mattbell

Hi all,

Since there was so much interest in my last post, I thought I'd post my observations about how to avoid STDs.  I'm interested to hear your criticisms and feedback.  Data sources and analysis are available upon request. 

Observations on STDs: 
(I’ve tried to make this as gender/sexuality neutral as possible)

- HIV is by far the biggest threat to your life as it is common (1 in 300 Americans have it), deadly, and incurable.  Fortunately, you can easily lower your risk by using condoms for vaginal and anal sex and avoiding unprotected oral sex with people you don't intimately trust.

- If you have regular unprotected sex with a partner and they get HIV, there's a good chance it will get to you before they test positive for it, even if they test every 6 months.

- Syphillis, Gonorrhea, and Chlamydia are deadly if untreated, but it's easy to catch (via regular STD testing) and cure them early before bad things happen.

- Nearly all STDs are "silent" (aka asymptomatic) in most people who are infected.  That's how the little buggers trick us into spreading them.  :-)   This is even more reason to get tested regularly.

- HSV1&2 are very common and hard to avoid due to their ease of spreading (although some efforts can be made by infected parties to reduce risk by avoiding sexual contact when sores are present).  There is a risk (1 in 500 to 2000 lifetime risk) of catching a deadly disease (Herpes Encephalitis) if you get HSV1, but most people have oral HSV1 already so it's hard to reduce that risk except by avoiding HSV1 entirely, which as I mentioned is hard to do.  There is a serious “ick” factor with genital HSV1 and HSV2… while not life threatening, it may turn off potential partners.

- Hepatitis B is common and can cause serious problems, but there's a vaccine.  Get it if you haven't already.

- HPV is very common (1 in 15 Americans have it at any time) and can cause deadly cancers but the risk of death can be very dramatically reduced via annual pap tests.  However, there are also many other consequences to getting it, from necessary painful surgery to potential infertility.  Prevention of HPV transmission is hard -- pap tests are only 80% accurate, transmission mechanisms are not well understood, there’s no test for men, infectiousness rate is high (at least 1% per sex act), and condoms help but not by much.  There's a vaccine which substantially reduces the risk of HPV, but does not eliminate it. 

- Good data on risks of STD transmission via unprotected oral sex is very hard to come by.

Course of action for reducing STD risks:

- Be open.  Talk to your partners about your sexual history and ask about theirs. 

- Get tested.  You and every (oral/vaginal/anal) sex partner should get a full range of STD
tests at least every year, if not every 6 months.  This should include HIV,
Syphilis, Gonorrhea, Chlamydia, Hep B (unless vaccinated), and Hep C.  There’s a site (www.tstd.org) that offers a full battery of tests for $250.  Various local clinics and Planned Parenthood offer somewhat less convenient but free STD testing.  Every woman should also get a pap test for HPV at least once a year.  There is now a highly sensitive HPV DNA test that can test for the presence of the virus in advance of cervical cancer, and should be done in conjunction with the pap test every year for maximum effectiveness.

- Avoid untrustworthy people.  Make sure you can trust your (oral/vaginal/anal) sex partners.  If you think they might lie about their habits or STD results, don't have sex with them.

- If you get tested regularly, then HIV is the only common STD that can still kill you.  Everything else that can kill you can be cured in time, with the exception of HPV-induced throat cancer.

Here's how to prevent yourself from contracting HIV:

Short (but somewhat inaccurate) answer:  Avoid unprotected (vaginal/anal) sex.  Make sure all your partners, and their partners, get tested too.

Long answer:  Take everyone you’re having regular unprotected (vaginal/anal) sex with, everyone they are having regular unprotected sex with etc.  Let’s call this your network. Having a big network is dangerous.  STDs can travel very fast on this network, so in a sense you're all one big fluid-bonded body, and anyone they have sex with becomes your partner by proxy.  If you're not having unprotected sex then your network is just you, and you’re much safer.  Now take everyone who's having any sex, protected or not, including oral sex, with anyone in this network.  Make sure all those people (and their unprotected partners) are getting regular HIV testing.  That should very dramatically drop your risk of catching HIV before one of them tests positive for HIV.  

- Avoid protected vaginal sex when:
    - You don't trust the partner.
    - The partner has not had a recent comprehensive STD test with good results.

- Avoid unprotected oral sex when:     (yes... almost no one has protected oral sex, but I figured I should clarify anyway)
    - You have any sores or infections.  This increases the risk of catching other STDs.
    - You have bleeding gums, you just flossed, or there's any other reason why  there would be an open wound in your mouth.
    - You don't trust the partner.
    - The partner has not had a recent comprehensive STD test with good results.
    - Your partner has HPV.  (This is not proven yet, but is a likely source of how oral HPV is contracted)

- Get the Hepatitis B and HPV vaccines.  The HPV vaccine will likely be available for men starting in 2010, and may substantially protect against oral cancers. 

- Kissing is a low risk activity:
    - If you kiss a lot of people, you will probably get oral HSV1.  You will probably get it anyway.   There's a small risk of dying from HSV1-related diseases, but this risk is an order of magnitude lower than, say, dying in a car accident.
    - There's some low risk of getting other treatable STDs, but nothing unavoidably life-threatening.

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I'm interested to hear feedback on this