STIs and Sex

A conversation about STIs is not easy to have. There is so much stigma associated with them and it becomes exceedingly crippling when you take all that external stigma and internalise it. First, you have a hard time accepting that you, ‘of all people’ have an STI. All ranges of emotion may surface, including disgust and “you were supposed to know better” moments. If you find it difficult to look at yourself the same way, I can’t imagine it will be easy to tell your friend(s) or partner(s) that you have an infection.

All this shame we carry around where STIs are concerned can affect our inter- and intrapersonal relationships. To be frank, the inability to talk about STIs is part of the reason why having new sexual partners is one of the risk factors for contracting an STI. According to the World Health Organization (WHO), 2019:

- “More than 1 million STIs are acquired every day worldwide”

- Chlamydia, gonorrhoea, syphilis, or trichomoniasis account for an estimated 376 million new infections annually

- More than 500 million people are estimated to have genital herpes, and

- More than 290 million women are infected with human papillomavirus (HPV)

You’d think that because STIs are so common, we’d have easy flowing conversations about them like tummy aches and flu. Please note that this statement is not meant to downplay the impact STIs have on sexual, reproductive, and general health – they are a public health issue.

According to the National Institute for Communicable Diseases (NICD), South Africa had an estimated number of 2.3 million gonorrhoea, 1.9 million chlamydia, and 23 175 syphilis new cases in women aged between 15 and 49 in 2017. The numbers were higher in men. What is of great concern in the South African context is co-infection with HIV. STIs, just like any other infection, cause activation of immune cells which migrate to the infected area, making it easier for HIV to infect these cells. The story goes, infection with one STI makes you susceptible to infection with another.

What are the common STIs?

STIs are either caused by bacteria, viruses, or parasites. Viral STIs cannot be cured, but they can be managed. Bacterial and parasitic STIs are curable:

Hepatitis B

“Hepatitis” means inflammation of the liver (reaction of the liver to infection or injury), hepatitis B is inflammation of the liver caused by the hepatitis B virus (HBV). HBV is one of the leading viral causes of chronic liver disease and cancer. The good news is, it is vaccine-preventable. The various routes of transmission of HBV are:

Human papillomavirus

HPV can either cause benign (non-cancerous) or malignant (cancerous) lesions, depending on the subtypes and the persistence of the infection. Infection with the low-risk HPV subtypes results in the development of warts in the genital area, mouth, or skin. There is no treatment for HPV infection, these lesions resolve on their own but that may take up to a year. There are procedures that your doctor can perform to remove the warts, but these won’t prevent them from reappearing. Some people may not show any symptoms and most will clear the virus from their system.

HPV is commonly spoken about in the context of cervical cancer. Cancer often results from failure to detect pre-malignant lesions caused either by persistent infection or infection with the high-risk subtypes.

Like HBV, HPV is vaccine-preventable. However, the HPV vaccine has a high efficacy if it is administered before HPV exposure, i.e., before a girl child starts having sex of any form. This is why South Africa rolled out a national school-based HPV vaccine program, targeting young girls from age 9, in April 2014 (HPV vaccine introduction in South Africa). Another way of reducing the incidence of cervical cancer is having a pap smear as a screening tool. A pap smear will detect pre-malignant (not yet cancerous) lesions and early intervention will prevent them from progressing to cancer. Accessibility and affordability, however, are a huge problem.

Other cancers caused by HPV are anal, throat, and penile. Men, therefore, are also at risk of developing cancer, and unfortunately for them, there aren’t any screening tests for these other cancers.

According to the CDC, HPV is the most common STI. HPV can be spread through oral, anal, or vaginal sex. It can be spread even if the infected person is asymptomatic. One of the annoying things about HPV is that you can develop symptoms years after getting infected so that means you are unwittingly spreading it to others (if you change or have new sexual partners), and you can’t know for sure who you got it from. Frequent and proper condom use, as always, is the best way to protect yourself. However, HPV is very sneaky, and if you come in contact with an infected area that is not covered by the condom, you will get it.

Herpes

Herpes is a whole family of viruses and different members of the herpes family cause different infections. These include cold sores, genital herpes, chickenpox, and shingles. No, I didn’t make a mistake, cold sores and chickenpox are caused by herpes viruses. Herpes viruses are your “friends for life”, they are reactivated and cannot be cured. The focus of this post will be on herpes simplex viruses 1 and 2 (HSV-1, HSV-2), which primarily cause cold/oral sores and genital sores respectively. However, the glories of oral sex have made it possible to be infected with HSV-1 in the genital area and HSV-2 orally. Unlike HPV, there are anti-viral drugs used to manage the infection, however, they don’t necessarily prevent re-activation.

How do STIs affect your sex life?

The common symptoms of abnormal vaginal discharges, sores, ulcers, and other lesions may force you to avoid sexual relations. Lower abdominal/pelvic pain during sex, a symptom of pelvic inflammatory disease (PID) commonly caused by gonorrhoea and chlamydia, can also prevent you from having sex. Bleeding after sex can also be a sign of infection that makes you avoid sex.

How do you protect yourself?

In as much as we preach and promote frequent and proper condom use, we can’t really force people to use condoms if they don’t want to. So for the people who have their reasons for not wanting to use condoms, you will have to have that difficult conversation about STIs with your partner(s) and, together, have regular STI screens at the clinic. Another effective way of preventing infection is getting a vaccine for the vaccine-preventable STIs, before exposure.

The long-term effects of untreated STIs can be detrimental to one’s sexual, reproductive, and general health. A wide range of complications including cancer, infertility, meningitis, death, etc., are seen with untreated STIs. In the South African context, HIV co-infection is also a huge problem. If you can, please ask your health care provider about getting regular STI screens, and if you cannot, continue practicing safe sex and monitor for symptoms.

Once again, you have chosen to learn with me and I am very grateful for that. To those who have given me feedback, thank you so much and I still encourage everyone to keep the conversation going, spread the word far and wide and help me get the information to as many women as possible. Be the first to know when I upload a new post by subscribing below. To those who have subscribed, I apologise for the silence and I promise that as soon as I'm done with exams I will give you the weekly tips and additional information I have promised. Stay safe and continue spreading the love, we will meet next Saturday.