Ask the Doctors

Hello dear readers, and welcome back to our monthly letters column. Let’s dive in!

-- We had several questions regarding how E. coli is finding its way into romaine lettuce, and whether thorough washing can render suspect batches of leafy greens safe again.

To the first question, the answer is that there are numerous potential entry points in the food chain between farm and table. Contamination of E. coli can come from wild birds or animals, fertilizer, irrigation water and the many humans who handle our food as it moves through the stages of production. Each situation in each new outbreak is unique.

As to whether you can successfully wash E. coli out of your lettuce, the answer is no. Even after a sustained and powerful washing, enough of the microscopic toxins will remain in the countless nooks, crannies and crevices of the lettuce -- or other vegetables -- to get someone sick. The advice is to not only throw all suspect produce away, but to use bleach to clean the shelf or drawer it sat in.

-- After a column about the spike in STDs in young people, we heard from a reader regarding the HPV vaccine for older adults. Human papillomavirus, one of the most common sexually transmitted infections, can lead to cancer or genital warts. “News reports keep saying that teenagers should get the HPV vaccine,” the reader wrote. “But what about those of us over 30? Heck, I’m over 60 -- and I worry. Back in the day, we didn’t know about the risks of oral sex. We thought it was safe. Could you explain the risks -- and what we should do now?”

Gardasil, the HPV vaccine, was originally recommended for young people between ages 9 and 26 years. The rationale was that the optimal time for HPV immunization is prior to an individual’s first sexual contact. After age 26, there is an increased likelihood of prior exposure to HPV, which reduces the potential benefit of the vaccine. However, for anyone with no prior sexual exposure, or with a single sexually monogamous relationship, the risk of prior HPV exposure may be low enough to recommend the vaccine. The good news is that in October 2018, the FDA approved Gardasil for people aged 27 to 45. We hope that insurance coverage will soon follow.

-- After a column about an extreme reaction to a food allergen, a registered nurse from Wisconsin asked us to remind everyone of the lifesaving potential of the EpiPen. “I am an allergy nurse and feel there were missed opportunities to educate the public,” she wrote. “People with food allergies should avoid those allergens AND be prepared to promptly treat, if necessary, with injectable epinephrine.”

We’ve said it before and we’ll happily say it again -- if you have a food allergy, please always carry an EpiPen or other form of injectable epinephrine. It can save your life.

Thank you, as always, for your thoughts, comments and -- we’re always so touched -- kind words. We’ve had a lot of clinical questions lately, so just a reminder that unfortunately we can’t offer diagnoses or give second opinions. See you with more letters next month!

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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