Let’s talk about STIs

What used to be known as an STD (sexually transmitted disease) is more commonly now known as an STI (sexually transmitted infection). No matter what name or initials you assign it, it’s still a chronic problem that affects both men and women fairly equally.

The problem is twofold. First, the rates of STI transmissions are not declining. According to the Centers for Disease Control and Prevent (CDC), HIV infections in the U.S. have not decreased since 1991. That fact underscores the second part of the problem: Safe sexual behavior is not on the rise either. The CDC reports that there are nearly 20 million new STIs in the U.S. each year.

Even more disturbing is the rise of STIs in a certain demographic group. “We’re definitely seeing an increase in younger people under twenty-five,” says Dr. Catherine Creticos, chief of infectious diseases at Advocate Illinois Masonic Medical Center in Chicago.

Don’t get caught with your pants down.
Sadly, these staggering statistics shouldn’t even exist. “There’s no reason for anyone ever to have an STI or an HIV infection. Period,” says Dr. Creticos. So what’s the best way to avoid STIs? Take steps to prevent them from occurring in the first place.

Condoms can reduce the risk of transmission of Hepatitis B, HIV and other STIs, says Creticos. But other protective barriers, such as dental dams, are important as well. “People don’t think of rectal and laryngeal orifices as sources of transmission, and people don’t use protection during oral sex,” she says.

“We have seen a rise of transmission of STIs from extra-genital sites, through oral sex as well as the rectum. Nearly seventy-five percent of STIs are missed because doctors don’t culture in the mouth and rectal areas. Some women practice rectal intercourse as a way of preventing pregnancy, and they don’t realize they can acquire STIs this way, and oral sex can transmit HPV, HIV, herpes, chlamydia, etc.,” Dr. Creticos says.

The most effective way to stay on top of STIs is to be tested regularly and treated. Communication with your partner also plays a key role. “Truthfully, it gets down to being honest with partners, being aware of your partner’s body and noting any usual changes, trying behavior modification such as reducing the number of partners, delaying the onset of sex and exercising better judgment. These all have been shown to reduce the risk of STIs,” Dr. Creticos explains.

For her patients who are repeat offenders, so to speak, she discusses counseling and works on harm prevention with them. “If they do engage in risky behavior while drinking, for example, then I tell them to make sure they have protection or make a conscious decision ahead of time and make a change. I encourage small changes to reduce risk,” Dr. Creticos says.

How did we get here?
Blame can be tossed around as to why STIs are so prevalent, but there’s no one clear answer. Dr. Creticos says although it’s complicated, one of the biggest hurdles is behavior modification, particularly in response to some aspects of our culture. “Behavior is very, very difficult to change,” Dr. Creticos says. “People tend to think they’ll get away with it.”

In talking to patients with STIs, Dr. Creticos says she constantly hears two main reasons why people failed to take protective measures when engaging in sex. No. 1: “I was in love so I didn’t want to think about that.” No. 2: “They didn’t look like they had an STI.”

With younger people, the issue is a bit different. Dr. Creticos educates sophomore students at New Trier Township High School in Winnetka, Ill., about HIV transmission, and she says the largest issue is cultural. “Young people are reluctant to go to the drugstore to buy condoms because of the stigma around teenage sex, so we talk about centers where they can drop in,” Dr. Creticos says.

“It’s difficult for young people to navigate that conversation around safe sex,” she says. “If we do want to improve this, we need to educate people about STIs and where to get condoms, how to use them properly and how to talk to them about using them.”

Overall, Dr. Creticos says, the best way to address STIs is to remove the stigma attached to them. “An STI is like any other healthcare issue, and if you have a problem, get it taken care of and approach it with your partner the same way. Take it away from all the social things associated with it. It’s a medical problem so try to deal with it that way,” she says.