By: Dr. A.R. Williams, Illustrations by: Emma Barnett
Oral Gonorrhea
Ever get “strep throat” after going down on a guy? Let’s just say it might not be strep. You might have the oral gongh.
The bacteria Neisseria gonorroeae, or gonorrhea, is derived from the Greek word meaning “flow of seed.” Evidently, the milky penile discharge that is one of the main reasons that otherwise healthy adolescent males show up in the doctor’s office goes back millennia.
These days over 300,000 Americans are reported to the CDC each year as testing positive for gonorrhea and for almost a decade now, the rate has been higher among women than men. Most cases are urethral (the urethra empties pee out from the bladder), but in some large city clinics up to 20 percent of positive samples come from the oropharanx, a.k.a. the throat.
Patients are often asymptomatic, but may have pharyngeal exudates, or white spots on the back of the throat, swollen lymph nodes in the neck, redness and/or pain with swallowing. Usually symptoms develop 2 to 10 days after exposure.
One downside to having the oral gongh is that it can spread, causing things like “pink eye” or conjunctivitis. Gonghunctivitis anyone? Have you ever seen anyone with gonghunctivitis? Of course not! They are hiding inside.
Prevention: Condoms help, but condoms work best for preventing HIV infection. They are less reliable at preventing the spread of other STDs like gonorrhea. Getting tested for STDs at a clinic or the doctor’s office annually is super important. These days you don’t even have to get swabbed— there’s now a urine test for Gonorrhea in widespread use. It’s always good to wash your hands before and after sexual activity, too. Especially before touching your face.
Treatment: Antibiotics! Unlike HIV, which is a virus, Gonorrhea is a bacteria which means it can be treated by antibiotics. Unfortunately, resistance to some antibiotics, such as Cipro, is growing. Make sure you get a shot of Ceftriaxone in the doctor’s office or a prescription for Cefixime or Doxycycline pills. “Partner packs” should be given out, too.
HIV seroconversion
There have been a lot of developments in HIV research over the past 20 years. Just to review: the human immunodeficiency virus causes a syndrome called AIDS, which usually occurs after 10 years of infection without treatment. AIDS most notably destroys an individual’s immune system, leading to a whole host of problems, including deadly infections and cancers. Now that treatment has existed since the advent of AZT in the early 1990’s, people who comply with their medications can live for decades with AIDS. Unfortunately, even with treatment they can risk infecting others.
There are two main ways to monitoring a patient’s HIV disease—viral load, or how many copies of virus are floating in the blood, and CD4 count, the number of healthy white blood cells. A patient with HIV is healthiest with a non-detectable viral load and a normal/high CD4 count.
Dr. John Coffin at Columbia University first compared an HIV infection to a train speeding off a cliff: the viral load is how fast the train is approaching the cliff and the CD4 count is how much track remains.
We now know that someone’s viral load also correlates to how infectious they are. In other words, the faster their train is speeding along, the more likely their sexual partners will get infected during a one-time sexual encounter. For instance, a study in Uganda with serodiscordant couples (i.e. one person had HIV, the other was negative) found that each log increment in the viral load, i.e. 10,000 v. 100,000 copies in the infected partner’s blood, was associated with a rate ratio of 2.5 for infection of the HIV-negative partner.
What’s important to know is that the viral load spikes immediately after someone is initially infected, peaking within two months before dropping off substantially. In other words—if you screw someone who had a slutty period two months ago, you are taking a bigger risk of contracting HIV.Someone newly infected is the least likely to have signs of infection
Prevention: Condoms! Condoms! Condoms! Condoms! Condoms! Condoms!
Treatment: HAART (Highly Active Antiretroviral Therapy) targets the replication and spread of HIV through the body. These days, folks usually start HAART when their CD4 count drops below a certain point. Once the immune system is sufficiently damaged, patients also have to take medications to prevent new, opportunistic infections.
IUDs and PID
Many Western European women who use birth control use an IUD, but Americans have been slow to embrace them. Compared to our more sensible European counterparts, Americans have been behind on a lot of things, such as gun control, texting, bisexuality, etc.
The IUD, or intrauterine device, has been around for decades and offers a lot of advantages for safely preventing pregnancy. IUDs are now available in both hormone-containing (levonorgestrel, a kind of synthetic progesterone) and copper-containing designs that can last for up to 10 years with modest initial effort.
In large part IUDs have a bad rap in the USA because they became associated, both in scientific studies and in the public mind, with pelvic inflammatory disease or PID way back in the mid-20th century.Those concerns are now known to be overblown.
PID, an infection of the female reproductive organs, is commonly associated with Gonorrhea or Chlamydia infections, but can also arise from microflora of the female genital tract (i.e., anaerobes, enterics, G. vaginalis, H. influenzae, and S. agalactiae).
According to studies in the leading British medical journal, Lancet, there is a transient increased risk of infections in the three weeks immediately following insertion of the IUD. Therefore, women who have active STD infections shouldn’t receive an IUD at that time. However, physician skill and experience is far more important for successful IUD insertion as the IUD device itself is not associated with increased risk of infection.
Another big hurdle to IUD’s is the healthcare and insurance system in the United States. Many Western European countries pay for IUD insertion, whereas individuals in the US, including those with insurance, will be liable to pay hundreds of dollars out of pocket.
A good alternative to the IUD is the NuvaRing which is replaced every month and has the advantages of self-insertion and more short-term control over fertility.
Prevention: Find a good doctor and get tested for STDs annually. And call your Congressperson!
Treatment: Antibiotics. Patients treated for Chlamydia should also be treated for Gonorrhea given the high rates of co-infection. For women with PID, intravenous (or IV) antibiotics are needed and/or pills for 14 days due to the severity of the infection.
Back hole cancer
Although we tend to think of homosexuals engaging in anal intercourse, most of it is actually practiced by heterosexuals. Dan Savage, venerable sex expert, once said that on the average Saturday night, 14 times as many heterosexual couples are having anal sex as homosexual couples. That’s a lot of Farrah Fawcetts.
What tends to get glossed over is that 90% of anal cancer, similar to cervical cancer, is associated with certain strains of the Human Papillomavirus (HPV), in particular 16 and 18 (Strains 6 and 11 are associated with warts) that attack the transitional skin lining at the end of the vaginal or anal canal.
In other words, if you’re having anal sex, you need to protect your anus from cancer just like you protect your vagina. And if you don’t have vagina (fellas), just be glad you have one less thing to keep up with. So does this mean that you need to get the HPV vaccine and a pap smear for your butt? Yes.
The Food and Drug Administration (FDA) first approved an HPV vaccine for women (not men) in 2006 with the indication to prevent cervical cancer. By 2008, the FDA had widened the indication for women to include vulvar and vaginal cancers. It was not until this past November that the FDA approved the Gardasil vaccine for males 9-26 years of age. Fortunately for your butt, as of December 22nd 2010, the FDA has now approved Gardasil for the prevention of anal cancer for both genders.
With this new oppurtunity to prevent future forms of cancer, anyone under the age of 26 should get the HPV vaccine series. If you are over 26 years of age, you could still get the vaccine, but you will have to pay more. The vaccine works best for those who are not yet infected.
When to go a step further and get a anus pap is less clear. Higher risk groups- those having receptive anal intercourse with multiple partners- would benefit the most.
Prevention: Condoms. HPV vaccine. Anus pap (screening for abnormal cells with a swab stick).
Treatment: Unfortunately HPV, like HIV, is a virus, so it is not readily curable. However, recent studies suggest women with existent HPV infections who get the vaccine increase their health. For individuals who have dysplastic cells on a pap, a biopsy (like a colposcopy of the cervix) can be performed to evaluate for the degree of abnormality and determine whether treatment (like surgery or chemo) is needed.
THE WORST STD OF ALL , REGRET
Unfortunately there is no vaccine for the worst STD of all: regret.
Complaining about having sex is kind of like complaining about having too much money: for those going without, your problems may breed resentment.
On the other hand, there is no excuse for bad sex. Bad sex often stems from difficulty communicating. Successful communication is dependent on trust and openness, but it also depends on how well you know yourself and your boundaries. Sexual relations are an interactive process where your preferences and fantasies will continue to evolve throughout your lifetime. Trying to reflect on your own desires and how to express them to your lover prior to the heat of the moment is strategic for your mental and emotional health.
If you are at a period in your life where sex isn’t worth it, that’s okay, too. Just be glad you don’t have gonghunctivitis.
Prevention: Abstinence.
Treatment: Getting laid.
