Women’s Health

Sexually Transmitted Diseases (STD)

There are many reliable websites available to obtain information about sexually transmitted diseases. My hope is not to replicate them but to distill them, to provide you with some valuable information and to address some issues that you may not find in your internet or library searches.

It is rare to find a sexually active individual who has not had an STD. What? How can that be? STDs are common, most existing in an asymptomatic form. Most of the STDs I’m referring to have never been a problem and never will be a problem for those that have them. Other sexually transmitted diseases, however, can have devastating consequences to one’s health. In addition to the threat to a woman’s health, an STD may have enormous consequences to her emotional well-being and self-esteem. A woman’s initial reaction to the news that she has a sexually transmitted disease includes:

  • Depression
  • Despair
  • Betrayal
  • Loss of self-esteem
  • Anger

This is quickly followed by numerous questions that include:

  • How did I get this?
  • Can I give it to someone else?
  • How long have I had it?
  • Did he cheat on me?
  • Who did I get this from?
  • Can I pass it on to someone else?
  • Will I be able to have children?
  • Do I have to let my partner know?
  • Will I always have this problem?
  • Does this make me “dirty”?
  • How can I live with myself?

The Reality of Sexual Transmitted Diseases(STDs) is the Following:

Reality # 1: They are common!
STDs are common–especially among young people. The Alan Guttmacher Institute (AGI) analyzed and published an important survey in January of 2004 [Perspectives on Sexual and Reproductive Health, 2004, 36(1):6-10]. In their study they note the following:

18.9 Million new cases of STDs were reported in the year 2000
15-24 year-olds represent 25% of the sexually experienced population
9.1 Million of the newly diagnosed STDs reported in 2000 were among 15-24 year-olds
3 STDs (human papillomavirus, trichomoniasis and chlamydia) accounted for 88% of all new cases of STD among 15-24-year-olds.

Additionally, consider some additional information:

In March 2007 the National Cancer Institute reported that the overall prevalence of HPV in the U.S. in women ages 14-59 was 26.8%
At any one time there are 20-40 million Americans with HPV
About 60 million Americans have had the virus that causes genital herpes
As estimated 3 million Americans are infected with chlamydia each year
In 2005 there were 339,593 cases of gonorrhea reported in the United States.
About 10,000 women are diagnosed with HIV each year in this country—80% of these cases arise from heterosexual contact.
Each year in the U.S. more than 1 million women experience an episode of acute pelvic inflammatory disease (PID)–more than 100,000 women become infertile as a result.

Reality #2: Not all STDs cause symptoms
Many STDs cause symptoms such as foul odor, vaginal discharge, redness, soreness, warts and other visible lesions. The majority of STDs, however, cause no symptoms at all but exist in an asymptomatic or dormant state—at least for a while. It is this asymptomatic state that allows an individual to unknowingly pass it on and cause a serious infection to his or her partner. Examples include HPV, genital herpes, hepatitis B, chlamydia, gonorrhea and HIV.

Reality #3: STDs cover a broad spectrum of diseases.
Some of these diseases are not serious and do not generally have a large emotional component for most women (examples include bacterial vaginosis and trichomoniasis).

At the other end of the spectrum are diseases that can be life-threatening such as HIV/AIDs and viral hepatitis.

There are diseases which are not life threatening but can pose a significant threat to one’s future fertility—gonorrhea, chlamydia, and pelvic inflammatory disease (PID).

There are diseases which are not life threatening and generally do not pose a significant threat to future health but are not completely curable either. Examples of such STDs are human papillomavirus (HPV) and genital herpes. The emotional reaction most women have to HPV is quite variable and to some extent depends on how the disease manifests itself—warts or abnormal pap smears.

Still there are other diseases that are serious but easily eradicated such as syphilis.

There are sexually transmitted diseases that carry a tremendous emotional stigma well out of proportion to the actual damage caused by the disease—genital herpes is perhaps the perfect example of an STD that often causes an emotional breakdown well beyond what can be justified by its implications for potential harm.

Finally, there are rare diseases that you’ve never even heard of but should be aware of such as lymphogranuloma venereum (LGV) and chancroid.

Reality #4: The risk factors of STDs are well known. They include:
Young age (15 to 24 years old)
African-American race
Unmarried status
Geographical residence
New sex partner in past 60 days
Multiple sexual partners
History of a prior STD
Illicit drug use
Admission to correctional facility or juvenile detention center
Meeting partners on the internet

Reality # 5: There’s lots of misinformation out there!
For over 30 years I’ve talked to professional women who believed that herpes increased their cancer risk, that HPV would make them sterile and that HIV wasn’t as serious a problem as it “used to be”. Many of these women claimed to get their information from the internet, their friends, television commercials, their parents, magazines and even another health care provider. Some women admit that their beliefs aren’t based on any known facts, but instead harbor beliefs based largely on their own fears. I’m constantly amazed by the apparent willingness of ignorant, unqualified and “well meaning” individuals to offer their “help”. Still more surprising is that many women accept the information they get from unqualified individuals or from dubious sources (women’s magazines, paid advertising by pharmaceutical companies). Few things are as dangerous in the medical world as the intersection of good intentions, ignorance and panic.

Perhaps the only thing worse than no information is too much information! In order to obtain sound advice be certain of two things—that your information source is qualified and that they have no financial interest in the information they dispense.

So be careful of your information source! This includes your best friend, a neighbor who happens to be a nurse, your mother, boyfriend, most newspaper and magazine articles and many websites.

Also be skeptical of individuals and corporations that stand to profit from the information they dispense—various websites and pharmaceutical companies that advertise heavily on TV and in magazines.

Oftentimes, government websites are some of the best sources of information available. Consider some of these.

Reality #6: In many cases, even knowledgeable health professionals don’t have all the answers to your questions
In some instances it isn’t possible to know the medical answer with certainty. For example, if you’ve had a positive chlamydia culture but not had symptoms it’s unlikely that it will impact your future fertility but there is virtually no way to be certain about your ability to conceive in the future—at least not until you try. If you’ve been diagnosed with genital herpes should you take medication to prevent possible recurrence or to decrease the likelihood of infecting your partner? The answer will depend on many factors, but ultimately involves some “guesswork” on the part of your health care provider as well as your own comfort level. Your health care provider will not be able to provide you with exact statistics on the likelihood that you’ll suffer a recurrent infection or the likelihood of infecting your partner.

Reality #7: Even when medical information is available the decisions you make may depend on personal psychological factors.
For instance, it may not make much “medical sense” for someone who had a mild case of genital herpes to take prophylactic anti-viral medication for the rest of their life. Yet, rarely, some women insist on doing so. For them, the psychological benefit of feeling that they are actively preventing even a small risk of recurrence or transmission is worth the cost and burden of taking daily medications for extended periods of time.

Reality #8: In many cases there is no “one size fits all” answer.
If you had venereal warts 10 years ago and have not had a recurrence since, is it necessary to tell your partner? The answer to this question will depend on many circumstances and there is no “one size fits all” answer.

Reality #9: Asking your health care provider to “test me for all STDs” is often not realistic—worry about the ones that are important to you.
Health care providers generally test for serious STDs that can affect your health. For instance we encourage testing for HIV, hepatitis, gonorrhea and chlamydia. Whether or not routinely screen for syphilis, herpes and HPV is a more complex issue and depends somewhat on your medical history, your symptoms and lifestyle. Routine testing to determine if you’ve even been exposed to oral or genital herpes may or may not provide helpful information to you. The same may be true of routine HPV screening for women with negative pap smears and no physical findings. The extent to which you require testing will depend on your risk factors (see above), your understanding of these diseases and your need for reassurance. Ironically, women who seem most concerned about STDs are often at lowest risk while woman at very high risk for STDs frequently avoid testing altogether. Another irony is that women often wish to be tested for comparatively benign diseases such as bacterial vaginosis or herpes while refusing HIV or hepatitis screening.

Reality #10: Medications alone cannot heal the psychological trauma
I’m often stunned to hear the following from women: “I’d rather have cancer than herpes”. What an incredible statement! Genital herpes is an STD that in the vast majority of cases causes little pain, few recurrences, does not affect future fertility and does not cause cancer. The real implication of herpes is its “stigma”. So powerful is that six-letter word that it has driven some women to thoughts of suicide and even homicide–the assumption being that their husband or boyfriend “gave” it to them. But the fear and stigma associated with the word “herpes” often blocks out rational thought to such an extent that conversation isn’t even possible until the crying, the anxiety and the hurt begin to subside.

Reality #11: STDs are the result of lifestyle choices
It comes as no surprise that STDs are more prevalent in younger age groups (15-24). Youth is a time of growth, experimentation and often poor choices. Many errors—some serious—result from testing the limits of vehicular speed, alcohol, drugs, sex and emotional fulfillment. No one passes through life without making some bad judgments, but a wise person learns to minimize risks, learn from mistakes and commit to self improvement. Making mistakes is human foible— to not learn from them is a human tragedy. Multiple partners multiply your risk. Condoms offer some, but only limited protection. The best protection against STDs is a mutually monogamous long term sexual relationship with a trustworthy partner.

Putting STDs in perspective

Once a woman has entered the arena of sexual expression the risks of sexually transmitted infections become real. Those who are too frightened to assume even the slightest risk of a sexually acquired infection may avoid contact altogether. Those who are careless, reckless and thoughtless expose them selves and their partners to emotional and physical pain. Most men and women live in the midst of this spectrum—desirous of an intimate relationship and intelligent enough to avoid needless risk. Arm yourself with as much knowledge as possible, practice a disciplined approach to sexuality and be thoughtful to your partner. Life is fraught with risks but a wise person learns to manage them.