I talked to Dr. Sarah Guerry and health educator Ana Delia Hernandez, both from the Los Angeles County Department of Public Health’s STD Program. What stuck out to me the most was hearing that females have a greater chance of getting STDs and that they have more STDs than males. I always thought that guys had more STDs. I realized it’s important to get accurate information because what you believe is not always right.
L.A. Youth: What is an STD?
Dr. Sarah Guerry: It is an infection that is passed from one person to another, via sex. And there are STDs and STIs—sexually transmitted diseases and sexually transmitted infections.
L.A. Youth: What is the difference between an STI and an STD?
Guerry: They’re related. HPV is a great example. Human Papillomavirus is an infection that causes disease. It causes genital warts and cervical cancer. Herpes is an infection that causes the disease of painful ulcers (sores) or itching.
L.A. Youth: How are STDs transmitted?
Ana Delia Hernandez: It can’t be an STD if it’s not transmitted by sex, so sex has to be involved. But the definition of sex is really broad. Most people think penis and vagina sex but you don’t actually have to have penetrative sex. It can be rubbing, you know, stuff teenagers will often do. They’re not doing the things that can cause pregnancy but they are touching each other’s genitals. So for bacterial STDs it’s through infected fluid such as infected pre-cum or infected semen or vaginal secretions. Chlamydia and gonorrhea are transmitted through infected fluids. If you don’t use a condom, you can get that. And then there are the ones that are transmitted through skin-to-skin contact. Herpes and genital warts, even if you use a condom, sometimes can still be transmitted because of that friction that happens during sexual intercourse.
Guerry: But I do think that it’s also important to talk about the kinds of sex people have. When I work in teen clinics and I would ask ‘Have you had sex?’ and the kid would say ‘No’ and then I would follow-up with, ‘Well, you know, let’s talk about different kinds of sex. And I’d say ‘penis and vagina sex?’ ‘No’. Penis and mouth sex?’ ‘Oh, yes.’ So I think people really try and play down what they might be doing.
Delia Hernandez: Yeah, so oral sex, vaginal sex and anal sex are ways of transmitting STDs.
L.A. Youth: What’s the most common STD among teens?
Guerry: HPV—Human Papillomavirus—is by far the most common sexually transmitted infection in teenagers. It’s incredibly common. . [There’s the HPV vaccine, which covers two of the four types of HPV that cause the most kinds of cervical cancer and the most warts.] Chlamydia is the most common bacterial STD [among STDs that are required to be reported]. Chlamydia is a really bad STD because it can cause infertility and chronic pelvic pain. We have a really good treatment for it so I think those things make it a reportable disease.
L.A. Youth: Why is this?
Guerry: There are a bunch reasons why teens are more likely to have sexually transmitted diseases. Number one is biology. There’s something anatomically different—primarily about young women because their cervix is more vulnerable to sexually transmitted diseases. Number two, teens are much more likely to have shorter relationships. As people get older, they’ll tend to have one partner for a year. Teens, even if they’re going steady, it’s for a month. Teens are also much more likely not to wear condoms. They’re much more likely to be drinking and trying to not think about what they are doing. They’re much less likely to be going to their doctor and talking about STDs.
L.A. Youth: How can they prevent getting an STD?
Delia Hernandez: First of all, being able to talk about it. A lot of times, people are embarrassed to talk about STDs. And really if you’re not able to talk to your partner about it, then maybe you’re not ready. But ways of preventing STDs are by use of condoms. There is the male condom and now there is the female condom. There are a lot of complaints with the male partner with the condom. They say it’s too tight or whatever so now we have the female condom, which empowers women to take on that role of protecting themselves. And then informing yourself. We always tell people, be careful what you read on the Internet. You want to stay on reputable websites. So anything that comes from the CDC [Centers for Disease Control and Prevention], anything that comes from the health department.
Guerry: Keep your number of sex partners as low as possible. A teen girl can only have one sex partner and she’s at super high risk for having an STD. Abstinence is best and then one partner and ideally choosing that sex partner well. You’ve seen the ads—it’s not who you’re having sex with, it’s who that person has had sex with. So having a talk about sex: ‘Who have you had sex with before? Have you been using condoms?’ Otherwise stay away.
L.A. Youth: Are any contraceptives 100 percent effective in preventing STDs?
Guerry: Yes. Condoms are 100 percent effective at preventing STDs if used consistently and correctly for bacterial STDs (anything that is spread by fluids). So that’s chlamydia and gonorrhea. Unfortunately for herpes and HPV, it significantly decreases your risk but it’s not 100 percent. If the condom is not covering the area where they have the herpes, it’s not going to protect you.
Delia Hernandez: The use of lubricant would be a good idea because you’re cutting back on friction so if things are slippery and slidey, you don’t have the propensity for those tears, which allow the virus to enter the body.
Guerry: In fact, lubricant is a good idea for any kind of sex with condoms. They’re less likely to break.
L.A. Youth: Are STDs treatable?
Guerry: Yes. All STDs are treatable. Chlamydia, gonorrhea and syphilis can all be treated and even cured. Things like herpes, you can’t cure but you can give medicines to make the symptoms go away. And then of course [there’s] HIV, which is also a sexual transmitted infection. You can’t cure it but we have drugs out there [to control it].
L.A. Youth: How difficult is it to live with an STD?
Delia Hernandez: Viral STDs can be lifelong. If somebody acquires herpes at a very young age, you’re going to be 70 or 80 with it. It can be a major toll on them. You think about, nobody is ever going to want to have sex with me, am I ever going to be able to get married, am I going to be able to have children?
Guerry: And then they also have to tell their partners and so I think that emotionally can be really hard for people to do, especially teenagers. They’re embarrassed enough to talk about using a condom and then now they have an STD and how embarrassing to have to track down the people you’ve had sex and say, ‘Hey, by the way, I might have given you something.’
Delia Hernandez: And even going to the clinic can be embarrassing. Oh I got an STD. Why did this happen to me? When in reality it happens to a lot of people.
Guerry: STDs are incredibly common so we need to be comfortable enough talking about it so that people can know that they need to get tested, know that they can go to the doctor and get treated because in the end, all of this is treatable and you can take care of yourself and your partner.
L.A. Youth: You talked about bacterial and viral. What’s the difference between them?
Delia Hernandez: Bacterial we know as treatable but repeatable. Chlamydia and gonorrhea can be cured, which means that if anyone is infected with chlamydia or gonorrhea you can get medication for it and cure that infection. However, if you have intercourse with somebody who is infected, you can get chlamydia and gonorrhea several times, over and over. Viral STDs like herpes, once you acquire it, it’s in your system for the rest of your life. So there’s no way to cure it. You can treat the symptoms but it doesn’t leave your body.
Guerry: With HPV, the virus that causes warts and cervical cancer, most of the time the body can clear it. So it really depends on what the virus is. But for most viral STDs, which include HIV and herpes, it stays with you forever.
L.A. Youth: Do STDs hurt?
Guerry: Depends. The vast majority of women who have chlamydia have no symptoms so it doesn’t hurt. They don’t even know they have it. If it doesn’t get cured then they can have problems. It can cause discharge, it can hurt when you have sex.
Delia Hernandez: For chlamydia and gonorrhea, you can have pain during urination. However, not everybody gets symptoms. This is why STDs are passed around because people can have them and not even know they have them. They continuously have unprotected sex and pass it on to the next person. Herpes hurts because it’s that open lesion so it can cause pain. With HPV, which causes genital warts, you will have a small wart in your genital area and it doesn’t cause any pain.
L.A. Youth: How can you tell if you have an STD?
Delia Hernandez: If you notice anything like pain during urination or you have any kind of discharge from the genital area, those are indicators that there might be an infection.
Guerry: Women are much more likely not to have symptoms but similarly guys who are having anal sex often have zero symptoms at all. If you’re a sexually active teen, you should be going to the doctor at least once a year and getting an STD check, especially if you’re a girl. Women, because of their reproductive tract, have many more complications. So that’s why these recommendations for screening teens, the strongest is around teen girls. And because it’s asymptomatic [shows no symptoms]. Whereas guys know; if they have a drip, they’re going to come in sooner or later.
L.A. Youth: Who’s more likely to get an STD, a guy or a girl?
Guerry: In general, females have more STDs than guys and this is worldwide. Women are more vulnerable to STDs. So if you look at Africa, even though the guys have many sex partners and the women have fewer, there’s more HIV in women. Same thing in the U.S. That’s also complicated by the fact that we have very strong testing programs in females. Women go and see their doctors regularly whereas guys don’t so maybe we’re detecting a little bit more. You do have sub-populations though. Amongst gay men, there is a subset of incredibly high-risk guy, like, gay teens.
L.A. Youth: Where can teens get tested?
Guerry: All over L.A. Calling this number [800-758-0880] is a resource. You can enter in your zip code and it does a clinic locator for you. DontThinkKnow.org has a clinic locator that highlights teen-friendly clinics. If you’re a female under the age of 25 and you live in L.A., you can order a test for chlamydia and gonorrhea and it’ll get sent to you at home and you can test yourself. So you don’t even have to go and see a doctor. Unfortunately, at this point we don’t have a home test kit for guys.
Delia Hernandez: We have 11 L.A. County clinics where you can get tested and treated for STDs, free. You don’t even have to make an appointment; it’s a walk-in basis. You can access the clinic phone numbers and addresses online on the L.A. County Dept of Public Health website.
L.A. Youth: What ethnic group has a higher chance of getting an STD?
Guerry: Well, STDs like everybody. They don’t care who the person is but we’ve seen not only in L.A., but in California and all the nation, that African-American teenagers have much higher rates of chlamydia and gonorrhea than do whites. And then Latina women have at least double the rates of chlamydia than white women do. It’s complicated to say why it’s happening.