As I've blogged about numerous times before, antibiotic resistant gonorrhea is becoming a growing problem around the globe. The data is more than a little frightening, but some recent research suggests that while untreatable gonorrhea may be inevitable, that doesn't mean the inevitable can't be delayed. Work in England and Wales suggests that careful monitoring of resistance, and choosing appropriate replacement antibiotics, may be able to postpone the development of more bacterial strains that are resistant to the last oral drug regimen that is still generally considered to be fully effective.
That said, prevention is still the best choice. Fortunately, it's a relatively straightforward task for dealing with gonorrhea infections. Consistent condom use, for anal, oral, and vaginal sex, is a very effective way at arresting transmission. Combined with regular screening for anyone not in a mutually monogamous relationship, it should keep most people from having to worry about whether or not there is an effective cure.
I got a lovely e-mail the other day from a young man who was thinking about having sex for the first time and had a few questions. The questions were good ones, but what I found particularly interesting was that he'd talked to his parents about his concerns and they told him that they "didn't know of any history of STDs in the family." On one hand, I thought it was great that he could talk to his parents about this type of decision. I wish more parents and teens were comfortable enough having "the talk" in a way that could actually empower young people to make positive, active choices about whether or not they want to have sex. However, the message they gave with that one statement was highly problematic. Saying they didn't know of a history of STDs implied:
- That they'd know if either one of them had an STD, presumably without testing
- That STDs are the sort of things that run in families, rather than being behaviorally acquired
- That testing isn't something they think about, or talk about, even when their teen is bringing sexual health questions to them
Talking to teens about sex is a wonderful thing, but the conversation should be about more than whether the teen is ready, emotionally, to engage in vaginal sex or any other form of sexual activity. That's a huge part of it, but so is talking about protection -- not just in the sense of using condoms, but in terms of knowing what the risks of sex are and how to evaluate which of them someone is willing to take in any given circumstance. That includes a recognition that many STDs have no symptoms, and you can't tell if someone has an infection just by looking at them or asking if it hurts when they pee. You have to ask them about testing, and they have to actually know what they've had done.
It was approximately 5 year ago that Farrah Fawcett, actress and pinup, died of anal cancer. Now, the Farrah Fawcett foundation is supporting research to help improve the lives of others affected by HPV-related cancers. It's a great legacy for the movie star, who helped raise awareness of the role of HPV in non-cervical cancers before she died, and whose foundation continues to work to increase awareness of anal cancers in women and men.
Anal cancers are most commonly seen in gay men, due to the association with HPV infection and anal sex, but they can affect anyone. Unfortunately, screening is rare even for high risk populations. An anal Pap smear is available, and minimally invasive; it's just not widely recommended or used. Fortunately, as with all HPV-related cancers, there are risk-reduction options. Two HPV vaccines are now available and consistently using barriers for anal, oral, and vaginal sex is also an effective way to lower the risk of virus transmission.
A study looking at the health of HIV positive kidney transplant patients after transplantation may have accidentally stumbled onto something quite interesting. Their research, which was recently published in the American Journal of Transplantation, suggests that an anti-rejection drug and immunosuppressant known as sirolimus may have reduced patients' viral reservoir when it was given to them after transplantation. Over time, patients on the drugs saw a decrease in the number of HIV infected blood cells seen in their bodies. This suggests that the ways in which sirolimus modulates the immune system may have been able to impact the health of the viral reservoir, a possibility which had been previously brought up by other in vitro studies.
If it turns out that such a hypothesis is correct, it could open an entirely new area of HIV treatment research. However, first these results need to be confirmed. The transplantation study wasn't actually designed to look at how sirolimus affected the course of HIV disease. It was just fortunate that the researchers had the data to reanalyze when other researchers suggested that sirolimus might be a new way to attack the virus.
I wanted to draw your attention to the fact that Trojan Condoms and the American Sexual Health Association have put together a cute website at FactsAboutCondoms.com. With April being the official Sexually Transmitted Infections Awareness Month, now is a great time to check it out. (Around here, EVERY month is Sexually Transmitted Infections Awareness Month, but I can't expect the rest of you to share my all consuming passion for the subject.)
The site looks like it will be particularly useful for college students, RAs, and sex educators working with the collegiate population, as they have a number of nice handouts and posters that would perfect for use on campus. However, they also have some fun videos about condoms - both their history and use - that a broad range of people may enjoy watching. I actually found the video about how condoms are made to be fascinating, even if it is a bit of a glorified commercial for Trojan!
According to news reports, Iowa is currently considering revamping its laws around the criminalization of HIV transmission. Right now, a person with HIV can be sentenced for up to 25 years in jail for failing to disclose their HIV status to a partner, even if they practiced safe sex and had a viral load so low that infection was extraordinarily unlikely.
Personally, I think that revamping such laws is an excellent plan. Intentional, malicious exposure to HIV or other STDs is a rare thing. Far more often, people put off disclosing their status because of fears of stigma, violence, or rejection -- fears that are often quite legitimate.
While I'd love for disclosure to be easier for people, criminalizing lack of disclosure isn't the way to make that happen. It just makes people more scared of keeping track of their status - knowing that having sex while knowingly positive could mean they were breaking the law. After all, what people don't know, they probably can't be arrested for. At least not when it comes to transmitting HIV.
Although I don't always trust The Huffington Post as a news source, this article about J.P. Morgan Chase refusing to serve as the credit card processor for a condom marketing site has enough evidence to render it seriously disturbing. Apparently the bank's credit card payment service Paymentech considers condoms to be "adult-oriented" products and thus prohibits supporting their sale. That's not only offensive to me as a health educator, it's also highly hypocritical. Chase presumably provides payment services to a number of drugstores and similar locations that stock condoms on their shelves. Why should someone trying to make them more acceptable to women be penalized for focusing on safe sex and empowerment? If you agree that it's all a bit ridiculous, the founder of Lovability has started a Change.org petition in protest. Maybe getting enough publicity will encourage Chase to consider changing their policy on supporting the sales of products that are undeniably good for public health.
Sexual coercion isn't something that only happens to women. An article recently published in the journal Psychology of Men and Masculinity found that almost half (43%) of all high school and college aged men reported being coerced into engaging in sexual behaviors, almost entirely by female partners. The types of coercion were both similar and different to the types of coercion used against women. Many men reported being verbally and physically coerced, as well as being taken advantage of after drug or alcohol use, and as with coercion in women, these types of coercion were associated with decreases in safe sex. However, more than a quarter of the men who experienced coercion reported that they were coerced through seduction.
Seduction coercion occurred when female partners tried to use sexual or sexualized behaviors (such as stripping) to coerce young men into having sex. This occasionally took place in the context of statutory rape, when an older female partner was using sexual pressure on a younger man. Unfortunately, complaints about such coercion by young men are often easily dismissed because of the way that young men are assumed to always want sex, or the belief that they are supposed to want sex any time it is offered. Talking about this type of coercion might make them seem less manly, to both themselves and the people they are looking to for help, even if seductive coercion is no less an assault than if something similar were to happen to women.
This is another example of how the problems with the way we talk about sexual decision making are problematic for people of both sexes. Men should get to choose whether or not they want to have sex, just as much as women. Furthermore, if they choose not to, it should not be seen as any reflection on their masculinity, but as a personal choice made for personal reasons. Some women like to have a lot of sex, some men don't. Neither group should be judged for a failure to conform to societal expectations about sex.
Furthermore, while in theory it's lovely that the app keeps testing information on their webpage, it's not exactly easy to find. The only way you'd even know it was there was if you read news coverage or happened to notice the "Grindr Health" item in the site map at the bottom of the page. If Grindr really cared about promoting the sexual health of the men that used it, they'd put that information front and center in the app... not bury it in the fine print of their website. There's no health information anywhere obvious in the app -- I just downloaded it to check, although I didn't create an account in order to get past the front page.