Gynecological Health, Preventive Care, Reproductive Health
In this edition of Candid Consult, we’re asking OB/GYN Dr. Nathan Watters of Cherry Hill OB/GYN all of the STD-related questions you’ve wanted to know but may have been too embarrassed to ask. We get it, it can be awkward to have those honest conversations with your doctor. But chances are, they have heard it all before. Your healthcare provider is your ally and is there to help arm you with the most accurate and up-to-date health information and can help you navigate any sexual health situation (no matter how uncomfortable!)
Before we dive into the interview, we wanted to share some important facts on STD prevalence and prevention.
First off, it’s important to know that sexually transmitted diseases (STDs) are very common and can be a very real threat. It’s estimated that about 68 million people in the U.S. are living with an STD. In other words, about one in five Americans is carrying an STD at any given moment.
The good news: STDs can be preventable. Of course, abstinence is the only 100% foolproof way to protect yourself from an STD. However, practicing safe sex by using barrier protection methods (i.e. condoms or dental dams) can be very effective as well.
Prevention is so important because if left untreated, STDs can lead to serious health concerns. In women, STDs can result in chronic pelvic pain, pelvic inflammatory disease, infertility, and/or severe pregnancy and newborn complications.
Now, with all of this in mind let’s get into those burning questions for Dr. Watters.
In the very technical sense, yes. “STD” stands for Sexual Transmitted Disease. “STI” stands for Sexually Transmitted Infection.
A disease typically signifies a more advanced condition or infection and may carry an associated stigma, which is why there has been an effort to shift the term to infection. Many infections can be asymptomatic and are not considered a disease until they present with symptoms.
Regardless of what you call them, it’s important to know that both STDs and STIs need to be screened for and treated.
It ultimately depends on your sexual behaviors.
The Centers for Disease Control (CDC) recommends that any sexually active female under the age of 25 receive at least annual screenings for gonorrhea and chlamydia because a majority of cases in the United States occur in this age group. There are not specific guidelines beyond age 25, but if you are having intercourse outside of a trusted, monogamous relationship or are having symptoms, you should get screened. If you’re entering a relationship with a new sexual partner, it may also be a good idea for both partners to get screened to ensure a “clean bill of health” before any activity.
It’s also important to know that there are two parts to testing and screening: swabs and blood tests. Swabs will test for things like gonorrhea, chlamydia or HPV. Other STDs including HIV, hepatitis, and syphilis must be tested through blood work. If you’re looking for a full spectrum of screenings, both blood and swab tests are recommended.
Yes, some STIs can be present without symptoms and others may have delayed symptoms. For example, gonorrhea and chlamydia can be present without any symptoms. Similarly, syphilis initially presents as a painless ulcer which if it is located inside the vagina may go unrecognized. Other sexually-transmitted viruses like human papilloma virus (HPV) or human immunodeficiency virus (HIV) can take weeks, months, or years for symptoms to develop. This is why screening for STIs even when a patient doesn’t have symptoms is so important.
Pelvic pain, discharge, and lesions may be more obvious symptoms of an STD. If you are experiencing any of these symptoms and are (or have been) sexually active, it’s important to contact your doctor.
Unfortunately, not. If you are exposed and treated for an STD, you are susceptible again after treatment. For the bacterial infections (i.e. gonorrhea, chlamydia, syphilis), treatment will include a short-course of antibiotics and follow-up testing to confirm the treatment worked. Certain STDs like herpes and HIV are lifelong infections and require ongoing treatment.
Yes and no.
Cold sores come from the herpes virus and there are two strains that can cause cold sores: HSV-1 and HSV-2. HSV-1 is very common among the population and is often not obtained through sexual contact (many people are exposed when they are young from kissing older relatives, etc) and usually causes cold sores on the mouth.
HSV-2 is less common and traditionally obtained through sexual activity (oral, vaginal, anal intercourse) and usually produces sores on the gentials. You can, however, get HSV-1 on your genitals and HSV-2 on your mouth and regardless of how you obtained either strain: both can be transmitted through kissing and sexual contact.
If you have symptoms of a cold sore or anogenital lesions you should refrain from all activity including kissing until the lesions have completely healed. It’s important to know that the virus can be spread even when you are not showing signs of infection. It is also important to know that even condoms don’t always work against active lesions. The good news is that if you are prone to outbreaks there are daily medications you can take to prevent them.
Not always, there are many reasons for vaginal discharge! Discolored or increased discharge can be a symptom of a non-sexually transmitted infection (such as a yeast infection) or could even be due to hormonal changes. It’s important to consider your recent sexual activity to better understand if this symptom could be linked to an STD and if you have any concerns it is always best to call your doctor.
Yes! You can be at-risk of both giving and receiving an STD through oral sex. You can develop infections of the throat with gonorrhea and chlamydia as well as sores around the mouth with herpes.
No! Let me repeat: No. Birth control in any form (i.e. the pill, patches, IUDs) only works to prevent pregnancy. Birth control does not provide any protection again STDs. Barrier contraceptives (i.e. condoms/dental dams) can protect against some STDs, but are not 100% effective.
Possibly. Often, pelvic pain is not related to an STD. Pelvic pain during sex is very common and may be related to other conditions including endometriosis, cysts, or tension. Your anatomy – how your uterus is positioned in your pelvis – may also make intercourse painful during certain positions. Severe infections with gonorrhea of chlamydia or an active herpes outbreak can also make intercourse painful. We want sex to be enjoyable and if you are having pain for any reason don’t hesitate to call your doctor so that we can help you figure out the cause.
If you shave/wax, you may be more prone to ingrown hairs. If you’ve recently shaved, and are noticing one bump that isn’t terribly uncomfortable, it could simply be an ingrown hair. A first herpes outbreak tends to exquisitely painful, with larger lesions appearing inside the vulva and around the vagina. Subsequent outbreaks tend to be smaller but are still generally painful. Herpes lesions will change over time and may weep a clear fluid. If you are concerned, come see us!
If you are looking to get screened or think you may have been exposed to an STD, we encourage you to contact your doctor who can discuss your options privately, confidentially, and always judgement-free.
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