Recent measles outbreaks, which have disproportionately impacted New Yorkers, feel like an unforced error. Although the measles/mumps/rubella (MMR) vaccine has been available for more than 50 years, the highly contagious illness has landed dozens in the emergency room. Time and science has proven that vaccines are safe and effective,  but there are still many misconceptions.

While most of the measles cases in the current outbreak in New York City are among children who were never vaccinated, 10 percent of confirmed measles patients are among those who had previously received a dose of the MMR vaccine, according to the New York City Department of Health and Mental Hygiene. Because the immunity conferred by the vaccine can wear off over time, this has prompted adults to seek another round of vaccinations that were previously completed in childhood. Erick A. Eiting, MD, MPH, MMM, Associate Professor, Emergency Medicine, Icahn School of Medicine at Mount Sinai, explains why some adults need “booster” vaccinations and which shots you may want to discuss with your primary care physician.

What is a “booster” and why might I need one for a childhood vaccination?

Booster shots are additional doses of a vaccine that was previously administered. Adults may need to “boost” their immune system so that they are adequately protected from an illness. The need for a booster shot depends on the person and the vaccine. Certain vaccines may be needed before international travel or after reaching a particular age. People who work in health care may need booster shots because they are exposed to certain diseases more frequently and need the extra protection.

Do I need a booster shot for measles?

If you have proof of immunity to measles, you don’t need a booster. Proof of immunity includes one of the following:

• Written documentation of two doses of the vaccine during childhood
• Lab tests that show enough measles antibodies in your blood
• Lab tests confirming an actual measles infection
• Being born before 1957

If none of the above applies, talk to your doctor about getting an additional dose of the vaccine. People with higher risk of getting measles (health care workers, for example) should get two doses.

What other booster shots may be needed as an adult?

In addition to MMR, you may need an additional vaccination for hepatitis A, typically a food-borne illness, and hepatitis B, transmitted through infected body fluids. Both illnesses can cause severe liver damage. Health care workers are usually required to get the hepatitis B vaccine, and the hepatitis A vaccine is often encouraged before international travel.

Booster shots are also required for the tetanus/diphtheria/pertussis (Tdap) vaccine.  This combination vaccine protects against tetanus, diphtheria, and pertussis (whooping cough). It needs to be updated every 10 years, although health care workers may be required to do so more frequently, and you will receive a booster if you get a cut that lands you in the emergency room. 

Which other illnesses should I be vaccinated against?

In addition to your annual influenza vaccine—which should be received by healthy people starting at six months—speak to your primary care physician about the following:

• Shingles. Adults over the age of 50 who have previously had the chickenpox should be vaccinated against this painful rash. Shingles comes from the same virus as the chickenpox and can flare up when the immune system is weakened, including during times of increased stress, following physical trauma, and while fighting a disease like cancer or HIV.   
• Pneumococcal diseases. Smokers over the age of 19 and adults over 65 should be vaccinated against this set of conditions. The vaccination protects against pneumonia (infection of the lungs), meningitis (infection of the tissue covering the brain and spinal cord), and bacteremia (infection of the bloodstream).
• Human papilloma virus (HPV). First introduced in 2006, this vaccine protects against HPV 16 and 18—the strains most associated with cervical cancer. Previously, the vaccine was only approved for those up to 26; however, the U.S. Food and Drug Administration recently approved the vaccination for people up to age 45.

There is a common belief that the purview of urologists is limited to the male anatomy. In dealing with the penis, prostate, and other portions of the male reproductive tract, urologists are essentially “gynecologists for men,” right?

Wrong. Urologists treat both men and women and there are many situations when a woman should check in with a urologist instead of a gynecologist. Barbara M. Chubak, MD, Assistant Professor, Urology, Icahn School of Medicine at Mount Sinai, explains what a urologist really does and why women should book an appointment.

What is a urologist?

Urologists specialize in the urinary tract and surrounding organs—including the kidneys, ureters, bladder, and urethra—as well as external genitalia encompassing the clitoris, vulva, vaginal vestibule, and introitus (the opening that leads to the vaginal canal). Gynecologists, by contrast, treat the female reproductive organs.

Additionally, urologists are both physicians and surgeons. Treatment with medicine or surgery is used as most appropriate for the disease and the patient.

So what kind of doctor should I see if I have a urinary tract infection?

A routine urinary tract infection can be managed by your primary care physician. However, if you get more than three UTIs per year or the UTI does not go away after antibiotics, it’s best to consult a urologist. In addition, the following serious symptoms definitely warrant a visit to a urologist:

• Blood in the urine
• Gravel or stones in the urine
• Increased or decreased urinary frequency or urgency
• Waking at night to urinate
• Difficulty getting the urine out or difficulty holding it in (i.e. urinary incontinence)

What female-specific concerns may bring me to a urologist?

A urologist can help with several common bladder issues that affect women following pregnancy, such as:

• Incontinence, or urine leakage
• Pelvic floor dysfunction, the inability to control the muscles supporting the bladder, vagina, and rectum
• Pelvic organ prolapse, the drooping of any of the pelvic floor organs, including the bladder, uterus, vagina, small bowel, and rectum

Additionally, if you are experiencing sexual dysfunction such as pain with sexual activity, lack of genital arousal, or lack of pleasure with sexual activity, a urologist may be able to help.

Sexually transmitted infections (STIs) can sometimes be a difficult topic to discuss. However, it is essential that sexually active people know about safe sex practices and be aware of their exposure risk. Dinaz Irani, MD, answers questions about STIs that will help keep you and your partners safe. Mount Sinai Urgent Care offers STI testing, if needed.

How do I know when to get tested for an STI?

It is important to get tested if you have had unprotected sex, sex with a new partner, sex with multiple partners, or sex with a partner who you know has an infection. Additionally, it is important to get tested if you have any symptoms of an STI. Anyone at increased risk for STIs should be screened even if they do not have symptoms.

Who is at increased risk for STIs?

The U.S. Centers for Disease Control and Prevention (CDC) recommends that all sexually active women under the age of 25 be tested for both chlamydia and gonorrhea annually. Chlamydia is the most frequently reported STI in the United States and is seen mostly in people between the ages of 15 and 24. Women 25 or older should be tested if they have a higher risk of having chlamydia or gonorrhea; this includes having new or multiple partners, having a partner with a known STI, or being pregnant. Routine screening for the infection is not recommended for men.

The CDC also recommends syphilis testing for anyone with symptoms of syphilis or who is sexually active with a partner who has syphilis. Syphilis is becoming more common and rates are increasing among men who have sex with men as well as heterosexual men and women. Pregnant women should be tested, as syphilis can be transmitted to an unborn baby. According to the CDC, men who have sex with men and sexually active men living with HIV should be screened for syphilis regularly.  The CDC also recommends that anyone taking pre-exposure prophylaxis (PrEP), daily medication taken to lower the risk of becoming infected with HIV, also be tested routinely for syphilis.

What are the symptoms of an STI and how are the infections diagnosed?

Common symptoms of an STI include genital or rectal discomfort, abnormal discharge, pain with urination, or genital or rectal sores. See a physician if you are experiencing any of those symptoms. However, many STIs do not cause symptoms so you will not know if you are infected unless you get tested. STIs can be diagnosed from urine tests, swabs, or bloodwork. Chlamydia, gonorrhea, and trichomoniasis can be detected via a urine test or swab. Herpes can be diagnosed by swabbing the sores themselves or through blood tests.  Syphilis, HIV, and hepatitis can all be diagnosed via bloodwork. 

Genital warts, molluscum contagiosium, and scabies can be diagnosed based on their appearance and typically do not require testing. Bacterial vaginosis and vaginal yeast infections can be diagnosed with swabs but are often easy to diagnose on a physical exam; although these are not considered STIs, their symptoms may be more noticeable after sexual intercourse. 

What happens if I have an STI and do not get treated?

Left untreated, STIs can cause very serious health conditions, including pelvic inflammatory disease, infertility, organ damage, certain cancers, and even death. Even the thought of contracting an STI can make some people anxious. At Mount Sinai Urgent Care, we want your experience to be fast, easy, and as stress-free as possible. To get tested, you can walk in without an appointment during our convenient daytime, evening, and weekend hours. We are even open on holidays.

Our physicians will discuss your concerns, perform a physical exam if needed, and treat you right away if appropriate. Most test results are complete within a few days. We will call you with your results as soon as they are available. If needed, a physician will discuss your results as well as how to prevent your partners from becoming infected and how to prevent infections in the future.