A heartbreaker of a patient came into my clinic today. She is a 20-year-old college freshman, and her tale began on New Year's Day, when she went to the emergency room complaining of lower back pain. The doctors there thought she had a kidney infection, but checked her for STDs.  Turns out she had both chlamydia and gonorrhea. She has been with the same boyfriend for the past three months, with no other sexual partners in that time (though he confessed to another partner). She followed up with me two weeks later, feeling better after her treatment. I stressed the importance of making sure that her partner got treated for both infections before she had sex with him again. We planned to have her come back in a month for a retest to make sure the infections were gone.

I saw her today in the clinic, two weeks ahead of schedule. She complained of cramping, and then confessed to me that while she watched her boyfriend swallow the medications to treat the infections, she then had sex with him that night. Unprotected. So she was worried that she may have become reinfected. To make matters worse, she reported feeling several "bumps" on her vulva. Two of them hurt, she said, and the others didn't.

One look at her vulva confirmed her worst fears--she had genital warts, and likely had herpes as well. I sent a culture to confirm my impression, and rechecked her for gonorrhea and chlamydia. Fortunately, the last two hadn't returned, but the herpes test was positive.

4 STDs in three months!! Including herpes, the gift that keeps on giving. It's bad enough telling patients that they have a sexually transmitted infection, but giving the news of herpes is even worse. Even a quick Google search gives you the information that there's no cure for this infection. As her doctor, I know that herpes doesn't mean the end of her sex life, that there are medications to keep it under control and that she may not have another outbreak for years. But telling her this didn't stop her from shaking and crying at the news. I asked, as gently as I could, why she continued to have sex with this walking petri dish (though not in those words). She honestly answered that she doesn't want to be alone, that it's "better to be with someone" until she finds "the right one." I hope she finds the strength to leave this jerk before he gives her a worse infection (and I'll be testing her for HIV at her follow-up visit). I can dispense antibiotics without a thought, but wish I could write a prescription for self-esteem as easily. Have any of you felt like you needed to stay with someone who was so obviously unhealthy for you?