Thursday, May 14, 2009

The Rules of STI Disclosure

Tertiary, Brain-Eating Syphilis.
And you thought HPV was scary?

Q: What are your "rules" in terms of sti disclose? Always before sexual activity no matter the type of STI?*

A: It depends on the circumstances. In the case of a one-time encounter, if safe practices are insisted upon and used (condoms, dental dams, etc.) then I think the infected partner can use their discretion about whether to disclose. If someone is willing to have casual sex, they should be willing to assume some risk therein. But the infected person has to be reasonably sure that they're never going to date the person or see them again, because if they find out later that you withheld that info, that can be a big violation of trust and hurt potential intimacy between the two. And if you're using barrier methods anyway, you're being as safe as you can be.

If a person is dating someone that they hope to continue dating, it's a good idea to disclose prior to any activity that presents risk. But more importantly, people who intend on fucking someday should ASK about STIs and when the person was last tested, sooner rather than later. I usually ask about it right up front. Of course, I'm sex educator so I can get away with asking questions like that and it not seeming out of character, but it's a question people have the right to ask. It's an awkward conversation, but usually I condition it with something like, "Hey, let's have a really awkward, uncomfortable conversation for a minute; I don't have any sexually transmitted infections, do you?"

Almost without exception, the person replies, "No, I was just tested X months ago and haven't had sex with anyone since/have used condoms every time" or "You know, it's been a while since I got tested, I should do that." The only time someone has balked I ultimately broke up with them over it, because they were clearly just not smart about the reality of risk they faced, something that, in my line of work, I can't abide.

If a person has gonorrhea, chlamdyia, or syphilis, they should be treated and finish treatment before having sex, and then they don't need to disclose--because those STIs are curable. It's not necessary, in my view, to talk about STI history if you have had something you know has been cured. But ongoing infections, like HIV and herpes, do need disclosure and behavior monitoring to reduce the risk.

With HIV, obviously, condoms are always necessary no matter what. With herpes, if the infected person is on treatment (Valtrex or other antiviral) and hasn't had an outbreak for a period of months, the risk of transmission is insanely low. Disclosure is necessary, but the person with herpes can assuage the fears of their partner by saying, "I take Valtrex, I always use condoms, I've been tested so I know I don't have any other STIs, and I haven't had an outbreak for X months." That's the best you can do, and if the partner freaks out, they're probably not worth dating.

As for HPV, I just don't care. I have students who come in all the time who are like, "OMG my girlfriend was just diagnosed with 'high risk HPV,' do I have to tell everyone I have sex with in the future?" And usually I tell them that if they want to earn their Scouts Honor badge by telling, they can, but since everyone has HPV, if they're using condoms, they're doing as much as they can to reduce the risk. And besides, the chances they will have sex with someone else who has HPV at some point are like 100%. And for the last f-ing time, the Pap Smear is the most effective cancer screening tool in medicine and it detects almost all cervical cancer and pre-cancerous changes. And if you have genital warts, you have genital warts. So for fuck's sake, stop freaking out about HPV. Merck is just trying to scare you into spending $500 on their vaccine.

So those are my 'rules.' Hope that helps!


*I'm not discussing the far less common, but no less annoying, STIs here like hepatitis (that is a vaccine you need to get), chancroid, molluscum, crabs, scabies, etc. You can learn more about them at the American Social Health Association links above.

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