Q: My girlfriend’s dentist found a lesion in her mouth. It was biopsied and it turned out to be cancer due to the Human Papilloma Virus. Am I at risk of contracting cancer by kissing her?
Jason-Vancouver
A: The Human Papilloma Virus (HPV) comprises many different types of viruses. Certain types cause warts on the skin, and others cause warts in the genital area. HPV can be sexually transmitted, and is well known to cause cervical cancer. Over the past 5-10 years HPV has also been linked to mouth and throat cancer (oral cancers).
Ten years ago oral cancer mainly occurred in older white men who smoked and consumed alcohol. Over the past 5-10 years oral cancers are occurring in a younger generation (people in their 30’s and early 40’s), and is due to HPV.
A study in Stockholm, Sweden, found that cases of oral cancer increased seven times from 1970-2007. They found that while HPV caused only 54% or oral cancers from 1998-1999; it caused 84% of these cancers in 2006-2007. Experts say in 2011 there will be 45,000 cases of head and neck cancer, and more than one third of those cases will be linked to HPV infection.
HPV is found in saliva, semen and genital secretions. HPV can be sexually transmitted. The main risk factor for HPV related throat and mouth cancer is oral sex. In a recent study it was shown that there was an elevated risk of developing HPV related oral cancers associated with a high number of oral sex partners. There was also an association with acquiring HPV related oral cancer among people who begin having oral sex at an early age.
Another study at Johns Hopkins by Gypsyamber D’Souza, PhD, showed that not only oral sex to be a risk factor for HPV related throat and mouth cancer, but also deep open mouthed French kissing was a risk factor as well. Dr. D’Souza, however felt this risk was small. He stated: “People with oral HPV infections should not be concerned about interacting with their loved ones in a normal way. Salivary transmission of HPV is very rare.”
There is no known cure for HPV. The way to prevent HPV is vaccination. The CDC recommends that children (both boys and girls) get their shots when they are 11 or 12 prior to any sexual activity.
In conclusion it is probably unlikely that you would contract oral HPV related cancer from your girlfriend by kissing her. However if she has a history of HPV in her genital area then you may contract it through engaging in oral sex with her.
 Q: My husband and I are taking our ten year old granddaughter to France this summer. We have been looking forward to this trip for two years. I am concerned about the measles outbreak I heard on the news. My husband and I are both 75 years old. What sort of precautions should we take?
Gina-Portland
A: Western Europe (particularly France) is having a large outbreak of measles. The World Health Organization (WHO) reported that France has had 4937 cases of measles between January and March of this year compared to 5090 cases in all of 2010.
This seems to be a backlash from the discredited 1998 study of Andrew Wakefield linking the measles/mumps/rubella (MMR) vaccine to autism. Many French children between the ages of 10-19 have not received an MMR vaccine.
The outbreak has been exported to other countries as well including the United States.
The best recommendation I can make is to ensure your granddaughter has received her two doses of the MMR vaccine (usually the first at 12-15 months of age and the second at 4-6 years).
Also, in general, an adult older than 18 born after 1956 should receive at least one dose of the MMR. MMR is a live vaccine, and is not given to immunocompromised individuals, and pregnant patients.
In summary you and your husband do not need to worry about measles, and make sure your granddaughter has received her two shots of the MMR prior to travel to France.
Q: Do you have any tips for staying healthy on airplanes?
Larry-Cannon Beach
A: There are no definite guidelines to avoid getting sick on airplanes, and many people have their own rituals. The following are some of the best tips I can think of:
- Staying hydrated and avoiding alcohol and carbonated drinks will help avoid jetlag. Plain water and green tea are very good ideas.
- Walking around, and rotating your ankles on a frequent basis will help avoid blood clots.
- Starting a multivitamin prior to travel may be beneficial (couldn’t hurt)
- Bring some hand wipes with you and wipe down anything you touch including the in flight magazines.
- Eat lightly and avoid junk food. This helps with digestion.
- Ask to move seats if the person next to you is sick.
- Finally, my own ritual, take an airborne prior to boarding the airplane and when deplaning. Really helps!
 Q: I read with great interest your column about the couple that went to South America and the vaccines they needed. I am going to China next year and am worried about what happens if I get sick there. Any recommendations?
Amanda-Portland, Oregon
A: First of all remember as I mentioned in that prior column, it is always a good idea to visit a physician at least a month prior to travel to foreign countries. At that visit you should receive a prescription for an antibiotic that you take with you. This antibiotic is to be taken should you get diarrhea while traveling.
The following are some tips to consider prior to travel. Be sure to have your health insurance identification card while traveling. Call your insurance company to check whether or not you are covered while traveling abroad. If you are not covered you can buy a short term health insurance policy. Complete the information page inside your passport which provides emergency contact information. If you have a pre-existing condition carry a letter from your physician describing the condition and any medications you are taking.
If you become ill while traveling contact the nearest US embassy or consulate for a list of local physicians and medical facilities. The consulate can help you find medical assistance, contact family, and can assist in transferring funds.
My final recommendation is to visit the website International Association for Medical Assistance to Travelers (www.iamat.org). This site contains a wealth of information including a list of English speaking foreign doctors.
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Q: My family and I are going on an Alaska cruise in August. My aunt took a cruise a few years ago and came home sick. What precautions can our family take so we don’t get sick?
Michael, Portland
A: Cruise ships bring together people from all over the world. Unfortunately, some of these passengers board ships with various gastrointestinal and respiratory ailments. The most well recognized recent outbreak of illness on board cruise ships was the Norwalk virus in 2002.
Before you book a cruise it is a good idea to check its sanitation score. Go to the Vessel Sanitation Program website. The CDC puts out this website, inspects all cruise ships that carry more than 12 passengers and scores their cleanliness. A total score of 85 or less is deemed unsatisfactory.
Also make an appointment with your health care provider and get a clean bill of health. If you are sick you may want to contact the cruise line and see about sailing on other dates. They should be flexible, because they don’t want a ship filled with sick passengers.
While cruising, washing your hands often is the number one way to avoid getting sick. Wash with soap and water specifically before and after eating, smoking, touching your face, or going to the bathroom. Also remember to stay hydrated. Alcohol and hot weather can cause dehydration, so if you are especially prone to dehydration drink fluid with electrolytes (i.e. Gatorade).
To avoid seasickness, try chewing ginger or getting ginger tablets. Green apples, acupressure wristbands, getting fresh air and looking at the horizon are also ways to avoid seasickness. If you do get seasick, however, you can try over-the-counter medications like Dramamine, although they do make you sleepy.
 Q: About five years ago I developed a painful sore on my penis. I saw my doctor and he told me I had herpes. I haven’t had any more sores. My doctor recommended using condoms when I am sexually active. Since I haven’t had any more sores do I still have herpes and do I still need to wear condoms?
Chris-Clatsop County
A: Genital herpes is a common sexually transmitted disease that affects about 45 million Americans (more than 1 in 5). It is caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes infections are caused by HSV-2. HSV-1 can cause genital herpes but it more commonly causes infections of the mouth and lips called “fever blisters” or “cold sores”.
Herpes is spread through direct skin contact…that is directly from the site of infection to the site of contact. So if you have a cold sore and kiss someone you can transmit the virus to their mouth. Or, if you have genital herpes and engage in intercourse you can transmit the virus to your partner’s genitalia. Remember you can also get the HSV-1 by using a person’s lipstick who has a history of cold sores! You can not get herpes from sitting on a toilet seat.
The herpes virus usually causes small painful blisters that burst and develop into a painful ulcer. This usually lasts about 7-10 days. Prior to development of the blisters one usually experiences tingling or burning sensation over the skin where the blisters will appear. Other symptoms of the virus include enlarged lymph nodes, vaginal discharge, and sometimes painful urination.
Once the painful ulcer resolves, the virus remains inside nerve cells in a sleep-like or latent state. In most people the virus reactivates from time to time and causes the same symptoms over again. One needs to be aware that the virus can be transmitted even without symptoms which is called asymptomatic transmission. Asymptomatic transmission is far less likely than spreading the virus when the lesions are present.
Although it is not known exactly why the virus reactivates and causes outbreaks at various times there are certain triggers which are believed to be involved. These include firstly anything that lowers the immune system such as being run down, menstruation, drinking a lot of alcohol, prolonged stress, and conditions that lower the immune system (i.e. HIV and multiple sclerosis). Exposure of the area to strong sunlight can also cause an outbreak. Certain foods high in arginine (i.e. nuts, chocolate, and caffeine) are also known to reactivate the latent virus.
Herpes can never be cured. However antiviral medication prescribed by your healthcare provider can shorten and relieve the duration of symptoms. Also if one develops many recurrent herpes outbreaks a daily suppressive antiviral medication can reduce the frequency of the herpes outbreaks.
100% prevention of genital herpes is through abstinence. If abstinence isn’t an option then condoms are the alternative for prevention. Latex condoms are preferable over animal membrane condoms because the virus can penetrate them.
In conclusion you still have herpes although without any outbreaks it is in a latent state. However, although it is latent it is still quite possible to transmit it sexually and latex condoms are the best prevention of transmission. Also follow up with your physician for medication and testing if necessary.
Q:My son is 13 years old and has severe acne. It really depresses him and I was wondering if you had any suggestions to alleviate his problem skin?
Tracy-Warrenton
A: Acne is a skin condition caused by bacteria called Propionobacterium acnes (p. acnes). Acne is characterized by whiteheads, blackheads, and inflamed red pimples or “zits”. Acne occurs when pores on the skin become clogged with oil. This occurs when glands on skin produce too much oil, and pores become blocked accumulating dirt, debris and bacteria thus causing acne.
A very gentle treatment option may be diet change. While some physicians do not believe poor diet is a cause of acne others do think there is a connection. In my opinion following a good healthy diet (including lots of fruit and vegetables, and at least six glasses of water a day) may be of benefit, and in the big picture it is a good idea for general health benefits.
Some self care steps to lessen the effects of acne include: cleaning the skin gently with a non drying soap (i.e. dove or Neutrogena) one to two times a day; shampoo the hair daily, and keep the hair off the face; do not squeeze or pick at the pimples (this may lead to scarring and skin infections), and in fact avoid touching the face altogether with your hands or fingers (they carry bacteria on them); and avoid greasy cosmetics or creams.
If these steps do not clear up the acne you may want to try over the counter acne medications which contain benzoyl peroxide, sulfur, or salicylic acid. They work by killing the bacteria, drying up the oil and causing your skin to peel.
If the pimples are still a problem you can take your son to see a dermatologist or your pediatrician. They can prescribe oral antibiotics, and stronger creams and gels that may work for him. The pediatrician is also a good idea because he/she will address your son’s depression. The teenage years are trying enough let alone having to deal with acne. Also your son may want to consider seeing a facialist on a regular basis to help unplug the pores.
Finally there are some alternative options which include: black currant seed oil or evening primrose oil, Echinacea, calendula, tea tree oil, and goldenseal. Also eating foods high in beta carotene, such as carrots, pumpkin, cantaloupe and other yellow-orange fruits and vegetables is another alternative remedy. Stress is a contributory problem for acne, so try relaxing with a cup of tea made from lavender or chamomile.
In conclusion start treatment with a healthy diet high in beta carotene. Remember to use all of the self care steps above, and in severe cases see a pediatrician and/or a dermatologist. A good facial is always helpful as well. Alternatively the homeopathic options may be the best pathway.
 Q: I had shingles 10 years ago. I am 65 years old. Am I immune from further episodes or should I have the shingles vaccine?
–M.L., Portland
A: Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. After a case of chickenpox, the virus remains dormant in nerve cells. It then can reactivate years later and cause shingles. This occurs in approximately one million people a year. It is unclear what causes this re-emergence of the varicella virus to cause shingles. You will never get shingles if you never had chickenpox.
Shingles is most common in people over 50 but can develop at any age. Also, people who are immunosuppressed (i.e., HIV disease, or patients on chemotherapy or high dose steroids) are at an increased risk of getting shingles. Usually the older you are the more severe and lengthy the disease course will be.
Shingles usually manifests itself as a rash or blisters on the skin. It can be excruciatingly painful. One of the major concerns with shingles is the complication called postherpetic neuralgia, which is a debilitating pain over the rash site that can last months or even years. Shingles can occur more than once, though this is not common. It can recur in only 1 to 5 percent of patients. If it does return, the rash will appear in a different location on the body.
A person cannot get shingles from someone who has shingles, and also a person can’t get shingles when exposed to a person with chickenpox. However, a person can get chickenpox when exposed to someone with shingles via respiratory droplets (or breathing it in). Pregnant women who have never had chickenpox should absolutely stay away from patients with shingles.
In 2006, the Food and Drug Administration approved a new shingles vaccine, Zostavax. The CDC recommends anyone over the age of 60 should receive the vaccine even if they had shingles in the past. Zostavax was found to reduce the risk of shingles by about half, and if you happen to get shingles after receiving the vaccine, the risk of postherpetic neuralgia is reduced by 67 percent.
The vaccine’s most common side effects are redness, soreness, swelling and itching at the injection site. It also may cause headaches. The vaccine is effective for at least six years.
Patients who shouldn’t receive the vaccine are people with immunocompromised illnesses (i.e. leukemia/lymphoma, HIV/AIDS with low T cell counts, people on high dose steroids) or people with allergies to gelatin or the antibiotic neomycin.
You have a 1 to 5 percent chance of getting a recurrence of shingles. Though it is rare, the complication with postherpetic neuralgia can be quite devastatingly painful. Therefore, I would recommend you get the shingles vaccine as long as you don’t have an underlying immunocompromised state.
– Dr. Phyllis Ritchie
Q: Since the H1N1 outbreak, I have been only buying antibacterial soaps for my family. Lately I have been hearing these products may be harmful. Is this true?
Carol, Salem
A: Many antibacterial soaps and sanitizers contain a chemical called triclosan. Triclosan was invented about 35 years ago and initially was used as a surgical scrub in the operating room. Triclosan is not only found in antibacterial soaps, but it is also used in many common household products such as cleaning supplies, some hand gels, dish detergents, toothpaste, and even some bedding. According to the Centers for Disease Control and Prevention, triclosan is used in so many products that it was detected in the urine of 75 percent of people tested.
The abundant use of triclosan is a concern. Like antibiotics, overuse of antibacterial soaps can be expected to foster resistant bacteria. Triclosan has also been linked with skin irritation, allergy susceptibility and endocrine dysfunction. Major supermarkets in the United Kingdom have banned selling products containing triclosan.
Therefore, unless you are in a health care setting, using products with triclosan may be more detrimental than beneficial. In my opinion, plain soap and water is the gold standard for good hygiene outside the health care setting.
Q: I appreciated your information about bedbugs and thrift stores/garage sales. My friends and I are fond of shopping at them. You didn’t mention anything about freezing as a way to kill the insects and their eggs and larvae, and there is conflicting advice and information on the Internet. I have a stand-alone upright freezer used primarily for storing summer fruit, and I always put woolen clothes in it if they can’t be washed on hot (to kill potential moth eggs). I also put any wool I purchase in there, too (I’m a knitter).
Any info on whether it’s effective against bedbugs and how cold and long you’d have to store them?
– Tonia, Portland
A: Freezing to kill bedbugs in a household freezer is simply unreliable. The freezer must get at least below -10 Fahrenheit, which is below normal household freezer temperatures. Also the items should not be bunched up at all when placing them in the freezer as this may allow for the bedbugs to cuddle up in warm corners. Finally, when attempting to kill bedbugs in the freezer the items must stay in the freezer for at least 72 hours to a week without opening the freezer.
I recommend skipping the freezer as a method to kill bedbugs. Putting clothing in the hot drier for at least 30 minutes would kill the bedbugs and probably not damage most material. Otherwise, I would recommend dry cleaning.
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