Too often, the Internet is filled with rumors about the dangers of vaccines. And those rumors are typically based on misinformation, disinformation and fear.

That’s been the case with Gardasil® (Quadrivalent Human Papillomavirus  (Types 6, 11, 16, 18) Recombinant Vaccine), the vaccine that protects girls and young women from the human papilloma virus (HPV).  Many people who have HPV may not show any signs or symptoms.  This means that they can pass on the virus to others and not know it. A male or female of any age who takes part in any kind of sexual activity that involves genital contact is at risk.

While all medicines carry some risk, the benefits of being vaccinated against HPV far outweigh the small potential dangers.

A large part of the backlash against this vaccine may be due to an effort by the drug’s manufacturer to make vaccination mandatory.

Do I believe that young girls and women should be forced to get the vaccine? Absolutely not. Coercion would be a mistake. And that attempt by the drug maker appeared, in this physician’s opinion, to place profits above the right to make a personal choice.

But, getting past the bad decisions of pharmaceutical companies, let’s look at the benefits for our daughters and ourselves. We know for a fact that HPV is connected to cervical cancer. And we know for a fact that cervical cancer is a horrible disease.

So, if you can get a vaccine that will largely protect you against HPV, then getting vaccinated is an absolute no-brainer. Gardasil® protects against four types of HPV: two types (Types 16, 18) that cause about 70 percent of cervical cancer cases, and two more types (Types 6, 11) that cause about 90 percent of genital warts.

The HPV vaccine is typically offered to girls and women between the ages of 9 and 26.  Given in a series of three injections (initial vaccine, another in two months and the last in six months).   For adolescents and younger, I would recommend discussing the vaccine with your gynecologist when your daughter comes in for her first gynecologic visit, which should be between 11 and 12 years of age. That first visit is only for an introduction to a gynecologist and a pelvic examination is not performed. It is a “get acquainted” visit and it is then that the benefits of the vaccine should be discussed.  Gardasil® is most effective if you can vaccinate before a woman risks being exposed to HPV … in other words, before she becomes sexually active.

As a woman gets older, her body isn’t as susceptible to the damage of HPV, so vaccinating isn’t recommended.

– Yvonne S. Thornton, MD, MPH

Why it’s essential to offer kids comprehensive sex education

Monday, August 31st, 2009

In a recent study, about half of teens surveyed admitted to sexual activity. It’s a fact of life that adults have to face squarely.

And adults probably would be naïve to assume that the only ones having sex are the ones who are willing to admit to it.

But there’s another factor to consider: kids without access to comprehensive sex education may not know enough to call the sex that they’re having “real” sex.

Consider this finding from another survey, this one of ninth graders, that appeared in the journal Pediatrics in April 2005:

Adolescents evaluated oral sex as significantly less risky than vaginal sex on health, social, and emotional consequences.

That study found that, because of their assumptions about it being less risky, considerably more ninth-graders were having oral sex than were having vaginal sex.

Clearly, we’re failing our children if they believe that oral sex is less dangerous to their health. Oral sex can expose teens to the same sexually transmitted diseases — herpes, Chlamydia, gonorrhea, and HIV — as “real” sex. The only risk they’re avoiding by having oral-genital or anal-genital intercourse instead of genital-to-genital contact is pregnancy.

So why don’t kids know the risks?

Because we adults are not providing them with frank, comprehensive sex education.

We all want to keep children safe and preserve their innocence. But think for a minute — would you hand over the car keys to a child who’s never had a driving lesson? Teens are exposed to a more powerful drive than the one to get behind the wheel. Those raging hormones of adolescence are a biological imperative. We ignore that irrepressible drive at our children’s peril.

As an Ob-Gyn, I see the consequences of inadequate sex education. After years of decline, STDs are on the rise among adolescents. So is pregnancy.

We need to be honest with our children about sex, not because we expect them to be sexually active any more than when we expect them to crash the car when we tell them to buckle up. We must do it to protect them. We would be negligent not to. And, we need to discuss sexual intercourse and all the attendant risks along with the responsibilities before they are teenagers.

Age-appropriate sex education must be available to all youngsters. It must be comprehensive, and include detailed information about homosexuality, heterosexuality, anal-genital intercourse, oral-genital intercourse, and sexually transmitted diseases, as well as abstinence. We must tell our youth the entire story, without flinching or sugar-coating. A child’s future fertility, even his or her life and quality of life can be at stake. If that doesn’t merit giving them the truth, I can’t imagine what does.

– Yvonne Thornton, MD, MPH

Should schools provide voluntary testing for STDs?

Friday, August 7th, 2009

Yesterday, I was on Dr. Nancy’s noontime show on MSNBC, as one of two medical expert guests, to discuss whether schools should be permitted to offer voluntary testing for sexually transmitted diseases (STDs) to their students.

As you’ll see from the video, we three physicians (who are also all mothers) — Dr. Nancy, myself, and a doctor from the Medical Institute for Sexual Health in Austin, Texas — agreed that this is a no-brainer. Of course, we should allow schools to offer voluntary testing for STDs.

Why should we test? Because, in a pilot program at eight high schools in the Washington, D.C. area, 13 percent of the teens who took advantage of voluntary testing were found to be infected, most often with chlamydia and gonorrhea. Chlamydia often causes no symptoms but, if left untreated, can lead to chronic pelvic pain due to pelvic inflammatory disease, an increase in ectopic (abnormal) pregnancy and infertility. Only by testing can we be certain to discover and treat it.

This does not mean we want our teens to be intimate at such a young age. But we must face the fact that, despite our best efforts, some are becoming intimate. And, because of this, some teens face the risk of sexually transmitted diseases that, if left untreated, can cause lifelong damage.

No one would be forced to get a test and no one is suggesting anything but that we make the tests available to kids who wish to know whether they’ve been exposed. If they fear that they are infected, we must give them a way to find out for sure so that they can get treatment.

– Yvonne S. Thornton, MD, MPH