Hot Fun in the Summertime!
We enjoyed so very, very little of that last year. So, it’s no wonder that this year—with many of us fully vaccinated and many restrictions lifted—we’re eager to make the most of this year’s opportunities. But before we get too carried away with that, it’d be worth assuring that this summer’s festivities don’t result in another season’s misery. One great way to do that: avoid a sexually transmitted infection (STI).
And there are lots of those out there: a report published earlier this year by the Centers for Disease Control and Prevention (CDC) noted that about 26 million people in the US were newly diagnosed with an STI in 2018 (the most recent data available). About half those infections occurred among youth ages 15 to 24. Four STIs—chlamydia, trichomoniasis, genital herpes, and human papilloma virus (HPV) accounted for 93 percent of these infections. Four less-common STIs (human immunodeficiency virus (HIV), syphilis, gonorrhea, and hepatitis B) accounted for the rest.
So—how to avoid an STI? Well, there’s always abstinence: If you’re not having sex—any sex, anal, oral, or vaginal—you’ll likely avoid infection with an STI. If that lacks appeal (I mean…), next-best is mutual monogamy with an infection-free partner.
Proper use of condoms is a BIG help—male latex condoms are highly effective at preventing STIs. And if you’re sexually active, get tested: as we’ve learned from COVID, testing—even in the absence of symptoms—can reveal infections. Once found, STIs are treatable.
There are also very specific prevention options for HPV and HIV: vaccination and pre-exposure prophylaxis, respectively. These deserve special attention.
Human Papilloma Virus (HPV)
Gardasil® 9 is a vaccine against HPV. And it prevents way more than “just” genital warts: it can prevent about 90 percent of the 36,000 HPV-related cancers diagnosed in the US each year.
HPV-related cancers include cervical, vaginal, and vulvar cancers in women, penile cancers in men, and oropharyngeal (throat) cancers in both women and men. Preventing these cancers is critically important: routine screening is available for only cervical cancer, so the other HPV-related cancers can go undetected for some time.
So, what’s not to love about the HPV vaccination? Chiefly, its rate of uptake: the latest figures available from the CDC show that in 2019 only about 54 percent of teens were fully vaccinated against HPV; about 72 percent had received one dose of the vaccine. (Full vaccination requires two to three doses, depending on the age at which vaccination begins.)
It’s astonishing that—for a vaccine that actually prevents cancer—the rate is so low. One reason for that may be that ideally, HPV vaccination needs to begin between the ages of nine and 12. Some parents are uncomfortable vaccinating children against a virus that is transmitted via sexual activity. And children can’t consent to their own vaccination, so even if they’re aware of the benefits they’re unable to obtain it on their own.
But even if you weren’t vaccinated as a child/teen, it may not be too late. Vaccination of older adolescents and young adults (up to age 26) requires a series of three (v. two) injections but can still be effective. Even if you’re between the ages of 27 and 45, talk to your health care provider: if you weren’t adequately vaccinated when you were younger, there may still be benefit to vaccination.
Human Immunodeficiency Virus (HIV)
While it’s not yet vaccine-preventable, another virus we’ve made major strides toward preventing is the human immunodeficiency virus (HIV). Pre-exposure prophylaxis (PrEP)—Truvada® or Descovy®—used consistently, does a great job of preventing HIV: it reduces the risk of getting HIV from sexual activity by 99 percent.
PrEP can benefit a wide range of HIV-negative people. Among them: sexually active gay, bisexual, and straight people (both cis- and transgender) who have an HIV-positive partner or a partner whose HIV status is unknown. Also, those who have multiple partners, use condoms inconsistently (or not at all), or have been prescribed non-occupational post-exposure prophylaxis.
Among those for whom prevention came too late—those who are already HIV positive—there’s been major progress on disease management. Antiretroviral drug therapy (ART) keeps a person’s viral load low, slowing progression of the disease. Aside from the significant benefit the patient derives, there’s another major upside with ART: someone with a low viral load is less likely to transmit the virus to others.
We’re working hard to squeeze two summers’ worth of fun into just this one. Let’s just assure we don’t spoil it all with an infection we may spend many, many seasons regretting. ▼
Marj Shannon is an epidemiologist and writer. She can be reached at email@example.com.