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Wednesday, November 29, 2023

Every new sexual contact puts you at risk for STDs

Dr. Gabe Mirkin

The U.S. Centers for Disease Control (CDC) reports that 20 million new cases of venereal diseases occur every year. One out of five North American adults have a sexually transmitted disease (STD), and STDs cost the U.S. healthcare system nearly $16 billion/year (Sexually Transmitted Diseases, April 2021;48(4):208-221). Worldwide, 31 percent of adults have genital Human Papilloma Virus (HPV) that can cause genital and oral cancers (Lancet Glob Health, 2023 Sep;11(9):e1345-e1362).

STDs include bacterial, viral, and parasitic infections usually acquired through vaginal, oral, or anal sex, or they can be transmitted in blood transfusions or by sharing needles. Herpes can be spread by skin-to-skin contact. There are more than 100 STDs; the more common ones include chlamydia, gonorrhea, human immunodeficiency virus (HIV/AIDS), human papilloma virus (HPV), syphilis, trichomoniasis and genital warts. Chlamydia, gonorrhea, syphilis, and trichomoniasis are easily treated and cured if caught early, but they often go undetected because they may cause mild or no symptoms.

Symptoms: You can acquire an STD and have no symptoms at all, but you will usually suffer discomfort in the mouth, genitals, bladder and/or anus, and painful or frequent urination. You may also suffer:
• genital or oral discharge
• sores, blisters or bumps on the genitals or mouth
• itching and redness in the genital area
• vaginal odor
• genital, oral or anal itching or bleeding
• belly pain
• fever

Prevention: Condoms can reduce infection, but any skin or fluid contact can spread most STDs. The only way to know that you will not be infected with an STD from an infected partner is to avoid anal, vaginal, oral and skin-to-skin contact.

Vaccines: Vaccines to help prevent Human Papilloma Virus (HPV) have been available since 2006. The CDC recommends vaccinating boys and girls starting at age nine and catching up on vaccination up to age 26 for men and women. People between ages 26 and 45 should discus vaccination options with their doctors. Vaccinations against hepatitis B are also recommended.

Diagnosis and Treatment
If a person has persistent genital symptoms, most doctors will:
• look at a smear for trichomoniasis, bacterial vaginosis and lice
• culture herpes from blisters
• order urethral, oral or rectal culture or nucleic acid amplification test for gonorrhea
• order urethral or urine culture or nucleic acid amplification for chlamydia
• order blood tests for syphilis, HIV, hepatitis B and C and herpes
• order urine tests: urinalysis and look for trichomoniasis
• swab tests for HPV, chlamydia, gonorrhea, and herpes
At-home test kits are available for chlamydia, gonorrhea, syphilis, trichomoniasis, and hepatitis C.

If you have urinary tract symptoms and are convinced that you may have an STD, but the tests do not reveal a cause, you need help. Some infectious-disease doctors will put you on two oral antibiotics, such as doxycycline and ampicillin, for two weeks. If that fails, they may give you intravenous antibiotics. This is not a recommended practice since most doctors are afraid to treat a person without a definitive diagnosis, and some doctors are very critical of this approach.

In one study, giving doxycycline to high-risk men 24-72 hours after sexual relations resulted in a two-thirds reduction in the incidence of syphilis, gonorrhea, and chlamydia. All subjects in the study reported having a venereal disease within the previous year (N Engl J Med, April 6, 2023; 388:1296-1306). Other similar reported studies can be found in Clinical Infectious Diseases, March 2020;70(6):1247-1253; JAMA, 2019;321(14):1380-1390; and Lancet Infectious Disease, Mar 2018;18(3):233-234.

My Recommendtions
Recommendations to avoid sex have failed miserably to reduce the incredibly high rate of STDs. Every new sexual contact puts you at significant risk for acquiring an STD. Most people are protected from acquiring STDs when they stay in an exclusive relationship with the same partner who is also exclusive. Many people continue to have urinary tract symptoms even after they have been treated for an STD. Treatment with antibiotics is not recommended in regular medical practices, but many people have improved with this regimen.

Dr. Gabe Mirkin is a Villager. Learn more at www.drmirkin.com.

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