Your Honest-to-God Guide to STDs

Chances are, if you’re reading this, you’re scared by the idea of catching some sort of STD. Or at least you have been in the past. That night you got drunk and didn’t have a condom but went for it anyway. Or the guy you hooked up with who had a reputation for sleeping with every third girl in the phone book.

Perhaps you freaked out and rushed to get tested the next morning. Maybe you started Googling around frantically to convince yourself that you’re OK, only to find horrifying images and statistics about how people lost internal organs, limbs and never, ever had sex again because they were so hideously deformed by some pesky infection… Your mind begins racing, your liver DOES hurt, you think to yourself. It must be an early onset of AIDS. Obviously…

Establishing-the-Architecture-of-HIV-2The unfortunate thing about STD “education” is that it focuses on very specific information: symptoms, treatments, and every worst-case scenario. Any real world experiences or likelihood is absent. Down-to-earth guidance on how this information should affect your behavior is usually glossed over — telling you to abstain from having sex (yeah right) and to use a condom (even though it doesn’t prevent everything).

As a result, people start getting paranoid and some serious social stigmas develop.

What’s never discussed is the actual prevalence of STD’s, the realistic chance of catching these STD’s or what the experience of catching them would be like.

I still remember the night a girl I was dating told me that she had HPV. I felt like I was going to vomit. I immediately imagined that my cock had morphed into a giant tumor, shooting pellets of cancer into girl’s cervixes. Or the time one of my best friends told me over the phone that he had what appeared to be a herpes breakout. I nearly cried for the guy. Holy shit. What was he going to do? No woman would ever date him again.

But as I learned more, got tested more, spoke to more doctors and did more research, I realized that the truth is STD’s are more complicated than previously assumed, and that getting many of them would be a far more benign experience than I ever imagined. For instance, there are over 100 strains of HPV, and only four of them lead to most cervical cancers in women, and that’s assuming it’s left untreated for a period of years or decades, and THAT is assuming she hasn’t already been vaccinated, and then even if she does get cervical cancer it’s very unlikely to be fatal. So what I assumed was my cancer-laden pee-shooter in my pants, actually had something like a 1/100 x 1/100 x 1/2 x 1/100 chance of actually killing a girl.

The more I’ve learned about STD’s, the more I’ve encouraged people to relax a little bit about them. I know that sounds crazy, but seriously, relax about them. Wear a condom. Get tested periodically. Stay away from the people with crack habits. Do that, and you’re going to be fine. Seriously.

For instance, about 1 in 1800 people is diagnosed with syphilis in the United States each year.1 By contrast, you have a 1 in 84 chance of dying in a car accident in your lifetime, just to give you some perspective. And the difference is syphilis can be cured with a little penicillin. Car accidents are another story.

The reason most STD information is absolutely terrifying is because 1) terrifying information sells in the media and 2) religious nuts don’t want anybody to have fun.

We do a dismal job of sex education in our culture. And one product of ignorance is fear.

What I aim to do with this article is to break down the most common STD’s in the most realistic way possible. Statistics, symptoms and treatments are listed. Sources are included. But I’m also going to list a couple of other things that you won’t find anywhere else: 1) what the experience of actually contracting that STD would be like; and 2) how likely you are to catch each STD if you had rampant unprotected sex.

In fact, I’ve put together a statistic of my own for each STD: the RAW Score. The RAW Score is a rough estimation of the average number of single Americans you would have to have unprotected vaginal sex with to contract that particular STD. For STD’s which are cureable, I did this by taking the amount of estimated number of cases per year (which is higher than reported number, obviously), and then factoring it into the amount of single individuals in the US (approx. 102 million2) to get a percentage of single individuals who contract said STD each year. For STD’s which are incurable, I simply take the percentage of the American population (about 319 million) with that STD. I realize this method is ridiculous and flawed, but the numbers are so stark that it gets the point across nicely: you’re not likely to catch anything serious any time soon.

And finally, I will say this again and again: use fucking protection. Don’t be an idiot. Use protection, get tested regularly. And one more time, in case some people can’t read: USE PROTECTION, GET TESTED REGULARLY

Chlamydia

Living With It: Uncomfortable… especially for guys when they stick a cotton swab up your peehole. Then you take some pills and it’s gone.
Curable: Yes (2-4 Weeks)
US Prevalence (new cases annually): 2.86 million 3
RAW Score: 36 Partners
Condom Protects: Yes

Chlamydia is a minor bacterial infection mostly transferred through intercourse. In men it’s uncomfortable and generally harmless. In women, there’s a very small chance that if untreated, it can cause some damage to her reproductive system.

Symptoms include burning pee and, dudes, your balls might ache. While 25% of men don’t experience symptoms, a full 70% of women do not experience any symptoms,4 which actually makes it more dangerous for them (most doctors recommend women screen for chlamydia at least once a year).

Gonorrhea

Living With It: Painful. Hope for no pus. Then you take some pills and it’s gone.
Curable: Yes (within a month)
US Prevalence (new cases annually): 570,000 5
RAW Score: 179 Partners
Condom Protects: Yes

Gonorrhea is Chlamydia’s big brother. In fact, the two often occur together. The difference is that gonorrhea can be transferred via any orifice: penis, vagina, anus, mouth. It often takes a few weeks for symptoms to show up, and it’s even more unpleasant to deal with.6

The symptoms for gonorrhea include painful urination, aching balls for guys, swollen urethra, sore throat, and pus coming out of your genitals. Yes, that was pus coming out of your genitals.

Apparently there’s a new strain of gonorrhea which does not react to antibiotics. So this STD has made a bit of a comeback in terms of riskiness. Be careful.

Syphilis

Living With It: Itchy. Then 15 years later you go insane and kill yourself… (no, seriously.)
Curable: Yes
US Prevalence (new cases annually): 55,400 7
RAW Score: 1841 (no, that’s not a typo)
Condom Protects: No

The famous philosopher Nietzsche was a bit of a lush and had a fondness for prostitutes. Somewhere along the way, he contracted syphilis and his body began to wither from the inside out. Over the course of this torturous process, he famously proclaimed “God is dead” and slowly slipped into dementia and died.

Syphilis was the 19th century’s version of the AIDS epidemic. It was famously cured by Alexander Fleming in 1928 and even though it hasn’t been much of an issue since, it is back on the rise, especially among gay men. 8

Syphilis plays itself out in stages. The first stage is you get bumps or breakouts, not dissimilar to herpes I imagine (forgive me for not looking up images.) This happens a few weeks after contracting the virus. From there, after a few months, you break out into rashes. These rashes go on for weeks or months and eventually subside. From there, the you have no symptoms. Then 15-20 years later your internal organs start bleeding, you lose control of your motor functions, and you start losing your mind.

So the moral of the story? Get tested sometime in the next 15 years…ya know, whenever you get a chance.

HPV (High-Risk Strains)

Living With It: A nuisance. A few years of awkward conversations. One painful operation for women.
Curable: No, but it typically leaves on its own after a few years. There is also a vaccine for women and men now9 (get it!).
US Prevalence: 78 million 10
RAW Score: 4 Partners
Condom Protects: No

HPV is where things begin to get interesting. HPV is the latest STD freak-out in the media. If all you’ve heard is the few tidbits that get passed around, it sounds horrifying. Most sexually active men and women will get it at some point in their lives, it causes cancer, condoms don’t protect it, and warts are going to cover your face and you’re going to suffocate to death.

This is all true. OK, the warts on the face and suffocation part isn’t, but the rest is. But what’s more important is the information you DON’T hear. And here it is: there are over 100 strains of HPV. All except for about six of them are basically harmless. And all but two have no symptoms in men. Feeling a little better? Good, let’s keep going…

The two that cause symptoms in men cause genital warts. Warts sound terrible, but they’re completely harmless and can be removed within the matter of days with basic surgery (a few weeks to few months with a self-applied chemical treatment). The other four high-risk strains can, if left untreated, lead to cervical cancer in women. New studies are also showing that oral sex with someone who has these strains can potentially lead to throat cancer down the road.11 But HPV throat cancer rates are still insanely low and the other rare type of cancers caused by HPV are insanely uncommon and almost never fatal.

The good news is that women are getting checked more and more for lesions on their cervix these days. Also, women who do get lesions can have a minor but painful procedure that prevents them from getting cervical cancer, so it’s nothing to freak out about. The HPV vaccine is being given to just about every girl under 26, and again, men can get it now too. And when you factor in that HPV usually leaves your body naturally after a few years (assuming you’re healthy) chances are this is going to be almost a non-issue 5-10 years from now.

If you’re sexually active, chances are you’ve already got at least one strain of HPV. But again, only six out of over 100 are considered high-risk, and you’re far less likely to have those. Women get regular screening for HPV, assuming they see their doctor regularly. Unfortunately, most places are unable to test men for HPV. The only way men can know if they have it is if someone you’re dating tells you they have, or if you happen to find a wart. Either way, it sucks, kind of ruins your week, causes a lot of awkward conversations… but you move on and everything ends up being fine.

Genital Herpes

Living With It: There’s a good chance you already have it.
Curable: No, but who cares?
US Prevalence: 24.1 million 12
RAW Score: 13 Partners
Condoms Protect: No

So I have good news and bad news. The bad news is that a shit-ton of people have herpes (including probably myself). The good news is that the vast majority of people never show symptoms and don’t have enough for it to show up in their blood levels.

I have to admit, Herpes was the big one I was terrified of getting (the reason I’m not worried about HIV is below). Then I started researching it for this article and realized I probably already have it. And chances are you have it too!

See, there are two types of Herpes: HSV-1 and HSV-2. HSV-1 usually causes breakouts around the mouth — we just call them cold sores or fever blisters. Over 80% of the population has HSV-1 although at any given time almost none of us have a break out. HSV-2 causes breakouts around the genitals.13 The majority of people never get breakouts or get such minor breakouts that they don’t even realize that it’s herpes. My friend who has had a breakout said that he originally thought his was just a bug bite. It wasn’t until a second one showed up that he decided to get it checked out. It’s been over three years and he hasn’t had another breakout since. He’s also in a monogamous relationship and his girlfriend has never had a break out.

Herpes never goes away, but it’s harmless. In fact, even if you do get breakouts, most people stop getting them after a couple years. And if you’re one of the unlucky few who actually does get a bad break out, you can take medication to suppress them. So there. Not worried about herpes anymore… After all, I probably already have it, and so do many of you.

HIV

Living With It: Expensive and stressful, but assuming you’re not African, you’ll live.
Curable: No
US Prevalence: 1.1 million 14
RAW Score: 290 Partners
Condoms Protect: Yes

HIV is no longer the death warrant it once was. Don’t get me wrong, contracting it would be awful and surely life-altering. But you would live. I just hope you have good health insurance. As of 2011, the life expectancy of someone who contracts HIV is 40 years from the day they contract it. When in doubt, just look at Magic Johnson.

There are some demographics which are far more likely to catch HIV than others, primarily gay men and drug users. 80% of all HIV cases come from gay man sex or dirty needles. When it comes to vaginal sex, it’s almost impossible for a man to catch it from a woman, while a woman can catch it from a man. But anal sex seems to be the big culprit here.

Also, I hate to say it, but HIV positive cases are predominantly lower income classes. African-Americans account disproportionately for 42% of all HIV cases in the US. The disease practically doesn’t exist in Western Europe at this point.15 And as of 2013, we’re getting some very early accounts of people possibly being cured of the disease.

The symptoms of HIV are flu-like symptoms a couple weeks after contracting it. From there your immune system slowly shuts down over the period of years. There are a lot of therapies and treatments available and most people who contract it are able to live functional, mostly normal lives, assuming they get the proper medical care. So the news on the HIV front over the past few decades has actually been mostly good.16

But still, use a damn condom.

Pregnancy

Living With It: Completely and irreversibly life-changing
Curable: Uhh… err…
US Prevalence: Your mom had it at least once
RAW Score 100 sexual encounters
Condom 85% effective

Over the years I’ve had dozens of people ask me about STD’s, many of them looking for information, but many of them simply looking for reassurance that they were not going to shrivel up and die. I always tell them that 1) they’re going to be fine; and 2) they should be far more worried about babies. Notice the 1 in 100 times. That’s not 100 partners, that’s 100 occurrences of unprotected intercourse. That’s MUCH more likely than anything else listed here with the exception of Herpes.

I can tell you, in all of my years working as a dating coach, with all of my sexual partners, with all of the crazy hedonistic people I partied with, I’ve only known one person who had a herpes break out, a few people with HPV, and one person who had Chlamydia. I’ve never met or even heard of anyone who got HIV. I’ve never met or heard of anyone who got cervical cancer. I’ve never met or heard of anyone who contracted gonorrhea or syphilis. But I can think of probaby a dozen people who have dealt with unwanted pregnancy or had a major pregnancy scare.

Do not fuck around with this.

As a woman, welcome to the growing population of single mothers. Everything is about to change. If you’re lucky, the guy will stick around and help. But if he doesn’t, good luck. Not only do single mothers juggle some of the hardest responsibilities in society, but children of single mothers often grow up to have the most behavioral and academic problems.

If you’re a man and you don’t want to be a deadbeat and run off, then you’re not in for an easy time by any means either. Prepare to cough up half of your paycheck for the next 18 years, even if she marries someone else, even if she becomes financially self-sufficient and you’re broke. You have to pay. The paternity laws in many states are still heavily balanced in favor of mothers and so visitation rights, not to mention custody rights, can be hell to go through. If for some reason you and the mother don’t exactly get along, prepare to hire a good lawyer.

And even if the woman decides to not keep it, welcome to the most gut-wrenching experience of your life. I’m lucky in that I’ve never had to deal with a legitimate pregnancy, but I know people who have — staunch, hardcore, liberal, don’t-give-a-fuck party-goers — and shit gets real, real fast. It’s easy to walk around and say, “I would do this or that,” but when it comes time to walk the walk, many people can’t stomach it. Or even if they can, they live with the guilt for the rest of their lives.

So if you don’t want to be a mommy or daddy, get contraception. If you don’t know or trust someone, use protection. If you’re sexually active, get tested regularly. Have open conversations with your sexual partners about this stuff: “Have you been tested? Are you on birth control?” Yes, it’s awkward. But yes, it’s always worth it.

Stay smart and stay safe.

(Cover image credit: Shawn Latta)

Footnotes
  1. CDC – Primary and Secondary Syphilis — United States, 2005–2013
  2. Office, U. C. B. P. I. Facts for Features: Unmarried and Single Americans Week Sept. 16-22, 2012 – Facts for Features & Special Editions – Newsroom – U.S. Census Bureau.
  3. CDC – Chlamydia Statistics
  4. Board, A. D. A. M. E. (2012, May 31). Chlamydia. PubMed Health.
  5. CDC – Gonorrhea Statistics.
  6. Board, A. D. A. M. E. (2013, April 25). Gonorrhea. PubMed Health.
  7. CDC – Syphilis Statistics.
  8. CDC – STD Data and Statistics.
  9. CDC – STD Facts – HPV and Men
  10. CDC – STD Surveillance – Other STDs (HPV) |
  11. Stock, M. L., Peterson, L. M., Houlihan, A. E., & Walsh, L. A. (2013). Influence of Oral Sex and Oral Cancer Information on Young Adults: Oral Sexual-Risk Cognitions and Likelihood of HPV Vaccination. Journal of Sex Research, 50(1), 95–102.
  12. CDC – Genital Herpes Statistics.
  13. Board, A. D. A. M. E. (2013, August 5). Genital herpes. PubMed Health.
  14. CDC – HIV in the United States – Statistics Overview.
  15. European HIV & AIDS Statistics | AVERT
  16. Board, A. D. A. M. E. (2013, May 19). HIV/AIDS. PubMed Health.
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