Let’s Talk About Sex . . . ually transmitted diseases

By Dr. Katie E. Golden, MD

Patients often come to the Emergency Department (ED) for concerns regarding exposures or symptoms of sexually transmitted diseases (STDs). These infections are incredibly common. In 2017 alone, there were 2.3 million cases of gonorrhea, chlamydia, and syphilis diagnosed in the U.S, and the rates continue to rise. According to surveillance reports, Mecklenburg county outpaces both the state and country for cases per year. And these are only the cases that were diagnosed and reported.

As an ED doctor, I do my best to encourage open discussions about sex-related concerns with my patients.  This can be understandably difficult for some people, and so I am here to answer common questions about STDs, and hopefully help our community take a small step towards normalizing the conversation about sexual health.

What are the most common STDs?

The most frequently encountered STDs are gonorrhea and chlamydia (G+C). There are, of course, many types of infections that can be spread through sexual activity: genital herpes, genital warts, syphilis, HIV, hepatitis, trichomonas, to name just a few.  In this article, we will mainly refer to G+C given they are the most common.

 

How do you get infected?

G+C infections are caused by bacteria and are spread through vaginal, anal, or oral sex. While the bacteria is spread through semen and vaginal fluid, it can infect multiple different areas of the body: the penis, vagina, cervix, urethra, even the eyes, and throat. This means that you can develop the infection from contact with a bodily fluid containing the bacteria, or tissue that is already infected. It is important to know that G+C can be spread without penetration or ejaculation.

 

What are the symptoms?

Many people with G+C do not have any symptoms, so you can understand why transmission and infection is so common. The symptoms of infection, furthermore, can be very different from person to person.

Symptoms in people with a vagina include painful or frequent urination, change in the consistency or smell of vaginal discharge, abnormal vaginal bleeding, pain with vaginal penetration, or lower abdominal pain. Symptoms in people with a penis include painful urination, abnormal discharge coming from the penis, and pain or swelling in the testicles. Anal infections typically produce pain (with penetration or pooping), anal itching, discharge, or bleeding from the anus.

 

How do I get tested?

STD testing is easy and readily available. If often requires nothing more than peeing in a cup. If a patient is having more severe symptoms, we will obtain a swab from the cervix, anus, or tip of the penis to collect a fluid specimen. The swab is quick and relatively painless. Testing for other STDs, such as HIV and syphilis, requires collecting a blood sample for analysis.

You should get tested if:

  • You are experiencing any of the symptoms listed above
  • You have had sex without a condom
  • A current or sexual partner is diagnosed with an STD
  • AT LEAST once a year, even if you use a condom (if you have had more than one sexual partner, you should consider testing every 3 to 6 months)
  • If you are pregnant (note that STD testing is a standard part of prenatal care)

You can get testing done at:

  • The public health department, as well as community clinics, where they perform testing for free (there is a list of clinics below for your reference*)
  • Your doctor’s office or Planned Parenthood can also provide testing (though this may come with payment depending on your insurance coverage)
  • We can provide screening and treatment options in the ED, but our resources are limited compared to those at the clinics (for example, we do not test for HIV in the ED unless a patient is exhibiting signs of an acute infection – this is because follow up care and treatment is a crucial part of testing, which we cannot provide from the ED)

 

What is the treatment?

Treatment is simple and effective if the infection is caught early. G+C (and even syphilis) can all be cured with a single, one-time dose of an antibiotic. Some cases require a full week of antibiotics, and your doctor will know which treatment is best for you. When a patient comes to the ED with either a known exposure or symptoms of an STD, we will often treat them for both G+C at the same time as it can be hard to distinguish which bacteria is causing the infection (and testing can take several days).

The most important component of treatment is that it be administered as soon as possible to avoid unwanted complications, as well as the unintentional spread of disease.

 

What happens if I don’t get treated?

There are a number of complications that can arise when an STD is not treated:

  • Patients with a cervix can develop a condition called Pelvic Inflammatory Disease (PID), in which the infection spreads up into the uterus and fallopian tubes. This can lead to infertility, an increased risk of an ectopic pregnancy, and even chronic pelvic and abdominal pain.
  • In patients with a penis, the infection can spread into the epididymis (the tube that carries sperm from the testicles into the urethra), which can cause pain and swelling in the testicles. In rare cases, this can also lead to infertility.
  • Gonorrhea, in advanced and rare cases, can spread to other organ systems and cause a serious infection throughout the body that is sometimes fatal.
  • Untreated infections in pregnant patients can lead to spontaneous miscarriage, or serious infection of the baby during childbirth.

 

If I am sexually active, how do I protect myself?

The only real way to completely eliminate the risk of an STD is to not have sex. Since this is not realistic for most people, the following guidelines are the best way to stay safe:

  • Use a condom! Other methods of birth control help reduce the risk of pregnancy, but they do not protect against infections. Barrier protection methods (condoms and dental dams) are the best way to reduce the risk of contracting an STD. (Please note that STDs can be spread between partners even with proper use of a condom).
  • If you have been treated with an STD, do not have sex until you have completed your full course of treatment (and your symptoms fully resolve). If you were treated with a one-time dose of antibiotics, the CDC recommends waiting 7 days until after treatment to have sex.
  • If you are being treated for an STD, it is critical that you inform your sexual partners, especially given your partner may be infected without symptoms. They should be tested and treated.

 

FREE STD CLINICS IN CHARLOTTE

  1. The Public Health Department
  • Two Locations:
    • 2845 Beatties Ford Road
    • 249 Billingsley Road
  • Hours
    • Mon, Tues, Thurs, Fri: 8-11am, 1-4 p.m.
    • Wed: 10am – 1pm, 3-6pm
  • Info
    • Free screening for HIV, syphilis, chlamydia and gonorrhea is provided on a walk-in basis for those without symptoms (no appointment is needed)
    • If you know you’ve been exposed to an STD or are experiencing symptoms, you’ll need an appointment so they can perform a (free). Call 704-336-6500 to book an appointment.
  • More information about the Health Department’s STD testing can be found here
  1. Community Clinics (all offer free HIV, Syphilis, Hepatitis C, G+C screening)
  • Second Tuesday of each month
    • Location: Lake Norman Free Clinic, ​14230 Hunters Road, Huntersville
    • Hours: 11am – 12:30pm
    • Note: Spanish counseling available
  • ​Every Tuesday
    • ​Location: Northpark, 251 Eastway Drive, Charlotte
    • Hours: 6-8pm
    • Note: Spanish counseling available ​
  • Every Wednesday
    • Location: RAIN, 601 E. 5th St., Suite 470, Charlotte
    • Hours: 5-7pm
  • Second and Fourth Thursday of each month
    • Location: Goodwill Opportunity Campus, 530 Wilkinson Blvd, Charlotte
    • Hours: 12:30-3:30pm
  • More information about these clinics can be found here