MST/STI or the joys of sex

Today, we are going to talk about STDs (Sexually Transmitted Diseases), recently renamed STIs (Sexually Transmitted Infections) to help you see more clearly about the different STDs/STIs and above all to protect yourself as well as possible against these infections which unfortunately pass , most often unnoticed.

What is an STD/STI?

Sexually transmitted infections or STIs are infections caused by bacteria, viruses and parasites and transmitted sexually. In France, they are unfortunately constantly increasing except for HIV, which has stabilized since 2007.

STIs are mainly transmitted by oral-genital, vaginal or anal contact. Many STIs, including chlamydia, gonorrhea, hepatitis B, HIV and syphilis, are also transmitted from mother to child during pregnancy and childbirth. It is recommended to do a complete and preventive screening about every 3 months when you have several sexual partners and every year when you are a single partner.

Why did we switch from STDs to STIs?

Since Covid, screening has generally decreased , but late screening leads to late diagnosis and therefore a larger number of potentially infected people.

There has also been an increasing spread of STIs since the 2000s among those under 30, including Chlamydia infections and gonorrhea, which is partly explained by a decrease in condom use.

We have therefore changed the term to encourage screening (infections vs. diseases) because a large proportion of STIs do not cause symptoms.

How to protect yourself from STIs/STDs?

The prevention of sexually transmitted infections is essential and mainly involves:

• the use of the condom during all the reports (vaginal, oral, anal) is the surest prevention today. Although this does not provide 100% protection against the papillomavirus, herpes and syphilis which can be transmitted simply in case of contact.

• vaccination for hepatitis B virus (HBV) and papillomavirus (HPV)

• in the case of HIV, PrEP (pre-exposure prophylaxis) is now offered to HIV-negative people which, when taken before and after unprotected sexual intercourse, helps prevent infection.

What are the most common STIs?

Two broad categories of STIs can be distinguished:

- bacterial or parasitic diseases that can be cured

- viral diseases, which cannot be cured but whose symptoms and progression can be limited.

A. Curable bacterial or parasitic diseases

Syphilis

Very contagious , it mainly affects men who have sex with men. Syphilis is manifested by the appearance of ulcerations , called chancres, on the genitals: they are characterized by small painless plaques or pimples on the skin and mucous membranes. Untreated, it can lead to serious and permanent problems (brain damage, blindness or paralysis). Many people with syphilis do not have symptoms and do not know they are infected. The use of a condom does not provide 100% protection because some chancres may not be covered by the condom.

Screening by blood sample.

Treatment: antibiotics.

Gonorrhea or more commonly hot piss

Due to a bacterium, gonococcus, it mainly affects men under 30, but some women can be affected. For men, there are most often tingling or burning while urinating, or yellow discharge from the penis or rectum. Women who are affected may experience pain when urinating, during intercourse or have yellowish/bloody vaginal discharge and stomach pain, sometimes angina can also be part of the symptoms. Untreated, the disease can cause inflammation of the uterus and infertility. A pregnant woman can also transmit the infection to her child.

Screening by vaginal swab (rather than urinary) in women, urine or penis swab in men and anal and/or throat swab if anal/oral sex in women and men.

Treatment: antibiotics.

Chlamydia infections

Caused by the bacterium Chlamydiae trachomatis: they represent the most common STIs in women, especially in young women. Pain when urinating (urination) is one of the symptoms, but the disease is most often asymptomatic. We can sometimes observe pain in the lower abdomen, burning sensations or abnormal discharge from the genitals. The major risk concerns the fertility of affected women and the increased chance of having an ectopic pregnancy.

Screening by vaginal swab (rather than urinary) in women, urine or penis swab in men and anal and/or throat swab if anal/oral sex in women and men.

Treatment: antibiotics.

Trichomoniasis

It is manifested in some women by an increase in vaginal secretions, which can smell bad and be yellowish/greenish in color and pain during urination. Often, men have no symptoms; some have a burning sensation when urinating or after sex. Trichomoniasis can increase the risk of contracting or transmitting other STIs such as HIV, and pregnant women with the disease are at risk of having premature and low birth weight babies.

Screening by vaginal swab in women and urine or urethral swab in men. Treatment: antibiotics.

B. Viral diseases, difficult or impossible to cure, depending on the type of virus

Hepatitis B (HBV)

Caused by a highly contagious virus (HBV), hepatitis B primarily affects the liver. Hepatitis B symptoms are not always present and the disease may go unnoticed. It can be characterized by the onset of fever, muscle aches, nausea, diarrhea, dark urine and yellowish complexion. Its diagnosis is based on blood serology.

Screening by blood sample. Can be cured without treatment, but you can also be a carrier for life. Vaccination prevention.

Genital herpes

Genital herpes can also go completely unnoticed. Some people may have been in contact with the virus and never develop symptoms of herpes. They are likely to transmit the virus to a partner because the virus is present on their mucous membranes intermittently without any symptoms. The main symptoms if there are any: Vesicles (kind of painful bells) that appear on the sexual organs and/or the anus and pain when urinating. These small pimples can be accompanied by headaches, stomach pains and urinary pain. A pregnant woman with genital herpes or carrier of the virus must be particularly monitored because the virus can be transmitted to the child and have serious consequences.

Screening by inspection of the lesions by your doctor with local sampling to confirm the diagnosis, if necessary. Drug treatment can reduce symptoms and pain but the virus is never eliminated.

The human papillomavirus (HPV)

80% of women and probably as many men have an HPV infection at some point in their lives. It is very easily transmitted (with or without penetration) and is the most common viral STI. After contamination during sexual intercourse, the person most often has no symptoms. In the majority of cases the infection heals in a few weeks or months. But, in 10% of cases, the HPV viruses can persist and they will then modify the development and growth of cells and cause genital or anal warts (condyloma) or cancers (cervix, penis, vagina, anus and throat). Condoms do not provide perfect protection because they do not cover all of the genitals. Only vaccination of young girls and boys protects against HPV.

Vaccination from 11 to 14 years old in 2 doses and catch-up possible in 3 doses from 15 to 19 years old.

Pap smear screening.

Drug treatment that can act on warts.

HIV

The Human Immunodeficiency Virus attacks the cells of the immune system, mainly certain white blood cells, weakening the immune defences.

In which case do we speak of HIV or AIDS or seropositivity?

When a person has AIDS, he is already heavily infected with HIV. But not everyone infected with HIV develops AIDS. A person who is tested positive for HIV is said to be "seropositive", that is to say that she is a carrier of the virus without this necessarily implying that she is at the AIDS stage or even that she will get there one day. .

Although there is still no cure for HIV infection, tritherapies or multitherapies (combination of several antiretroviral drugs) today allow thousands of people living with HIV to prolong their lives in the best possible conditions.

Take the opportunity to test your knowledge of HIV and other STIs with our recap of misconceptions related to STIs.

As a gift, some received ideas about STIs:

STIs are transmitted only during unprotected penetration.
FAKE. Lesions due to STIs such as cankers/rashes (syphilis), condyloma (HPV), vesicles (herpes) are highly contaminating and skin contact is sufficient for there to be a risk of transmission.

The condom protects against all STIs.
FALSE, precisely because some infected areas (warts, chancres, vesicles) may not be covered by the condom. Contact between these infected areas and the mucous membranes of the partner may then be sufficient for there to be a risk of transmission of an STI (HPV, herpes and syphilis).

The treatment taken by an HIV-positive person can allow him to no longer transmit his HIV, even during unprotected sex.

TRUE , if this treatment has reduced the presence of HIV in the body to the point that it is no longer detected on the tests. We then speak of an undetectable viral load (virus level in the body): HIV then becomes intransmissible even during unprotected sexual relations. Thus, undetectable = untransmittable.

There is no way to cunnilingus in a protected way.
FALSE , With a square of latex it is possible because it will cover all the vaginal walls and prevent any contact between the mouth and the vulva. The square of latex can also be used to make a rimming in a protected way. You can cut a condom to make one.

After unprotected sex, I can directly take an HIV test to find out if I have been infected.
FALSE , You have to wait 6 weeks after taking the risk (unprotected sexual intercourse, sharing a syringe) to do a classic screening (blood test) and 3 months for a self-test or rapid test. These waiting times are essential to make the test result 100% reliable. During these 6 weeks, you can take post-exposure treatment and serological monitoring for 3 months.
NB one of the advantages of the self-test is that the result is obtained immediately (it is "fast") but the waiting time to make the test result 100% reliable is 3 months, i.e. say twice that for a conventional blood test.

A couple where one of the two partners is HIV positive can have children naturally.
TRUE, if it has an undetectable viral load. She can thus have sex without a condom without any risk of contamination and therefore start a family.

An HIV-negative person can take medication before sex to prevent HIV infection.
TRUE , thanks to pre-exposure prophylaxis (“PrEP”). PrEP is a drug offered to HIV-negative people which, when taken before and after sexual intercourse without a condom, helps prevent HIV infection. This treatment is composed of anti retrovirals and will prevent the virus from settling and multiplying in the body. The person then remains HIV-negative.

The blood test is the only 100% reliable test for HIV contamination.
FALSE , Whatever the method chosen, it is the fact of respecting the waiting period according to the type of screening that makes the test 100% reliable, namely:

• 6 weeks for a classic blood test
• 3 months for a self-test

Any intimate contact can lead to contamination by the papillomavirus.
TRUE . The HPV virus is transmitted through contact between mucous membranes and infected skin. Caressing infected female and male genitalia can be enough to get infected.

Only girls should be vaccinated against the papillomavirus (HPV)
FALSE . Boys are as much at risk as girls of being infected with the papillomavirus and it can also cause illness in them.

There is no point in vaccinating virgin teenagers against the papillomavirus (HPV)
FALSE . It is precisely before the first sexual contact that the HPV vaccine is most effective. It will stimulate the production of anti-HPV antibodies which will act effectively in the event of future contamination. It will neutralize the virus so that the infection cannot develop. The HPV vaccine helps prevent cancers (cervical, penis, vagina, vulva, anus and throat) and warts (genital or anal warts) caused by this STI.

Fellatio without a condom does not present a risk of transmission of an STI?
FALSE . There is a risk of transmission - greater for the person giving the fellatio than for the person receiving it - of chlamydia, herpes, gonorrhea, hepatitis B, HIV and syphilis.

We don't take any risks by sharing a sniff straw:
FALSE . Sharing a sniff straw represents a real risk of transmitting hepatitis B or C.

I can use any kind of lube with a condom
FALSE ,. Only water-based or silicone-based lubricants can be used because greasy substances (vaseline, oil) could weaken the condom and it could tear during sexual intercourse.

To conclude: the very first symptom of STIs/STDs... is not having any! So at the risk of repeating yourself (yes, but it's important!): get tested every 3 months if you change partners regularly, and at least every year if you're a single partner. And we don't forget that the condom does not protect against all STIs/STDs... all the more reason to get tested regularly.
Have fun... YES... but by protecting yourself and getting tested.

For more resources:

family-planning.org _ : the association which accompanies and educates on subjects around sexuality is full of resources (contraception, support for abortion, contraception and discrimination)

Preventionist.org : all the answers on STIs

Sida-info-service.org : the association that answers questions about AIDS and STIs.