On Risk and STDs

[mattbell]

I've recently been frustrated that people either tend to dramatically overestimate or underestimate risks of particular activities.  Neither one is good... people can end up paralyzed with fear or regretting their recklessness.  The frustration around unknown risk came up recently in  discussions of sexually transmitted diseases.  There are a lot of scary stories of bad things that can happen to you, and ... well... they can happen to you.  But if your response to these stories is to just sit around and remain abstinent until marriage like the Bush administration advises, well, you're missing the point and you're missing the fun. 

I decided to fix that.  After a few hours of research online, I now have as good a sense as I can about the risks of various STDs.  There are nice ways of quantifying risk.  For example, you can think of the risk of a particular activity or lifestyle in terms of the number of days it shortens your life on average.  For example, every time you skydive, you run about a 1 in 70,000 risk of dying.  If you're in your twenties, each skydive will cost you on average about six hours of your life.  I have a coworker who has done about 4000 skydives.  His lifetime of skydiving has carried a three year risk that he's fortunately beaten the odds on, but for him, it's worth it.

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Here's how this kind of thinking works:

There are some people who are very worried about catching HSV1 (oral herpes, aka cold sores) because it can lead to the fatal disease herpes encephalitis.  Crunching the numbers, catching HSV1 costs you about 4 days (or, if you prefer, 16 skydives :-).  Not too bad.  Which is good, considering 90% of people have HSV1 by age 50. 

Don't want to get Hepatitis B?  Get immunized.  It will add 9 days to your life.   

The big one, though, is HIV.  Because HIV is so deadly, there has been a lot of research on how dangerous the transmission is. 

Just one act of unprotected vaginal sex (receiving) from an HIV+ partner costs you 73 days (or 292 skydives).  If your regular partner catches HIV, they will very quickly suck the life out of you.   Use a condom, and it goes down to 1.5 days per act.  Unprotected fellatio with an HIV+ man costs the woman 5.8 days per act. 

Now there's a great reason to make sure your sex partner(s) are trustworthy and tested regularly. 

Then there's HPV.  What's frustrating about HPV is that the actual risks in transmission are not clear, and there's no way to test guys for it.  While the chance of HPV-induced cervical cancer killing you is low if you get regular pap tests, it can still lead to unpleasant surgery.  What's actually more dangerous is oral cancer caused by HPV.  HPV-induced oral cancer is currently shortening the average American's life by 22 days.  There's currently no oral pap test, and virtually no education on it.  This is one reason why I'm so excited about getting the HPV vaccine approved for guys -- from what I can tell of the pathology, there's no reason it wouldn't work to prevent oral cancers as well as it works to prevent cervical cancer.

This reasoning can be applied to other kinds of risks too. 

A lifetime of driving a car shortens your life by 91 days due to the chance of dying in a car accident.   However, all you have to do is wear your seatbelt, and you get 57 of those days back.  Sweet.  I'm looking to buy a new car.  I can get side impact airbags for an extra few hundred dollars.  It turns out that a lifetime of side impact airbags saves me 5.3 days.  Not bad. 

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Now, one important thing to remember is that all risks are based on averages.  If you're really choosy with your partners, the Hep B vaccine may only save you a few hours.  If you frequent gay bathhouses, it will likely save you hundreds of days. 

Also remember that the risks listed here are risks of death... there is also quality of life to consider as well. 

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I'm now feeling a lot better about STD risks.  It's a lot better than living in the dark.

Comments

[radiantsun.livejournal.com]

Awesome!