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The More You Know: Sexually Transmitted Infections

by Lyndsey Harper, MD

We all know they exist but no one is talking about them. Let’s change that! Sexually Transmitted Infections, also known as STIs or STDs are either bacteria or viruses spread through sexual activity. Sexually transmitted infections are extremely common but are typically surrounded by unnecessary anxiety and shame due to the lack of education and open communication.

Education First
The more you know about STIs and how they’re transmitted, the better equipped you’ll be to not only prevent them, but also help erase judgement and embarrassment.
There are more than 20 known STIs but the four most common are HPV, chlamydia, gonorrhea, and genital herpes.

HPV or human papillomavirus is by far the most common STI. In fact, the vast majority of people will have an HPV infection at one point or another. HPV is a virus that is spread very easily and has many strains. Some strains can cause genital warts, but the more common ones cause abnormal pap smears, or even cervical cancer. There's no test for HPV in men, and there's also no treatment available for a positive test. Usually our bodies will clear HPV on its own like a cold, but for some people, this is not the case. As usual, condoms can prevent transmission. Another extremely important way to prevent HPV is with the vaccine. This vaccine reduces the risk of developing an HPV related cancer by up to 99%. The vaccine is approved for boys and girls over age 9 and is highly encouraged for everyone to get. Our hope is that one day, HPV and cervical cancer will be eradicated, and we have the tool to do that in this vaccine.

Chlamydia is the second most common STI, and gonorrhea is the third. As OB/GYNs, we see and treat these all the time. Chlamydia and gonorrhea are both bacterial infections that can cause yellow discharge, painful urination and irregular vaginal bleeding. You can get tested for both with a swab in the vagina. They are usually easily treated with antibiotics. Importantly, the partner that you think gave it to you must also be treated, as you can be reinfected from the same partner, and he or she can go on to infect other people as well. If these are left untreated, a woman can develop pelvic inflammatory disease that can result in pelvic pain and even infertility. This is why regular screening (at least yearly) is recommended. If you have either gonorrhea or chlamydia, it's better to get it easily treated early on, rather than wait in order to avoid these unnecessary issues.

The fourth most common STI is genital herpes or HSV. More than 11% of the population in the US has genital herpes. There are two strains: HSV-1 and HSV-2. In general, HSV-1 is less severe with less frequent outbreaks than the HSV-2 strain. The initial outbreak of HSV is usually the worst. Women can have painful sores in the vagina, labia, around the anus and on the thighs. HSV is diagnosed with a swab of the lesions themselves. There are blood tests to detect HSV, but these are only helpful to determine how long you've had the infection (recently or not), not for diagnosis. Unfortunately, HSV recurs throughout their lives. Often during illness, times of stress or even around their menstrual cycle, women can notice flares. There are prescription medications that can be taken to shorten the link and severity of an outbreak. For people with frequent outbreaks, these same medications can be taken daily to prevent those outbreaks as well. The best way to avoid transmission to partners is to avoid any contact when you think an outbreak is coming on. Often patients describe a tingling or burning feeling in the area, and you should avoid contact until all of the lesions are completely healed. As usual, condoms are recommended, and the preventive daily medicine can also reduce transmission as well.

STIs can be passed through oral, vaginal and anal sex, through the skin, genitals, mouth, rectum or body fluids. An STI may or may not cause symptoms and, because of this, someone could spread it without even knowing. Although there are some alternative prevention methods for some STIs, the number one thing to remember is condoms, condoms, condoms. Condoms are the best way to prevent transmission all 4 of the most common STIs.

If you or your partner have been diagnosed with an STI, please remember, this is just a fact. It’s important that you are open about an STI diagnosis with your partner or partners to prevent further transmission.

Despite what sex ed may have taught us, STIs mean nothing about you as a person, your character, your worthiness to be loved or your right to enjoy sexual pleasure. Many times these are just simple blips on the radar of life that can be easily overcome and worked through. The important steps are prevention, frequent screening, following through with medications, and communication with healthcare teams and partners.

Lyndsey Harper, MD is the Founder & CEO of Rosy, a Board Certified Ob/Gyn and sex medicine expert.