Sexually Transmitted Infections - a short course

Published:

Dear Dr. Myrtle,

I am interested in becoming sexually intimate with someone, and I am having a hard time finding out more about sexually transmitted diseases. Can you give me some information about things I should be thinking about?


Sometimes I talk people who are unclear about the potential for sexually transmitted infections. Trying to get their pleasure needs met, some are reluctant to protect themselves from something that they can’t see or "believe". Others find themselves terrified at the possibility of becoming infected or passing an infection to someone else. There are elements of truth in both positions, and it’s hard to make decisions with little (or no) information.

Sorry for interrupting, but why do you say "sexually transmitted infections", instead of "STDs" or sexually transmitted diseases?

Ah, you noticed. It’s because I think we need to leap out of history and confront reality - these aren’t diseases that we’re talking about, they’re infections. A long time ago, before science knew anything about bacteria or viruses, some people would "get diseases", and some people thought that Venus had something to do with it. (This is where the old term "venereal diseases", or "VD" came from.) Now that we know that people are being intimate and contracting infections (in the same way that we catch a cold), rather than being cursed by a "disease", I think we should talk about sexually transmitted infections (STIs), instead.

I like to think of STIs in a different way. Consider this from an microbe’s point of view: they’re just looking for a good home. A microbe wants to find just the right environment where they can survive, set up a home, eat, and raise a family. Maybe set up the ranch for their kids.

The problem with this is, of course, you don’t want to have a virus or bacteria (or whatever), setting up home in your urethra, cervix, skin, spinal cord, etc. Live and let live only goes so far when there are consequences for your health, or your partner’s or family’s health. (Maybe you had other plans for your body.) Any infectious particle or microbe is looking for opportunity, and if you provide it with a passage to a nice place to grow and thrive, it takes advantage of that opportunity. If you don’t want something living with or in you, then you have decisions about your behavior that can make it difficult to become a condo complex for sexually transmitted infections.

So what does it mean to have a "sexually transmitted infection"?

It’s important to realize that not everyone has a sexually transmitted infection. On the other hand, many people who think that they don’t have an infection, do. For instance, we don’t often think of "mono" (Epstein Barr Virus Infection) as potentially sexually transmitted until you remember the label "Kissing Disease". Infections such as CMV, Herpes, and EBV (see the table below) are frequently passed between people with kissing (aka "oral contact").

It’s also important to realize that not everyone who has a particular infection got that infection through sexual contact. Infections such as warts - yes, those same old ones on your hand or eyelid - are transmitted by contact between humans. Is this "sexually transmitted"? Maybe - it depends on what you were doing when you touched another human. Genital warts (HPV) are transmitted between people who touch, although they are caused by different subtypes of the same virus (HPV) that causes the warts on your fingers. The warts are called "genital warts" only because the infection involved the "genitals". Herpes Zoster (shingles) is often not contracted sexually (rather, someone gets chicken pox as a kid), but it’s on this list because it can be sexually transmitted as well.

I thought you could tell if someone had a sexually transmitted infection by looking for sores or discharges.

While this is sometimes true, you usually cannot tell if someone has a sexually transmitted infection just by looking at them. Most people do not know that they are infected (they do not have symptoms) unless they have laboratory testing. While it’s true that some infections are more often noticeable (men often have severe urethral burning with gonorrhea, while women sometimes have vulvar itching and increased vaginal fluid with trichamonas), most people find out about sexually transmitted infections by getting themselves tested by a health care professional.

How many infections are there? It doesn’t really matter how many infections are possible, right? It matters more that:

  • as a group, they are really easy to get,
  • many adults in the U.S. population have them without knowing it,
  • you almost never know when you’ve been in contact with someone who has an infection (because they don’t have symptoms), and
  • some are completely curable, while all the rest are treatable, but not curable.

How many infectious "thing-ies"? The best answer is "some". More than you’d think, maybe, but not enough to make touching someone else a bad thing.

You see, it’s not going to help to think about the number of infections that can be sexually transmitted. I have never met someone who intentionally decided that "... today, I want to get Chlamydia! ..." You, me, and the rest of the world are being sexually intimate for reasons other than catching an infection.

What’s most important is that you have regular infection screenings by a healthcare provider. If you screen yourself and ask your partners to be screened before you are sexually intimate without barriers, you can make informed decisions about whether you want to risk getting that infection.

Consider this example: "Alex" meets "Ronnie". They are really attracted to each other, and decide to be sexually intimate. Because they don’t know what they may have come into contact with previous sexual partners, they use barriers consistently until they can make appointments to be seen by their healthcare professionals. Because they have access to free or reduced-fee infection screening, they request testing for chlamydia, gonorrhea, trichomonas, Herpes, and HIV. Until they get the results back, they continue to use barriers and safer-sex techniques, but "Alex" thinks this is fun since it prompts them to come up with some outrageously fun things to try.

"Alex" was positive for chlamydia, is treated (and cured) by the clinic, and has no other evidence of transmissible infections. Alex never had any symptoms of an infection, ever, and is pretty surprised by the news.

"Ronnie’s" blood showed evidence of previous exposure and infection by the herpes virus type 2. Ronnie has no idea how this could be, because Ronnie has never had any sores and has had very few other sexual partners. Ronnie’s healthcare provider explains to both Alex and Ronnie that more than 20 percent of the adult population in the U.S. has Herpes, and most (80 percent) are unaware that they have the infection lingering in their body. The provider also explains that the infection is lifelong, although there is treatment which can help clear an outbreak, as well as suppress outbreaks from happening. The provider also mentions that Alex could be infected by Ronnie through intimate contact even if Ronnie is not having an outbreak of painful sores.

Now, Alex and Ronnie have some decisions to make.
Do they still want to be intimate together? If yes, then how will they use barriers and toys together?

  • Sure, why not. But they decide to use barriers for genital contact with Ronnie, not share sex toys, and be more aware of washing their hands after being intimate.
  • No Way! Alex freaks out and decided to end the relationship. (Ronnie decides that it is just as well, because if Alex can’t work on being creative about the solutions, then Alex isn’t enough of a partner for Ronnie.)
  • Absolutely. You only live once. Barriers be damned, and they slosh their sexual juices with abandon.

The exciting part of this is that it’s how you touch, not that you shouldn’t touch. Alex is an adult, and can decide whether to accept the risk of getting Herpes from Ronnie. Ronnie is an adult, and can decide to insist on the consistent use of barriers, because Ronnie doesn’t want this to pass to someone else. The key is now each person has the information to make decisions for themselves. If they were sexually intimate without getting tested, then the worst infection epidemic (chlamydia is the #1 bacterial infection; HVP is the #1 viral infection) in U.S. history would go on rumbling over their lives.

Get yourself tested today for sexually transmitted infections if you have ever been sexually intimate. Each new partner and you should undergo screening, and make decisions based on the results. Screening needs to be done before you decide not to use barriers, and screening done " ... last year sometime ..." doesn’t count. Empower yourself to have the most flagrantly pleasurable sexual life you choose for yourself, and keep your health, too.

Take Care,

Dr. Myrtle