Category Archives: Dr. Know

Healthful Side Effects of Gay Marriage & Coming Out – Who Knew?

Hey, we all know it is stressful living with lies. But a new study suggests coming out of the closet can actually improve your health!

NBC News has a discussion based on Carlo Joyce’s story.

“After I came out at 19, things got better with my family,” he recalled. But then he joined the Marines and had to hide his sexuality all over again.

He had to go to strip bars to fit in, and when the other guys talked about sex, or dating, he had to be sure he changed the gender in his stories. “It was very stressful to live that double life,” he explained. “I always had to watch what I said.”

Now, in a study released today in the journal Psychosomatic Medicine, a team of psychologists and neurologists from McGill University and the University of Montreal has found that leading that double life affects physical and mental health. Gays, bisexuals and lesbians who disclosed their sexuality to family, friends and co-workers were psychologically healthier and had lower levels of a key stress-related hormone than those who were still “in the closet.”

That finding could help explain a remarkable study published last year by a group of researchers from Columbia University in the American Journal of Public Health. They found that after Massachusetts enacted its same-sex marriage law in 2003, there was a significant drop in medical and mental health care visits — and therefore costs – incurred by gay men.

Read the rest at NBC News.

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Release : February 1, 2017
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Language : English.
Runtime : 102 min.
Genre : Horror.

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How do you know?

Dr. Know shares this transcript from an online chat.

Rob: Talk to me about HIV. Not sure about it all.

Dr. Know: what do you need to know?  My point is that an HIV test only detects antibodies to the virus, not the virus itself.  Most people convert to positive within 6 months of infection, but some can take a year or more.  So, they are most contagious/infectious when they think they are negative

Rob: I have never known anyone that is positive.  All my friends have told me that they are negative.  Now you are saying that they don’t know?  I guess if they have had partners that they really don’t know right?

Dr. Know: It scares me when I see negative for negative on here.  The only truly negative HIV test is the HIV test and a viral load, and insurance companies won’t pay for the viral load as a screening test.  Yes, I’m saying that they don’t know.  IF they have had unsafe sex with someone, they have no idea if they have been infected or not.  And, there are a lot of guys that will say they are negative, play unsafe, and know that they are positive.

Rob: That is why I never have sex without a raincoat on.

Dr. Know: the only safe sex is no sex, so play as safely as you can, and always use condoms.  very smart on your part.

Rob: That is what I thought.  You can still get it even with condoms?

Dr. Know: condoms can break.  and, don’t ever keep a condom in your wallet.  That causes the condom to break down, and anything can get through it.  always use water soluble lubes as well.

Rob: What about sucking cock that you are not sure of?  DO you use a condom then too?

Dr. Know: as far as I know, there have not been any documented cases of HIV transmitted by sucking cock, unless you have sores or cuts in your mouth.  also, don’t deep kiss anyone within an hour of them brushing their teeth;  brushing can cause microscopic bleeding, and you could get infected that way too if you have any sores/cuts in your mouth.  also, I think swallowing is safer that holding cum in your mouth to spit it out later; too much contact with the lining of your mouth

Rob: Man you are a wealth of information.  I thank you.

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FAQ: Gay Men’s Health

Dear Dr. Know,
What (if any) special concerns should I have if I am a gay man?

Patient in PA

Dear Patient,
Yes, gay straight and bi men who have sex with men should observe the following health care screening:

HEALTH CARE SCREENING FOR MEN WHO HAVE SEX WITH MEN

  • Physical exam: every 3 to 5 years
  • Family history.  This should be reviewed/updated at every physical exam.
  • Lab screening: fasting glucose, cholesterol particularly
  • Be honest about your sexual practices:  are you top, bottom, versatile?  Are you monogamous in your relationship? In what sexual practices do you engage?  If your physician is uncomfortable with these issues, find another physician.
  • HIV test every 3 to 6 months depending on your sexual practices.  Do you practice safe sex? If not, get screened more often.
  • Syphilis test every 3 to 6 months.  Syphilis is rampant in this community, and condoms may not protect you.  This goes for herpes and venereal warts.
  • Venereal wart immunization.  Unfortunately, this immunization is approved only for men up to the age of 26, and it is very expensive:  $200 a shot for 3 shots.  60 to 75 % of men who have sex with men have venereal warts, and they can be anal, so you don’t necessarily know that you have them.
  • Anal pap smear if you have ever bottomed, no matter how remotely.  Anal cancer is more common in men who have sex with men than cervical cancer is in women.
  • Venereal wart anal screening for exposure to the strains of the venereal wart virus that are known to cause cancer.
  • Gonorrhea and Chlamydia screening:  as needed based on symptoms and sexual practices
  • Hepatitis A and B immunizations.  Get screened first.  Screening should also include hepatitis C.  Many of my patients have had hepatitis A, B and/or C and never knew it.  You don’t neeed the immunizations if you have already had the infection.  If you are HIV positive, you should receive a double dose of hepatitis B vaccine.  Ten percent of people infected with hepatitis B become chronic carriers, and can infect their partners; and a small percentage of the chronic carriers will develop liver cancer.
  • Herpes 2 screening.  Are you positive for exposure?  A simple blood test will answer the question.
  • Evaluation of nicotine use
  • Evaluation of drug and/or alcohol use
  • Screening for depression

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Dr. Know on How the Penis Really Works

Q: I am having erection problems.  What are my options?

Dr. Know replies:

I heard once in a lecture on erectile dysfunction that the penis is nothing more than a glorified vein.  After I stopped laughing, I had to agree with the speaker.  Basic penile anatomy is two corpus cavernosa, large vascular tubes that fill with blood.  Erections are mediated by the release of nitrous oxide into the corpus cavernosa, which leads to smooth muscle relaxation, allowing inflow of blood.

Treatment of erectile dysfunction can be chemical, surgical, or mechanical.  There are three oral drugs available:  Viagra, Levitra, and Cialis.  These medications work by inhibiting a chemical called phosphodiesterase type 5, which makes the nitrous oxide more effective.  All of these medications are most effective when taken on an empty stomach, which is one hour before food, or two hours after food.  Viagra and Levitra should be taken up to one hour before anticipated sexual activity, and are effective for up to four hours.  Some of my patients report some effect from these medications for up to twenty-four hours.  Cialis is the 36 hour pill.  I call it the weekend party drug:  good from Friday night until Sunday morning.  There is now daily Cialis as well, allowing you to always be ready for sex.

Muse is a urethral suppository.  You insert the suppository into the urethra, massage the penis, and you achieve an erection in 5 to 10 minutes that will last 30 to 60 minutes.

Caverject is an injectible medication.  It is injected directly into the base of the penis, producing an erection that can last up to 60 minutes.

An erection that lasts more than four hours as a consequence of using any of the above treatment modalities is an emergency.  You should get to an emergency room as soon as possible, or permanent damage to the penis can occur.  This condition is called priapism, and can be very painful.  The treatment is drainage of the corpus cavernosa with large bore needles.

Surgical treatment is an implant, some permanently firm, some inflatable.  Two implants are required, one for each side of the penis.  Complications can include infection, and erosion of the implants through the head of the penis.

Mechanical treatment is the vacuum pump device.  A cylinder is placed around the penis, and a vacuum is created which causes the penis to fill with blood.  Usually, a ring of some kind is used at the base of the penis to keep the blood in place.  These devices are frequently used by men who do not have erectile dysfunction.

Send your questions to Dr. Know to men@men4men.com

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DR. KNOW Hepatitis

Dear Dr. Know,
What is hepatitis and how is it spread?
Does a condom protect me?
Curious in Tampa

Dear Curious in Tampa, here’s what you need to know about hepatitis.  You can find this information at the CDC. www.cdc.gov/hepatitis

What is hepatitis?
“Hepatitis” means inflammation of the liver. Heavy alcohol use, toxins, certain medications, bacterial infections, and some diseases can cause hepatitis. Hepatitis also refers to a group of viral infections that affects the liver. These are three different, contagious liver diseases caused by three unrelated viruses. Although all three types of hepatitis can cause similar symptoms, they have different modes of transmission.
The best way to protect yourself from hepatitis A and B is to get vaccinated.

How is hepatitis spread?
HEPATITIS A is usually spread when a person ingests fecal matter— even in microscopic amounts—from an infected person. Among men who have sexual contact with other men, hepatitis A can be spread through direct anal-oral contact or contact with fingers or objects that have been in or near the anus of an infected person. Hepatitis A can also be spread through contaminated food or water, which is why travelers to certain countries are at risk.

HEPATITIS B is spread when body fluid—such as semen or blood— from a person infected with the hepatitis B virus enters the body of someone who is not infected. The hepatitis B virus is 50–100 times more infectious than HIV and is easily transmitted during sexual activity. Hepatitis B can also be spread through sharing needles, syringes, or other drug-injection equipment.

HEPATITIS C is spread through contact with the blood of an infected person, primarily through sharing needles, syringes, or other drug-injection equipment. Hepatitis C can also be spread through sexual contact, although scientists do not know how frequently this occurs. Rough sex, sex with multiple partners, or having a sexually transmitted disease or HIV appears to increase a person’s risk for hepatitis C.

How common is viral hepatitis in the United states?
While rates of acute viral hepatitis have been declining, around 1.2 million people are living with chronic hepatitis B virus infection and 3.2 million with chronic hepatitis C virus infection. Many do not know they are infected.

Should I be vaccinated?
Experts recommend that all gay and bisexual men be vaccinated for hepatitis A and B. The hepatitis A and B vaccines can be given separately or as a combination vaccine. The vaccines are safe, effective, and require 2–3 shots within a 6-month period depending on the type of vaccine.  If you are HIV positive, you should receive double the adult dose of Hepatitis B vaccine.  For maximum protection, a person should complete all shots in the series. There is no vaccine for hepatitis C. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially sharing needles or other equipment to inject drugs.

Should I also be tested?
Experts recommend that, if at all possible, gay and bisexual men should be tested for hepatitis B at the same time they get their first dose of vaccine. If tests reveal that a man has never been infected, then vaccination will protect him. If he has a resolved infection, he is now immune and the vaccine offers no benefit. If he is living with a chronic infection, the vaccine offers no protection and he is capable of spreading the virus to others. His sexual partners should be tested and he should be referred for medical care. Testing is not recommended for hepatitis A, and testing for hepatitis C is recommended only for gay and bisexual men who engage in risky behaviors or have HIV.

Acute and chronic viral hepatitis
Hepatitis A appears only as an acute or newly occurring infection and usually lasts no more than 6 months. Although hepatitis B and hepatitis C can also begin as acute infections, each can develop into a chronic, or lifelong, infection.Over time, about 15%–25% of people with chronic hepatitis infection develop serious liver conditions, including liver damage, cirrhosis, liver failure, and even liver cancer.

What are the symptoms of viral hepatitis?
Not everyone shows symptoms when they have viral hepatitis. Symptoms, if they appear, are similar for all types of hepatitis and can include: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice. Symptoms of acute infection typically last a few weeks to several months. Although most people remain symptom free for many years, some experience ongoing symptoms similar to those of acute hepatitis.

How is viral hepatitis diagnosed and treated?
Doctors diagnose the infection using one or more blood tests, depending on the type of hepatitis. For people with acute viral hepatitis, doctors usually recommend rest, adequate nutrition, fluids, and in certain situations, antiviral medication. In a few cases, people with acute hepatitis are hospitalized. People who have acute hepatitis typically feel sick for a few months before they recover. People with chronic viral hepatitis infection should seek the advice of a doctor experienced in treating hepatitis B or hepatitis C and should be monitored on a regular basis. Some may also benefit from antiviral medication. Several treatments are available that can significantly improve health and may delay or reverse the effects of liver disease.

For more information
Talk to your health professional, call your health department, or visit www.cdc.gov/hepatitis

What is hepatitis?
“Hepatitis” means inflammation of the liver. Heavy alcohol use, toxins, certain medications, bacterial infections, and some diseases can cause hepatitis. Hepatitis also refers to a group of viral infections that affects the liver. These are three different, contagious liver diseases caused by three unrelated viruses. Although all three types of hepatitis can cause similar symptoms, they have different modes of transmission.
The best way to protect yourself from hepatitis A and B is to get vaccinated.
How is hepatitis spread?
? HepATITIs A is usually spread when a person ingests fecal matter— even in microscopic amounts—from an infected person. Among men who have sexual contact with other men, hepatitis A can be spread through direct anal-oral contact or contact with fingers or objects that have been in or near the anus of an infected person. Hepatitis A can also be spread through contaminated food or water, which is why travelers to certain countries are at risk. ? HepATITIs B is spread when body fluid—such as semen or blood— from a person infected with the hepatitis B virus enters the body of someone who is not infected. The hepatitis B virus is 50–100 times more infectious than HIV and is easily transmitted during sexual activity. Hepatitis B can also be spread through sharing needles, syringes, or other drug-injection equipment.? HepATITIs C is spread through contact with the blood of an infected person, primarily through sharing needles, syringes, or other drug-injection equipment. Hepatitis C can also be spread through sexual contact, although scientists do not know how frequently this occurs. Rough sex, sex with multiple partners, or having a sexually transmitted disease or HIV appears to increase a person’s risk for hepatitis C.
How common is viral hepatitis in the United states?
While rates of acute viral hepatitis have been declining, around 1.2 million people are living with chronic hepatitis B virus infection and 3.2 million with chronic hepatitis C virus infection. Many do not know they are infected.
should I be vaccinated?
Experts recommend that all gay and bisexual men be vaccinated for hepatitis A and B. The hepatitis A and B vaccines can be given separately or as a combination vaccine. The vaccines are safe, effective, and require 2–3 shots within a 6-month period depending on the type of vaccine. For maximum protection, a person should complete all shots in the series. There is no vaccine for hepatitis C. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially sharing needles or other equipment to inject drugs.
should I also be tested?
Experts recommend that, if at all possible, gay and bisexual men should be tested for hepatitis B at the same time they get their first dose of vaccine. If tests reveal that a man has never been infected, then vaccination will protect him. If he has a resolved infection, he is now immune and the vaccine offers no benefit. If he is living with a chronic infection, the vaccine offers no protection and he is capable of spreading the virus to others. His sexual partners should be tested and he should be referred for medical care. Testing is not recommended for hepatitis A, and testing for hepatitis C is recommended only for gay and bisexual men who engage in risky behaviors or have HIV.
Acute and chronic viral hepatitis
Hepatitis A appears only as an acute or newly occurring infection and usually lasts no more than 6 months. Although hepatitis B and hepatitis C can also begin as acute infections, each can develop into a chronic, or lifelong, infection.Over time, about 15%–25% of people with chronic hepatitis infection develop serious liver conditions, including liver damage, cirrhosis, liver failure, and even liver cancer.
What are the symptoms of viral hepatitis?
Not everyone shows symptoms when they have viral hepatitis. Symptoms, if they appear, are similar for all types of hepatitis and can include: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice. Symptoms of acute infection typically last a few weeks to several months. Although most people remain symptom free for many years, some experience ongoing symptoms similar to those of acute hepatitis.
How is viral hepatitis diagnosed and treated?
Doctors diagnose the infection using one or more blood tests, depending on the type of hepatitis. For people with acute viral hepatitis, doctors usually recommend rest, adequate nutrition, fluids, and in certain situations, antiviral medication. In a few cases, people with acute hepatitis are hospitalized. People who have acute hepatitis typically feel sick for a few months before they recover. People with chronic viral hepatitis infection should seek the advice of a doctor experienced in treating hepatitis B or hepatitis C and should be monitored on a regular basis. Some may also benefit from antiviral medication. Several treatments are available that can significantly improve health and may delay or reverse the effects of liver disease.
For more information
Talk to your health professional, call your health department, or visit www.cdc.gov/hepatitis.
Department of HealtH & Human ServiceSCenters for Disease Control and PreventionDivision of Viral Hepatitiswww.cdc.gov/hepatitis

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EDITORIAL A Negative HIV Test Doesn’t Mean What You Think

Dear Dr. Know,
What does a negative HIV test really mean?  Am I off the hook?
Worried in Washington.

Dr. Know writes:

HIV is an RNA retrovirus.  What this means is that the genetic material in the HIV virion (virus particle) is RNA.  Once a cell is infected, the RNA must be converted to DNA before more virus particles can be produced in the cell.  Unfortunately, the HIV DNA is inserted into the nucleus of every infected cell.  This means that once you are infected, you can never be cured, at least not with current technology.  A cure would require the destruction of the HIV DNA in the genes of the nucleus, and we don’t have the technology or medications to accomplish this.  The human genome project has discovered countless strands of retrovirus DNA in our genes, so HIV and retroviruses in general are not new to us.

An HIV test detects antibodies to the virus, or the immune system’s attempt to fight the virus.  It only detects antibodies, it does not detect the virus.  Most people convert to HIV positive within 6 months of infection, but some people take 12 months or longer to become positive.  This means that people think that they are safe to have unsafe sex with a partner when they are most infectious.  Think about it.  Early in HIV infection, HIV viral loads can be one million copies of HIV per milliliter of blood or more.  Let me say that again:  one million or more copies of HIV per milliliter of blood. And, the HIV test will be negative.  So, who do you think is more infectious:  someone HIV negative but just infected, or someone HIV positive on medications whose viral load is undetectable?

So, a negative HIV test doesn’t mean that you don’t have HIV, it only means that you haven’t yet produced antibodies to HIV.  The only truly negative HIV test is a negative HIV test and a negative viral load. Very few doctors are aware of this fact.  I have attended lectures on LGBT health care, and asked the speakers if they screen for acute HIV infection, and the response I get is a blank look.  When you are first infected, it feels like the flu; the symptoms are the same.  If you become ill with a flu-like syndrome, you should consider HIV as the cause if you have had any unsafe contacts within a month of the symptoms.

Do you have a question for Dr. Know?  Email dr.know@men4men.com

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