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STD Awareness: Asymptomatic Shedding of Herpes

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Q: Can I catch herpes if my partner isn’t having an outbreak?
A: Yes, your partner can transmit the virus even if he or she isn’t experiencing symptoms. In fact, most genital herpes infections are transmitted in the absence of symptoms.

When most people think about genital herpes, they think about the symptoms that are associated with it: clusters of blistery sores around the genitals or buttocks. But most genital herpes infections don’t have symptoms — they are asymptomatic — or the symptoms are so mild or nonspecific that the person suffering from them doesn’t even make the mental connection. It is estimated that only 10 to 15 percent of people with herpes exhibit symptoms, which may be a silver lining for the millions who unknowingly carry the virus, but it also helps it spread more easily.

What is genital herpes, anyway?

Genital herpes can be caused by two types of herpes simplex viruses — either herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2). The difference between the two viruses is that HSV-1 is more active when it infects the facial region, where it can cause cold sores; HSV-2 is more active when it infects the genitals. Genital infections with HSV-1 tend to be milder than genital infections with HSV-2. The Centers for Disease Control and Prevention states that, among Americans 14 to 49 years old, 1 out of 5 women and 1 out of 9 men have a genital HSV-2 infection. Because that stat doesn’t count genital HSV-1 infections, the overall number of people with genital herpes is actually higher.

An “outbreak” occurs when genital herpes symptoms appear. The most well-known symptom is a cluster of blisters or open sores in the genital or rectal area. Continue reading →

Can Oral Herpes Be Spread to Genitals?

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A cold sore on the lower lip on the second day after onset. Image: CDC

Herpes simplex virus is mystifying, fascinating, and sneaky. Mystifying because we have yet to unravel all of its secrets; fascinating because when we do uncover one of its mysteries, we are amazed by the capabilities of such a tiny, microscopic object; and sneaky because it enters our bodies by stealth and conceals itself in our cells, taking us by surprise when it comes out of hiding and causes outbreaks of blisters and other lesions.

It can also be confusing. Herpes simplex virus actually comes in two flavors: HSV-1 and HSV-2. HSV-1 is associated more with oral herpes, which can cause “cold sores,” a type of blister that appears on the lips or face. HSV-2 is associated more with genital herpes, which can cause blisters and other lesions in the genital area. It used to be standard to describe HSV-1 as an “above-the-waist” infection and HSV-2 as a “below-the-belt” infection — but now many researchers are pointing out that it’s more appropriate to say that HSV-1 is both an orally and genitally transmitted infection while HSV-2 is a predominantly genitally transmitted infection. If HSV-1 enters the body in the genital area, it can cause a genital herpes infection — and likewise, if HSV-2 enters the body in the facial area, it can cause an oral herpes infection.

Using condoms and dental dams during oral sex reduces risk of herpes transmission.

What exactly is a cold sore, anyway? A cold sore, also known as a fever blister, is a cluster of blisters that can pop up around the lips or even in the mouth. Sometimes, cold sores are so painful that eating or drinking is difficult, and in extreme cases sufferers must be treated for dehydration. An especially severe infection could also cause high fever or swollen lymph nodes, and in young adults a first oral HSV-1 infection might be misdiagnosed as tonsillitis, possibly leading to unnecessary tonsillectomies. Most symptomatic first-time cold-sore outbreaks occur during childhood, and take about two or three weeks to clear up. Luckily, the first infection is almost always the most severe, and when the infection is reactivated it usually happens without symptoms.

Because both cold sores and genital herpes are caused by herpes simplex viruses, and because oral herpes is so common, many people are concerned that they might be more vulnerable to acquiring a genital herpes infection than they previously thought. They might have a lot of questions, and if they’ve sought answers to those questions, they might have heard a lot of conflicting answers. Let’s see what the scientific literature has to say.

  • Can I get genital herpes if someone with cold sores performs oral sex on me?

Because HSV-1, the virus responsible for most oral herpes infections, can also cause genital herpes, many people wonder if someone with cold sores can transmit the virus to someone else by performing oral sex, resulting in a genital herpes infection. Other people wonder if HSV-1 can be transmitted via oral contact with the anus, resulting in a herpes infection in the rectal area. The answer to these questions is: Yes! Continue reading →

STD Awareness: An Update on Antibiotic-Resistant Gonorrhea

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Last year, we shared the fascinating and frightening story of the emergence of increasingly antibiotic-resistant gonorrhea, an STD caused by the gonococci bacteria. The sexually transmitted scourge, which we only so recently reined in with the development of antibiotics, has been performing some genetic gymnastics to defeat almost every drug we’ve thrown at it. We douse it with certain drugs, and the bacterium literally spits them back out at us, and it inactivates other drugs by snapping the active molecules in half. Sulfa drugs, penicillins, tetracyclines, fluoroquinolones — they all make a gonococcus heave a bored sigh. Luckily, cephalosporins were still an effective treatment, but recently there have been reports of stubborn gonorrhea infections caused by the latest and greatest (and some might say most hated) strain of gonococci.

The bacteria that cause gonorrhea continue to evolve, right under our noses!

Well, the story isn’t over — just like the bacteria that cause gonorrhea, the tale is rapidly evolving. The latest class of antibiotics that the gonococci are chipping away at is the cephalosporin family, which includes several chemically related drugs that work in similar ways — and that can likewise be defeated by microbes in similar ways. Cephalosporin-resistant gonorrhea was first reported in Japan and documented in a few European countries. The Japanese case that inspired the New England Journal of Medicine to declare last year that it was “time to sound the alarm” was an oral gonorrhea infection that was resistant to one member of the cephalosporin family: ceftriaxone.

Earlier this month, the prestigious medical journal JAMA reported the first North American sightings of gonorrhea that failed treatment with another cephalosporin: cefixime. Yeah, I know, you’d rather hear about Big Foot or UFO sightings, not evidence that something as real and unmythical as Gonorrhea 5.0 has landed in your back yard. Luckily, there’s plenty you can do to protect yourself from it, and we’ll tell you all about it toward the end of this article. (Spoiler alert: It involves using condoms!) Continue reading →

STD Awareness: Gonorrhea of the Throat

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Gonococci can band together to attach themselves to a human cell. Image: Dustin Higashi, University of Arizona

My fellow Generation Xers might remember an episode of Chicago Hope in which a very young Jessica Alba portrays a teenage girl with a gonorrhea infection in her throat — also called pharyngeal gonorrhea. The actress later reported being shunned by members of her church, disillusioning her from the religion she grew up with. It is a testament to the power of taboo that even a fictional association with a sexually transmitted disease (STD) can elicit such negative reactions.

Taboos can affect the ways we relate to one another sexually, as well. Many of us conceptualize of disease as “dirty,” and the flip side to that is to think of people without disease as “clean.” This kind of stigmatizing language can be found in phrases like “She looked clean” and “Don’t worry, I’m clean” — all to describe people who are perceived to be or who claim to be free of STDs. With all the baggage we put on STD status, it can be difficult to ask a partner to use a condom or dental dam during oral sex. Some people might think we don’t trust them or are underhandedly questioning their “cleanliness.” These sorts of fears can cloud our judgment when it comes to protecting our health, but there is nothing wrong with asking your partner to use protection during oral sex — especially if you don’t know one another’s STD status. There are many good reasons to use barrier methods when engaging in oral sex, and pharyngeal gonorrhea is just one of them.

Unprotected oral contact with a penis puts you at the most risk of acquiring pharyngeal gonorrhea.

Gonorrhea is most famous as an infection of the cervix or the urethra. But gonococci, the bacteria that cause gonorrhea, can thrive in other warm, moist areas of your body — not just the reproductive tract, but also the mouth, throat, eyes, and anus. Gonococci can be transmitted to your mouth or throat via oral sex — most likely via unprotected oral sex. Symptoms might include a sore throat, but 90 percent of the time there are no symptoms at all. Continue reading →

STD Awareness: “Can I Get an STD from Oral Sex?”

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As tools to reduce risk for STD transmission, dental dams are not to be ignored.

Editor’s Note: Other posts of interest to readers include: “STD Awareness: Gonorrhea of the Throat,” “STD Awareness: Oral Herpes,” and “Can Oral Herpes Be Spread to Genitals?“

Many consider oral sex to be a safer form of sexual activity compared to vaginal or anal intercourse. For this reason, they might put less emphasis on the use of latex barriers, such as dental dams and condoms, during oral sex. Unfortunately, this idea is misguided and can lead to the transmission of preventable infections.

It is generally true that oral sex presents less of a risk for contracting sexually transmitted diseases (STDs) — but this risk is not trivial, especially when people are under the impression that they don’t need to use barrier methods during oral sex. Most sexually transmitted diseases can be passed along by oral sex, including chlamydia, gonorrhea, syphilis, hepatitis B, herpes (which can be transmitted back and forth from the mouth, as cold sores, to the genital region, as genital herpes), human papillomavirus (HPV), and HIV. Even pubic lice can be transferred from the genital region to eyelashes and eyebrows! Additionally, intestinal parasites are more likely to be transmitted via oral sex than through vaginal sex. A microscopic amount of fecal matter containing parasites can be infectious, and can be unknowingly ingested when present on genitals.

Seventy percent of adolescents who reported engaging in oral sex had never used a barrier to protect themselves from STDs during oral sex.

Some bacterial STDs, such as gonorrhea and syphilis, can do permanent damage if not treated in time. Furthermore, gonorrhea of the throat is much more difficult to treat than gonorrhea in the genital or rectal areas. And some viral STDs can’t be cured (such as herpes and HIV), while others can cause chronic infections that have been linked to cancer (such as hepatitis, which is associated with liver cancer, and HPV, which is associated with throat cancer as well as cervical cancer and anal cancer). Continue reading →

STD Awareness: Intestinal Parasites

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This colorized scanning electron micrograph shows Giardia lamblia reproducing asexually. Image: Stan Erlandsen, CDC’s Public Health Image Library.

This colorized scanning electron micrograph shows Giardia lamblia reproducing asexually. Image: Stan Erlandsen, CDC’s Public Health Image Library.

Most sexually transmitted diseases are caused by bacteria or viruses, but some are caused by organisms that are classified as completely different lifeforms. Trichomoniasis, for example, is caused by a protozoan organism; protozoa occupy their own kingdom, separate from plants, animals, and bacteria. Intestinal parasites are often protozoan organisms, but can also include parasitic worms (which are members of the animal kingdom). They are spread through contact with fecal matter — and as such, they can be transmitted sexually as well as nonsexually. Intestinal parasites are usually transmitted by fecal contamination of food or water, and are most common in areas with insufficient sewage treatment and untreated water in the wilderness. Some pathogens, however, have low infectious doses, making their sexual transmission more likely.

What has eight flagella and can live in your intestines?

Oral contact with the anus, also called anilingus or rimming, is the primary means of the sexual transmission of these pathogens. Putting fingers or hands in your mouth after they have had contact with the anus is also risky. Other modes of transmission include oral sex, as genitals can be contaminated with feces, as well as sharing sex toys and other equipment. For these reasons, it is very important to use dental dams or latex gloves during contact with the anus; to clean the anus before engaging in rimming; to clean or use condoms on shared sex toys; and to use condoms or dental dams during oral sex. Continue reading →

STD Awareness: Cytomegalovirus and Molluscum Contagiosum

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Most sexually transmitted diseases (STDs) are caused by microorganisms – lifeforms that are too small to be seen without a microscope. Many STDs, however, are caused by viruses, which technically aren’t even alive. Rather, viruses are pieces of genetic information that are stored in protein capsules. When these capsules come into contact with a host cell, the genetic information is able to enter the cell and hijack its machinery so that the host cell manufactures copies of the virus, as well as potentially harmful viral proteins. Many well-known STDs, such as herpes and HIV/AIDS, are caused by viruses, but this month we will focus on two lesser-known viral STDs, cytomegalovirus and molluscum contagiosum. Your local Planned Parenthood health center, as well as other clinics, health departments, and private health-care providers, can help you get a diagnosis and treatment for these STDs.

Cytomegalovirus leaves granules inside its host cells called inclusion bodies, pictured here. Photograph from the CDC’s Public Health Image Library.

Cytomegalovirus leaves granules inside its host cells called inclusion bodies, pictured here. Image: Public Health Image Library, CDC

Cytomegalovirus

The bad news is that most people are infected with cytomegalovirus (CMV) at some point in their lives. About 80 percent of the U.S. population is estimated to be carriers, about 4 in 10 Americans are infected with CMV before puberty (usually through contact with saliva), and adults can be reinfected through sexual activity. The good news is that among healthy adults, a CMV infection usually does not have any symptoms, though if they do they could seem like a mild case of mono. Being reinfected with the virus later in life also carries with it only a small risk for symptoms in healthy adults.

And back to the bad news: While an infection with cytomegalovirus usually does not have symptoms, if someone is infected while pregnant it can harm the fetus. About 1 in 100 U.S. babies is infected with CMV, but usually doesn’t show symptoms. Every year in the United States, around 5,500 babies are born with symptomatic cytomegalic inclusion disease (CID). Symptoms of CID vary, but the most severe include mental retardation and hearing loss. If the mother was already infected before conception, there is a 2 percent chance the virus will be transmitted to the fetus; however, if the infection occurs during pregnancy, this risk jumps into the 40 to 50 percent range. Continue reading →