Sexual Health: Coach Carr wasn’t completely wrong

Remember in Mean Girls, when Coach Carr tries to scare everybody out of sex?

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While that was a little extreme, sexually transmitted infections (STIs) can be very serious. To add to the confusion, the symptoms of a STI can range dramatically- from having no signs, to subtle changes, to making you incredibly sick or even causing cancer.

And STIs are probably more common than you think. Worldwide, there are nearly one million new infections with curable STIs every day1. Yes- every DAY. In the United States, about 110 million men and women have a STI. And the problem is getting worse- in 2015, the prevalence of chlamydia, gonorrhea, and syphilis was at an all-time high2.

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Credit: CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention

Let’s talk about how often you should get screened, and signs that you may have a STI. If you have any concerning symptoms, make sure to go see a doctor quickly, to keep both yourself and your sexual partners safe.

Screening

Many STIs are clinically silent; up to 70-80% of women with chlamydia report no symptoms. That makes it’s important to get screened at regular intervals, even if you have no reason to suspect you have a STI.

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Current US screening recommendations. Risk factors include unprotected sex with new partner, already have STI, having sex for money, and other high-risk behaviors. Recommendations differ for pregnant women. Defer to your healthcare provider’s individualized recommendations.

These are just recommendations for regularly scheduled screenings. If you’re a young person with no major medical problems, your main health screenings will be for STIs. Everybody should get testing if you had unprotected sex with a new partner (FYI testing may not be positive for at least 6-8 weeks). If you aren’t offered screening, ask for it. Your physician will be impressed that you’re such an empowered, conscious individual, so yay you!

What happens if you do contract one of these infections? Below are some of the more common symptoms of STIs, in order of prevalence.

HPV

HPV is the most common STI worldwide. As you may have heard, there’s two types of HPV: low-risk and high-risk. The low risk type cause genital warts. While they aren’t particularly attractive, they aren’t painful and don’t have any other consequences. But the high-risk type is associated with a significantly increased risk of cancer, most notably cervical, but also vaginal, penile, anal, and head/neck cancers. And there are no symptoms until cancer starts developing.

Over 250,000 women died from cervical cancer in 20123, and almost all were associated with HPV infection. This is why the HPV vaccine is such an amazing breakthrough- we have never before had such an easy way to prevent cancer. Make sure to check to see if you are vaccinated, and if not, talk with your doctor about if it would be a good idea. Men up to 21 and women up to 26 can get vaccinated (although check with your insurance too- some won’t cover it for people older than 18, womp womp).

Gonorrhea, Chlamydia, and Trichomonas

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The triple threat- I grouped these together because they tend to present very similarly. In both women and men, they often don’t cause symptoms. For women, it can cause changes in vaginal discharge, pain with sex or urination, or bleeding. In men, it can cause penile discharge, painful urination, or testicular swelling. All three can be treated with a course of antibiotics.

So what’s the big deal? In women, these infections can progress to cause Pelvic Inflammatory Disease, an ascending infection in the uterus and fallopian tubes that affects 800,000 women in the US every year4. It can present with severe abdominal or pelvic pain, fever, and generally feeling ill. Even if it’s treated appropriately, it leads to chronic pelvic pain in almost half of women, infertility in 19%, and an increased risk of ectopic pregnancy4. At the most extreme, it can be deadly.

HSV

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Herpes simplex virus, or sometimes referred to simply as herpes, causes genital warts. Before you develop warts, you may feel pain or burning in the area where they pop up. People aren’t typically screened for it, so if you develop any suspicious lesions, go to the doctor, and they may swab it to diagnose you. As one patient once said, “It’s the gift that keeps on giving.”  While you can take medication to prevent flares and decrease risk of transmitting it to a partner, there is no cure. If left untreated, herpes usually recurs; in rare cases, it can cause “encephalitis,” a brain infection which can cause seizures.

Syphilis

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Syphilis is one of the oldest known STIs. Originally brought to the Americas by sailors in Christopher Columbus’ voyage, the disease ran rampant in Europe, especially affecting prostitutes. The term femme fatale, or “poison woman”, is believed to be partially derived from the devastation of syphilis5. Despite its historical status, syphilis has been becoming more of a modern issue. The prevalence of syphilis is on the rise in the US, with more than triple the cases in 2014 compared to 20006.

The other problem with syphilis? It can present in a variety of ways, and is even called “the great imitator” because it looks like a bunch of other diseases. The first sign of infection is usually a painless skin lesion (“chancre”) at the initial point of contact, so usually on the genitals. If not treated, the chancre goes away. It will come back with a variety of different skin rashes all over the body, and possibly feeling ill (fever, weight loss, joint pain). In between these episodes, you can be completely asymptomatic as the syphilis is latent, although probably really confused why your skin has been breaking out in strange rashes. If it is still not treated, it can infect the brain (called neurosyphilis), leading to problems walking, vision changes, dementia, and psychosis.

I know I just terrified you with how devastating syphilis is, but good news is it’s easily treated with penicillin! So… silver lining?

HIV/AIDS

For most people, this is the big one- the STI that everybody knows and dreads. As prevalent as it is, Human Immunodeficiency Virus (HIV) is a fairly new disease, first being discovered in the 1980s. While initially it was most prevalent in homosexual men, it is now found in people of all genders and sexual orientations. It can be spread through sex, sharing needles, or blood transfusions (although this is very rare now that we can screen blood bank products for the virus). In the past, there was concern that HIV could be spread through other types of contact, like handshakes, hugs, sharing drinks or swimming pools, leading to HIV+ people being segregated and publicly humiliated. This is NOT true.

If someone were to become infected with HIV, they may develop an initial short illness that looks like mono or flu 2-4 weeks after exposure. It’s very non-specific, and can include fever, rash, GI problems, or just generally feeling gross. It usually goes away on it’s own in 1-2 weeks, so for most people, not really enough to make them worried they have HIV. Then, the virus will become latent in the body for anywhere from 3-20+ years; this means there will be no symptoms, but they are still contagious. They would eventually enter into the last stage of the illness- AIDS.

So what’s the difference between HIV and AIDS? Acquired Immune Deficiency Syndrome (AIDS) is someone who is HIV+ who has developed an “opportunistic” infection, meaning an infection that most people with a healthy immune system would not get sick from. Depending on how severe their disease (based on a lot of things, including if they are treated or how long they have had it), they can become sick from microbes in our everyday lives, and be at increased risk for multiple cancers.

As devastating as HIV is, there is some good news- public health efforts to decrease incidence is working. In 2015, HIV had fewer new infections and claimed fewer lives globally than at any point in the last 20 years7. There is also a spectacular history of patients becoming involved in the drug development process, and because of them we now have multiple options for HIV treatment (if you have more interest in this, I definitely recommend How to Survive a Plague, a fascinating documentary on Netflix). HIV is transforming from a death sentence to a manageable chronic condition, but you need to be diagnosed and treated early.

Let’s Talk About Sex, Baby

Some of these diseases (including chlamydia, gonorrhea, HIV, and syphilis) are reportable diseases. That means your provider must report that there’s a new case to the public health department/CDC. Don’t worry, your identity will be kept confidential. These numbers are more to track epidemics, and see where they need to focus prevention efforts. There’s no secret list that they keep track of all of the names of people with STIs. However, part of having a reportable disease is that sexual partners will need to be notified, either by you or the health department.

Okay, the idea of telling someone you’ve had sex with that they have been exposed is terrifying. Especially if they’re someone you don’t speak to regularly, or if you contracted the STI from someone other than your monogamous partner. At worst, it can cause you to feel unsafe if you are in a controlling or abusive relationship, and in this case, talk with your physician or someone you trust, and make sure to prioritize your own safety.

If you don’t feel comfortable telling your partner, there are other options: the public health department can notify them, and they will keep your identity secret. They would just say that they have been exposed and they should get tested. If you have a non-reportable illness, like HSV, but you still want to anonymously notify partners, there are some notification services, like Don’t Spread It, that can provide a way for you to do that. Going forward, if you have a chronic STI, you will also need to tell new potential partners. The STD Project has some good concepts and resources for how to prepare for that.

Knowledge is power. And everybody deserves that, including Tinder guy, your sleazy ex- but most importantly, you. Sharing that knowledge with others will help them take better care of themselves, and prevent further spread of disease.

Nobody thinks it will happen to them. But there’s something you can do about it.

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If you have more questions, talk to your doctor. There is also more information on the CDC and Planned Parenthood websites.

 

Works Cited

  1. Newman L, Rowley J, Hoorn SV, et al. Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. Plos One. 2015;10(12). doi:10.1371/journal.pone.0143304.https://www.cdc.gov/nchhstp/newsroom/2016/std-surveillance-report-2015-press-release.html
  2. Reported STDs at Unprecedented High in the U.S.: Press Release. CDC. October 2016.
  3. World Cancer Report 2014. World Health Organization. 2014. pp. Chapter 5.12.
  4. Sutton MY, Sternberg M, Zaidi A, St Louis ME, Markowitz LE. Trends in pelvic inflammatory disease hospital discharges and ambulatory visits, United States, 1985–2001. Sex Transm Dis. 2005;32(12):778–784.
  5. Hughes, Robert (2007). Things I didn’t know: a memoir(1st Vintage Book ed.). New York: Vintage. p. 346.
  6. 2014 Sexually Transmitted Disease Surveillance. CDC. November 2015.
  7. HIV: from a devastating epidemic to a manageable chronic disease. World Health Organization. 

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