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A Handle on your Health: Cupid’s Itch – Sexually Transmitted Diseases

Tuesday, February 5, 2019

Sex makes a lot of people happy for a few minutes out of their day. Unfortunately it can also make you miserable for a few days or for life.  Sexually transmitted diseases are on the rise after over two decades of decline. 

Texas is a big state and so we have a lot of STDs to deal with. Hays County, unfortunately, has some of the highest rates of STDs in the state.  

What are we talking about when we refer to STDs or STI (sexually transmitted infection)? Most commonly we mean HIV, Chlamydia, Gonorrhea, Herpes, Syphilis and Hepatitis. 

Chlamydia has the distinction of being the most common infection. The ages 15-24 are the most commonly infected. 

But Chlamydia, Gonorrhea and Syphilis can at least be cured while herpes and HIV are with you forever.   They can be asymptomatic to wildly painful and, as stated earlier, they are on the rise.

Why after years of decline are sexually transmitted diseases making a comeback? I would say that when HIV/AIDS hit in the early 80s that public awareness of safe sex practices was made a priority. AIDS was a death sentence then and so people were much better at protecting themselves either through abstinence or use of condoms or having fewer partners. Now HIV is treatable, not curable, but treatable. The people are having much freer sex these days and with a lot more partners. Some clinics have stopped trying to give out condoms because people aren’t using them. Public funding has been decreased over the years for STD screening and treatment and may have contributed too.  

I would argue that it is not hard for schools to be more involved and it doesn’t cost money for them to take a few minutes each month to discuss safe sex. The internet has helped too. Hook up sites like Tinder, Grinder or Ashley Madison make it easier than ever for people to engage in casual sex.

How do you know if you have a STD? Gonorrhea and chlamydia usually cause burning with urination or a purulent discharge but not always, as sometimes they are asymptomatic for weeks. Herpes causes painful, itchy blisters and ulcers on or around the groin. If you have a cluster of blisters down there, you have herpes. 

Syphilis can present in many ways or stay silent for years. It can hide and make detection difficult, but when it does present itself early on it likes to cause a bump in your groin that turns into a "painless" ulcer. 

HIV presents like the flu with vague symptoms of fatigue, muscle aches and fever. Eventually as it progresses, you can develop skin rashes and unexplainable weight loss. Any of these may cause your lymph nodes to swell in your groin.

Detection is usually made through simple urine or blood tests. You no longer need the "swab" up the urethra. You can just urinate in a cup for gonorrhea or chlamydia testing and HIV and syphilis only need a small sample of blood to test. That’s the easy part. The hard part is getting people to the clinic to be evaluated regularly so we can detect and treat these diseases early and reduce their spread. 

Because some of these diseases can be asymptomatic for a time, screening is important. Yearly testing in populations at risk is necessary if we’re going to be proactive in trying to reduce disease.

Treatment for HIV has really progressed. You can now live a long healthy life with the new drugs. In fact, the drug Truvada, can prevent HIV infections and is called Prep (pre exposure prevention). This is good news but one worry is that it has reduced the fear of contracting HIV and unsafe sexual activity is prevalent again and so the other diseases, especially syphilis – which has doubled in the last few years – are on the rise.

Chlamydia is easily treated with one dose of Azithromycin and one week of doxycycline. Gonorrhea is a problem now as it has developed resistance and there are reported cases of strains that are completely resistant to all antibiotics. I can’t imagine burning pee everyday of my life. Most gonorrhea is still susceptible to a shot of Rocephin mixed with 1gm of Azithromycin, thankfully.  

Herpes is for life, but daily use of acyclovir can significantly reduce outbreaks and its spread to others.  

What can happen if these diseases are left untreated?  Pain, infertility, PID (pelvic inflammatory disease), cancer, miscarriages and even death can occur if you ignore these diseases.

What is the most foolproof way at prevention?  Abstinence – I’m laughing as I write that because we all know we are not going to stop people from having sex.  So let's be sensible. 

We need increased use of condoms and yearly surveillance by our clinics. Limiting the number of partners you have and making your partner get tested will reduce spread. Vaccines are helpful for some types of hepatitis and HPV. Reducing IV drug use in our community would help.  Girls, what doesn’t help is oral contraceptives. They provide no aid in disease spread but they are excellent at stopping unwanted pregnancies.  

If you’re worried about a possible STD, go see your doctor or local departments of health. The department of health in San Marcos can be reached at 512-393-5520.  And please remember, practice safe sex Hays County.  

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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.