Questions about Sexual Diseases

The next two Q&A topics generated some heated debate from people who mistakenly assumed that I said it is impossible to contract an HIV infection through vaginal intercourse. I never said that. I have no doubt that it can spread that way because cuts, tears, and abrasions may develop in the vagina. A man may develop similar epithelial defects, or also pass HIV through his semen. While it is possible to transmit HIV via vaginal intercourse, I think the risk of this has been overemphasized in the press, and the risk of dying from other diseases has been underemphasized.

To illustrate this, let’s look at data from the CDC’s National Vital Statistics Reports. For 1999, the most recent year for which final data are available (I have no idea why the government takes so long to finalize their data), death from HIV is not even in the top ten list for all races, sexes, and ages. What is in that list? Heart disease, malignant neoplasms, cerebrovascular diseases, chronic lower respiratory diseases, accidents (unintentional injuries), diabetes mellitus, influenza and pneumonia, Alzheimer’s disease, nephritis, nephrotic syndrome, nephrosis, and septicemia. Have you ever heard the general press discuss nephritis, the nephrotic syndrome, or nephrosis? Have you ever heard a scary public service message about these diseases? (Do you even know what they are?) Do somber Hollywood celebrities ever give you stern warnings about them? Or what about septicemia? I’ve never heard any such message, yet I’ve heard thousands about HIV. Now can you understand why I used the words overemphasized and underemphasized?

HIV shows up in the top ten lists only when deaths are categorized by age. Even then, the statistics show results that may surprise you if you obtain your information from the mainstream media. People in the 20 to 24 age group were 83 times less likely to die from HIV than from greater threats (accidents, assaults, suicide, malignant neoplasms, heart disease, congenital malformations, and chromosomal abnormalities). People in the 25 to 34 age group were over 10 times less likely to die from HIV than from greater threats (accidents, suicide, assault, malignant neoplasms, and heart disease). Imagine that! Even in such young people, cancer and heart disease (often thought to be primarily diseases of the elderly) are bigger killers than HIV. Here is a question that truly underscores why I say that people worry too much about HIV and too little about things that are more likely to kill them: how often have you heard someone in the 25 to 34 age group worry about dying of heart disease or cancer before their 35th birthday? To most such young people, an early death from cancer or heart disease is unthinkable . . . so inconceivable that I have never heard anyone that young express this fear. On the other hand, I have seen them crying and trembling with fear after just one occurrence of vaginal intercourse.

People in the 35 to 44 age group were over 8 times less likely to die from HIV than from greater threats (malignant neoplasms, accidents, heart disease, and suicide). People in the 45 to 54 age group were almost 30 times less likely to die from HIV than from greater threats (malignant neoplasms, heart disease, accidents, chronic liver disease and cirrhosis, cerebrovascular diseases, suicide, and diabetes mellitus). In other age groups, HIV did not make the top ten lists. Combining data for people aged 20 to 54 reveals an interesting statistic: those people are 16 times less likely to die from HIV than from another cause — some of which you may never have heard of. Furthermore, this group includes homosexuals, drug abusers, and heterosexuals who engage in anal intercourse. It also includes countless heterosexuals who don’t use drugs or have anal sex, but aren’t very choosy about selecting sexual partners.

There is no doubt that HIV stirs up quite an emotional reaction in some people, but for a moment I’d like to ask you to dispassionately consider this matter. If you do that, you cannot help but face the fact that you’re far less likely to die of HIV than you are of something else. This is true even if you bend over backwards to look at the most gloomy statistics and consider only the high-risk age groups and don’t separate out homosexuals, drug abusers, or heterosexuals who engage in risky behavior (anal sex, or being cavalier in regard to partner selection). If you do omit those groups, the risk is considerably less.

I’ve read all sorts of statistical analyses of the death risk for heterosexuals who don’t abuse drugs, don’t have anal sex, and are prudent in partner selection. The figures show that those folks are hundreds to thousands of times less likely to die of HIV than from other causes. Even if you insist on looking at only the highest-risk age groups and don’t omit the people who engage in risky behavior, the risk of death from something other than HIV is about 94%. From this, I think that any fair-minded person would have to conclude that HIV has indeed been overemphasized. Thousands of public service commercials about HIV and none about some diseases that are bigger killers, yet are unknown to the average American? Is this balanced? Obviously not.

The June 9, 2003 Forbes magazine ran an interesting article for which they interviewed Dr. Lewis Goldfrank, a renowned physician and author. If you read this article, you will likely agree with Dr. Goldfrank that people spend too much time worrying about things that are not likely to kill them and not enough time worrying about their real threats. Based on the statistics presented in that article, people are over 21 times as likely to die from complications of "bad eating and physical inactivity" than they are from AIDS. People know that poor eating, overeating, and inactivity negatively affect health, but how many people worry about those habits? Do they generate 21 times the fear of AIDS? Obviously not. Why? Because the mainstream media selectively chooses stories to emphasize. When they do this, their coverage can create false impressions about the frequency of various events. For example, a few years ago there was such a spate of shark-attack stories that I began to wonder why sharks were suddenly so aggressive. The truth came out the next year. There was no torrent of shark attacks that prior year, just unusually heavy press coverage of them.

When I was a child, I read and heard accusations by people outside the United States that our media presented a distorted view of the truth. I thought they were nuts. Censorship and biased news presentations occur only in communist and socialist countries, I thought. We did the same thing? Preposterous. I now realize that the media are guilty as charged. They suppress or trivialize stories that don't fit the agenda they wish to push, and magnify the importance of their pet stories. They often claim to give "fair and balanced coverage." Preposterous.

The media coverage of HIV is often so distorted that terming it propaganda is justified. If you think this statement is radical, you likely won't after reading an exposé ("Whatever Happened to AIDS and Straight Men?") in the March, 2004 issue of Details magazine that quoted experts who admitted that it was deliberately deceptive to instill fear of AIDS in heterosexuals who did not use IV drugs or have sex with people in high-risk groups. Author Kevin Gray wrote ". . . the politically incorrect truth is rarely spoken out loud: The dreaded heterosexual epidemic never happened." He then cited facts that explained how and why this AIDS propaganda was disseminated. Here are some of the article's highlights:

Kudos to Kevin Gray and Details magazine (www.details.com) for publishing this article. I think it should be read by everyone, especially the propagandists in the media who are responsible for deliberately spreading AIDS misinformation. The credibility of journalists is paramount, but too many of them have willingly discarded this fundamental attribute for cheap sensationalism and the desire to curry favor with certain special interest groups. Like Kevin Gray, I prefer the truth. You?

Should heterosexuals worry about AIDS?
Why did the media lie about this?

Q: I just heard an interview with Bernard Goldberg, a respected journalist who had a long career with CBS. He wrote a book entitled Bias: A CBS Insider Exposes How the Media Distorts the News. In this interview he said that the media distorted the facts about AIDS as it pertains to heterosexuals. Basically, he said that the media made it seem like any heterosexual could get AIDS from regular (vaginal) sex, but that AIDS was really only a problem for gay men and heterosexuals who injected drugs. Tell me, Dr. Pezzi, did the media lie to us? Have they wrongly instilled a fear in us heterosexuals who don't use drugs? Why did it take so long to expose this myth? Thank you for your time, Jeff.

A: Yes, Bernard Goldberg is correct: the media lied about this. Why did it take so long for the truth to come out? I've been writing about this for years, and some doctors who are far better known than I am have said the same thing. However, if the media disagrees with either your message, its implications, or how it is presented, they will quash your message. The media love things that are politically correct whether or not they ARE correct. Regarding the notion that heterosexuals should be shaking in their boots about AIDS, some people speculated that the media spread this myth to curry favor with homosexuals, or perhaps because the media seem to have taken it upon themselves to sanctify and champion the causes of anything dealing with homosexuality, homelessness, minorities, and women's rights. Homosexual men, of course, have good reason to fear AIDS. They also have good reason to make us believe that we're all at risk for this disease. Why? Because it makes it so much easier for them to get funding to support AIDS research.

I know we like to think we live in a time in which such a propagandized distortion of the truth doesn't occur, but unfortunately we often can't get our facts straight even when they're not laden with deep sociological implications. Take something as simple as body temperature. Ask doctors what is normal, and 99% will answer, "98.6° F." You've probably heard that a million times, too. There's just one problem: this number is based on research done in the early 1800's, and was passed from generation to generation with few people questioning its validity. The actual average body temperature is about 97.6°. In the morning, it's about a degree lower, and later in the day it's usually a degree (or more) higher, depending upon activity level and other factors. I don't intend to turn this into a treatise on body temperature; I just want to point out how we're so susceptible to believing things if we hear them often enough.

In the case of the myth about how heterosexuals should fear AIDS even if they don't abuse injectable drugs or engage in anal intercourse, there is more to how this myth gained credence than mere repetition. During my years of training, I'll never forget the subtle but unmistakable brainwashing I and my colleagues were subjected to regarding this matter. I could spend hours writing about that experience, but the bottom line is that we were pressurized into adopting certain attitudes toward homosexuals and their — oops, OUR — disease: AIDS. I don't favor ignoring AIDS research just because it will likely be of tangible benefit only to gay men and drug-abusing heterosexuals, because I think every taxpayer is justified in wanting more federal dollars to fight "his" disease. Michael J. Fox wants money for research on Parkinson's disease, Mary Tyler Moore wants more diabetes research, and on and on. We all have our pet projects and interests, and just because someone has a vested interest in funneling more dollars to something that threatens him doesn't make that cause any less worthy. Hence, I don't object to the fact that gay men want more money to research AIDS. Instead, what galls me is the ease with which the truth of this matter has been trampled. Unfortunately, this deliberate distortion of the truth has left in its wake a lot of collateral damage. I've seen heterosexual patients in the ER sobbing uncontrollably, worried that they may have contracted an HIV infection just because they had vaginal intercourse. What used to be one of life's greatest pleasures is now something that we often fear more than Russian roulette. The needless hand-wringing engendered by this pervasive myth about how HIV is spread has damaged many lives, causing people to fret about an unfounded fear. We all have enough real fears to conquer without losing sleep over things that aren't worth worrying about. How much time do you spend worrying about whether you will die in a car accident? Do you stop driving and huddle under your bed just because many people die in car crashes? No, because automobile transportation is too vital to life. Well, sexual pleasure is one of the foremost things that makes life worth living. It is prudent to be cautious, but don’t let fear rule your life.

I discussed this subject in more detail on my ER web site. You may also wish to read The Myth of Heterosexual AIDS by Michael Fumento. Yes, heterosexuals can contract an HIV infection, but if heterosexuals don't use contaminated needles or engage in homosexuality, their risk of acquiring AIDS is vanishingly small. In fact, one state that once required HIV testing before issuing a marriage license ended that requirement when so few positives appeared — remember, those people may not have acquired HIV via vaginal intercourse, but rather by drug abuse, sporadic homosexuality, or anal intercourse that some heterosexuals engage in.

Let's put this risk into perspective. I've seen several people killed during traffic accidents while on dates. I've seen people who died while engaging in sporting activities. I've seen men who died at work. I've seen people who died from a faulty furnace. As a former ER doc, I've seen people die in just about every way possible, yet I've never seen a non-drug-using heterosexual die of AIDS. But do people worry about dying in traffic accidents on dates? Or do they worry about dropping dead while playing sports? Or at work? Or sleeping at home? No. Virtually no one worries about such things, although those and dozens of other seemingly innocuous events are far more likely to kill than vaginal intercourse. Do you see how the media have twisted the facts? Heterosexuals now think of sex as a potentially lethal event that is one of their gravest threats. Does this make any sense to you? Virtually every heterosexual who isn't an IV drug user dies of something besides AIDS, but the media do not harp about this — they rant about HIV as if we had good reason to make this our supreme fear.

The HIV virus has been so politicized that it will be years, if ever, before people put this into proper perspective. As a doctor, I'm flummoxed by the fact that people are usually oblivious to infectious agents and diseases that are far more of a threat to them than is the HIV virus. I am not encouraging people to take unnecessary risks with their health, but only to spend more time worrying about their greatest threats and less time fretting over less likely dangers (see the following question). Let's face it — no one has enough time to worry about every risk we face, because everything we do carries some risk. I could be killed while snowmobiling, because there are plenty of kooks in that sport who drive at grossly excessive speeds on the trails. Or I could be killed while mowing my lawn. It's hilly, and riding lawn mowers occasionally tip over and crush their riders. Or I could drown, be hit by lightning, or be crushed by a falling tree while logging. After three close calls, I invented a way to cut down trees from a safe distance. This is the correct way to deal with risk: identify what is most likely to kill you, then think of a way to reduce that danger. Incidentally, I also invented various ways to reduce the risk of STD transmission, and I'll announce these in future editions of my book.

Dismantling a common myth about the transmission of STDs

Q: You've answered somewhat similar questions on your excellent web site, so I thought I'd write to you for advice. My college prof assigned us to write a paper on a sexual misconception. Anything come to mind?

A: Yes. I've received so many requests from college students asking for help with their papers that I've begun to wonder if I should offer a service writing term papers for a fee. :-)

There are countless sexual misconceptions, but since you're in college, I presume your teacher is not interested in shattering myths that prevail only amongst teenagers and the proletariat. To impress your professor, you need a myth that even an intellectual might fall for. OK, here goes.

Nowadays, people usually interrogate prospective sexual partners before sleeping together. The tacit message I've seen in innumerable sources is this: your risk is decreased if your partner has had few sexual partners. This seems so intuitively obvious that you may wonder why I am discussing it. Why? Because it is misleading. Let's analyze this. This simplistic assumption would be true if disease transmission were 100% per sexual experience, but it is not. For example, from one act of intercourse, the risk of female-to-male transmission of herpes is 0.05%; male-to-female spread occurs 0.2% of the time (you might hear somewhat different statistics from various sources). While the odds are worse for gonorrhea (female-to-male, 20%; male-to-female, 70%), gonorrhea is easily cured. The risk of HIV transmission varies with type of intercourse (vaginal versus anal) and presence of lesions, like herpes, that break down the vaginal lining or penile skin. If those lesions are not present, some docs think that vaginal intercourse is very unlikely to spread HIV. Some physicians and scientists say the risk is zero, or close to it. I doubt the risk is zero, because virtually everything carries some risk — even drinking water.

For the record, I've had more patients die from using a blow dryer than from AIDS if they were heterosexuals who never used drugs or engaged in anal intercourse. I've also had more patients succumb from welding, chainsaw or mower injuries, snowmobiling, hunting, jogging, alcohol abuse, drug abuse, overeating, smoking, driving to school or church, drowning, climbing in trees, or stupidity (like touching live electrical wires while standing in a pool of water). A few years ago, Americans were treated to a spate of brief public service commercials in which somber Hollywood celebrities gave us condescending short speeches about AIDS. Ask yourself this question: if prevention of death is the goal, why have I seen a thousand commercials about AIDS and none about chainsaws, obesity, or the hazards of electricity? Hmmm? I suppose those celebrities get their information from biased sources that give them a skewed perspective. I obtained my information firsthand. When a man was cooked by electricity, flattened in a car accident, or died in any one of numerous other obvious ways, I did not need a pathologist or medical examiner to tell me why he died. Nor did I need some politically motivated statistician or spokesperson to tell me what is killing 99.9% of Americans. I've seen tens of thousands of patients, so my sample is large enough to be statistically valid. From this, I know that heterosexuals spend their time worrying about the wrong things. Instead of worrying about AIDS, it would be far more logical to worry about dying from food that your spouse cooks for you. Remember Poppin' Fresh™, the adorable little Pillsbury Doughboy™? Or Betty Crocker^®, Mrs. Butterworth’s^®, and similar icons? The processed foods they represent have contributed to the death of more heterosexuals in the United States than has the HIV virus. This is probably true even when heterosexuals are not excluded because of shooting drugs or engaging in anal intercourse, and it is undoubtedly true when these risky subgroups are omitted. Obesity, heart attacks, diabetes, strokes, cancer — those are the big killers that people should worry about. Dr. Dean Edell recently reported a study that suggested the high rate of heterosexual transmission of AIDS in Africa is not due to sexual intercourse (as had long been presumed) spreading a different subtype of HIV than is prevalent in the US, but is instead due to unsafe medical practices such as using dirty needles. Interesting.

The bottom line from the preceding discussion is that the risk of acquiring some sexually transmitted disease from one episode of intercourse is less than 100%, and very low for the incurable diseases that concern most people. Thus, what matters more is not how many people you've slept with, but how many times you've slept with them. I've been exceptionally careful about who I sleep with, and my precoital interrogatory/investigation is probably more thorough than that of just about anyone else. However, most people are not so careful, and they gloss over subtle hints that would be red flags for me. If they're horny, they jump into bed. Thus, the risk these people assume is unknown to them. What difference does it make to switch from Partner #1 with an unknown risk to Partner #2 with an unknown risk?

I will illustrate this by looking at a hypothetical example. For the sake of simplicity, assume the risk of spreading a disease is 1% per sexual encounter. Assume that Person A had sex with eight partners, and Person B had sex with four partners. Who has a higher risk of acquiring the disease? That's right, you cannot determine risk based on number of partners, so I will give you more data. Person A slept with each partner twice, and Person B slept with each partner 20 times. We should also know the prevalence of the disease. Let's say that is 1%. Now who is more likely to acquire the disease? Let's do the math:

Person A
8 partners x 1% prevalence = 8% chance of encountering a partner with the disease
8 partners x 2 sexual encounters per partner = 16 episodes of sex
16 episodes of sex x 1% chance of transmitting the disease per encounter if the disease is present x 8% chance of encountering a partner with the disease = .0128 = 1.28% chance of acquiring the disease

Person B
4 partners x 1% prevalence = 4% chance of encountering a partner with the disease
4 partners x 20 sexual encounters per partner = 80 episodes of sex
80 episodes of sex x 1% chance of transmitting the disease per encounter if the disease is present x 4% chance of encountering a partner with the disease = .032 = 3.2% chance of acquiring the disease

Therefore, although Person B slept with half as many partners as Person A, Person B is over twice as likely to have acquired the disease. Thus, the most important factor isn't number of partners, it is the total number of sexual encounters. If Hollywood folks are smart enough to lecture us about staying safe, why don't they give us the real story? Don't they teach math at Hollywood High?

Can some sexual lubricants kill HIV?

Q: I just heard about a study which showed that some sexual lubricants can kill the HIV virus. Is this true? Amanda

A: You're probably referring to a study led by Samuel Baron, M.D. at the University of Texas Medical Branch at Galveston. He found that three sexual lubricants (Astroglide, Vagisil, and ViAmor) reduced the rate of HIV replication by more than 99.9% when those lubricants were mixed with HIV-infected semen. However, those experiments were conducted in test tubes, not humans. What works in vitro (in a test tube) doesn't always work in vivo (in living beings). Furthermore, those samples were allowed to sit for 24 hours because Dr. Baron said it takes some time to deactivate HIV. I hate to be flip, but HIV would probably be deactivated after sitting for 24 hours in a McDonald's malt, a glass of orange juice, or a zillion other fluids that have no special anti-HIV effect.

Whether or not those lubricants prove to kill the HIV virus during sex, it is nevertheless advisable to use a sexual lubricant if vaginal lubrication is insufficient because adequate lubrication minimizes the risk of transmission of various sexually transmitted diseases.

If you're looking for a sexual lubricant that kills HIV and potentially other STDs, I discuss a much better alternative in my book.

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