The Itch You're Afraid to Scratch

You don’t have the time. You have no reason to take one. You would rather avoid the uncomfortable test. You don’t want to know the results. These are common excuses to avoid or put off getting tested for a sexually transmitted infection (STI).

Unfortunately, the statistics are working against you.

Not getting tested can result in extremely dangerous health outcomes for yourself (including genital warts, blisters, infertility, cancer and death), any of your potential partners and any future children either of you may eventually decide to have. It sounds very dramatic, but the data on STIs speaks for itself; the facts and figures paint a bleak picture for non-condom users hoping to get out of a sexual relationship unscathed.

There’s no mystery about the fact that a lot of us are having sex. Statistics Canada recently found that by age 20-24, 80 per cent of Canadian’s reported having at least one sexual partner. At least one. Statistics Canada published a report in 2005 that indicated 31 per cent of females aged 18-19 and 39 per cent of males aged 18-19 reported having more than one sexual partner in the last year. This means that the person you are now shacking up with has probably been with someone else. This opens up a chain of sexual partners through which an STI can travel through and find its way to you.

Still not convinced there’s a high risk factor for contracting an STI? According to Statistics Canada, 854,817 people in Canada aged 15-49 reported being diagnosed with an STI. In addition, virtually every STI has been on the rise in recent years, as the focus has shifted from more common STIs like chlamydia and gonorrhoea to those that are incurable, like AIDS.

Not knowing a lot about exactly how you can get an STI, what having it means and how to get tested and treated is actually very common — not only in high schools but also on many university campuses. So where can you go to get the information you need?

The Internet is a wealth of information on just about everything and would most likely be anyone’s first stop. However, as we all know, not all of the information you find on the Internet is valuable or accurate. If you’re too timid to visit a doctor, finding reliable sources and images to identify the infection and explain its associated risks can be difficult.

In search of information on STIs, there are two websites which are particularly helpful — and were used extensively in the gathering of information for this article. Sexualityandu.ca is a Canadian website which is administrated by the Society of Obstetricians and Gynaecologists of Canada. Virtually all of the practical information you need on STIs and your sexual health can be found at this website. If you’re looking for some more technical details of a specific problem you suspect you have or have been diagnosed with, Health Canada has a series of information sheets that will give you an easy to read background on a variety of STIs (http://www.hc-sc.gc.ca/dc-ma/sti-its/index-eng.php).

There are some gaps in the literature available online — and to get frank and honest answers you’ll have to go beyond books and websites. In a recent interview, Alex McKay (PhD), research coordinator for the Sex Information and Education Council of Canada, filled in those details and revealed a clear picture of the sometimes complex issue of our sexual health.

What are your most common misconceptions? Well, if you think you are safe from STIs because both your partner and yourself have recently been tested and are in a monogamous relationship, you would be wrong. Yes, completely wrong. Just because you and your sexual partner have both been issued a clean bill of health from your doctor does not mean that you are not carrying an STI.

McKay explained that typical tests offered in doctor’s offices cover three main STIs: chlamydia, gonorrhoea and syphilis. They do not test for herpes simplex 1 or 2, hepatitis, AIDS or HPV. The good news is that you can request simple blood tests that cover Hepatitis and AIDS. The bad news? There are no commonly available tests for HPV — an STI that causes genital warts and 70 per cent of all cervical cancer — or for herpes simplex.

McKay went on to explain that herpes simplex and HPV are much more common than people think. herpes simplex infects approximately 22 per cent of the Canadian population, and nearly 75 per cent of the population will be infected with HPV at some point. Most people living with HPV and herpes simplex have no knowledge that they are carrying and transmitting the disease because they are completely asymptomatic.

In fact, a number of STIs can be carried and transmitted by individuals who are completely unaware they have them. Many STIs exhibit no symptoms, especially in the initial stages. To prevent negative health outcomes it is important to be tested for the STIs which have commonly available tests as well as use condoms consistently. McKay cites this as the number one thing which can significantly reduce the likelihood of becoming infected.

Consistent condom use means using one throughout your monogamous long-term relationships, not just on one night stands with questionable classmates. It also means using it every time you have sex, and not just when you have the presence of mind to use one or when you’re feeling responsible. Condom use isn’t as common as you might think — Statistics Canada’s 2005 health report indicated that of sexually active individuals aged 20-24, 44 per cent reported having sex without a condom. The disturbing trend is that as the age range of a group increases, consistent condom use decreases. This means that 13-15 year olds are using condoms more consistently than 20-24 year olds.

It seems, then, that the knowledge we gain from our sex education classes in high school either wears off or we develop new and great excuses to ditch the rubber barrier between us and disease. McKay cautions against these excuses and forgetfulness — you may think that you are going to be with this partner forever, but next year you may be with someone else in an equally lengthy and monogamous relationship. When these partners begin to build up (even over several years) you’ve could have become infected and infected others with STIs you didn’t even know you had.

Even with consistent condom use, STIs can be transmitted from skin to skin contact, as well as oral sex — which is becoming an increasingly popular way to transfer herpes. Everyone has heard that you shouldn’t perform oral sex if you have a cold sore — but apparently people are still doing it, and transferring herpes simplex type 1 (the virus that causes common cold sores) to the genital area, causing infections and outbreaks of herpes simplex type 2 (genital herpes) is on the rise.

Sexualityandu.ca helps to clarify the distinction between different types of STIs. as bacterial, viral or parasitic. chlamydia, gonorrhoea and syphilis are all categorized as bacterial STIs, whereas genital herpes, HPV and HIV are all classified as viral STIs. Parasitic STIs include crabs (public lice) and scabies.

The bottom line is that you need to protect yourself and others to help prevent the spread of the disease and avoid the negative health outcomes associated with the infections. The first step in protecting yourself is educating yourself. You may think you have an excellent knowledge base in the area of STIs, and it’s unlikely that someone like you would get one — but you may be wrong about the things you thought were facts. The following is a brief overview of the major STIs in Canada and the things you need to know about each of them.

Chlamydia

FACT OR FICTION: You can’t get it from giving or getting head. FACT

How can you get it? Vaginal, anal or oral sex.

How common is it? According to Statistics Canada, chlamydia is the most commonly reported bacterial STI in Canada. 72,390 cases were reported in Canada from January to December of 2007. This rate has been steadily increasing since 1997.
Chlamydia is also much more common in females. Sexualityandu.ca indicates that females account for over two thirds of all reported cases. It is also extremely common in young people — 2/3 of all reported cases are in the 15-24 age group.

Common symptoms? This is one of the STIs which you can have and transmit without even knowing it. Health Canada refers to it as the “’silent disease’,” because more than 50 per cent of infected males and 70 per cent of infected females have no symptoms.
Health Canada does list potential symptoms for those in the minority who may experience them.

Both men and women may experience discharge (from the vagina or penis) or a burning sensation when peeing. Symptoms unique to women infected with chlamydia are pain in the lower abdomen, fever, chills, pain during sex and vaginal bleeding between periods after sex. Symptoms unique to men are burning and itching at the opening of the penis or pain and swelling of the testicles.

How do I know if I have it? Fortunately, there is a commonly available, free urine test or pap smear that can detect chlamydia. If you are male and were tested for STIs several years ago, you may be concerned of the painful penis-swabbing technique that was used to test previously. This involved inserting a Q-tip-like swab into the penis. There are now more sensitive tests available in Canada and the U.S. which do not require this painful test — they are instead simple urine tests. McKay stated that if you are approached with a Q-tip, simply ask for the urine test. It is available at most clinics.

Treatment options? A single dose of antibiotics can be prescribed by your doctor to treat the infection and get rid of it. It is curable and non-permanent.
What are the long-term health outcomes? If you don’t go for regular tests or ignore symptoms Health Canada indicates you have the potential to become infertile, suffer from chronic pain in your pelvis or have an ectopic pregnancy which can be fatal.

Gonorrhoea

Common Names: the clap, a dose, a drip

How can you get it? Vaginal, oral or anal sex.

How common is it? According to a study by Statistics Canada, Gonorrhoea is the second most commonly reported bacterial STI in Canada. 11,515 cases were reported in Canada from Jan. - Dec. 2007. Sexualityandu.ca also says gonorrhoea is much more common in males; more than 60 per cent of cases are “attributed to males.”

Common symptoms? Again, according to Sexualityandu.ca, most men and women are completely asymptomatic (experience no symptoms). Health Canada indicates that for men who do experience symptoms, a burning sensation when peeing, yellowish or white discharge from the penis and painful or swollen testicles are the most common.

Women more typically experience symptoms and these usually occur two to five days after infection and these include a yellowish or bloody discharge and a burning sensation when peeing.

It is important to note that even in the absence of symptoms, women can suffer dangerous health outcomes from living with the infection.

How do I know if I have it? This is one of the STIs for which tests are commonly available. Having a urine test or pap smear will determine if you have it. You must visit a doctor, however, and keep in mind Gonorrhoea is commonly mistaken for a yeast or urinary tract infection — but is much more dangerous.

Treatment options? Your doctor will typically prescribe a dose of powerful antibiotics — however more and more strains of gonorrhoea are becoming resistant to these antibiotics.

Long-term health outcomes? Health Canada explains that having gonorrhoea can lead to pelvic inflammatory disease which comes with a score of painful symptoms that can result in infertility and abscesses in your uterus or fallopian tubes.
Men can suffer scarring of the urethra, making peeing difficult and painful.
In addition it makes both sexes more susceptible to contracting AIDS — an STI that is fatal and for which there is no cure.

Syphilis

Common Names: Sif, pox, bad blood

How can you get it? Vaginal, oral, anal sex, intravenous drug use or contact with broken skin.

How common is it? According to Sexualityandu.ca, “syphilis affects 3.5 per 100,000 people in Canada, nearly nine times the rate in 1997.” Rates are rising faster for males than females, especially males over 30. Health Canada found 1168 reported cases in Canada from Jan. - Dec. 2007.

Common symptoms? Syphilis has a wide range of symptoms, and they are unique to each stage. In the first stage a small painless sore or ulcer can develop where the infection has entered your body. In second stages, hair loss, patchy rashes on your palms or feet may occur accompanied by swollen glands, fever or joint and muscle pain.

How do I know if I have it? A simple blood test is commonly available at your doctor’s office.

Treatment options? Your doctor will most likely prescribe penicillin or some other form of antibiotics, which have been an extremely effective treatment for syphilis.

Long-term health outcomes? According to Health Canada, if syphilis is left untreated, it can move through five stages. During one of the later stages syphilis can do serious damage to your body by affecting your brain, blood vessels, heart and bones, eventually leading to death. It also drastically increases your risk of contracting AIDS. It can progress through many stages with very few symptoms — which makes testing extremely important.

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)

Fact or Fiction? You can get HIV or AIDS from giving or receiving oral sex. FACT
You can get HIV or AIDS from kissing someone, using the same utensils as them, swimming in the same pool or from being bitten by insects such as mosquitoes. FICTION

How can you get it? Vaginal sex, oral sex, anal sex, intravenous drug use or infected or unsterilized tattoo needles.

How common is it? The Public Health Agency of Canada estimated that in 2005 58,000 people were infected with HIV. Sexualityandu.ca indicated that 30 per cent of these people were unaware they were infected.

Common symptoms? Many people are asymptomatic, but Sexualityandu.ca described some of the symptoms that are commonly experienced: constant weight loss and fatigue, night sweats, loss of appetite and constant diarrhea. These are easily attributed to disorders other than HIV or AIDS, so it is important to get regularly tested if you are sexually active — especially if you are engaging in “high-risk sexual behaviours.”

How do I know if I have it? A blood test is commonly available at your doctor’s office, however if you recently had unprotected sex the test may not accurately diagnose the virus until up to six months after infection.

Treatment options? The virus does not have a cure, however there have been significant advancements in medications that are prolonging and increasing quality of life for people who are infected.

Long-term health outcomes? Sexualityandu.ca explains that AIDS itself is not fatal, but it weakens your immune system so much that common infections and health problems result in death, as your immune system can no longer cope with them.

Herpes simplex virus-2 (genital herpes or HSV-2)

Fact or Fiction? Once you have genital herpes, your sex life is over. FICTION

If you have genital herpes, you will know it. FICTION

If you have been tested for STIs and the results came back negative, you do not have genital herpes. FICTION

Everyone has herpes, because everyone gets cold sores. FICTION

Cold sores are herpes. FACT

How can you get it? Any skin to skin contact, including vaginal sex, oral sex or anal sex. You can get HSV-2 from performing oral sex, or transmit HSV-2 by performing oral sex.

How common is it? McKay indicated that approximately 22 per cent of Canadians have HSV-1 (the type which causes cold sores, localized to the mouth) or HSV-2 (genital herpes) However, Health Canada indicated that HSV is not a reportable disease in Canada and knowledge of its prevalence is limited.

Common symptoms? Sexualityandu.ca lists several symptoms: genital itching, small blisters in the vagina, on or around the penis or testes, on or around the anus, on or around the thighs or buttocks, tender lumps on the groin, fever and headaches, painful sores after blisters burst and painful urination.

How do I know if I have it? For many people genital herpes can be an extremely ambiguous and confusing disease. How do you know, for example if it is just a pimple or ingrown hair, or a genital herpes sore? There is no commonly available test for genital herpes, however, you can visit your doctor when you have a sore or outbreak to have the area swabbed. This can then be tested for HSV-2. Testing positive does not mean you are destined to a life of breakouts and flare-ups, however. It could be your only outbreak ever, or you may experience them yearly, or more frequently than that.

Treatment options? The virus does not have a cure and remains with you for the duration of your life. There are treatments available through your doctor to control and treat flare-ups or genital herpes outbreaks, however. You should always avoid sexual contact during an outbreak, although you may still transfer the disease if you are not having an outbreak.

Long-term health outcomes? McKay made clear that genital herpes is simply a skin condition. There are no serious long-term health concerns from contracting and carrying the disease, besides the uncomfortable and embarrassing outbreaks. It is important that you inform all of your sexual partners prior to sexual contact so you can both discuss risk — genital herpes can be transmitted even when using a condom. Many individuals carry genital herpes with no symptoms or outbreaks and pass it on to other individuals who may or may not experience the painful outbreaks, and since there is no commonly available test it is important to protect yourself by using condoms and dental dams consistently.

Hepatitis B

Fact or Fiction? Hepatitis B stays with you for life. FICTION

You can never have sex again, once you contract it. FICTION

How can you get it? Vaginal, anal or oral sex. Any blood to blood contact can transmit the disease, including sharing needles, razors or even toothbrushes that have come into contact with infected blood.

How common is it? According to a study by the Public Health Agency of Canada, an average of 2,868 cases were reported yearly between 1990-1994. More recent statistics were unavailable.

Common symptoms? As with most STIs, both long term and acute infections of hepatitis B can be completely asymptomatic. SexualityandU.ca indicated that when someone does experience an acute hepatitis B infection they may experience flu-like symptoms. These include fatigue, aching joints, stomache pain, loss of appetite and nausea. It can even cause jaundice, which indicates liver problems may have a developed as a result of the disease.
With chronic hepatitis more serious and sometimes fatal liver problems may occur, and drinking alcohol will speed the destruction of the liver in these people.

How do I know if I have it? Doctors can administer a blood test.

Treatment options? Hepatitis B is treated in different ways based on acute versus chronic cases. According to Sexualityandu.ca, acute cases can be cleared by the body’s immune system within the first six months of infection. This does not require treatment. However, if the body does not clear the virus it can continue to live in the infected for the duration of their life. This is known as chronic hepatitis B. There are medications that your doctor can prescribe to prevent it from spreading, but they are not appropriate for everyone.
In order to prevent yourself from ever getting hepatitis B, you can receive a vaccination.
If you suffer from an acute hepatitis B infection (lasting less than six months) you can resume sexual behaviour again after the infection has cleared your body. Ninety per cent of adults recover from an acute infection.

Long-term health outcomes? If you leave the disease untreated you put yourself at risk for serious liver damage. Sexualityandu.ca indicated that cirrhosis, liver cancer and liver failure are all possible outcomes of untreated hepatitis B. In addition, hepatitis B can seriously increase your risk of contracting HIV.

Human papillomavirus (HPV)

Fact or Fiction: HPV can clear up on its own within a few years. FACT

HPV is harmless. FICTION

HPV can cause cancer. FACT

How can you get it? HPV can be transmitted through vaginal, oral or anal sex and skin-to-skin contact.

How common is it? Sexualityandu.ca indicates that HPV is the world’s most common viral STI. McKay estimated that approximately 75 per cent of Canadians will be infected with HPV at one point in their lives. Health Canada has also verified this estimation, but mentions that HPV is not systematically measured in Canada, nor reported, so prevalence estimates are made based on limited information.

Common symptoms? According to Health Canada most cases of HPV have no symptoms, and a healthy immune system will eventually clear the virus. However, it can manifest itself in different ways. One of which is to cause genital warts. These can appear in both women and men.

How do I know if I have it? If you receive regular Pap tests and specifically request to be tested for HPV you can be tested for one of the many different variations. Some variations are responsible for virtually all types of cervical cancer, where others (considered “low risk”) are associated with genital warts.

Treatment options? The Canadian government is currently focussing on prevention, and vaccinations are available for many of the common strains of HPV. Genital warts caused by HPV can be removed, but this will not eliminate the virus. Again, a healthy immune system can clear the virus on its own.

Long-term health outcomes? Sexualityandu.ca indicates that HPV can cause skin warts, genital warts, pre-cancerous lesions and lead to certain types of cancer.

Crabs (pubic lice)

Fact or Fiction? You can get crabs from public toilet seats. FACT

You can get crabs in areas other than the pubic hair surrounding your genitals (like your armpits or eyelashes). FACT

You cannot get crabs if you get a “Brazilian” and are bald in your pubic region. FICTION

What is it? They are similar to head lice (both are extremely small parasites) except that they make their home in your pubic hair and are somewhat flatter and rounder than head lice.

How can you get it? By coming into contact with someone who has crabs, or surfaces and fabrics (sheets, beds or clothing) that have been contaminated by persons who have them.

What are common symptoms? Intense itching, small black spots where you have been bitten, small blood stains in underwear and raised, grey areas (bumps) around the hair follicle where eggs have been laid.

How can it be treated? A non-prescription lotion or shampoo can be purchased at just about any drug store or pharmacy to clear them up. If you have an extremely difficult to get rid of case, you can visit a doctor to get a prescription for topical Malathion or Lindane. Your bed should be vacuumed and all of your clothing, linens and towels should be washed in extremely hot water and sealed in plastic bags for two weeks to ensure all of them have died.

What can you do to protect yourself?

McKay advises consistent condom use and regular testing. Health Canada has guidelines available on its website, as does Sexualityandu.ca, the major points are:

“Learn about safer sex methods;
Make informed decisions and talk to your partner(s) about their STI status and the use of protection;
Use condoms consistently and correctly;
Get tested for STIs if you are sexually active; and
If you are diagnosed and treated for an STI, be sure to follow your health care provider’s treatment and follow-up recommendations. You can easily be re-infected if your partner is not treated as well.”

Average: Select ratingPoorOkayGoodGreatAwesome

Your rating: None Average: 5 (5 votes)