The young woman on the other end of the phone sat in stunned silence. Carol Grim, a One Medical virtual provider, had just told her she’d been diagnosed with human papillomavirus (HPV) and chlamydia – two sexually transmitted diseases (STDs) that were nowhere on her radar.
“Those are jarring results to get, especially if you’ve never tested positive for anything before and you have no signs,” the San Francisco registered nurse says. The woman came in for a routine Pap test, but she wasn’t worried about an STD because everything seemed normal. “We just happened to catch it on her Pap, which came back abnormal,” Grim says.
She’s not alone: STDs (sometimes referred to as sexually transmitted infections or STIs) are on the rise and many people don’t know they’re at risk.
The bottom line? If you’re sexually active or planning to be, you need to pay attention.
3 STIs That Are on the Rise
According to the Centers for Disease Control and Prevention (CDC), reported cases of three common STIs — chlamydia, gonorrhea and syphilis — have increased for the first time in a decade. And they’re affecting young people, particularly women, more than anyone. Syphilis cases rose by 15.1 percent between 2013 and 2015, and gonorrhea and chlamydia cases climbed by 5.1 percent and 2.8 percent, respectively.
While both men and women are at risk, the consequences can be especially dire in young women. “Women can have an infection for months or years without ever knowing it,” Grim says. “This could put them at risk for pelvic inflammatory disease (PID) and that can lead to uterine scarring and fertility issues.”
Luckily, there are ways to lower your risk. Here are the top three ways to avoid getting an STI:
1) Wear condoms– even during oral sex.
Surprised? You’re not the only one. “When I ask patients if they use condoms during oral sex, they look at me like I have three heads!” says Sarah Vensel, a physician assistant in San Francisco. “No one ever thinks about it or really realizes they can actually contract and spread an STI that way.”
While a 2012 Salon article pointed out the difficulty in quantifying the exact risk for oral sex, it’s safe to say the risk is very real. One study from the University of Pittsburgh Medical Center found that women who received just oral sex were almost 10 times more likely to contract herpes than women who weren’t sexually active at all.
Regardless of what kind of sex you’re having, it’s a good idea to include a condom. And traditional male condoms aren’t the only option: women can also protect themselves with the female condom. “Condoms are without a doubt the best — and only — form of protection against STIs and HIV/AIDS for sexually active people,” says Logan Levkoff, a sexologist on the television show Married at First Sight.
And you’re not necessarily off the hook just because you’re in a committed relationship. Even if you believe you’re both monogamous and have been screened appropriately, cheating is an unfortunate possibility that sometimes becomes a reality. “I had a patient who was in a relationship with someone for five and a half years who still seemed to come down with an STI,” Vensel says. “On occasion, things happen.”
2) Know how often you need to be tested.
Rather than assume your provider is ordering every test in the book on an annual basis, understand exactly which tests you’re getting and how often you should be getting them. “If a person is high-risk, meaning they have multiple partners, are not being consistent with condom use, are IV drug users, or have had contact with sex workers, then they should be screened every quarter,” Grim says. “Otherwise, everyone should definitely be screened before every new relationship.”
Your screening frequency may vary depending on your age, whether you’ve had symptoms or past infections, or whether you’re in an open relationship. The most important thing is to discuss all these factors with your partner(s) and provider.
And contrary to what you may have learned from television, there is no single one-size-fits-all standard panel for STI screening; the tests you need depend on your personal risk factors. “Patients often come in asking for a ‘full screening,’ but most providers don’t do herpes testing because it’s so inaccurate,” Vensel says. “Then the patients who’ve asked for this ‘full screening’ receive all negative results and think they’re in the clear when in reality, that may not be true.”
Demanding every test under the sun isn’t the way to go either. “A lot of times a patient will say, ‘I want everything.” That really opens up the dialogue for questions and lets me explain why we wouldn’t order certain tests,” Grim says. Labs should really be based on individual lifestyle and risk factors.”
3) Communicate openly.
Having a frank, honest, and open dialogue with your partner or partners is one of your best bets for staying safe. Start the conversation outside the bedroom and include information about past sexual practices, testing and results.
“In order to achieve ideal sexual health, we are openly communicating with our partners about sexual function as well as STI status,” Levkoff says. “The only way we can do that is to be screened regularly and talk candidly to our partners.”
And communication is just as important in the doctor’s office. “We’re not mind readers!” Vensel says with a laugh. “Open communication is the most important thing.”
The first step is to find a provider you really feel comfortable with and to check any reservations at the door: he or she has most likely seen and heard it all and is committed to compassionate listening and unprejudiced care. “Don’t be ashamed or worry about any kind of judgment,” Grim says. “Consider your physical exam a great opportunity to talk about your lifestyle and plan your care.”
“With screening and condoms, there is no reason why we should be seeing rising rates of STIs,” Levkoff says. “Good education and judgment-free communication about sex, sexual pleasure, and protection are the best means of combating rising numbers.”