There are few topics as taboo as sex. By extension, infections passed through sex (and yes, other non-sexual acts) often carry stigma. It’s even deeply embedded in the verbiage we use. I often hear patients say they are “clean” after negative sexually transmitted infection (STI) testing. This suggests having an STI makes you “dirty.” I find comparison to the common cold useful here, which has become so prevalent that we added the word “common” to the name. Sexually transmitted infections, including human papillomavirus (HPV), are also very common and can pass between people as easily as a cold, yet STIs provoke feelings of embarrassment and shame in many people. Furthermore, as most STIs are without symptoms, we are less likely to be prompted by our body to self-isolate until we seek treatment and recover. Think about if you were invited over for family dinner and you had pneumonia with a horrible cough. You’d probably postpone until you were feeling better and seek treatment, right? STIs don’t often produce similar ‘warning signs’ that prompt us to be evaluated.
So what does this all mean? Are STIs unavoidable? Should we just throw in the towel now? Become celebate? Not at all. Sex is a huge part of human existence. We engage in sex for connection, intimacy, expressions of love, exploration, spirituality, stress reduction and, of course, procreation–just to name a few! There are a great many proven STI prevention and treatment strategies that can minimize risk to both yourself and your partner(s). Below I’ll be discussing three of the most common types of STIs. Other infections, such as HIV, syphilis, hepatitis, or herpes simplex virus won’t be covered in this post.
Gonorrhea and chlamydia are both extremely common STIs.
Gonorrhea and chlamydia are by and large the most-common STIs; specifically in young, sexually active women and other people with cervixes. These two STIs are actually what form the basis of our screening recommendations:
- Annually for all sexually active women under age 25 (this applies to transgender men and gender diverse people with a cervix, too).
- Annually for people age 25 and older with risk factors (such as with new or multiple sex partners or a sex partner who has an STD).
Screening is especially important because the most common symptom for both gonorrhea and chlamydia is no symptom. Yet both have the potential to cause more serious disease, fertility issues, and pregnancy complications in the future if they are not treated.
Prevention of sexually transmitted infections
For both gonorrhea and chlamydia, proper use of condoms can be used to help prevent transmission, and regular screening helps identify the infection before spreading it. Note that these STIs can be transferred orally and aren’t exclusive to sex between a penis and a vagina. Rarely, when condoms are used, these infections can still be transmitted.
Gonorrhea symptoms and treatment
For women and other people with female-associated anatomy, gonorrhea symptoms are often mild and can sometimes be mistaken for a bladder or vaginal infection. Symptoms may include:
- Pain or burning sensation when peeing
- Increased vaginal discharge
- Vaginal bleeding between periods
Gonorrhea is easily treated with antibiotics via a one-time injection typically in the buttocks. An oral medication will also be prescribed to be taken. Patients should wait a full seven days after starting treatment before engaging in any sexual activity.
Chlamydia symptoms and treatment
Chlamydia often also has no symptoms–and when present, they can occur weeks after infection. Chlamydia symptoms in people with female anatomy may include:
- Abnormal vaginal discharge
- Burning sensation when peeing
Chlamydia is easily treated with antibiotics, and people should abstain from any sexual activity for seven days after a single-dose antibiotic or until they complete a seven-day course of antibiotics.
Gonorrhea and chlamydia infections can also occur in the rectum and cause rectal pain, discharge, itching, bleeding and/or painful bowel movements. See your provider if you or a sexual partner has any of these symptoms or others–including an unusual sore or smelly discharge.
Most sexually active individuals will contract HPV during their lifetime.
HPV is most often transmitted through vaginal, anal or oral sex with someone who has it. There are more than 200 strains, some can also be transmitted through skin-to-skin contact. Because of this, HPV is incredibly common, and around 80% of sexually active individuals will contract at least one strain in their lifetime.
This is why the CDC recommends the HPV vaccine series for all people beginning at age 11 (and up to age 45 if not previously vaccinated), which protects against the most harmful diseases HPV can cause, including cancers. While people of any gender can be vaccinated, only people with a cervix can be tested for HPV. Unfortunately, there are no commonly accepted ways to test men at this point, so people with a penis should always use condoms with new partners.
HPV is added on as part of a Pap smear test, usually at age 30 and after. The reason for this is because it is so common we expect many sexually active people will have HPV under age 30 and usually their immune system will clear the infection within a year or two.
Prevention of HPV
Vaccination can reduce your risk of getting the types of HPV infections that are most likely to lead to cervical, vaginal, vulvar and anal cancers. Condom use can also lower your risk of getting or spreading HPV. But anyone who is sexually active can get HPV, even if you’ve only had sexual contact with one partner. Symptoms can also develop years after having sex with someone who has HPV since it can sit dormant in the body for a while. It’s not uncommon to get HPV more than once, especially if you have new sexual partners. Depending on the strain, HPV can be passed between two partners with vaginas.
Treatment of HPV
When patients find out they have HPV, they often fear the worst. In all likelihood, the body will resolve an HPV infection on its own, and providers will keep a close eye on it during regularly scheduled Pap smears.
If advanced abnormal cells are found during a Pap smear, your provider may schedule a follow-up colposcopy. This is a procedure where we visually examine the cervix, vagina and vulva using a colposcope. The provider may take a small tissue sample for testing.
If that biopsy is concerning, then your provider will schedule a follow-up LEEP procedure, which is both therapeutic and diagnostic. This means it works to hopefully remove all of the abnormal cells and gather more information about them. It is also theorized to help your body direct its immune fighting capabilities towards the area of abnormal cells. For many patients who reach this stage of HPV, the LEEP is as far as treatment goes. On rare occasions, if abnormal cells and HPV are caught very late, it may be diagnosed as cervical cancer during either the colposcopy or LEEP.
It’s really important to note that the natural course of HPV cells turning cancerous takes up to 10 years. So, by staying up to date with Pap smear recommendations, most people will be protected from illness.
In summary, the majority of us will contract a HPV in our lifetime. Many of us will be exposed to and contract other forms of STIs. These infections are rarely life-threatening and the fear of having one should not prevent you from seeking testing and care. Just as your health is not defined by catching a cold, your sexual health is not defined by contracting STIs.
Follow provider recommendations for all screenings (including those not discussed in this post — Hepatitis B/C, HIV, Syphilis), and never feel ashamed to talk openly about your experiences or symptoms. We’re here to help.