Q. I recently heard that sexually transmitted infections are on the rise. What exactly are they and what can I do about it?
A. Sexually transmitted infections (STIs) are not an easy topic but one that should not be avoided due to their high importance. As the name implies, STIs are infections passed primarily through sexual contact including vaginal, oral, and anal sex, as well as close skin-to-skin contact in some cases. They are certainly becoming more prevalent with an increase in chlamydia rates by 33% over the last decade and an increase in gonorrhea rates by nearly 182%. This goes to show that STI’s are more common than many people realize. In Canada, infections such as chlamydia and gonorrhea continue to be reported at high rates, particularly among teens and young adults. However, we are also seeing increasing numbers among people in their 30s, 40s, and beyond. One reason STIs continue to spread is that many cause either few symptoms or none at all. People often feel completely well and do not realize they are infected, yet they can still pass the infection on. This is why routine testing is such an important part of sexual health.
One of the biggest myths we hear is that STIs only affect certain “types” of people. However, anyone who is sexually active can get an STI. Age, gender, relationship status, and sexual orientation do not make someone immune. Even people in long-term relationships can be affected if one partner had an infection before the relationship began.
STIs are caused by bacteria, viruses, or parasites depending on the type.
Bacterial STIs: These include chlamydia, gonorrhea, and syphilis. The good news is that bacterial STIs are usually curable with antibiotics. When treated early, most people recover fully. When left untreated, however, they can lead to serious complications such as pelvic inflammatory disease, infertility, chronic pelvic pain, and increased risk of HIV.
STIs: Viral: Viral STIs include human papillomavirus (HPV), herpes (HSV), human immunodeficiency virus (HIV), and hepatitis B. These infections are usually lifelong, but they can often be well managed. Medications can reduce symptoms, lower viral levels, and significantly reduce the risk of transmission. With proper treatment and follow-up, people with viral STIs can live long, healthy lives.
Parasitic STIs: Trichomoniasis is the most common parasitic STI. It is often easily treated with prescription medication once diagnosed.
As suggested above, many STIs cause no symptoms at all which is one of the reasons they can spread so easily. When symptoms do appear, they can be mild or mistaken for something else. Possible symptoms include:
· Unusual vaginal or penile discharge
· Burning or pain with urination
· Sores, blisters, or ulcers on or around the genitals or mouth
· Itching, redness, or irritation
· Lower abdominal or pelvic pain
· Pain during intercourse
· Testicular pain or swelling
· Flu-like symptoms such as fever or swollen glands
Since these symptoms are unreliable for making a diagnosis, testing is the only way to confirm the presence of an STI and know for sure. You can make an appointment with your health care provider to discuss and perhaps order STI tests. If urgent symptoms are present, you may wish to consider going to an Urgent Care Clinic or an Emergency Department. Most tests involve a urine sample, blood work, or a simple swab. OHIP covers medically necessary STI testing, and no one should avoid testing because of cost or embarrassment.
Once a diagnosis of an STI is made, the treatment depends on the type of infection. For bacterial and parasitic STIs, antibiotics are prescribed as well as avoiding sexual contact until the treatment is complete. Partners may also need testing and treatment.
Viral STIs cannot usually be cured but medications can control the symptoms and reduce the risk of spreading the infection to others. Follow-up testing is sometimes recommended to ensure the infection has cleared or is well controlled.
Reporting STI’s to public health is mandatory to help reduce its spread. For those of you who may not wish to have this discussion with your partner, there is not choice in the matter as STIs are a reportable disease to Public Health Authorities. Plus, the partner in question may also need to seek treatment. In regards to the timing of reporting STIs, mpox must be reported to Public Health immediately whereas other STIs must be reported within one business day.
As is the case with many of our disease states we discuss in our column, prevention is key.
· Use barrier protection, such as condoms or dental dams (used for oral sex), correctly and consistently.
· Get vaccinated for HPV and hepatitis B when eligible.
· Get tested regularly, especially when starting a new relationship or if there has been unprotected sex.
· Talk openly with partners about sexual health and testing history.
STIs still carry unnecessary stigma, and that stigma often prevents people from seeking care. STIs are medical conditions, not personal failures. Getting tested, treated, and informed is a responsible step not only for ourselves but also for others.
For more information on this or any other health related topic, contact the pharmacists
