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]]>If you’re sexually active, particularly with multiple partners, you’ve probably heard the following advice many times: Use protection and get tested.
This is important because a person can have a sexually transmitted disease without knowing it. In many cases, there aren’t any signs or symptoms. In fact, that’s why many experts prefer the term sexually transmitted infections (STIs), because you can have an infection without disease symptoms.
But what types of STI testing do you need? And how often should you be screened? The answers depend on your age, your sexual behaviors and other risk factors. If you think you need STI testing, request it from your doctor. Talk to your doctor about your concerns and what tests you’d like or need.
Here are some guidelines for STI testing for specific sexually transmitted infections.
Get screened annually if:
Chlamydia and gonorrhea screening is done either through a urine test or through a swab inside the penis in men or from the cervix in women. The sample is then analyzed in a laboratory. Screening is important, because if you don’t have signs or symptoms, you can be unaware that you have either infection.
The Centers for Disease Control and Prevention (CDC) encourages HIV testing, at least once, as a routine part of medical care if you’re an adolescent or adult between the ages of 13 and 64. Younger teens should be tested if they have a high risk of an STI. The CDC advises yearly HIV testing if you are at high risk of infection.
Hepatitis C screening is recommended for everyone born between 1945 and 1965. The incidence of hepatitis C is high in this age group, and the disease often has no symptoms until it’s advanced. Vaccines are available for both hepatitis A and B if screening shows you haven’t been exposed to these viruses.
Request testing for HIV, syphilis and hepatitis if you:
Your doctor tests you for syphilis by taking either a blood sample or a swab from any genital sores you might have. The sample is examined in a laboratory. A blood sample is taken to test for HIV and hepatitis.
No good screening test exists for herpes, a viral infection that can be transmitted even when a person doesn’t have symptoms. Your doctor may take a tissue scraping or culture of blisters or early ulcers, if you have them, for examination in a laboratory. But a negative test doesn’t rule out herpes as a cause for genital ulcerations.
A blood test also may help detect a past herpes infection, but results aren’t always conclusive. Some blood tests can help differentiate between the two main types of the herpes virus.
Type 1 is the virus that more typically causes cold sores, although it can also cause genital sores. Type 2 is the virus that causes genital sores more often. Still, the results may not be totally clear, depending on the sensitivity of the test and the stage of the infection. False-positive and false-negative results are possible.
Certain types of human papillomavirus (HPV) can cause cervical cancer while other varieties of HPV can cause genital warts. Many sexually active people become infected with HPV at some point in their lives, but never develop symptoms. The virus typically disappears within two years.
There’s no routinely used HPV screening test for men, in whom the infection is diagnosed by visual inspection or biopsy of genital warts. In women, HPV testing involves:
HPV has also been linked to cancer of the vulva, vagina, penis, anus, and mouth and throat. Vaccines can protect both men and women from some types of HPV, but they are most effective when administered before sexual activity begins.
If you test positive for an STI, the next step is to consider further testing and then get treatment as recommended by your doctor. In addition, inform your sex partners. Your partners need to be evaluated and treated, because you can pass some infections back and forth.
Expect to feel various emotions. You may feel ashamed, angry or afraid. It may help to remind yourself that you’ve done the right thing by getting tested so that you can inform your partners and get treated. Talk with your doctor about your concerns.
Dr. Sharmila Majumdar
Make an Appointment at the Sexual & Mental Health Clinic
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]]>Many STIs are spread through contact with infected body fluids such as blood, vaginal fluids, or semen. They can also be spread through contact with infected skin or mucous membranes, such as sores in the mouth. You may be exposed to infected body fluids and skin through vaginal, anal or oral sex.
Most STDs don’t produce symptoms or, if they do, result in vague or generic flu-like symptoms that could be the result of many different conditions. It can be difficult to determine the cause of symptoms due to an STD without getting tested. Women are more likely than men to suffer symptoms such as bumps, itching, or burning urination due to a sexually transmitted disease/infection, especially in the genital region. Without those first noticeable signs of an STD, infections often go unnoticed and untreated, which can cause long-lasting or even irreversible effects if left untreated.
When symptoms do occur, they typically appear within days or weeks of exposure to an STD. Often, symptoms never appear or go unnoticed. Even if an infection never results in obvious symptoms, the STD can still be transmitted and progress into a more serious condition that may result in irreversible side effects. Regular comprehensive STD testing is the only way to guarantee a clean bill of sexual health. It is especially important to get tested for STDs after risky or unprotected sexual.
Many sexually transmitted diseases (STDs) are characterized by ambiguous or even flu-like symptoms in the early stages, making it difficult to specifically identify a sexually transmitted infection. For men, especially, a lack of symptoms is not a reliable measure of whether an STD is present. The symptoms that usually alert men to the presence of an STD are bumps or rashes on the genitals, discharge, discomfort or itching in the penis or testicles, or pain while urinating or ejaculating. Even a symptomless STD infection can have long-lasting or irreversible effects if left untreated.
STD symptoms in men usually take a few days to develop, but can take up to weeks (if there are symptoms at all). A lack of symptoms is often mistaken for a lack of an STD, but an infection can continue to progress even in the absence of symptoms. Because men so often don’t show symptoms, the only way to be sure that an STD is not present is to get tested regularly, especially after unprotected sex.
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Getting tested is the only way to know for sure if you do or do not have an STD. Visit our Hospital, Avis hospital in Jubilee Hills, next to Chiranjivee Blood bank, for consultation with the renowned sexual medicine specialist Dr. Sharmila Majumdar. Visit www.doctorsharmila.in
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]]>This is one of the most common misconceptions, responsible for many unwanted pregnancies. Also known as the withdrawal method, it has a high rate of contraception failure. This is because some pre-ejaculation fluid (or pre-come) may be released before the man actually ejaculates. This pre-come contains spermatozoids, and it takes only one sperm to get you pregnant! In addition, some men may not have enough self control to withdraw in time…
Keep in mind that pre-ejaculation fluid can also contain sexually transmitted infections, so pulling out will not prevent you from getting an infection.
The chances of getting pregnant while on your period are low, but it may happen, mainly in women with shorter cycle –i.e., if you get your period every 21-24 days. In such case, your ovulation occurs around the 10th to 12th day after the beginning of your period. Since sperm can live up to 5 days inside your body, if you have sex towards the end of your period, sperm can wait for the egg to be released and you may become pregnant.
But even in women with longer, regular cycles, the ovulation may eventually take place earlier… So remember, you can get pregnant at any time of the month if you have sex without contraception.
It has been suggested (mostly by internet rumours) that it is dangerous to take the emergency contraception pill more than one or twice in your life. According to the World Health Organisation: “Emergency contraceptive pills are for emergency use only and are not appropriate for regular use as an ongoing contraceptive method because of the higher possibility of failure compared with non-emergency contraceptives. In addition, frequent use of emergency contraception can result in side-effects such as menstrual irregularities, although their repeated use poses no known health risks.” Emergency contraception pills are very safe and do not harm future fertility. Side effects are uncommon and generally mild.
Some women believe that having sex in certain positions, such as standing up, sitting down, or if they jump up and down afterwards, they won’t get pregnant as sperm will be forced out of the vagina. In fact, sperm are very strong swimmers! It has been showed that within 5 minutes, sperm are able to reach the tube, where the fertilization of the egg takes place, and this happens regardless of the position you have sex in.
There’s no such thing as a “safe” position if you’re having sex without a condom or another form of contraception. There are also no “safe” places to have sex, including the bathtub, the shower or the sea.
Although these three methods are the best-known, there are 15 different methods of contraception (the available options differ in each country). Unfortunately -for women- there are only two choices for men (the male condom and permanent sterilization). Women have a choice of about 13 methods, including several of long-acting reversible contraception -this means you don’t need to remember to take it or use it every day or every time you have sex.
In the USA, 44% of adolescent girls ages 15 to 19 have had sexual intercourse. Although most of them have used contraception, teenagers frequently use methods with high failure rates -such as withdrawal, or they incorrectly use more reliable methods -such as the pill. In fact, 8 out of every 10 adolescent pregnancies are unintended.
The intrauterine device (IUD), a small device that is inserted into the uterus, has been traditionally reserved to women who have had children. However, new guidelines issued by the American College of Obstetricians and Gynecologists have changed this old perception. The IUD, together with the contraceptive implant, are considered now first-line contraceptive options for sexually active adolescents and young women. They are the most effective reversible contraceptives for preventing unintended pregnancy, with about 99% effectiveness.
Of course, the IUD and the implant do not protect against sexually transmitted infections, therefore you should also use condoms for that purpose.
These persistent misconceptions are, unfortunately, still responsible for many unplanned pregnancies. If the intercourse takes place during your fertile period, you may become pregnant, whether it’s the first or the hundredth time you’ve had sex, whether you liked it or not.
Condoms may occasionally break. Many people think that using two condoms (also known as “double bagging”) is safer than using one. Actually, it’s exactly the opposite: using two condoms causes friction between them, increasing the risk of breakage. Thus, two condoms should not be used, neither for pregnancy prevention or for safer sex. This is also true for using a male and a female condom at the same time. When used properly, a male condom is 98% effective at preventing pregnancy, a female condom is 95% effective.
During intercourse, adding lubricant may ease penetration, so sex is pleasurable and not painful. This is important when, for many reasons (such as stress, medications, taking the pill, etc) the natural wetness of the genital area is reduced.
Lubricants can be made from water, oil, petroleum or silicone. However, when using condoms, water-based lubricants should be used. Oil-based products such as petroleum jelly, creams, or baby oil and can damage the latex and make the condom more likely to split, resulting in no contraceptive protection.
Silicone-based lubricants are a newer form of lubrication; they are safe to use with condoms. However, they can be harder to wash off and may cause irritation.
This is another very common misconception. After stopping the oral contraceptive pill you may get pregnant immediately. But sometimes it may take two or three cycles for your fertility to fully return, no matter how long you have been using it. Some studies have shown that, within a year after going off the pill, 80% of women trying to get pregnant will get pregnant – exactly like women who were never on the pill.
Vaginal douching (washing out the vagina) after sex won’t help to prevent a pregnancy. Again, this has to do with spermatozoa being fast swimmers. By the time a woman starts douching, sperm are already well inside the uterine cervix, where no douching solution can reach them.
In fact, you should never douche. Douching can lead to many health problems, including problems getting pregnant, vaginal infections and sexually transmitted infections.
While you’re less fertile when breastfeeding, you may become pregnant. There is no accurate way to predict when fertility returns, even if you breastfeed exclusively. You may not menstruate for several months after giving birth, but at some point you will have your first ovulation. This is where you can get pregnant- and this will occur two weeks before you get your first period.
Thus, when nursing you should use birth control if you wish to avoid pregnancy.
If you have a regular cycle of 28 days, the ovulation usually occurs the 14th day of your cycle. But it’s not only that day that you are fertile. As said before, sperm can live in the cervix for up to 5 days, waiting for the egg to be released. Studies have shown that most pregnancies result from intercourse that takes place during a six-day period ending on the day of ovulation. Once the egg leaves the ovary, in about 24 hours it dies, and the fertile period is over.
However, even in women with a perfectly regular cycle, the hormonal balance involved in the ovulation process can be disrupted by many factors. These include stress, medications, etc, which can lead to an earlier or delayed ovulation. Thus, trying to avoid a pregnancy by just having intercourse on the “safe” days can be difficult and may eventually result in an unwanted pregnancy.
A survey conducted in France showed that “…one in ten young women ages 15 to 20 is not aware that the pill does not protect against HIV and sexually transmitted infections”. In fact, the only contraceptive method that offers protection against STIs is the condom. Barrier methods, such as the diaphragm, do not to keep bacteria out of the vagina. Others like the pill and IUD offer no STI protection at all.
Dr. Sharmila Majumdar
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]]>Today, there are approximately 30 STIs. A few can be fatal. Many women are living in fear of what their future may hold as a result of STD infection. It is estimated that 1 in 5 Indians between the ages of 15 and 55 are currently infected with one or more STDs, and 19 million Indians are newly infected out of which 63% are in people less than 25 years.
This epidemic is a recent phenomenon. However, most of these diseases were not around 20 to 30 years ago. Prior to 1960, there were only two significant sexually transmitted diseases: syphilis and gonorrhea. Both were easily treatable with antibiotics. In the sixties and seventies this relatively stable situation began to change. For example, in 1976, chlamydia first appeared in increasing numbers in India. Chlamydia, particularly dangerous to women, is now the most common STD in the country. Then in 1981, human immunodeficiency virus (HIV), the virus which causes AIDS, was identified. By early 1993, between 4 and 5 million Indians were infected with AIDS, over 12 million were infected worldwide, and over 160,000 had died in India alone. Over 10% of the total Indian population, 30 million people, are infected with herpes.
In 1985, human papillomavirus (HPV), began to increase. This virus results in venereal warts and often leads to deadly cancers. In 1990, penicillin resistant-strains of gonorrhea were present in all fifty states.
By 1992 syphilis was at a 40-year high. As of 1993, pelvic inflammatory disease (PIV), which is almost always caused by gonorrhea or chlamydia, was affecting 1 million new women each year. This includes 16,000 to 20,000 teenagers. This complication causes pelvic pain and infertility and is the leading cause of hospitalization for women, apart from pregnancy, during the childbearing years.
Pelvic inflammatory disease can result in scarred fallopian tubes which block the passage of a fertilized egg. The fertilized egg, therefore, cannot pass on to the uterus and the growing embryo causes the tube to rupture. By 1990, there was a 400% increase in tubal pregnancies, most of which were caused by STDs. Even worse is the fact that 80% of those infected with an STD don’t know it and will unwittingly infect their next sexual partner.
Syphilis is a terrible infection. In its first stage, the infected individual may be lulled into thinking there is little wrong since the small sore will disappear in 2 to 8 weeks. The second and third stages are progressively worse and can eventually lead to brain, heart, and blood vessel damage if not diagnosed and treated.
Chlamydia, a disease which only became common in the mid-1970s, infects 20 to 40% of some sexually active groups including teenagers. In men, chlamydia is usually less serious; with females, however, the infection can be devastating. An acute chlamydia infection in women results in pain, fever, and damage to female organs. A silent infection can damage a woman’s fallopian tubes without her ever knowing it. A single chlamydia infection can result in a 25% chance of infertility. With a second infection, the chance of infertility rises to 50%. This is double the risk of gonorrhea.
The human papillomavirus, or HPV, is extremely common and rapidly growing. 46% of the sexually active coeds were infected with HPV. Another study reported that 38% of the sexually active females between the ages of 15 and 21 were infected. HPV is the major cause of venereal warts; it can be an extremely difficult problem to treat and may require expensive procedures such as laser surgery.
The human papillomavirus can result in precancerous condition or cancer of the genitalia. By causing cancer of the cervix, this virus is killing more women in this country than AIDS, or over 6,600 women in 1991. HPV can also result in painful intercourse for years after infection even though other visible signs of disease have disappeared.
And of course there is the human immunodeficiency virus, or HIV, the virus that causes AIDS. The first few cases of AIDS were only discovered in 1981.
While the progress of the disease is slow for many people, all who have the virus will be infected for the rest of their life. There is no cure, and many researchers are beginning to despair of ever coming up with a cure or even a vaccine (as was eventually done with polio). In 1992, 1 in 75 men was infected with HIV and 1 in 700 women. But the number of women with AIDS is growing. In the early years of the epidemic less than 2% of the AIDS cases were women. Now the percentage is 22%
Teenagers are particularly susceptible to sexually transmitted diseases or STDs. This fact is alarming since more teens are sexually active today than ever before. An entire generation is at risk and the saddest part about it is that most of them are unaware of the dangers they face. We must give our teenagers the correct information to help them realize that saving themselves sexually until marriage is the only way to stay healthy.
The medical reasons for teens’ high susceptibility to STDs specifically relates to females. The cervix of a teenage girl has a lining which produces mucus that is a great growth medium for viruses and bacteria. As a girl reaches her 20s or has a baby, this lining is replaced with a tougher, more resistant lining. Also during the first two years of menstruation, 50% of the periods occur without ovulation. This will produce a more liquid mucus which also grows bacteria and viruses very well. A 15-year-old girl has a 1-in-8 chance of developing pelvic inflammatory disease simply by having sex, whereas a 24-year-old woman has only a 1- in-80 chance in that situation.
Teenagers do not always respond to antibiotic treatment for pelvic inflammatory disease, and occasionally such teenage girls require a hysterectomy. Teenage infertility is also an increasing problem. In 1965, only 3.6% of the married couples between ages 20 and 24 were infertile; by 1982, that figure had nearly tripled to 10.6%. The infertility rate is surely higher than that now with the alarming spread of chlamydia.
Teenagers are also more susceptible to human papillomavirus, HPV. Rates of HPV infection in teenagers can be as high as 40%, whereas in the adult population, the rate is less than 25%. Teenagers are also more likely than adults to develop precancerous growths as a result of HPV infection, and they are more likely to develop pelvic inflammatory disease.
Apart from the increased risk from STDs in teens, teenage pregnancy is also at unprecedented levels, over 1 million pregnancies, and 400,000 abortions in 1985. Abortion is not a healthy procedure for anyone to undergo, especially a teenager. It is far better to not get pregnant. Oral contraceptives are not as effective with teenagers, mainly because teens are more apt to forget to take the pill. Over a one-year period, as many as 9 to 18% of teenage girls using oral contraceptives become pregnant.
Our teenagers are at great risk. In a society that has abandoned God’s design for healthy meaningful sexual expression within marriage, our children need to be told the truth about the dangers of STDs.
We must now take a hard look at the message of “safe sex” which is being taught to teens through the media across the country. Some people believe that if teens can be taught how to use contraception and condoms effectively, that rates of pregnancy and STD infection will be reduced dramatically. It is significant to note that condoms, the hero of the “safe sex” message, provided virtually no protection from STDs.
Will condoms prevent HIV infection, the virus that causes AIDS? While it is better than nothing, the bottom line is that condoms cannot be trusted.
Condoms do not even provide 100% protection for the purpose for which they were designed: prevention of pregnancy. One study from the School of Medicine Family Planning clinic reported that 25% of patients using condoms as birth control conceived over a one-year period. Other studies indicate that the rate of accidental pregnancy from condom-protected intercourse is around 15% with married couples and 36% for unmarried couples.
Condoms are inherently untrustworthy. The FDA allows one in 250 to be defective. Condoms are often stored and shipped at unsafe temperatures which weakens the integrity of the latex rubber causing breaks and ruptures. Condoms break 8% of the time and slip off 7% of the time. There are just so many pitfalls in condom use that you just can’t expect immature teenagers to use them properly. And even if they do, they are still at risk. In addition, programs that emphasize condoms tend to give a false sense of security to sexually active students and make those students who are not having sex feel abnormal. Hardly the desired result!
The list of damages from unmarried adolescent sexual activity is long indeed. Apart from the threat to physical health and fertility, there is damage to family relationships, self-confidence and emotional health, spiritual health, and future economic opportunities due to unplanned pregnancy. Condom-based sex-education does not work.
Diseases such as chlamydia, human papillomavirus, herpes, hepatitis B, trichomoniasis, pelvic inflammatory disease, and AIDS have joined syphilis and gonorrhea in just the last 30 years. There is no question that the fruits of the sexual revolution have been devastating. I have also shown how our teenagers are at a greater risk for sexually transmitted diseases than are adults and that sex-education based on condom use is ineffective and misleading. There is only one message that offers health, hope, and joy to today’s teenagers. We need to teach single people to save intercourse for marriage.
Sex is a wonderful gift, but if uncontrolled, has a great capacity for evil as well as good. Our bodies are not made to have multiple sex partners. We can avoid almost all risk of STD and out of wedlock pregnancy by saving intercourse for marriage.
Delaying intercourse until teens are older is not a naive proposal. Over 50% of the females and 40% of the males ages 15 to 19 have not had intercourse. While not a majority, they are living proof that teens can control their sexual desires. Current condom-based sex-education programs basically teach teenagers that they cannot control their sexual desires, and that they must use condoms to protect themselves. It is not a big leap from teenagers being unable to control their sexual desires to being unable to control their hate, greed, anger, and prejudice. This is not the right message for our teenagers! Teenagers discipline themselves for things they want, desire and are convinced about. We can discipline our teens in their sexual lives if they have the right information to make logical choices.
Saving sex for marriage is the common sense solution. In fact, it is the only solution. We don’t hesitate to tell our kids not to use drugs, and most don’t. We tell our kids it’s unhealthy to smoke, and most do not.
It is normal and healthy not to have sex until marriage. Sexually transmitted diseases are so common that it is not an exaggeration to say that most people who regularly have sex outside of marriage will contract a sexually transmitted disease. Not only is saving sex for marriage the only real hope for sexual health, it is God’s design. God has said that our sexuality is to blossom within the confines of a mutually faithful monogamous relationship. What we are seeing today is the natural consequence of disobedience. We need to re-educate our kids not just in what is best, but in what is right; and abstinence is right.
Dr. Sharmila Majumdar
Sr. Consultant Sexologist & Psychoanalyst
MS Sexuality, M.Phil Clinical Psychology, PhD Cognitive Behavior Modification
Certified from Mount Sinai School of Medicine, New York, USA.
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