Q. I'm 26 and positive for HPV. Is there any point in my getting the new HPV vaccine?

A. There are 30 to 40 strains of sexually transmitted human papillomavirus (HPV). The vaccine Gardasil targets the four strains most closely linked to cervical cancer and genital warts. For women not already infected with these strains, Gardasil is almost 100% effective at preventing genital warts and cancerous or precancerous lesions of the cervix. That's why public health officials recommend that girls ages 11 to 12 be vaccinated — before they become sexually active.

Medications for postmenopausal osteoporosis prevention

Risk of osteoporosis increases after menopause, when levels of estrogen — which helps preserve bone density — drop. Until recently, most doctors recommended long-term hormone replacement therapy (HRT) to treat postmenopausal women who need medication to prevent bone loss. But things changed after results from a large trial on a common HRT drug showed that estrogen plus progestin (as the medication Prempro) did more harm than good. An increased risk for breast cancer and cardiovascular events outweighed the benefits of less colorectal cancer and fewer fractures. (See the Update from July 2002 for more information on the trial.)

Health experts now encourage most women who have been taking long-term HRT for osteoporosis prevention to consider an alternative. Fortunately there are several options. Each of the FDA-approved treatments (see chart) has potential benefits and risks that women and their doctors should weigh before making a decision. Even with HRT's proven risks, it may still be a good choice for certain women — especially in lower doses, which recent data have shown to have bone benefits comparable to higher, standard doses.

Recurrent Urinary Tract Infections

Questions to Discuss with Your Doctor:

• With each of the bladder or urinary tract infections that you have you had, as far back as you can remember:
  • What were the dates of each?
  • Was a urine culture done to prove you had an infection?
  • What treatment was given, and how quickly did you get better?
  • Did you have a fever, pain in your back, or nausea and vomiting?
• Have you ever been told that you have abnormalities in the way your kidneys or bladder, or the tubes connecting them, are built?
• Do you frequently develop bladder or urinary tract infections after sexual intercourse?
• Do you have any chronic medical problems (for example, diabetes or neurological disease)?
• Are you on any antibiotics to prevent recurrent bladder or urinary tract infections? If so, which one?
• If you are a woman, what type of contraception do you use (for example, a diaphragm, spermicide)?

Your Doctor Might Examine the Following Body Structures or Functions:

• Abdominal exam
• Genital exam
• Back exam for the presence of tenderness in the area of the kidneys

Your Doctor Might Order the Following Lab Tests or Studies:

• Clean-catch urine specimen for urinalysis and culture
• Ultrasound of the bladder
• Full pelvic/renal ultrasound
• Abdominal CT scan
• Cystourethrogram

Vaginitis

Questions to Discuss with Your Doctor:

• How long have you had this vaginal discomfort?
• Does it itch or burn?
• Do you have vaginal discharge? Does it have a bad odor? What is the consistency?
• Are you pregnant?
• Are you sexually active?
• Is sexual intercourse painful?
• Do you have pain or burning with urination?
• Are you urinating more frequently?
• Do you have urinary incontinence?
• Are you post-menopausal?
• Do you have vaginal dryness?
• Do you have diabetes?
• Have you recently taken antibiotics or corticosteroids?
• Is your immune system suppressed in any way?
• Do you take birth-control pills?
• Do you wear tight pants or synthetic fabrics (nylon)? (These are all predisposing factors for yeast infections).
• Have you or your partner ever had a sexually transmitted disease?
• Do you have fevers, chills, abdominal pain, joint pain, or a rash?

Your Doctor Might Examine the Following Body Structures or Functions:

• Abdominal examination
• Pelvic examination

Your Doctor Might Order the Following Lab Tests or Studies:

• Sample of the vaginal discharge to examine under a microscope (wet smear)
• Cultures of the vaginal discharge