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Sexually Transmitted Infections – A Brief Primer and a Call to Screen

By Dr. Arthur Lavin

Just saying sexually transmitted infection raises plenty of questions.

It is good to ask those questions, after all STD’s are extremely common.  Unfortunately, the CDC has just announced they are getting more common.

Because some curable STD’s are getting very common, Advanced Pediatrics is adopting the recommendation that all adolescents be screened for at least two of the most common STD’s- chlamydia and gonorrhea.  It’s easy, your adolescent simply pees in a cup at their 16 and 18 year old check ups.  About 10% of people at these ages are infected with one of these germs, and treating can protect against later infertility. And so, we will be collecting a urine sample from everyone at their 16 and 18 year old health evaluation visit, unless either the adolescent or parent request not to.

What is an STD?

An STD is any infection that is transmitted primarily through some sort of contact with the genitals.  Most of these infections are only transmissable through sex.  This is not because the germ is sexual in any way, but because STD germs tend to be much weaker than non-STD germs.  Their main weakness is that they die very quickly when cooled or dried.

Take a cold virus, many can live on the surface of a table in a cold room for 8 hours!  That’s right, you can sneeze in the morning and when you come home from work, your cold virus is ready to go, very much very able to infect whomever comes by and touches it and their nose.

Not so STD germs, they tend to die within seconds or at most minutes of being exposed to air.

Transmission via genitals keeps them warm and from drying out, that’s really the whole reason they are STD’s.

By the way, transmission of these germs can be by intercourse or oral genital contact.

What are the STD’s?

As with nearly all the infections we see in the US, nearly all the STD’s are caused by either viruses, bacteria, or parasites.

The main bacterial STD germs are chlamydia (CL), gonorrhea (GC), syphilis (SY),

The main viral STD germs are herpes, human papilloma virus (HPV), hepatitis B and C (HBV and HCV), and HIV/AIDS (HIV)

The main parasite STD bugs are trichomonas and scabies.

By far, really far, the very most common of all the STD’s is HPV.  This virus is found in the genital areas of over half of all adult American men and women, some say as many as 75% of us.  Nearly everyone with a genital HPV infection has no idea they do, and never will, since it causes no symptoms or problems in the vast, vast majority of those with it.   But sometimes, the HPV can cause warts in the genital or throat area, and cancer in the female cervix or male throat.  HPV is one of only two STD’s for which a vaccine can prevent the infection, the other being Hepatitis B.

No other STD comes close to being as common as HPV, but many are fairly common.

The common STD’s include of course HPV, but also chlamydia, gonorrhea, trichomonas, herpes.

Less common but not rare are syphilis, hepatitis B, and in some populations, hepatitis C and HIV.  Hepatitis C is not spread well sexually, it can be, but far more likely via IV drug use.

How common are STD’s?

Well, there are about 240 million adults in the United States.

According to the CDC, https://www.nytimes.com/2017/09/29/health/chlamydia-syphilis-gonorrhea.html, there are about 110 million STD infections in the US.  Some, many, people with an STD, have more than one, but however you look at it, millions and millions of people have an STD today, and many more will sometime in their life.

STD’s tend to be caught when young, many of the infections peak in adolescence, at ages 15-19 and 20-24.

Chlamydia is now found in nearly 10% of all girls ages 15-19 and 8% of all girls ages 20-24.  It is very, very common.

Like all infections, including colds, STD’s spread best in networks.  A person living completely isolated from all humanity, born into such isolation, is not going to suffer any common infections.

Just so, a person who only has one sexual partner their whole life, and that partner also only has one sexual partner their whole life, can never experience an STD.  STD’s only infect sexually, so one can only catch the germ from someone who already had the germ, from a prior partner.

The more partners, the greater the risk.

But, just like colds, it does not take many people to get the germs circulating.  About 3/4 of people with an STD had no more than one sexual partner in the year prior to the diagnosis.

Preventing STD’s

There are several strategies to prevent STD’s:

  1. Don’t have sex.  This works pretty well, until you have sex.  Since nearly everyone has sex at some point in their life, you can see that this strategy alone is a pretty bad foundation long term.
  2. Don’t have many partners.  This strategy can have an impact, but fairly limited, given that 3/4 of people with an STD only had one partner the year prior.  Still, the more partners, the greater contact with the network of STD’s the more infections.
  3. Immunize against hepatitis B and HPV.  Now we are getting somewhere.  If everyone got hepatitis B and HPV vaccine, the number of people infected by either virus would plummet, no matter what their sexual lives will be like.  This strategy works well, but only for two of the many STD’s.
  4. Use a condom.  This is perhaps the most powerful strategy to prevent STD’s, it prevents the vast majority, truly.  To take one example, when couples where one partner had HIV and one did not, proper use of a condom prevented transmission to the uninfected partner, 100% of the time!  The only STD’s condom use does not prevent are skin-to-skin infections like syphilis, herpes, scabies, but even they might be stopped if the presence on the skin is limited.
  5. If you don’t use a condom, some STD’s are very good at infecting, even after only one act of intercourse:  for chlamydia the germ infects 30-50% of the time, for HPV it’s about 50%, for gonorrhea it’s also 50%, for hepatitis B it’s as high as 70%– again after only one exposure!

Treating STD’s- some are curable, some are manageable

Here are the curable STD’s:  syphilis, gonorrhea, chlamydia, hepatitis C, scabies, and trichomoniasis

Here are the manageable (not curable STD’s):  herpes, hepatitis B, HPV, and HIV/AIDS

Scabies are best treated if noticed, they cause a very obvious, intensely itchy set of red bumps with little lines from them.  No rash, no scabies.

Trichomonas is an STD that primarily affects women, causing a malodorous vaginal discharge, again it tends to cause symptoms, so we treat as symptoms demand.

As noted, hepatitis C is too rare to screen for.

That leaves syphilis, gonorrhea (GC), and chlamydia (CL) as the curable STD’s that one might screen for.   GC and CL are far, far more common than syphilis and so easy to screen, so the current screening program will be focused on screening for GC and CL.

It is important to screen for GC and CL because:

  1. About 10% of people ages 15-19 have one of them.
  2. A vast majority of those infected have no symptoms.
  3. Untreated GC and CL infections can scar the ducts of the genitals, causing infertility.
  4. Treating GC and CL could prevent much infertility.

At this time we are not recommending universal screening for HIV/AIDS, but will screen those positive for GC or CL for it.

BOTTOM LINES

  1. Sexually transmitted infections are very much like non-sexually transmitted infections.  All types of infections are common, they affect all sorts of very good people.  We think of all infections as mainly about the germ, and focus attention on protecting people from the effects of germs, whatever the germ is.
  2. STD germs tend to infect only via sex because the germ is weak.  One moment of drying out or cooling off, and it’s dead.
  3. STD’s are very, very common, some infect about half of humanity (HPV).  Many infect mainly young folk, about 15-24 years of age.
  4. There are two immunizations that can prevent an STD- one is for hepatitis B, and the other is for HPV.
  5. Two STD’s cause almost no symptoms in anyone, but cause a lot of tragic infertility later in life.  Both can be cured if found.  They are chlamydia and gonorrhea.   Both are on the rise, about 10% of Americans have one of these infections in the ages of 15-19.    Advanced Pediatrics is going to collect a urine sample at every 16 and 18 year old visit to screen for chlamydia and gonorrhea, unless the adolescent or parent decide not to have this done.

To your health,
Dr. Arthur Lavin

 

 

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