Sexuality - “STIs only happen to others…”

Sexually transmitted infections (STIs) don’t only happen to other people. STIs are contracted when someone has sexual contact with an infected partner. Viruses don’t differentiate between social status, age or appearance. Although most STIs are more common among men, complications are more common and serious in women.

The best way to prevent STIs is to avoid behaviours that expose you to such infections. By far the most important factor in contracting an STI is the number of sexual partners you have. The higher the number of partners you have, the higher your risk of being exposed to an STI. Same-sex intercourse among men is also a major risk factor. Always using a condom for sexual intercourse is an effective way of reducing the risk of contracting most STIs.

WHAT ARE THE MOST COMMON STIs?

Chlamydia, gonorrhoea, herpes, genital warts and AIDS are the most widespread STIs in Quebec. Other conditions include trichomoniasis, parasite infections (pubic lice and scabies), hepatitis and syphilis, which are less common but still very active.

Chlamydia and gonorrhea Chlamydia is the most widespread STI in Quebec, with over 2,500 new cases each year. The main reason this infection is so prevalent is that it has no noticeable symptoms, or they are so discrete that infected individuals are unaware of its existence, thereby favouring its spread. Symptoms, when they are present, usually appear one to three weeks after exposure. In women, they can include abnormal vaginal discharge, pain in the lower abdomen or when urinating, spotting, or fever. In men, symptoms of chlamydia may include itching inside the penis, pain upon urinating, discharge from the penis, and pain or swelling of the testicles. If left untreated, chlamydia can lead to pelvic inflammatory disease, ectopic pregnancies or infertility. This is why women between the ages of 20 and 25, along with those having had several sexual partners, are automatically tested during their annual medical check-up.

Gonorrhea can also be asymptomatic. However, when symptoms do manifest, they appear more quickly, usually three to five days after sexual contact with an infected individual. Gonorrhea symptoms are similar to those that may appear with a chlamydia infection. And like that infection, gonorrhea can lead to chronic pelvic inflammation and even infertility in women if left untreated.

Due to the high prevalence of chlamydia and gonorrhea in Quebec, anyone having had unsafe behaviours should undergo screening. If the test results are positive, a single dose of antibiotics is usually enough to cure both chlamydia and gonorrhea.

Genital warts and HPV The human papillomavirus (HPV) causes genital warts, also called condyloma, as well as certain cancers of the cervix, vulva and vagina. Most HPV infections are asymptomatic and pose no health danger, however. There are many HPV strains and the virus is so widespread that it is estimated that nearly half of all Quebec adults are carriers!

Genital warts are “pimples” that appear on the genitals. They can be itchy or painful, and can appear in different locations. In women, they are usually inside the vagina or on the cervix, but they may also appear on the vulva, around the anus or on the thighs. In men, genital warts are located on the penis or scrotum, and also around the anus or on the thighs. HPV is transmitted through direct contact during sexual intercourse.

HPV can also cause various genital cancers. The most common is cervical cancer in women. HPV screening in this case can be performed using the Pap test, which is part of the gynaecological exam.

Genital warts must absolutely be treated in order to reduce the risk of transmission and of certain cancers.

Vaccines against the most common HPV strains are now offered to girls aged 9 to 26. It helps substantially reduce the risk of contracting the HPV strains responsible for genital warts and several genital cancers.

Genital herpes Herpes is another widespread viral infection. Two types of virus can cause herpes: HSV-1 and HSV-2. The first type is the one we usually find in individuals who suffer from herpes labialis, commonly known as cold sores. As for HSV-2, it usually causes genital herpes. The virus is transmitted through direct contact during sexual intercourse. Oral-genital sexual activity is no exception: persons with cold sores can therefore transmit the virus to their partners during oral sex.

The first infection does not always produce symptoms. Fever and headaches are sometimes present. The virus usually manifests as small blisters that, upon rupturing, leave painful lesions that last from 14 to 21 days. Infected individuals are most contagious when they have lesions, but they can transmit the virus at any time. Unfortunately, there is no treatment to fully cure herpes. Once infected, infected persons are carriers for life. There are many antiviral drugs, however, that can reduce the frequency, duration and intensity of herpes outbreaks. These individuals must always use a condom during any sexual activity in order to reduce the risk of transmission.

HIV Although HIV/AIDS are receiving less media attention now, the infection remains very active and hundreds of new cases are declared each year. HIV is by far the most serious STI because it is fatal and we still do not have a cure for it. However, life expectancy and quality of life have greatly improved for persons infected with HIV since the advent of new drugs that make it possible to slow the disease progression.

AN EFFECTIVE WAY TO AVOID STIs

Other than abstinence, the best way to prevent STIs is to have a mutually exclusive relationship with an uninfected partner. Otherwise, the only effective way to reduce the risk of STIs is to use a condom every time you have sex. When used properly, a condom offers good protection against most STIs, including HIV. Keep in mind that it must be used for all sexual activities – in other words, for genital intercourse as well as for oral and anal sex. There are also condoms for women, incidentally. Lastly, condoms are the only method that protects against both unwanted pregnancy and STIs.

In recent years, a recrudescence of several STIs has been noted among both younger individuals and those over the age of 50. While there is no longer a need for contraception in the latter age group, it is still important to use protection against STIs.

There are many STI information resources available, such as the website put together by the Society of Obstetricians and Gynaecologists of Canada (www.sexualityandu.ca). If you have any questions, don’t hesitate to consult these resources or to speak to one of your healthcare professionals. Your sexual health is important too!