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STI Intro | Summary of STIs | Prevention | Testing |

Oral Sex: How Risky? | Advice | HIV*PACT

Introduction:

FACT: The three most common STIs on the Stanford Campus are HPV, Herpes, and Chlamydia (Vaden Health Center).

FACT: An estimated 1 of every 4 teenage girls, including those at Stanford, has a sexually transmitted disease (Center for Disease Control).

This high rate of STIs highlights the fact that there is a continuing need for STI education and STI prevention resources on campus. The SHPRC aims to give students both the knowledge and the motivation to make safer sex choices.

Further, the prevalence of STIs on college campuses should also serve as a reminder that many of the people that we reach have, had, or will have an STI at some point in their lives. Therefore it is important to spread awareness without spreading stigma about STIs. Remember, except for viral STIs (HIV, HPV and herpes), all STIs can be cured or treated and managed. We should never attempt to scare someone into safer sex practices at the expense of alienating someone else. In fact, our goal is not to scare anyone, but rather through a realistic picture of risk, encourage people to practice safer choices.

STIs: a Summary

Adapted from Scarleteen.com’s STI Risk Assessment: The Cliff’s Notes and Vaden Virtual Library

Burning, itching, or discomfort “down there”? The problem could be minor, or it could be a sexually transmitted infection (STI). STIs are infections which are easily transmitted through sexual intercourse (SI) with an infected partner (vaginal, oral, anal) and/or sexual touching (ST) (hand to genital, genital to genital). The most common STIs affect 5 to 20% of students in this order:

Human Papillomavirus (HPV) / Genital Warts

Herpes

Chlamydia

Hepatitis B

Gonorrhea

Syphilis

HIV

Human Papillomavirus (HPV) / Genital Warts

Stat: 50% of sexually active men and women will contract HPV at some point in their lives.

What is it exactly? There are more than 30 different known strains of HPV that are sexually transmissible, many of which are potentially cancerous, and some which are direct causes of cervical cancer. HPV is often called genital warts, because when it is externally symptomatic, it appears as tiny cauliflower-like warts on the genitals. However, in most cases, HPV shows no external symptoms, though it is still present and highly contagious. Condoms do not offer full protection against HPV.

How is it spread? Through skin-to-skin or mucous membrane contact during oral, vaginal anal or manual sex.  It is most likely, by far, to be spread by genital-to-genital contact (vaginal intercourse, anal intercourse or rubbing two sets of genitals together without a latex barrier). In other words, there does not need to be exposure to body fluids, such as semen, to pass HPV to partners.

What are its symptoms? Most people with HPV show no signs or symptoms, yet can still transmit the virus to their partner. When symptoms do occur they are in the form of small, cauliflower-like warts on the vulva, vagina, anus, penis, inside the urethra, or in the throat.

How is it diagnosed? Through a microscopic exam of tissue samples (taken during a gynecological or urological exam) and the visual examination of warts, if they are present. For women, a PAP smear may reveal precancerous conditions caused by HPV. When a visual exam is not sufficient, a colposcope (a special magnifying instrument) can help to detect HPV. Unfortunately, diagnosing HPV in men is often difficult, so a man with a clear STI screening should not consider himself at no risk of having HPV. Female students should start getting PAP smears 3 years after becoming sexually active, or when they are 21 (whichever comes first). PAP smears are available at Vaden Health Center.

Is it treatable? Warts can be removed by various methods, namely by being frozen off (cryotherapy) or burned off (electrocauterized), via use of a patient-applied solution, dissolved with acid solutions, or removed by laser surgery. Overall, those methods are relatively painless, and are usually done in your gynecologists office, not in a hospital. Which method is used depends on the patient, the avilability of methods, and the particular warts and strain in question.

Is it curable? No. Even when the warts are removed, the virus may still remain present in the body, and can be transmitted to partners when no warts are present, and cause long-term health problems like cervical cancer. Some people may, however, shed the virus over time.

How can we protect against it? Condoms offer some protection, but because condoms do not cover the entire genital area, it is limited. But the use of condoms during vaginal or anal intercourse or oral sex, and dental dams suring feamle oral sex can offer protection, and should be used to help prevent HPV and other STIs.

Herpes Simplex

Stat: About one in five people in the United States over age 12 — approximately 45 million individuals — are infected with HSV-II, the virus that causes genital herpes. Around 50 – 80% of the adult population has oral herpes, which most people contracted through casual contact in childhood.

What is it exactly? There are two types of the Herpes Simplex Virus: Simplex I and Simplex II. Simplex I or oral herpes usually infects the mouth (cold sores are Herpes Simplex I), and Simplex II, or genital herpes, usually infects the genitals. However, both types can be transmitted sexually (through kissing and oral sex as well as through skin and genital contact), and HSV-I is not limited to the mouth area. It can also sometimes cause genital-area or anal-area lesions. Herpes is one of the most common sexually transmitted diseases in the United States.

How is it spread? Herpes viruses are spread by contact between an infected area of the body and an uninfected, susceptible area of an uninfected person’s body. This means that herpes can be spread from ANY affected part of the body: penis, vulva, anus, mouth, lips/face, etc. If virus from an active sore is on a hand or an object, it can also be transmitted that way — for instance, a person with cold sores could wipe their mouth with their fingers, then perform manual sex on an uninfected person and infect them that way. It can even be transmitted from hand to eye. Ouch.

Sexually, it can be spread by vaginal anal or oral intercourse, manual sex, general touch or kissing. Herpes is most contagious when one person with the disease has an active sore, however it may also be spread when no sores are visible or percieved to be present.

What are its symptoms? A rash or blisters that recur in small clusters that may be seen on the vulva, vagina or cervix, on the penis, buttocks or anus, or on the mouth and other areas of the body. It is generally itchy, sore or painful.

The first occurrence of herpes may also cause itching or burning while urinating, swollen glands, fever, headache, loss of appetite, and general lethargy or tiredness. These first symptoms usually occur within one month of the initial transmission, but a rash may not be visible or occur for years afterward.

How is it diagnosed? It can only be accurately diagnosed by a doctor or clinicians sampling of an active sore, but there are other means of testing available, though they are less accurate.

Is it treatable? Herpes symtpoms and outbreaks can be reduced with medication, but the disease still remains in the body and is contagious even when treated.

Is it curable? There is currently no cure for any form of the Herpes virus.

How can we protect against it? People with Herpes should NOT have physical sexual contact (vaginal or anal intercourse, oral intercourse, manual intercourse, kissing, etc.) with others when sores are present or when they can feel the sensations that signal an approaching outbreak. Because people can have herpes infections without having a visible rash or outbreak, and because condoms only offer limited protection from herpes (since herpes can infect areas of skin not covered by condoms), both sexual partners should be tested for Herpes BEFORE any sexual intimacy of any sort, and safer sex should always be practiced.

Chlamydia

Stat: Chlamydia is the most common sexually transmitted bacterial infection in the United States, with about 3 million new cases reported annually. Chlamydia is so common in young women that, by age 30, 50% of sexually active women have evidence that they have had chlamydia at some time during their lives.

What is it exactly? A bacterial infection which infects the cervix and can spread to the urethra, fallopian tubes, and ovaries in women. It can cause chronic bladder infections and pelvic inflammatory disease, ectopic pregnancy, and permanent infertility. Chlamydia can also infect the throat when acquired through oral sex.

In men, chlamydia infects the urethra and can spread to the testicles, which can cause male infertility. Accoording to Planned Parenthood, chlamydia can also lead to Reiter’s syndrome, especially in young men, which involves eye infections, urethritis, and arthritis. One in three men who develop Reiter’s syndrome become permanently disabled.

How is it spread? Through vaginal or anal intercourse, oral sex, during childbirth, and in rare cases, from hand to eye and other nonsexual contact.

What are its symptoms? In most cases, chlamydia shows no symptoms. When symptoms are present, they may include: pain or burning while urinating, vaginal bleeding, painful intercourse for women, spotting between periods or after or during intercourse, stomach or abdominal pain or nausea, fevers, swelling or pain of the rectum or cervix, or in men, of the testicles or fertility problems.

How is it diagnosed? By a urine or tissue sample from the genitals or throat. Vaden offers free STI screening for Chlamydia.

Is it treatable? Yes, with antibiotics. However, it’s so important that ALL partners are treated when Clamydia shows up in one. If you get Chlamydia and get treated, but your partner does not, and you keep having sex (particularly unprotected), you can wind up passing the infection back and forth again and again. It’s also very important to abstain from sex until all partners are completely finished with treatment, and found, via a new test afterwards, to be clear of the infection.

Is it curable? Yes, but you can get it again.

Can it effect fertility? In both men and women, left untreated, chlamydia can cause infertility. Chlamydia can also cause (via PID) ectopic pregnancy, and in infants, chlamydia can cause pneumonia, eye infections or blindness.

How can we protect against it? By using condoms every time for vaginal intercourse or anal intercourse and oral sex.

1. Hepatitis B
   • Transmission: SI, infected needles. A vaccine is available.
   • Symptoms: May be none; sometimes fatigue, nausea, abdominal pain
   • Potential complications: Cirrhosis, liver cancer, liver failure, death
   • Test: Blood test
2. Gonorrhea
   • Transmission: SI
   • Symptoms: Often none; Women: lower abdomen pain, heavier or irregular menstrual bleeding; Men: penile discharge, pain with urination
   • Potential complications: Women: pelvic inflammation, infertility, tubal scarring, tubal pregnancy; Men and Women: bloodstream infection
   • Test: Swab of cervix for women, urine sample for men
3. Syphilis
   • Transmission: SI, ST
   • Symptoms: Three stages: 1. Painless skin ulcers; 2. Rash, lymph node enlargement; 3. Neurological/blood vessel damage
   • Potential complications: Progressive neurological and blood vessel damage
   • Test: Blood test
4. HIV
   • Human Immunodeficiency Virus
   • Transmission: SI, infected needles
   • Symptoms: Stages: 1. Flu-like symptoms which disappear in 2 to 3 weeks; 2. Fevers, herpes, shingles, yeast infections; 3. AIDS: Serious infections, cancers, neurological diseases
   • Potential complications:
     numerous and life-threatening
   • Test: Blood test

Prevention

Prevention is more effective than treatment. Individuals without symptoms can transmit STIs, so abstaining from sexual contact eliminates risk. When sexually active:

• Form a monogamous relationship.
• Get yourself and your partner(s) tested when appropriate.
• Watch alcohol and other drugs (they lower inhibitions and impair judgment, which increases risk).
• Use a new latex barrier (condoms and dental dams) every time.
• Know that condoms may not protect against STD’s which are transmitted by touching.
• Talk openly to your partner about protection. Your health and well-being are worth it.
• Get Hepatitis B vaccine.
• Avoid oral/genital contact when you or your partner has a “cold sore” (often caused by Herpes).
• Don’t ignore early symptoms. Early treatment is most effective.
• Get the HPV Vaccine

Safer choices:

• Don’t engage in sexual activity with anyone except yourself. Employing this strategy alone carries the least risk, but is impractical for many people.
• Have only one sexual partner, and get tested for sexually transmitted infections together before engaging in sexual activity.
• Use barrier methods (condoms, dental dams) to prevent fluids (semen, vaginal fluid, blood) from contacting each other. These strategies can be used together for even greater levels of protection, or employed individually depending on the situation.

These are “safer” choices because they aren’t risk free. HPV, herpes, and other STD’s can be transmitted from skin-to-skin contact, at times even when they are asymptomatic. For more information please refer to specific STD fact sheets, or ask an SHPRC counselor.

Testing

VADEN

Free STI testing for Stanford students!
• If you request STD testing, Vaden will screen for chlamydia, gonorrhea and syphilis because these are easily detectable. Vaden can also test for HIV.
• Genital Herpes belongs to a larger virus family including strains, so many people without the genital form will test positive in a blood test. Therefore, Vaden does not test for herpes unless specifically requested to. Diagnosis is usually performed after a visual inspection and a culture of actual symptoms such as a herpes sore. HPV can also be diagnosed via visual inspection of manifested symptoms, or via an annual Pap smear.
• Hepatitis strains can be transmitted sexually, so if you haven’t been recently vaccinated Vaden may advise this test as well.

Free HIV Testing through HIV*PACT: Peer Anonymous Counseling and Testing
This is a peer-run program offering anonymous testing, meaning that a patient doesn’t use their name and there is no record of the test. It is also an oral test, a positive feature for those uncomfortable giving blood.

PLANNED PARENTHOOD (various locations)

Free STI Testing
Planned Parenthood offers testing for chlamydia, gonorrhea, syphilis, and HIV. The chlamydia and gonorrhea tests are urine tests, while the syphilis and HIV tests are blood tests. Test results can be obtained in 1-2 weeks, and the HIV testing can be done confidentially and anonymously.

Students can sign up for a state-funded program at Planned Parenthood so that the testing is free.

Oral Sex: How Risky?

Many people are unclear on the risks associated with oral sex. Questions about oral sex and the risk of contracting an STD are very common in outreaches and at the SHPRC. Many people engage in unprotected oral sex, and are particularly concerned with the risks associated with not using protection.

What are the risks:

• Herpes is probably the biggest STD risk during oral sex. Both strains of herpes can live in the mouth or the genitals, and particularly during outbreaks (cold sores, herpes lesions) can be passed from one place to the other. Many people have oral herpes, more than 50% of a random group of people will have antibodies to the virus (indicating some level of infection). Having oral herpes for most people is no big deal, a cold sore during times of stress or illness is usually little more than an annoyance. Genital herpes can be more complicated and uncomfortable, but there are treatments (see Herpes Fact Sheet for more info). Care should be taken so that oral herpes are not passed to anyone’s genitals. In general it is not a good idea to have unprotected oral sex while any lesions are present.

• Chlamydia and gonorrhea can infect your throat, strep like symptoms, and are curable with antibiotics. These can also infect the eye, and though rare, eye infections can have serious consequences, so be careful with fluids.

• HIV can be passed through unprotected oral sex, but it is more likely to be passed during unprotected penetrative sex. The infected semen/precum or vaginal fluid must enter the body through a cut or sore in the mouth or esophagus. The virus is unlikely to be passed from a person’s mouth to another person’s genitals.

• HPV can be passed during oral sex, but it is rare. HPV has been found on vocal chords.

• Syphilis can be passed similar to HIV. Syphilis is curable.

Reducing Risks:

• To reduce the risk of infection during unprotected oral sex, limit exposure to sexual fluids and ensure that no cuts or lesions are present in the mouth or on the genitals.

• Use barrier methods – though many people feel that barrier methods detract from oral sex, they are very effective at preventing STD transmission:

• Oral-penile sex: Male condom, no spermicide (kills taste buds), flavored condoms are available.
• Oral-vaginal sex: Dental dams – can buy them, or you can use non-microwaveable saran wrap, or cut up a latex glove.
• Oral-anal sex: Dental dams, non-microwaveable saran wrap, cut up latex glove

**Spit or swallow? Limiting exposure to semen reduces risk of infection, so ejaculation away from partner’s body is the safest. That said, the mouth is the place most likely to contract something like HIV, so the conventional wisdom is, “swallow or spit, just don’t let it sit.”

STI Advice at SHPRC

Although we’re not doctors, all of the staff members at the SHPRC are trained both in sexual health information, and in peer counseling. We are also very well versed on the resources available on and near campus, and can offer you referrals.If you have any concerns or just want to talk, come in any time during our open hours, and talk to a peer in a relaxed atmosphere with a peer. Of course, anything discussed will remain COMPLETELY confidential.

HIV*PACT: anonymous free peer HIV counseling and testing

Visit the HIV*PACT website, or read the information below for a summary.

The American College Health Association estimates that one in every 500 college students (0.2%) is HIV positive. HIV is a sexually transmitted infection (STI).

Many contraceptives, including birth control pills, do NOT protect you against HIV and other STI’s. While condoms do not provide 100% protection, they do offer the best protection currently available. Condoms are available at Sexual Health Peer Resource Center and Vaden Health Center Pharmacy.

Anonymous HIV testing and counseling are offered at Vaden Health Center. They are provided by highly trained undergraduate and graduate Stanford students.

• When: Monday to Friday, all day, all year (summer hours vary)
• Where: Health Promotion Services, Vaden Health Center, 2nd floor
• Cost: Free for registered students
• Procedure: Every student has two appointments: one to take the test, and one to get the results.The second appointment is always exactly one week after the first, at the same time, and with the same counselor. Don’t schedule an appointment until you know that you can make both appointments.

To schedule your appointments, go to the East Clinic or West Clinic at Vaden (first floor), or call (650) 498-2336 Extension 1 (Vaden Medical Services).

* Information for “STI Testing at Vaden” taken from Vaden’s website

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