Question & Answer Forum

New Q&A’s
Thanks to all of you for your questions and patience!
We hope to answer your questions as frequently as we can.
Personal responses are not possible and due to time limitations, volume, and duplication, we read all questions but select only a few for posting.

Are little white bumps herpes?
Irritation and sex toys
What STD causes smelly urine?
Can you get vaginal strep without sex?
How do I treat yeast?
I’m always itchy before my period, why?
Cold burning and orgasms
How is trich transmitted between women?
How do I keep herpes from spreading to other parts of my body?
Discharge after miscarriage, could this be a STD?
Ask Us A Question

Please check our archives section first, we may have already answered your question.

Archives

1. What type of std’s can you get from lesbian sex?
As detailed more on our website, the list of STD’s woman can theoretically pass to other women through sex is a lot longer than the list of those that have been investigated closely in research studies. And, as always, risk of transmission really depends on the sexual behavior involved; since not all women practice the same sexual behaviors with their women partners, it’s hard to generalize to the whole universe of lesbians. That said, we can make a few generalizations. The answer to your question is: we’re not sure. But here is what we do know: based on good research, it’s pretty certain that women can transmit human papillomavirus (HPV), the virus that causes genital warts and most cervical cancers. Because herpes simplex virus (HSV; the virus that causes genital herpes) is transmitted by direct contact of skin or membranes (either those in the genital tract or the mouth), as is HPV, genital herpes is likely also transmissible between women. The same could be said for transmission of the virus that causes molluscum contagiosum.

Diseases that are transmitted by infected vaginal secretions (most prominently, trichomonas, a common cause of sexually transmitted vaginitis), are definitely transmitted between women (so your partner should be treated if you are diagnosed with it). Diseases that infect primarily the cervix, like chlamydia and gonorrhea, can theoretically be transmitted depending on whether women are having insertive sex with contaminated hands or sex toys (but again, definitive data are not available). Neither are data available on transmission of syphilis between women, but again, it’s theoretically possible.

So, there’s quite a lot to learn about this topic; hence, our research (and website).

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2. My girlfriend is experiencing a thick vaginal discharge with itching but her doctor does not think it is a yeast infection. Is it safe to perform oral sex? Can a yeast infection be passed on to me during oral sex?

There are several reasons for a vaginal discharge that one might perceive as ‘abnormal’ (i.e., having a different consistency, odor, color, or amount than usual). These vary from the completely normal variation of vaginal discharge over the course of the menstrual cycle (discharge is more watery during ovulation) to the thick, ‘cheesy’ discharge associated with yeast infection. Unfortunately, without getting a sample of the discharge to look at under the microscope, there is absolutely no way to predict what the cause of the discharge is (and believe me, people have been trying for years to do this without a microscope in the picture). The three major causes of ‘vaginitis,’ as it’s known, are yeast (also called vulvovaginal candidiasis), bacterial vaginosis (BV), and trichomonas (‘trich’). Only trichomonas is a definite STD (BV might be, but we don’t know yet).

If your GF has a yeast infection, there is no risk for you if you perform oral sex on her; and, since over half of women normally have yeast living in the vagina without any problems, her passing it to your vagina shouldn’t be a problem either. Trichomonas doesn’t infect the mouth or throat, so that wouldn’t be an infection you’d get from performing oral sex on her either. Finally, BV results when the normal bacteria in the vagina actually increase in number; these bacteria don’t live in the mouth either, so oral sex wouldn’t be an issue.

The best advice is for your GF to get a specific diagnosis of what is causing her discharge. Remember, women can also get a chemical vaginitis: irritation from products (soap, detergents (including those in some lubricants), douches, deodorants) applied to delicate mucous membranes, so consider those as a possible source of irritated private areas!

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3. What are some ways to prevent spreading HPV if one partner has it already?

The glib answer is: wear a total body condom. Many people are infected with various types of HPV (some say about 75% of the population at some point in their lifetime, and possibly more), and it’s more common to have it without any symptoms (like genital warts or an abnormal Pap smear). Most HPV transmission (by far) occurs when people have no signs or symptoms, because an infected person ‘sheds’ the virus even when there are no obvious abnormalities. So, it’s difficult to avoid getting infected unless you really practice serious barrier use.

The serious answer is: you can reduce, but not eliminate, your risk (probably–no definitive data) by not having sex or by using barrier methods if you do have a genital warts. If you don’t have warts but know you have HPV, you are like millions of other people (who are out there doing whatever they’re doing in a more unenlightened state–and probably happier too–than you are). The problem with saying that you should always use barrier methods is that you probably won’t shed HPV for your whole lifetime (most people stop doing so after a couple of years at most). This doesn’t mean they can’t start shedding again, or get infected with new subtypes of the virus. So, the best thing to do is to really not clear. I would recommend ensuring that you and your partner have routine Pap smears done (every 1-3 years, depending on your prior Pap history), and beyond that, it really depends what your own “HPV history” is.

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4. I have HPV, I found out 5 years ago. I haven’t had a symptom since, do I still have it?

You’d think we would have the answer to this, but actually, we are not entirely sure. We do know that in women who get infected with HPV for the first time, we can’t really detect the virus (even by the most sensitive methods, like PCR) after an average of about 2 years. Does this mean it’s gone away completely? Maybe. Hopefully. Most people estimate that it’s still there in very small amounts too low to be detected even by PCR. Is it still transmissible at such low amounts? We don’t know, but hopefully not–or at least, not as much as it was early in in the infection.

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5. Okay, this sucks, but my vagina and vulva are terribly itchy. I haven’t noticed any discharge, in fact my entire ‘area’ has been very dry lately. what’s up? any ideas, ladies?

Please see my response to question number 2 also. Basically, not all causes of ‘vaginitis’ present with the primary symptom of abnormal discharge. In fact, especially with yeast, external symptoms such as you describe can be the predominant complaint. Another thing to consider is an irritated (some say ‘allergic’) reaction to soaps, detergents, lubricants, etc so it’s always important to consider what’s touching what down there. Finally, genital herpes doesn’t always present (especially in women) as the classic ‘blister’ on one’s genitals; itching or discomfort can be a principal sign. The best thing to do is to get examined (by a good provider!) when you are experiencing the symptoms you mention.

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6. Recently I got “trich”, the only sexual contact I had was with my girlfriend. She did not develop any symptoms, although we both took treatment. I would like to know if it can be transmitted any other way or did she necessarily transmit it to me?

We always treat trich as a STD, though there are always stories of women who have reportedly not been ‘sexually active’ for years who show up with this infection. In such cases, I always wonder just who is taking the sexual history…anyway, the problem with trich is that it can indeed live a long time in the vagina and surrounding glands, so it’s difficult to say when exactly you acquired it. For that reason (as is true with many STD), we aren’t usually able to pinpoint ‘who gave what to whom.’ What’s most important is that you both get treated, as you have done. Also, it’s pretty common for trich not to have any, or very mild, symptoms in women.

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7. I have had only 2 partners in my life…I was married to a man for 13 years and we were each others firsts and now I am with my g/f who has never ever had sex with anyone….what are my risks of having HIV????? (He has been tested negative for the virus)

It sounds like what you are asking is: what is my risk of getting HIV from a woman who has never had sex with anyone (since your only other previous partner is known to be negative). If this is true, I am not sure what your concern is, at least about sexual transmission. The only other ways HIV is acquired is by exposure to blood or blood products, to contaminated needles (i.e., intravenous drug use), or from mother to fetus/infant. If neither you nor your GF has none of these other risk exposures, and she has never been sexually active, you are at very low (I’d hazard to say nonexistent, but one can never say never these days), risk indeed.

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8. There is a lot of confusing information about Hepatitis C… is it sexually transmitted? Most research seems to be about heterosexual sex. Is wet kissing ok? What precautions are recommended?

There are no specific data that I’m aware of that assess risk of sexual transmission of the hepatitis C virus between women, so what we know is derived from studies of heterosexuals (as you noticed). The virus is present in blood, and most transmission occurs through this route (i.e., contaminated blood or blood products, sharing of needles). Procedures involving blood, such as tattoos, may also be a specific risk if proper sterilization practices aren’t used. Sexual transmission between heterosexuals appears not to be common (most experts doubt that this is a ‘significant’ route of exposure). For lesbians though, the risk is probably most affected by exposure to blood during sex, for example with menses, or if needle sticks occur during ‘blood play’ (temporary piercings or shallow cuttings). In these situations, I’d exercise caution if I knew my partner was infected (i.e., avoid direct exposure to blood, especially to mucous membranes or involving any sharp objects). Finally, the hepatitis C virus has not been shown to be transmitted by contact to saliva, so wet kissing should be OK.

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9. HPV is now estimated to occur in 50% of heterosexual women. I was diagnosed with cervical dysplasia and had a LEEP procedure performed. I want to know what the instances are of transmission between women through cunnilingus if the infection is sub clinical. I am bisexual and a lifetime of dental dam use is more than a major disappointment. And what about those 50% of het women who surely receive oral sex without protection? I cannot find any substantial data confirming an epidemic of genital warts in the throat. Please answer this question for me, I have been researching like mad and all I ever hear is dental dams.

Ah yes, those delightful dental dams…but that is another topic entirely. Actually, it’s doubtful that women transmit HPV to each other through oral sex (again, anything is possible, but see below). The reason you don’t hear or read much about genital warts occurring in the throat is that the HPV types that cause genital warts do not find the mouth or throat terribly hospitable, and generally don’t ‘set up house’ there. There are, though, specific HPV types that do prefer the oral mucosa, but these have not (yet) been shown to be associated with any serious diseases in otherwise healthy persons (one can sometimes see oral warts, though, in people w/ advanced immunosuppression. So, the risk of your transmitting a ‘bad’ HPV (like the high risk type that likely caused your cervical neoplasia) to your partner who performs oral sex on you is not an issue.

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10. What is recurrent monolial vaginitis?

This depends. “Moniliasis” is a now outdated term for vulvovaginal candidiasis (VVC), otherwise known as a common yeast infection. A minority of women (possibly ~10-15%) will suffer frequent recurrences of VVC (defined as >3 episodes a year), to which your question refers. It’s not clear why recurrent VVC affects some women and not others.

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11. My partner and I have been together for a few months. Just last year I was told that I had “trich.” I have been cured from “trich” for about six months. Now, if my partner was recently told that she had the STD, herpes, is there a possible chance that they are linked? If they are, how are they?

I can’t think of a reason that trichomonas and genital herpes should be related other than they are both sexually transmitted infections. Treatment of trichomonas is usually successful, as it probably was in you. Also, you didn’t say what kind of genital herpes your partner had; was it a new infection, or did she find out she has had it and not known it? The latter is a much more common scenario since over 90% of people infected w/ the genital herpes virus have no idea they’re infected…but back to your question: unless I’m missing some important details, I can’t see any connection.

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12. My friend just found out she has herpes and all of the information that the doctor gave her about sex was directed towards men and women. Is there a resource for her that deal specifically with lesbians living with genital herpes?

Alas, as is the case with many of these problems, not that I am aware of. However, some of the general references can be helpful even for lesbian couples. One good source is the American Social Health Association (see our links for their website), which has developed some user-friendly materials for infected persons and their partners.

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13. My partner is considering getting her tongue pierced because we have heard that it is more stimulating during oral sex. A few questions for you — is this true? What are the chances of infection in the newly pierced tongue during cunnilingus? Any info would be appreciated. Thanks!

No, thank YOU for your interesting question. Well, call me a dweeb, but since I get to answer the questions I have to say I am not in favor of tongue piercings (I know I am inviting all kinds of criticism for this but hey, you asked, and maybe it will increase visits to the web page). You must keep in mind that I’m an infectious disease doctor, so I get to see all the most extremely gruesome complications of piercings that occur; I’m sure others feel very differently based on positive personal experiences. Needless to say, then, I don’t have the answers for you regarding an increase in sexual satisfaction for the partner of the pierced. With regard to the potential for infection of the newly pierced tongue, all I can say is that they occur and have been reported. How frequently they happen (and conversely, how frequently NO problems occur) is not really known, because only the bad outcomes tend to get reported. A couple of things to consider in your decision-making process are 1) the length of time it takes for the piercing to heal, especially in a very moist environment; 2) the possibility for healing to stimulate the formation of scar tissue, which can persist even if the piercing is removed; and 3) the nasty bugs that normally live in human mouths that I would not want to get an infection with. Feel better about your decision?

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14. What is the current status of research on whether lesbians are more at risk for breast cancer? The last I’d heard there was a slightly higher risk than for the general population.

Data are definitely accruing as part of federal and local efforts to study this very question. One excellent source of information on this topic is the website for the Mautner Project for Lesbians with Cancer, at www.mautnerproject.org.They are a great organization and will have the most up to date info.

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15. My girlfriend discharges blood whenever we have sex (inserting a bare finger). There isn’t any itch or abnormal discharge. Her menstruation is regular. Is there any reason for this? Thank you.

The only way to see if there is a reason for this (and there is always a reason…) is to look inside and see if there are any sources of bleeding that could be provoked or irritated with insertive sex. Potential sources could be the cervix (especially an infection there, like chlamydia), or a site along the vaginal wall itself (a small ulcer or erosion). A site of bleeding doesn’t necessarily mean something bad like an STD, but it would be well worth checking out with a speculum examination.

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16. My girlfriend had a herpes breakout once, and never since. But her doctor told her it lives inside of her forever and she has to take preventative medicine. My question is, can I get herpes from her if she is not undergoing a “breakout” but yet, it is still living inside her body? And can I get it from performing oral sex on her?

Herpes is forever, just like the saying goes, but how many people continue to ‘shed’ the virus (HSV) even when they are not experiencing outbreaks is still under study. Current research suggests that MOST HSV transmission occurs ‘silently,’ i.e., from people who have no idea they are a) infected, or b) able to infect others. However, whether everyone with a history of genital herpes has to take ‘preventive medicine’ is a matter of debate. Antiviral medications (acyclovir, famciclovir, valacylovir) do reduce the amount of HSV shed by people who aren’t having visible outbreaks, but whether everyone should be taking potent medications to prevent that kind of transmission is not yet clear (but is being closely studied). So, the answer is that yes, you very likely can get it when she is not having any outbreak (I’m sorry to say) depending on what you are doing, although woman to woman HSV transmission from direct genital to genital contact or hand to genital contact has not yet been reported (it’s certainly out there as an anecdote, as most providers who care for lesbians with herpes can tell you). Regarding oral sex: you won’t infect your mouth with the kind of HSV she has (if it is HSV-2, which it likely is based on what her provider told her). If it is HSV-1, which causes 15-20% of all genital herpes and tends to cause less severe disease, then you can indeed infect your mouth, but odds are you have HSV-1 already (~85% of the population has it by adulthood; it’s the virus that causes many cold sores). I know, it’s confusing. Some of the websites devoted to HSV can provide more detailed information.

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17. Can you get herpes from a cold sore and if you can, what is it? 1 or 2? and does it cause a scab on you down in your private part?

Yes, unfortunately, you can contract genital herpes from contact to an cold sore in the mouth that is caused by HSV-1 (which actually causes the majority of oral cold sores in otherwise healthy individuals). In fact, between 15-25% of all genital herpes is caused by HSV-1, with the remainder being caused by HSV-2 (which is only transmitted from genital to genital area, and does not infect the mouth). When outbreaks do occur, the sores of genital herpes due to HSV-1 are pretty much indistinguishable from that caused by HSV-2. The good news, though, is twofold. For one, most people (up to 85%) have been infected with HSV-1 orally by the time they reach adulthood, which means they have antibodies to the virus and do not get infected genitally. Second, genital herpes due to HSV-1 usually has a less severe clinical course than that caused by HSV-2, meaning the outbreaks are usually less painful and occur less frequently. You may also want to refer to questions 12 and 16.

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18. Is any research going into developing an over-the-counter test to see if one is in a period of (HSV) sub clinical shedding. If you know you have it, the best prevention would be to only have sex when you know you are not shedding, but that ability is not available. I envision a thin sheet you can place over the site of infection that would turn another color if shedding were present.

I assume you are talking about genital herpes here, since there has been so much information coming out recently about sub clinical shedding. That basically means that infected people actually do ‘shed’ or excrete the virus (HSV-2) even when they are not having outbreaks, and unfortunately this is turning out to be true. As yet, only culture and PCR (polymerase chain reaction) have been used to document sub clinical shedding in research studies, and I’m not aware of any devices such as you describe. That would be quite a control measure!

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19. Doc, what is micose? a french (word) infection?

I like the thought of this being a French infection somehow, but I think you are referring to the French word for ‘mycoplasma,’ which is a group of bacteria that have been known to be associated with various genital conditions for some time. In particular, mycoplasmas can be found in women with pelvic inflammatory disease, in some infections during pregnancy, in bacterial vaginosis, and to a lesser extent in men with urethritis. Current research is actively investigating whether or not these interesting organisms may play a role in other genital problems, like infection of the cervix.

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20. Can the Strep virus in the vagina have the same symptoms as those of a yeast infection?

This is an interesting question but first, remember that it is the Strep (short for streptococcus) bacteria, not virus (in fact, the tabloids got it wrong when they referred to the “flesh-eating virus,” because it was, in fact, a type of Streptococcus they were talking about). The vagina can be colonized normally with different kinds of streptococcus. I think the one you are probably referring to is Group B streptococcus (GBS), which is notable for causing sometimes severe outcome in infants, and for which women are tested before vaginal delivery. Most of the time, the presence of GBS as vaginal flora in the non-pregnant woman is not a cause of problems. However, there have been some reports in the literature of women who did have ‘vulvovaginitis’ associated with high growth levels of GBS and the absence of yeast (which is a typical cause of vulvovaginitis, which basically means an inflammatory or irritated state of both the vagina and vulva). So, while I think it is probably uncommon, it is an interesting area to keep your eyes on.

21: This is a wonderful website ..I hadn’t seen it ’til now. I would like to make a comment about this and other resources for lesbians and females who have sex with females. I know I have brought this up before, but it is an ongoing issue. The issue is gender identity.

There are queer females who are masculine identified, but not necessarily transgendered in the sense that they id as men. I am talking mostly about females who id as butch, transgendered butch, stone Butch…they may id as women too or they might not. To some, butch is another gender…not man not woman. They too have sex with females. They have female bodies and need the same health info and care as those who id as lesbians or women or femmes or queers. I just want to encourage all of you to take this into account when developing visual, oral, or written resources for ‘lesbians’ or ‘women who have sex with women’…to make it friendly and accessible to butches and femmes and lesbians, etc. My standing suggestion is to use the term ‘female to female…’

There are too many butches in the g/l/t/b queer community that do not feel comfortable getting a gyn exam or a breast exam or mammography….they might have body dysphoria (for lack of a better word) or just feel embarrassed or don’t relate to ‘women’s’ issues. This is an extension of general lesbian issues…it is part of why there is a need for sensitive, informed health care providers, researchers and educators and why we are all here to begin with.

Thanks

Thanks very much for your comments. I couldn’t agree with you more about the gender identity issues. We are frequently torn between using the term ‘lesbian’ to connote a self-conferred identity, and ‘women who have sex with women’ to focus less on that and more on the actual behavior. We have used the latter more given that our focus is on STD, but as you can see, when creating a name for our site, felt that it was important for us to be identified easily as a resource for anyone with the term ‘lesbian’ in mind–regardless of how they identified themselves. We considered also using ‘female-to-female,’ but thought it sounded a bit too clinical and ‘research’-oriented. Although one goal of our site is to disseminate info on our STD research, its major objective is education and resource provision. Hence our staying with the perhaps less-than-ideal ‘woman-to-woman.’

I’ve heard repeatedly that butches are among the least likely to access routine gynecologic health care (from those who consider themselves same, and from providers who have managed to cultivate a reputation for providing sensitive and non-judgmental care to them) I agree that anything we can do to improve this situation is really key.

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22. My girlfriend whom has never had any sexual contact with anyone but me, was recently diagnosed with (Trich). I was prescribed Metronidazole as well as her. We have been together for almost three years, and curiosity has taken over. How else did she get infected with me being her one and only partner? Please respond as soon as possible.

One thing one learns very quickly in the STD business is never to get specific in the ‘who gave it to whom’ conversation. This approach is not as much of a cop-out as it sounds; with most STD, we really can’t tell how long they’ve been present or who did give it to whom. Trichomonas is a perfect example. “Trich” is an extremely hardy protozoan (bug) that can live for long periods, especially in moist, protected areas of the genital tract in women (like the glands that supply vaginal fluid). How long is not really known, but estimates run from months to several years. As I mentioned in an earlier question about Trich, it’s really not clear. So, your partner could possibly have gotten the infection before you arrived on the scene; alternatively, you could have had a Trich infection that you didn’t know about, and given it to her. The bottom line is, you both need treatment.

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23. I had a sexual encounter with a woman last Summer, and since then, I have had recurring lesions in my outer vaginal area. These lesions occur once per month (before, during, or after my cycle), and range from being boil (or cyst)-like to being small and sore. There has never been more than one to form at a time. I had a screening for herpes, but it came back negative. Any ideas????

Whenever someone tells me they have ‘recurring lesions,’ and we are in the U.S., I think: herpesherpesherpes. Herpes would be by far the most likely cause of your lesions, given how common it is. It would help to know what your ‘screening’ was. If someone tried to culture your lesions, the likelihood of them being positive would depend a lot on how old the lesions were (it’s easier to culture the virus when they are just forming), how the sample was collected, and how good the lab is that was used. If you had a blood test done to look for antibody to herpes simplex virus, I’d want to know what type of test, since many of the commercially available blood tests for herpes are not helpful in distinguishing type 1 from type 2. There are other causes of recurrent genital lesions (chronic yeast vulvovaginitis; chronic dermatologic conditions, including irritative or chemical conditions; Behcet’s syndrome, an uncommon type of autoimmune disease) that would be worth investigating, but I’d be eager to rule out herpes first if I were seeing you as a patient.

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24. Is scabies an std?

Only in the sense that it is spread by close contact; so, you can give a bedmate scabies without having sex with them, and you can get scabies from using clothes or linens that an infected person has seeded with the little buggers and their eggs. Obviously, sex just provides the perfect opportunity for that exchange to happen.

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25. More commentary on butches and health care…

Dear Folks, As the study coordinator and the person who sees all of the women in the research jeanne is describing (the “lesbianstd.com” group!) I’d like to add something to the dialogue. Through Seattle’s sexual minority women’s clinic and the pilot & current study, I’ve seen over 600 sexual minority women (from total femmes all across the spectrum up to & including post-surg. MTFs) and can affirm the great difficulty with butch-identified females and gynecology. In fact, in the pilot study, I asked women to identify themselves as butch or femme & (anecdotally) compared this to their Pap screening frequency — BIG difference, with femmes more regular. I’ve come to believe that specifically targeted outreach & education materials are required for butches. Not having resources for this, my fall-back position (so to speak!) has been to encourage every woman being seen to refer her partner to the study. This is NOT principally to increase enrollment, but to develop a reputation in the community as a provider who can deliver sensitive, gentle, compassionate care to a group who perennially feels even more disenfranchised from health care than the rest of us. As a result, I now see more and more women who tell me they heard about me from a friend or a partner or work colleague… whatever… and they were reassured by this contact that they would be safe with me. Until we have some research that identifies the best outreach and education strategies for butches, developing a strong referral base for them is our only recourse. In other words, we shouldn’t assume that our “lesbian-friendly” referral list is also “butch-friendly”.

Kath

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26. I have a girl friend…I discharge blood when she [inserts] a finger inside me. The amount of blood depends on my period. It’s more when my period is nearer and sometimes no blood is discharged (after period time)…what is the matter?

Please see my answer to question no 15. Any abnormal bleeding should prompt a complete gynecologic evaluation. Given the timing, it’s possible that your cervix may just bleed more readily around your period, but you need to rule out other conditions as mentioned to be sure.

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27. My partner has herpes, type 1. She has known now for about a month. We have not been sexually active in a long time, but we have caressed each other and kiss on each other’s breast. My question is, can I get herpes, any type, from just rubbing and kissing her. Also, can herpes form in other places other than the mouth and vaginal area?

Genital herpes, whether it’s caused by HSV-1 (your partner’s type) or HSV-2, is caused by direct contact with infected areas (namely, skin or mucous membranes). While HSV-2 in adults virtually infects primarily the genital areas, HSV-1 is much less picky, and can infect other body sites if it can inoculate itself well enough into the skin (HSV-2 can do this too, but it’s less common, especially in otherwise healthy adults). There are several classic conditions that describe this, such as herpes gladiatorum (in which one wrestler infects another anywhere on the body through prolonged–and presumably sweaty!–direct skin contact) and herpetic whitlow (when a person is infected on the finger, usually from contact to oral secretions). Getting the virus these ways (i.e., onto skin, as opposed to mucous membranes) is easier if there is a cut or break in the skin, but can also happen if the skin appears to be visually intact (there may be microscopic openings the virus can pass through). So, yes, you can definitely get either of these viruses from rubbing skin, and you are very likely to get HSV-1 by oral contact. You can find out if you are at risk for infection with HSV-1, though, by getting your antibody status to both viruses checked. As long as one of the newer, more specific tests are used, you may set your mind at ease and find out you’re already infected (which is likely with HSV-1, and possible with HSV-2, as noted in several questions).

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28. I’m confused…recently my partner was tested positive for chlamydia and negative for gonorrhea. I was tested negative for chlamydia and positive for gonorrhea. she is blaming me for her contraction of chlamydia, is there a possibility I gave it to her? why didn’t I contract chlamydia as well? Or vice-versa her contracting gonorrhea. please help me I’m very perplexed.

Like I said, in this business, we never get into who gave what to whom. It’s a losing proposition to try to pinpoint this, because usually it’s hard to tell exactly when an infection was acquired. We do know that most STDs, including gonorrhea and especially chlamydia and herpes, are transmitted from people who don’t realize they have the infection. So, the bottom line is that anything is possible in terms of who gave what to whom. In terms of why your chlamydia test isn’t positive, there could be several explanations. You may just not have gotten infected; or, you may have gotten it, but the test didn’t pick it up (not all tests are perfect, by any means, especially for chlamydia); or, you got infected but the infection cleared itself up (I wouldn’t count on that and we recommend treating contacts to infected persons regardless of whether they test positive or not). I agree, it is confusing, and dealing with partners’ concerns and fears about this issue is one of the most challenging parts of this business.

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29. Within 24 hours of having sex with my girlfriend and my vibrator, we both had an outbreak of a rash. Hers went away in a few days while mine turned into a massive outbreak of sores and lesions that were incorrectly diagnosed as herpes. After a week of suffering and 4 doctors later, I was diagnosed with a staph infection probably due to the vibrator. Since this turned out to be a very serious infection and a huge scare for both of us, I was wondering how often this kind of infection has occurred with the use of sex toys.

Well, the fact that you both had a rash after the vibrator, but that hers cleared up soon after, suggests several possibilities. First, you both may have been allergic to the vibrator or some other substance you both came into contact with; your allergic dermatitis evolved to what is called a ‘superinfection,’ meaning that bacteria (like staph) take advantage of a pre-existing skin condition and go wild, making it worse and truly infected. This can happen to some people and not others, and might correlate with whether you had a lot of staph on your skin to begin with, or just your own ability to deal with the staph infection itself. Second would be that you both did get infected with staph from the vibrator itself or something else you contacted, and you just got a bigger dose of whatever badness it was than she did. Finally, some people actually get hives (urticaria) due to vibration, warmth, or cold, but these are usually short-lived and shouldn’t predispose you to developing a further infection. Without having seen you both, it’s hard for me to tell what it was. It does bring up the importance of making sure your toys are as clean as possible/realistic, but even then, one can’t always prevent this sort of thing from happening. I can tell you that there is no medical report of this happening, so you appear to be the first documented cases on the internet!

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30. I have a question about the strep virus. My girlfriend and I have been together for a little over a year and a half. We have had a lot of stress in our lives….living apart, money, kids, you name it. We get along great and are very much in love. Our problem is is that about a year ago she started itching very badly around her clitoris for about a week a month….and in the last 6 months I’ve gotten strep throat 3 times. She went to her Doc and he tested for strep, HIV and Diabetes…and strep came back positive and the rest came back neg. She was told she has chronic Strep and that it could come back without notice, We think it is caused by stress…So, I guess now we have to use protection every time. Do you agree? or is there anything you know about that we can do.

Your situation sounds a little confusing to me and more than a little frustrating for you. As I wrote in an earlier question about streptococcus in the vagina, one type of streptococcus (commonly called Group B strep, or GBS) is not usually a cause of symptomatic vaginitis, though in certain situations it can be, and can certainly cause problems if present during delivery of a baby. However, it’s a different streptococcus than the one which causes ‘strep throat’ — the latter is caused by Group A streptococcus. I haven’t heard of either of these organisms being transmitted from genitals to throat, or vice versa. I’d see if you really are protected from further ‘strep throats’ during the time you are using protection, and if that turns out be the case, please let me know!

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31. Is there any knowledge of how to tell just how long someone has been infected with genital herpes? I was recently diagnosed and am trying to figure out how long I have had it so I know how far to go back in contacting former partners.

The only way to do this definitively is to have your blood tested at two points in time: once before you got infected, to prove that you didn’t have antibody to the herpes virus then, and once after you are infected, to prove that you’ve developed the antibody as a result of infection. The vast majority of the time that’s not possible, even when someone presents with symptoms, but for people who have had the infection for a while and not known it, it’s obviously completely impossible. So, right now, we really don’t have any way of pinpointing how long you’ve had this common infection.

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32. I had a full hysterectomy 7 months ago and to this day when my girlfriend inserts her fingers in me (after love making) I have bloody discharge. Very rarely do we get done and I don’t bleed at all. I had a hematoma that they left inside but my ob-gyn said it would go away. My doctor said we must be being too rambunctious…

As discussed in an earlier q and a, persistent bleeding after any genital contact should be checked out with an internal exam, even if you have already had a hysterectomy. Odds are good that if you had a hematoma, this might be an explanation for your bleeding, but it should be checked out anyway. Certainly ‘rambunctious’ sex can damage delicate vaginal and anal mucosa, which is why people use lubricant. If you and your provider have ruled out a serious condition (like a persistent or growing hematoma, an infection, or persistently disrupted genital tissue), you might want to consider using lubricant in order to reduce any trauma to the area. If you are already using lube, you might want to consider using more (again, after making sure your exam is normal). The other questions addressing this are #’s 15 and 26.

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33. I was just diagnosed with chronic cyelic vulvitis and (as a) carrier for the strep virus (vaginal). Can I give my partner any of these during oral sex? And what is cyelic?

The issue of colonization (what some people refer to as a ‘carrier state’) with strep (a bacteria, not a virus) was discussed in previous q and a’s (20 and 30). It’s not the same bacteria that causes ‘strep throat,’ so giving it to your partner in her throat when she performs oral sex on you is not a concern. ‘Cyelic’ is not a medical term that I can find (though it’s similar to some terms used to refer to the bladder), though you might mean ‘cyclic,’ which means ‘recurrent.’ If that’s the case, what you may have is a recurrent vulvitis, or inflammation of the external genital tissues (vulva). This is often, but not always, due to yeast infection, and might respond to antifungal therapy.

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34. What is the transmission rate of giving my lover HPV through oral sex and having our vaginas come in contact?

The types of HPV that live in the mouth are not the types that cause either external genital warts or cervical cancer. However, it’s much more likely that the genital types are transmitted through genital to genital contact (for example, vagina/vulva to vagina/vulva), or on hands (and possibly toys, though no one has shown this for certain). Unfortunately, I can’t provide a good estimate of a rate of HPV transmission for the situation you describe: that is, the incidence of HPV transmission occurring per sexual act. That data is not really available even for heterosexual sex. We do know, though, that among women who have just recently become sexually active with men at least, acquisition of HPV is incredibly common within the first year or so after initiating sexual activity (for example, ~60% of these women will be infected by at least one type of HPV by then). I believe that the rates are probably similar, depending on how direct the skin-to-skin contact is, with sex between women. As far as oral sex, interestingly, there isn’t much evidence to suggest that transmission by this route is common. As I’ve noted before, the types of HPV that cause warts and cervical cancer are pretty specific for the genital tissues, and don’t really like the environment of the mouth, at least for the establishment of long term residency…which is not to say that you couldn’t infect your girlfriend if you literally went from one site to another, however. While I wouldn’t say that we can be sure that oral sex is totally safe (what is these days?!), I do think that is probably not a principle route for HPV transmission–but the final word is not yet in. You may also want to see the discussion about transmission of various types of HPV in our archives section.

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35. My girlfriend has just been diagnosed with PID. Symptoms are acute and she is currently in the hospital receiving antibiotic treatment. My question is–could I have Chlamydia and hence passed it on? And also the other alternative is…should I be treated as a preventative to receiving PID through sex with each other? Thanks, I look forward to your response.

And a related question…

How likely is it to get Chlamydia from lesbian sex?

Chlamydia is one possible cause of PID (pelvic inflammatory disease), in which one or more pelvic organs including the uterus, Fallopian tubes, and ovaries are inflamed and irritated. Other bacteria, however, are usually involved, and may include gonorrhea and the bacteria commonly seen in bacterial vaginosis (a common cause of vaginitis). So, treatment for PID usually involves more than just treating chlamydia. Standard recommendations are that male partners of women with PID be treated with antibiotics that are active against chlamydia and gonorrhea. While no standard recommendation for female partners of women with PID exist, I would strongly recommend that you be treated in the same way as we manage male partners, since there is a possibility that either of these organisms could have been the culprit in your girlfriend’s case. Even better would be for you to get tested for these bugs, then treated. It’s very possible that you had chlamydia and passed it on, because 9 of 10 women who have the infection don’t know they have it (they have no symptoms or signs). However, keep in mind that not all women with PID have chlamydia, either; the percentage that do ranges from about 15% to 40% depending on which study you are looking at. But, it’s best to be certain, and to get treated anyway.

We don’t know any specifics about transmission of chlamydia from one woman to another, but I have definitely heard of several cases where this was strongly suspected to have occurred. Since chlamydia is passed through infected secretions from the cervix that pass down into the vagina, it makes sense theoretically that these secretions could be passed to another woman by insertion of contaminated hands or toys into the vagina. But, we don’t know how often this occurs.

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36. My partner has sort of like dandruff in her vagina and it’s quite itchy at times. What do you think it is?

The appearance of dandruff-like material often indicates that the skin is being chronically irritated, or at least exposed to something that is provoking a persistent ‘sloughing’ or shedding of epithelium. One possibility is to try changing soaps that she uses directly on the pubic area; another is to change the detergent that she uses to wash underwear in. Alternatively, some infections like yeast (vulvovaginal candidiasis), or occasionally herpes, can masquerade with a dermatitis-like presentation, so if it doesn’t go away with some basic measures like ruling out an allergic reaction, I’d have someone take a look at it.

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37. Is it safe to use an over-the counter anti-yeast medication even if you have not been properly diagnosed as having a yeast infection, but have all the symptoms?

Well…this is a bit of an issue for me. On the one hand, if (a) a woman is at low risk for STD acquisition, meaning she is in a (really) monogamous relationship and has had no risk of having been exposed to STD like chlamydia or gonorrhea or genital herpes, (b) she has had a prior diagnosis of a yeast infection and recognizes the symptoms well, and (c) she has responded well to treatment with over the counter yeast medications previously; then I think it’s reasonable to use these products. And, I certainly believe in empowering women (actually anyone) with control over caring for themselves as much as possible. The problem is that the symptoms of yeast infection, in many women, are pretty nonspecific: this means that they may have some itching with vaginal discharge, or an irritated redness in the vulva. Vaginal discharge, of course, is also a sign of other causes of vaginitis — namely, bacterial vaginosis and trichomoniasis — as well as a sign of infection of the cervix with STD like chlamydia and gonorrhea. As you might guess, treatment of all these conditions is quite different than that for a yeast infection; and not treating them adequately, particularly in the case of the STDs, can have very dire consequences. Vulvar itching and redness can be a sign of genital herpes, which many women don’t realize they have. Not surprisingly, I think that most women who experience vaginal discharge or vulvar itching would prefer to think they have a yeast infection as opposed to an STD, so they do very likely head to the pharmacy to self-treat for the lesser of all evils. That tendency could lead to a reduced likelihood of correct testing and treatment for STD, unless women know their risk for STD and have had experience with yeast infections before.

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38. I was diagnosed with genital HSV-1 in April, and I haven’t had an outbreak since then. But, after the outbreak was over, there was a grayish type scarring on the lower part of my vagina leading to my anal area… is that common or should I get tested for another STD?? PLEASE RESPOND/THANK YOU

Mucosal areas–like that seen in the inner labia, or the lining of the mouth–can certainly have scarring like the rest of the body’s connective tissues, and changes in pigmentation (coloration) are among the slowest to resolve (and sometimes don’t resolve completely). It’s difficult to say whether your residual ‘scarring’ represents part of the normal healing process, or something you should be concerned about; why not have it checked out by a knowledgeable provider just to set your mind at ease?

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39. You talk about testing for HPV by PCR? What is that? Thanks. Great web site.

Thanks for your comment on the web site. PCR refers to “polymerase chain reaction,” which is one of several new tests used to detect very small amounts of infectious agents, like bacteria and viruses. Basically, tests like PCR make millions of copies of an organism’s genetic material (usually DNA), so that even if a very small amount of organism was there to start with, it is still detectable. This technique has opened up a lot of new doors in my field of work; not only are we finding that a lot more people are infected than we had previously thought, but we can now collect specimens with much greater ease than previously. For example, PCR (and a similar test called LCR, which you may hear about) can be used to detect chlamydia in urine; this is great for girls who might be scared to get a pelvic examination, or for guys who would prefer not to have a small q-tip like swab inserted an inch or so into their penis (I can’t imagine why). So, increased ability to find infection, and performance on what we call ‘non-invasive’ specimens like urine, make these tests a great advance in the field of STD control.

I asked about the nature of “PCR.” My doctor recommended a “culture” with a swab like a throat culture to test me. Is this something different?

It’s great that you asked your doctor about PCR (I think you did). These people need to be kept on their toes…but back to your question. Yes, culture is definitely different. Culture requires the actual growth of an infectious agent (bacteria or virus) in a laboratory. This means that the agent has to be a) alive, and b) usually transported to the laboratory with care so it doesn’t die. For PCR, in contrast, we are only detecting the genetic material (usually DNA) of these bugs (see above question), so we don’t need them to be so perky (indeed, even to be alive) when they arrive at the lab. This makes PCR able to detect more infections than culture in most cases (but not all). PCR is also the only test that can diagnose some infections for which we can’t even culture the bug–the most dramatic example being human papillomavirus (HPV).

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40. What are the symptoms of HIV?

Good question, but way too complicated to answer here depending on the stage of the infection and many other factors. For some excellent discussions about this and other aspects of HIV/AIDS, I suggest you take a look at web sites devoted to this topic. Several we would suggest have information as it applies to women, lesbians in particular. These include the San Francisco AIDS Foundation site, The John Hopkins AIDS Service site, and The Body. You may want to peruse our links page as well.

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41. My partner was told that she had herpes type 2 down in her vaginal area. The way she described her sores and the way they looked, I have those sores on both my left and right arm. The doctor called it herpesortize or something of that type. Can I get herpes on my arms?

8/28/00
Sometimes I feel like my job is mostly about giving people bad news. As if it’s not enough that you can get herpes in your private parts, you have to find out that you can essentially get it anywhere on your body. While HSV-2 (the type of herpes that causes most genital herpes) has a preference for genital tissue, it can occasionally infect other areas of the body, especially in persons whose immune systems are compromised. HSV-1 more commonly infects non-genital areas, the most obvious one being the mouth, where it causes ‘cold sores.’ It too, however, can also infect areas like the tips of the fingers (a condition called ‘herpetic whitlow,’ classically seen in persons providing oral or respiratory care to people who are shedding the virus in their mouth, and in whom no prior infection with HSV-1 is already established at another body site). This type of process can certainly involve the arm if it is directly inoculated through a break in the skin. The fact that your condition is on both arms makes it somewhat less likely to be an actual infection with HSV-1 or HSV-2, unless both arms were infected at the same time. However, if the term your doctor used was ‘eczema herpeticum,’ that would indicate that he or she thought that HSV actually did infect an area of the skin that had eczema already.

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42. My partner and I have decided to have a child. My old boyfriend was a willing donor. We never made it as far as oral sex before I started to feel uncomfortable but now he tells me he’s having a discharge from his penis. I wanted to know could I have caused that with him just performing oral sex?

8/28/00
I think I need a little more information here, or at least some clarification. It sounds like he performed oral sex on you, which wouldn’t involve his penis in the deal; if so, it’s hard to see how the act could possibly be related to the appearance of penile (urethral) discharge. On the other hand, if you performed oral sex on him, that’s another story. Some STD that cause urethral discharge can be transmitted by oral sex–notably gonorrhea, and people infected in the throat often don’t have any symptoms of a sore throat, so don’t know they have the infection. However, if you are at low risk for gonorrhea infection of the throat (as I suspect you are), he may be one of the many men who have a urethritis related to oral sex for which we don’t have a great explanation. It’s probable that some of the bacteria that normally live in the mouth (again, I’m assuming that’s how he was exposed–if not, you really have nothing to worry about as far as I can tell) actually infected his urethra, and caused an irritation resulting in discharge. In our STD clinic, we see a large number of men who have urethritis in the setting of having received oral sex, but turn up with negative tests for chlamydia and gonorrhea. This is a pretty interesting and active area of research. Typically, the condition is treated with antibiotics and resolves–eventually. Finally…you’re sure he doesn’t have other partners who could have served as a source of his condition–right???? Of course, you should also be sure that he’s been screened for all the usual infections before donating, including HIV and hepatitis.

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43. I’m very very confused about the transmission of HPV – my girlfriend has HPV and we’ve been waiting to have sex until we have some decently clear answers – so maybe you could help me out. I’ve read that HPV is nearly impossible to get via oral sex, that the virus doesn’t infect the throat. Is this true, or is there still a risk of contracting HPV via unprotected oral sex (i’m allergic to latex!!!). As far as digital sex goes, if I have no visible wounds on my hands, and perform digital sex then wash my hands afterwards, am I at risk? There have been questions like this posted on the archives, but the answers are contradictory – one says everything short of wearing a body condom is a risk, one says HPV is not transmissible via oral sex. Please help?

9-6-00
I’m sorry if the information on HPV appears contradictory; this often happens when we either don’t know enough about a condition to address it with certainty, or when there is controversy about it. In the case of HPV, part of the confusion stems from the fact that there are actually hundreds of different types of HPV, over 70 of which can infect the genital area. Even the genital types differ significantly among themselves, as some of them cause cervical cancer, and others cause genital warts. With regard to your first question regarding oral sex and HPV transmission: the types of HPV that normally infect the genital area and cause warts or cancer do not normally establish persistence (i.e., live long) in the mouth. And, there is some good preliminary evidence to say that even if you look hard for genital types of HPV in the mouth, you are unlikely to find it. This would indicate that you are unlikely to get genital infection with HPV if your partner performs only oral sex on you, even if she is infected with HPV in the genital area. Would I say it’s impossible? Of course not! I would just say it’s unlikely, because there are 2 potentially confounding issues. First, there are HPV types that prefer the oral mucosa (mouth lining). These do not appear to be as common as those that infect the genital area, and do not appear to infect the genital area themselves. Second, we do occasionally see oral warts that can be caused by genital HPV types in individuals who are immunosuppressed (for example, people with low CD4 cell counts due to HIV infection), and who have been orally exposed to genital HPV types. So, it can happen (which is why I almost never use the words ‘never’ or ‘impossible’). Finally, you don’t need to have wounds on your hands to effectively colonize your skin with HPV (though it probably helps the virus if you do). Again, the genital types are not the HPV virus types that establish infection on your hands (i.e., the types that cause plantar warts on fingers and toes). So, the major risk if you did get your partner’s genital HPV on your hands would be that you’d transmit it to your own genital area. Diligent hand washing should help to prevent this.

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44. Can chlamydia and gonorrhea stay dormant in your body for 1 1/2 years? I’m currently being treated for it until test results confirm it and I’m wondering if my ex-husband could have passed it on to me. He had an affair the last year of our marriage.

9-6-00
The specific answer to your question is different for both infections, but one general principle applies to both: it’s really hard, if not impossible, to establish exactly when a person got infected with almost any STD. There are obviously some exceptions, of course, but even seemingly ‘obvious’ cases can lead us down the wrong path. We get into this a lot in counseling people who have a new STD, because it’s quite natural for them to ask “where did I get this thing?” (also, “how could I, of all people, have gotten it?”). That said, we do know that chlamydial infections can persist in women for months to possibly years, so 1-1/2 years would not be impossible. Furthermore, 9 out of 10 women infected with chlamydia have no signs or symptoms. If I were you, I would certainly want to get a good diagnostic test to confirm if the infection is truly present, however. The natural course of gonorrhea is probably somewhat shorter, but it too can hang around in women for at least months, often causing no symptoms to alert its host of its presence.

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45. My girlfriend of six months has been chronically irritated vaginally on and off for five years. She had been diagnosed for years with yeast. Shortly after we got together, I began having symptoms of itchiness and burning. We were both recently diagnosed with strep (she came up with staph as well). She is currently being treated with clindamycin. Is this related to erythromycin (I am allergic to it). I am open to taking antibiotics after trying numerous natural approaches but: a) want to be sure it’s not some form of erythromycin or doxycycline, what else will work? b)want to get a sensitivity test to find out exactly what antibiotics will and will not work, it seems difficult and costly to find doctors willing or able to do this, I live in northern California.

9-5-00
As discussed in earlier questions (see archives under “etc..”), there is some debate as to whether or not streptococcus species (a bacteria commonly referred to as “strep”) can actually cause or contribute to vaginitis syndromes. When you say that you and your girlfriend were both diagnosed with strep, and her with staph, do you mean from cultures of your vagina? If so, it’s unclear why the cultures were done in the first place. We do not routinely recommend bacterial cultures of the vagina, except in special situation such as the rare case when one suspects toxic shock syndrome or another relatively unusual infection. The major reason for not getting bacterial cultures from the vagina is that they generally don’t provide any useful information to direct treatment. Many women have staph and strep as part of their normal vaginal bacteria, with both bacteria living at normally low numbers and coexisting peacefully with the normally predominant lactobacilli. Bacterial cultures do not tell you if you have too many of any particular species. So, giving antibiotics in the situation you describe not only does not follow current clinical guidelines; I would be concerned that it could actually disrupt the balance of your normal vaginal flora even further. With regard to your question about antibiotics, yes, clindamycin is distantly related to erythromycin, but the relationship is distant enough that allergy to one does not preclude use of the other (that said, I’d be cautious, depending on what your particular allergic reaction is, and discuss taking it with your provider). Finally, sensitivity testing for bacteria in the vagina is not routinely indicated for the reasons I discussed regarding culture in the first place. On the other hand, if persistent or recurrent yeast is a concern, then fungal sensitivity (susceptibility) testing makes more sense, and is becoming more routinely used. Some providers use fungal cultures to look for yeast (usually Candida species) that may be resistant to commonly used antifungal medications, especially if women are having recurrent yeast infections.

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46. My girlfiend’s ex had genital warts. I really don’t know that much about them, only what I’ve read here. My gf says the disease can only be transmitted when warts are present and that they never were together during that period and that I have nothing to worry about. Is this true?

10-3-00
Alas, would that it were so… genital warts are caused by specific types of human papillomavirus (HPV 6/11). Unfortunately, most sexual transmission of HPV very likely occurs from people who are ‘shedding’ the virus from their skin or genital secretions, but do not have visible genital warts. In fact, most people infected with HPV 6/11 probably don’t even develop genital warts at all, but may be capable of transmitting the infection nonetheless. The likelihood of your girlfriend having acquired HPV from her ex is high (some would say it’s almost certain); whether you get them from her depends on whether she still has HPV present to transmit, and what type of sexual contact you have. The more contact from mucosal lining to mucosal surfaces, or the more mixing of genital secretions, or the more skin breakdown or abrasion is involved, the more likely HPV transmission is to occur. HPV is a very easily transmitted virus, and as I said, most people experiencing a new case of warts do not report that their partners had warts at the time. So, unfortunately, you do have something to worry about–that’s the bad news. The good news is that you are probably no different from most other sexually active people, since HPV infection is so common; most of us are probably exposed to various genital types of HPV at some point in our sexual lives. Just remember: like all other women who are sexually active with women, you need to get regular Pap smear screening (which means annually until you’ve had at least 3 normal Paps in a row, then every 2-3 years), regardless of your sexual history and whether or not you or your partner experience warts.

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47. Is trichomonis and trichomoniasis the same thing? I was told by my ob gyn that I had trichomonis. When I looked it up, it was among the vaginal infections with yeast infections,etc. and trichomoniasis was under STDs. I noticed the symptoms were similiar, and the medicines were the same.

10-3-00
Yes! The bug that causes this STD is Trichomonas vaginalis, which many people call “trich” (pronounced “trick” for short); it infects the vagina in women and the urethra (the passage for urine along the penis) in men. If a person is infected with Trichomonas, the condition is called “trichomoniasis.” Trichomoniasis is really the only cause of vaginitis that is definitely sexually transmitted, and if you have it, your partner(s) should always be treated also (with metronidazole, which can be given as a single dose). Sexual transmission of Trichomonas has between women been documented. By the way, thanks for submitting an easily answered question!

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