What's your problem?

Doctor Louise answers readers’ questions.

The doctor-patient relationship

Chris from Northern Queensland writes: I am worried that my new doctor and I have got off to a bad start. Not long after he gave me my HIV diagnosis I ended up back in his clinic with an STI. I’m not making excuses but it was just this one time when I got out of it and had casual unprotected sex. Now I think this doctor doesn’t have any respect for me. I haven’t been positive long and where I live there are not a lot of HIV GPs to choose from.

Dr Louise replies: I can tell you are in a bit of a dilemma. So, firstly let me reassure you a little.

As HIV professionals, part of our job is to test and treat people for STIs [1][Sexually Transmissible (or Transmitted) Infection] Infections spread by the transfer of organisms from person to person during sexual contact. Also called venereal disease (VD) (an older public health term) or sexually transmitted diseases (STDs). . And part of that job is giving people positive STI results. As such, your doctor probably has not thought too much more about it.

I suspect this is more about how you are feeling about the situation than a true reflection of your doctor’s attitude. You mention there are not many doctors in your area working with HIV so it would be good if you could feel comfortable talking to him. Try telling him straight how you feel and see how you go. Mention to him that you value the relationship you have with him and that you felt embarrassed.

The other thing I would ask you to think about is what was going on around the time of the incident that contributed to you wanting to ‘get out of it’? Were there other stressors – alcohol, drugs or other pressures that contributed?
Do you want to chat to your doctor or a counsellor more about these things . . . or just leave it for now and start again when you see him next?

I hope that helps!

What STI is that?

John from Sydney writes:
I was recently diagnosed with something called lymphogranuloma venereum. I am HIV positive and had some anal pain and discharge. I went to my doc and she did a number of STI tests and this one came back positive. Can you tell me about more about it?

Dr Louise replies:Hi John,
lymphogranuloma venereum (LGV) is an STI caused by chlamydia.

It is endemic in some areas of Africa, Asia and South America but until recently it has been quite rare in industrialised countries. Initially, we were only diagnosing this condition in MSM who had been recently sexually active overseas, but there have been more cases reported in Australia over the past few years.

Most people have some symptoms, so they come along for testing. Mostly they complain of anal symptoms such as pain, discharge, diarrhoea or constipation and they may also have swollen lymph glands in the groin and feel generally unwell.

Initially, we test for chlamydia and if that is positive we ask the laboratory to specifically look for the types of chlamydia that cause LGV.

LGV is usually treated with a three-week course of the antibiotic Doxycycline. We also have to test partners and treat them if appropriate.

Remember that any STI increases the risk of transmitting or acquiring HIV, so regular STI testing is a good idea.

ASK DOCTOR LOUISE

Keep your questions under 100 words and email them to pl@napwa.org.au [2].

Dr Louise Owen is Clinical [3]Pertaining to or founded on observation and treatment of participants, as distinguished from theoretical or basic science. Director of the Centre Clinic in St Kilda. Her advice is not meant to replace or refute any advice given by your own doctor as your individual medical circumstances are best dealt with by your own practitioner.