Dear Dr. Roach: What are the chances of picking up a disease if I engage in homosexual sex? What are the types of diseases I might encounter and their consequences? I don鈥檛 think you have ever discussed the medical implications of this important subject. Has it become taboo in the medical profession?
D.A.
Many people feel uncomfortable discussing sexual-health issues with their medical provider, but you are right that it is important to talk about. While the frequencies of sexually transmitted infections vary with different types of encounters (male with male, male with female, female with female), it still is possible to acquire any of the sexually transmitted infections through different kinds of intimate activities.
Particularly for men who have sex with men, HIV remains the biggest concern, because the consequences are so important. HIV has become a chronic disease with proper treatment, but it still has dramatic effects on overall health and on the likelihood of developing infection and cancer.
Thus, prevention remains critical, and talking about it ahead of time is very important. You can protect yourself from HIV by choosing your sexual partner carefully (I recommend that both partners be tested ahead of time when possible), by using condoms, and, in some cases, by using medication to prevent transmission (called pre-exposure prophylaxis, or PrEP).
Alcohol and drugs can predispose people to make unwise decisions, such as having unprotected sex, so don鈥檛 make decisions while intoxicated.
The same advice is appropriate to reduce risk of the other STIs as well, such as syphilis (which is making a dramatic and regrettable comeback in some parts of the U.S.), gonorrhea and chlamydia, and less-common infections such as LGV (lymphogranuloma venereum). Genital herpes simplex virus infections are common with both heterosexual and same-sex encounters.
Two STIs, hepatitis B and HPV, can be prevented very effectively with vaccination. All people considering a new sexual encounter should be tested for immunity to hepatitis B and vaccinated if not immune. HPV vaccine should be given to anyone in the appropriate age group (nine to 26 for women, nine to 21 for men, but it鈥檚 particularly important for transgender adults, or for men who have sex with men, up to age 26).
Although these diseases can be treated, prevention is best. Herpes and HIV cannot be cured. Regular testing is appropriate for people with ongoing sexual activity.
There are many good sources for more information. One place to start is the Centers for Disease Control and Prevention, at tinyurl.com/STIfacts, but your medical provider can give you more personal recommendations.
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Dear Dr. Roach: My medical doctor has recommended that I see a rheumatologist. I already see a neurologist. Can you explain the difference between these two specialties?
K.B.P.
鈥淩heum鈥� is a watery substance; rheumatism, or what we would now call arthritis, was thought to be due to an excess of watery humour. A rheumatologist is an expert in connective tissues of the body, especially the joints. A rheumatologist must first complete an internal medicine residency before a fellowship in rheumatology.
A neurologist is an expert in the nervous system of the body, both the central nervous system (brain and spinal cord) as well as the peripheral nervous system.
There are some conditions where both a rheumatologist and a neurologist can provide valuable insights. Several come to mind: Lyme disease is one; systemic lupus erythematosus is another.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med. cornell.edu