By: Dr. A.R. Williams, Illustrations by: Emma Barnett
Oral Gonorrhea
Ever get âstrep throatâ after going down on a guy? Letâs just say it might not be strep. You might have the oral gongh.
The bacteria Neisseria gonorroeae, or gonorrhea, is deÂrived from the Greek word meaning âflow of seed.â EvÂidently, the milky penile discharge that is one of the main reasons that otherwise healthy adolescent males show up in the doctorâs 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 deÂcade 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 posiÂtive samples come from the oropharanx, a.k.a. the throat.
Patients are often asymptomatic, but may have pharyngeÂal exudates, or white spots on the back of the throat, swolÂlen lymph nodes in the neck, redness and/or pain with swallowÂing. Usually symptoms develop 2 to 10 days after exposure.
One downside to having the oral gongh is that it can spread, causing things like âpink eyeâ or conjunctivitis. GonghuncÂtivitis anyone? Have you ever seen anyone with gongÂhunctivitis? Of course not! They are hiding inside.
Prevention: Condoms help, but condoms work best for preÂventing HIV infection. They are less reliable at preventing the spread of other STDs like gonorrhea. Getting tested for STDs at a clinic or the doctorâs office annually is super imÂportant. These days you donât even have to get swabbedâ thereâs now a urine test for Gonorrhea in widespread use. Itâs always good to wash your hands before and after sexÂual activity, too. Especially before touching your face.
Treatment: Antibiotics! Unlike HIV, which is a virus, GonorÂrhea is a bacteria which means it can be treated by antibiÂotics. Unfortunately, resistance to some antibiotics, such as Cipro, is growing. Make sure you get a shot of Ceftriaxone in the doctorâs office or a prescription for Cefixime or DoxyÂcycline pills. âPartner packsâ 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 individualâs immune system, leading to a whole host of probÂlems, including deadly infections and cancers. Now that treatment has existed since the advent of AZT in the early 1990âs, 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 patientâs HIV disÂeaseâviral load, or how many copies of virus are floatÂing 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 viÂral load is how fast the train is approaching the cliff and the CD4 count is how much track remains.
We now know that someoneâs 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 inÂstance, 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 copÂies in the infected partnerâs blood, was associated with a rate ratio of 2.5 for infection of the HIV-negative partner.
Whatâs important to know is that the viral load spikes immeÂdiately after someone is initially infected, peaking within two months before dropping off substantially. In other wordsâif 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! ConÂdoms! Condoms! Condoms! Condoms!
Treatment: HAART (Highly Active Antiretroviral TheraÂpy) 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 sysÂtem 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 beÂhind 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 (levonorgÂestrel, a kind of synthetic progesterone) and copper-containing deÂsigns 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 beÂcame 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 commonÂly associated with Gonorrhea or Chlamydia infections, but can also arise from microflora of the female genital tract (i.e., anaerÂobes, enterics, G. vaginalis, H. influenzae, and S. agalactiae).
According to studies in the leading British medical journal, LanÂcet, 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 shouldnât receive an IUD at that time. However, physician skill and experience is far more important for successful IUD insertion as the IUD deÂvice itself is not associated with increased risk of infection.
Another big hurdle to IUDâs 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 reÂplaced every month and has the advantages of self-inÂsertion 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-infecÂtion. For women with PID, intravenous (or IV) antibiotics are needÂed 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 interÂcourse, most of it is actually practiced by heterosexuals. Dan SavÂage, venerable sex expert, once said that on the average SatÂurday night, 14 times as many heterosexual couples are having anal sex as homosexual couples. Thatâs a lot of Farrah Fawcetts.
What tends to get glossed over is that 90% of anal cancer, simÂilar 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 transiÂtional skin lining at the end of the vaginal or anal canal.
In other words, if youâre having anal sex, you need to proÂtect your anus from cancer just like you protect your vagina. And if you donât 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 preÂvent cervical cancer. By 2008, the FDA had widened the indiÂcation for women to include vulvar and vaginal cancers. It was not until this past November that the FDA approved the GarÂdasil 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 canÂcer, anyone under the age of 26 should get the HPV vacÂcine series. If you are over 26 years of age, you could still get the vaccine, but you will have to pay more. The vacÂcine 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 interÂcourse with multiple partners- would benefit the most.
Prevention: Condoms. HPV vaccine. Anus pap (screenÂing 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 womÂen 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 perÂformed to evaluate for the degree of abnormality and deterÂmine 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 comÂplaining about having too much money: for those goÂing 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 inÂteractive process where your preferences and fantasies will continÂue 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 isnât worth it, thatâs okay, too. Just be glad you donât have gonghunctivitis.
Prevention: Abstinence.
Treatment: Getting laid.
