Off to College? Avoid Herpes 101

Bloomberg View , August 15, 2014

Talking to college doctors is fascinating and scary. The people who run campus health services have a unique window onto campus life. They see all kinds of students. They ask all kinds of questions. They don’t give out grades. And they know the hazards of the environment.

College doctors learn to expect a Monday morning parade of fractures, the products of weekend partying. They counsel students whose first intimate sexual experiences have left them with HIV or, more commonly, Type 1 herpes, which now constitutes about two-thirds of new genital cases among young women. They treat everything from malaria (a hazard of trips to exotic locales) to upper respiratory infections. Lots and lots of upper respiratory infections.

Earlier this summer, I spent several days hanging out with college doctors at the American College Health Association’s annual meetings. I listened to presentations on such perennial topics as mononucleosis and student drug use. I toured an exhibit hall that lived up to one doctor’s description: “a lot of condom vendors” (also health insurance). Most important, I chatted with attendees about what parents and students need to know about staying healthy at college.

Most of that advice isn’t exactly cutting-edge. “Wear shoes so you don’t come in with glass in the bottom of your foot” comes to mind, along with the related “Have at least one pair of shoes that aren’t flip-flops.” “Don’t play with stray or wild animals that might carry rabies.” “Wash a wound with soap and water before putting antibiotic ointment on it.” These tips may sound like common sense, but they reflect problems college doctors run into fairly often. Sometimes even the obvious stuff needs to be spelled out.

I’ve gathered the advice into two lists: one for parents before and after kids enter college, and the other for students on their own. Both audiences can learn from the lists, of course, so share the link. Let’s start with what parents should keep in mind as their children enter school this fall:

1) Regardless of what the school requires, have your student get the full range of vaccines. Minimum requirements reflect state politics, not medical advice. College doctors recommend more. Entering students will probably already have had hepatitis B and mumps-measles-rubella vaccines early in life. If not, they should get them, along with vaccines for meningitis; human papillomavirus (HPV); hepatitis A; and tetanus, diphtheria and pertussis (Tdap).

Although hepatitis A doesn’t cause chronic liver problems, it does give you a nasty gastrointestinal illness that could wreck a semester. And, surprisingly, many college students come down with pertussis (whooping cough), not because they were never vaccinated for it but because the vaccines they had as babies have worn off. If, like me, you remember wrenching coughs that lasted for months after your other symptoms had passed, you probably had it, too. It’s rarely life-threatening in young adults, but a booster shot that includes pertussis, not just the tetanus-diphtheria mix we of a certain age received, can save your kid a lot of pain.

If a student hasn’t had the full range of vaccines before starting school, most college health centers offer them. Around October, students should also get an annual flu shot, often offered at special campus clinics.

2) Make sure your child learns to swallow a pill. Like Velcro sneakers, liquid medications have left a generation of kids bereft of a basic life skill. They can practice with Tic Tacs.

3) Connect with local specialists. College health centers are staffed by primary-care physicians. A student with a chronic disease such as diabetes should have a local specialist, just in case. Ask your local physician for a referral or get one from the college health service. This recommendation goes double for psychiatrists and counselors. If your child has been in psychological care, find a local specialist, and don’t expect to rely on phone consultations. Unless your child has a car at school, figure out the transportation in advance.

4) If your child wears contacts, make sure she comes to school with an updated pair of glasses.

5) Arrange for disability accommodation, even if you don’t expect to need it. If your child had a 504 plan in high school, do all the paperwork, even if you don’t plan to ask for accommodations in college. “Everyone who goes off to college is very optimistic,” says one college doctor, and students with disabilities sometimes find themselves needing more adjustments than they hoped. It’s better to navigate the bureaucracy in advance, when you have plenty of time, than to deal with a crisis.

6) When you arrive on campus, visit the college health center. This makes sure students know where it is -- yet another example of planning ahead. Also, it gives parents a chance to meet the doctors before the cone of confidentiality descends.

7) Check on health insurance. Student fees generally cover services at the campus health center, and college doctors are often more generous with their time than the typical primary-care physician. (Different schools have different policies about billing insurance.) But if a student needs a trip to the emergency room or something else the college can’t provide, insurance comes into play. If you have insurance, find out how it applies, especially if the school is out of state. If you don’t have insurance, ask the student health center what the options are.

8) Hit the drugstore. Start equipped with a supply of over-the-counter medicines, as well as maintenance medications for chronic conditions. Bring basic first-aid supplies. Buy sunscreen (and send your kid a new supply in the spring).

9) Stay in touch. Respect your kid’s independence, but set up a schedule to talk regularly (which does not mean daily). Visit campus during the year, and take your child and friends out to dinner. Knowing their friends is important. “Students need to find connections to people who are good for them, not bad for them,” says a campus physician. As with specialists, electronic communication is never as good as laying eyes on the situation. Realize, too, students and college experiences vary enormously, so your own college life wasn’t necessarily the norm then and almost certainly isn’t now.

10) Be aware that trouble at home spills over into college life. Divorce, money problems or the death of a grandparent can damage a student’s mental and physical health, derailing a college career. Let the college know what’s up and let your kid know it’s OK to ask for help. Helicopter parents drive college docs crazy, especially when they second-guess medical decisions, but parents who pay no attention to their kids’ college lives worry them more.

OK, parents. That's it for you. Here’s my advice specifically addressed to students.

When you go away to college, everything changes: the hours you keep, the people you live with, the food you eat, the way you spend your leisure time, even the bed you sleep in. The climate may be different. You may be living -- and walking, biking or skateboarding -- in a city for the first time. Or you may suddenly be in the boondocks. You’re surrounded by people who are far more diverse, in every respect, than your family members and likely more varied than the kids in your high school. You’re newly responsible for things you may have never had to worry about, from getting yourself up in the morning to remembering to buy toothpaste or get a flu shot. And that’s not even considering the academic demands.

All this change makes college exciting, but it also can wreck your health. Students often don’t realize how much stress they’re under until they’ve been to the campus health center with several different illnesses. So here's my advice:

1) Get enough sleep. Easy to say, hard to do. (I spent my own college years in a constant state of severe sleep deprivation.) The most practical version of this advice is to know whether you’re someone who can sleep whenever you have the opportunity -- that’s me, fortunately -- or whether you need to stick to a schedule. If you need a routine, don’t let weekends throw you off. Stay within two hours of the same bedtime every night and get up at the same time, even if you’re tired. Avoid the cascade of staying up later and later until you’ve flipped night and day. And if you need to stick to a schedule, don’t take a restaurant or bar job that will keep you up until the wee hours three nights a week. Find something that doesn’t affect your bedtime.

Ideally, you’ll get a roommate with matching sleeping habits, but if you don’t, stick to what your body needs. Let your roommate know that while it’s fine for her to stay up late, you’re going to have to hit the sack. This isn’t about changing or judging her behavior. It’s about knowing yourself.

2) If you were an athlete in high school, don’t give up on sports just because you weren’t recruited for the college team. The fun, the structure, the stress relief and the exercise are still important to your mental and physical health. Join an intramural team (or more than one). You might even try walking on to the intercollegiate squad. But don’t wait until your muscles have atrophied and you’ve gained the freshman 15 before you start exercising. Remember, sports can be recreation, not a job. Enjoy yourself.

3) If you get a cold, don’t take a multisymptom medicine. For a cough, take a dedicated cough medicine; for congestion, a decongestant. If you have multiple symptoms, you may need several different medications. Multisymptom medicines tend not to have a high enough dose of the active ingredient you need for what ails you.

4) Recognize your drinking limits. They may not be the same as other people’s or the same as they were for you the previous night. Avoid binge drinking, which is defined as four drinks in a two-hour period for women and five for men. It’s an independent risk factor for developing alcoholism. It’s also the reason college doctors see so many concussions and broken bones.

5) If you come home drunk, don’t take Tylenol to forestall a hangover. It can hurt your liver. Wait until morning.

6) Avoid stray dogs in foreign lands and cute kitties on the street. If you get bitten and the animal runs away, as is likely, you’ll have to undergo an extraordinarily unpleasant series of shots to make sure you don’t contract rabies and die. No matter how much you love animals and how harmless and adorable this one looks, stay away.

7) Three weeks is not a “long-term monogamous relationship.” Neither is three months. It’s no accident that condom vendors were well-represented in the exhibit hall at the ACHA. Sexually transmitted infections are a huge component of college medicine. Chlamydia in particular is rampant on campuses, and students often don’t know they’re carrying it. Although doctors attribute its spread to the “hookup culture,” you don’t have to participate in casual hookups to be vulnerable. Disease can spread easily through a series of exclusive relationships. Sexually active women should make sure they’re screened annually for chlamydia, which is treatable but can have serious long-term complications.

College physicians also see a scary number of cases of herpes, particularly in women who’ve received oral sex. The psychological effects can be as bad as the physical pain, especially for young women who’ve never had intercourse. “It’s really traumatic,” said one physician, who recommended using a dental dam or creating a makeshift one by cutting a condom longways. Most STI screenings don’t routinely test for herpes, but you can ask for a blood test for antibodies, which take about six weeks to show up after infection.

There are two herpes viruses: Type 1 and Type 2. Type 1 is traditionally thought of as the oral form, associated with cold sores in the mouth, but both types go both places -- genital and oral. That’s why oral sex often leads to transmission. Most herpes on college campuses is Type 1, which is good news and bad news. The good news is that many students have Type 1 antibodies because they got cold sores when they were little, so they’re unlikely to contract the disease. The bad news is that even if they have no symptoms, they can infect someone who doesn’t have the antibodies. That’s why about two-thirds of new herpes cases among young women are Type 1. They catch the disease from partners who don’t know they’re carrying it. Bottom line: Get a blood test. If you and your partner both have Type 1 antibodies, you’re highly unlikely to transmit the disease. But if only one of you does, be careful.

8) If you get mono -- and you likely will -- just take it easy.More than 80 percent of adults come down with mononucleosis before they’re 30, many of them in college. There’s no shortcut to getting well. You need to rest and conserve your energy. If you feel well enough to exert yourself, keep in mind you’ll probably be tired the next day, so focus on what’s most important.

9) If you get a cut, don’t just slap antibiotic cream on it. Once upon a time, pretty much everyone knew that the first thing you do with a cut is clean the wound with soap and water. But apparently that first-aid wisdom hasn’t been transmitted to the next generation. If the cut is severe or doesn’t close easily, go to the health center or emergency room for sutures right away. If a wound is too painful to clean, the doctor can numb it. If you don’t clean it, you’re likely to wind up with an infection that will hurt a lot worse.

10) Take advantage of the college health center. As salaried physicians whose services are covered by student fees, college doctors can spend a lot more time with their patients and see them more often than most primary-care physicians can. They don’t have to jam every conceivable issue into one 15-minute visit, and they can do more follow-up checks. Plus, they see themselves as educators who are there as much to answer questions as to administer treatments. They know a lot about negotiating college life. If you’ve got a question or concern, go see them.