Dating seems to be getting harder and harder. The ghosting, the catfishing, the blatant lying. We’ve all been there. Finding the right match can sometimes feel like taking on a second (or third) job. Yes, it can seem like work trying to find a way to balance attraction, chemistry, location, and timing to find “the one.” Now add to that a sexually transmitted infection (STI), and things can get even more complicated.
Sexually transmitted infections are nothing new. They’ve literally been around for centuries. These infections have gone by different names over the years: venereal disease (VD), “the clap,” “the drip,” “the clam,” etc. In healthcare, they’ve usually been referred to as sexually transmitted diseases (STDs). However, the most up-to-date term, sexually transmitted infection, has been used more commonly by sexual health educators and providers because it describes the condition more accurately as an infection, which is what it is. The term disease also carries a certain stigma with it, making sexually transmitted infection the preferred nomenclature over STD.
Let’s take a minute to break down the difference between infection and disease. An infection occurs when a pathogen (think: bacteria, virus, or even parasite) enters the body and stimulates a reaction from your immune system. Disease, on the other hand, occurs when that infection causes symptoms, damages the body, and leads to illness. There are many kinds of infections that never develop into diseases.
This is especially true for STIs, which, more often than not, never get to the disease stage. In fact, many people don’t even know they have an STI (this will become important later when we discuss testing). STI can cause symptoms like burning with urination, urinary frequency or urgency, urethral discharge, swollen lymph nodes, fever, and so on. But sometimes STIs are completely asymptomatic.
The term disease is loaded with negative connotations, misconceptions, and shame. There’s already too much unnecessary stigma around STIs because they result from sexual activity, and for some reason, many cultures around the world still have a problem with sex. Referring to sexually transmitted infections as diseases only adds to that stigma and shame, which can sometimes make it harder for people to talk openly about STIs with their providers and/or partners, get tested, and practice safer sex.
If you’re someone who has contracted or is living with an STI, you’re not alone. STI rates have been on the rise in recent years. In 2018, the Centers for Disease Control & Prevention (CDC) estimated that 1 in 5 people had an STI. That’s nearly 68 million infections! Twenty-six million new STIs were acquired that year. Nearly half (46%) of all new STIs in the country occur among young people (ages 15-24). And an estimated 25% of people in the United States are living with an incurable STI.
What follows is a discussion about the most common STI and how to navigate the world if you’re one of the many people who acquire these infections. As we already mentioned, there’s nothing to be ashamed about. If you’re sexually active, it simply comes with the territory. What I hope is that these words will help the reader make the best decisions possible to treat, prevent, and protect themselves and their partners from STIs.
Curable vs. Incurable vs. Undetectable
More than thirty different bacteria, parasites, and viruses are known to be transmitted through sexual contact. This means any kind of sexual contact from direct skin-to-skin transmission to oral, vaginal, and anal sex. Some STIs can even be transmitted from mother to child during pregnancy, childbirth, and breastfeeding. Of the eight most common STI pathogens, four are curable—syphilis, gonorrhea, chlamydia, and trichomoniasis—and four are incurable—hepatitis B, herpes simplex virus (HSV), human papillomavirus (HPV), and human immunodeficiency virus (HIV).
So-called curable STIs refer to infections that are usually treated with a single dose or short course of antibiotics. Sometimes that means taking a single pill, while other times, it means a shot in the butt at your doctor’s office. Your provider may also recommend your partner(s) be tested and/or empirically treated. Either way, the treatments for this group of STIs are generally pretty straightforward once the right diagnosis has been made.
Incurable STIs refer primarily to viral infections that cannot be treated or cleared by the body on its own. Once infected, you essentially live with the virus forever. That doesn’t mean you immediately become a leper or sexual outcast. Plenty of people lead productive and sexually fulfilling lives even after being diagnosed with an incurable STI. Some of these incurable STIs can lay dormant and be asymptomatic for years. Even when they do pop up from time to time, the outbreaks can typically be treated with medication or in-office care.
A quick word on HIV and what it means to be undetectable. We’ve come a long way in our battle with HIV and AIDS, the acquired immunodeficiency syndrome that occurs if HIV goes untreated. A diagnosis of HIV/AIDS used to be a near-sure death sentence. AIDS killed more than 300,000 men and women in the United States between 1987 and 1998. Death rates began to drop in 1995 with the introduction of effective antiretroviral medications. Our treatment and prevention of HIV with newer medication regimens have made living with HIV not just a possibility but a reality. In fact, people with HIV who achieve and maintain an undetectable viral load—the amount of HIV virus measured in the blood—by taking antiretroviral therapy (ART) daily cannot sexually transmit the virus to others. This concept, known as U=U (Undetectable=Untransmittable), has been supported by a number of high-quality clinical trials.
Know Your Status
Getting tested for HIV and STI can be a scary and overwhelming experience. Trust me, I’ve been there. It’s often uncomfortable bringing these things up with your healthcare provider. And many providers don’t take the time to ask the right questions to assess your STI risk.
But knowledge is power. The frequency with which you get tested should depend on your frequency of sex and/or number of sexual partners. People who are sexually active with more than 1 partner should consider getting tested every 3-6 months. Regular testing is important because, as we mentioned previously, STIs can often be asymptomatic.
Getting tested regularly can also be empowering and educational. Don’t make it more difficult than it has to be. Think of STI testing as just another part of keeping up with your health, like getting your teeth cleaned at the dentist’s office. And make sure to use the opportunity to discuss ways to keep yourself safe from sexually transmitted infections going forward.
If you end up being diagnosed with an STI, it’s on you, to be honest with your partner(s). It may not be easy, but it’s the right thing to do. Your partner deserves to know the information so they can test and be treated, if necessary, as well. Partner notification isn’t always possible, especially in the case of one-night stands or anonymous sex, but do your best to give your partners a heads-up.
If you’re diagnosed with one of the so-called incurable STIs, find the right time to tell future partners. It’s not something you have to advertise on your dating profile or bring up on a first date. Take your time and choose the right moment once the two of you have really gotten to know each other. The most important part is that you bring it up before engaging in sexual activity so your partner can make an informed decision.
Before having these conversations, inform yourself about the topic at hand. Get your STI facts straight. This is something your healthcare provider can help with. The CDC also has a wealth of information about HIV and STIs on its website. Be clear and open with your partner. Educate them on what the STI means, what it doesn’t, and what precautions you and they can take to prevent its spread.
Treatment, Suppression, and Prevention
As we briefly mentioned before, many STIs are treatable and curable with a simple prescription. STIs like gonorrhea and chlamydia are treated with an intramuscular injection of ceftriaxone and a weeklong course of doxycycline, respectively. In fact, these two STIs are so common that many people are empirically treated for both when they present with common symptoms like urethral discharge.
Some individuals with HPV, herpes, molluscum contagiosum, and more recently monkeypox, may present with small genital lesions. These lesions can be of various sizes, some painful and others painless. HPV lesions and molluscum can often be treated by freezing, curettage, or laser in the office. Herpes and monkeypox lesions are best treated by antiviral therapies.
People diagnosed with HIV should begin antiretroviral therapy as soon as possible regardless of CD4+ T-cell count, both for individual health and to prevent HIV transmission. Early HIV diagnosis and treatment is therefore not only vital for individual health but also as a public health intervention to prevent new infections. According to the CDC, the importance of adherence to ART should be stressed, and patients should be informed that antiretroviral therapy does not protect against other STIs.
Sometimes the best defense is a good offense. The same could be said for HIV and STI treatment. In recent years, medical options for suppression and prevention have become increasingly available. Take, for instance, herpes. Once infected, HSV is incurable. But there are antiviral medications that can treat outbreaks and, when taken daily, can suppress the virus and reduce the likelihood of future outbreaks. Whether you are a candidate for suppression antiviral therapy depends on the frequency and severity of your outbreaks, but it’s definitely worth discussing with your doctor.
Pre-exposure prophylaxis (PrEP), a strategy to reduce new HIV infections, has become increasingly popular in recent years. PrEP involves daily use of oral antiretroviral drugs or an intramuscular injection given every 2 months to prevent HIV infection. Studies have shown that PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed.
Because STI rates have increased year over year for the last decade, there is new interest in post-exposure prophylaxis (PEP) that may help reduce transmission of certain STIs. PEP has been available for HIV for a while now and involves taking a combination of antiretroviral medications shortly after potential exposure. Recent data have suggested that taking doxycycline within 24-72 hours of condomless sex may reduce the risk of STI (including gonorrhea, chlamydia, and syphilis). The CDC is still evaluating this research and points out that current efficacy data only applies to men who have sex with men and transgender women. Studies among heterosexual, cisgender women are ongoing. Still, from a public health perspective, this is pretty exciting news!
It’s a dog-eat-dog dating world out there. And STI can make navigating that world even trickier. Hopefully, our discussion has left you with some tools to do so more easily. Remember when it comes to STI: you’re not alone, and there’s certainly nothing to be ashamed of. Disclosing your status is key to building a lasting, trusting relationship with your current and future partners. Be proactive about protecting yourself by always using condoms and taking advantage of suppressive and prophylactic treatments when available. Lastly, get tested. As scary as it may seem, knowing your status is a crucial part of engaging in a healthy and active sex life.
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