Sexuality and U

Frequently Asked Questions

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If abstinence from penetrative sex is practiced is the woman protected from sexually transmitted infections/diseases?

No. Rare cases of HIV transmission have been reported in which the only transmission of fluid has been during oral sex. In addition, mouth-to-penis contact (fellatio) can transmit gonorrhoea, syphilis, hepatitis B, herpes simplex virus and chlamydia and mouth-to-vulva contact (cunnilingus) can transmit herpes and syphilis.

The use of a dry latex condom during fellatio (mouth-to-penis contact) or a dental dam during cunnilingus (mouth-to-vulva contact) can be effective. A dental dam can be obtained directly from a medical supply store. Spermicidal condoms are not recommended, as they are unlikely to provide better protection, and the taste is very often unpleasant. The only way to be absolutely certain, however, is to avoid any contact with bodily fluids.

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Birth Control

What should be done if a woman is found to have chlamydial or gonococcal cervicitis with an intrauterine contraceptive device (IUCD) in situ?

Antibiotic therapy for the patient and for any sexual contacts must be initiated immediately. If there is any suggestion of PID (pelvic inflammatory disease), the device should be removed after initiating antibiotic therapy. Individual judgment can be applied regarding removal of the device in cases where a woman has completed her family and there is no evidence of PID. She should be counselled regarding the use of barrier contraceptive methods to avoid future infections.

Does the diaphragm or cervical cap offer protection against sexually transmitted diseases (STIs)?

Yes, the diaphragm and spermicide combination offers potential protection from some STDs such as gonorrhea ,chlamydia and trichomonis by providing a mechanical barrier and a bactericidal/viricidal effect. Protection from transmission of HIV, Hepatitis B etc is less certain. This method affords no protection from STIs such as herpes or genital warts (condylomata). The diaphragm has also been shown to reduce the incidence of cervical neoplasia.

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What happens if I get diagnosed with Chlamydia? Does my boyfriend need treatment too?

In Canada, there are certain infections and diseases that are tracked by the government. Many sexually transmitted infections (STIs) are included in this category and chlamydia is one of them. Once a person tests positive for Chlamydia, a chain of events occurs. The lab that performs the tests will contact the local public health department and the healthcare provider that performed your test. Someone will then contact you and ask you to come in for treatment. The current treatment for Chlamydia is one dose of an antibiotic called Azithromycin. It is taken by mouth. You must not have sex for seven days after you and your partner(s) have been treated so that the antibiotic has time to work, otherwise you are still at risk of passing on the infection.

The second part of the chain is contact tracing. This means you will be contacted by someone from the medical department responsible for tracing (usually its the public health department). They will want to know who has had any sexual contact with you recently (usually within the past 60 days). It is very important that you are honest and tell them, so that those other people can be treated too. Public health will then contact those other people anonymously (the person or persons will not be told that you named them as a contact) and provide testing and treatment.

What causes chlamydia?

Chlamydia is a common sexually transmitted infection. It is a bacteria that can be transmitted through body fluids (semen, vaginal secretions, saliva).

Many people with chlamydia do not have symptoms or signs of an infection. Symptoms may ocircleur and can include a discharge from the vagina or penis, itching or burning while urinating, or even a sore throat (if contracted during oral sex with an infected partner).

Untreated chlamydial infections may lead to pain and infertility so it is important to see your health care professional if you are concerned that you may have been exposed to chlamydia during unprotected sex.

Treatment with antibiotics is simple and effective. Both partners must be treated even if one does not have any symptoms.

My partner and I have been treated for a chlamydia infection. If we were not entirely cured, can we give it to another person through sexual contact (not penetration, just touching)?

Yes, you can. If one partner touches their genital region and then touches the other person’s genital area, many sexually transmitted infections can be passed on in this manner. This also includes oral-genital, oral-anal, and regular penetrating intercourse. So you, your partner, and the new partner(s) need to be tested again. If any of you test positive, it is really important to take all the medication prescribed to cure the infection.

If you test positive for Chlamydia, does your doctor report it to public health? Will they then inform your partners, or is that up to you?

It depends a bit on where you live. In most places, the lab that finds the positive test sends copies of the results to the doctor that ordered the test and the local public health agency. Your health-care provider may take information from you regarding your sexual contacts and encourage you to inform them yourself. If that is uncomfortable or not possible, the local public health agency will also be speaking to you about your sexual contacts. They will find and inform those contacts confidentially and will help to provide treatment for both you and your partner(s).

Can chlamydia be transmitted any other way than through sex?

Chlamydia is a sexually transmitted disease of the reproductive organs. Among adults, it is transmitted only through having sex with an infected person. Babies, however, can become infected during birth if their mother is infected. Chlamydia cannot survive on objects in the environment, so using a public toilet or sharing towels or clothing with an infected person doesn’t spread it.

If you have just tested positive for chlamydia, and you are in a monogamous relationship (only one sex partner), it is important to note that you may have been infected from a prior relationship. The infection can be present for many months or even years without symptoms. The disease may be difficult to diagnose because many people develop no symptoms at all, though they may remain infected and pass the disease on to others. Among those who do get symptoms, they usually occur about one to three weeks after having sex with an infected person.

In women, chlamydia can cause burning with urination, an abnormal vaginal discharge, light vaginal bleeding (especially after intercourse), or pain in the pelvis or lower abdomen. In men it can cause a penile discharge or pain during urination.

Is Chlamydia curable?

Chlamydia can be cured with antibiotics, usually with a single dose. Follow your healthcare professional’s instructions, and, as with any medication, take as directed and complete the entire duration of the prescription, even if your symptoms disappear.

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Cold Sores

I get several cold sores during the year. Am I putting my partner at risk for an STI if I perform oral sex or even kiss him/her?

Cold sores are the result of Herpes Simplex Virus (HSV). The vast majority of cold sores are from HSV-1. The vast majority of cases of genital herpes (that is penis, testicles, vagina or anus) are from HSV-2. However, HSV-1 can affect the genital area and HSV-2 can affect the oral area. Therefore you are putting your partner at risk of either oral or genital herpes. The problem is knowing when you are infective and unfortunately this is impossible to predict. You can spread the virus even before the actual cold sore is visible. If you are in a long-term relationship and your partner is aware of the risk, then you can decide together whether to use condoms to help prevent Herpes infection. Keep in mind that a condom may not provide 100% protection.

Can you transmit cold sores during oral sex?

Cold sores are small red blisters that generally appear on the lip and outer edge of the mouth. They are extremely contagious and are usually caused by the Herpes Simplex Type 1 virus (HSV-1). One should avoid contact with others who are uninfected when a sore is present, in particular kissing and oral sex. If a person with a cold sore performs oral sex on their partner, there is a strong possibility that that partner will develop genital herpes. Thus it is recommended that a person with a cold sore abstain from performing oral sex on their partner until the lesion has healed. If abstaining is not possible, then appropriate precautions, such as the use of an oral dam or latex condom, should be taken.

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Herpes/Genital Warts

Will male condoms protect against Herpes or the Human Papilloma virus (HPV)?

Protection against disease transmission is much less effective against such sexually transmitted diseases as Herpes and the Human Papilloma Virus, which can be located on skin surfaces not covered or protected by a condom. The female condom theoretically may be more effective in this situation because it covers a greater area.

My new partner told me he has herpes, and that there is no cure for it. What does this mean for me if we decide to sleep together? Help!

Herpes is a viral infection caused by the Herpes Simplex Virus (HSV), types 1 and 2. HSV can affect the mouth area (commonly called a cold sore) or the genital areas. It is spread by direct contact with these areas. It can be transmitted by sexual intercourse (vaginal or anal), oral sex, or kissing, depending on which area is affected.

When the virus first enters the body, it usually causes a painful, blister-like lesion in the infected area. The blister then bursts, forming an ulcer or sore, then crusts over and heals, over several days to weeks. Sometimes, however, the virus can infect a person without causing sores, so they do not know they have it. Once inside, the virus lives at the root of the nerve that supplies the skin where it entered, and stays there for the rest of that persons life. It lies inactive most of the time, but periodically can reactivate and cause blister-like lesions in the same area of skin. This is called an outbreak.

The number and frequency of these outbreaks varies from person to person. Some may never have another occurrence, and others can have them very frequently. Outbreaks generally happen more frequently soon after the person is first infected, but also tend to happen at times when a person is under physical or emotional stress, or when their immune system is suppressed.

Subsequent outbreaks of herpes are usually less painful than the first one, and generally heal quicker. No treatment is necessary, as the sores will go away by themselves. There are pills (acyclovir, famciclovir and valacyclovir) that can be used to shorten the length of an outbreak, but they do not cure the infection. There is also a cream that can be applied to the affected skin, but whether or not it actually helps is unclear.

People who get very frequent outbreaks can take a low dose of the oral medication daily. This has been shown to reduce the number of times the virus reappears.

Avoiding sexual contact when there are visible lesions is the easiest and most obvious way to reduce the chances of spread to an uninfected partner. Herpes is most contagious when there are lesions, but there is a small chance (around 1% - 5%) that a person with herpes could be shedding the virus even if there are no symptoms. Condoms are generally a good idea to prevent infections, but if the site of the herpes lesion is not covered by the condom, they may not prevent transmission. Recently, studies have shown that giving a person with herpes a low dose of medication every day can decrease their partners chance of becoming infected.

Babies can pick up the virus from their mothers during vaginal delivery. The chance of a baby becoming infected is very small, especially if the mother has had the infection for some time (as opposed to becoming infected while she is pregnant). Sometimes, women with herpes are given medication at the end of the pregnancy to prevent recurrences. If there is a lesion at the time of labour, a cesarean section will often be carried out because this has helps to reduce infection in the baby.

Because herpes is a lifetime infection, it can cause many problems in relationships. One sticky situation is when one partner develops herpes for the first time in the context of a long-term, monogamous relationship. The other person may assume their partner was unfaithful, and while that is a possibility, it could also be that he or she has had the virus for years, but never had a noticeable outbreak. The key is open communication. Your partner did the right thing by telling you before you became intimate. The good news is that herpes is not usually a fatal or serious infection, except in babies, or in people whose immune system is depressed.

I recently learned that my partner has had herpes in the past and I’m not sure what to do. How can I protect myself?

When a partner has herpes, there is a risk that you could get it too. You’ll want to understand how to lower the risk for infection and ways to talk with your partner. If you have been sexually active before, you may already have been at risk for herpes. Because herpes can be spread without symptoms (asymptomatic shedding) it can be hard to know when a person became infected and who infected them. In an intimate, sexual relationship with a person who has herpes, the risk of contracting the infection will never be zero. Some couples have sexual relationships for years without transmitting herpes just by avoiding sexual contact during outbreaks, using condoms regularly and using suppressive antiviral therapy to reduce outbreaks. Couples deal successfully with herpes all the time. For many, it is a minor inconvenience. Since herpes does not pose a serious health risk, some couples choose not to use condoms in a long-term relationship.

Ways to reduce your risk include:

1. If someone has a symptom around the mouth (oral herpes), she/he should not perform oral sex until all signs have healed.
2. If someone has signs or symptoms around the genital region (genital herpes), he/she should not have sexual activity until all signs have healed.
3. When there are no symptoms present, using latex condoms for genital-to-genital contact reduces the risk of transmission.
4. One antiviral medication for herpes, valacyclovir, has recently been shown to reduce the risk of herpes transmission. When taken daily by a person with a history of recurrent genital herpes, valacyclovir can reduce the risk of transmission to a partner who does not have the virus by 50%. It’s likely that a combination of suppressive valacyclovir and condoms provides greater protection than either method alone.
5. Partner communication. It is important for both partners to become educated about herpes and to make decisions together about which precautions are best.

I had unprotected sex in the shower with someone and later found out that he has herpes, and may have had an outbreak at the time. I then performed oral sex on someone else about a week later. My question is can my 2nd partner get herpes if I didnt perform oral sex on the infected person?

If the first partner with herpes had an outbreak at the time you had unprotected intercourse, you could have picked up the virus around your genitals. If you did not perform oral sex on the first partner, the area around your mouth would not have been affected, and you could not transmit the virus to the 2 nd partner by oral sex alone. Its a bit more complicated than that though. Many people dont realize that cold sores are a type of herpes. If you have ever had a cold sore around your mouth you could potentially transmit the herpes virus to any partner by kissing or when you give oral sex. The chances of that are much greater if there is actually a cold sore present.

So the simple answer to your question is no it is unlikely that your second partner could have gotten herpes based on the exposure you describe. Having said that, unprotected sex (with a person it sounds like you didnt know very well) puts you at risk for a host of other sexually transmitted infections including HIV, and is never a good idea.

How can you tell if you have genital warts? What are the signs and symptoms of genital warts? How are genital warts treated? How can transmission of genital warts be prevented?

The signs and symptoms of genital warts include:
1. Tiny, pink or red swellings in the genital area that grow quickly
2. Several warts close together may have a cauliflower shape
3. Itching or burning in your genital area

Genital warts often disappear even without treatment. Depending on the size and location of the warts, there are several ways to treat them. Health care providers may help by treating them with medications or surgical treatments. If the underlying virus isn’t completely eliminated, however, genital warts may reappear even after treatment.

Medications are applied directly to the affected area (the wart itself). These include:

1. Imiquimod (Aldara)
2. Podofilox (Condylox)
3. Trichloroacetic acid
4. 5-fluorouracil cream (5%)

Surgery may be necessary to remove larger warts or warts that don’t respond to medications.

Surgical options include:
1. Freezing with liquid nitrogen (cryosurgery)
2. Burning with electricity (electrocautery)
3. Laser treatments

Although treatments can get rid of the warts, none gets rid of the virus. Because the virus is still present in your body, warts often come back after treatment.Do not try to treat genital warts with over-the-counter medications. These are not made to be used on the moist tissues of the genital area, and if used on the genitals, they may cause even more pain and irritation.

The only way you can prevent getting an HPV infection is to avoid direct contact with the virus, which is transmitted by skin-to-skin contact. Practicing safer sex can decrease the risk of genital warts. But, using condoms doesn’t eliminate the risk entirely because they still may allow you or your partner to come in contact with infected skin.

If you or your sexual partner have warts that are visible in the genital area, avoid sexual contact until the warts are treated. If you’ve developed genital warts for the first time, inform your sexual partner so that he or she can get treatment and take precautions to prevent spreading the condition to others.


How can I protect myself against herpes?

The herpes simplex virus type 2 (HSV-2) causes genital infections. Herpes simplex virus type 1 (HSV-1) usually is associated with oral lesions, however can be transmitted to the genital area through oral-genital contact. Transmission can occur with active infections but as well when no lesions are visible. Condoms can reduce the risk of transmission. Abstinence during active outbreaks is recommended as virus shedding is more prominent at this time. A recent publication has shown that, in patients with recurrent genital herpes, a daily dose (500mg) of valacyclovir can reduce the rates of recurrent outbreaks, shedding of the virus, and transmission to a non-affected partner.

Corey L, Wald A, Patel R et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med, 2004; 350: 11-20

How are genital warts transmitted?

Genital warts are caused by the human papillomavirus. The virus can manifest its presence by causing visible warts, but can also be present silently. It can infect the external genitalia, as well as the cervix, vagina, urethra, anus and mouth.

The virus is usually transmitted by sexual contact, including genital, oral and anal. Avoiding contact with the visible warts, and using condoms, may help decrease transmission. However there is no perfect method, except abstinence, to prevent transmission. There is no clear evidence that treating genital warts decreases infectivity.

Can you transmit cold sores during oral sex? If so, do they turn into genital herpes?

Cold sores and genital herpes are caused by two strains of the Herpes Simplex virus (type 1 and type 2).  Although type 1 most commonly causes cold sores, and type 2 causes genital herpes, either one can infect the mouth or the genital area.  One should avoid contact with others if they have a cold sore, particularly kissing and oral sex. If a person with a cold sore performs oral sex on their partner, there is a possibility that their partner could develop genital herpes. Thus it is recommended that a person with a cold sore abstain from performing oral sex on their partner until the sore has healed. If abstaining is not possible, then appropriate precautions, such as the use of an oral dam or latex condom, should be taken.

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What is an oral dam?

Also known as a dental dam, an oral dam is a barrier made out of latex, a condom or plastic wrap that will help reduce the spread of bodily fluids during oral sex. These can be used when performing oral sex on the anal or vaginal area. When performing oral sex on a male, using a regular condom on the penis is the recommended method. Its very simple to make an oral dam out of a regular male latex condom: simply cut the closed end off the condom leaving a latex tube, then cut down the length and unroll it to make a rectangle. Dental dams can also be purchased on the internet.

Can you get infections from anal sex?

Many sexually transmitted infections (STIs) can be transmitted through anal sex. This includes chlamydia, gonorrhea, herpes, genital warts, HIV, hepatitis, syphilis, and trichomonas. The risk is present with female-female, male-female and male-male anal intercourse, and can be decreased if you use condoms.

There used to be a story that you could catch STIs from toilet seats, especially those found in public washrooms. Is this true?

Though highly unlikely, it is probably possible to get pubic lice from a toilet seat. Since they are parasites that need a host animal to survive, they cannot live on a toilet seat for very long. You would have to use the seat shortly after someone who is heavily infected. It is difficult to be certain how often this happens or if this even happens at all. It is assumed that the chances of it happening are fairly remote. There are no other known STIs that can be transmitted in this manner.

If you have a hysterectomy, are you still at risk of getting infected?

Yes, you are still at risk of getting infected. Many STIs live in the vagina or on the vulva and are therefore independent of the cervix and womb. These include Human Papillomavirus, Chlamydia, Herpes Simplex Virus, Pubic lice and others. There are some STIs that prefer to live on or in the cervix. Gonorrhea and Chlamydia are very prevalent in North America and they can both infect the cervix. The danger, of course, is that they can travel up the cervix, through the womb and into the pelvis. This is called Pelvic Inflammatory Disease and can be a serious illness.

If you have had a hysterectomy, that passage is no longer open, so the infection would be confined to the vagina. Some of these infections, however, live in various parts of the body when they are not active and get to their target via the blood stream. There are women who have had a hysterectomy who still get Pelvic Inflammatory Disease. We do not know if this is from an old infection that has been lying dormant and then becomes reactivated, or if it is a new infection that has somehow found its way into the pelvis. You can also still get HIV and other infections that enter the body through the blood stream. Any opening in the skin, regardless of where, can allow these to enter.

I have heard about non-specific urethritis. Is this common or even an STI?

This is the name given to infections of the urethra, usually in men, that are not caused by gonococcus, the bacteria that cause gonorrhea. It is very common and the vast majority are sexually transmitted infections. There are many causes of urethritis, including Chlamydia (up to 60% of cases), Trichomonas and Ureaplasma. It can also be caused by chemical irritants.

Because it can take up to three weeks from time of infection for symptoms to appear, it is often unknowingly spread to new partners. The symptoms may be mild or there might be lots of discharge, especially in the morning. There may also be burning with urination, itchiness at the opening of the penis, urgent need to void and a feeling of heaviness in the scrotum. On rare occasions, it may lead to a more serious infection in men that is difficult to treat. In women, it can cause an infection of the pelvis, which can affect the chance of future pregnancies.

An infected person should be re-tested four to seven days after treatment and should not have intercourse until both partners are cured. Medications should not be stopped as soon as symptoms disappear because this increases the risk of re-infection. The course of all prescribed medications must be completed.

I have been diagnosed with HPV because I had an abnormal Pap smear. What do I do?

Human Papilloma Virus, or HPV, has many different strains. Some cause genital warts, some cause changes in the cervix that gives an abnormal Pap smear, and many do not cause symptoms at all. Most of the time, your body’s immune system will clear the virus over the course of 1.5 to 2 years. However, sometimes the virus is difficult to get rid of, and the infected cervix tissue needs to be treated. Your doctor will discuss this with you. In the long run, the most important thing is to continue to come for regular Pap smears. This can help monitor whether or not the infected tissue is healing itself, and whether treatment may be needed.

I am a lesbian, and I wondered if it is possible for women to give each other STIs and if so, what can I do to protect myself?

Although most sexually transmitted infections (STIs) are less likely to be transmitted between women, it can still happen. HIV, Hepatitis B, chlamydia, gonorrhea and trichomonas can all be transmitted by vaginal secretions (including menstrual blood). Syphilis, and viruses like herpes and human papilloma virus (HPV) are spread by direct contact. This means that practices like oral sex and direct genital/genital contact can pass on these organisms if a barrier is not used, the same as with heterosexual couples. They can also be transmitted on fingers or sex toys during intimate contact.

A dental dam is a flat piece of latex that is used as a barrier between one persons mouth and the other persons vulva or anus. It can reduce the risk of infection from oral sex. Dental dams can be purchased or they can be made from a non-lubricated condom by cutting it open into a rectangle. Household plastic wrap can also be used.

Ways to reduce your risk:

1. Limiting the number of sexual partners you have and knowing them well
2. Having a mutually monogamous relationship
3. Use barrier protection until both partners test negative for STIs including HIV
4. Not sharing sex toys, washing them between uses or covering them with a new condom each time
5. Looking for any sores on your partners genitals and avoiding any contact with broken skin
6. The main principle is to avoid sharing any body fluids.

How can I guarantee complete privacy when talking to my doctor about STIs?

Information that you share with your physician is completely confidential. There are, however, a few exceptions to this rule. Some STIs are reportable, which means a doctor is obliged to report their findings to the local health authority. If you tell your doctor that you previously had a STI, that information remains between the two of you. The doctor only has to report certain STIs if she/he did the test on you and has the result. They use this information to make sure that infectious diseases do not get out of control in the general population. They might contact you and ask you to inform your previous sexual contacts so that they may be treated.

Do you have any information on pubic lice or ‘crabs’?

Pubic lice are parasites, requiring a host animal in order to survive. They may be transmitted sexually or by simple person-to-person contact. They may also be transmitted through infected clothing or bedding, and very rarely by infected toilet seats. Remember that they are parasites and need a living host. Survival on a toilet seat would be short lived. Pubic lice are different than head and body lice. They can be passed on as long as the lice or eggs remain alive on the infested person. It can cause symptoms ranging from mild discomfort to intense itching. There are many different medical treatments; the most common is permethrin creme rinse. Sexual partners should also be treated. There are no long-term effects and the treatment is usually 100% effective. If recurrences occur, the treatment is the same.

Do employers have the right to ask you if you have or have ever had an STIs?

With a few limited exceptions, no, employers do not have the right to ask if you have ever had an STI. Certain professionals, such as doctors and dentists, are obliged to be tested for Hepatitis B and C. You are not allowed to perform surgery if you have one of those infections. Also, some jobs require employees to have some kind of personal insurance, and many insurance companies will not insure you without being tested for HIV first.

Can you suggest ways of dealing with the fact that either yourself or a loved one has an STI?

Being upfront with each other is always the best plan. Of course, it is difficult to tell someone that you have an STI. It is even more difficult to tell them after they’ve become infected. Education is your best protection against further problems. Find out as much as you can about the particular STI, and know how long you should abstain from sexual contact. You should learn what signs and symptoms to look out for, and how to prevent future infections.

Often, the emotional aspects are a little more difficult to deal with. Remember that some people are more affected than others. If a loved one has an STI, reassurance is always helpful. Try to be non-judgmental - it only takes one partner to infect someone. Most STIs are manageable with few long-term effects other than a need to be cautious. Still others are completely curable. HIV and Hepatitis are the exceptions and there are many support groups for people who have been affected.

Are you at risk if you donate blood or you’re sexually involved with someone who donates blood?

No, not at all. Donating blood is done using sterile techniques which means it is as close to germ-free as possible. It is done by drawing blood from your vein with an IV needle. The IV needles are only used once and they are sterilized and wrapped in sterile packages before use. This is very different than someone doing IV drugs with a needle that gets used more than once and by more than one person. Today, it is very safe to have a blood transfusion in Canada. However, blood is a complex human tissue that is “transplanted” from one person to another. Like any other medical procedure, it can never be completely without risk. Canadian Blood Services is committed to cutting this risk as close to zero as possible. For example, all donors - including the “regulars” - are screened to ensure suitability. Every unit of blood is tested for the viruses linked to AIDS, hepatitis B and C, and a form of adult leukemia (HTLV-I and II), as well as the syphilis bacterium. This was not the case just ten years ago.

Are some STIs more common in certain countries than others?

Yes, some are more common than others depending on which country you are in. The best example of this would be HIV. A number of African countries have very high rates of HIV compared to North America, Europe and Australasia. The reasons for this are numerous and too extensive to cover in this answer. Most of the STIs tend to be worldwide, and rates differ by socio-economic class more than anything else.

Am I still at risk for STIs if I have been in a monogamous relationship for several years?

If both partners are 100% monogamous over several years and neither is aware of any previous STI, it is unlikely that you are at risk. However, if your partner has an STI that has periods of dormancy, then you might get infected when you think everything is okay. For example, HSV (Herpes Simplex Virus) or Herpes can lie dormant in your partner for years. You might have sex when they are becoming infective but there are no obvious sores. This would put you at risk for Herpes. As well, you might discover years after the time of infection that you have an STI such as HIV, which may not display symptoms for years. Human papillomavirus, which is the main cause of abnormal PAP tests, may show up years after the initial infection. In fact, with that particular virus, it is almost impossible to tell when the infection occurred.

If you are going to have sex with your partner is there any way of knowing if he has a sexually transmitted infection without asking him?

The problems with sexually transmitted infections are that many people, particularly women, have no symptoms. Some symptoms for men include the need to pee often, burning and pain when you pee, drip or discharge from the penis and/or sores, bumps or blisters near or on the penis, testicles or mouth.

To ensure you are not affected it is important to get checked for sexually transmitted infections if you are sexually active. It is also important to remember that the most effective form of contraception is a birth control pill and condom to avoid unwanted pregnancies and harmful sexually transmitted infections.

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Oral Sex/Kissing

Is it possible to get an infection from oral sex?

Yes, it is possible to get a sexually transmitted infection from oral sex. The infections most commonly transmitted by oral sex include herpes, human papilloma virus (HPV), gonorrhea, syphilis, chlamydia, some forms of hepatitis and HIV (human immunodeficiency virus). To protect yourself, you can use a condom or a dental dam during oral sex

Can you get STIs from French kissing?

Deep kissing such as French kissing does still carry some risk of transmission of sexually transmitted infections (STIs). Dry kissing on the mouth is generally safer.

Though HIV is present in any body fluid including saliva, the risk of transmission from oral contact (deep kissing), without any open sores or cuts, in or around your mouths, is extremely low. It can thus be considered a “safer sex” practice.

Cohen, MS et al. The Lancet. 356.July 22,2000. 272

Herpes lesions around your mouth can be transmitted to your partner. Kissing your partner’s genitals can put you at risk of other STIs.

Can you transmit cold sores during oral sex? If so, do they turn into genital herpes?

Cold sores and genital herpes are caused by two strains of the Herpes Simplex virus (type 1 and type 2).  Although type 1 most commonly causes cold sores, and type 2 causes genital herpes, either one can infect the mouth or the genital area.  One should avoid contact with others if they have a cold sore, particularly kissing and oral sex. If a person with a cold sore performs oral sex on their partner, there is a possibility that their partner could develop genital herpes. Thus it is recommended that a person with a cold sore abstain from performing oral sex on their partner until the sore has healed. If abstaining is not possible, then appropriate precautions, such as the use of an oral dam or latex condom, should be taken.

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My partner and I began our steady relationship in the early 1980s, when HIV/AIDS first became known. We both had other sexual relationships prior to getting together. Should we be tested or even be concerned about STIs?

HIV would be the major concern but the vast majority of people infected with HIV develop AIDS within 10 years. If you were exposed more than 20 years ago and have no symptoms of AIDS it is unlikely that you have HIV. There are cases where there is no evidence of the disease for 15 to 20 years but this is unusual. In cases where HIV is detected, anti-viral therapy can extend this period.

Is testing for herpes a part of the usual screening for sexually transmitted infections (STIs) or is a separate test required to test for herpes?

If you visit a health care provider to be screened for a sexually transmitted infection, he/she will ask you questions about your medical and sexual history and what your concerns are. If you are having symptoms, he/she will ask the type of symptoms, how long they have been present, and how severe they are.

A physical exam would then be performed (a genital examination for men, and a pelvic examination for women) to look for signs of infection. The health care provider will collect samples during the exam, and send them to the lab for testing, along with blood or urine tests.

Even if you have no symptoms and you have a normal exam, you may still be infected with a sexually transmitted infection (STI). Telling your health care providers about your risk factors helps them to test you appropriately.

If you visit your health care provider to be screened for STIs, you will likely be tested for chlamydia, gonorrhea, and HIV (a blood test), but you will have to ask your health care provider to be sure about this. If your visit is for a routine Pap smear, your doctor may only do a Pap smear and pelvic exam, unless you have symptoms or you specifically ask to be tested. Never assume that you are being tested for all STIs - ask your health care provider!

A test for herpes is not part of the usual screening for STIs. If active genital herpes lesions are present at the time of the appointment, your health care provider will consider the diagnosis of herpes based on your symptoms and the appearance of the ulcer. He/she may confirm the diagnosis by swabbing the ulcer and sending the sample to the laboratory for testing.

However, If you have no active herpes lesions present at the time of the exam, it is unlikely that your doctor will test you for herpes (HSV-2) unless you specifically request it. If you and your health care provider think that HSV-2 testing is necessary, a blood test can be done that will indicate whether you have been infected with HSV-2 at some time in the past.

How long does it take for an STI (for example HIV/AIDS) to be picked up by a test?

If you are exposed to the Human Immunodeficiency Virus (or HIV), the virus that causes AIDS, it takes some time (a few days to months) for your body to develop antibodies against the virus that can be detected by the blood test. This is the reason why it is recommended to have a second blood test 3 to 6 months later to detect any new antibodies. In the meantime, use condoms to protect you and your sexual partner.

STI’s that are picked up by culture (such as chlamydia or gonorrhea) are generally detectable right away, especially if there are symptoms. If you have any ulcers on your genitals, these should be swabbed for herpes and syphilis while they are still visible. If a syphilis infection is new the blood test may not yet be positive. Talk to your doctor. If there is any doubt, these tests can be repeated in a few months.

How do women get tested for STIs? How about men?

For women, swabs of cervical secretions taken at the time of a speculum examination can screen for chlamydia and gonorrhea. Trichomonas can be diagnosed by taking a sample of vaginal discharge, mixing it with saline fluid, and looking for the motile organism under the microscope. The (dead) organism can sometimes be detected on a Pap smear.

For men, swabs of urethral secretions can detect chlamydia and gonorrhea. “First void” urine can be tested for chlamydia.

Genital warts are usually diagnosed by visual examination, by your health care provider. A biopsy can be performed if the diagnosis is uncertain.

Herpes lesions are also frequently diagnosed by sight, and by history. A swab of the lesion can culture the virus, and not only confirm the diagnosis but type the virus (type-1 generally causes oral herpes; type-2 is most often responsible for genital lesions). Blood tests for herpes antibodies are not felt to be as accurate.

Hepatitis B, C and HIV are diagnosed by blood tests. A repeat blood test 3-6 months after possible exposure to HIV is recommended to pick-up possible delayed antibody conversion.

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