What you don't know can hurt you
Ventura County’s lesser-known and most popular STDs
By Kit Stolz 07/30/2009
The most feared of all sexually transmitted diseases is the potentially deadly AIDS/HIV virus, which in 2005 struck 30 people in Ventura County, according to the Department of Public Health.
That, ironically, is the good news. The rate of AIDS/HIV infection has stabilized in recent years, and even declined slightly from that of five years ago.
The bad news is that more than 50 times as common as the HIV/AIDS virus is a sexually transmitted bacteriological disease called chlamydia. Chlamydia is epidemic in the United States, and the rate of infection in Ventura County has doubled in the last 10 years.
Chlamydia was diagnosed in 1,570 people in Ventura County in 2005, the most recent year for which there are official statistics. Most of those who contracted the disease were young. Nearly one-quarter of those who came down with the sexually transmitted disease were teenagers, and almost one-half of those who contracted the disease were between the ages of 20 and 24.
It’s the most frequently reported of all sexually transmitted diseases, both nationwide and in Ventura County. Although it’s not the most common of sexually transmitted diseases, it’s one of the most likely to cause problems if not treated.
The real hazard of chlamydia is not that so many people have it and know it, but that a far larger number of people have it and don’t know it.
“It’s one of the most common infections we see,” said Dr. Kirk Cook, who works as a family doctor and serves as a public information official for the county, “but the number of cases we see is just a fraction, because most people who contract this disease do not have symptoms.”
According to the U.S. Centers for Disease Control, about three-quarters of infected women and about one-half of infected men do not show signs of chlamydia.
If symptoms do appear, they show up within one to three weeks after infection.
In women, medical experts say that the most common symptom is a vaginal discharge, pain during urination, pelvic pain or pain during sex.
In men, the most likely symptom is a burning experienced during urination. Because men’s sexual organs are simpler, the disease is more likely to be seen, but symptoms can vary. One Ventura County patient, who wished to keep his
identity private, found a sore on his penis after a sexual adventure overseas.
“It didn’t hurt, but it was gross,” he said. “I couldn’t believe it. I never saw anything like it. It looked like a crater on my dick. It just got bigger and bigger. I had to go to the doctor.”
Easy to cure and easy to contract, again
Chlamydia is one of the easiest of all sexually transmitted diseases to treat. A single dose of an antibiotic pill named azithromycin can cure the disease, although doctors typically ask patients to return to take a second dose of the medicine, because one-quarter or more of those who are initially diagnosed with the disease are reinfected within months, usually by the same partner who passed on the disease in the first place.
“In California, the largest population affected by this disease are in the ages of 15-25,” said Cook. “I think that’s partly because these are people who are not mature adults, and also because chlamydia is not a disease that kills people, the way the HIV/AIDS virus can, so it’s easy to get complacent. But if this disease goes untreated in women, it can lead to pelvic inflammation and scarring of the fallopian tubes. This is a disease with bad long-term consequences for fertility.”
If a woman has no symptoms, or overlooks cramping, pain or a bloody discharge, the chlamydia infection can spread, often resulting in PID, or pelvic inflammatory disease, which can damage a woman’s reproductive organs. According to the Guttacher Institute, an international nonprofit organization focused on sexual health, about 20 percent of women who contract PID will lose their fertility permanently.
Why patients often don’t know who gave them the STD
According to Dr. Adina Nack, a sexual health educator at Cal Lutheran University who published a book last year about women’s experiences with sexually transmitted diseases such as HPV, the human papillomavirus, STDs can remain hidden in the body and without symptoms for so long that a patient often isn’t sure who gave him or her the disease.
“One of my interviewees had been married once, gotten divorced, and then when she was with her second husband came down with symptoms of a sexually transmitted infection,” Nack said. “We tend to think that if we are exposed to one of these diseases, that we will get the symptoms within a short period of time, but it’s very possible to be exposed to an STD and not see your first symptoms for upwards of 18 months.”
This was the case of one young Ventura County woman, “Helen,” who had gotten engaged to be married when she suffered her first outbreak of genital herpes. She assumed at the time that her fiance had given her the disease, despite his denials, but now realizes that she probably picked it up when she was an undergraduate in college.
“It was horribly painful, and I blamed him,” she said. “I had no idea what was happening to me — I didn’t know anybody who had had herpes. It caused a lot of stress in the relationship, and we eventually broke up.”
Genital herpes is not on the list of sexually transmitted diseases reported to government medical authorities because, according to the Centers for Disease Control, blood tests for genital herpes can be “difficult to interpret.”
Blood tests can detect the presence of antibodies to herpes, but cannot reliably distinguish between herpes simplex type 1, which is more likely to cause fever blisters around the mouth, and herpes simplex type 2, the virus which usually causes genital herpes.
The virus is the most common sexually transmitted disease, infecting an estimated 45 million to 60 million Americans, according to the CDC.
Herpes can be passed on even if no symptoms are present. Although antiviral prescription drugs such as Valtrex can make the disease less painful and contagious, it’s still a disease profoundly damaging to what Nack, in her book Damaged
Goods, calls a woman’s “sexual self.”
An older woman in the San Fernando Valley, “Jamie,” wrote in an e-mail interview how she was devastated by a diagnosis of herpes simplex type 2 from a lover who died before she found out that he gave her the sexually transmitted disease.
“I was so wounded that I shut down socially. I had no social life for many years and did not even think about dating. I could not begin to imagine the misery and humiliation of having to have that infamous ‘talk’ that we, who know we have herpes, are supposed to have with a potential mate or lover. It is ironic because those who are spreading it are those who do not know they have it, which is most people with herpes,” she said.
Recovering from a sexually transmitted disease
According to Nack, the emotional devastation “Jamie” experienced when she caught a sexually transmitted disease is often what happens to women who contract STDs. Nack thinks this reflects the way we as a people have decided to look at sexual health.
“In this country, we consistently want to hold women responsible for sexual health, but not their male partners,” she said. “You can see this attitude play out with the Gardasil vaccine, which can protect against HPV (human papilloma virus, aka genital warts) in both men and women, but which has been marketed only to young women, and not as an HPV vaccine, but as a cancer vaccine. I don’t think we’re doing men any favors by letting them off the hook when it comes to taking care of their sexual health. They won’t get cervical cancer, but I have seen some seriously bad cases of genital warts on men.”
Nack points out that more than 6 million new cases of HPV are diagnosed each year, making it the second most common sexually transmitted disease after herpes. Complicating matters is the fact that the test for cervical cancer, the Pap smear, can detect the presence of abnormal HPV-altered cells around the cervix, but cannot detect the genital wart virus on external sex organs. A doctor who isn’t careful can give a patient the impression she doesn’t have HPV when she does, or can lead a patient to fear cervical cancer, when in fact she may only have contracted the virus that can sometimes develop years later into cervical cancer.
All too often, according to Nack’s research, doctors stumble over the complexities and uncertainties of diagnosis of sexually transmitted disease, especially in women. Two-thirds of the more than 40 women she interviewed at length complained that their doctors misdiagnosed their STDs, failed to explain them clearly, or even hurt them unnecessarily in treatment, adding to the pain and confusion.
Patients often go into “diagnostic shock” when they learn they have a sexually transmitted disease, Dr. Cook confirms.
“If a patient has symptoms, sometimes the diagnosis comes as a relief, especially with chlamydia, which is easy to treat,” he said. “But sometimes a patient will say, ‘I don’t even know what you’re talking about,’ or, ‘I never heard of it.’ Part of a doctor’s job is education, and with STDs, that means encouraging patients to contact sexual partners and encourage them to come in for treatment.”
Christine Lyon, of Planned Parenthood in Santa Barbara, points out that young patients are often reluctant to go to their family doctors for tests or treatments, knowing that this will likely spark questions from parents. She encourages young people who suspect they have an STD, or who want to know how to protect themselves, to visit Planned Parenthood or a county health clinic if a visit to a family doctor sounds intimidating.
“One in four young women in this country have an STD,” she said. “A lot of those cases are chlamydia. The known rate of chlamydia is higher in women than in men, but that’s probably because they are more likely to receive routine screening. Our goal is to treat anyone who comes through the door and wants reproductive health services.”
The good news about STDs
Contracting a sexually transmitted disease often turns out to be a strengthening experience in the long run, according to Dr. Nack. Many of the women she interviewed look back on themselves before they were infected as naive and passive, too compliant to the wishes of men.
“Once you decide you might want to be intimate with someone, you have to have ‘The Talk.’ You have to get your partner to be as honest as possible about their sexual health,” Nack said. “Because there’s a heavy moral stigma against being sexually active, it’s difficult for young girls to take an assertive role, but it’s really necessary. Condoms are great for preventing fluid-borne STDs, such as HIV, chlamydia, and gonorrhea, but skin-to-skin contact still takes place in sex, and that can pass other STDs, such as HPV and herpes.”
“Jamie” completely agrees that women must protect themselves, and objects fiercely to victims of sexually transmitted diseases being blamed for their misfortune.
“The herpes social stigma really makes me mad because it is the only serious harm it does to most people who contract, it,” she wrote. “It is not fair to make us lepers. I hate the stereotype ‘herpes whore.’ I got it while being faithful to a man I loved, a guy who should have gotten a special Oscar for Performance in a Personal Life. If you have sex with anyone — and at some point nearly everyone does — you risk contracting the herpes simplex virus. We are not bad people. We are unlucky.”
“Jamie” has taken to wearing confrontational T-shirts in public places, with slogans such as “VALTREX” or “HERPES DISCLOSURE.” She watches the expressions on the faces of people she passes, curious to see if they’re shocked, horrified or understanding, and gives out information on herpes if they’re curious.
She writes that she has mostly taken this one-woman personal sexual education campaign to places such as Venice Beach, but this summer plans to go to more conservative places.
If you see her, she hopes you will say “hi” and be accepting. She says she is only trying to protect you from the pain and heartbreak of coming down with an STD.