Having the courage to go for an STD/STI test is one thing, and waiting for the result is another. However, it is a whole different feeling when you find out to be positive of sexually transmitted disease.

Even though STDs are available in various types and not all of them are as serious as others, they have some level of shame and stigma attached to them. 

Regardless of whether you have chronic or curable STD, you will still feel some weight of shame on you.  If you test positive for an STD, you just have to face it and deal with it as a reality.

Though the subject may seem scary, managing your emotional and mental health is vital after getting STI/STD diagnosis. This post outlines tips you can use to help you manage and treat sexually transmitted diseases.

Read on!

What is mental health?

Mental health is a state of mental wellbeing where a person is able to realize his/her abilities, can cope with stress, work productively and make a contribution to the community.

It is the foundation of our personal and collective ability as human beings to think, move, earn a living, interact with others, and enjoy life.

Determinants of mental health

The level of mental health of a person is determined by several social, psychological, and biological factors. 

Poor mental health has also been associated with frequent social change, stressful work environments, poor physical health, gender discrimination, and human rights violations.

Tips to help you take care of your mental health after an STD diagnosis.

• Collect information and feed your mind.

After receiving the bad “news,” the first thing you should do is gather information about the particular STD/STI. Learn about the disease as this will not only help you but the people around you too.

Also, research your STD, how you can transfer it, how you can avoid spreading it to others in your life. By knowing the facts about the disease, your brain broadens, and ultimately you feel less ashamed of yourself.

• Accept your feelings and know it is okay to be upset.

Coming to terms with a positive STD test result is no fun; it can be uncomfortable, painful, and embarrassing. It is easy to get angry and feel bad about yourself.

However, bottled-up feelings usually do not end up in a good way. Once you are confirmed positive, allow your emotions out. As much as we want to be strong for ourselves and our loved ones, we are also human beings.

Do not strain yourself to staying positive or being ‘okay’ immediately after receiving the news. Allow yourself some time and let the process follow its course until the end.

Generally, the perfect way of maintaining good mental and emotional health is nurturing feelings and not hiding, controlling, or stifling them.

• Don’t put yourself down.

After going through the healing and acceptance process, do not stop your life; move on to the next step in life. Having an STD doesn’t make you less of a person.

Doing what you love doing can help with easy recovery. Staying active not only gets your mind away from the situation but also lifts your moods, boosts your appetite and the quality of your sleep.

Remember, being positive of STDs/STIs does not compromise your sexual ability and history; it only means that you need to practice safe sex. And the best way of being sure of your status is to go for an annual STI screening. You can do this as part of regular visits to your health care provider.

• Inform your partner.

A positive STD test result always comes as a shock, regardless of your relationship status. This makes it hard to start a conversation about a sexually related disease.

However, understanding that it is normal to start a conversation, you will begin to feel relieved and remain positive.

And while these conversations might be painful and less comfortable, it is best to face the reality head-on. Stand up and take the honest step, regardless of your partner’s reaction to the news.

• Get support from people who matter.

Persons who test positive for sexually transmitted infections may require strong advice and support during their recovery process. And while this can be effective on others as a release mechanism, releasing this type of sensitive information is difficult.

Reach out for support and discuss the situation with people of the same status, your loved ones, family, and friends. Do not avoid people around you as their love, care, and compassion will help you breeze through the treatment.

Remember, anytime you are about to take an STD test or even after getting the result, try to be around people who will offer love, care, and support immediately. 

People can provide prompt help in case the news resulted in a shock or a heart attack. They can also be a great source of strength during these trying moments and help you take care of your mental health.

• Take good care of yourself.

After a positive STD test result, your whole being can receive a shock and drive you into making irrational decisions. Therefore, it is vital to take extra care of yourself emotionally, physically, and mentally.

Apart from drugs and treatments, you will be given by your GP. It is also vital to avoid exposing yourself to risk factors. Practice safe sex, immerse yourself into a favorite hobby or anything that makes you feel good.

Conclusion

Like other diseases, most sexually transmitted disease is curable and goes away with the proper medical and self-care. However, the news may present some shame and stigma, making you feel bad about yourself.

Therefore, taking care of your mental health and your general wellbeing is vital in ensuring you stay positive and active throughout the recovery period. Accept your feelings, feed your mind, get support from people who matter to you, and don’t put yourself down.

Remember, being positive of STDs/STIs does not make you a lesser person, and it is not the end of the world for you. Keep doing what you enjoy and face reality with the courage to remain strong and active at all times.

Written by

Beril Miller 

The post How could this happen to me? Dealing with an STI diagnosis… appeared first on Walk In GYN Care.

What are mycoplasma and ureaplasma?

The term “mycoplasma” is widely used to refer to any organism within the class Mollicutes, which is composed of eight genera (including Mycoplasma, Ureaplasma, Acholeplasma, Anaeroplasma, and Asteroloplasma).

The mycoplasma include:

• Mycoplasma hominis
• Mycoplasma genitalium
• Mycoplasma fermentans(incognitus strain)
• M. pneumoniae

The ureaplasma include:

• Ureaplasma parvum
• Ureaplasma urealyticum

What are they? Are they bacteria or viruses?

Mycoplasma and ureaplasma are the smallest free-living organisms. They lack a cell wall, therefore neither mycoplasma nor ureaplasma can be visualized by routine gram stain microscopy. It is hard to diagnose their presence because of difficulty in growing or culturing them in the lab. In order to culture these organisms, specialized media and very strict conditions are required.

Do Mycoplasma and ureaplasma live in normal genital tract?

Yes, Many healthy asymptomatic adults have genitourinary colonization with Mycoplasma and Ureaplasma spp. The percentage of women with vaginal colonization by M. hominis, M. genitalium, and Ureaplasma spp increases after puberty in proportion to the number of lifetime sexual partners. It has been seen to vary from 0% in never active women to upto 70% in sexually active women

Does this mean these women are infected and contagious?

This does not mean that these women are “infected”, if these are not creating any symptoms, then these mycoplasmas and ureaplasma are considered normal inhabitants of the genital tract.

How is M. Genitalum different from other Mycoplasmas and Ureaplasma?

M. genitalium was first described in 1981 after being isolated from the urethral specimens of two men diagnosed with non gonococcal urethritis (NGU). Studies have suggested a strong causative link between M. genitaliuminfection and urethritis in men and an association with cervicitis and pelvic inflammatory disease (PID) in women.

When can Mycoplasma and Ureaplasma spp cause infections?

Mycoplasma and Ureaplasma spp normally stay attached to mucosal epithelial cells (lining) of the respiratory or urogenital tracts. However, they can spread to other sites and cause infection when there is a break in the lining and/or an underlying defect in host defenses, such as in the developing fetus, premature infant, or immunosuppressed adults.

M. genitalum in addition to above evades the immune system and alters the host’s immune system, which allows it to survive in the host’s body.

How common is M. Genitalum?

In studies from the United States, M. genitalium is present in approximately 1 percent among young adults in the general population. In comparison, the prevalence of gonorrhea is 0.4% and Chlamydia is 2.3%. Amongst STI clinics and in population with multiple STI risk factors, prevalence may range from 4 to 38 percent.

What are the risk factors for these infections?

Young age (e.g., <20 to 22 years old), smoking, recent sexual intercourse, and an increasing number of sexual partners are some risk factors.

In which conditions have the mycoplasma and ureaplasma infections been implicated?

Infections that have been linked to various types of mycoplasma and ureaplasma include:

M. hominis

• Pelvic inflammatory disease (PID) – not proven
• Chorioamnionitis
• Postpartum and postabortal fever
• Pyelonephritis
• Central nervous system infections
• Septicemia
• Wound infections, especially postoperative wounds
• Joint infections
• Upper and lower respiratory tract infections
• Endocarditis
• Neonatal bacteremia and meningitis
• Neonatal abscesses

Ureaplasma spp

• Chorioamnionitis
• Postpartum and postabortal fever
• Congenital pneumonia
• Neonatal bacteremia
• Neonatal abscesses
• Non gonococcal Urethritis in males – not proven
• UTI

M Genitalum. 

• Non gonococcal urethritis (men)
• Cervicitis
• PID
• UTI in men and women
• Preterm birth and abortion – not proven

Is M. genitalum an STD and is transmitted sexually?

Sexual transmissibility of M. genitalium is supported by both clinical and molecular epidemiologic evidence. As above, M. genitalium is detected more frequently among sexually-experienced

Furthermore, in DNA-typing studies, sexual partners often harbor identical bacterial genomic strains.

Can there be other infections that co-exist with Mycoplasma Genitalum?

Chlamydia trachomatis is the most commonly reported co-infecting organism.

How does M. genitalum present in Men?

M. genitalium infection accounts for 15 to 20 percent of NGU cases reported per year among men in the United States. M. genitaliumdetection is more frequent in men with persistent or recurrent urethritis. It may also be associated with balanitis (inflammation of the glans penis) and posthitis (inflammation of the foreskin).

How does M.genitalum affect women?

M. genitalium can ascend from the lower to upper genital tract after sexual transmission

Cervicitis

Cervical inflammation is the most common manifestation of M. genitalium infection in women and is usually described as mucopurulent cervicitis (MPC).

Pelvic inflammatory disease

Several studies have observed associations between detection of the organism and clinical signs and symptoms of PID.

Clinical presentation of M. genitalium-associated pelvic inflammatory disease (PID) may include mild to severe pelvic pain, abdominal pain, abnormal vaginal discharge, and/or bleeding, similar to PID due to C. trachomatis.

Which specimen is most accurate for men and women?

Among men, the diagnostic performance of first-void urine specimens in detecting M. genitalium is higher than that of urethral smear specimens

Among women, vaginal specimens are more diagnostic. In one study of 400 women the relative sensitivity of PCR for M. genitalium was 86 percent with vaginal swabs as compared to 61 percent with first-void urine.

When to test for M. Genitalum?

 If a sexually active person presents with evidence of urethritis, cervicitis, or pelvic inflammatory disease, it is recommended to test for M. genitalium also in addition to other STI’s. If women or men continue to have symptoms of these conditions despite completion of appropriate therapy, regardless of initial cause, then testing for M. genitalium is also recommended.

How are Mycoplasma and Ureaplasma infections diagnosed?

They are diagnosed by testing vaginal swabs or urine specimens. For women, vaginal swabs are more accurate.

There are either culture based or RNA based tests for detection of these organisms called NAAT based tests.

Culture based methods are difficult to implement because of reasons described above. Most hospital microbiology laboratories are not prepared to culture them.

RNA based or PCR-based assays are becoming increasingly available in multiplex kits for the diagnosis of respiratory and genitourinary tract pathogens. The only drawback is that we cannot test for sensitivity to drugs through RNA based tests.

A DNA chip assay is capable of identifying 13 targeted urinary tract pathogens including M. hominis and U. urealyticum, with relatively high sensitivity and specificity compared to PCR tests. It is not currently commercially in use in the US.

Which drugs are effective in treatment of Mycoplasma spp and Ureaplasma spp?

Most mycoplasmas and ureaplasma are susceptible in vitro to macrolides (e.g. Azithromycin), tetracyclines, (e.g. Doxycycline) and fluoroquinolones (e.g. Ciprofloxacin). Azithromycin is active against Mycoplasma genitalum (considered an STD).An exception is M. hominis, which is not susceptible to macrolides.

Which antibiotic is the best for which species?

M. GENITALUM

Azithromycin – is the first line treatment. It is 100-fold more active against this organism than the tetracyclines or most fluoroquinolones. However, resistance is increasing. In certain regions, the estimated rate of azithromycin resistance in isolated M. genitalium strains has been as high as 40 percent. Suggested treatment dose is Azithromycin 1g orally.

Failed or recurrent infection with M. genitalum

Moxifloxacin– If Azithromycin failed and there is documented persistence or recurrence then next choice is Moxifloxacin. There is also increasing evidence of resistance to fluorquinolones.

MYCOPLASMA HOMINIS

Doxycycline – is recommended for non pregnant adults with disease caused by M. hominis

Clindamycin: is recommended for infants with disease caused by M. hominis,

Fluroquinolones have been found to be effective, however there is increasing development of resistance seen in mycoplasmas.

UREAPLASMA SPP.

Doxycycline – is recommended for non pregnant adults with disease caused by Ureaplasma spp

Clarithromycin, Azithromycin and Ofloxacin (fluoroquinolones) are also effective for ureaplasma spp.

Clindamycin is not active against Ureaplasma

Azithromycin or Clarithromycin: is recommended for infants with disease caused by Ureaplasma spp,

Which symptoms could suggest clinical disease warrantying treatment in Women?

• Recurrent Vaginal infections not responsive or resistant to routine treatments of BV.
• Recurring infections after sexual intercourse.
• Persistent vaginal burning, malodorous discharge with negative cultures for routine culprits – Candida and Gardnella etc with negative Gonorrhea/ Chlamydia and Trichomonas.

Please remember that these are presumptive associations and linkages. We still need robust trials and larger studies to prove these organisms as primary causative agents of vaginal infections.

Do partners need to be treated for M. genitalum infection?

Although there are no guidelines for partner referral and treatment, it is reasonable to screen all sexual partners of laboratory-confirmed cases of M. genitalium and treat if positive. If screening of sexual partners of index patients with confirmed M. genitalium is not possible, it is reasonable to empirically treat for M. genitalium given the evidence of sexual transmission of this organism.

How long does M. genitalum take to grow and infect someone?

Although the incubation period of this pathogen remains undefined, screening should target sexual partners in the past 60 days. Treatment for partners of patients with confirmed M. genitalium infection is the same as for patients.

When should we treat Mycoplasma or Ureaplasma?

If patients have clinical signs and symptoms, caused by a Mycoplasma or Ureaplasma spp, then they should be treated. In contrast, patients who just have these organisms in their genital tract with no symptoms, do not require treatment.

Treatment paradigm for Mycoplasma and Ureaplasma

M. hominis

Non-pregnant

Doxycycline: 100mg PO BID x 7 days

If allergy

Moxifloxacin: 400mg PO daily x 10 days

Or

Pregnant

*Clindamycin: 600mg PO every 8hrs x 7 days

Ureaplasma

Doxycycline: 100mg PO BID X 10 days (14d if PID)

Or

Azithromycin: 1g PO single dose

*Clindamycin not effective against ureaplasma

M. genitalum

Azithromycin: 1g PO single dose

If resistant or recurrent infection

Moxifloxacin: 400mg PO daily x 10-14d

Rest assured, we are here to help you navigate this difficult issue at Walk IN GYN Care

Well wishes

Dr. Adeeti Gupta

The post Mycoplasma and Ureaplasma – The big conundrum appeared first on Walk In GYN Care.

As per the CDC, in 2016, a total of 1,598,354 chlamydial infections were reported to CDC in 50 states and the District of Columbia. This case count corresponds to a rate of 497.3 cases per 100,000 people. From 2000–2016, the rate of reported chlamydial infection increased from 251.4 to 497.3 cases per 100,000 people.

Increasing Chlamydia in Metros

The rate of reported cases of chlamydia in the 50 most populous metropolitan statistical areas (MSAs) increased 6.2% during 2015–2016 to on an average 5 per thousand individuals. During 2015–2016, the rate of reported cases of chlamydia increased 3.9% among women (639.8 to 664.5 cases per 100,000 females) and 10.9% among men (331.8 to 368.0 cases per 100,000 males).

Increasing Chlamydia in NYC

Recent preliminary data from our own Women’s health centers, in NYC and the surrounding boroughs indicates Chlamydia rates of 12.5 per thousand women in contrast to the national averages of 5 per thousand people. These are still preliminary but serve as a clear warning sign that early screening, diagnosis and treatment is essential.

Treating Chlamydia

Chlamydia can be easily cured with antibiotics. Persons with chlamydia should abstain from sexual activity for 7 days after single dose antibiotics or until completion of a 7-day course of antibiotics, to prevent spreading the infection to partners. It is important to take all of the medication prescribed to cure chlamydia. Medication for chlamydia should not be shared with anyone. Although medication will stop the infection, it will not repair any permanent damage done by the disease. Sex partners need evaluation, testing, and presumptive treatment if they had sexual contact with the partner during the 60 days preceding the patient’s onset of symptoms or chlamydia diagnosis.

Testing and Insurance Coverage

The diagnosis of Chlamydia is easy. All you need is a vaginal swab or a urine test. It can even be tested through a routine pap. Insurances may or may not cover this testing as a part of your routine “annual” visit. However, as you can see, “You may have it and not even know it”!!!

 Stay tuned

 Dr. Adeeti Gupta

The post Drastic increase in STD’s – Let’s talk Chlamydia! appeared first on Walk In GYN Care.

1. All Vaginal discharge are not infectious.  Recurrent and persistent mixed vaginal infections can now be accurately diagnosed by a vaginal culture which can be performed through the Pap smear test at the same time.

2. Mixed infections with Candida (Yeast) and BV (Bacterial Vaginosis) are more common than you think. 70% of episodes of vaginitis are caused by BV and Yeast.

3. For most women, Vaginitis resolves without any difficulty.

4. Feminine hygiene products, panty liners and douches need to be retired and sent to the land far far away.

5. BV is not an STD! However, partner treatment may help reduce recurrent infections. Long term (6 months) weekly courses of vaginal metronidazole gel after an initial 1 week treatment with oral metronidazole or Tinidazole may be needed if you have recurrent bacterial infections.

6. Your daily chores after a work-out can wait. Excessive sweating, swimming in the pool, hanging out at the beach, wearing tight clothing for long durations can cause vaginal pH imbalance. One needs to hit the shower as soon as possible after a work-out to avoid that irritating BV or Yeast from haunting us.

7. Using mild soaps with no fragrances or irritants is the key. Look for the “water-based” on the label if you use vaginal lubricants!

8. Barrier creams like A&D cream, Aquaphor or the baby diaper rash creams go a long way in preventing chafing and irritation down there.

9. Oral Probiotics supplementation (50 billion CFU daily) in the right amounts daily is the key in healing and preventing recurrent infections.

10. Recurrent Yeast infections may need long term weekly courses of Fluconazole tablets (Need to be prescribed by your OBGYN with caution). Vaginal Boric acid suppositories (compounded by a pharmacist) may help in those persistent infections caused by the resistant yeast.

For more detailed discussion, check out our video series at That’svagenius.

Be safe, be strong and be prepared.

Your friends at Walk In GYN Care

#justwalkin

The post BV or Yeast – Little Known Facts appeared first on Walk In GYN Care.