351 - Safer Sex Part 1
Nothing without risks
Sexual health is an important topic that spans many more things besides simply condoms and abstinence. Sex, like everything, has risks, and the more informed we are about what they are and how to keep ourselves and everyone else healthy.
A few terms and clarifications first:
An STI is any sexually transmitted infection. Infections are a common thing in humans. STIs are just a term for certain viral, bacterial, or other infections that tend to be transmitted through the exchange of bodily fluids. Some STIs can be contracted through non-sexual situations. Similarly, it’s possible to have an infection from something like the common cold virus in your urethra that can seem like an STI.
An STI may develop into an STD (sexually transmitted disease), which happens when pathogens disrupt normal body function or damage structures in the body. Not all STIs will develop into STDs. For instance, the human papilloma virus (HPV) is an STI, and if it develops into genital warts or cervical cancer, it is then considered an STD.
Safer sex is preferred over the term safe sex, because it’s not about removing 100% of the STI risk from sex (that would be impossible). It is statistically more likely that people are 20 times more likely to die on a car trip than from contracting HIV. Instead, safer sex refers to anything we do to lower the risk of STIs, including selecting sexual activities or using barriers.
Understanding common STIs
HPV - Human Papillomavirus
The most common STI with an estimated 90% of people being infected at some point in their life.
There are no tests to determine “HPV status,” only tests to screen for related cervical cancer in cervix-possessing people over 30 or by doing a biopsy on a wart.
Many different strains, many of which have no symptoms.
Some strains have been linked to certain types of cancer.
Some strains can cause genital warts.
Symptoms may not show up for years so it can be very hard to identify its source.
There is a vaccine:
Generally only given to people under 26 but you may be able to get one up to age 45 if you talk to your doctor about it.
Only prevents a few strains of HPV, but they are the ones the cause most HPV-related cancers.
HPV rates have decreased significantly since the vaccine was introduced in 2006.
HSV - Herpes Simplex Virus
Related to chickenpox and mononucleosis, both of which are also super common and also stay in your body for the rest of your life.
Transmitted by contact, which includes kissing.
There are two strains of herpes, HSV-1 and HSV-2:
HSV-1 is most often found in oral herpes but can also be transmitted genitally.
Estimated at over 60% of the population and most never know it.
HSV-2 is genital.
Both strains often have no symptoms or may have a small number of outbreaks in life.
Symptoms involve outbreaks, which generally start as a tingling sensation around the genitals, anus, thighs, or mouth, and then lead to blisters or sores. An outbreak generally lasts 2-7 days.
While it can be transmitted even when dormant, it is much less likely to do so.
Treatments exist, which can keep outbreaks to a minimum or even eliminate them. Talk to your doctor about the pros and cons of medical treatment based on your experience.
The CDC does not recommend testing for people without symptoms because:
The rate of false positives in tests is somewhat high.
Studies have not shown that diagnoses actually increase barrier usage.
“The harm of a possible false positive test may be a greater concern than the benefits of an actual diagnosis.”
You can get tested, though, you just need to convince your doctor.
Trichomoniasis
The most common curable STI.
It is a protozoan parasite that generally infects the lower genital tract in AFAB bodies (vulva, vagina, cervix, or urethra) and the urethra in AMAB bodies.
70% of infected people have no symptoms.
Symptoms include inflammation, itching, irritation, redness, burning after urination or ejaculation, and discharge from penis or vagina.
Can be cured with antibiotics.
It may also go away on its own but will likely last much longer and might develop a more severe infection.
Scabies and Pubic Lice
Small parasitic mites that can cause irritation and infection (very similar to head lice, chiggers, and fleas in that they are an actual creature, rather than a virus, bacteria, or fungus).
Can last a long time without treatment and are contagious.
Generally easy to cure and often doesn’t even involve prescription drugs.
Syphilis
Bacterial infection.
Symptoms usually show up 10-90 days after infection.
Starts with one or more sores, which can look like many other diseases.
Very easy to test for and can be cured with antibiotics if identified.
If untreated, can lead to incredibly serious health consequences and can infect a baby in the womb.
Get tested regularly and take your full course of antibiotics if contracted.
Hepatitis
There are three types of hepatitis viruses: A, B, and C.
Affects the liver.
No sure-fire cure exists but there are treatments.
Most cases don’t cause symptoms and will resolve on their own but it can become chronic so it’s important to have your doctor monitor your liver and look into treatments.
Vaccines exist for A and B and most children in the US born after 1991 have already been vaccinated.
Hep C is usually transmitted via blood to blood contact, such as sharing needles, but it can be transmitted sexually less commonly. According to the CDC, over 90% of people with chronic Hep C can be cured with treatment.
Chlamydia & Gonorrhea
Very similar to each other in their symptoms and risks.
More than half of people don’t experience any symptoms.
Symptoms generally include discharge, pain, or a burning sensation when peeing.
Has potential to cause more serious or permanent health problems if left uncured.
Can be cured with antibiotics.
Condoms protect very well against them both.
HIV - Human Immunodeficiency Virus
For much more in-depth info, check out episode 197 about HIV/AIDS.
Virus that weakens the immune system and if left untreated can develop into AIDS (Acquired Immune Deficiency Syndrome), where the immune system is weakened to the point where severe infections, called opportunistic infections, are more and more common, eventually resulting in death if untreated.
Cannot be cured but very effective treatments exist now.
PEP and PrEP are two different pills that can help prevent but not cure:
Pre-Exposure Prophylaxis is called PrEP:
Taken by HIV-negative people who are at risk of being exposed.
Taken once daily. Can reduce risk of sexually transmitted HIV by more than 90%.
Requires prescription but in the US almost all health plans cover it 100%. Also many state and federal programs exist to help uninsured people.
Post-Exposure Prophylaxis is called PEP:
Must start taking it within 72 hours of possible HIV exposure (sooner is better).
Treatment is taken for 4 weeks.
Financial support options are available (hiv.gov is a resource for this information).
The science is clear with HIV: Undetectable = Untransmittable.
If someone with HIV follows their treatment and maintains an undetectable viral load, they cannot transmit the virus to others. Many studies have recreated these findings.
Your risk of HIV infection from someone who knows they have it and maintains an undetectable viral load is 0, while sex with someone who doesn’t know their status is a potential risk.
Knowledge is power
Some overall main points to remember:
STIs and STDs are extremely common, much like chicken pox and strep throat.
The majority of people with STIs don’t have symptoms and can pass it to others.
All STIs are treatable, meaning there is some kind of medical intervention to improve symptoms or possibly keep it under control completely.
Most STIs are even curable with antibiotics or antiviral medications.
But treatment or a cure won’t help you if you don’t know you have it, which can lead to much worse symptoms (not to mention passing it to others).
Certain STIs like HSV and HIV can have varying levels of risk based on preventative medication or presence of an outbreak. The risk of transmission is not equal all the time but you need to know you have it and learn about it in order for that to help you.
Testing for STIs
The standard STI panel given by most clinics only includes screening for 4 STIs:
Gonorrhea, Chlamydia, Syphilis, and HIV because these are ones that can be asymptomatic or easily missed but can have serious or fatal consequences if undetected.Some expanded screening tests may also include trichomoniasis and Hepatitis B & C.
Doctors generally won’t test you for herpes unless you have an active infection or you specifically tell them to (and even then you may have to convince them you can handle the info).
Any time you’re getting tests done, be sure to ask which ones they are testing for and understand what that means.
Free and low cost testing is available in most US cities through clinics.
Consider setting up a personal testing schedule to make sure you’re up to date on your health.
Talking about it with others
Fight against the stigma:
The stigma of STIs potentially causes more harm than the actual STIs do, or at least makes them more dangerous.
Don’t make STI jokes. There are other, better ways to be funny.
Don’t use “clean” to refer to a negative test result:
To say you are “clean” of STIs means you think anyone who has them is dirty.
Getting sick is part of life. We’ve all had colds, chicken pox, rashes, flus, or other infections. They don’t make us unclean.
There is no STI panel that tests “for everything,” so this is literally impossible to know.
Share your negative status when appropriate, not as a status symbol:
It supports stigma against people with STIs.
It is relevant to discuss with a partner before a sexual encounter, not on your dating profile
For many of us, if we see someone say this, it immediately makes us less likely to trust them because it signals that they don’t really understand STIs.
Sexual Health does not mean absence of infection:
Sexual health refers to many things, including mental health, awareness and access to treatment of STIs, freedom from coercion and stigma, sexual healthcare, pregnancy or birth control, and many other things.
Don’t assume anyone’s STI status:
Always talk about STIs as if someone with an STI is listening (because they probably are).
Almost everyone will have at least one in their life and the emotional impact can be more devastating than the actual infection could ever be.
Studies have shown that while most people assume polyamorous or consensually non-monogamous folks have more STIs, on average they have a lower rate of STI transmission despite having equal or more sexual partners.
This is attributed entirely to the fact that they are more likely to be more informed, talk more openly about their sexual health practices, and more likely to practice safer sex.
Those traits are not exclusive to non-monogamous people and can be adopted by anyone.
Share this information!
The only cure for STI stigma is education and increasing the number of people in the world who bother to learn about them and talk about STIs in a matter-of-fact way.