Ask Dr. H: Week 6

Dr. Jill Hoxmeir, Public Health Professor

Dear Dr. H,

What are the current rates of sexually transmitted infections? I feel like they have decreased. As I’ve been in college, I’ve known people who have had MANY partners, but they don’t have any diseases. Either they practice “protected” sex or the rates have gone down a lot.

Dear anonymous,

Sexually transmitted infections run rampant in our country and yet no one we know has ever had one… at least not that they’ve told you.

“Nearly half of the 20 million new sexually transmitted infections (STIs) diagnosed each year are among young people aged 15-24 years,” reports the Centers for Disease Control [CDC] and Prevention, while about one in four new cases of HIV infections occur in youth 13-24 years.

That’s quite a bit of STIs for people in the college-age range. Of course, this doesn’t specifically speak to the STI rates among students at Central, but it does shed light on the millions of young people in our country affected by infections that are easily prevented. Currently, there is no population-level data for STIs among the Central students – so, truth be told, I cannot make a specific, evidence-based assessment on the trends of STIs among our students.

That being said, STIs are very common among college students at the national level, and, for some STIs, appear to be increasing – not using condoms, getting tested, or talking to partners about STI history all increase risk for getting an STI. Many STIs (like HPV, chlamydia, and gonorrhea) are often asymptomatic – meaning people who are infected don’t experience any symptoms.

So, unless people who are sexually active get routinely tested, they may not even know they have an STI. When left untreated, these STIs can lead to further health complications and even infertility. Women, in particular, tend not to experience symptoms with the aforementioned STIs.   

HPV, or the Human Papilloma Virus, is the most common STI – the CDC estimates that nearly all sexually active men and women will get it at some point in their life. Some strains do not cause health issues while others can cause genital warts, which can also be asymptomatic and yet is very common among young people.

We’ve all seen the gruesome pictures of herpes or genital warts, but most of the time, people don’t even know they have these STIs, and yet they can still be transmitted between partners even if the infected partner does not have symptoms.

You mention people you know who have “MANY” partners but no “diseases.” Something very important to consider is that, especially in the case of HPV, an initial infection does not produce “disease.” HPV can be spread through vaginal, anal, and oral sex, and high-risk strains cause most cervical cancers, in addition to cancers of the vulva, vagina, penis, anus, and throat.

The CDC estimates 33,000 new cases of cancer each year in parts of the body where HPV is also found – presumably from HPV infection acquired years or even decades prior. Even if people use condoms for penis-and-vagina-sex, but not for oral or anal sex, they are still at risk for HPV. Someone can have HPV, not know they have it because they don’t have symptoms, spread it to others, who then may or may not experience any symptoms themselves until years later when cancer develops.

The bottom line: if you’re sexually active, regular STI testing is highly recommended – once per year and even more frequently if you have sex with multiple partners. If you are having sex with someone you don’t know very well – or aren’t sure if they are having sex with other people – always use condoms for vaginal, oral, and anal sex.

If you’re in a relationship, talk about your testing history and, better yet, go get tested together to know your STI status. Many STIs can be cured with antibiotics. Even those that cannot – like genital warts, herpes, and HIV – can be healthfully managed.

Consider talking to your healthcare provider (shout out to Planned Parenthood and Central’s Student Medical and Counseling) about the HPV vaccine as well, which protects against certain strains of HPV most commonly linked to cancer and genital warts.   

People don’t always know they have an STI when they do, and people don’t always feel comfortable sharing their STI status because of stigma. I would highly advise against basing your personal risk for getting an STI on your perception of how uncommon they are among your peers.

Even if you believe that people at Central just don’t have STIs, the truth is that rates are probably higher than you think, and at some point, your pool for sexual partners will get larger. If you’re not in the habit of making healthy and safe decisions around your sexual activity now, then you are putting yourself and any future partners at risk later down the road.