Imagine this scenario. You wake up one Monday morning feeling suddenly feel itchy down there. Maybe it’s a reaction to a new washing soap or the lacy thong you wore last weekend, instead of your trusty cotton hipsters, you think, and somehow get through that work week. But when Saturday rolls around, it is still not gone away. Now you start worrying whether your last sexual encounter or the fever you had 3 months ago has anything to do with your lady bits being irritated now.
“Is it something dangerous,” you wonder, frantically googling STI symptoms and end up convinced you’ve contracted something. But you’re too terrified to do anything more to address it.
“What if it is actually something?” you think, behaving a little like Samantha Jones in Sex and the City when Tom Reymi, her male sexual counterpart, refuses to get intimate with her unless she gets tested for HIV.
I don’t blame you for being so worried. The sneaky nature of sexually transmitted diseases makes them hard to detect, especially since the symptoms often take a while to show up. That compounded with the taboo that comes along, makes you want to keep actively seeking screening for these commoner-than-you-think illnesses on the back burner. A grave problem that accompanies STIs (sexually transmitted infections), is that it predisposes the person to contract HIV more easily. But as the adage goes, better safe than sorry, here I am going to list out the symptoms, if any, that they present with and how often to get yourself tested as they remain unrevealed.
Before I delve into STIs, I feel the need to clarify that a bacterial or fungal infection of the vagina/vulva is different from an STI and is not routinely screened for. If you have any symptoms such as copious white discharge or if it’s foul-smelling then you need to see your healthcare provider.
Now back to STIs and how you screen for them. Ideally, you should be doing an STI screening test yearly, even if you show no symptoms, especially if you are sexually active. This is akin to yearly master health checks to screen for diabetes and high blood pressure as these do not have symptoms (not in the initial stages at least).
The peculiarity of STIs is that some of them present with symptoms, these abate and then the patient becomes a silent carrier. Due to the absence of symptoms, the infection can spread to other partners and nobody is any wiser. Without further ado, let’s dive into the most common STIs.
Chlamydia: Chlamydia is an STI caused by a strain of bacteria called Chlamydia trachomatis. For most people, both men and women, it remains asymptomatic and even if you get them, they aren’t very alarming. Think burning urine (easy to confuse with a urinary tract infection), vaginal discharge (oh so easily ignored), lower abdominal pain (that’s like second nature to us), spotting after intercourse (ignored, ignored and yet again ignored) and bleeding or spotting between periods (who is even counting these episodes anymore!). With vague and easily ignorable symptoms, the person remains unaware and can pass on the infection during unprotected sex of any kind. After 2-4 weeks of the initial symptoms, there is relief and the patient enters the carrier state.
Gonorrhoea: While chlamydia is milder and more forgiving, gonorrhoea, caused by the Neisseria gonorrhoeae bacterium, is not quite so. It manifests with more severe symptoms, including severe lower abdominal pain, burning urine and sore throat in females while in males, it presents with pain in the scrotum, penis discharge or painful intercourse. While untreated gonorrhoea can lead to infertility, ectopic pregnancy, scarring and inflammation, it can be easily treated with antibiotics.
Syphilis: Syphilis, caused by the bacteria Treponema pallidum, is another bacterial disease that spreads through sexual contact. As far as symptoms go, the hallmark of syphilis is painless ulcers in the genitalia. These can be accompanied a week later by skin rashes. Flu-like symptoms, fatigue and weight loss can occur and soon these abate. While it may seem like the patient has recovered, the syphilis bacteria can act upon the nervous system and heart and manifest many many years later (think in your 50s or 60s) as tertiary syphilis.
Guidelines for bacterial STI screening:
Testing is done by taking swabs from the cervix in women, the urethra in males, throat or rectum. Men and women with multiple sexual partners (or if their partners have other sexual partners) should be screened yearly. Gender-diverse persons with a cervix and transgender men must also be screened yearly. For patients who were treated for chlamydia/syphilis/gonorrhoea, a retest is required 3 months later. On the basis of reported sexual practices, a rectal test might be required. The Centre for Disease Control stresses on annual screening of sexually active adults under the age of 25 if they are male, female or pregnant women. The same screening guidelines are followed for bacterial STIs like chlamydia, gonorrhoea and syphilis.
Chlamydia, gonorrhoea and syphilis are 100% treatable by appropriate antibiotics taken for the full course as prescribed by your practitioner. However, any damage caused by the infection cannot be reversed, which makes screening that much more necessary. Requesting an STI screening might feel awkward, but try to be as honest with your healthcare provider as you can. You owe it to yourself. Out of embarrassment do not self-medicate off of google and put yourself at further risk.
There are several viruses that can be transmitted via sex, including the human immunodeficiency virus (HIV), Hepatitis B and C viruses, the human papillomavirus (HPV) and the herpes simplex virus (HSV).
Of these, HIV and hepatitis B are routinely screened for in pre-employment processes and before medical procedures such as surgery or blood donation. One of the biggest issues with viruses is that they can infect humans without resulting in symptoms for years, even decades, making us more likely to transmit them to our sexual partners since we are often completely unaware of their presence.
Unprotected intercourse, needle sharing for illicit drug usage and the presence of any other STI warrants testing for HIV. Unlike the other STIs, the test screening for HIV requires a simple blood test and the reports can be expected within a day’s time. Yearly screening is mandated for all those who engage in sex with multiple partners, engage in sex work or have a partner(s) infected with HIV. Pregnant women are also screened for it during pregnancy as HIV can be passed on to the baby at the time of delivery or during breastfeeding and appropriate measures can minimize the risk of transmission. In case of a positive result, more testing is required to confirm the diagnosis, to see what all organ systems could be affected as well as to check for the load of the virus in the body. On the basis of the organ systems involved, treatment for HIV is given in addition to the anti-virals.
While HIV can wreak havoc anywhere in the body Hepatitis B and C are confined in their effects to the liver. Aside from being sexually transmitted (the risk increases if the person engages in anal sex), it is also spread by unsafe blood transfusions and sharing of needles in drug abuse. Hepatitis B can also be transmitted from mother to child during delivery if the mother is a carrier of the virus. Hepatitis C can be treated by antiviral over the course of 2-3 months whereas Hepatitis B requires longer antiviral treatment and monitoring for future development of liver cancer.
HPV (Human Papillomavirus infection) on the other hand presents with painless genital warts in males and in females. But here lies a catch. While males can go unscathed by this infection, the same virus can fester in the female body to transform into cervical cancer somewhere in the future. The routine Pap smear which has probably been advised to you on your routine body check-up was to take cells from your cervix for examining for any abnormalities. This routine screening for cervical health is important because this virus has no symptoms and the infected person is often a silent carrier. The screening is advised in your 20s and up until the age of 60. Depending on the cell changes, your doctor will call you for your next test 6 months or up to 3 years later. This viral infection is pretty much the predominant cause of this cancer so be regular in your pap smear appointments. There is no antiviral for HPV but warts can be removed by a skin specialist and if present, cervical cancer is operated on by a gynaecologist. And yes, today there is also a vaccine for HPV.
Herpes is sexually transmitted and presents with painful blisters and sores in the genital region. Swabbing of infected ulcers and blood tests confirm the diagnosis. Unlike the other STIs, the CDC does not recommend routine screening for herpes because it is mostly symptomatic. Screening the blood for herpes infection is many times inaccurate with a high rate of false positive results. Due to this limitation and very obvious symptoms, Herpes is not screened for but rather directly diagnosed.
The most important aspect of looking after your sexual health is being honest and open with your healthcare provider (they have seen it all, don’t fear judgement) and safe sex practices such as the use of condoms and limiting the number of sexual partners. And yes, be safe at being sexy and get screened yearly.
Dr Farah Adam Mukadam is a Bengaluru-based family physician and author of Newborns and New Moms. She vlogs on Instagram and YouTube as Dr Farah_Momstein