by Randall S. Frederick

“So when was the last time you got tested?”

“I have this friend and she’s seeing this guy. Can you believe they’ve been dating a month and he hasn’t offered to get tested?”

Everyone needs to be tested for an STD because, of course, almost everyone already has one. The question is not whether you have one – it is which ones. Many individuals contracted an STD through childbirth or inherited one from a parent, but for those who didn’t, the only way to avoid getting one is to never have vaginal, anal, or oral sex going forward. Many STDs are latent or in remission, but nevertheless a threat to potential sexual partners.

A 2015 report by the World Health Organization located that two out of three adults under the age of 50 already has the herpes simplex virus 1, some 3.7 billion people worldwide. While this alone is alarming, HSV-1 is only one of the eight herpes viruses that can infect humans. Some, like chicken pox and roseola, are associated with childhood sicknesses while others can cause Epstein-Barr (HSV-4, or mononucleosis) which can cause certain types of cancer and even multiple sclerosis. As sexual health educator Martha Kemper adds, “It used to be thought that HSV-1 caused all infections above the waist and HSV-2 was responsible for those below. While it is more common for HSV-1 to infect the mouth and HSV-2 the genitals, we know now that either strain of the virus can cause infection in either place. Herpes is spread when cells from infected skin come in contact with either broken skin (like a cut or a sore) or mucous membranes such as the lips or genitals.” 

And now the Centers for Disease Control and Prevention has confirmed something that’s been implicit in discussions of the Zika virus for a while: Zika is effectively a sexually transmitted disease.

During the current election cycle, the Republican Party’s platform includes an amendment reasoning that porn is “a public health crisis.” Without wading into this argument too deeply, it is worth noting that the GOP’s efforts to protect children from Internet pornography are commendable though they miss the proverbial forest among the trees. Declaring porn a public health crisis is both a misunderstanding of what constitutes a health crisis, and a misdirection. The true health crisis in America right now is a failure on the part of schools and colleges to help teenagers and college students effectively understand their emerging autonomy and responsibility for individual sexual health. It is time to have a deeper, more informed discussion of sexual health.

Whatever kind of body we possess, there are typically a number of openings: the anus and urethra in male bodied individuals, the vagina in female-bodied individuals, along with the eyes, mouth, and other orifices that humans possess. When we have sex or participate in sexual activities (yes, including masturbation), friction can produce tiny, invisible abrasions though which infections can pass into the bloodstream via a number of ducts and vessels connected to the bladder and genitals – for men, the prostate and testes; for women, the ovaries and cervix. Once these particularly sensitive organs are infected, long-term damage can take place in a short period of time and has plenty of places to spread.

For example, during vaginal intercourse, the man’s penis rubs against the woman’s labia, causing tiny, invisible abrasions. The bacteria that causes syphilis might be transferred from the penis to the woman’s labia during intercourse; the virus that causes AIDS might also pass from the man’s semen into the woman’s bloodstream. If the bacteria that causes gonorrhea enters the woman’s urethra during intercourse, it can linger inside her body for a long time untreated and unnoticed. The lingering bacteria can then infect the next person who has sex with her. When a person contracts syphilis, the germs form a tiny ulcer, or sore, often on the vulva or penis. Meanwhile, the disease gets worse – and that individual’s next sexual partner may become infected, in exceptional cases leading to an inability to have children because of sterility.

To that end, and without judging or sounding an alarm bell, some of the most frequent sexually transmitted diseases are entirely overlooked and need to be discussed. As a sexual educator, I believe there is no shame in contracting or having an STD. However, I firmly believe that there remains a mandate to understand communicable diseases and to begin making conscious choices for the sexual health of ourselves and our partners. I want to address some of the Most Common STD’s to help us understand whether our fears are grounded and what constitutes a true “public health crisis.”

Common STDs

Gonorrhea is a sexually transmitted disease (STD) that can infect both men and women. It can cause infections in the genitals, rectum, and throat. It is a very common infection, especially among young people, and is communicated by having vaginal, anal, or oral sex with someone who has gonorrhea. The disease is also called “the clap” or “the drip”The bacterium Neisseria gonorrhoeae can grow in the mouth, throat, or anus, multiplying easily in mucus membranes of the body, especially in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (the tube that carries urine from the bladder to outside the body) in women and men. It is identified by

• Greenish yellow or whitish discharge from the vagina
• Lower abdominal or pelvic pain
• Burning when urinating
• Conjunctivitis (red, itchy eyes)
• Bleeding between periods
• Spotting after intercourse
• Swelling of the vulva (vulvitis)
• Burning in the throat (due to oral sex)
• Swollen glands in the throat (due to oral sex)
• Greenish yellow or whitish discharge from the penis
• Burning when urinating
• Painful or swollen testicles

In some women, symptoms are so mild that they go unnoticed and many women think they have a yeast infection and self-treat with over-the-counter yeast infection drugs. Because vaginal discharge can be a sign of a number of different problems, it is best to always seek the advice of a doctor to ensure proper diagnosis and treatment.

Chlamydia is a common STD that can infect both men and women. It can cause serious, permanent damage to a woman’s reproductive system, making it difficult or impossible for her to get pregnant later on. Chlamydia can also cause a potentially fatal ectopic pregnancy (pregnancy that occurs outside the womb). Most people who have chlamydia have no symptoms. If you do have symptoms, they may not appear until several weeks after you have sex with an infected partner.

You can get chlamydia by having vaginal, anal, or oral sex with someone who has chlamydia. If your sex partner is male, you can still get chlamydia even if he does not ejaculate (cum). If you’ve had chlamydia and were treated in the past, you can still get infected again if you have unprotected sex with someone who has chlamydia.

Genital Warts are growths on the skin of the genital area and around the anus. They are caused by certain types of the human papilloma virus (HPV). There are more than 100 types of HPV. Some types of HPV produce warts on different parts of the body, like plantar warts on the feet and common hand warts. Some can lead to certain cancers — these are called high-risk types of HPV. And some produce genital warts. Most genital warts are caused by one of two types of HPV — types 6 and 11. Genital warts can appear in the mouth or genital area — the vulva, vagina, cervix, rectum, anus, penis, or scrotum. They are passed from one person to another by skin-to-skin contact, usually during sex play. Genital warts are very common. Between 500,000 and 1 million people get genital warts every year.

Genital Herpes are common in the United States, and is an STD caused by two types of viruses. The viruses are called herpes simplex type 1 and herpes simplex type 2. You can get herpes by having vaginal, anal, or oral sex with someone who has the disease. Fluids found in a herpes sore carry the virus, and contact with those fluids can cause infection. You can also get herpes from an infected sex partner who does not have a visible sore or who may not know he or she is infected because the virus can be released through your skin and spread the infection to your sex partner(s). Most people who have herpes have no, or very mild symptoms. You may not notice mild symptoms or you may mistake them for another skin condition, such as a pimple or ingrown hair. Because of this, most people who have herpes do not know it. Genital herpes sores usually appear as one or more blisters on or around the genitals, rectum or mouth. The blisters break and leave painful sores that may take weeks to heal. These symptoms are sometimes called “having an outbreak.” The first time someone has an outbreak they may also have flu-like symptoms such as fever, body aches, or swollen glands. Repeat outbreaks of genital herpes are common, especially during the first year after infection. Repeat outbreaks are usually shorter and less severe than the first outbreak. Although the infection can stay in the body for the rest of your life, the number of outbreaks tends to decrease over a period of years.

Pelvic Inflammatory Disease is an infection of a woman’s reproductive organs. It is a complication often caused by some STDs, like chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID. The condition can be treated if diagnosed early, however, treatment won’t undo any damage that has already happened to your reproductive system. The longer you wait to get treated, the more likely it is that you will have complications from PID. You are more likely to get PID if you

• Have an STD and do not get treated;
• Have more than one sex partner;
• Have a sex partner who has sex partners other than you;
• Have had PID before;
• Are sexually active and are age 25 or younger;
• Douche;
• Use an intrauterine device (IUD) for birth control. However, the small increased risk is mostly limited to the first three weeks after the IUD is placed inside the uterus by a doctor.

Hepatitis has three versions, A, B, and C, each of which can have an impact on your overall health. Hepatitis A, B and C are viral infections that are estimated to be affecting approximately 5-6% of the American population. The best defense against the above forms of Hepatitis is abstinence. Treatments for Hepatitis depend on the type that one has, but as always prevention is better than cure. This viral infection affects an individual’s liver, causing it to be inflamed. It is important to go and test for any of the Hepatitis viruses because some might remain in the body for long and not show signs, but others will show clear signs. Therefore, people who have changed their sexual partners in the last six months, people who have multiple sexual partners, people who received organs or blood transfusions, and people showing the following signs and symptoms should seek medical attention:

• Yellowing of the white part of the eyes as well as the skin
• Nausea, vomiting, high fever, itching, and fatigue
• Abdominal discomfort around the liver area on the right side beneath the lower ribs
• Muscle pain
• Dark urine and loss of appetite

Syphilis is an STD that can cause long-term complications if not treated correctly. Symptoms in adults are divided into stages. These stages are primary, secondary, latent, and late syphilis. Syphilis has been called ‘the great imitator’ because it has so many possible symptoms, many of which look like symptoms from other diseases. The painless syphilis sore that you would get after you are first infected can be confused for an ingrown hair, zipper cut, or other seemingly harmless bump. The non-itchy body rash that develops during the second stage of syphilis can show up on the palms of your hands and soles of your feet, all over your body, or in just a few places. Syphilis can also affect the eye and can lead to permanent blindness. This is called ocular syphilis. You could also be infected with syphilis and have very mild symptoms or none at all.

HIV/AIDS has two forms. HIV stands for Human Immunodeficiency Virus, and it is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). This STD is incurable, and it is one of the worst STDs on the planet because it focuses on killing the body’s immune system, leaving it defenseless against all other diseases. According to CDC STD surveillance 2013, slightly more than 3 out of every 1,000 Americans have HIV, making it a very common STD. HIV and AIDS have claimed so many lives, especially in developing nations, and it continues to be one of the most dangerous STDs of all time. Abstinence is the best protection from the disease though; correct use of a condom will go a long way in preventing transmission and acquisition of it. Although HIV has numerous signs and symptoms, some of the most common ones include:

• Flu-like symptoms (Fever, headache, fatigue, and sore throat)
• Extremely high fever
• Chronic Diarrhoea
• Serious weight loss
• Coughing and shortness of breath
• Swollen lymph nodes
• Unexplained fatigue
• Opportunistic infections

Zika is a new addition to the list of recognized STDs, though some biologists have been trying to have the virus added to the list of known STDs since 2008. The Center for Disease Control, as noted previously, recently labeled Zika as an infection that can be contracted through sexual activities. Because this is a new classification, both they and this site recommend frequently and consistently seeking out information as it becomes available. For now, the CDC states

Men and women who want to reduce the risk for sexual transmission of Zika virus should use barrier methods against infection consistently and correctly during sex or abstain from sex when one sex partner has traveled to or lives in an area with active Zika virus transmission. Based on expert opinion and on limited but evolving information about the sexual transmission of Zika virus, the recommended duration of consistent use of a barrier method against infection or abstinence from sex depends on whether the sex partner has confirmed infection or clinical illness consistent with Zika virus disease and whether the sex partner is male or female.

The delay in this new classification has largely been because of the limited understanding of how the virus mutates and where it originates. Given the global alarm aroused by the Ebola pandemic, public officials have been reluctant to address the concerns and findings of the scientific community. Many believe that Zika is a mosquito-born virus, much to the frustration of the scientific community. “We have been a little bit frustrated by the lack of focus on Zika as an STD,” says William Smith, executive director of the National Coalition of STD Directors. “There has been credible evidence that sexual transmission could be as important a focus for us in preventing Zika as mosquito-borne transmission.”

Though many health classes address STDs, they may not thoroughly distinguish between STDs and STIs. Diseases that are spread through sexual contact are usually referred to as sexually transmitted diseases or STDs for short. In recent years, however, many experts in this area of public health have suggested replacing STD with a new term—sexually transmitted infection, or STI. The concept of “disease,” as in STD, suggests a clear medical problem, usually some obvious signs or symptoms. But, as you may have noticed, several of the most common STDs have no signs or symptoms in the majority of persons infected. Even when symptoms appear, they may be mild and thus easily overlooked. So the sexually transmitted virus or bacteria can be described as creating “infection,” which may or may not result in “disease.” This is true of chlamydia, gonorrhea, herpes, and human papillomavirus (HPV), to name a few. For this reason, for some professionals and organizations the term “disease” is being replaced by “infection.”

There are many kinds of sexually transmitted diseases and infections. And they are very common, so don’t allow shame over your appearance or what you think about an STD give you an unreasonable amount of anxiety. More than half of all of us will get one at some time in our lives, many are treatable, and many have no impact on your daily life when in remission and during correct treatment. The good news is we can protect ourselves and each other from STDs. Practicing safer sex allows you to reduce your risk of getting sexually transmitted diseases, though if you’ve done anything that puts you at risk of infection, getting tested allows you to get any treatments you may need.

I’m a big advocate for local health centers like Planned Parenthood. In fact, Planned Parenthood is always at the top of my recommended visits for friends who are unsure or worried about their sexual health. If you go and you’re clear, that’s amazing. But if you go and you have in fact contracted an STD, early detection is a proactive and positive first step toward informed sexual health.

Still, while Planned Parenthood is great for helping inform you of your condition and advising you on treatment options, you should still be examined by your doctor if you notice any unusual changes or uncharacteristic symptoms in your sexual health, especially if your partner has an STD or symptoms of an STD.

Can’t reiterate or stress that enough. Talk to your doctor. Get tested – frequently. There’s nothing to be ashamed of, as long as you are taking responsible actions to have safer sex for yourself, taking preventative measures with sexual partners, and exercising reasonable discretion.

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Further Reading

“It’s Official: Zika is a Sexually Transmitted Infection” National Geographic, by Maryn McKenna

List of STDs and Their Symptoms, via Std-gov.org