The Elephant in the Dorm Room Part 2: Herpes, Chlamydia, and PID

August, 1982

Genital Herpes is one of the better known and more socially stigmatized of STDs, as shown in the August 1982 cover of Time Magazine above. A sexually active male has a one in five chance of being infected in college, while his female counterpart has a one in four chance of being infected. Anatomical differences make genital herpes transmission from male to female almost three times as common as female to male transmission. Hence, more women are positive for genital herpes than men.Those infected often have significant psychosocial problems, especially just after becoming infected.

HSV-1

HSV-1 causes oral Herpes, thought to infect from 50% to 80% of the population, and is known as the cause of “fever blisters” around the mouth, or “canker sores” inside the mouth. In the early 1980’s, a second strain of the Herpes Simplex virus affecting genitalia appeared to be spreading rapidly through sexual transmission. From then on, Herpes Simplex 1 (HSV-1) was accepted as the cause of oral infections, while Herpes Simplex 2 (HSV-2) caused genital herpes. Each strain can cause oral or genital herpes in some people, however. Studies show that those infected with HSV-1 often have a less severe outbreak of lesions when infected with HSV-2; as many as 75-90% of those with with HSV-2 are unaware they are infected. When open sores are present, large numbers of viruses are shed, and the risk of contagion is high. Many are unaware that even if no lesions are present, viruses can still be shed as much as 10% of the time and others can still be infected, though the chances are far higher when lesions are present. Recurrences do tend to decrease in number and severity over time. Herpes Simplex has a cousin known as Varicella Zoster, which is the cause of chickenpox in children. Like Herpes Simplex, once Varicella Zoster infects its host it lies dormant in nerve tracts until it is triggered to migrate to the skin surface and form vesicles, which then rupture, leaving open sores. When varicella recurs later in life when the immune system is weaker, this is a painful condition called shingles.

Symptoms of an initial HSV-2 outbreak vary in severity; flu-like symptoms, headache, low grade fever, and of course painful, inflamed vesicles or open sores on or around the genitals are common. Enlarged inguinal lymph nodes can sometimes be observed in an initial outbreak of genital herpes as well. In any situation where inguinal lymph nodes are swollen or tender, this is reason to seek medical attention without delay, since enlarged inguinal nodes indicate significant pathology occurring in the genital area, with the lymph nodes attempting to “wall off” the infection to prevent spread to the rest of the body. More on this below.

All sexually active college students would do themselves a big favor by asking their doctors to test their herpes status. Let go of the social stigma. Muster the courage by closing your eyes for a few minutes and envisioning being either the recipient or the caller in a “You gave me Herpes!! or “I’m so sorry to have to tell you this but…” Anyone infected can take comfort in knowing that he/she is certainly not alone. Plus, if you know you have herpes, you can treat it. Genital herpes outbreaks can be limited in number, severity, and duration by any one of three drugs presently on the market- Valtrex, Famvir, and Zovirax. Taking these drugs continuously as suppressive therapy reduces risk of transmission by as much as 50-75%. Although genital herpes can seem like a Very Big Deal to a young single person, once in a committed relationship, it loses much of its significance, especially with suppressive drug therapy and care to avoid sex when active lesions are present. There are cases of people married for decades where transmission of HSV-2 does not occur. This would be the case more often when it is the woman infected, for reasons explained above. Read more about HSV and get support here.

There was a highly publicized civil case in Oregon recently in which a woman was infected with HSV-2 by a man she had met on an online dating site. The woman was awarded almost a million dollars because the man had failed to inform her of his HSV-2 infection before having sex with her. This goes to the core reason behind psychosocial effects of genital herpes or any other communicable STD: If you know you are positive for an STD, you are morally and otherwise obligated to inform any potential partner before having sex. This applies regardless of whether or not you  are on suppressive drug therapy or you intend to use a condom.

Now on to chlamydia, the most common bacterial cause of STDs. The good news is that since chlamydia is caused by a bacteria, it is curable with antibiotic therapy. It is another “silent” STD since those infected, especially women, are often unaware they have it. Left untreated, chlamydia can cause “PID,” or Pelvic Inflammatory Disease, which can lead to irreversible damage to the female reproductive tract and infertility. All sexually active women should be tested for chlamydia at least annually; if infected, all sexual partners must be treated as well, and they should abstain from sex for at least seven days afer treatment is initiated.  If the woman’s partner is not treated or is treated inadequately, she can easily be reinfected. The more infections a woman has, the greater the potential damage to her reproductive tract. It is also believed that chlamydia infections facilitate infection with HIV, the AIDs virus.

Now for a story about PID and inguinal nodes. While in pharmacy school, I went on Spring Break with a big group of college kids. We’d been at the beach for a few days when one of my friends, a very cute, petite girl next door type, asked me to come with her into the bathroom. Once there, she told me that she had not been feeling well, had no appetite, and she showed me “these knots rights here.” She told me that she had had sex when she “probably wasn’t quite ready” and that she thought she “had some little cuts down there.” Any time sex results in small tears in the vagina, the possibility of infection with STDs is enhanced. Non-sexually transmitted bacterial infections are also more likely to occur. As it happened, I had just finished a pathology course, and recognized the knots as swollen inguinal nodes. I knew just enough to tell my friend that this was serious, and that we needed to get her medical attention. I  found a physician who very kindly offered to meet us at his office on that Saturday. Since no nurse was available I held my friend’s hand during what turned out to be a very painful examination. The doctor told us that he was very glad we had called him, because my friend had a severe case of PID. He told us to leave his office immediately and meet him at the hospital in a nearby city. My friend was admitted to the hospital and placed on IV antibiotic therapy. She was in the hospital for almost a week, and her parents flew in to be with her. The doctor later told me that if we had waited even a few hours longer, my friend might have gone into septic shock, and could have died. I never asked what the pathogen was. So, young ladies and gentlemen, have a healthy respect for enlarged inguinal nodes. If present, especially with other symptoms like low grade fever, malaise, and loss of appetite, seek medical attention.

Next Week- Part 3: Gonorrhea, Syphyllis, and (Yikes!) Crabs

The Elephant in the Dorm Room Part 1: Sexually Transmitted Disease

My goal in writing this series of articles is not to engage in a long boring lecture about the immoral nature of premarital sex. Rather, it is to arm you with information about STDs, not just in the form of medical information and statistics, but to provide you with hypotheticals illustrating how STDs can affect your life long term. Your chances of contracting an STD in college are about one in four. You’re probably telling yourself “Doesn’t happen in my crowd.” Yes, STDs do happen in “your crowd.” All the time. More than half the participants in a study done among college students believe they can tell if someone has an STD just by looking at them. That statistic goes a long way in understanding the sociological contributors to the STD epidemic. You have the same chances of contracting an STD at your local junior college as you do at Harvard or Stanford, regardless of the crowd you hang out with there. Presidents of the “best” sororities and fraternities get infected, too. Very few of your peers are going to tell you they have an STD because 80% don’t know they are infected, or if they do know they are embarrassed about it. It’s a hush-hush thing, which serves as yet another factor that misleads college students about the epidemic nature of STDs on college campuses.

10 Truly Shocking Stats on STDs and College Students

There is a reason we have 7 billion Humans on Earth. The instinct to reproduce, to have sex, is among the most powerful instincts in our species. Hormones that drive this, primarily testosterone levels in both males and females, peak around college age and start falling off around age 30. STD pathogens evolved to take advantage of this human instinct that oftentimes overrides logical cautious thinking, and they have been very successful in doing so. STD bugs don’t care who you are, what your SAT score is, what socioeconomic group you come from, or what country you inhabit. Their only job is to survive and to reproduce, and they are Equal Opportunity Infecters. The combination of alcohol (especially binge drinking) or other drugs with this overwhelmingly powerful reproductive instinct yields a synergistic, one plus one equals three advantage for transmission of STDs. The combination of hormones and intoxicants causes logical, cautious thinking to fly out the window, greatly decreasing your ability to protect yourself by using condoms, or by abstaining altogether. People who are intoxicated often have sex with people they never would have otherwise, and they are far, far more likely, directly proportional to degree of intoxication, not to protect themselves by using condoms. If epidemiologists were asked to design the top two perfect environments for STD proliferation, it would be an MTV Spring Break Party or Saturday night on a large college campus located in a major metropolitan area.

Party nights on college campuses are an STD microbe’s playground. When college kids party, STD bugs party. Remember that. We’ve all heard “Friends Don’t Let Friends Drive Drunk.” Considering the health threats, “Friends Don’t Let Friends Have Drunk Sex,” either. It’s not a bad idea to assign a second task to your Designated Driver, or assign a second person the role of Designated Drunk Sex/STD Preventer when you  go to a party together. Seriously. This person needs to be a little assertive to qualify for the job, since he/she is going to grab your arm as you are leaving the party with someone, your judgment obviously impaired. The idea is to give you one chance to seriously rethink what you’re doing, not to fight with you about it or create a scene.

The most important point to be made is that sexual contact with another human being is not to be taken lightly, especially where viral STDs are concerned. Once these viruses move in to your body, they do not move out. When you have sex with someone, you are for all practical purposes as far as STD viruses are concerned, having sex with all of your partner’s partners. Millennials are known for their more fluid approach to sexuality. More of you experiment with same sex relationships. More of you describe yourselves as bisexual than previous generations. Again, no moral judgments here, but this characteristic does increase risk of STDs.

Let’s start with the most common STD: Human Papilloma Virus, or HPV. You’ve heard of genital warts. Some of you have probably seen the gross pictures of genital warts which are caused by several strains of this virus. Warts are not the biggest problem caused by HPV, however.  Other strains of HPV are known in the medical community as THE cause of cervical cancer in women. Some young women are fortunate enough to have been vaccinated for some strains of HPV, but this does not eliminate their risk of cervical cancer. Young women who have had sex have very likely contracted some strains of HPV, but could still benefit from the vaccine.  Those who are vaccinated will still have to be monitored, since new strains of HPV are always evolving, and the vaccines protect against only about 70% of the strains that cause cervical cancer.  Just as we can’t cure the common cold because the numerous viruses that cause colds are constantly changing, neither can we cure HPV.  Most men and many women become infected without their knowledge, and therefore unwittingly pass the virus on to others. There is no test for HPV in men unless they have an active lesion that can be tested. If a young man infects a young woman with HPV, she is not going to call him years later to inform him she has just been diagnosed with carcinoma in situ and has had a procedure that could jeopardize her ability to have children, and will require continuous monitoring for cancer for the rest of her life. The guy will never know about the problems his refusal to use a condom has caused in the lives of his female sex partners, unless of course he marries one of them. Many women don’t discover their HPV infection until years or even decades after being infected, when they are diagnosed through a Pap smear.

As a general rule, STDs have more health and reproductive consequences in women than in men. Young women tend to be less assertive than their older counterparts. Eighteen year old Jane College is far less likely to insist on a condom to protect herself from STDs, especially if her new boyfriend, 20 year old Joe College, who oftentimes does not know he is carrying STDs, insists on not using a condom because “it feels better.” Sixty per cent of college women say they would still have sex if their partner refused to wear a condom. Women are not quite this “door- matty” as they get older and wiser, but unfortunately STDs score big proliferation advantages from this characteristic of younger women. In a perfect world, both Jane and Joe College would always use condoms because they are aware that this sexual interlude could later cause Jane College to become infertile and/or to get cervical cancer. Since the intent here is not to scare you into abstinence, regular Pap smears protect women from cervical cancer with very few exceptions. It is far better however, to avoid infection in the first place.

Armed with this knowledge, you should insist on safe sex or no sex at all. Sexually active college students should assume they are infected with HPV if they have ever had even one incident of unprotected sex. The more sex partners you have, the more strains of HPV you are likely to have.

Here is a must read article on HPV

HPV is also strongly associated with increased anal cancers and increasingly, throat and mouth “oropharangeal” cancers from oral sex with an infected partner.

Since HPV is spread by mere skin to skin contact, it is the most common STD. Human Papilloma Virus spreads exponentially on college campuses because of its ability to evolve quickly, the difficulty those infected often have in recognizing infections, and the tendency of those who do know they are infected to keep it secret. Choose your partners carefully, watch the drinking, and above all, practice safe sex.

Next Week Part 2: Herpes, Chlamydia, and a bit about PID.