Primary care does not only involve the treatment of acute or chronic diseases. It also includes disease prevention. For all adults (including LGBTQ+), there are national recommendations for routine screening for the early detection of numerous conditions, including:
- Mammograms and self-examination for breast cancer
- Vaginal exams and Pap testing for cervical cancer
- Colonoscopies for colon cancer
- Self-examination for testicular cancer
- PSA blood testing and digital rectal exam for prostate cancer
- Routine screening for elevated cholesterol
- Routine blood pressure checks for hypertension
- Frequent STD and HIV screening for sexually active individuals
- Routine skin exams, especially for those who are fair-skinned or sun-worshippers for skin cancer.
- Screening for hepatitis C, especially for the “baby-boomer” generation.
Primary care also includes providing education and treatment focused on changing behavior to enhance health, including:
- HIV and STI risk-reduction counseling and use of Truvada for PrEP
- Dietary changes to reduce high cholesterol, lower weight or improve blood pressure
- Counseling and/or medication to assist with smoking cessation.
Finally, preventive primary care strongly encourages immunizations, based on age and risk-factors. Adult patients often are not aware of their immunity status to many common diseases, such as chicken pox, measles, mumps or German measles, since these vaccinations are given in early childhood. There are simple blood tests to determine if someone needs a vaccine or booster dose.
All adults should be immunized periodically against tetanus/diphtheria/pertussis (whooping cough). College-bound patients should receive the meningococcus vaccine. Older adults should consider a vaccination against shingles and well as a series of two immunizations against pneumococcal pneumonia (Prevnar and Pneumovax). Everyone is at risk for influenza and should receive their annual “flu shot.”
Sexually active individuals, especially men that have sex with men, should strongly consider getting vaccination against hepatitis A and B. All infants now receive those injections, but adults likely have not. While these infections are becoming less common in our country, they are highly contagious and often spread sexually or are food-borne. Vaccinating against them can easily prevent potentially serious or even fatal infections. Hepatitis A and B vaccines are also recommended for those who travel abroad to many countries.
Finally, human papilloma virus (HPV) is one of the most common, yet hidden STI’s in our community. It can lead to unsightly and incurable genital, anal or oral warts. More importantly, it is a major cause of cervical, penile, anal and throat cancers. The rates of anal cancer are much higher in gay men than in the general community. There are no blood tests to screen for HPV. Pap tests in women can detect HPV infection and identify early cancers or pre-malignant lesions. Similarly, anal Paps should be performed periodically on men who have receptive anal sex with men, especially those with a history of HIV or peri-anal warts(HPV), to screen for anal cancer. There are effective HPV vaccines for those 26 yrs. old and younger. All teens and young adults are encouraged to receive the HPV vaccine before they become exposed.