Ask A Gyno: All About STDs
08.23.16
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Anxious small talk was invented for three scenarios: 1) elevator rides with people you vaguely know, 2) that part of the first date when you’re not seated yet and have to stand awkwardly in the busy neck of the restaurant as people bump into you and 3) the gynecologist’s office — pants off, feet in the stirrups.

You notice I did not say Man Repeller, correct? No hoo-ha small talk today, y’all. It’s straight to the STD stuff with Dr. Ronnie Salzman, a New York metropolitan-based obstetrician-gynecologist who has been in practice for 25 years. We asked, she answered.

Have more questions? Add ’em in the comments below.

1) When it comes to STDs, is oral sex more or less risky than genital-to-genital sex?

Both the vagina and mouth are made of the same type of skin, making them both vulnerable to the same infection. They can equally catch Herpes, HPV, Gonorrhea and Chlamydia.

1a) I never use condoms or dental dams during oral (no one does, right?) — exactly how stupid is that?

Latex condoms (NOT sheepskin!) can prevent the transmission of the HIV (AIDS ) virus, but not 100%, due to leakage or breakage of the condom. Latex condoms have also been proven to protect against the transmission of STDs. Of course, there is still plenty of skin not covered (think testicles and groin). These spots could harbor genital warts (caused by the HPV virus) or a variety of skin ulcers, like herpes.

Dental dams…They too offer protection, but the tongue (or whatever) is still exposed.

1b) So what’s the point?

Even though barrier protection is not 100%, latex condoms really lower the probability of infection by decreasing the number of germs that you are exposed to. Let’s say — making up numbers here — that without condoms, you are exposed to 1,000 infectious particles but with condoms you’re only exposed to 50; the chance of being infected is lower!

2) Can you just look at someone’s genitals and tell right away that they’re clean?

Some infections are easily seen, like herpetic ulcers, warts or pus dripping out of the tip. But these very same germs can be there and not be seen.

3) Naked grinding or “messing around” but no oral/penetrative sex: what potential risks are we looking at?

Warts and ulcers (from Herpes or Syphilis) can definitely be transmitted skin-to-skin.

4) I got the HPV shots years ago. Can I cross “contracting warts” off my worry list? What about HPV? Is that the same thing? What about the cancer it causes?

HPV is extremely common and, most of the time, resolves on its own. We start testing for it when a woman is 30 years old, when it is a bit more concerning if it hasn’t cleared spontaneously by then.

Warts are caused by the HPV virus: Human Papilloma Virus, papilloma meaning wart.

The HPV vaccine has greatly reduced the occurrence of warts, and more importantly, HPV-related, potentially pre-cancerous cervical and vaginal HPV infection. BUT, it’s not 100%. Good news: the antibodies stimulated by the vaccine help your body fight it off, even if you do get the infection.

Warts are unsightly and a pain to treat but don’t cause much damage. They are usually caused by the type of virus that does not cause cancer, although you could have the more offensive strains as well.

They will not fall off or go away by themselves, so they must be removed. There are many removal methods, including a prescription liquid for home use. They are more usually removed in the gyno office by:
1. Acid
2. Freezing
3. Electro cautery
4. Lazer

PLEASE remember that most of the time a healthy immune system, especially primed by the HPV vaccine, can limit reinfection and help resolve present infection.

5) Terrified of herpes: how common is it, can’t you still get it if you use protection, and do I need to ask my gyno to do a blood test to see if I have it each time I get checked for STDS?

Ah, herpes, the dreaded virus, so misunderstood!

Herpes, also a virus, lingers in the body and can re-erupt in times of stress and/or during menstruation. Yes, the ulcer/blister that herpes causes is painful, but it doesn’t cause (as far as we know) cancer.

Most people have been exposed to the herpes virus in the form of cold sores on mouths/lips, the antibodies that develop following exposure help fight off future attacks and help resolve them if they occur to the mouth or vagina.

These antibodies are in our blood and can be measured in a blood test. They last forever, so once they show up, you don’t have to be tested again. Antibodies are formed in response to vaccines and infection.
So, yes, they show that you have been exposed, but their purpose is to battle the germs whenever you are infected so that they can prevent infection in the first place, or fight once infected. Think: our bodies’ warriors.

And, alas, yes, you can get herpes even if you use protection.

There are pills that help heal the eruptions (ulcers) and decrease viral shedding, making a “carrier” less infective and less contagious.

6) I’m sexually active and have more than one partner a year…How often should I be getting checked for STDs?

Each new visitor brings with him/her a new opportunity to be infected with something. Therefore, you should be tested with each encounter, but also note that different infections have different incubation times. Let your doctor know about your sexual history so that they can make the right judgement call about whether or not you should come back in a few months to get tested again.

This is a good resource about how the various tests work.

7) In your professional opinion, but also in your opinion as a woman who has lived in this world, what is the best way to ask a partner about their sexual health history, especially if you’re “just hooking up” with someone but not exclusive?

An active sex life is a beautiful thing but it’s a bit dangerous as far as STDS go. Ideally, if you are close enough to someone to be “doing it,” you should be able to just outright ask about their sexual (infection) history.

Someone worthy of you should offer it up and be truthful. If you need help getting the conversation started, try this resource.

All this being said, frequent testing is the best bet because most things are treatable.

Have more questions? Check out our Round Table on Sexual Health or our advice on how to tell someone you have an STD. Dr. Ronnie Salzman has been an obstetrician-gynecologist for 25 years. She’s based in the New York metropolitan area.

Photographed by Krista Anna Lewis. Creative Direction by Emily Zirimis.

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