I don’t understand why some activities are seen as safe and some aren’t.
For example- man-woman vaginal sex. You have a thing meant to be jammed into places, being jammed into a place designed to have that very thing jammed into it. I can see that if you have a sore or something, but for normal skin?
And why would oral sex be any more dangerous than kissing a mouth? Mouths have sharp, hard teeth that even if they never come in contact with the other person’s naughty bits are going to bite their own cheeks and leave cuts where something could enter. The chances of blood contact mouth to mouth seems like it would be higher than mouth to something without all those teeth nearby.
Then, condoms are supposed to nearly eliminate the risk of transfer. But what about the externals parts being rubbed against each other? Wouldn’t something on the skin just jump on over? For fluid-borne diseases, I can see that the woman would be protected from the guy’s seminal fluids, but the guy is going to get girl-juice all over his pelvis even with a condom.
Makes little sense to me.
Begin with the idea that there is no such thing as “safe sex.” There is “safer sex,” but that is all. Sex, of all varieties carries some risk to it.
Man/woman sex: the whole jammer/jammee thing? Not designed. Evolved. Which means that it is flawed. Vigorous sex can lead to loss of lubrication. Loss of lubrication can lead to microtears in the vaginal wall. Microtears make disease transmission that much easier. Also, as the whole point of seminal fluid is to get the sperm into the uterus, there is a chance that some germs can be transmitted as well - bacterial, viral, or parasitic infections like to take hold in the uterus, the fallopian tubes, and the lower abdomen. It’s called Pelvic Inflammatory Disease, and it’s very bad.
Oral sex is (WAG) more dangerous than just kissing because mouths tend to have their own type of bacteria, and so long as you brush your teeth regularly, the worst you’ll get from kissing is mononucleosis. Oral sex juxtaposes two different bacteria reservoirs. It’s the popularity of oral sex that has made the distinction between genital herpes and oral herpes nonexistant. Those in the know now speak of herpes simplex virus I and herpes simples virus II.
Condoms do not eliminate the risk of disease transfer. They reduce the risk of disease transfer. Specifically, the reduce the risk of disease transferred by exchange of bodily fluids - HIV, gonorrhea, et cetera. There are a host of diseases that don’t require bodily fluids to be infectious. Top of the list is herpes, which can be transmitted skin to skin without either party showing any symptoms of infection. Genital lice (crabs), human papilloma virus (genital warts), and urinary tract infections in women are some of the others.
But don’t, if you have any blood-to-blood transmitted diseases. Brushing your teeth abrades your gums.
I have a slightly different question about the OP’s point: what is the order of risk with non-condom sex? An ex-girlfriend and I decided to hook up, after a few years apart. We assessed very differently the risks of unprotected sex (which we’d been having when we were a monogamous pair, after verifying that neither of us had an STD). Between us, since we’d last been together, we’d had sex, sometimes unprotected, with a few (very few) people, all of whom professed to be symptom-free and whom neither of us had any reason to think might be HIV-positive (no junkies, no one-night stands, no one who admitted to past gay- or bi-sex, etc.)
I felt the order of likelihood of either of us transmitting any sort of STD to the other was extremely high, sort of on the order of getting run over by a truck or hit by lightning. She seemed to think that it was about 50/50 one of us would actually transmit an STD if we had unprotected sex. I thought that was ridiculous, statistically speaking, though I understood her concerns, so we were much more cautious than I felt was necessary.
I have another, related question here too: my further point was that, even if somehow one of us HAD had an undetected STD to transmit, was the transmission automatic? IOW, isn’t it likely that we could have unprotected sex but still not transmit the STD? And if we did transmit an STD, how long would it probably take to manifest itself? I was thinking (somewhat morbidly) that I’ve probably got around twenty or twenty-five years to live (I’m 55)–if I came down with full-blown AIDS (which I’m usually pretty careful about avoiding, of course) anytime in the next five years, couldn’t I live with the disease for quite a while with current managements and treatments? IOW, if losing only years 75-80 of my life is all I’m risking by having occassional unprotected sex with a women who seems pretty safe, is that so bad, especially if the odds against actually contracting AIDS are minuscule?
So in short ,what are the chances? I’'m not looking for actual Vegas odds, but simply an order of probablility: who’s closer to being right, my ex-GF who says that ANY unprotected sex is a death warrant, or me, who says that the downside to unprotected sex is the very unlikely possibility of losing a few years off very end of my lifespan?
I work in a setting where I design a lot of STD testing and intervention programs, and we sometimes use the terms “semen depositors” and “semen receivers” to explain the difference in transmission likelihood. Those who receive semen are more at risk of also receiving and STD from and infected semen depositor than the other way around. The CDC has used this theory to explain some transmission patterns, including why the rates of HIV had risen among women.
That said, we also explain that there are so many variables that it is almost impossible to predict. At a conference recently a researcher presented data that indicated that vaginal intercourse with an infected semen depositor had a 1 in 12 chance of transmittal. But, anal sex with would have a 1 in 8 chance of transmittal, since there was often more abrasions. And, injection drugs had the highest chance of transmission of 1 in 4. Again, this was one research study with a lot of limitations, but it illustrated the differences in risk behaviors.
The person’s immune system also plays a significant role, since a compromised immune system makes it less likely that your body will respond to the STD. Co-infections of STDs are common.
The viral load of the STD also has an impact. A recently infected person usually has a higher viral load, and is more likely to transmit. Unfortunately, these are also often the individuals who have not developed symptoms and/or been treated.
And of course, all STDs are different. Herpes can easily be transmitted via oral sex; HIV, not so much. HPV is often undetected in men, but can be transmitted easily through vaginal or anal sex.
And, since the symptoms range from none at all to severe pain, rashes and burning, many people have no idea they have been infected. I can’t tell you how many surprises happen at some of our sites when we recommend a routine STD test, the person consents to the test thinking they have no worries, and come back with an STD. For men, it’s almost the norm rather than the exception, since so many STDs do not show overt symptoms in men.
In short, these are all the reasons that the message has been simplified to: “use a latex condom every time.” The odds are just too unpredictable.
Thanks, Jane. The problem with simplified messages is that they tend to get ignored since they’re not true. That is, you KNOW that you don’t have to use a condom every time to avoid contracting an STD, so you tend to you assume that, since you know the message that you must use one every time isn’t true, you can’t trust the messenger any more, so anything goes.
Kinda like the scare tactics of marijuana use: I knew that puffing on a single doob wouldn’t turn me into a heroin addict overnight, so all I could be sure of was that the people who warned me that marijuana was a certain gateway drug were totally wrong about that. Now if they’d actually warned me about the things that marijuana DID do (like make me uncomfortably paranoid at times) that might have deterrred my doob-puffing. Sometimes oversimplifying is counter-productive.
Could you elaborate? What STDs do not show overt symptoms in men? What STDs tend to be a surprise to the person taking the test but not a surprise to those administering the test?
The issue with the simple message is that it really can happen with “that one time.” And it does. So while it might not be “true,” it’s nevertheless necessary. And with the number of people with undiagnosed infections, it’s still damn good advice.
For the STDs that often have no symptoms in men (or often women, for that matter), the two that we see the most are HPV and chlamydia. Some men do have symptoms (burning, pain, frequency, discharge, fever), but most arrive on our doorstep after their partner has either developed symptoms and confronted them about it, or because we did a routine test on their partner and their partner brings them in.
I use these as examples because left untreated, chlamydia can cause infertility and HPV is the virus causes some types of cervical cancer.
As for the “surprise” factor… we are rarely surprised anymore. We kind of assume that if you tell us that you have had a certain number of partners, that number is usually higher. And, if you tell us that you had unprotected sex once or twice, that number is usually higher. It can be very hard for people to be honest when it comes to sex or money. We’ve had 60 year old grandmother’s who tested positive, and the occasional 12 year old as well. STDs really are equal opportunity. We just try our hardest to not be judgmental, because after all-- it’s a virus or a bacteria. The same type of thing that you can catch through your nose.
Also problematic is the fact that few men have routine screenings for STDs (in the states it’s just not a part of routine care), and many women assume that a pap test is an STD screening. So, when you ask a women if she’s been screened and she says “yes,” ask more questions. We use urine tests for most STDs (including a new test for Trich, which is very under-diagnosed) and the occasional swab.
Another point about STD rates that I just remembered… the rates are often under-reported for the simple reason that it’s less costly to treat than to test, then treat. So, if we have a woman who tests positive and she brings her partner (or partners) in, we usually do not test them. We presumptively treat them (often with a single-dose antibiotic) as though they have the infection. So, these cases never technically “get reported” or show up in disease statistics.
Is this one single test that will show results for all possible STDs?
Also, how do STDs break down into lists of “curable” vs “treatable but, sorry, you’re gonna have it forever now (herpes in on this list, right?)”?
Unfortunately, there is not one test for all STDs. But we’re getting closer.
We currently use a combined test for chlamydia, gonorrhea and trich for both men and women. We are actually doing a pilot test of this method for a laboratory right now. This can be collected using urine, which is a big plus for the guys. (no swab!) We also test women for HPV using the same liquid-based pap kit. These are all donw routinely, using what we call “opt-out” testing, which means we say something like “we test all people for these things, is that OK with you?” About 90% of people say yes when it’s presented as routine, which it is.
For syphilis, we use a blood test that requires us to send the blood to a lab, and for HIV we are currently using a rapid testing method that provides results in under 30 minutes. We use a different screening protocol for these right now, but we are considering using an opt-out model for the HIV screening as well.
As for the treatable vs. curable… here’s a quick list with some caveats.
Herpes-- treatable. But not curable at this point. Our standing joke at the office is “What’s the difference between true love and herpes? Herpes is forever.” Although we often joke about herpes, it’s no joke to many of it’s sufferers. Some people’s outbreaks are severe and frequent, despite anti-retrovirals. Other people have one outbreak and never have another one.
Chalmydia-- curable. But if left untreated can cause PID and infertility. And it often has no symptoms.
Gonorrhea-- curable. But there are some antibiotic resitant strains that make it more difficult.
Trich-- curable. And becoming much more common.
HPV–This is a tricky one. There are over 100 different related viruses as work. There is no treatment for the virus itself, but a healthy immune system can usually fight off HPV naturally. There are treatments for the diseases that HPV can cause, including cervical cancer and genital warts. But those are definitely not trips you want to take. And they often reoccur.
Syphilis–curable in the early stages.
HIV. Treatable. And it’s a little like HPV-- there isn’t a cure for the virus itself, but there are a lot of treatments for it and for the associated conditions.
Those are the big ones. We’re also looking at bacterial vaginosis right now as an STD as part of a study. It can cause poor birth outcomes, so we’re trying to track transmission and treatment.
I love my job!