What's sex got to do with it?

STIs are on the rise and can hide behind a cruel disguise


Steadily increasing in prevalence since the 1990s, sexually transmitted infections (STIs) continue to spread on university campuses. What’s even scarier: you may not know you have one.

The asymptomatic nature of Canada’s most prevalent STIs means routine testing for these infections is a necessity.

According to Dr. Lewis Tomalty, chief of service in medical microbiology at Kingston General Hospital and associate professor at Queen’s, over half of the most commonly spread STIs often show no symptoms. “Chlamydia and gonorrhea have both increased over the past decade. However, with so many people (especially females) asymptomatic, we can only postulate on the absolute increase in numbers,” Tomalty told the Journal via email. “There is no doubt though that a number of STIs continue to increase.”

Those between the ages of 15 and 30 experience the highest rate of STIs. Within this age bracket, chlamydia is the most common culprit, and 80 per cent of women who have it are asymptomatic, as opposed to 50 per cent of men.

“If you don’t know if you’ve got it, then how do you know you’ve got to get tested?” Tomalty said.

Chlamydia, induced by a bacterial parasite and transmitted through bodily fluids, can be the result of unprotected sex. Gonorrhea is a similar bacterial infection that thrives in any warm, moist place within the body, including a woman’s cervix, uterus and fallopian tubes, as well as the mouth, throat, eyes, anus and urethra.

Syphilis, a previously rare STI in Canada, is increasing its presence significantly, according to Tomalty. Also bacterial, syphilis cruelly mimics the symptoms of other medical conditions — fever, fatigue, headache and sore throat. If untreated, it can progress through four stages of illness, beginning in the primary stage with a painless ulcer where the bacterial infection has been contracted.

“The trouble with syphilis is that the initial clinical manifestation is a painless lesion known as a chancre,” Tomalty said. “When something is painless, patients may not seek medical help. In females, the lesion can be internal and thus unrecognized.” As with any untreated illness, the longer a sexually transmitted infection lives within the body, the greater the chance of complications. The plausibility of long-term complications with untreated cases of STIs should be a concern for those who fall into the higher-risk age bracket.

Various strains of human papillomavirus, for example, are known to lead to cases of cervical cancer in women.

According to the Society of Obstetricians and Gynecologists of Canada, 75 per cent of Canadians are estimated to experience at least one HPV infection at some point in their lives, most of whom show no symptoms.

The herpes virus also carries a viciously high rate of recurrence.

“If we have somebody who is diagnosed with herpes, we have to watch that they’re not passing it on,” Tomalty said.

While vaccinations assist the eradication of these viral STIs, syphilis, chlamydia and gonorrhea, all of which fall into the bacterial category, can be passed on to children through childbirth.

The latter two can lead to infertility if left untreated, and syphilis, in extreme cases, can be fatal in its final stage.

The bacterial nature of these infections, however, makes them easily treatable with antibiotics and thus curable.

“There’s no more risk of one of these infections than there is with an infection in your toe,” Tomalty said.

Nevertheless, persistent stigma about STIs prevents many individuals from acknowledging the prevalence of these infections.

“It’s still not a topic we’re comfortable with,” said Tomalty, referring to the negative implications that remain attached to STIs.

There’s a need, he added, to eradicate them to ensure individuals are getting tested routinely.

Tomalty said that while the general public grew more comfortable with discussing safer sex after the HIV outbreak in the 1980s, the topic continues to provoke anxiety for most.

“There’s always going to be a stigma around STIs. Remember when we called them sexually transmitted diseases?” Tomalty said. “We’ve gone away from that term now because so many are silent, and because the connotation there is negative.”

According to Tomalty, reducing the stigma relies partially on drawing similarities between an STI and any other type of infection.

“If someone has strep throat, they have an infection, and we say they’ve got an infection, not a disease,” he said.

“In universities we have an incredibly astute, bright population,” Tomalty said. “With continued education, the stigma can be minimized.”

Educating individuals on the basic facts of STIs is the best means of encouraging routine testing for STIs, he added.

“Someone who finds out they’ve been infected probably isn’t going to run down the street telling everybody they’ve been infected, but they shouldn’t beat themselves up about it either,” Tomalty said.

Additionally, individuals should take comfort in knowing that modern medical advances have made testing for Canada’s two most common STIs considerably less intrusive.

“In terms of being tested for chlamydia and gonorrhea, it’s very simple. It’s a urine test, for both men and women,” Tomalty said.

Ten years ago, this wasn’t the case. Those getting tested had to undergo a more invasive swab test.

Tomalty said that annual testing is recommended, even if you’re practicing safe sex.

For women, Tomalty recommends an annual pap test as a cautionary measure, as well as an annual physical assessment for everyone.

Higher-risk sexual behaviour necessitates more frequent STI testing, according to Julia Hodgson, clinical nursing facilitator for the Sexual Health Team at Kingston, Frontenac and Lennox & Addington Public Health.

“We recommend testing based on risk,” Hodgson said. “Level of risk can depend on things like number of partners, types of partners and condom use, but you don’t have to be ‘high risk’ to get a common STI like chlamydia.”

Regardless of the level of risk, most people are probably not getting tested often enough, according to Hodgson.

“I think that many people, especially young adults, will wait until something is wrong before they see a health care provider. Unfortunately, testing based on symptoms does not work for sexually transmitted infections because many people with STIs have no noticeable symptoms,” Hodgson told the Journal via email.

Like Tomalty, Hodgson said she recommends annual testing, but emphasized individual subjectivity.

“It’s important to talk to your health care provider about your risks and what testing frequency is right for you,” she said.

While routine testing is the best option, individuals, and particularly university students, are easily dissuaded from booking an appointment.

“Perceived low risk of infection, fear of stigma, and the fear of the psychological burden of living with, or having an STI, can all play a role,” according to Caroline Pukall, director of sex therapy service in Queen’s department of psychology.

Pukall said factors such as discomfort discussing sexuality, fear of finding out a potential sexual partner has an STI and a general lack of knowledge surrounding STIs prevent open communication among sexual partners, making STI contraction more likely.

“One issue,” Pukall said, “is that not enough people know about some risks of STIs through oral sex, and not many students know that the condom cannot completely protect one from herpes or HPV.”

Pukall listed a number of measures people can take to maintain optimal sexual health, including open discussions concerning sex, negotiating safer sex, knowing when to say no when needs or demands are not being met, and remaining clear-minded and knowledgeable so as to make the best possible decisions.

“People generally know basic information about STIs and how to prevent them,” Pukall said. “But knowing is not the same as knowing and being motivated and acting in a way that is consistent with sexual health.”

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