Ask Dr. Denise: Gout & STD screening

The Filipino Journal: October 20-November 5 2006 issue; Volume 20, Number 20 p 10
By Denise Koh, BSc (mcl), MD, CCFP

* My dad suffers from gout. What is it, and what can he do to treat it?

Gout is a disease in which uric acid (UA, the normal end product of the breakdown of purines) crystals deposit in body tissues. This causes recurrent attacks of severe joint pain and inflammation, deposits in soft tissues, kidney problems, and kidney stones. Many genetic and environmental factors affect the chain of events that regulate UA formation, transport, and disposal. Any problem in these processes can lead to too much UA in the blood and gout. Filipinos have a predisposition to gout. There is a higher blood level seen in Filipinos living in North America compared with Filipinos living in the Philippines. Filipinos have a limited ability to excrete/remove UA leading to a tendency to high blood UA levels manifested when a diet with a relatively high purine content, such as the usual North American diet, is eaten. Your dad can do several things to control his disease: lose weight, avoid foods high in purines, avoid alcohol (increases production and impairs removal of UA), avoid dehydration (drink lots of water!), and avoid diuretics (“water pills” often used for high blood pressure) if possible. High purine foods include visceral (organ) meats (liver, tripe), sardines, shellfish, turkey, salmon, trout, beans, peas, asparagus, and spinach.


* I have a new sexual partner and was told to get checked for STD’s, even though I feel fine. What is involved in an STD screen, and when should someone get checked?

A common misperception is that no symptoms, means no STI (sexually-transmitted infections). This is far from the truth, and is a huge reason for the continued spread of STIs. Get tested when: you have unprotected (no condom) sex, you have a new partner, you are worried about it, you are experiencing any symptoms such as discharge, pelvic pain/burning, lumps, bumps, sores, unusual vaginal bleeding, or fertility concerns. Many people choose to get tested regularly, such as every 6 months, or with their annual physical exam. A typical screen can include blood tests for HIV (anonymous and requires your consent), Hepatitis B, Syphilis, and Herpes Simplex (although some docs don’t check for herpes because it is so common, and can’t be cured). Gonorrhea and Chlamydia can be checked in two ways: 1) a pee test or 2) a swab. For women, this is a swab of the inside of the cervix (opening of the uterus) requiring the insertion of a speculum typically used in Pap tests. For men, this requires a swab of the urethra/inside the penis. If you are uncomfortable with the swab tests, you can get the pee test instead, keeping in mind that these tests are not as sensitive as the swabs. It’s way better to get tested than not—for treatment and relief from easily treatable infections, management with improved outcome of the non-curable ones, prevention of spread, and peace of mind. Tests for Genital Warts are more specialized and seldom performed (extremely common and difficult to treat), but often a doctor can recognize them on examination. Tests for vaginal infections (not necessarily sexually-transmitted) such as yeast, trichomonas, and bacterial vaginosis are usually reserved for women with symptoms.