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STIs (Sexually Transmitted Infections)

Edmonton Snapshot

15% of guys tested positive for an STI in the past twelve months (Sex Now, 2014/15)

More than 1/3 of guys in Edmonton were not tested for STIs in the past twelve months (Sex Now, 2014/15)

Numbers don’t lie: STI rates are rising in Edmonton. The only people at absolutely zero risk of catching an STI are those who don’t have sex of any kind. That includes oral sex as well. We know that’s not realistic for most of you. And it doesn’t have to be.

Learning more about STIs will help you make safer sex choices, become more confident when negotiating safer sex practices with your partners, and seek testing and medical treatment when you need to so that you don’t pass STIs unto others.  The more you know, the better you can figure out what level of risk you’re comfortable taking so that you can have a fun and satisfying sex life.

[Note: We talk about HIV prevention and testing in its own separate section]

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Chlamydia is the most common reportable STI in Alberta. In 2013, Edmonton had the second highest rate of Chlamydia in the Province with 5,339 cases reported or a rate of 420.5 per 100,000 persons.

Gonorrhea is the second most common reportable STI in Alberta. In 2013, Edmonton had the second highest rate of Gonorrhea in the Province with 813 cases reported and a rate of 64 per 100,000 persons.

Just over 6% of Edmonton gay and bisexual guys report testing positive for Gonorrhea and/or Chlamydia in the last 12 months (Sex Now Survey, 2014/15).

There are a few common STIs caused by bacteria that you may have heard of (Gonorrhea and Chlamydia) and one you probably haven’t (NGU). Read on to learn more.

[Note: Syphillis is also a bacterial STI but we will talk about it in the next section.]

Gonorrhea & Chlamydia

You can catch these STIs in your urethra (where urine comes out), the back of your throat, your anus (your butt), or your front hole/internal genitalia (for trans guys). Transmission can occur through oral sex, anal sex, frontal sex, or by using shared sex toys like dildos. About half of the time you might have symptoms and feel the infection, but half the time you won’t. That’s why regular, routine testing is very important if you’re sexually active.

If you are feeling symptoms from either of these infections, you’re most likely going to feel it inside your dick. It might burn when you take a leak, some discharge might leak out of your penis (the discharge could be clear, could be white, sometimes it’s a weird greenish colour), or in more serious cases, the infection can cause testicular discomfort—basically your balls might be tender and feel painful. In pre-op trans guys, pretty much the same infections can cause these symptoms in the front hole and its inside parts, also causing itchiness, pain, discharge, bleeding, and even more serious complications if left without treatment.

NGU (Non-gonoccocal urethritis)

NGU can cause pain when you pee, discharge from your urethra, testicular symptoms, or again, no symptoms at all. NGU basically means you have an infection that was passed on through sex into your urethra that is not gonorrhea. It may also have been caused by another bacteria, or even a virus like herpes.

Treatment

Since chlamydia, gonorrhea and NGU are bacterial, they can be treated with antibiotics. If you’re having symptoms, those usually start to go away within a couple of days after taking the antibiotic. You might not think any of these are a big deal, but if they are left alone without any treatment, it can cause some big problems. The infection can move up through your urethra into your body and cause pain in your testicles and prostate. Extreme infections, if left untreated, can even cause pain and swelling in your joints!

Some of the most unpleasant STIs can be those which affect your skin. They can cause blisters, sores, or warts in your genital area or on other parts of your bodies. In this section, we will focus on herpes and syphilis in depth. There are other rarer STIs that affect your skin such as chancroid and LGV which usually cause swollen and tender lymph nodes in your groin and pus-y genital sores. Both are treatable with antibiotics, however, so don’t worry.

Because many skin-related STIs can be passed by skin-to-skin contact, the use of barriers like condoms and dental dams can reduce  the risk of transmission but will not completely eliminate it.

Note: We’ve given HPV-which sometimes causes genital warts- its own section.

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Herpes

The STI on most people’s lips—quite literally—is herpes. Herpes Simplex is a virus that causes “cold sores,” aka those painful blisters you can get on your lips or around your mouth. But you can also get herpes blisters and sores on your genital area as well.

Now here’s something tricky about herpes. There are two types—not-so-cleverly called Herpes Type-I and Herpes Type-II. Most herpes infections on a person’s mouth are Type-I and most infections in your genital area are Type-II. However, you can get either type in one or both places. For example, if you had a cold sore and gave someone a blowjob, you could give them genital herpes. Or vice versa, if you had a herpes blister on your penis and someone gave you a blowjob, you could pass it on to their lips or mouth.

Signs you might have a herpes infection would be a feeling of tingling or pain beneath the skin, maybe some swelling in your groin (lymph nodes), and then the trademark blisters that pop up on your skin. You are most contagious to others when you have active sores, but you can also pass it on right before or after an outbreak. So if you start feeling one coming on, it’s a good idea to take a break so you don’t give it to someone else.

Since herpes is a virus, it cannot be cured but there is medication you can take to either prevent the outbreaks from happening, or make the outbreaks less severe if you already have one. The only test easily available for genital herpes is having an active blister or sore swabbed. If you are diagnosed with herpes, the (sort of) good news is that your first outbreak is usually the worst one and as time goes on the outbreaks often become less common and severe.

Finally, if you have a suspicious sore or a painful blister on your junk and you don’t know what it is, DO NOT PUT ANYTHING ON IT. No creams, no Polysporin, nothing. If that small group of blisters turns out to be herpes, it can easily be spread to other parts of your skin and make your future outbreaks even bigger.

Syphilis

Edmonton Snapshot:
  • Starting in 2003, the number of infectious syphilis cases dramatically increased in the province and a syphilis outbreak was declared in Alberta in 2007.
  • In recent years in Edmonton and across Alberta, MSM have been disproportionately affected by syphilis, accounting for almost 85% of the 300 cases reported in 2015. The number of cases doubled between 2014 and 2015 in Alberta.
  • Just over 1% of Edmonton gay and bisexual guys report testing positive for syphilis in the last 12 months (Sex Now Survey, 2014/15).

Another important sore-related STI is syphilis. Syphilis is transmitted by contact with a syphilitic sore, typically through condomless anal, oral, or frontal sex. Using a condom is your best line of defense against syphilis but keep in mind that syphilitic sores can be present in areas not covered by condoms and other barriers.

This infection comes in stages. During the first stage, a painless sore (chancre) usually develops and will heal on its own. Lots of guys won’t even notice they had one. The sore could occur in your genital region including in or around your anus, and on your lips or in and around your mouth. Even after the sore goes away, the infection stays in your body and can come back in other ways as the stages of syphilis progress.

Eventually, syphilis may cause a rash to develop on your hands and feet, or swollen lumps in your groin, armpits and neck. The rash will also go away but, again, the infection will stay in your body it eventually affects your heart and your brain (causing a change in your vision, hearing, and even your behaviors).

As bad as this sounds, syphilis is a bacterial infection and it can be treated effectively with antibiotics. Testing for it involves a blood test and if you have an unusual sore, it can be swabbed and tested for syphilis too. Regular STI testing is a great way to catch and treat syphilis before it progresses to further stages.

There are some infections that can affect your liver that can be caught through sexual acts—which you may know as Hepatitis A, B or C.

Hepatitis A is passed on through poop. There’s not really a nice way of putting it. You can catch Hepatitis A through contaminated food or water, or sexually through activities like rimming.  If you catch Hepatitis A, you might have some symptoms like yellowing or itchiness of the skin or dark-coloured urine, along with nausea, fever, and fatigue which could last for a few weeks. It eventually goes away, though, and after you catch it once, you develop lifelong immunity against it. But to prevent getting it in the first place you can use barriers like dental dams for rimming, ensure good hygiene is practiced,  or, even better, get vaccinated. Talk to your doctor about the vaccine and if you meet certain criteria, you can get vaccinated at no cost while getting tested for STIs at the STI Clinic.

Hepatitis B is passed on through blood or bodily fluids like cum—through sex or sharing drug equipment like needles. Hepatitis B can be dangerous as you might not know you have it until years later when it’s caused some severe damage to your liver. The good news is that if you were born in Canada and you received your regular vaccinations while you were school-aged, you’ve probably already had the 3-part series of vaccines against Hepatitis B and are therefore already protected. If you are not sure of your vaccination history, you can get a blood test that will check to see if you are protected against Hepatitis B.

Most people consider Hepatitis C to be something that only people who inject drugs get through sharing needles. That’s not totally true. Hepatitis C has now been shown to be transmitted through rougher, higher-risk sexual activities too. Bad news: there is no vaccine to protect you against it.  Good news: brand new treatments are available with very high chances of curing infection.  Make sure you ask about getting tested for Hepatitis C at your next STI screening. Getting tested and treated for Hepatitis C early can reduce your risk of severe liver damage.

When it comes to avoiding any of these infections, you need to take a look at what type of sex you’re having and with who—and figure out exactly what types of risks you’re comfortable with taking in your sex life.

If you are having sex with multiple partners it’s just basic math that you will have a higher chance of catching an STI than if you are only having sex once a year with one person. Having sex under the influence of substances (“Chemsex” or “PNP/Party and Play”) can also impact your capacity for practicing safer sex or put you in contact with guys who may be more likely to have an STI. We talk about how to use sex and party drugs in a safer way here.

Condoms and other barriers remain your best option for preventing STI transmission, although as we’ve mentioned, not even condoms can protect you against all STIs. If you don’t consistently use condoms or you feel like you may have come into contact with an STI some other way, getting tested early can make treatment easier and also prevent you from passing it along to others.