Hi, about STD...
A young man asked to get tested for sexually transmitted infections (STI or STD). He and his girlfriend are in their early 20s, healthy, and updated on vaccines – including human papilloma virus (HPV), hepatitis B. Recently, she saw her gynecologist, who did a pelvic exam and checked her for chlamydia, gonorrhea, and HPV.
“It’s routine,” her gynecologist said. So, his girlfriend asked him to do the same.
I was touched by their strong sense of shared responsibility, but I said, “We don’t routinely test men for STD.”
“Oh, she’s going to be mad,” he said.
I’ve been chewing on that comment for a while; I’d like to elaborate on this apparent double standard. For almost a decade, three STDs – chlamydia, gonorrhea, and syphilis – have been rising at an alarming, unrelenting rate.
Most of us will contract some form of STD and just don’t know it. Take HPV alone – according to the CDC, “85% of people will get an HPV infection in their lifetime.” Most (90%) will clear HPV infection in years. But many – both men and women – will develop genital warts, genital and throat cancers. About 70% of throat cancer is caused by HPV.
Another headache: chlamydia and gonorrhea infections often have no symptoms, especially in women. Yet these infections are a major cause of infertility and pregnancy complications. The thing about STD: not knowing isn’t the same as not gnawing.
But screening STD is different than treating STD. The purpose of screening is to check the population at large – who have no symptoms – to reduce the chance of future disease.
We screen sexually active, young women routinely for STD because the burden is high, and the consequences can be dire. Men get a pass because:
1. Anatomy makes men’s infections more obvious than women’s. They call attention and can be caught in time.
2. If women are getting screened regularly, there is insufficient evidence to show screening men provides additional benefits.
The 2021 U.S. Preventive Services Task Force states that “the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men.” But keep in mind, this recommendation could change in the future. Most health providers recommend STD screening in certain high-risk groups such as men who have sex with men or have HIV or have anonymous sex, etc.
That day, with my young patient, instead of testing, we talked about other good ways to reduce STD transmission such as condoms and vaccinations.
As a clinician, I love STD discussions, prevention, and treatment. Science prevails. I can cure gonorrhea, chlamydia, trichomonas, and syphilis with readily available, affordable antibiotics. Whenever I think of Gardasil-9 – the highly effective HPV vaccine which can reduce our risk of pre-cancer infections, cancers and genital warts by 80 to 99% – I see rainbows, and I hear harps.
Another unique thing about STD, I can treat my patients and their partners without seeing the latter. In the world of STD, I’m the Shel Silverstein’s tree that keeps giving.