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Ask an STI Doctor: Rimming, flesh-eating bacteria, drug-resistant gonorrhea, and more

, by Emily Land

STIs virus bacteriaThis summer, The Dr. Is In hosted Dr. Nicholas Moss, who is the Director of the HIV and STD Section of Alameda County Public Health Department to answer our burning questions about sexually transmitted infections (STIs).

The members of our Positive Force group asked some insightful questions about skin infections, chlamydia, and drug resistant gonorrhea—to name a few. Here’s what we learned about STIs in San Francisco, especially as they relate to people living with HIV.

What infections can be spread by rimming?

Nicholas Moss, MD, MPH: There are a few different types of infections that can be spread by rimming. First, infections that can be transmitted from skin to skin contact (like syphilis) could be spread by rimming. Syphilis bacteria live in active skin sores, or lesions, and can infect other skin it comes in contact with. I’ve even seen one patient who had a syphilis sore on his forehead. People can get gonorrhea of the throat, so that’s another infection that could be spread by rimming. Chlamydia of the throat is not spread orally, to my knowledge. So there’s probably no risk of getting or transmitting chlamydia when rimming.

Also, it’s possible to get other kinds of infections when you come into contact with fecal material. It’s possible to get hepatitis A, and infections like diarrheal illness and food poisoning if you come into contact with someone who has recently been infected with something like salmonella.

What’s going on with drug-resistant gonorrhea?

I think we’re headed to a world where we have strains of gonorrhea that we just aren’t able to treat. Over the last 70 or so years that we’ve been using antibiotics to treat gonorrhea, the bacteria has gotten better and better at beating the drugs we’ve used to kill it. “Drug resistant” just means that the bacteria has evolved to the point where certain antibiotics no longer work against it. So far, we’ve had a few cases of people with gonorrhea that’s extremely difficult to treat, but it’s very rare. Now, we routinely use two drugs at the same time to treat gonorrhea to make sure that we get rid of the infection.

How do you know if you do get drug-resistant gonorrhea?

We ask people to wait about a week for their gonorrhea treatment to work. If, after a week, you still have symptoms then you should give your doctor another call.

What are chlamydia symptoms to look out for?

If you have a chlamydia infection in your urethra, you might have pain or a burning sensation when you pee. Or, you might get symptoms around your rectum, like pain or discharge. It can feel like constipation. There’s one type of chlamydia called LGV where men get swelling in their groin creases and the lymph nodes that are there. So if you have soreness there, and you’re feeling sick or have a fever, it’s time to see your doctor.

I heard that shaving your body hair makes you more likely to get skin infections. Is this true?

Bacteria that causes skin infections, like MRSA, can get into and live in tiny cuts in your skin (that you might not even be able to see). Certainly things like shaving your hair can give you more of those cuts on your skin, which is probably why you’ve heard this. But I’d say you should balance this with how you want to live your life. If you’re somebody who gets a lot of skin infections, then it might be worth not shaving your body. But otherwise, if you practice good hygiene then shaving your body hair is probably not something you need to worry about.

What kinds of problems do flesh-eating bacteria cause?

Flesh-eating bacteria is what people say colloquially to refer to bacteria that cause infections like staph (staphylococcus) or strep (streptococcal). These are very rare, but not so rare that I’ve never seen them. These kinds of infections need to be treated right away. Usually, a surgeon will need to cut out the infected skin and the person will be put on really strong antibiotics.

Other simpler skin infections caused by staph or strep bacteria can cause pus-filled lumps or abscesses. These can be anywhere on the body, including in the butt and in places like your armpits. These have to be drained, and the person is also put on antibiotics. To prevent these kinds of infections, practice good hygiene like washing with soap and water.

What is cellulitis?

Cellulitis is a type of infection that can be caused by different types of bacteria. It’s an infection of the skin, and it usually spreads. It causes the skin to be red and sore to the touch. We often see it in the legs—it can be caused by athlete’s foot that’s not really well treated. Bacteria will get into a crack in the skin caused by athlete’s foot, and the infection will spread up the leg. Usually, it’s caused by the strep bacteria, and can be treated with antibiotics.

Is the over-use of antibiotics in agriculture responsible for drug-resistant “super-bugs” like MRSA?

I don’t know if there are specific instances of drug resistance developing in direct response to the antibiotics used in agriculture. But most infectious disease doctors are against the use of antibiotics in agriculture. Just putting antibiotics out there in the environment, unnecessarily, increases the odd that we’ll get these resistant types of bacteria.

Are people living with HIV more likely to develop these kinds of skin infections?

It’s possible that people who have a compromised immune system may be more likely to develop certain infections. But really, it’s hard to know what the effects might be for long-term survivors or others living with HIV. So many of these infections we’ve been discussing are common. So if you have an undetectable viral load, if your CD4 cell count is over 500, if your immune system is in good shape—you maybe will get one extra cold or flu every year. But otherwise you’re going to run the risk of getting these skin infections like everyone else. If you want to protect yourself—opt for good hygiene. Choose the level of risk that you want in your sex life. And if you don’t feel well, go see your doctor. Get things that crop up looked at by a medical professional.

Need more information about sexually transmitted infections? Check out the STI articles that are part of Strut’s online resources. Gay, bisexual and transgender men can get tested for STIs for free, in San Francisco at Strut. Find more info on FREE STI testing, here.


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