STD Awareness: The Surprising Sexual Transmission of Non-STDs

What is a sexually transmitted disease, or STD? If someone catches their partner’s cold during sex, is that cold an STD? According to the Office on Women’s Health, an STD is “an infection passed from one person to another person through sexual contact.” Unless the cold was passed through sexual contact, rather than mouth-to-mouth contact, it would not be considered an STD. Others say that, for an infection to be considered an STD, its sexual transmission must make it significantly more common in the population. So, a disease like the common cold would probably be just as common even if people never had sex.


MRSA, meningitis, and the virus that causes pinkeye can be transmitted sexually.


However, there are some infections, such as hepatitis C or bacterial vaginosis, whose status as official STDs is controversial. While researchers argue with one another over where to draw the line between an STD and a non-STD, let’s take a look at some bacteria and viruses that can be transmitted sexually, even though they’re not officially categorized as “STDs.”

MRSA: Methicillin-Resistant Staphylococcus aureus

MRSA bursting out of a dead blood cell. Image: Frank DeLeo, NIAID

MRSA bursting out of a dead blood cell. Image: Frank DeLeo, NIAID

You’ve probably heard of MRSA, which is pronounced “mersa” and stands for methicillin-resistant Staphylococcus aureus — a strain of bacteria that is resistant to every antibiotic in the penicillin family, as well as others. S. aureus, or “staph” for short, is the same bacteria responsible for TSS, or toxic shock syndrome, which has most infamously been associated with the use of highly absorbent tampons. But mostly, staph is a common cause of skin infections, which could be deadly in the pre-antibiotic era, but these days usually don’t raise too many eyebrows.

Unfortunately, with the emergence of MRSA, which is difficult to treat with the usual drugs, we might once again have to worry about minor skin infections blossoming into life-threatening conditions. Additionally, MRSA has found a way to hop from person to person via sexual contact, and sexually transmitted MRSA has been documented in both heterosexual and MSM (men who have sex with men) populations. Untreated, it can lead to a form of gangrene in which tissue blackens as it dies. Continue reading

STD Awareness: Sexual Transmission of Zika Virus

Zika

Zika virus. Image: Cynthia Goldsmith, CDC

I first heard of Zika virus in an epidemiology class, when another student made on offhand remark: “Did you know Zika virus can be transmitted sexually?” Ever vigilant for material for the STD Awareness column, I excitedly scribbled the name of the virus in my notes. But upon further investigation, I found that there were only a couple of documented cases of the sexual transmission of this virus that no one had heard of, and decided there was no reason to freak people out about yet another potential STD when rates of more common STDs, like chlamydia and gonorrhea, were on the upswing.

A year later, Zika virus was splashed across headlines on a daily basis, mostly for its newfound association with birth defects, but also in light of revelations that it could be transmitted by sex.


Access to condoms and reliable contraception is more vital than ever.


While Zika virus is usually transmitted by mosquito bites, the discovery that it can be sexually transmitted made it the only known virus that could be spread both sexually and by mosquitoes. It’s also the only known mosquito-borne virus that can cross the placenta to harm a fetus. Like several other viruses, including CMV and rubella, Zika is implicated in serious birth defects. But many health authorities worry that its potential as a sexually transmitted pathogen is dangerously underestimated. As of August 31, there have been 23 confirmed sexually transmitted cases of Zika virus in the United States — but sexual transmission will rise as the virus jumps into local mosquitoes, which will also make it difficult or impossible to tell if a sexually active Zika patient got the virus from sex or directly from a mosquito.

Earlier this year, sexually transmitted Zika virus in Texas made headlines, with many journalists incorrectly proclaiming it the first known case of sexual transmission. In fact, Zika’s sexual transmission was first documented in 2008, before “Zika” was a household name and the married couple who published their experience in a scientific paper thought they could share their STD status in relative obscurity. Despite referring to themselves as “Patient 1” and “Patient 3,” a science reporter quickly figured it out and (with their permission) revealed their identities in a 2011 article — still years before Zika-bearing mosquitoes would hit the Americas and trigger a microcephaly epidemic that propelled the virus to infamy. Continue reading

Hepatitis B Vaccine: The Importance of the Birth Dose

babiesDid you know that Saturday kicked off National Infant Immunization Week, which is part of a worldwide observance that shines the spotlight on the importance of vaccination? Most of us think of infant immunization as a tool to protect babies from childhood illnesses like chickenpox and whooping cough. But did you know that one infant immunization protects them from cancer later in life?

Globally, hepatitis B virus (HBV) is one of the top causes of cancer. Every year, it kills more than three-quarters of a million people worldwide. An HBV infection might be defeated by the immune system, but when it’s not, it can become a chronic infection. And chronic infections can lead to serious health outcomes, including cirrhosis and liver cancer. The younger you are, the less likely you’ll be able to fight off an HBV infection — 90 percent of infants infected with HBV will develop chronic infections, and 25 percent of them will go on to die prematurely after developing liver disease. Compare that to 2 to 6 percent of infected adults who will develop chronic infections.


Because infants are so vulnerable to developing chronic infections, vaccinating them against hepatitis B at birth makes sense.


Most people think of hepatitis as a bloodborne disease, and it is spread very efficiently when IV drug users share needles, during needle-stick accidents and other occupational injuries, or by using contaminated piercing needles, tattoo equipment, or acupuncture needles. Even sharing items like razors, toothbrushes, and nail clippers can do it, as the virus can survive outside of the human body for a week. HBV can also be spread by sexual contact, including vaginal and anal sex.

Lastly, babies and children can be at risk as the virus can be transmitted from mother to infant during birth, and during early childhood when risk of chronic infection is high. A significant number of people with chronic infections acquired them during early childhood, but we don’t know exactly how they got them, as their parents and other household contacts were negative for the virus or its antibodies. Since infants and children are at the highest risk for developing chronic infections, focusing on that population for prevention is very important.

Luckily, there’s a vaccine. Continue reading

STD Awareness: Is Bacterial Vaginosis a Sexually Transmitted Disease?

Not to scale: Gardnerella vaginalis under a microscope. Image: K.K. Jefferson/Virginia Commonwealth University

Gardnerella vaginalis under a microscope. Image: K.K. Jefferson/Virginia Commonwealth University

Bacterial vaginosis, or BV, is the most common vaginal infection among people 15 to 44 years of age. It’s caused by an overgrowth of harmful bacteria, such as Gardnerella vaginalis. A healthy vagina hosts thriving populations of Lactobacillus bacteria species, but when these “good” bacteria are crowded out by certain types of “bad” bacteria, the vaginal ecosystem can be shifted, causing BV.

There is a lot of confusion about BV. Is it a sexually transmitted disease (STD)? What are the symptoms? How can you avoid it?

All good questions. Let’s examine them one by one.

Is BV an STD?

The consensus seems to be that BV isn’t officially an STD, but even reliable sources have somewhat contradictory information. Planned Parenthood doesn’t list BV as an STD on their informational webpages. The Centers for Disease Control and Prevention (CDC) does include BV on their STD website, but also says that “BV is not considered an STD.”

On the other hand, the Office on Women’s Health says that “BV can … be caused by vaginal, oral, or anal sex” and that “you can get BV from male or female partners.” And there’s an entire chapter devoted to BV in the premier medical textbook on STDs, and its authors say that, while sexually inexperienced females can get BV, “the weight of evidence supports sexual transmission” of G. vaginalis, the bacteria species most famously implicated in BV infections.

The same webpage on which the CDC declared BV not to be an STD also says that it can be transferred between female sexual partners. Indeed, women who have sex with women have higher rates of BV. Since vaginal fluid could spread BV, partners can change condoms when a sex toy is passed from one to another, and use barriers like dental dams when engaging in cunnilingus (oral contact with the female genitalia) or rimming (oral contact with the anus).

What about heterosexual transmission? Continue reading

STD Awareness: Can Oral Sex Cause Throat Cancer?

mouthLast month, actor Michael Douglas gave a frank interview in which he revealed that human papillomavirus (HPV) caused his throat cancer. And, he continued, he got the virus from performing oral sex — specifically, cunnilingus (oral contact with female genitalia). It’s unusual for celebrities to be open about their STD status — and Douglas’ spokesperson has since backpedaled on his comment — so Douglas is to be commended for bringing light to a taboo and little-understood topic. But there were a few things he got wrong, too.


No matter your gender or sexual orientation, performing unprotected oral sex can increase cancer risk.


HPV is a common virus that can be spread by most sexual activities — including vaginal, anal, and oral sex, as well as rubbing genitals together. There are many strains of HPV, which come in two main categories: low-risk HPV, which can cause genital warts; and high-risk HPV, which can cause cancers of the cervix, anus, vagina, vulva, penis, mouth, and throat. The majority of HPV-related cancers are caused by two strains of HPV: HPV-16 and HPV-18.

The good news is that there is a vaccine that can protect you from infection by HPV-16 and HPV-18. Furthermore, most people clear an HPV infection within two years. HPV-related throat cancer is rare, affecting just 2.6 out of 100,000 people.

Can oral sex really lead to throat cancer?

Unfortunately, it is absolutely true that oral sex can transmit HPV, and a chronic infection can cause cancer. Oral sex is indeed sex. It’s not “third base,” it’s not “almost sex,” it’s plain old, straight-up sex, carrying with it the potential for both pleasure and disease transmission. Unfortunately, because so many of us have a lax attitude toward it, fewer people take precautions when engaging in oral sex, and are less likely to use condoms or dental dams. Combined with low vaccination rates for HPV in the United States, the virus is even easier to acquire than it needs to be. Continue reading

STD Awareness: 10 Myths About Sexually Transmitted Diseases

The Internet is brimming with contradictory claims about sexual health, and you don’t know what to believe. Your friends give you advice, but you’re not sure if it sounds right. To make things worse, you might not have had evidence-based, medically accurate sex education in your school. In this edition of our STD Awareness series, we’ll take on a few myths about sexually transmitted diseases to help you sort fact from fiction.

1 MYTH: You can tell if someone has an STD by looking at them.
You might expect that if someone has an STD, their genitals would have blisters, warts, or noticeable discharge. But your partner looks fine, so you might think there’s no need to ask when his or her last STD test was.

However, while many people with STDs do have visible symptoms, they’re the exception rather than the rule. For example, three out of four women and half of men with chlamydia have no symptoms. Herpes is often spread when there are no symptoms present. Someone can be infected with HIV — and capable of transmitting it to others — and go years without showing any signs. A quick visual inspection can’t tell you very much about someone’s STD status.

2 MYTH: You can’t get an STD from oral sex.
While it is generally true that oral sex presents less of a risk for contracting STDs, this risk is not trivial. Most STDs can be passed along by oral sex, including chlamydia, gonorrhea, syphilis, hepatitis B, herpes, human papillomavirus (HPV), and HIV. You can reduce your risk by using barrier methods like condoms and dental dams consistently and correctly.

3 MYTH: Condoms can’t prevent the spread of HIV.
Many proponents of abstinence-only education state that condoms don’t protect against HIV, claiming that latex condoms have holes that are large enough for viruses to pass through. This claim isn’t backed by evidence. An intact latex condom dramatically reduces your risk of being exposed to sexually transmitted viruses such as HIV. (It is true that a lambskin condom does not provide adequate protection against HIV.) Continue reading

Over 90 Percent of What Planned Parenthood Does, Part 11: Diagnosing and Treating Epididymitis

Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl doesn’t know about.

Planned Parenthood Arizona treats epididymitis.This statement might raise a few questions:

Q: What’s epididymitis?
A: Epididymitis is the inflammation, or swelling, of the epididymis, resulting in pain in the scrotum.
Q: That’s great, but what the heck is an epididymis?
A: The epididymis is a tube that is connected to the testicle, and is where sperm are stored before ejaculation. The epididymis is 12 to 15 feet long, but is coiled tightly enough to fit inside the scrotum alongside the testes!


Chlamydia causes 70 percent of epididymitis cases in young heterosexuals. This STD is easily treated but frequently asymptomatic — and prevented by condoms.


So, basically, epididymitis is a condition that can strike anyone whose reproductive anatomy features an epididymis. It is generally caused by a bacterial infection — which may be sexually transmitted, such as gonorrhea and chlamydia, or may not be sexually transmitted, such as tuberculosis. Very rarely, epididymitis can be caused by other pathogens, such as viruses, fungi, or parasites. Inflammation of the epididymis can also be caused by the heart medication amiodarone (also known as Pacerone).

Epididymitis most commonly affects males between the ages of 14 and 35. Risk factors, regardless of age, include being uncircumcised, a history of prostate or urinary tract infections, having had surgery in the urinary tract, having a history of a neurogenic bladder, an enlarged prostate, regularly using a catheter, and not using condoms during vaginal or anal intercourse.

The symptoms of epididymitis usually develop over one or two days and can include: Continue reading