As fewer boys today are getting circumcised than in the past, a new study adds support to the procedure.  

The study, published Monday in the journal Cancer, a journal of the American Cancer Society, found that circumcision reduces the risk of prostate cancer. the authors suggest that circumcision lowers the chance of infections and inflammation that may contribute to cancer.

Many studies have found that sexually transmitted diseases (STDs) including HIV are associated with an increased risk of prostate cancer.  other studies have found that circumcision reduces the risk of infections including STDs.  Viruses can slip into the mucosal layers under the foreskin and thrive in the moist environment there, so removing the foreskin appears to lower the risk of infections taking hold.  the authors theorized that since circumcision therefore would also reduce the incidence of prostate cancer.

The investigators analyzed data from more than 1,700 men with prostate cancer and a nearly equal number of men without cancer.  Approximately 70 percent of all men, who ranged in age from 35 to 74 had been circumcised—the vast majority right after birth. Men who had been circumcised before their first sexual intercourse were 15 percent less likely to develop prostate cancer than those who were not circumcised. 

“From these results, we estimate that circumcision may prevent about 10 percent of all prostate cancer cases in the general population,” said Janet L. Stanford, a co-author of the study and research professor at Fred Hutchinson Cancer Research Center in Seattle. 

Men who were circumcised after their first intercourse, however, did not benefit from the reduced risk.

In addition, men circumcised prior to having their first sexual encounter had an 18 percent reduced risk for developing a more aggressive form of prostate cancer.

Infections are estimated to be the cause of 17 percent of cancers worldwide. other cancers that have been linked to infections include cervical, stomach and liver cancers. In fact, one study found that circumcised men are less likely to infect their female partners with the human papillomavirus, or HPV, which is linked to cervical cancer.

Infections are thought to cause a chronic inflammation, which can lead to DNA damage as well as other changes that may help cancers thrive. the study did not find a higher rate of self-reported STDs in men who had prostate cancer, though the authors suggest that the men may not have known they had an STD if they had been a carrier without symptoms. 

Oh, Discover. You’re such a tease. You have Ed and Carl and Razib and Phil and Sean, an (all-male, ahem) cluster of science bloggy goodness. But then you also fawn over HIV deniers Lynn Margulis and Peter Duesberg. Why can’t you just stick with the science and keep the denial out?*

But no, now they’ve let it spill into their esteemed blogs. I was interested to see a new blog pop up there, The Crux, a group blog “on big ideas in science and how these ideas are playing out in the world. the blog is written by an outstanding group of writer/bloggers and scientist/writers who will bring you the most compelling thoughts throughout the world of science, the stuff most worth knowing.” Sounds ok, let’s see what stories are up…oh, one on HPV! right up my alley. And hey, a woman! Bonus.

Ohhhhh, it’s actually one on HPV vaccine misinformation, written by the author of the fawning Duesberg article referenced above. Faaantastic.

The author, Jeanne Lenzer, poses the question, Should boys be given the HPV vaccine? and answers herself that “the science is weaker than the marketing.”

What does she base this conclusion on? a recent paper examining HPV vaccine in boys, maybe? No, of course not. she uses the 4-year-old NEJM study demonstrating the efficacy of the then-new vaccine as the main basis of her claim, and it’s a house of cards from there. Let’s look at what she says, shall we?

First, let’s start with the 2007 NEJM paper. this paper tested the multivalent HPV vaccine, which contains HPV types 6 and 11 (these cause warts and aren’t further examined in this particular paper) and 16 and 18 (cause cancer, focus of this research). the goal was to “assess the prevention of cervical intraepithelial neoplasia grade 2 or 3, adenocarcinoma in situ, and cervical cancer caused by HPV-16 or HPV-18.” this makes sense that they’re looking at cancer outcomes only due to types 16 and 18–after all, while other HPV strains can cause cancer, HPV 16 and 18 are the only cancer-causing types included in the vaccine. They even note in the introduction that HPV 16 and 18 cause about 70% of all HPV-related cervical cancers, but that’s still not 100%. I mean, they state this right in the paper: “The primary hypothesis stated that, as compared with placebo, the vaccine would reduce the incidence of high-grade cervical intraepithelial neoplasia related to HPV-16 or HPV-18 in the per-protocol susceptible population.” I spell this out because this is one of Lenzer’s criticisms, which I’ll come to in a bit.

So they have this vaccine. who did they test it on? In this trial, it was women ages 15-26, and the mean age of this group was approximately 20 years old. Age at sexual debut was 16–so on average, women in this trial had been having sex for about 4 years with 2 sexual partners by the time they were vaccinated. Now, for those of you familiar with the vaccine, that age range may seem a bit odd–because the vaccine is currently recommended to be given to girls starting at around age 11. But you see, this is one way they ended up at that recommendation–because of SCIENCE! (I’ll also come to that in a minute).

All right, they have young women, initially just a bit over 12,000 of them in 13 countries. Let’s look at their eligibility criteria (who could actually participate):

Women were eligible to participate in the study if they were not pregnant, did not report abnormal results on a Papanicolaou smear, and had had a lifetime number of no more than four sex partners.

That’s it, and it’s an important thing to note. for initial enrollment, they didn’t have to be HPV negative. this becomes important later.

The eligible women were randomized into the treatment or placebo groups, and then received 3 doses of the vaccine (or placebo), and were asked to report any serious adverse events for up to 15 days post-vaccination. the women also underwent pap smears and HPV testing at this point. They also had a number of follow-up visits to be re-tested, up to 4 years post-vaccination.

About those baseline tests. even though they enrolled a bit over 12K women, they found that at baseline, pap smears were abnormal for 11.8% of subjects in the vaccine group and 11.1% in the placebo group. In other words, they were already infected with a strain of HPV at the beginning of the study. They further examined everyone using both DNA and serological testing for HPV 16 and 18, and found that about 10% of their cohort was already positive for HPV 16, and about 3-4% for HPV 18. thus, they analyzed their data in several different ways, including doing an analysis including the pre-existing HPV 16 & 18 positive participants, and another one without them.

They also analyzed by eliminating participants who hadn’t fully followed or completed the protocol, including getting only one or two doses instead of the targeted three; having missing samples; or “general protocol violations,” which apparently consisted largely of not getting the month 7 swab at the right time, or administration of IgG, immunosuppressive drugs, or blood products–all things that could affect study outcomes.

Now the numbers. When they looked at women who’d followed protocol *and* were susceptible (ie not already infected with HPV 16 or 18 upon entry into the study), efficacy was 98% at preventing HPV-16/18-related high-grade cervical lesions. And what are “high-grade cervical lesions,” you might ask? according to the NCI:

High-grade means that there are more evident changes in the size and shape of the abnormal (precancerous) cells and that the cells look very different from normal cells. HSILs are more severe abnormalities that have a higher likelihood of progressing to cancer. HSILs include lesions with moderate or severe dysplasia or carcinoma in situ.

This is basically the step before cancer, and as noted above, one of the endpoints of the study, yet Lanzer calls them “innocent cellular abnormalities” and cites this paper, which doesn’t match her claim. if she’s referring to the line that “most HPV infections are easily cleared by the immune system,” I hate to break it to her that the ones that are “easily cleared” aren’t usually the ones causing the more serious dysplasia and carcinoma in situ. Rather, those HPV-caused lesions typically are examined via colposcopy and biopsy of the area to check for cancer. (Bonus scavenger hunt for the phrase “coffee ground-like discharge!”). Next, a woman with abnormal cells can expect to undergo a LEEP procedure, where portions of your cervix are removed with a burning electric wire under local anesthetic, and the foul smoking remains of your cells are sucked up into the smoke shark, “a sleep, powerful, smoke-eating machine.” after that one, side effects include infection, hemorrhage and possibly cervical incompetence. these are rare, but if we’re talking vaccine side effects versus possible outcomes from HPV infection, these types of outcomes need to be considered as well–not just death from cervical cancer.

What I’m trying to say here is that Lanzer may be minimizing these “innocent” non-cancer findings just a wee bit.

OK, so 98% efficacy in their target population who followed the study perfectly. what about if they included everyone? for that, they do what’s called an “intent to treat” analysis, basically putting everyone back in the pot. As Lanzer notes, this is when efficacy falls to a reported 44%, but she completely fails to note that the bulk of this was because the women had pre-existing HPV 16/18 infections and/or lesions. Like almost all vaccines, getting it isn’t going to help you if you’re already infected and showing symptoms. As I mentioned before, SCIENCE! this is why it’s so strongly recommended now to get the vaccine prior to the onset of sexual activity–if you’re already HPV-infected, the vaccine will not do you as much good. Hence, the current recommendation to receive the vaccine prior to the onset of sexual activity (ages 11-12ish).

OK, I’ve had about all I can take and this is getting to be a post of Oracian lengths. to jump to the end–why didn’t they just wait 20 years or so to see if there would be more cancers in the placebo versus unvaccinated group? besides the whole waiting 20+ years thing, maybe because that would be totally unethical? I’ll take this right from the discussion section:

Although prevention of invasive cervical cancer is the main goal of prophylactic HPV vaccination, it is ethically unacceptable to use invasive cancer as the end point in efficacy trials. Cervical intraepithelial neoplasia grade 3 and adenocarcinoma in situ, which the International Federation of Obstetrics and Gynecology classifies as stage 0 noninvasive cervical cancers, are clinically important outcomes because they are likely to persist and may become invasive without treatment.

Thing is, even if they had followed these women for 20 years, doing checkups say every 6 months, they would have to follow standard treatment protocols (like the LEEP nastiness I mentioned above) and as such, would be doing everything they could to prevent cervical cancer in any case. so, these precancer endpoints are more ethical substitutes, and still show the ability of the vaccine to prevent abnormal cell changes that can lead to cancer.

Finally–Lenzer uses her supposed refutation of HPV vaccine efficacy in girls to then argue that we’re looking to give this vaccine to boys unnecessarily. she cites first that there are only 300 anal cancer deaths in the US every year (one of the cancers the HPV vaccine should reduce in men–and women, I might add). Small potatoes–why give the vaccine to boys over 300 deaths, right? But oddly enough (or, not?), she gives the barest of lip service to a group of HPV-associated cancers which affect men more than women, head and neck cancers. Guess what–there’s a lot more of those than anal cancers, and several studies suggest that HPV-associated head and neck cancers are actually increasing in incidence.

Even when she does mention oral cancers, she asks rhetorically, “what about the claim that Gardasil might prevent anal and oral cancers men may get from having sex with other men?” Um….why focus only on men having sex with men? perhaps it hasn’t occurred to Lenzer that oral and anal cancers in men can also be transmitted to them by female partners, and vice versa–so we’re not just talking about “gay” cancers in men. I wonder if her wording was purposeful, though, as it’s easier for many in society to dismiss concerns about diseases that are transmitted via homosexual sex acts.

To wrap up, some drama. Lenzer frets about the possibility of developing Guillain-Barré syndrome from the HPV vaccine:

given this, is it worth the risk of exposing millions of youth to the as yet uncertain harms of the vaccine? the CDC states that in rare instances, some vaccines may trigger the potentially fatal and paralyzing condition Guillain-Barré, and Nizar Souayah, MD, of the University of Medicine and Dentistry of New Jersey in Newark, says he and his colleagues found “clear evidence from our database of an increased incidence of Guillain-Barré syndrome in the first six weeks, especially the first two weeks, after [HPV] vaccination.” Guillain-Barré is very rare, even among people who are HPV vaccinated, but the problem is emblematic of the downsides of subjecting millions of people to any medical treatment.

The link takes you to a WebMD article from the 2009 American Academy of Neurology meeting reporting on a study by Nizar Souayah. the WebMD article states:

overall, the vaccine does not raise the odds of developing Guillain-Barre syndrome (GBS), a disorder of the peripheral nervous system, says Nizar Souayah, MD, of the University of Medicine and Dentistry of New Jersey in Newark.

“But there is clear evidence from our database [the VAERS database--TS] of an increased incidence of Guillain-Barre syndrome (GBS) in the first six weeks, especially the first two weeks, after vaccination,” he tells WebMD.

Still, the risk is extremely low: 26 in 10 million in the first two weeks and 30 in 10 million in the first six weeks after vaccination. That compares to 5 in 10 million odds in the general population, Souayah says.

Leznar bills herself as an investigative reporter, but didn’t even bother to dig up the published version of this research. the numbers are fairly similar, so even if we accept that your chance of developing GBS from the HPV vaccine are 30 in 10 million (which are a bit sketchy coming from the VAERS database), that would still be only 3-6 times higher than those who didn’t receive the vaccine, with a condition that’s extremely rare to begin with. (To put it in perspective, the likelihood that you’d be struck by lightning in any year are about 1 in 750,000 according to NOAA). You have much better odds of contracting GBS from eating a poorly cooked chicken breast, as Campylobacter infections are a bigger cause of GBS than vaccinations. even influenza infections cause more GBS than vaccines.

To sum up, in case it’s not painfully obvious by now, Leznar’s article is full of half-truths and omitted facts–so many that it would take me an entire series of articles to go through the rest of her post, and I haven’t even gotten into any post-2007 HPV vaccine research! to top it all off, she doesn’t even try the “fair and balanced” journalist approach, instead quoting only vaccine “skeptics” but not those who are in favor of HPV, and of then ends on the “I’m not anti-vaccine” note–she can’t be, as she thinks smallpox is bad! (Of course you’re not, neither is anti-vaccine advocate Barbara Loe Fisher. Is there a drinking game for that somewhere?)

I’ll end with my own addendum.

My 11-year old daughter is vaccinated for HPV. my 9-year-old son will be vaccinated. I wish they’d had the vaccine when I was younger, so I didn’t have first-hand knowledge of the Smoke Shark, who still haunts my dreams.

*And yes, I know that Discover is owned by the Gucciones, who have ties to another HIV denialist besides Duesberg and Margulis. [UPDATE: Turns out Guccione doesn't appear to own Discover any longer, and that it was sold last year to Kalmbach publishing. Thanks to Ed & Razib for the correction.]

National Tuberculosis Control Programme (NTBCP)HIV weakens the immune system and increases the chances of developing other infections. these infections are called opportunistic infections’ because they take opportunity of your weakened immune system. TB is one of these opportunistic infections.Yes TB is curable even when you are living with HIV. the medicines that fight TB work just as well in people living with HIV as they do in people who are not living with HIV. the benefits of good nutrition when on TB treatment and living with HIV cannot be over emphasised. It will improve one’s quality of life; make you stay alive. Move and work efficiently. your doctor will decide which combination of medicines will work best for you. Anti-retroviral therapy (ART) is for life while TB treatment is taken for at least six months. It is important  that people who have TB get tested for HIV as soon as possible so that they can receive treatment for HIV and other HIV-related infections if found to be positive. NTBCP contact details: 24042431

Integrated Diabetes Prevention and Care Programme (IDIAP) SwazilandDiabetes is a lifetime disease which develops as a result of failure of insulin production, insulin action or both since insulin regulates the use of sugar in the body these will result in a chronic rise of blood sugar, causing damages in the brain, kidneys, heart, eyes and nerves.Insulin is a chemical or hormone which is made by the pancreas. It enables body cells to take in sugar from the blood and use it for energy. the warning sins of diabetes include: frequent urination, excessive thirst, increased hunger, blurred vision, weight loss, tiredness, lack of concentration and frequent infections. Individuals who experience these symptoms should consult the nearest health facility immediately. Type 2 Diabetes can be prevented in individual at high risk of developing it by using cost-effective interventions: healthy diet and physical exercise to maintain an ideal body weight. you need to visit health centre to know your body mass Index (BMI).unfortunately, diabetes is ‘not curable’ as yet but it is ‘controllable’ in order to prevent its chronic complications which lead to high death rates. Complications of diabetes include poor erection in men, diabetic ulcers, stroke and heart disease, among others.IDIAP Office contacts: Tel 7713 1727 Hatzin Centre Room F2 new Satellite Bus Rank Manzini

The Swaziland Breast Cancer Network (SBCN)The vision of the Swaziland Breast Cancer Network is to be an efficient and effective provider of breast cancer services in Swaziland. the vision is attained through collaboration with strategic partners and working close with the medical community to make cancer treatments accessible and affordable for the people. its mission is to assist in improving the survival rates of people directly affected by breast cancer in Swaziland through awareness creation, counselling and advocacy.Breast cancer occurs when unhealthy cells grow in the breast. Breast cancer is affecting a growing number of women in Swaziland. To date breast cancer includes women in their 20s, 30s, 40s and above. a small percentage of men are seen with breast cancer too. When breast cancer is found and treated in its early stages there is a greater chance of long-term survival.To reduce your risk of breast cancer: early detection is the key. By doing breast self-examination (BSE) every month you will get to know your breasts; their shape, size and feel. most breast changes are not cancerous, but if you find one you should be checked by a doctor immediately. all women and men should do a BSE every month. Young women should do a BSE one week after their monthly period. After menopause, pick the same day each month to do a BSE; same for men. To reduce your chances of breast take a walk or join in fitness activities and exercise regularly; eat a LOWFAT diet rich in fruits and vegetables; don’t become over weight and do not smoke cigarettes. Remember if you have a family history of breast cancer the risk is higher.Contact days: Tuesday Manzini City Council & Thursday Room4 Mbabane Government Hospital

Elizabeth Glaser Pediatric AIDS Foundation SwazilandThe Elizabeth Glaser Pediatric AIDS Foundation began supporting the government of the Kingdom of eSwatini in 2004 to prevent HIV infections and reduce HIV-related morbidity and mortality among women, children and families. the Foundation’s strategic support mirrors the comprehensive prevention of mother-to-child transmission (PMTCT) approach adopted by the ministry of Health and is part of the national PMTCT and HIV care and treatment programmes.since 2008, the Foundation has realigned its approach in Swaziland to focus on the integration of comprehensive, quality HIV prevention, care and treatment services into maternal and child health settings for pregnant women, their children and their spouses. Approximately 180 000 people are living with HIV in Swaziland. of those 14 000 are children under the age of 15 (UNAIDS, Report on the Global AIDS Epidemic 2010). the Foundation currently supports 59 sites providing PMTCT services and six sites supplying care and treatment (C & T) support to women, children and families living with or affected by HIV and AIDS.EGPAF Office contact details: 240408081, new Mall building Mbabane.

SokaUncobe – Medical Male Circumcision National CampaignCircumcision is a minor surgical procedure for removing the fold of skin (foreskin) that covers the head of the penis. To support your son throughout the process of counselling; operation, rest; and check. if your son is younger than 18 years you as a parent or guardian are requested to give informed consent for the procedure to be done by signing a consent form. This can be done in the following ways. the parent or guardian can independently bring the youngster to the clinic to give consent. the school will send you consent forms to sign and all necessary information will be provided to you by the guidance and counselling officer or at any, SokaUncobe site. a clinical counselor may be requested to come to the community to talk to parents and their consent.in the days and weeks following the operation you will be a great support to your son. Encourage him to go for a check-up on the 2nd and 7th day after the operation. Ensure he follows the clinic’s instruction. Sex and masturbation are not allowed for six weeks after circumcision and the longer your son abstains the greater the benefit. if he experiences severe pain, swelling, bleeding or any signs of infection, call the emergency number or return to the clinic/ nearest health facility.  Dial 977 for more information.

I was diagnosed with STD trich which I have mess for but I took blood test for other stds how soon should I know I just took the test yesterday. also when should I have symptoms of it if I do have it?

If you suspect a possibility of you getting HIV via sexual intercourse or needle puncture, it is protocol to wait at least 6 months before testing, or else the blood test may yield a false negative. Testing usually takes a few days.

Here, it takes about 3 days.

Its been 2 years now since my last sex, but this issue had just occurred to me. I have never thought of it before until now.
Also, what should my CONDITION be now if i have STD or HIV that i never knew i had from my 2 years ago sex?
Pls help me, I am freaking out right now.

I just went through the same experience. I lost my virginity unprotected to a girl whom I think has had sex before. this happened about 2-3 years ago and only did it once.
I am 20 years old now and this conscious thought only came to me the other day about it so I checked myself, the wait was kind of long. I tried to go last year with some friends but the wait list was was too long for the rest of the day. I would try to go right when it opens or 30 minutes before to get in and out.

And if it was protected sex then chances are slim to none.

Safe journey.

STD is a term for sexually-transmitted disease which can be one of many and symptoms vary widely.
With exception of viral diseases and syphilis you would definitely feel trichomaniosis or gonorrea and other bacterial diseases.
HIV is usually asymptomatic at this stage. Syphilis can be latent. HVC, HPV and genital herpes might not be manifested depending on many factors.
HIV and syphilis
metapathogen.com/HIV-1/HIV-1-…
metapathogen.com/syphilis/

If you have hiv There may not be any syptoms except maybe some flu like symptoms.other STDs have symptoms such as Discoloration, bumps or lacerations, Painful discharge, painful urination. honestly your best bet is to get tested. they have many clinic which do the tests for free. better Safe than sorry

ROME — In a clinical trial that dramatically confirmed years of observation, early use of antiretroviral therapy reduced the risk of transmitting HIV between couples. the approach also reduces the risk of clinical symptoms of HIV infection, although not to the same degree, according to Myron Cohen, MD, of the University of North Carolina Chapel Hill, and colleagues. the findings support the use of antiretroviral therapy as a public health measure to slow the rate of HIV transmission, Cohen and colleagues reported online in the new England Journal of Medicine and at the International AIDS Society conference here.Action Points  

• Explain that in a clinical trial that dramatically confirmed years of observation, early use of antiretroviral therapy reduced the risk of transmitting HIV between couples.
• Note that the approach also reduces the risk of clinical symptoms of HIV infection.

“The study demonstrates a terrific benefit from earlier therapy,” Cohen told MedPage Today. “It’s quite simple – there’s a clinical benefit for the patient and a dramatic, nearly 100%, reduction in transmission.”

The key question now, he added, is how to best use the knowledge to slow the progress of the HIV/AIDS pandemic.

That’s especially true because “we don’t have enough resources” to treat all those for whom therapy is clinically indicated, according to Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases.

“With the resources we have, we can’t do everything,” he said, so the question is how to use the findings to have the most impact.

Sustained suppression of HIV in genital secretions is the “most likely” explanation for the reduction in transmission observed in the HIV Prevention Trials Network (HPTN) 052 study, Cohen and colleagues concluded.

The HPTN 052 trial enrolled 1,763 couples, in nine countries, in which one partner was HIV–positive and the other was not. the HIV-positive partners all had relatively robust immune systems and antiretroviral therapy was not indicated according to guidelines.

The HIV-positive partners were randomly assigned to get triple-drug antiretroviral therapy or to wait until the treatment was indicated, with the hypothesis that members of the early-treatment group would be less likely to transmit the virus to their uninfected partners.

A clinical hypothesis was that those getting early treatment would also have a lower risk of serious HIV symptoms: Pulmonary tuberculosis, severe bacterial infection, a World Health Organization stage 4 event, or death.

The HTPN 052 trial was designed with enough statistical power to show a 20% reduction in the risk of transmission, but it was stopped early when an interim analysis showed the risk reduction was 96%, Cohen and colleagues reported.

Indeed, of the 28 transmissions that were genetically linked to the infected partner, only one took place in the early-treatment group (HR 0.04, 9% CI 0.01 to 0.27, P<0.001), they found.

There were 39 cases of HIV transmission, including 11 that could not be linked to the infected partner, the researchers reported. of those, only four were in the early treatment group. the hazard ratio was 0.11 with a 95% confidence interval from 0.04 to 0.32, which was again significant at P<0.001.

Cohen told reporters that the single case of transmission was at best equivocal: the initially uninfected partner was shown to have acquired HIV 85 days after her partner began therapy, but genetic analysis suggested she had been infected more than 50 days and as much as 84 days earlier.

“Our interpretation is that it’s very likely that transmission took place before her partner had enough antiviral to suppress viremia,” Cohen said.

There was also a benefit of early treatment in terms of the primary clinical endpoints, Cohen and colleagues reported. There were 40 such events in the early-therapy group and 65 in the delayed-therapy group (HR 0.59, 95% CI 0.40 to 0.88, P=0.01).

The difference was mainly driven by the incidence of extrapulmonary tuberculosis, seen in three participants in the early-therapy group and 17 in the delayed-therapy group, a difference that was significant at P=0.002.

There was no significant difference between the groups in incidence of pulmonary tuberculosis, they found.

The researchers also reported:

• 82% of the 28 linked transmissions took place in Africa.
• In 18 of the 27 cases in the delayed-treatment group, the source of HIV was a woman; the source of the sole transmission in the early-treatment group was a man.
• 55% of the cases of extrapulmonary tuberculosis were seen in India.
• 97% of the couples were heterosexual and 94% were married.
• 50% of HIV-positive participants were men.
• There were 23 deaths, including 10 in the early-therapy group and 13 in the delayed-therapy group, a difference that was not significant.

Aside from the primary clinical endpoints, 246 HIV-positive participants had one or more severe or life-threatening adverse events, but there was no significant difference between the groups.

The report comes as a series of recent results, including the HPTN 052 trial, has provided “strong encouragement” for the use of antiretroviral drugs to prevent HIV infection, according to Scott Hammer, MD, of Columbia University in new York City.

They include the use of a microbicide gel, containing an anti-HIV drug, to reduce the risk of women acquiring the virus, and a study of oral prophylaxis to prevent infection among men who have sex with men, Hammer noted.

HPTN 052 suggests that there is a “dovetailing of individual and public health benefits” that supports such approaches, Hammer argued in an accompanying editorial in the journal.

But drug therapy as prevention “is not the ultimate answer to controlling and ending the HIV epidemic,” he argued, because of such concerns as adverse events, the possible emergence of drug-resistance, and cost.

Nonetheless, Hammer concluded, such an approach has the “potential to preserve health and control the epidemic until a safe and effective HIV vaccine is a reality.”

The study was supported by the HIV Prevention Trials Network and the National Institute of Allergy and Infectious Diseases. Study drugs were donated by Abbott Laboratories, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, and Merck.

The journal said Cohen did not report any disclosures.

The journal said Hammer reported financial links with Merck and Progenics.

Some STDs (such as HIV) may not have symptoms for a long time. if you get HIV, you may not have symptoms for years. The only way to find out if you have any STDs is to get tested. Don't wait until you have symptoms.

tons of STDS and you cant be sure the time the symptoms, but if your questioning this and you had sex and you feel weird "down there", or there is weird discharge you might want to go to a doctor.

Theres many std's out there so its hard to say when or if you ever do get symptoms of the sexual transmitted disease. It just basicallity all depends on the persons immune system and how it affects the blood system.

it depends, however sometimes with an STD like chlamydia you dont get any symptoms at all

some std's have no symptoms,for peace of mind go 2 the doctor

(assuming they haven't fallen to some opportunistic infection)

I need to explain the connection between rashes, fever, headache etc. to HIV, but I just can't think why killing white blood cells would give you a headache.

CHAMBERSBURG — Patients of a Chambersburg urology practice recently received a potentially unsettling letter, advising them to get tested for HIV and hepatitis because reused instruments had been used for their prostate biopsies.

Medical and legal experts say reusing biopsy needles is not recommended for several reasons, and that Urology Associates of Chambersburg could now face a range of legal repercussions.

While the risk of infection is statistically very low, experts advise that every man who received a letter should be tested. the tests are being conducted at Chambersburg Hospital and paid for by the urology practice.

A 68-year-old Chambersburg area man told Public Opinion that he received his letter in the past week and went in for the blood work Friday. Due to the potentially sensitive nature of his situation, Public Opinion agreed to keep him anonymous.

He had his biopsy done about four years ago by Dr. Christopher Klinko. while the procedure was typically less than comfortable, he was pleased with the doctor’s care and said everything seemed to be done very professionally.

“Everything looked very sterile and clean, very efficient,” he said.

When he received the letter, Klinko’s patient wasn’t too concerned at first. his wife convinced him to go for the test. A phlebotomist at the hospital told him there have been a significant number of other men getting the same test done in recent weeks.

“I hadn’t given it much thought. my feeling was, with the time that elapsed, something would have shown up already,” he said. “Then I realized it could take a long time for HIV to show up.”

Dr. Jay Raman, a urological surgeon and assistant professor of surgery at Penn State Hershey Medical Center, said in some cases it takes between seven and 10 years for HIV to become apparent in an infected person. Symptoms of hepatitis typically appear within two to four years after initial infection.

“The most aggressive strains will show up early, but being asymptomatic does not mean you’re in the clear,” Raman said.

According to the letter sent to Urology Associates’ patients, the practice used biopsy needles and guides that are labeled “single use only.”

“We have recently discovered that some prostate biopsy instruments were reprocessed using a detergent scrub, sterilized and then re-used in our office,” the letter states. “Corrective action was immediately taken and instrument reprocessing has been terminated.”

Raman explained that an ultrasound probe and a tubular device called a cannula used in the procedure are not disposable. They are disinfected and sterilized after each use in a special liquid formulated to kill bacteria.

Since biopsy needles or “needle guns” actually pierce the patient’s rectal wall and the prostate to collect tissue samples, they should not be reused, he said. at his hospital, the needles are immediately placed in a “sharps” container and disposed of as biohazardous waste.

Raman said chemical sterilization is “more than adequate to kill all conventional bacteria,” but HIV and hepatitis are considered “more hardy viral agents.” He was unable to provide a statistical likelihood of patients being infected by “reprocessed” instruments, but said it is a very low.

His personal risk of contracting hepatitis if he is accidentally stuck with a bloody needle during surgery is about 1 in 500,000, Raman said. the risk of catching HIV the same way is about 1 in a million.

Add to those long odds the fact that the needles at Urology Associates went through some form of sterilization, and the likelihood of infection becomes quite rare. still, Raman recommends getting tested to anyone who received a letter.

“If it was me, I would. I think the risk is overall very low, but certainly it’s higher than zero,” he said. “In that case, I think it’s worthwhile to be better safe than sorry.”

There is another reason why reusing biopsy needles is not a very good idea, Raman said. each use would make the device a little less sharp. Performing biopsies with a blunt needle decreases the procedure’s accuracy and increases the risk of complications.

He said this is the first case of reused biopsy needles that he has heard of. Asked why any medical practice might do such a thing, he suggested that saving money was probably the motivating factor.

According to the website for a medical supply company based in New Jersey, urological biopsy needles range in price from about $100 to $240 for a box of 10. the instruments are typically 1-2 millimeters in diameter and 10-15 centimeters long, Raman said.

Public Opinion was unable to determine how many patients received letters from Urology Associates. A receptionist answering the phone at the office said the doctors are declining to comment on the matter.

According to their letter, Klinko and Dr. Louis Glass are practicing urology at the office on Fifth Avenue in Chambersburg. Some patients told Public Opinion they had been treated there in the past by Dr. William Haren, who apparently no longer works there.

A fourth urologist, Dr. Kambiz Tajkarimi, reportedly left Urology Associates earlier this year. He is now practicing exclusively with Summit Health, which operates hospitals in Chambersburg and Waynesboro, according to the organization’s spokesperson, Jessica Walter.

After Glass and Klinko sent their letter, Tajkarimi mailed a letter to about 800 of his own former Urology Associates patients on May 11.

“I had no knowledge of the conduct described in that letter and resigned from employment with the practice when I learned of this matter,” his letter states.

Walter said that while Urology Associates is an independent practice, the doctors associated with the office are also associated with Chambersburg and Waynesboro hospitals. When Summit Health was notified about the reused needles, an internal investigation was done at both locations.

“We found that we are compliant — all single-use devices are disposed after one use at both Chambersburg Hospital and Waynesboro Hospital,” Walter wrote in an e-mail.

Dr. Anna Laakman, a visiting assistant professor at Penn State’s Dickinson School of Law, is an expert in the area of medical malpractice law. she said Urology Associates could potentially face legal recourse. the affected patients would have to prove three basic elements to hold their doctors civilly liable for malpractice.

First, they would have to prove that the practitioners “breached the standard of care,” and that reprocessing biopsy needles is not considered customary medical practice.

“Certainly the needles being labeled for one use only would be powerful evidence to support the claim that they were negligent,” Laakman said.

Next, the patients would have to prove that they were actually harmed or contracted a disease.

Finally, they would have to prove the harm was caused by the actions of the doctor or doctors in question.

With the low likelihood of infection, the ultimate success of a malpractice claim in this situation would be “questionable,” Laakman said.

The doctors at Urology Associates notified the Pennsylvania State Board of Medicine, Summit Health and the primary care physicians of all their patients about the incident, according to their letter.

Kevin Murphy, a representative of the Pennsylvania Department of State, confirmed that the Board of Medicine had been notified and the matter “remains under active investigation.” He said it has also been referred to additional “federal, state and local” agencies.

He said that “if it is determined that a physician strayed from accepted practice,” the board could suspend or revoke the doctor’s license to practice medicine in Pennsylvania.

A spokesperson with the Pennsylvania Department of Health wrote in an e-mail that the department “cannot comment on any possible pending or on-going investigations.”

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Jim Tuttle can be reached at or at 262-4754.

What is a prostate biopsy?

A prostate biopsy is a medical procedure performed on men to check for the presence of prostate cancer. Dr. Jay Raman said between 25 and 30 percent of men who have the test will be positive for cancer.

Raman said the procedure is also performed at his hospital with the use of at least some anesthesia. the patient lies on his side and an ultrasound probe and guide tube are inserted into his rectum.

A series of measurements are taken using ultrasound data, and a biopsy needle is pierced through the rectal wall into the prostate. Between 12 and 14 “cores” of tissue measuring about a millimeter wide and a centimeter long are then removed for testing, Raman said.

All the samples are collected with one needle, which is supposed to be thrown out after the procedure, he said.

Can you begin to feel symptoms the first day after a sexual encounter?

It depends on

1) what STD are you suffering from?
2) Environmental conditions. etc weather, humidity
3) your body resistance

If you ever suspect you have STD, see a doctor and stop having sex till you are sure you don't have it.

you really don't feel the effects, they sort of just happen. just like aids. you don't know that somebody has it, unless you see somebody taking their aids medications! the effects really don't kick in until the next sexual encounter with your partner. make sure if you do have an std to let your partner know.

no most people don't even know that they have a disease until they go the doctors

no,a week maybe more

Hello, if you mean hiv probably 2-4 weeks for acute infection

depending on what std you would have contracted would determine how long you would expect to see anything if anything appears at all. more and more studies are showing that people have been contracting std's by a partner that had one but was never aware of having it. you would not be able to tell if you had contracted one the day after the infected intercourse. there have been cases where someone has been infected with the HIV virus but did not get diagnosed until strange symptoms started to appear…7 years later!!! by that time, it was too late and the man lost his battle but moral of the story, if you think you have an std, please please PLEASE get yourself checked. you don't even have to go to your family doctor…you can go to planned parenthood and they would be able to do it for free and under confidentiality. std's are a serious matter and if you don't know for sure that you are 100% clean, you can potentially hurt yourself and the rest of your partners for the rest of your life.

no, there is an incubation period

No I dont think so . studies say anywhere from 3 days to 6 months

some cases you would never know because you dont have any syptoms like Hpv the strains 18 + 20 of that virus that COULD lead to cervical cancer .

It depends upon the STD and what sex you are. In women, symptoms often appear much more quickly and severely than in men, and some STDs may have no symptoms at all.

It usually takes longer than a day to feel any symptoms; however, if you have any questions, it's best to talk to your doctor.