• Laura Boyle

Just The STI Facts, Ma'am

Updated: May 30


If you don’t get my extremely dated reference, that man is a character from one of the first police procedurals, the 1950s Dragnet, Joe Friday, who is credited with coining “Just the facts, Ma’am,” although his character never actually said exactly that; rather, he said a hundred varieties of sentence that included “the facts” and “ma’am” and the media condensed it.


Disclaimer: I am not a doctor. Please see your doctor, and not some research I put together in the winter of 2020, if you believe you have an STI and need treatment.


Now, some STI facts.


What does STI stand for? An STI is a Sexually Transmitted Infection. It’s commonly used for what was called a Sexually Transmitted Disease for many years (the Center for Disease Control, CDC, has continued using STD although sexual education and medical professions have changed from the word Disease to Infection because infection is seen to carry less stigma), and was called a venereal disease (or not mentioned at all) for decades prior.


Ok, so like… AIDS? HIV/AIDs, and a lot of other infections, depending how broadly you define sex. The classic “STI testing panel,” as suggested by the CDC if you have new sexual partners, is gonorrhea, chlamydia, syphilis, HIV, and Hepatitis B & C; as well as women having a pap smear every few years to check if certain strains of HPV have caused irregular cell growth. Additionally, many doctors test for trichomoniasis, and BV can be sexually transmitted. Note that this doesn’t include any mention of HSV (herpes), or any of the “cruds” that can run through a whole polycule- flu, colds, noroviruses, any virus you can think of that you pass by droplets or easily by kissing and close contact (like sexual contact). We’ve decided some of these are “sexually transmitted” and some aren’t - and HSV is right on the border, because lesions can appear anywhere on your body, although they’re most common on mouths and genitals, so it can easily be transferred with or without sexual contact; yet it’s one of the most stigmatized STIs.


Today, we’re going to go over some facts about STIs, their frequency in North America, and typical medical advice for testing and prevention of their spread.


Gonorrhea



It is a bacterial infection caused by a bacteria called Neisseria gonorrhoeae. It most commonly infects the vagina, cervix, uterus, penis and fallopian tubes, and can exist in the anus, throat, or mouth as well. It’s relatively common, over 500k reported cases in the last year I could find data for (2018).


People with vaginas are more often infected with it than people with penises, but also are much more likely to be asymptomatic.


If symptoms show, it is usually within the first week of being exposed, but may take up to a month to manifest.


Genital infections symptoms for people with vaginas include a burning feeling while urinating and yellow or bloody discharge. If not treated they may lead into abdominal pain and Pelvic Inflammatory Disease (PID), which can cause infertility and bladder issues. For people with penises, they include the same burning, greenish-yellow or white discharge, and painful or swollen testicles. They can also develop bladder issues, as well as infertility and urethral issues, with untreated gonorrhea, but they are much more likely to seek treatment because they are more likely to have symptoms.


Throat and mouth infections are most often asymptomatic, and cause fewer potential complications.


Rectal infections involve anal itching, discharge and soreness or pain.

In extremely rare cases, gonorrhea can enter the bloodstream and cause severe complications or death. This is most likely in the case of immunocompromised people, such as HIV/AIDS patients or cancer patients undergoing treatment.


Diagnosis is by testing a discharge sample, taking a swab of the affected area, or by urinalysis.


There are several different antibiotics used to treat gonorrhea. In recent years antibiotic-resistant strains have become more common, and may require more than one course of antibiotics. Additionally, you can get it more than once, so making sure all your partners who may have been exposed, and their partners in turn if there are any positive results, is important to avoid re-infection.


Regular testing and barrier use (condoms, dental dams, and gloves) consistently and correctly is the best way to prevent the spread of gonorrhea.



Chlamydia


Chlamydia is a bacterial infection. It affects people with vaginas more often than people with penises. In people with penises it typically begins in the urethra and spreads from there; in people with vaginas it most often infects the cervix first and then spreads to the urethra, fallopian tubes, and ovaries if untreated.


If untreated it can cause infertility, ectopic pregnancies, and bladder infections as well as PID.


Diagnosis of genital cases can be completed by urinalysis.


Chlamydia is extremely common. 50% of women by age 30 demonstrate signs of a past chlamydia infection. Nearly 2 million cases are reported each year in the USA.


Much of that high number is because of improved rates of testing, because most cases do not include symptoms. Of those that do, the ones in people with vaginas include painful intercourse and painful urination, some in all people may include fevers or abdominal pain, and the ones in people with penises include discharge.


Luckily, chlamydia can be cured with antibiotics. However, it is extremely important to make sure partners get tested, and as it can also infect the throat, make sure a throat swab test is done as well if someone is positive on a genital infection. After the course of treatment is complete, re-test to make sure it has been effective, as this is also an infection that has antibiotic resistant strains.


Regular testing and barrier use (condoms, dental dams, and gloves) consistently and correctly is the best way to prevent the spread of chlamydia.



Syphilis


Syphilis is caused by a bacteria called treponema palladium, and unlike chlamydia and gonorrhea, affects more people with penises than people with vaginas. It is passed through contact with a sore on an infected person’s body. These are usually on people’s mouths, genitals, or anuses, although they could be on any part of someone’s skin.


Syphilis is beginning to decline again, from a high a few years ago of reported cases. There were 36,000 cases in the US in 2018, according to the CDC. There is a theory that syphilis cases go in about ten year cycles up and down. However, the US is trying very hard to eliminate syphilis by finding and treating cases, so maybe the numbers will continue to drop.


Syphilis has 4 stages, each with different symptoms. 1 is a chancre, or kind of sore, at the point of exposure to the disease. It appears one to six weeks after exposure, and may not be noticed by the person with the infection, because it can be painless and hidden inside the mouth, vagina, or anus. 2 is a skin rash, which appears as a series of sores, some of with are the size of pennies, and which are contagious and filled with bacteria. This is the most contagious stage. If not treated, the rash will pass and the person will enter stage 3, the latent stage, where one can’t pass it on to anyone else but also the bacteria remains in the body. This stage can last many years. If it continues untreated, stage 4 causes many full-body issues, including heart, vision, liver, and brain issues. Death can be the ultimate result of untreated syphilis.


Penicillin can usually cure syphilis, but if the person has had it more than a year more than one course or more than one antibiotic may be needed to completely clear the infection. All partners should get tested and appropriately treated as re-infection is possible.


Regular testing in case you don’t happen to notice symptoms on internal or hidden portions of skin like mouth, vagina, or anus, and barrier use, are your best bets for preventing and promptly treating syphilis.



HIV


Human Immunodeficiency Virus (HIV) is the virus that causes AIDS. It attacks the body’s immune system, making it impossible for the body to fight off even minor illnesses like the common cold.


According to the WHO there are nearly 38 Million people living with HIV worldwide. In Africa, infections are at truly crisis levels of transmission; 25 million cases are there. About 4 million current HIV cases are in the US and Canada.


It is transferred by bodily fluids - blood, semen, penile and vaginal secretions, and breastmilk. Testing can find trace amounts of HIV in saliva, but kissing has never been found to be a source of transmission - unprotected oral, anal, and vaginal sex, sharing needles, HIV+ mothers breastfeeding, blood transfusions in unsafe conditions, and wound-to-wound contact that exchanged blood are the proven sources of HIV transmission.


It can take 3 months for antibodies to appear in your system, so a negative test after unprotected sex with a partner that would be accurate for many other STIs should be repeated 3 months later to be reflective of HIV status. There is a blood test that is screened for these antibodies as standard HIV testing.


Luckily, through an intensive combination of antiretroviral drugs and consistent healthcare, the evolution of HIV into AIDS can be slowed immensely, and people who are HIV+ can live long, full lives, unlike the years of the first AIDS crisis, when the antiretrovirals had not been developed and a diagnosis was functionally a death sentence.


While cures are being investigated, there is no cure for HIV currently.


Annual or semi-annual HIV screenings for yourself and your partners, using condoms for oral, anal, and vaginal sex, and being aware of the STI statuses including HIV statuses of your partners’ networks can all help prevent the spread of HIV.


PrEP is a daily medication now available to help prevent the spread of HIV, it is meant primarily for the HIV negative partners of HIV positive people. There are other groups who it may be useful for. PEP is a short-term medication taken after an exposure to HIV. Scarleteen has an excellent write up on the details of PrEP, PEP, and and other biomedical means of preventing the transmission of HIV here: https://www.scarleteen.com/article/sexual_health/the_real_deal_on_hiv_prep_and_pep



Hepatitis:


Hepatitis A is not typically transmitted via sex, and there is an available vaccine, so it is not a major concern for this.


Hepatitis B also has a vaccine and is less of a concern in North America as a result; generally, using barriers and avoiding blood contact is sufficient for prevention even if you are not vaccinated. Symptoms appear within 90 days, and involve an acute stomach bug that can last for up to 6 months. 95% of Hep B cases resolve on their own, but the 5% that don’t can cause liver disease, which is extremely dangerous. If discovered early, there is treatment that can be used to make the virus inert to lower both that risk and the risk of transmission.


It used to be thought that Hepatitis C was only rarely sexually transmitted and was primarily passed through shared needles and occasionally through blood contact caused by edge-play BDSM actions, but some studies in the early 2010s seem to indicate that sex that is more “vanilla” can also spread Hepatitis C because of microtears in the vagina or anus. Using barriers and avoiding blood content is also the preventative measure to take for this variety of hepatitis.


Hepatitis C symptoms are similar to Hepatitis B symptoms; they can begin 2-12 weeks after exposure. However, Hepatitis C is different from B in that only 20-30% of cases get symptoms.


Like HIV, Hep C tests are antibody tests checking for antibodies that respond to the virus and then there is a follow up test to look for the virus itself.


There is an anti-viral treatment that can completely cure Hepatitis C, unlike Hep B. Direct acting anti-virals can cure anyone in 8-12 weeks. However, after being cured, re-infection is possible, so being careful to avoid infection risks is important.


Regular testing, using condoms on insertable toys and changing them between partners if you use the same toy with multiple partners, and not using any BDSM impact implements that get blood on them with anyone else.



HPV


Human papillomavirus, or HPV, is the name for the group of viral infections that cause warts. Not all forms of HPV cause visible warts, but all diseases that cause warts are strains of HPV. Not all forms of HPV are sexually transmitted. Of the ones that are, they are ranked as high risk or low risk. Low risk strains cause anal or genital warts, and high risk strains are asymptomatic but change cells and can cause cancer. The low risk strains are no fun to have, but won’t harm your health long term. 1 in 4 North American adults have a strain of HPV at any given moment, and if you’ve been sexually active, odds are you’ve had it at some point. Most people clear most of these infections on their own.


Therefore, we test for the results of high risk strains. Right now there is not a genital test for men although they are working on developing one. Women get their cervixes tested by having PAP smears to look for irregular cells. If they only have irregular cervical cells once, and the (more frequent than usual, annually) next PAP or two are normal, then their body cleared the virus. If the paps continue abnormal, there is surgery to remove the abnormal cells.


HIV+ people are recommended to get an anal pap smear to look for irregular cells in that area; recommendations are beginning to change and some providers are suggesting them for all men who have sex with men and women who have large amounts of anal sex, especially with multiple partners.


HPV, transmitted sexually or otherwise, that gets into the throat, if it is one of those high risk strains, it can cause throat cancer, and is one of the top causes of throat cancer.

It’s impossible to completely avoid risk of HPV strains, as they can affect anywhere on the skin, but the highest-risk strains now have a vaccine! The CDC recommends vaccination in children, beginning at age 9-15, who only require 2 doses of vaccine to be immune, and highly suggests it for anyone who has not had it ages 15-26, who require 3 doses. Insurance companies now will cover the HPV vaccine up to age 45, and if you’re sexually active, it is a REALLY GOOD IDEA. Generally, as with pretty much all of these STIs, consistently and correctly using barriers will lower your risk as well; as with all skin-contact transfer infections, the rate of effectiveness of barriers is about 70% rather than about 97% with consistent and proper use. So get the vaccine if you can, immunity to some of the worst strains is better than just “lower risk.”



Trichomoniasis


One of the most common STIs, it is especially common in adults under 35.

It is caused by a parasite, trichomonas vaginalis. While, as the name implies, it mostly likes to live in vaginas, it can be passed back and forth between partners of any gender, and getting partners treatment to avoid reinfection is important.


Part of why it is easy for there to be reinfection, is that 50% of cases have no symptoms. Those that do have a wide variety of symptoms. People with vulvas may have vulval itching, vaginal discharge of a variety of colors from yellow to dark green. They may also have pain during urination or sex. People with penises are less likely than people with vulvas to show symptoms, but if they do it is most often urinary pain.


Complications are extremely rare in people with vaginas, but in people with penises, prostate problems can result from untreated trichomoniasis.


Antibiotics can cure this STI, although sometimes they need two courses to fully clear the infection.



BV


BV stands for Bacterial vaginosis. It can only occur in people with vaginas, and is the most common cause of vaginitis symptoms in women of childbearing age. It is caused by an imbalance in vaginal flora and an excess of one bacteria or another.


As a result, it's not exactly an STI - it's a bacterial and pH imbalance that can be caused by sexual contact, yes, but also by over-aggressive washing, wearing sweaty clothes too long after a workout and pretty much anything else that has an effect on your vagina.


It is extremely common- it’s hard to get good data for it, but about 2 million people in the USA have it at any given time.


It’s asymptomatic about half the time and is confused for a yeast infection by many women at other times - a thin white discharge and change in odor is the most common symptom combination.


It can lower your body’s defenses against other STIs and therefore endanger you.


It is diagnosed by microscopically examining the discharge; it can also be diagnosed by a combination of lowered vaginal pH and a fishy odor.


Because it is bacterial, it is treatable by antibiotics.


Correctly using barriers for sexual activity and having proper bathroom hygiene (wipe front to back!) reduces risk of contracting BV.



HSV 1 and 2


Herpes Simplex 1 and Herpes Simplex 2, are two closely related viruses. Both are common - the World Health Organization estimates that about 78% of adults on earth have one or the other, and in North America about 50% have HSV 1 and 16% have HSV 2. These two viruses are very similar and present almost identically, as crusty or itchy sores if symptoms do present. They can both exist anywhere on the skin, although HSV1 is more commonly known as ‘oral’ and HSV2 as ‘genital’ herpes.


Not everyone has symptoms at all, and many people have one small initial outbreak with swollen glands and a fever and 1-2 sores and never have an outbreak again. Others have recurrent outbreaks, of which the first is usually the worst. Having one herpes simplex variety seems to provide immunity to the other.


With almost all STis, barrier use is helpful for prevention. However, as skin-contact transfer infections, the rate of effectiveness of barriers for herpes is about 70% rather than about 97% for fluid-transfer infections, even with consistent and proper use. Additionally, as a skin-contact transfer type of infection many of the infections are non-sexual in transfer, so using barriers during sex is nowhere near a guarantee that you won’t get HSV 1 or HSV 2.


Providers can diagnose just based on examining sores, or can swab sores for a lab sample to verify it. There is also a blood test, which is not recommended as a routine screening, but is used to verify an infection suspected by the previous diagnosis methods.


For the vast majority of people, herpes isn’t a threat to their health, and symptoms aren’t sufficiently severe to require herpes to be included in a standard testing battery. However, if someone in your network is immunocompromised, you can request regular blood testing from your doctor.


If you have severe painful outbreaks or symptoms, there are antiviral treatments available, and people who have immunocompromised people in their partner network may also want to use these even if their outbreaks and symptoms are not especially uncomfortable for them, to keep their viral load lower and therefore less likely to spread.


Not getting treatment might make your outbreaks more frequent or more severe, if you are someone who gets outbreaks anyway. Other infections can trigger herpes outbreaks, leading to the old-fashioned name of “fever blisters” and the more current “cold sores” for oral outbreaks.


HSV 1 and 2 are both viruses for which you have antibody markers forever, and which may never fully leave your system. This incurable status adds significantly to the stigma surrounding them.



Other Sexually Transmitted Infections we don’t give enough credit:


Cytomegalovirus (CMV): CMV is a virus in the herpes family (like HSV 1&2, and chicken pox and shingles). It’s mostly known because your obstetrician will test you for it when you’re pregnant, as it might lead to birth defects. It’s functionally asymptomatic, but can remain in your system in trace amounts for life. It can be transmitted sexually or non-sexually, any exchange of body fluids, including from mother to child through childbirth or breastfeeding, and by blood transfusions or transplants. Barrier use during sex can lower your chances of an active infection or a re-infection, but since kissing and nonsexual contact can pass it, it’s pretty much impossible that you not be exposed, and 8/10 adults in the US have it.


Molluscum: MCV is a skin infection that can be transferred sexually, but isn’t always, and hasn’t gotten the stigma of being an STI that herpes has. There are four numbered strains. MCV-2 is the strain that is most often transmitted sexually. The other three strains are typically diseases of childhood, which may be why MCV hasn’t gotten the stigma attached that HSV does, despite having the same spreading mechanism - skin to skin contact - and also creating papules that can open into sores. Whether to treat MCV is a little bit controversial. Because most cases clear themselves within 6-12 months, some providers suggest just letting it run its course and being careful about skin to skin contact with that area of your skin (including ceasing to shave while you have it, as that will spread the infection). Other providers prefer treatment with cryotherapy (freezing) or a topical agent, especially depending how many bumps or how large an area is, to keep it from spreading further. Barriers can help, but as with other skin-contact transfer infections, the rate of effectiveness of barriers is about 70% rather than about 97% with consistent and proper use.


Note: You cannot get a yeast infection as an STI, but you can get one as a result of the antibiotics that you take to resolve some of the other infections on this list, or poor hygiene on the part of a partner.



Additional Information on Barrier Use:


I reference consistently and correctly using barriers for safer sex throughout this piece. For some good, layman-phrased information on what barriers are, how to use them, and the level of protection against certain STIs, I really like this article from Scarleteen, an online website for sex ed: https://www.scarleteen.com/article/bodies/all_the_barriers_all_the_time


For those of you who think gloves sound like overkill, they may be for your particular risk profile, but they avoid the odds of spreading BV, HPV, and HSV through your network.


If you think barriers for oral sex sound like a bit much, there are several of these infections we’ve discussed here that can be be transmitted that way, including chlamydia, gonorrhea, hepatitis, HSV, HIV, and syphilis.


It is widely culturally understood that condoms are a good idea for vaginal and anal sex, although some of that awareness seems to be waning the further we get from the peak of the AIDS crisis. Safer is sexy! Discussing these issues with partners and mutually agreeing on a form of barrier use that works for your relationship with them, and applying it consistently, is an important and ongoing step in everyone’s relationships.


Lastly, while I think everyone is acutely aware of this at this writing (because COVID-19 is a major Thing right now) there is always something to be said for the simple art of washing your hands.

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