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Close-up of a woman’s face with her left index finger on her chin, appearing thoughtful; text reads 'I thought a thing like that could never happen to me…' with '1,500,000 Americans have SYPHILIS or GONORRHEA and don't know it' on a red background; featured image for Walk In GYN's blog post 'Drastic increase in STD’s – Let’s talk Chlamydia!'

Drastic increase in STD’s – Let’s talk Chlamydia!

Appalling 2016 statistics released by CDC indicate a drastic increase in STD’s and they are still on the rise.
Recent preliminary data from our own Women’s health centers, in NYC and the surrounding boroughs indicates Chlamydia rates of 12.5 per thousand women in contrast to the national averages of 5 per thousand people.
Continue reading “Drastic increase in STD’s – Let’s talk Chlamydia!”…
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Ureaplasma… leads to BV or not to BV?

I Had a UTI for Years—Here’s Why My Doctor Didn’t Find It
by AIDEN ARATA
For the truth on this little-known—but all-too-common—infection, I turned to Adeeti Gupta, a New York–based obstetrician and gynecologist and the founder of NYC’s first walk-in gynecological clinic. Keep scrolling for all the need-to-know details on this shockingly common bacteria.
Continue reading “Ureaplasma… leads to BV or not to BV?”…

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World map with 'Covid-19' text in smoky white color over light and dark pink brush strokes; featured image for Walk In GYN's blog post 'Covid-19 – Your Questions Answered'

Covid-19 – Your questions answered!

 

Don’t let Covid-19 restrict your access to your doctor! 

We are open and here to help the fearless women of NYC and if you are in self quarantine and need help we can offer “telehealth” consults ($70 fee if your insurance does not cover – please use the “Book and appointment” button to request a time. 
If you or your family member are feeling sick and do not know how to proceed, please read this Covid-19 Fact sheet.
#walkingyncare
#caringwithcompassion

Questions?

 

Is Covid-19 transmitted sexually?

So far, we don’t have any clear data in that regard. It’s transmitted by close contact (within 6 feet) of anyone having symptoms of the infection. We do not recommend any sexual contact/ kissing etc in such a situation.

Is it safe to go on a blind date or use a dating app in the current situation?

We recommend asking the 3 questions and if the answer to any is a “yes”… then you answer should be a “no”
– Do you have a fever, cough, runny nose of other flu like symptoms?
– Have you travelled outside the US in the last 14 days?
– Have you been in close contact with anyone who tested positive for COVID-19?

Covid-19 and pregnancy – What if I am pregnant and I came into contact with someone who is positive? 

So far we don’t have enough data to prove that Covid-19 is transmitted to the fetus. Since it is transmitted through air and droplet secretions, we recommend that if you are pregnant, you should be extra careful and avoid large crowds, avoid close contact with anyone with such symptoms and stay home if you can.

Will Covid-19 affect my birth control?

No. So far, we do not have any evidence that it does.

Is Covid-19 an STD?

So far, we do not have evidence that it is.

I am trying to get pregnant. Should I wait until the pandemic passes?

We recommend waiting, since at the point, we do not have enough data about how it will (if it will) affect the pregnancy and the newborn. It’s better to be safe and take appropriate precautions and delay your efforts if you can. If you are undergoing IVF etc, then we do recommend taking absolute care and stay home as much as possible.

What kind of vitamins and dietary precautions should I take?

We recommend taking a multivitamin, vitamin D, additional Zinc supplements and an anti-oxidant such as Omega-3. A healthy balanced diet, rich in greens and antioxidants can go a long way. Try to eat home cooked meals and thoroughly wash all your produce even if it says triple washed.
>>>>
Stay tuned
Dr. Adeeti Gupta
CEO, Founder
Close-up of a glass of fresh water in a woman's hand as she sits comfortably in bed; featured image for Walk In GYN's blog post 'Post Operative Recommendations'

Post operative recommendations

This is an outline of some commonly asked questions for post-operative care. Please do not consume if you are allergic to any of these medications.

 

Which medications should I buy over the counter to help in my recovery?

  • Pepcid: 20mg twice daily. The first pill, first thing in the morning before food and again 30 min before
  • Colace: 100mg orally twice daily – buy over the
  • Tylenol or Acetaminophen extra strength: 500mg, 2 tab every 6- 8 hours as
  • Motrin/Advil: 600mg orally every 8 hours as needed for pain.
  • Mylanta (or Simethicone) bottle: 2 teaspoons orally 8 hours if feeling heartburn or gassy.
  • Probiotics: 1 capsule daily with food. Start day after surgery.

 

Which prescription medications do I need?

  • Pain medication: as directed by your physician on the day of surgery.
  • Antibiotics: as prescribed.
  • Special medications such as birth control pills if prescribed by your doctor.

 

What can I eat or drink?

  • Drink at least 10-15 glasses of water every day.
  • Eat easy to digest, light foods like chicken soup, sandwiches, yoghurt, low fat milk, and ginger ale
  • High fiber diet, if unable to tolerate high fiber diet
  • Take Metamucil or Citrucel 2 teaspoons daily in water at 8p.
  • Eat Salads (thoroughly washed) and light dressings.
  • Can eat fresh fruits, spinach, whole grains etc.
  • Please take into account any food allergies that you may have.

 

Which Foods should I avoid?

  • Avoid a lot of cheese, spicy food, marinara sauce, and orange juice.
  • Avoid very greasy foods.
  • Take into account you food allergies.

 

Can I shower? If so, how?

  • Please shower and clean your entire body INCLUDING the INCISION area with mild soap and water. Do not rub vigorously. After shower, just gently pat dry with a soft towel and leave the wound are open to sit.
  • Wear loose clothes. Avoid tight fitting clothes, which do not let air circulate easily.
  • Shower daily.

 

How much weight can I lift?

  • Do no lift weights heavier than 5 pounds.
  • Try not to bend, if you have to, use your knees to lower yourself and lift something.
  • You can climb stairs slowly, one step at a time.
  • When getting up from the bed, first turn on the side and then lift yourself up to void direct strain on the stitches.

When should I call the doctor or go to Emergency Room?

  • High-grade fever with or without chills > 101 deg
  • Difficulty breathing
  • Chest tightness
  • Fainting
  • Heavy vaginal bleeding
  • Continuous vomiting
  • Increasing swelling or redness of the
  • Foul smelling discharge from the vagina or from the
  • Severe abdominal pain.

 

What should I expect as normal?

 

  • Pain at the incision site is normal.
  • Cramping pain such as menstrual cramps is normal.
  • Slight vaginal bleeding/ spotting or bleeding like a normal period or less than a normal period may be expected.
  • Nausea on the first day or two may be expected.
  • Difficulty sleeping, getting out of bed is expected. It will pass.
  • Bloating and constipation is expected so we strongly recommend Metamucil, high fiber diet, Colace and probiotics as above to avoid that.

 

DO’s

 

  • You can walk around the house and even go outdoors around the house slowly.
  • When resting, keep your legs elevated on a pillow to avoid leg swelling.
  • Take the incentive spirometer home and continue to take deep breaths 20 times every hour.
  • Do NOT stay in bed all the time. Complete bed rest may lead to increased risk of blood clots.
  • Do not stay alone at home the first night after your procedure. If you are going to be alone, make sure you have your phone with you and someone to call in case you need assistance.

 

DONT’s

 

  • No heavy weights to be lifted.
  • No intercourse, tampons, douching until you get clearance from doctor.
  • No smoking.
  • Do not use an abdominal belt to support the incision.
  • Do not plan long or intense travel plans.

 

PLEASE DO NOT FORGET TO GO FOR YOUR POST-OP APPOINTMENT as recommended below:

 

Hysterectomy/ Laparoscopy/ any abdominal surgery: 1 week after surgery.

D&C/ Hysteroscopy/ polypectomy/ fibroid resection: 2 weeks after surgery.

 

If you are experiencing any of the emergency symptoms as described above, please call 911 or go to the nearest emergency room. You can also reach us at:

Middle Village patients: 718-898-1170.

Walk IN GYN Care: 917-410-6905

 

Open packaging box of menstrual cups; featured image for Walk In GYN's blog post 'Menstrual Cups Unraveled'

Menstrual cups unraveled!

The rising popularity of menstrual cups has prompted some interesting conversations surrounding periods, sustainability, and the stigma around menstruation. If you’re part of the majority of American women who’ve got used to using and disposing of tampons and napkins regularly, you may want to consider the period cup, an alternative device that will lessen the number of products you use on your period. Here, we are going to list some of the pros and cons of switching to menstrual cups to help you make that decision.

THE PROS

Environmentally-friendly

Menstrual cups are great news for the conscious shopper, as most are designed for long-term use and are made with sustainability in mind. Maryville University points out how brands are willing to spend big bucks to take advantage of marketing trends, which includes using buzzwords like “environmentally-friendly” and “sustainability” to expand their target markets. Thankfully, this is not the case with menstrual cups, as they are actually good for the earth by design. Unlike tampons and napkins, cups don’t clog up landfills and use up trees during their production.

Lower costs

A cost breakdown on The Huffington Post reveals that a woman will spend around $1,800 on feminine hygiene in her lifetime, with the bulk of it going on constantly buying tampons. Investing in a menstrual cup means you’ll spend less on your periods as you can just use the same device over and over again. Keep in mind that some menstrual cups are disposable, so it’s important to read the fine print before purchasing one.

Fewer visits to the bathroom

Compared to tampons, which you need to change every four to eight hours, you can use menstrual cups up to 12 hours depending on your flow. However, it is generally recommended that you clean and change your cup every 4 to 6 hours to avoid infections. This still means fewer trips to the bathroom and less interruptions during your daily activities. It’ll also give you a better idea of just how much blood comes out during your period — it may be much less than you initially thought.
The cons of using a menstrual cup

Gross and messy factors

The main complaint with menstrual cups is that emptying it can be a messy process. Although most will find their own technique to empty the cup in a relatively clean way after a few tries, some may never get over the gross sight or feeling of it. Taking it out and cleaning it in a public bathroom just complicates things even more.

Comfort issue

Although not as daunting and invasive as the process of inserting an IUD, menstrual cups still take some getting used to. Removing the cup will take some practice, and reinserting it may not be the most pleasant feeling for some. Others may find that it’s difficult to find a cup that fits just right, and will have to go through different brands and shapes to find the perfect one. If your cup is leaking, it’s probably too small for your vagina. It’s really a case of trial and error, so don’t hesitate to try and change cup sizes if the one you buy doesn’t fit right. A rule of thumb to remember is that the small ones are usually for younger women with no history of child birth, while the larger cups are for older women who have previously given birth. Another reason a menstrual cup may be hard to insert is a vaginal infection, which can cause irritation during insertion, consult with your doctor if this is the case.

THE CONS

Health risks

As with any device that comes in close contact with our bodies, using menstrual cups come with some health risks, too. For instance, researchers from Western University reported a case involving a woman contracting toxic shock syndrome from using her menstrual cup — a common fear that people have about any kind of feminine hygiene product. The case study is a reminder that women should take all the necessary precautions and be vigilant about cleaning menstrual cups thoroughly between uses, as they can harbor unwanted bacteria that can cause complications. Aside from regular cleaning, avoid having sex with your menstrual cup on, as this can push it in deep and cause it to get stuck. If your cup does get stuck, simply press on it gently and slowly release it from the edges until it comes out. Don’t pull your cup because this will make the situation worse — see your doctor if you cannot get a menstrual cup out on your own.

The importance of comfort, proper hygiene, and access to the right supplies cannot be understated for menstruating women. UNICEF highlights how women menstruate for approximately 7 years during their lifetime, a big chunk of time and a significant one in an average woman’s life. With this in mind, it’s crucial for women everywhere to be familiar with options like tampons and menstrual cups in order to find the solution that suits them best.

Article specially written for WalkInGyn.Com
By: Alice Aria

Girl sitting with her face covered by her hands, elbows resting on a laptop palm rest; featured image for Walk In GYN's blog post 'Mycoplasma and Ureaplasma – The big conundrum'

Mycoplasma and Ureaplasma – The big conundrum

There is a lot of confusion amongst not only just you ladies but also amongst health care providers regarding these little bugs. So, we decided to break it down for you. Here is the scoop of what really is/ are mycoplasma and ureaplasma….

What are mycoplasma and ureaplasma?

The term “mycoplasma” is widely used to refer to any organism within the class Mollicutes, which is composed of eight genera (including Mycoplasma, Ureaplasma, Acholeplasma, Anaeroplasma, and Asteroloplasma).

The mycoplasma include:

  • Mycoplasma hominis
  • Mycoplasma genitalium
  • Mycoplasma fermentans(incognitus strain)
  • M. pneumoniae

The ureaplasma include:

  • Ureaplasma parvum
  • Ureaplasma urealyticum

What are they? Are they bacteria or viruses?

Mycoplasma and ureaplasma are the smallest free-living organisms. They lack a cell wall, therefore neither mycoplasma nor ureaplasma can be visualized by routine gram stain microscopy. It is hard to diagnose their presence because of difficulty in growing or culturing them in the lab. In order to culture these organisms, specialized media and very strict conditions are required.

Do Mycoplasma and ureaplasma live in normal genital tract?

Yes, Many healthy asymptomatic adults have genitourinary colonization with Mycoplasma and Ureaplasma spp. The percentage of women with vaginal colonization by M. hominis, M. genitalium, and Ureaplasma spp increases after puberty in proportion to the number of lifetime sexual partners. It has been seen to vary from 0% in never active women to upto 70% in sexually active women

Does this mean these women are infected and contagious?

This does not mean that these women are “infected”, if these are not creating any symptoms, then these mycoplasmas and ureaplasma are considered normal inhabitants of the genital tract.

How is M. Genitalum different from other Mycoplasmas and Ureaplasma?

M. genitalium was first described in 1981 after being isolated from the urethral specimens of two men diagnosed with non gonococcal urethritis (NGU). Studies have suggested a strong causative link between M. genitaliuminfection and urethritis in men and an association with cervicitis and pelvic inflammatory disease (PID) in women.

When can Mycoplasma and Ureaplasma spp cause infections?

Mycoplasma and Ureaplasma spp normally stay attached to mucosal epithelial cells (lining) of the respiratory or urogenital tracts. However, they can spread to other sites and cause infection when there is a break in the lining and/or an underlying defect in host defenses, such as in the developing fetus, premature infant, or immunosuppressed adults.

M. genitalum in addition to above evades the immune system and alters the host’s immune system, which allows it to survive in the host’s body.

How common is M. Genitalum?

In studies from the United States, M. genitalium is present in approximately 1 percent among young adults in the general population. In comparison, the prevalence of gonorrhea is 0.4% and Chlamydia is 2.3%. Amongst STI clinics and in population with multiple STI risk factors, prevalence may range from 4 to 38 percent.

What are the risk factors for these infections?

Young age (e.g., <20 to 22 years old), smoking, recent sexual intercourse, and an increasing number of sexual partners are some risk factors.

In which conditions have the mycoplasma and ureaplasma infections been implicated?

Infections that have been linked to various types of mycoplasma and ureaplasma include:

M. hominis

  • Pelvic inflammatory disease (PID) – not proven
  • Chorioamnionitis
  • Postpartum and postabortal fever
  • Pyelonephritis
  • Central nervous system infections
  • Septicemia
  • Wound infections, especially postoperative wounds
  • Joint infections
  • Upper and lower respiratory tract infections
  • Endocarditis
  • Neonatal bacteremia and meningitis
  • Neonatal abscesses

Ureaplasma spp

  • Chorioamnionitis
  • Postpartum and postabortal fever
  • Congenital pneumonia
  • Neonatal bacteremia
  • Neonatal abscesses
  • Non gonococcal Urethritis in males – not proven
  • UTI

 

M Genitalum. 

  • Non gonococcal urethritis (men)
  • Cervicitis
  • PID
  • UTI in men and women
  • Preterm birth and abortion – not proven

Is M. genitalum an STD and is transmitted sexually?

Sexual transmissibility of M. genitalium is supported by both clinical and molecular epidemiologic evidence. As above, M. genitalium is detected more frequently among sexually-experienced

Furthermore, in DNA-typing studies, sexual partners often harbor identical bacterial genomic strains.

Can there be other infections that co-exist with Mycoplasma Genitalum?

Chlamydia trachomatis is the most commonly reported co-infecting organism.

How does M. genitalum present in Men?

M. genitalium infection accounts for 15 to 20 percent of NGU cases reported per year among men in the United States. M. genitaliumdetection is more frequent in men with persistent or recurrent urethritis. It may also be associated with balanitis (inflammation of the glans penis) and posthitis (inflammation of the foreskin).

How does M.genitalum affect women?

M. genitalium can ascend from the lower to upper genital tract after sexual transmission

Cervicitis

Cervical inflammation is the most common manifestation of M. genitalium infection in women and is usually described as mucopurulent cervicitis (MPC).

Pelvic inflammatory disease

Several studies have observed associations between detection of the organism and clinical signs and symptoms of PID.

Clinical presentation of M. genitalium-associated pelvic inflammatory disease (PID) may include mild to severe pelvic pain, abdominal pain, abnormal vaginal discharge, and/or bleeding, similar to PID due to C. trachomatis.

Which specimen is most accurate for men and women?

Among men, the diagnostic performance of first-void urine specimens in detecting M. genitalium is higher than that of urethral smear specimens

Among women, vaginal specimens are more diagnostic. In one study of 400 women the relative sensitivity of PCR for M. genitalium was 86 percent with vaginal swabs as compared to 61 percent with first-void urine.

When to test for M. Genitalum?

 If a sexually active person presents with evidence of urethritis, cervicitis, or pelvic inflammatory disease, it is recommended to test for M. genitalium also in addition to other STI’s. If women or men continue to have symptoms of these conditions despite completion of appropriate therapy, regardless of initial cause, then testing for M. genitalium is also recommended.

How are Mycoplasma and Ureaplasma infections diagnosed?

They are diagnosed by testing vaginal swabs or urine specimens. For women, vaginal swabs are more accurate.

There are either culture based or RNA based tests for detection of these organisms called NAAT based tests.

Culture based methods are difficult to implement because of reasons described above. Most hospital microbiology laboratories are not prepared to culture them.

RNA based or PCR-based assays are becoming increasingly available in multiplex kits for the diagnosis of respiratory and genitourinary tract pathogens. The only drawback is that we cannot test for sensitivity to drugs through RNA based tests.

A DNA chip assay is capable of identifying 13 targeted urinary tract pathogens including M. hominis and U. urealyticum, with relatively high sensitivity and specificity compared to PCR tests. It is not currently commercially in use in the US.

Which drugs are effective in treatment of Mycoplasma spp and Ureaplasma spp?

Most mycoplasmas and ureaplasma are susceptible in vitro to macrolides (e.g. Azithromycin), tetracyclines, (e.g. Doxycycline) and fluoroquinolones (e.g. Ciprofloxacin). Azithromycin is active against Mycoplasma genitalum (considered an STD).An exception is M. hominis, which is not susceptible to macrolides.

Which antibiotic is the best for which species?

M. GENITALUM

Azithromycin – is the first line treatment. It is 100-fold more active against this organism than the tetracyclines or most fluoroquinolones. However, resistance is increasing. In certain regions, the estimated rate of azithromycin resistance in isolated M. genitalium strains has been as high as 40 percent. Suggested treatment dose is Azithromycin 1g orally.

Failed or recurrent infection with M. genitalum

Moxifloxacin– If Azithromycin failed and there is documented persistence or recurrence then next choice is Moxifloxacin. There is also increasing evidence of resistance to fluorquinolones.

MYCOPLASMA HOMINIS

Doxycycline – is recommended for non pregnant adults with disease caused by M. hominis

Clindamycin: is recommended for infants with disease caused by M. hominis,

Fluroquinolones have been found to be effective, however there is increasing development of resistance seen in mycoplasmas.

UREAPLASMA SPP.

Doxycycline – is recommended for non pregnant adults with disease caused by Ureaplasma spp

Clarithromycin, Azithromycin and Ofloxacin (fluoroquinolones) are also effective for ureaplasma spp.

Clindamycin is not active against Ureaplasma

Azithromycin or Clarithromycin: is recommended for infants with disease caused by Ureaplasma spp,

Which symptoms could suggest clinical disease warrantying treatment in Women?

  • Recurrent Vaginal infections not responsive or resistant to routine treatments of BV.
  • Recurring infections after sexual intercourse.
  • Persistent vaginal burning, malodorous discharge with negative cultures for routine culprits – Candida and Gardnella etc with negative Gonorrhea/ Chlamydia and Trichomonas.

Please remember that these are presumptive associations and linkages. We still need robust trials and larger studies to prove these organisms as primary causative agents of vaginal infections.

Do partners need to be treated for M. genitalum infection?

Although there are no guidelines for partner referral and treatment, it is reasonable to screen all sexual partners of laboratory-confirmed cases of M. genitalium and treat if positive. If screening of sexual partners of index patients with confirmed M. genitalium is not possible, it is reasonable to empirically treat for M. genitalium given the evidence of sexual transmission of this organism.

How long does M. genitalum take to grow and infect someone?

Although the incubation period of this pathogen remains undefined, screening should target sexual partners in the past 60 days. Treatment for partners of patients with confirmed M. genitalium infection is the same as for patients.

When should we treat Mycoplasma or Ureaplasma?

If patients have clinical signs and symptoms, caused by a Mycoplasma or Ureaplasma spp, then they should be treated. In contrast, patients who just have these organisms in their genital tract with no symptoms, do not require treatment.

Treatment paradigm for Mycoplasma and Ureaplasma

M. hominis

Non-pregnant

Doxycycline: 100mg PO BID x 7 days

If allergy

Moxifloxacin: 400mg PO daily x 10 days

Or

Pregnant

*Clindamycin: 600mg PO every 8hrs x 7 days

Ureaplasma

Doxycycline: 100mg PO BID X 10 days (14d if PID)

Or

Azithromycin: 1g PO single dose

*Clindamycin not effective against ureaplasma

 

M. genitalum

Azithromycin: 1g PO single dose

If resistant or recurrent infection

Moxifloxacin: 400mg PO daily x 10-14d

Rest assured, we are here to help you navigate this difficult issue at Walk IN GYN Care

Well wishes

Dr. Adeeti Gupta

 

Close-up of a woman’s face with her left index finger on her chin, appearing thoughtful; text reads 'I thought a thing like that could never happen to me…' with '1,500,000 Americans have SYPHILIS or GONORRHEA and don't know it' on a red background; featured image for Walk In GYN's blog post 'Drastic increase in STD’s – Let’s talk Chlamydia!'

Drastic increase in STD’s – Let’s talk Chlamydia!

 

As per the CDC, in 2016, a total of 1,598,354 chlamydial infections were reported to CDC in 50 states and the District of Columbia. This case count corresponds to a rate of 497.3 cases per 100,000 people. From 2000–2016, the rate of reported chlamydial infection increased from 251.4 to 497.3 cases per 100,000 people.

Increasing Chlamydia in Metros

The rate of reported cases of chlamydia in the 50 most populous metropolitan statistical areas (MSAs) increased 6.2% during 2015–2016 to on an average 5 per thousand individuals. During 2015–2016, the rate of reported cases of chlamydia increased 3.9% among women (639.8 to 664.5 cases per 100,000 females) and 10.9% among men (331.8 to 368.0 cases per 100,000 males).

Increasing Chlamydia in NYC

Recent preliminary data from our own Women’s health centers, in NYC and the surrounding boroughs indicates Chlamydia rates of 12.5 per thousand women in contrast to the national averages of 5 per thousand people. These are still preliminary but serve as a clear warning sign that early screening, diagnosis and treatment is essential.

Treating Chlamydia

Chlamydia can be easily cured with antibiotics. Persons with chlamydia should abstain from sexual activity for 7 days after single dose antibiotics or until completion of a 7-day course of antibiotics, to prevent spreading the infection to partners. It is important to take all of the medication prescribed to cure chlamydia. Medication for chlamydia should not be shared with anyone. Although medication will stop the infection, it will not repair any permanent damage done by the disease. Sex partners need evaluation, testing, and presumptive treatment if they had sexual contact with the partner during the 60 days preceding the patient’s onset of symptoms or chlamydia diagnosis.

Testing and Insurance Coverage

The diagnosis of Chlamydia is easy. All you need is a vaginal swab or a urine test. It can even be tested through a routine pap. Insurances may or may not cover this testing as a part of your routine “annual” visit. However, as you can see, “You may have it and not even know it”!!!

 Stay tuned

 Dr. Adeeti Gupta

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Genetic Cancer Screening Tests

You can find out your risks and the tests available by checking out the self-assessment tool below.

We can perform genetic testing if you have a strong family history of Breast/ Ovarian/ Uterine or Colon Cancer. However, we strongly recommend you filling out the family history questionnaire and assessing your risk by utilizing the tool below. You will need to schedule a separate genetic testing appointment and a follow up appointment to discuss the results. Please note that the results of genetic tests will not be discussed over the phone/ email or portal.

Family History Tool.

Thank you.

Wishing you a healthy future

Walk IN GYN Care team.

 

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Ureaplasma… leads to BV or not to BV?

Learn more about the hidden culprit as Dr. Gupta talks to Byrdie.com….

What is Ureaplasma ?

“Ureaplasma is a type of bacteria that is commonly found in the vaginal secretions of sexually active women,” explains Gupta. To be more specific, Ureaplasma is a subspecies of Mycoplasma, a bacteria that lives in mucous membranes. (Other types of Mycoplasma cause common illnesses such as walking pneumonia.) Untreated, a Ureaplasma infection can lead to chronic discomfort, pelvic inflammatory disease, and even complications during pregnancy.

How common are Ureaplasma bacteria?

The most surprising thing I learned about Ureaplasma is that despite its obscurity, this ailment is far from rare: According to Gupta, the bacteria are “extremely common.” She elaborates, “By adulthood, Ureaplasma is that despite its obscurity, this ailment is far from rare: According to Gupta, the bacteria are “extremely common.” She elaborates, “By adulthood, approximately 80% of healthy women have Ureaplasma spp. in their cervical or vaginal secretions. The prevalence increases with increase in sexual activity.” Yep, that’s 80%.

It’s worth noting that while a Ureaplasma infection can cause serious vaginal health woes, it’s common for healthy women to have some Ureaplasma bacteria present in their vaginas. After all, our nether regions are delicate ecosystems—it’s only when these florae are thrown out of balance that we feel unwell. Gupta elucidates, “Most of the time, Ureaplasma does not cause any symptoms. However, in rare cases, ‘good’ bacteria like Lactobacilli and Acidophilli can become outnumbered by the ‘not so great’ bacteria like Ureaplasma.”

What are the symptoms of a Ureaplasma infection?

As I wrote above, the most distinctive symptom of my experience with a Ureaplasma infection was that it was unlike any other illness I had experienced; it was mostly an aura of irritation that grew into a full-on burning sensation after sex or when I really needed to pee. Gupta adds that some common symptoms of Ureaplasma infection are “greenish discharge, fishy odor, and/or vaginal itching. It’s important to note that these symptoms are usually caused by bacterial vaginosis or trichomoniasis.” In short, an excess of Ureaplasma can lead to other reproductive health problems with more obvious symptoms.

Why don’t most typical exams test for Ureaplasma ?

Perhaps the most exasperating part of my years-long medical odyssey was how long it took to reach a diagnosis. Apparently, explains Gupta, there are actually a few good reasons doctors don’t include Ureaplasma bacteria in standard gynecological testing. “First, the prevalence of this bacteria is incredibly common in sexually active women,” she explains. “Second, and more importantly, there is little—if any—significant evidence suggesting that Ureaplasma is the culprit for painful vaginal infections.”

This isn’t to say that Ureaplasma is harmless. Instead, the idea is that Ureaplasma opens the door to yeast infections, UTIs, and bacterial vaginosis, so it often makes more sense to simply treat those illnesses. During my office visit, my nurse practitioner explained that Ureaplasma was most likely the underlying cause of my recurring BV and UTIs; without eradicating my reproductive system of Ureaplasma bacteria, even the most intense remedies for these other ailments wouldn’t stick. As Columbia University’s health information resource Go Ask Alice puts it, “Ureaplasma urealyticum (UUR) is a common sexually transmitted infection that often does not cause symptoms, but can affect the urogenital tract.”

What’s the next step if you think you might have a Ureaplasma infection?

“Your gyn can request the test for Ureaplasma through a vaginal swab or through a pap smear if you feel that you have symptoms,” says Gupta. Because all Mycoplasma bacteria lack cell walls, they’re resistant to typical antibiotics and require specific prescription treatments.

As far as prevention goes, Gupta argues that control is key: “Ureaplasma cannot be completely prevented, but it can be controlled. The best way to control it is by maintaining a healthy vagina flora. A healthy vaginal flora can be maintained by taking quality, high-dose probiotics and avoiding douching or using medicated vaginal washes.”

While my strict regimen of special antibiotics worked its magic, I sought temporary relief in hot baths with natural, mega-gentle soaps. My nurse practitioner also suggested that I forgo sugar for a few weeks to alleviate any inflammation in the area, a request that I first considered impossible, and also insane. Weeks later, however, I have to admit that she might have been right.

Finally, Gupta adds, “Being diligent about genital hygiene is also key—if you’ve been at the beach all day, or if you just worked out, you should hop in the shower right away. Avoiding too-tight clothing and wearing cotton underwear also go a long way.”

Full link is here.

http://www.byrdie.com/ureaplasma/

 

Small human figures with diverse facial features and professions, connected by dashed and solid lines; featured image for Walk In GYN's blog post 'Understanding HPV and Abnormal Pap Smears

Understanding HPV and Abnormal Pap Smears

What is HPV?

Human Papilloma virus (HPV) is a widely prevalent virus that is passed from person to person through skin-to-skin contact. Although these strains are spread through sexual contact, sexual intercourse is not necessary to spread HPV.  It may be spread through any sexual contact.  It has been suggested that about three out of four sexually active people may have a genital HPV infection  at some point in their lives.

How can we test for HPV?

There are over 120 known strains of HPV at present and only about 15 of those strains are linked to cervical cancer, and approximately 12 strains may cause genital warts.  For women over 30, a pap smear checks for any abnormal cells as well as detectable strains of high risk HPV.  In women under 30, high risk HPV is tested only if the pap smear reveals any abnormal cells.  This is because cervical cancer is very rare under the age of 30 and most women with HPV are able to clear the virus on their own.  Adolescents have an almost 80% clearance rate for high risk HPV.

What is an abnormal pap test and how do you proceed if you have an abnormal pap?

Abnormal pap results may be reported as “Abnormal cells of unknown significance (ASCUS)” , low grade intra-epithelial lesion (LGSIL) or high grade squamous intra-epithelial lesion ( HGSIL).  The next steps in care are decided depending on the results of the pap smear.  If you are positive for HR HPV ( high risk human papilloma virus) and don’t have any abnormal cells, you may just need to be watched closely for any cell changes.  You will be advised to have a test called colposcopy which includes examination of cervix under magnification and a cervical biopsy ( sampling). Depending on the results, you may need 6 monthly follow up or removal of abnormal cells by a small procedure called LEEP or cryo-freezing. It is important to remember that testing positive for HPV does not mean that you have cervical cancer.

Does HPV affect men? How can we test men?

HPV affects men as well as women.  HPV testing is currently not widely prevalent for males. Therefore, it may be hard to go back and figure out who the high risk HPV infection was contracted from. HPV can survive and lay dormant (asleep) inside the cervical cells for many years before detection.  Condoms may help prevent HPV transmission, but HPV can also infect areas that are not covered by a condom, therefore they may not prevent complete transmission. Here is some more information for HPV infection and testing in men. https://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm

How can we prevent HPV infection?

The current recommendations for prevention against high risk HPV infection include HPV vaccination. There are two such vaccines available. GARDASIL 9 is a vaccine indicated in females and males 9 through 45 years of age for the prevention of cervical, vulvar, vaginal, and anal cancers caused by human papilloma virus (HPV) Types 16, 18, 31, 33, 45, 52, and 58; precancerous or dysplastic lesions caused by HPV Types 6, 11, 16, 18, 31, 33, 45, 52, and 58; and genital warts. The injection is given in a 3 shot series over 6 months. The vaccine has  minimal, if any, side effects.  Most insurances cover the vaccination series. The vaccination can be offered or prescribed by your gynecologist or pediatrician.

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For any additional questions or to schedule the Gardasil vaccination, please feel free to walk in or call us as Walk IN GYN Care (www.walkingyn.com).