• How to stay safe with sexual activity?
• Basically, oral sex has a lower risk of HIV transmission but still can transmit herpes, syphilis, chlamydia, gonorrhoea.
• Handjobs, massages etc can’t really pass anything except if the person has a significant entry point (active bleeding/rashes) on the skin. Contaminations like used massage oil, on the other hand, can be a cause of infection as well.
• Anal sex is an STI partyland.
• Vaginal sex will always have a risk of transmission of STIs but this depends on the encounter itself.
• So basically, staying protected via the use of a condom for all the various activities is recommended. This is level one of protection (the basic minimum that should be done). Levels two and three include medications like exposure prophylaxis (PrEP and PEP) and frequent STI testings (for all parties involved).
So you’d remember in my last article I mentioned the incubation periods of STIs. Well basically, the incubation period is the time between exposure to the infection and when the symptoms start appearing. Simply put, it’s sort of the time taken for the infection to fully develop and overwhelm the body’s defenses. Doesn’t sound very friendly, does it?
Thankfully, as medical research pushes its advancements further and further, we learn more and more about each of these STIs and how they act and react to our interventions. Identifying incubation periods is one of these things and it helps tremendously in terms of preemptively treating someone after exposure or accurately testing and diagnosing a person with a STI.
Why is this important information?
Many adults live among us with infections that are sexually transmitted. A large number of them go about their day symptom-free. Some may not even know that they have an infection. A small number may know about it but fear the stigma that these infections carry, and so keep it to themselves.
So how do we know who’s safe to engage in sexual activities with?
This is where screening comes in handy. It is always wise for all parties to have themselves checked for sexually transmitted infections.
When should you get checked?
There are a few things to consider when deciding on this. Generally, it would be before starting an intimate relationship. That way, not only is there a sense of reassurance, but you can also plan on how to have safe sex if indeed your partner has an STI.
That being said, incubation periods of various STIs should also be taken into account as there is a window period between coming in contact with an infection and testing positive for the infection.
When to do STD Screening?
Sometimes, it’s not a clear-cut situation. Some people may be in open relationships, or there are those who partake in casual sexual encounters. While ideal, it’s not really feasible to have each and every sexual partner tested for infections before an encounter. This is where periodic testing and safe sexual practices come into play.
Given the various incubation periods of infections, how does one decide when and how often testing should be done?
The best approach is to have an open discussion with your physician about your sexual practices so that you can decide on screening options that are best suited to your lifestyle.
However, if such conversations aren’t your cup of tea, here is a general guideline on regular screening:
• All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.
• Annual chlamydia screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection
• Annual gonorrhoea screening for all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
• Syphilis, HIV, and hepatitis B screening for all pregnant women, and chlamydia and gonorrhoea screening for at-risk pregnant women starting early in pregnancy, with repeat testing as needed, to protect the health of mothers and their infants.
• Screening at least once a year for syphilis, chlamydia, and gonorrhoea for all sexually active gay, bisexual, and other men who have sex with men (MSM). MSM who have multiple or anonymous partners should be screened more frequently for STDs (e.g., at 3-to-6 month intervals).
• Sexually active gay and bisexual men may benefit from more frequent HIV testing (e.g., every 3 to 6 months).
Ideally, most people will get tested regularly for STIs as mentioned in the guidelines above. Let’s be honest though, many of us take them, “if it ain’t broke, don’t fix it” approach to health. A more likely scenario is we assume that our partners are STI-free and only see a doctor if things are not quite normal.
Fret not, doctors are not judges; there are no raised eyebrows or smirks when you come with a health-related complaint or concern. That being said, as a sexually active person, it is good to look out for early symptoms of an STI so you can get treatment as soon as possible.
Let’s talk about a few commonly encountered STIs and their incubation periods as well.
The incubation period is very important when it comes to deciding when to test for which infection. This is basically the time taken for your body to show symptoms after being exposed to the infection.
If you are still within the incubation period for that particular infection, testing for it will be futile. The infection will not be significant enough making it nearly undetectable. This theory does not apply if you already have symptoms of the infection though.
Having STD symptoms indicate that the infection is already significantly multiplying and is overwhelming your body’s immune system.
Chlamydia
The average time from exposure to the development of symptoms is usually about one to three weeks after sexual contact with an infected person.
The signs and symptoms of chlamydia infections in women are usually irritation in the genital tract and pain with urination (cervicitis and urethritis). In men, chlamydia is characterized by pain with urination, urinary frequency, and urethral discharge (urethritis).
Gonorrhoea
The incubation period is usually 2 to 5 days. But sometimes symptoms may not develop for up to 30 days.
- Painful or burning sensation when urinating;
- Increased vaginal discharge;
- Vaginal bleeding between periods.
- A white, yellow, or green discharge from the penis;
- Painful or swollen testicles (although this is less common).
- Anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements
(Both men and women can develop infections in the rectum, throat or eyes by having unprotected oral or anal sex.)
Gonorrhoea that affects your eyes may cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes.
Syphilis
The average time between infection with syphilis and the start of the first symptom is 21 days but can range from 10 to 90 days.
The first sign of syphilis usually appears 2 to 10 weeks following exposure. A red, oval sore, called a chancre (pronounced shanker) develops at the site where the bacteria entered the body. Chancres’ are usually painless.
Lesions usually heal without treatment within 6 weeks. A rash frequently appears about 6 weeks to 3 months after the chancre has healed.
We’ll discuss primary, secondary and tertiary syphilis at another time right. Let’s move on to herpes then.
Herpes
Incubation period: For HSV-1, the amount of time between contact with the virus and the appearance of symptoms, the incubation period, is two to 12 days. Most people average about three to six days.
The symptoms may take up to three months to appear in some cases. In others, you may pick up the virus but have it in a quantity that is not enough to overpower the body’s defenses. In situations like this, you would not develop symptoms until the threshold for that is breached.
As such, when we test for herpes antibodies, the test may show you to be positive but you may never have had symptoms suggestive of this. This may come as a surprise but it is entirely possible and common at that.
Pain, sore lips, burning sensations, tingling, or itching occur at the infection site before the sores appear.
The sores may heal spontaneously (without medications) within a few weeks but ideally, take some time to visit your physician for this and we can try to expedite the healing process and minimize scarring if any.
HIV
The earliest time after exposure that HIV infection can be diagnosed is approximately 9 days when HIV-1 RNA becomes detectable in blood. The RNA PCR test can be done in Malaysia but might have a slightly longer turnaround time in some cases. This is also a more expensive test rendering it less commonly requested for here. It is an entirely accurate test though.
After say four weeks of exposure, we can recommend antigen and antibody testing for HIV. This can be done via a rapid test or a standard laboratory test. Always request for a fourth generation test to be done within this time frame.
After three months of exposure is where a third generation test can be accurate. These tests only test for the presence of antibodies to HIV, instead of the antigen itself. This is why it takes more time for this test to be conclusive.
The HIV Pro-Viral DNA test can be used in specific situations where there are challenges to getting an accurate HIV diagnosis with other available HIV tests including HIV Antibody tests (3rd Generation HIV test), HIV Antibody and Antigen tests (4th Generation HIV test) as well as HIV RNA PCR test.
It is especially useful in the following situations:
- Diagnosing HIV in newborns born to HIV +ve mothers
- Elite controllers with undetectable HIV viral load despite not being on anti-retroviral treatment
- Individual with sero-negative HIV infections i.e. People who get infected with HIV but do not develop anti-HIV antibodies : see FALSE NEGATIVE HIV ELISA TEST
It can be used for situations where the diagnosis of HIV is challenging. It has a lower false-positive rate compared to the HIV RNA PCR test when used for diagnosis and it can be done 10 days post-exposure.
Ideally, however, you should be on HIV PrEP if your lifestyle exposes you to an HIV risk. This will minimize the anxiety surrounding the subject significantly.
If, for some reason, you require it; please come to the doctors within 72 hours after a potential exposure for HIV PEP. You can read more about PrEP and PEP in the article here:
In today’s society of modern medicine, we can help a lot with the prevention of HIV. We can provide assistance to ensure that even if you have been exposed to the virus, you do not pick it up and end up with an HIV infection.
However, once you have been diagnosed with HIV, we cannot cure you of it. At that stage, it will be a matter of us managing the virus with the aim of having you not progress through the stages of HIV and minimizing risk to the people around you.
In this sense, prevention really is better than cure.
HPV
Genital warts caused by the Human Papilloma Virus (HPV) can take up to 2-3 months to show. Clinically, there is no reliable test for men. For women, PAP smears should be done after you are sexually active.
We definitely recommend HPV vaccinations should be taken by everyone from ages 9-45 of age. This is regardless of gender and sexual activity.
Vaccination is an important part of sexual health because like HIV and herpes; this is an incurable infection at the moment. It is also something that can be of dire consequences as this virus is known to cause various types of cancer in the population.
Once again, prevention truly is better than cure here as well.
You can read more about this vaccination from this article here:-
As a quick reference, here’s a handy table you can use to decide when is a suitable time for your next test.
STI INCUBATION PERIOD WHEN TO TEST AFTER SUSPECTED EXPOSURE FREQUENCY OF TESTING FOR SCREENING?
TYPE OF TEST(S) AVAILABLE
CHLAMYDIA 1-3 weeks After 3 weeks – PCR testing
After 3 months, antibody testing
GONORRHEA 1-3 weeks After 3 weeks – PCR testing
After 3 months, antibody testing
SYPHILIS 21 days After 21 days
HERPES 3-7 days After at least one week – PCR testing
Antibody testing after at least one month Re-test after one month and three months
HIV 28 days After 10 days, for PCR testing
After 28 days, for Ab/Ag testing Re-test after three months and six months
Retest after a period of one month – three months depending on doctor’s advice.
In conclusion, I’d like you to truly take in the notion that prevention of these infections through various ways is definitely possible. The lifestyles should not be a hindrance in these instances. We have methods that are proven to work to prevent certain infections and we’re here to help you live your best life.
Prevention is much better in my opinion than having to end up tolerating or managing an infection just because of a minor mishap.
With that, my advice is to follow up on your vaccinations, STI testing, practice safe sexual practices with partners that are free of STIs, and be well.
Take care.
