STD Awareness: Is There a Vaccine for Syphilis?

Before antibiotics, syphilis was the most feared sexually transmitted disease (STD) out there. It was easy to get, quack cures were ineffective and often unpleasant, and it could lead to blindness, disfigurement, dementia, and even death. Syphilis rates were highest during World War II, and plummeted when penicillin became widely available later in the 1940s. By 2000, syphilis rates hit an all-time low, and many scientists thought the United States was at the dawn of the complete elimination of syphilis.

What a difference an antibiotic makes. Image: CDC

Unfortunately, it soon became apparent that syphilis wasn’t ready to go out without a fight. Since 2000, syphilis rates have nearly quadrupled, climbing from 2.1 to 7.5 per 100,000 people by 2015 — the highest they have been since 1994. If you look at the above graph, you might think syphilis rates have been pretty stable over the past 20 years — but if you zoom in, the fact that we’re in the midst of an epidemic becomes more clear.

After hitting an all-time low in 2000, syphilis rates have been increasing nearly every year since.

The epidemic is disproportionately affecting men who have sex with men (MSM), with Arizona seeing a higher-than-average syphilis rate in this group. Additionally, syphilis rates are climbing among women, who have seen a 27 percent bump between 2014 and 2015. And, since women can carry both syphilis and pregnancies, a rise in syphilis in this population also means a rise congenital syphilis (the transmission of syphilis from mother to fetus), which causes miscarriages, stillbirths, preterm births, neonatal death, and birth defects. Ocular syphilis — that is, syphilis infections that spread to the eyes and can lead to blindness — is also on the rise.

Men, women, babies — no one is immune to the grasp of syphilis. Continue reading

STD Awareness: Shaving, Waxing, and Trimming, Oh My!

Last month, the connection between body-hair removal and sexually transmitted diseases (STDs) once again gave rise to a flurry of headlines. Media had previously reported on “studies” purporting that the popularity of waxing is leading to the extinction of pubic lice, or that shaving increases risk for a little-known STD called molluscum contagiosum.

The idea that waxing one’s nether regions is tantamount to habitat destruction for the lowly pubic louse makes a certain amount of sense. But was it really true that waxing was leading to diminished pubic-lice populations, or just a case of the media blowing an obscure medical factoid out of proportion? Ditto with the claims about molluscum contagiosum — though they were based on perfectly plausible premises, having to do with shaving causing microscopic skin injuries that create openings for infectious viruses, the average reader might not have been able to rely on a journalist’s ability to translate a scientific article from “medical-ese” into an easy-to-understand, yet fully nuanced, magazine blurb.


The case isn’t closed on the link between body-hair removal and STDs.


As we’ve written before, the reporting in the popular media left out important details — such as the fact that these weren’t studies at all, but rather educated guesses based on observations, published as letters to the editor. No one was comparing pubic lice infestations or sexually transmitted infections between groups of people with and without pubic hair.

Until now.

The medical journal Sexually Transmitted Infections recently published a study based on a survey of 7,470 American adults who had had at least one sexual partner. The salient point the media pounced on was that removing pubic hair increases STD risk by 400 percent: NPR screamed that “Going Bare Down There May Boost The Risk Of STDs,” Time proclaimed “Grooming is linked to a higher risk of STIs,” and The Guardian spooked readers with a rather tasteless piece about “the health dangers of bikini waxing.” Even Saturday Night Live’s Weekend Update got in on the action, albeit with a crude joke about old men’s genitals.

But let’s leave headlines behind and delve right into the medical journal itself. Continue reading

STD Awareness: What Does “Congenital Syphilis” Mean?

Treponema pallidum, the bacteria that causes syphilis

Treponema pallidum, the bacteria that causes syphilis

Congenital syphilis, for centuries a leading cause of infant mortality, is often thought of as an antique affliction, relegated to history books — but it is on the rise again. Between 2012 and 2014, there was a spike in congenital syphilis rates, which increased by 38 percent and are now the highest they’ve been in the United States since 2001. As of 2014, the last year for which we have data, more babies were born with syphilis than with HIV.

The word “congenital” simply means that the baby was born with syphilis after being infected in the womb. When an expecting mother has syphilis, the bacteria that cause the disease can cross the placenta to infect the fetus — and will do so 70 percent of the time. As many as 40 percent of babies infected with syphilis during pregnancy will be stillborn or will die soon after birth. It can also cause rashes, bone deformities, severe anemia, jaundice, blindness, and deafness. Congenital syphilis is especially tragic because it’s almost completely preventable, especially when expecting mothers have access to adequate prenatal care and antibiotics. Penicillin is 98 percent effective in preventing congenital syphilis when it is administered at the appropriate time and at the correct dosage.


More babies are being born with syphilis — but this trend can be reversed with wider access to prenatal care.


Incidence of congenital syphilis is growing across all regions of the country, but rates are highest in the South, followed by the West. Rates have also been increasing across ethnic groups, but, compared to white mothers, congenital syphilis rates are more than 10 times higher among African-American mothers and more than 3 times higher among Latina mothers, illustrating the need to increase access to prenatal care for all expecting mothers — and to ensure that this prenatal care is adequate.

Anyone receiving prenatal care should be screened for syphilis at their first visit, and some pregnant people — including those at increased risk or in areas where congenital syphilis rates are high — should be screened a second time at the beginning of the third trimester and again at delivery. Continue reading

STD Awareness: Which STDs Are Resistant to Antibiotics?

pillsYou’ve probably heard of MRSA, which is pronounced “mersa” and stands for methicillin-resistant Staphylococcus aureus — a strain of bacteria that is resistant to methicillin, as well as pretty much every other antibiotic out there. MRSA is an example of evolution by natural selection — what didn’t kill its ancestors made them stronger, spawning a drug-resistant strain.


There are drug-resistant strains of gonorrhea, trichomoniasis, and syphilis.


Evolution is the force behind life’s diversity. Normally, diversity is a good thing — but when it comes to microbes that cause diseases like gonorrhea, trichomoniasis, and syphilis, these organisms’ ability to evolve new defenses against our antimicrobial drugs isn’t good for us.

STDs have plagued us for millennia, but it wasn’t until the 20th century that we finally developed antibiotics, which gave us a powerful tool against many of our most formidable sexually transmitted foes. Suddenly, scourges like gonorrhea and syphilis could be quickly and easily treated with a dose of penicillin.

Problem solved, right? Nope. Enter evolution by natural selection. Continue reading

STD Awareness: Will STDs Go Away on Their Own?

teensCan gonorrhea go away without treatment? Does chlamydia eventually clear up? Can trichomoniasis go away on its own? These are the kinds of questions people pose to Google before Google sends them here — at least that’s what I learned by looking at the blog’s stats. They’re tricky questions to tackle, and for so many reasons.

Some viral STDs stay with you for life, such as herpes and HIV. Others, such as hepatitis B and human papillomavirus (HPV), can be prevented with vaccines but cannot be cured. It’s also possible for the immune system to defeat hepatitis B virus and HPV — but in some cases, these viruses are able to settle in for the long haul, causing chronic infections that can endure for life and even lead to cancer.


Left untreated, syphilis can kill, and gonorrhea can cause infertility.


Non-viral STDs, like chlamydia and gonorrhea, can be cured. However, they usually don’t have symptoms, or symptoms can come and go, making it seem like an infection went away when it actually didn’t. You can’t know your STD status without getting tested, and you can’t self-diagnose an STD based on symptoms and then assume the infection went away when symptoms subside. Getting tested can uncover a problem and clear the way for treatment.

Nonetheless, people want to know if an STD can go away by itself — but there aren’t many studies on the “natural history” of curable STDs like gonorrhea, chlamydia, and trichomoniasis. Studying the natural course of a curable infection would require that scientists put their subjects at risk of the dangers of long-term infection, and no ethics board would approve such an experiment. Continue reading

STD Awareness: Are Condoms Really Necessary?

condoms in packetsCondoms are one of the best ways for sexually active people to avoid sexually transmitted diseases (STDs), but many worry that people are becoming more lax about protecting themselves. There are all kinds of myths swirling around about condoms — such as that they aren’t effective or that they kill the mood. And, thanks to anti-HIV medications, some people no longer see condom use as a matter of life or death.

The Centers for Disease Control and Prevention (CDC) recently announced that 2014 saw record highs in chlamydia, syphilis, and gonorrhea, which is a stark reminder that condoms protect against more than just HIV. So, even if you’re using medications to protect yourself from HIV, remember that syphilis is making a comeback, and can cause serious damage or even death when untreated, and that gonorrhea is rapidly evolving resistance to the last good drugs we have to treat it. Condoms are just as relevant as ever!

HIV

In 2014, the CDC announced it would start using the term “condomless sex” instead of “unprotected sex” to recognize that people could engage in condom-free sex, but still protect themselves from HIV by using Truvada, or pre-exposure prophylaxis (PrEP). Truvada is the first drug approved by the FDA to prevent HIV, and it can be taken by HIV-negative individuals to help their body ward off the virus before an infection can establish itself. The pill must be taken daily — using it inconsistently reduces its effectiveness. Continue reading

STD Awareness: Can I Use Plastic Wrap as a Dental Dam During Oral Sex?

plastic wrapIf you read this blog — or any sexual health website, really — you’ll probably see dental dams getting a lot of props. A dental dam (not to be confused with a female condom) is a square piece of latex that can cover the vaginal opening or the anus. Anyone wishing to avoid the oral transmission of STDs like herpes, gonorrhea, HPV, syphilis, chlamydia, and intestinal parasites, dental-dam advocates say, should use a latex barrier. Most people, however, have probably never even seen a dental dam, and they are not widely used. Perhaps their unpopularity is related to myths about oral sex being safe sex (it’s not!); perhaps it’s due to dental dams being expensive or difficult to find.


Plastic wrap hasn’t been evaluated by the FDA for STD prevention, and no studies have assessed its effectiveness in reducing disease risk during oral sex.


Some safer-sex aficionados have found ways around that, though. They might cut the tips off of condoms and make incisions along the sides, creating little latex rectangles. An even easier and cheaper option lies in plastic wrap, which many people use as a barrier while performing cunnilingus (oral contact with the female genitalia) or rimming (oral contact with the anus). It is inexpensive, easy to find, odorless, and tasteless, and can be purchased without even a hint of embarrassment (unless perhaps your other purchases include duct tape, cucumbers, and clothes pins). And it can be pulled off the roll in sheets as long as your heart desires!

Planned Parenthood endorses the use of plastic wrap for oral sex when dental dams aren’t available. The Centers for Disease Control and Prevention and AIDS.gov both recommend plastic wrap for use during rimming. Health authorities, such as AIDS.gov and the Idaho Department of Health & Welfare, recommend non-microwavable Saran Wrap, because microwave-safe Saran Wrap has tiny pores to let out steam — which might also let viruses and bacteria through. Continue reading