STI 101

Recently, I have been having quite a few conversations with people about how various STIs are transmitted. Consequently, I have become interested in discordant partners, meaning partners who have different statuses (e.g. one is HIV positive and the other is not). Now, I am a believer in being risk-aware. Life is all about taking risks. If someone is aware of all the risks in a given situation and makes an educated decision as a result, I have nothing but respect for the person, regardless of the decision made. That all being said, this STI 101 post will place a bit more emphasis on how to avoid contracting and spreading an STI in a situation where partners have differing statuses.

The STIs I will discuss in this post are chlamydia, gonorrhea, hepatitis B, herpes, human papillomavirus (HPV) and syphilis. If you are looking for HIV, here is my HIV 101 post. For each STI, I will discuss what is it, how it is transmitted, symptoms, basic testing information, treatment and how to protect yourself and/or how to not spread it to your partners.

Note: Similar to my HIV 101 post, I will not cite my sources throughout my post. I will link my sources at the end.

Chlamydia

What is it?

Chlamydia is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis.

Transmission

Chlamydia is mainly transmitted through vaginal and anal sex. It can also be transmitted from a pregnant mother to her child during birth. The child is most likely to be exposed to chlamydia if the mother contracts it during her pregnancy. Although rare, chlamydia can also be transmitted through oral sex and by touching your eye with your hand that has the bacteria on it. It is estimated that about 2.8 million new infections occur every year. Apparently, people under the age of 25 are the most susceptible to contracting chlamydia.

Symptoms

Most people who contract chlamydia will not experience symptoms. When someone does experience symptoms, they will usually appear about five to ten days after they contracted the STI. Some common symptoms are: abdominal pain, bleeding between periods, abnormal discharge coming from the genitals, painful urination, and genital and anal swelling. If chlamydia has infected the throat, the individual may experience a sore throat and if it has infected the eyes, the individual may experience eye redness, itching and fluid discharge.

If chlamydia is not treated for a long period of time, it can cause pelvic inflammatory disease (PID), which infects the fallopian tubes, ovaries and uterus, and epididymitis, which infects the urethra and testicles. Both of these diseases can lead to infertility.

Testing

A health care provider can determine whether or not someone has chlamydia by taking cell samples from the cervix (Pap Smear), penis, urethra or anus. Also urine can be tested. 

Since most people who have chlamydia will not experience symptoms, the only certain way to know if one has contracted chlamydia is to get tested regularly.

Treatment

Chlamydia is treated with antibiotics. If someone has contracted chlamydia, their sex partners should be tested and subsequently treated if they also have chlamydia. Individuals should not have sex (all forms of sex. Yes, oral counts.) until 7 days have passed if they took a single dose antibiotic or after they have finished taking their 7-day course of antibiotics. This is important because not having sex for 7 days will prevent the spread of the STI. Also the CDC (Center for Disease Control) recommends that people should be retested three months after they were treated just to be on the safe side.

Ok, so about sex…

Since chlamydia is mainly spread through unprotected sex, one should use condoms and dental dams to protect oneself from potential infection. I would also suggest using gloves while engaging in manual stimulation (i.e. fingering the vagina and/or anus) to avoid a situation in which a person could infect their eyes by touching it with a potentially contaminated hand.

Gonorrhea

What is it?

Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. It is also known as “the clap” or “the drip”.

Transmission

 Gonorrhea is transmitted though oral, vaginal and anal sex. Gonorrhea can also be passed from a pregnant woman to her child during childbirth. It is estimated that over 700,000 people become infected with gonorrhea every year.

Symptoms

Like chlamydia, individuals with gonorrhea usually do not experience symptoms. If someone does experience symptoms, they tend to occur one to fourteen days after the initial infection. Some common symptoms include: abdominal pain, bleeding between periods, painful urination, abnormal pain, genital discharge, urinating more than usual, anal discharge and genital swelling. If the throat is infected, one can experience an itchy, sore throat or trouble swallowing.

If a child contracts gonorrhea through the pregnant mother, it can lead to premature birth, stillbirth and infections of the blood, joints and eyes.

If gonorrhea remains untreated it can also cause pelvic inflammatory disease and epididymitis.

Testing

To test for gonorrhea, a health care provider could collect samples of abnormal discharges, cell samples from the cervix, penis, urethra, anus or throat and urine.

Treatment

Gonorrhea can be treated with antibiotics. However, recently, drug-resistant strains are evolving around the world, making treating gonorrhea very difficult. The CDC recommends treating gonorrhea with dual therapy with the use of two drugs to treat the infection. Please make sure to take all the prescribed antibiotics to ensure the infection is gone. Not sticking with the antibiotic regimen for the entire period of time can create more drug-resistant strains.

Ok, so about sex…

Since gonorrhea is spread through unprotected sex, one should use condoms and dental dams to protect themselves.

Hepatitis B

What is it?

Hepatitis is an infection of the liver. 

Transmission

The type of hepatitis virus that is most likely to be sexually transmitted is hepatitis B (HBV). HBV is transmitted through vaginal fluids, semen (cum and precum), blood and urine. Infected fluids must come in contact with cuts and tears in the skin and/or through mucous membranes, like the ones in the vagina, anus and mouth. HBV can be spread through unprotected oral, vaginal and anal sex. The friction created in unprotected vaginal and anal sex can cause the canals to tear, giving the virus a way to enter the body. HBV can also be passed from pregnant woman to her child during birth.

HBV can also be spread by sharing intravenous drug needles or using contaminated needles in piercing or tattooing.

Symptoms

Individuals who contract HBV usually do not experience symptoms. When someone does experience symptoms, they usually appear between six weeks and six months after the initial infection. Some common symptoms include: extreme tiredness, abdominal pain/tenderness, loss of appetite, nausea, joint pain, headaches, fever, hives, dark urine, and jaundice.

Testing

A health care provider can conduct a blood test in order to diagnose someone with HBV.

Treatment

A cure for hepatitis does not exist. In most cases, hepatitis B goes away on it’s own in four to eight weeks. However, in some cases, people become carriers and suffer from chronic HBV infection. Carriers can be contagious for the rest of their lives. There are drugs that can help treat chronic HBV, but again, a cure does not exist.

The HBV vaccine is given to prevent an infection, not to cure an already existing one. The vaccine causes the immune system to create antibodies that will fight off the virus.

Ok, so about sex…

One can protect themselves by using condoms and dental dams while having vaginal, anal and oral sex.

Herpes

What is it?

Herpes is an STI caused by two viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Both types can infect the oral and genital areas. However, oral herpes is mostly caused by HSV-1 and genital herpes is mostly caused by HSV-2.

Eight out of ten people in the US have oral herpes and one out of four have genital herpes.

Transmission

Herpes can be spread by touching, kissing and vaginal, anal and oral sex. A pregnant woman can pass herpes to her child during birth. Herpes is the most contagious while the individual has open sores. Cuts in the mouth, cuts in the skin and internal tears due to unprotected sex can make a person more susceptible to contracting herpes.

Symptoms

In many cases, someone with herpes may not experience symptoms for years. Or the symptoms can be so mild that they are not noticed or are not taken seriously.

With oral herpes, cold sores can appear on the lips/mouth and can last for a few weeks and then disappear. Symptoms can reappear weeks, months, or years later. Recurring outbreaks could be caused by: stress, menstruation, other infections, sunburn, sex and skin irritation.

With genital herpes, some symptoms include: clusters of sores on the vagina, cervix, vulva, penis or anus, itching and genital swelling. No one is sure what causes recurring outbreaks in genital herpes.

Initial herpes outbreak symptoms can also include: fever, headache, chills and flu-like symptoms.

Initial symptoms usually go away after two to four weeks and recurring symptoms usually go away after ten to fourteen days.

Testing

A health care provider can conduct a blood test to determine whether or not someone has contracted herpes.

Treatment

A cure for herpes does not exist. However, there are antiviral medications that can suppress recurrent outbreaks while the person takes the medication. Daily suppressive therapy for those who experience symptoms is available in order to reduce the likelihood of transmission to partners.

Ok, so about sex…

During an outbreak, an individual should refrain from having sex and/or kissing (oral herpes). However, it should be noted that even when symptoms are not present, a person could still potentially spread herpes with unprotected sex. Wait until seven days have passed and the outbreak has fully ended before having sex again.

Condoms and dental dams reduce the risk of transmission, but not completely. Contact with sores or fluids, not completely covered by condoms and dental dams, can transmit the virus.

If you are having sex with someone who has herpes, be sure to get tested regularly.

Human Papillomavirus 

What is it?

There are over one hundred types of human papillomavirus (HPV). Forty of those can infect the genital area. Genital HPV is very common. Many people have had HPV at one point and many do not know currently they have it.

Transmission

Genital HPV is transmitted through skin-to-skin contact during vaginal, anal and oral sex.

Symptoms

Most people who contract HPV do not experience symptoms. 

In many cases, the immune system clears up the virus on its own and the infection will disappear in eight to thirteen months.

However, in the cases, in which the body does not successfully fight off the virus completely, it can cause the body to change. These changes include genital warts and cancer. The strains of HPV that cause genital warts are considered low-risk. High-risk strains of genital herpes can cause cervical, vaginal, anal, penile and throat cancer.

Testing

A common way for someone to find out they have HPV is after receiving abnormal test results from a pap smear. During a pap smear, cell samples are taken from the cervix and tested for abnormalities. Other than a pap smear, there are no other tests for HPV.

Treatment

There is no cure for HPV itself. However, there are treatments for the genital warts and cancers that HPV causes. It is best to diagnose and treat a HPV-related cancer early while it is easily treatable.

There are two vaccines (Cervarix and Gardasil) that help to protect against the strains of HPV that are most responsible for causing cervical cancer. Gardasil also helps to protect against genital warts and other types of HPV-related cancers. Both vaccines are recommended by the CDC to young women between the ages of 11 and 26. Recently, the CDC has recommended that Gardasil should be made available to young men between the ages of 11 and 21. Gardasil is licensed for young men between the ages of 9 and 26.

Ok, so about sex…

Use condoms and dental dams to lower the chances of HPV infection. Barriers (condoms and dental dams) do not completely protect against HPV, but they are much safer than unprotected sex.

Syphilis

What is it?

Syphilis is an STI caused by the bacterium Treponema pallidum. 

Transmission

Syphilis is transmitted by contact with open syphilis sores. Contact can happen during vaginal, anal and oral sex. Rarely, syphilis can be spread through kissing if there are sores on the person’s mouth. It can infect the vagina, anus, urethra, penis, lips and mouth. About 36,000 people in the US contract syphilis each year.

Symptoms

Most of the time, a person who has contracted syphilis will either not experience symptoms or the symptoms will be so mild that the person would not really pay attention to them.

There are three stages of syphilis infection:

• Primary Stage – In this stage, painless open sores (known as chancres) appear on the genitals, in the vagina, on the cervix, lips, mouth, breasts, or anus. The sores usually appear about three weeks after infection, but may take up to 90 days. Without treatment, they last 3–6 weeks. Syphilis is especially contagious when sores are present. The liquid that oozes from them is very infectious.

• Secondary Stage – After three to six weeks, other symptoms may appear. These symptoms can disappear and reappear repeatedly for up to two years. These symptoms include: body rashes, mild fever, fatigue, sore throat, hair and weight loss, swollen glands, headache, and muscle pains.

• Late Stage – Long-term untreated syphilis can cause serious damage to the nervous system, heart, brain and other organs and even death.

Syphilis is not usually contagious during the latent stages (hiding period) in the first four years. Untreated syphilis can remain latent for many years or a lifetime. It can still be transmitted from a pregnant woman to her child.

Testing

Like many other STIs, a person who has syphilis will not usually experience symptoms. Regular STI testing will ensure that a syphilis infection is caught early and treated.

Treatment

Syphilis is treated with antibiotics and, in the early stages, syphilis is very easy to treat. Although syphilis is easy to treat, the effects of long-term untreated syphilis are not. A health care provider will test blood or fluid from sores to diagnose someone with syphilis.

Ok, so about sex…

Using condoms and dental dams will reduce the risk of contracting/spreading syphilis.

If there is anything you would like to see added or removed from this post, please let me know (along with the reasons for your request, of course).

CDC and HPV vaccine 

CDC STI main page

Planned Parenthood STI main page 

The Medicalization of Childbirth

Yeah, I know, I’m talking about medicalization again. Seriously though, it’s a process that influences so many aspects of our society and I dislike it so much! That all being said, I promise this is my last medicalization post for a little while so bear with me.

So what do I mean by “the medicalization of childbirth”? I would define it as the process in which the phenomenon of childbirth is seen as something that requires medical interventions in order to be successful. The female body alone is not seen as sufficient and, without these medical interventions, not only would the birthing process be unsuccessful, it would also be dangerous. This medicalization process did not happen overnight. According to Kristi Williams and Debra Umberson in their article, “Medical Technology and Childbirth: Experiences of Expectant Mothers and Fathers,” before the nineteenth century, “childbirth was treated largely as a natural process requiring little or no medical intervention. In the mid- to late-1800s, however, a number of social and cultural factors converged to open the door for medical involvement in the birth process…A central component of this effort was the medicalization of pregnancy and childbirth and the elimination of the competition of midwives” (149). The medicalization of childbirth was born out of competition and a need to make money. The Industrial Revolution also began at around this time and its themes seeped from the factory floor into the birthing room. The body, namely the female body, came to be seen as a machine that can break down and the doctor came to be seen as the mechanic. The doctor becomes the only person who can fix the flaws inherent in the female body. As a result, “the woman becomes the recipient rather than the producer of the child” (149-150). She loses her reproductive power as she is reduced to a potentially dangerous vessel from which the doctor must procure the child.

These themes are still present today. How many times have you heard a woman mention receiving and/or desperately needing epidurals or other forms of pain medication the moment someone brings up the topic of childbirth? And in this country, most births take place in a hospital under the guidance of doctors and nurses. But hospitals are places for the sick. Why should a perfectly healthy pregnant woman automatically be expected to have her baby in a hospital? Because women are made to be afraid. Women are scared of a process that they (and other mammals) have been doing for ages. As Kiki Zeldes and Judy Norsigian declare in their article, “Encouraging Women to Consider a Less Medicalized Approach to Childbirth Without Turning Them Off: Challenges to Producing Our Bodies, Ourselves: Pregnancy and Birth,” “Highly medicalized birth is now the norm for most women, and the perception is that they should fear birth—or at least worry about it incessantly. Many women believe labor and birth will involve insurmountable pain and suffering that can be controlled only with an epidural, and that a medicalized, high-tech birth is the best and safest option for them and their babies” (246). When you hear women talk about giving birth, all they can talk about is how painful and horrible it will be/was and how they will demand medication the moment they set foot in the hospital. You really can’t blame women too much when all their information about childbirth is gained from the medical system and the media. Have you ever seen a TV show or a movie that did not depict childbirth as a horrible apocalyptic event? I haven’t. Women are being primed from the start to have certain beliefs about childbirth. It seems as if giving birth is this horrible life or death situation that one can barely survive, which is interesting when one realizes that women and animals have been able to continue their species for all this time. How were women in the past able to bear it if it was so terrible? And don’t animals feel this pain too? If giving birth was so terrible, why haven’t mammals evolved to make this process completely painless? You would think (if we are analyzing this from an evolutionary standpoint) that since this horrible process could potentially affect the reproductive success of numerous species, a mechanism would have evolved to ease this process. But it hasn’t. Animals are usually able to bear it just fine. What makes humans so different? Are we weaker than animals?

Apparently, we are if all these medical interventions are anything to go by. The medical interventions I will be discussing in this post are elective inductions and caesarian sections (aka c-sections). 

• Inductions are measures taken to speed up the birth of a child. Inductions are appropriate if the continuation of the labor would negatively affect the health of the mother or the child. Inductions become ‘elective inductions’ when the labor is sped up for reasons other than the health of the mother or child. In a labor without complications and a healthy mother, there is no need whatsoever for inductions. And inductions in low-risk pregnancies come with risks. In the article, “Elective Induction of Labor as a Risk Factor for Cesarean Delivery Among Low-Risk Women at Term,” Arthur S. Maslow and Amy L. Sweeny discuss some of the risks and costs of having an induced vaginal birth. They reveal that inducing labor in an otherwise healthy pregnancy “significantly increased the risk of cesarean delivery for nulliparas [women who have never given birth before], and increased hospital predelivery time and costs” (917). Complications that arise from interventions can result in more interventions, which could result in more complications. This cascade effect could then put the mother and/or child at risk, necessitating an emergency c-section that was previously unneeded. Maslow et al. brings up another point: Not only are electively induced vaginal births correlated with an increased risk for an unplanned c-section, they also cost more money than a non-induced birth. Maslow et al. calculated the cost to be an “additional $273 per elective induction” (921). With an additional predelivery time of four hours (an extra four hours before the baby is actually born), the actual induction procedure and an increased chance of epidural use (probably due to the extra four hours of labor), it is not hard to see why an induced birth would cost more money (917, 921).
• Cesarean sections, also known as c-sections, are becoming a disturbing trend in childbirth in this country. Silver et al. discloses this alarming fact in their article,  “Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries:” In 2006, the c-section rate in the US reached over 29%. Much higher than the World Health Organization’s maximum recommended rate of 15% (1231). Although the Maternity Center Association in New York has declared that vaginal births are safer than c-sections, the American College of Obstetricians and Gynecologists “has determined that it is ethically permissible to accede to a request for an elective cesarean section from an informed woman (Klein 161). However, are women being properly informed? They are already being primed to believe that non-induced vaginal births are one of the most dangerous and/or painful events they can possibly experience. On top of that, many doctors in this country tend to tout c-sections as a much safer and much more convenient alternative. But is that really the case? Zeldes et al. do not think so. They disagree saying, “Most women are not aware that the pain of a cesarean birth may extend well beyond the postpartum period. A recent Birth article on postpartum problems showed that 18 percent of women who had a cesarean section reported pain at the site of the incision 6 months after surgery” (247). A cesarean section is a surgery with all of the risks and complications that come with it. The hospital stay is extended in order for the mother to recover from the surgery and Silver et al, lists other risks and complications that one has to think about before undergoing a c-section: “Serious maternal morbidity [illness] increases with increasing number of cesarean deliveries. The majority of this risk is attributable to that associated with placenta accreta [when the placenta attaches too deeply to the uterus] and/or the need for hysterectomy [removal of the uterus]. Placenta postoperative ventilation, intensive care unit admission, operative time, and days of hospitalization, also was increased with increasing number of cesarean deliveries”(1229-1230). All of these risks are not considered when perfectly healthy women decide to go under the knife.

 So as a result of a lack of knowledge and fear of pain, women allow these unnecessary medical interventions to occur, putting themselves at potential physical risk. However, a woman’s physical health is not the only thing that suffers. Williams et al. declare, “research on women’ s pregnancy and childbirth experiences suggests that the use of medical technology alienates many women by minimizing the importance of their roles and their level of control over their bodies and birth experiences” (147). Apparently, medical interventions have a tendency to decrease a woman’s birthing self-efficacy, meaning they negatively affect a woman’s belief that she is strong enough to give birth on her own.  N.K. Lowe further examines the birthing self-efficacy of pregnant women in their article, “Self-efficacy for labor and childbirth fears in nulliparous pregnant women”. Lowe states, “If a woman does not believe that she is capable of the tasks or effort required to cope with labor, she is unlikely to be motivated even to try. Avoidance of, or withdrawal from, the experience through anesthesial analgesia or even Cesarean section becomes an attractive alternative. Likewise, her thoughts about labor, including her affective state, are influenced so that labor becomes an insurmountable task generating great anxiety and fear” (223). Women are then encouraged to give up their control to medical “experts” and to medical interventions that are unneeded and potentially dangerous.

There is another school of thought, unrelated to fear and the “dangers” of vaginal birth, that support full elective medical interventions during childbirth: convenience. William F. Rayburn and Jun Zhang discuss the appeal of convenience in their article, “Rising Rates of Labor Induction: Present Concerns and Future Strategies”. They admit: “Scheduling an induction rather than waiting for spontaneous labor offers many advantages: easing domestic arrangements, ensuring attendance of the patient’s physician, and avoiding journeys during labor either from distant places or in severe climatic conditions” (166). Planning the birth of one’s child the same way one would plan a business meeting does seem appealing. And many women see it as exercising their right to choose and the ability to medically control the frightening birthing process. Being able to plan one’s labor also sounds like a dream to doctors. They could schedule deliveries to the days and times that are the most convenient for them. Also, according to Klein, elective c-sections and other medical interventions are supported by many in the medical community because the interventions make the birthing process something they can totally control (163). This is true for c-sections, especially. Instead of relying on the workings of a woman’s body and giving it the time and/or space needed for it to do what it has evolved to do, doctors can just perform the surgery, deliver the baby and move on with their day.

Despite the conveniences, as stated previously, there are a lot of health risks associated with elective c-sections and inductions that women are not being made aware of. Klein bemoans the fact that “women rarely receive the time (which should be at least an hour) that a full discussion of the complexities of birth alternatives deserves. Moreover, the person providing the counseling is often in a conflict of interest” (162-163). Women are not being properly informed of all the possible risks of medical interventions in part because these interventions tend to be more convenient for the doctor. The issue of choice and consent in regards to elective medical interventions is a gray one because how can someone make an informed decision without accurate information? Women are made to believe that vaginal births are terrifying and that c-sections, epidurals and inductions are the safest ways to give birth when that is not necessarily the case. Instead women should be made aware of the power and magnificence of their bodies. They should be aware that it is possible to give birth without heaps of medication and they do not need medical interventions in low-risk pregnancies. If after receiving accurate and detailed information, a woman still wants some medical intervention than that is her decision, but without being properly informed, it seems as if women are being trapped into believing that their bodies are once again not good enough.