Except When It's Drippy
STIs on the Rise Despite Pandemic Lockdowns
I admit it. I can’t figure out how to follow Tucker’s baked balls with anything even remotely as amusing. There were a few intriguing headlines in the last couple of weeks, but most of them turned out to have very little story behind them.
There was the one about the grocery store security guard who was stabbed by a guy trying to steal a box of condoms. (I wish someone had pointed the thief to the nearest health department which undoubtedly gives them out for free, and I hope the store doesn’t respond by locking up condoms.) There was the one that circulated on TikTok about the guy who accidentally uploaded his STI test results instead of his cover letter. (Apparently, the hiring manager did not take it as a sign of good judgment and responsibility, just poor multitasking ability. He did not even get an interview.) There was also the non-profit handing out condoms for Earth Day with sayings like “Before it gets any hotter, remember the sea otter” and “Fumbling in the Dark, think of the Monarch.” (For those who don’t get the connection between condoms and whooping cranes, the goal is to get people to stop hogging the planet by using birth control.)
The headline “A Man Rips His Lung Out After Masturbating” was alarming but turned out to be a gross exaggeration (which I’m thankful about for the man’s sake). The story was about a young Swiss man who was hospitalized for a few days after “aggressive masturbation.” He arrived in the ER with a swollen face and crunching noises coming from his neck down to his arms. Doctors diagnosed him with spontaneous pneumomediastinum, a “benign disease” that happens when air leaks from the lung and becomes lodged in the rib cage. It’s generally caused by rigorous exercise or extreme coughing fits, and researchers believe this is the first masturbation-induced case. He was released after a few days and is expected to make a full recovery with his lungs still in his chest.
Since I can’t offer anything as fun as toasty testes, I’ve decided to go all in on STIs this week. It’s a dry topic (except when it’s drippy, I suppose) but important nonetheless.
STIs By the Numbers
The Centers for Disease Control and Prevention (CDC) released its data on annual STI cases for 2020 earlier this month. The news is pretty much the same as it has been for the last 10 years: cases and rates continue to climb.
Some had hoped that the silver lining of social distancing would be fewer STIs since you can’t get chlamydia from 6 feet away. There was a drop off in reported infections at the beginning of that year while we were all still wiping off our groceries and bathing in Germ-X, but the end of the year more than made up for it.
There were almost 1.6 million cases of chlamydia reported. While this is a 13% reduction in the number reported in 2019, the CDC believes that this does not represent a reduction in actual case numbers but is instead a result of decreased screening for chlamydia during the early days of the pandemic.
There were 677,769 cases of gonorrhea reported. This is almost a 6% increase over 2019 and an 111% increase from the historic low reported in 2009.
There were 133,945 cases of all stages of syphilis reported in 2020 including 41,655 cases of primary and secondary (P&S) syphilis, the most infectious stages of the disease. Since reaching a historic low in 2000 and 2001—when it was on the verge of being declared eliminated—syphilis has increased each year.
There were 2,148 cases of congenital syphilis (babies born with the disease), including 149 congenital syphilis-related stillbirths and infant deaths. The rate of congenital syphilis is up 15% from 2019 and 254% from 2016. Cases of congenital syphilis represent a failure of both STI prevention and prenatal care.
I have nothing witty or insightful to add to these numbers. We need to be doing a better job preventing STIs which means more sex education, more condoms, more screening, and more treatment. Of course, all of this takes more money, and the budget for fighting STIs has been stagnant at best for years.
Warning for Butt-Play Enthusiasts; Drug-Resistant Shigella
Late last month, the World Health Association (WHO) warned us that there were an unusually high number of drug-resistant shigella infections in parts of the UK and Northern Ireland. The numbers aren’t large but represent a disturbing spike. Health officials in the UK have been following a particularly drug-resistant strain labeled XDR for the past few years. While there were just 16 cases reported to UK authorities between April 2020 and August 2021, 84 cases were reported between September 2021 and the end of March 2022. Most of the UK cases were in men who have sex with men. And WHO notes that nine other European countries have reported XDR cases as well.
Shigella doesn’t present like a typical Sexually Transmitted Infection (STI)—there’s no itching penis or dripping vulva, no bumps, lumps, or sores. In fact, many people may suspect they have food poisoning or a stomach bug because the primary symptoms are diarrhea (often bloody), intestinal cramping, and fever. The infection is caused by bacteria found in feces and can be transmitted through handshakes, food, drinking water, and improperly maintained pools. That said, it is also often the result of butt play when an anus, hand, penis, or sex toy is not properly cleaned before it comes in contact with a mouth.
While most cases of shigella resolve in a few days, some require hospitalization and medication. Public health experts are concerned because the XDR strain has been resistant to many of the available drugs—including penicillin, third generation cephalosporins, tetracycline, sulfonamides, quinolones, and azithromycin—which leaves few treatment options for severe cases.
Obviously, the best thing to do is to avoid shigella in the first place because even if you’re lucky enough to get a strain that’s not resistant to meds, the symptoms are extremely unpleasant. One UK man who believes he’s contracted the bacteria four times in recent years told Vice that it was far worse than getting gonorrhea because he felt miserable and was unable to go to work. Another suffered from unusual IBS symptoms for months after the infection.
Frequent washing of all body parts and sex toys is the best way to avoid shigella. The UK Health Security Agency suggests that couples wash their hands with soap after sexual contact, avoid oral sex right after anal sex, and use condoms because they can be changed between sex acts.
Shigella is often misdiagnosed; people who feel symptoms of the infection should tell their health care providers about any butt stuff they’ve done recently, and those who are diagnosed should avoid sex (as well as hot tubs and swimming pools) for at least seven days after the symptoms have subsided.
Teens Not Getting Screened for STIs
A new study published by the American Academy of Pediatrics found that too few sexually active teens are being screened for STIs. Researchers looked at data from the CDC’s 2019 Youth Risk Behavior Survey which added a question on STI testing to those about age of first sex, condom use, and alcohol before sex (not to mention those about fresh fruit consumption, violence, and bicycle helmet usage—the YRBS is pretty all-encompassing). The findings show that only 20.4% of sexually active high school students have ever been tested for STIs.
The CDC estimates that half of all STIs in this country occur in those under 25, and research has suggested that 1 in 4 sexually active young women has an STI. Young women are actually biologically more susceptible to certain infections such as chlamydia because they are more likely to have cervical ectopy (cells from the inside of the cervix on the outside) and they have less cervical mucus which can be protective. (Paging Cecily the Cervical Mucus Fairy.) If exposed to a sexually transmitted bacteria or virus, they are more likely than adults to get infected.
This is one of the reasons the CDC suggests that all sexually active young women under 25 be screened for chlamydia and gonorrhea each year. Both of these STIs are treatable with antibiotics, but they are often asymptomatic and can go undetected without screening. If left untreated, both can lead to Pelvic Inflammatory Disease and infertility later in life.
The CDC guidelines for young men who have sex with women are less directive and based on the STI rates where they live. It is recommended that young men who have sex with men (MSM), however, get tested for gonorrhea, syphilis, and HIV at least once each year.
The new findings show that young women are more likely than young men to be tested for STIs (26.1% versus 13.7%) but did not find any difference among young men based on sexual identity or sex of partners. While this may be a result of a small sample size of young MSM, the authors say it warrants further research to make sure the sexual health needs of these young men are being met.
There are many reasons that young people might not be getting tested including lack of awareness of the tests they need, embarrassment in asking health care providers questions about sex, confidentiality concerns (fear that their parents will find out), and logistical barriers such as transportation and cost. Health care providers may also be missing opportunities to offer STI testing because they assume young people are not sexually active, are uncomfortable discussing sex with their young patients, or are not making time to see adolescents without a parent in the room.
These findings suggest a need to increase awareness of the importance of STI testing among young people and providers. I would also add that parents need to get involved by talking to their kids about sex, helping them access prevention methods (mostly condoms but also the HPV vaccine), and facilitating alone time with a health care provider. Think about it this way: your future as a grandparent could be at stake.