Your Honest-to-God Guide to STDs

Chlamydia

Chlamydia is a relatively minor bacterial infection, mostly transferred through intercourse. In men, it’s uncomfortable and generally harmless. In women, there’s a chance that if untreated, it can cause pelvic inflammatory disease, which can lead to complications with pregnancies or even infertility.

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, which actually makes it more dangerous for women (most doctors recommend women screen for chlamydia at least once a year).¹⁰

Gonorrhea

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.¹²

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.

As for treatment, there’s good and bad news. The good news is that since gonorrhea is a bacterial infection, it can be treated with antibiotics.

The bad news is that there’s been a rise in antibiotic-resistant strains of gonorrhea in the past few years. There is only one class of antibiotics left that can treat it. And health officials are closely monitoring for signs of resistance to our last line of defense while new antibiotics are being researched.

So be careful.

Syphilis

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. Throughout 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.¹⁴

Syphilis plays itself out in stages. The first stage is you develop a sore or sores (usually just one, but not always). This happens a few weeks after contracting the infection and the sore is generally painless. From there, after a few months, you break out into rashes. These rashes go on for weeks or months and eventually subside. From there, 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 and Low-Risk Strains)

HPV is where things begin to get interesting. HPV was the STD freak out in the media a few years back. If all you’ve heard is the few tidbits that get passed around, it sounds horrifying: You can get HPV from vaginal sex, anal sex, or oral sex and most sexually active men and women will get it at some point in their lives. It causes cancer, condoms don’t completely protect against 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 200 strains of HPV and over 40 of them can be transmitted sexually.^18,19 The virus is so common that nearly all sexually active people get infected at some point in their lives. Only some of those strains can cause symptoms: high-risk strains can cause cancer and low-risk strains can cause warts. However, most people never develop any symptoms, even if they do come in contact with the virus. If you do develop symptoms, there is a 91% chance that your body’s immune system will clear the symptoms within 2 years.²⁰

The low-risk strains of the HPV-virus cause genital warts. These strains are called low-risk because they only cause warts and do not cause cancer. Warts sound terrible, but they’re relatively harmless and usually small and painless. There are several treatments available to get rid of them, from laser surgery to applying a cream for a few months.

The high-risk strains can lead to cervical cancer in women, as well as some other types of cancer like throat and anal cancer. Actually, HPV is the leading cause of cervical cancer in women. But here, again, it’s important to know that even most high-risk HPV infections occur without any symptoms, go away within 1 to 2 years, and do not cause cancer. It’s only when high-risk HPV infections persist for many years that they can lead to cell changes that, if untreated, can progress to cancer.

The good news is that women are getting checked more and more for lesions and/or abnormal cells on their cervix these days. A Pap test or Pap smear is recommended for all women between the ages of 21 and 65.²¹

For women who do get lesions, they can have a procedure that prevents them from getting cervical cancer, but it’s pretty painful and follow-ups with your doctor are necessary. That said, you shouldn’t freak out too much about it as it can at least be managed if not completely “cured.”

Your immune system is important in dealing with the virus and preventing recurrences, so it pays to take care of your health if you find out you have HPV. Drink less alcohol,²² stop smoking,²³ eat healthily, and take some supplements.^24,25

Also, the HPV vaccine is being given to just about every girl under 26, and again, men can get it now too. The vaccine called Gardasil protects against two high-risk strains of HPV that together cause 70% of cases of cervical cancer. It also protects against two low-risk strains of the virus that together cause 90% of genital warts. The newer Gardasil-9 vaccine protects against even more strains of the virus.²⁶

So if you’re sexually active, chances are you’ve already got at least one strain of HPV. But again, most of the time this won’t cause any symptoms, and even if you do get symptoms, your immune system usually deals with it within 1-2 years.

Women should get regular screening for HPV once they reach a certain age. Unfortunately, there is no HPV screening for men. Men can only be diagnosed with HPV when they have visible warts. And that sucks, ruins your week, causes a lot of awkward conversations… but you move on and everything ends up being fine.

Genital Herpes

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 the viral load required 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 simplex virus: HSV-1 and HSV-2. HSV-1 usually causes breakouts around the mouth—we just call them cold sores or fever blisters. Almost 70% of the world population has HSV-1,²⁹ although at any given time almost none of us have a breakout.

HSV-2 causes breakouts around the genitals.³⁰ 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 breakout.

Herpes never goes away, but it’s relatively harmless. In fact, even if you do get breakouts, most people stop getting them after a couple of years. And if you’re one of the unlucky few who actually does get bad breakouts, 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

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. Life expectancy for young people living in Europe and North America is only slightly lower than the general population provided you start treatment immediately after a positive HIV diagnosis.

That said, some demographics are far more likely to contract HIV than others: UNAIDS reports gay men and drug addicts who use dirty needles are both 24 times more likely to contract it than the general population globally. When it comes to vaginal sex, both men and women can contract HIV from an infected partner. Anal sex—whether it’s hetero- or homosexual—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.

But HIV infections have been declining to some degree in Europe and North America (more so in Europe).³³ And in 2013, there were some very early accounts of people possibly being cured of the disease, and in 2020, stem cell therapy looks very promising.

The symptoms of HIV are flu-like symptoms a couple of weeks after contracting it. From there, your immune system slowly shuts down over a period of years. There are a lot of therapies and treatments available and most people who contract it can 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.³⁴

But still, use a damn condom.

Pregnancy

Over the years I’ve had dozens of people ask me about STDs, 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 75 sexual encounters. That’s not 75 partners, that’s 75 occurrences of unprotected intercourse. That’s MUCH more likely than many of the STDs listed here.

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 breakout, a few people with HPV, and one person who had chlamydia. I’ve never met or even heard of anyone with HIV. I’ve never met or heard of anyone with cervical cancer. I’ve never met or heard of anyone who contracted gonorrhea or syphilis. But I can think of probably a dozen people who have dealt with an 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 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 US 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 a 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 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.