EVERY year on her birthday, Jess goes to get her annual checkup. She books her appointment with her ObGyn and asks to be checked for “everything”. The doctor examines her and tells her everything looks A-OK, then gives her a form to go to the lab to do some routine tests. About a week later, the doctor's office calls for her to come in to review her results.
At this point, Jess is mildly concerned… “Why couldn't he just e-mail me? What could this be all about? He said everything looked A-OK… and he should know.” She gets to the office and hears the phrase no one wants to hear. “You have tested positive for a sexually transmitted infection (STI).”
This scenario is one that plays out in my office (and I'm not exaggerating) every week. STIs are one of the more common reasons for visits to the doctor. In the United States of America, there are over 20 million new cases each year. In Jamaica, data from the Ministry of Health's website show over 40,000 new cases were reported in 2017. That number probably doesn't even begin to tell the story of how common these STIs are, as the majority of them are completely asymptomatic.
These bugs can infect the host and just do nothing. No itching, no odour, no abnormal discharge, no burning — nada. Look at Jess, for example, she saw her doctor and was told that everything looked fine. Let that sink in for a moment. An expert in female anatomy looked at Jess's vagina up close and saw nothing out of the ordinary. These bugs just sit there and wait for the night you can't be bothered with the condom so it can invade a new host. Either that, or it waits until you are stressed out from work, or not getting enough sleep — or anything that weakens your immune system — then it'll rear its ugly head. It may manifest as a foul-smelling discharge , vaginal itching, burning when passing urine (more so for men), or less obvious symptoms like pain during sex or bleeding after sex.
These bugs can sit there for years, making it sometimes very difficult to even know when you contracted them. Based on international and local data, on average, women will have around four to five sexual partners. That number is increasing as time goes by, which means it's nearly impossible to track the origin of a silent STI, unless you've been doing testing every year.
That brings us here – testing. The best way to know if you've been affected is to do the tests. That way, even asymptomatic infections can be picked up and treated before they become a problem. However, not all tests are created equal. Some are blood tests that check for the body's immune response to the STI. That's good for checking for previous HIV, hepatitis and syphilis exposure, but not as good to check for active infections like chlamydia, gonorrhoea or mycoplasma. These are best checked with more sophisticated DNA testing from a urine sample or vaginal swab. Testing is recommended once a year for women under age 25. For those over age 25, yearly testing is also recommended if you have a new partner or engage in so-called high-risk behaviour such as multiple sex partners or have a history of an STI.
We have come a long way with managing HIV since the 1980s, so many people are living long, fruitful lives with the virus, once on treatment. That's not to say we should stop worrying about it, as it's still a huge public health issue. The other bugs can silently wreck your internal pelvic organs if the infection spreads inwards. Pelvic inflammatory disease can become chronic and damage your reproductive organs, leading to infertility and/or long-standing pelvic pain.
Prevention is better than cure
Use a condom. Use a condom. Use a condom. Condoms significantly reduce the risk of an STI. There are non-latex options for those who are allergic, so there should be no excuses.
Many of the STDs can be cured, and all can be treated. So go out this month and get checked out. Find out if there are any silent STIs lurking in your vagina. Get them out and/or under control, and of course use a condom. Likewise, men should see a GP and get tested.
Dr Ryan Halsall is a consultant obstetrician gynaecologist who operates at ILAP Medical, 22 Windsor Avenue, Suite 2, Kingston 5. He can be contacted at firstname.lastname@example.org or 876-946-0353. Follow him on Instagram: @drhalsall
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