Talking sex with your doctor isn’t always easy. Whether you are afraid she or he will judge you, you just don’t feel comfortable sharing the intimate details of your life between the sheets, or you can’t think straight with a speculum between your legs, many people get tight lipped in the doctor’s office. But that doesn’t mean you don’t have questions.
We took the embarrassment (and speculum!) factor out of the equation and asked you, the CollegeCandy readers, to submit the questions you had regarding STDs and sexual health to our new pal, OB/GYN Dr. Lissa Rankin. She shares her experience and knowledge below. There were so many questions that we had to break it into two parts, so come back later to read the rest!
1. How does someone get tested for STDs?
If you wish to be screened for STD��s, screening is simple. Readily available blood tests exist for HIV, hepatitis B and C, syphilis, and herpes. Chlamydia, gonorrhea, and trichomonas can all be tested from swabbing the vagina or cervix, as well as from a urine test, and it’s important to get tested, since the presence of these infections may make you more susceptible to contracting HIV. HPV testing can be performed at the time of a pap smear, although this test is usually only done if your pap smear is abnormal. Genital warts, pubic lice and molluscum contagiosum are usually diagnosed by a doctor’s visual inspection or, sometimes, a biopsy. Most STD tests are readily available at any OB/GYN or primary care medical office.
2. How often should I get tested?
I recommend being tested any time you change sexual partners (or any time your partner does). So if you break up with your boyfriend and he hooks up with someone else, then wants to get back together, it’s time to get tested again. If you’ve been tested once and everything was negative, it’s a good idea to get retested in 6 months, just to make sure. After that, as long as you’re with the same partner and you know for sure your partner is faithful, you’re probably safe to just get your annual pap smear.
If you’re changing partners, you need to be tested before every new partner. If you’re changing partners daily- or even weekly, you’re putting yourself at high risk, even with frequent testing. Always use condoms in this situation, but understand that even condoms can’t protect you from all the cooties that are out there. Be safe!
3. How do you broach the subject with your partner?
You DON’T wait until things are hot and heavy before you bring it up. I recommend that women initiate the discussion by getting tested themselves. When you show your partner that you care about the health of both of you by getting tested, it will motivate him to do the same. So go ahead and draw the line in the sand. Tell him you don’t feel comfortable being sexual with him until you know you’re safe. Then use condoms anyway, just to be safe. But keep in mind that some STDs like herpes and HPV can still be transmitted, even if you use condoms, since the virus can still be shed from genital skin that isn’t covered by the condom.
If you already have an STD and need to tell your partner, bring him with you to the gynecologist. Having a doctor present to alleviate concerns and answer questions is a good way to break the news. Or write a letter if that’s easier for you, and include website links that can help answer his questions.
4. What are the odds of catching an STD through oral sex with ejaculation? And does the likelihood increase if you spit (it’s already in your mouth) or swallow?
Many young people enjoy oral sex over intercourse specifically because you can’t get pregnant and you’re less likely to get sexually transmitted diseases, but that doesn’t make it risk-free. As you can imagine, this is a hard thing to study. Few couples engage only in oral sex, so it’s hard to get a clean study. It’s not like you can take two groups of people and say, “You guys have intercourse and you guys have oral sex and we’ll study the risk of STD transmission!” No, that doesn’t work. So all we have is theoretical data, really.
So what do we know? You can get STDs from oral sex with ejaculation, but it’s pretty rare. Several factors increase your risk of contracting a STD from oral sex. If you have poor oral hygiene, such as oral ulcers, gum disease, or oral thrush, this makes you more susceptible to someone’s body fluids. If you hold semen in your mouth, this also increases the risk of transmission. It’s better to spit or swallow immediately, since stomach acids inactivate most infections.
If you give a man with herpes oral sex, and he is shedding the virus from his genitals, you can get oral herpes or herpes pharyngitis, leading to ulcers in the mouth and throat. While genital herpes (HSV-2) tends to prefer infecting the genitals, there can be some crossover, so HSV-2 can still cause problems in the mouth, although this is much less common. Transmission in the absence of genital ulcers in uncommon, although not impossible. Similarly, oral infection with syphilis can cause syphilitic mouth ulcers, or chancres.
Certain strains of human papillomavirus (HPV) can cause warts in the throat, although this is extremely uncommon. Some data suggests that HPV infection of the throat may also increase the risk of throat cancer, but again, this is an uncommon outcome. Having oral sex with a man with gonorrhea can cause a gonococcal throat infection, although this is usually asymptomatic. Chlamydia has also been isolated from the throats of men and women, although it doesn’t appear to cause symptoms.
Blood-borne STD’s or those carried in body fluids, such as HIV and hepatitis B and C, have a theoretical risk of transmission from oral sex. Poor oral hygiene or blood in the semen may increase this risk. Overall, a few reports of transmission from oral sex exist, but this appears to happen very rarely.
All in all, oral sex is much safer than either vaginal intercourse or anal intercourse, and transmission of STD’s is a rare but theoretical risk. If you decide to take your chances with oral sex, the likelihood is that you’ll be just fine. But if you wish to protect yourself, your partner can wear a condom. Flavored condoms exist specifically for the enjoyment of safe oral sex.