Sexually Transmitted Infections (STI)

For the next few weeks I will be looking at sexually transmitted infections (STI), since they have a great effect on men, sexually. I have used the term ‘sexually transmitted infections’ and not ‘disease’, because of the social stigma associated with a ‘disease’ and not an ‘infection’.{{more}} There are many sexually transmitted infections, but the clinically significant ones are those that are common to us in St. Vincent and the Grenadines and affect the male sexuality. I will therefore focus on the 5 most common ones, namely Herpes, Chlamydia, Gonorrhea, Genital warts and HIV. I know that there are many others, but these are not prevalent in this country (like LGV or GI), or are not predominantly sexually transmitted (like scabies), or rarely affect men (like Candida and Trichomonas).

This week I will start with Herpes, as it is the single most common STI worldwide. It is estimated that 20-40% of the adult US population is infected, and worldwide, as much as 90% of the world’s population. This is because most people who have the virus are not aware of it (only 1 in 6 in the US is aware), because most are without symptoms.

Herpes is the name of a large family of viruses, which can produce symptoms like the common cold or flu, to glandular problems, to skin rashes like chickenpox, to cancers. Some are sexually transmitted and the most common of these are the herpes simplex viruses 1 and 2. Traditionally, the type 1 was spread by kissing and was called the oro-facial type, while type 2, spread by sexual contact, was called the genital type. However, with varying and alternate sexual practices, it is now almost impossible to tell which is which, except by blood tests, as type 1 can be passed to the genitals by oral sex and vice versa. For practical purposes, if the person only has a cold sore called “night fever”, we doctors assume it is the type 1 caused by kissing, but as I said before, it is not always so; likewise, the type 2 tends to cause genital ulcers, but they may be caused by the type 1. From a practical viewpoint, it is immaterial which type it is, as the treatment and pathology is basically the same, even though the social stigma is different.

Herpes was not stigmatized until the late 70s to mid 80s in the US. As I said before, most of the world’s population, including most Vincentians, have evidence of previous herpes simplex infections. Most infections, even though symptomatic, are brushed off as the common cold or a simple rash or skin infection; besides most people do not recognize that the common cold sore is a herpes simplex infection contracted by the act of kissing. So how do you know that you have herpes? Most people who contract herpes simplex for the first time usually have a fever, with mild aches and pains. This is accompanied with or followed by a rash. The rash is classically on the genitals and can be accompanied by swollen glands in the groin. The initial rash comes up as a painful crop of vesicles or “water boils” and can range from the size of 1-2 pinheads, to as large as several 1-dollar coins. The rash lasts for 1-2 weeks and heals with a discolored area. The symptoms disappear, only to reappear several months later, but with less intensity. This cycle will repeat itself indefinitely throughout the person’s life. In other words, these out-breaks will recur every few months, but with less intensity and frequency, so that most people will have one or 2 outbreaks a year. This applies both to the oral and genital type. Some people will “outgrow” their infections, meaning after the first one or two attacks they no longer have attacks. This does not mean that they no longer have infections; instead they become latent carriers or “sleepers”. They can still cause infections in others, hence the reason for the high prevalence of herpes infections. It also explains the reasons why so many have evidence of previous infections, because some get the initial infection, then become carriers, not manifesting the symptoms periodically, but still being able to spread the virus. Next week, I will explain why and talk about treatment and prevention.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com