Good sex is safe sex

A good time can dangerously lead to a nasty infection. While monkeypox is currently making headlines, the rise of superbugs and persistent threats like HIV and HPV (human papillomavirus) highlight the importance of staying informed and vigilant about safe sex.

The World Health Organization states that there are thirty known transmissible species of bacteria, viruses, and parasites in the STI universe. “These are known to be transmitted through sexual contact, including vaginal, anal, and oral sex. Some STIs can also be transmitted from mother to child during pregnancy, childbirth, and breastfeeding,” the organization said in a statement released in May.

Dr. Jonathan Redelinghuys describes the alarming surge of treatment-resistant gonorrhea and the widespread prevalence of herpes as a “veritable hit parade” of sexually transmitted infections. “It’s like passing the parcel, but you never know when the tune’s going to end on you,” he said.

Treatment-resistant gonorrhea: A growing threat

The numbers are staggering. Every day, over 1 million curable STIs are acquired worldwide among people aged 15–49, according to the WHO. Most are asymptomatic, meaning no symptoms present. In 2020, an estimated 374 million new infections occurred with one of four curable STIs: chlamydia, gonorrhea, syphilis, and trichomoniasis. By 2022, 8 million adults in this age group were infected with syphilis, and more than 500 million people had a genital herpes infection. HPV is linked to over 311,000 cervical cancer deaths annually, and 1.1 million pregnant women were infected with syphilis in 2022, leading to over 390,000 adverse birth outcomes.

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One of the most alarming trends is the rise of treatment-resistant gonorrhea. Dr. Redelinghuys noted, “We are seeing an increase in gonorrhea infections that do not respond to conventional antibiotics, particularly in the US and Southeast Asia. This superbug phenomenon is not as prevalent in South Africa yet, but it poses a significant threat globally. There is a real possibility that gonorrhea could become resistant to all available antibiotics.”

Historically known as “the clap,” gonorrhea is a bacterial infection that causes painful urination and genital discharge. “The clap is not the kind of applause you want after sex,” said Dr. Redelinghuys. The bacteria responsible have demonstrated a remarkable ability to develop resistance to antibiotics, making it increasingly difficult to treat.

Syphilis: The deceptive STI

Syphilis is among the most dangerous STIs due to its deceptive nature. “It starts with a painless sore in the genital area, which disappears on its own,” Dr. Redelinghuys said. “Months later, it can cause rashes and bumps on your hands and feet, and in its tertiary stage, it can lead to severe neurological symptoms. Fortunately, syphilis remains highly treatable with antibiotics, and many people get accidentally cured when treated for other infections with antibiotics, like colds and flu.”

Through global efforts, the rate of new HIV infections remains stable, said Dr. Redelinghuys. “We have seen a plateau in new HIV cases,” he said. “However, the fight is far from over as we continue to address the challenges of prevention and treatment adherence.” Safe sex is prevention.

The silent infector: Chlamydia

Chlamydia remains the most common bacterial STI, with a predilection for mucous membranes. “Chlamydia often causes inflammation in the urethral tract and can lead to pelvic inflammatory disease in women,” Dr. Redelinghuys explained. “It is especially concerning for pregnant women, as it can be passed to the baby, potentially causing blindness. We treat all live births with a topical antibiotic to prevent this.” It can also cause a Bubo, and while the name might sound cute, the pus-filled boils it causes are not.

While Mpox has garnered attention for its prevalence in the gay community in Western countries, it is not solely a sexually transmitted infection. “Mpox requires prolonged skin contact for transmission,” Dr. Redelinghuys said. “In regions like parts of central Africa, where it is endemic, it spreads as a non-sexually transmitted disease through close personal contact.”

Herpes: Still widespread

Herpes remains a widespread infection. “Type 1 herpes, which causes oral herpes, affects about 90% of the US population,” Dr. Redelinghuys said. “Type 2 genital herpes cases have leveled off but are still significant, especially in poorer areas. Many people carry the virus without ever showing symptoms or they are rarely manifest.” Type 2 primarily causes genital sores. Both types can be transmitted via sex and non-sexually, with outbreaks triggered by stress, illness, or a weakened immune system.

HPV is the most prevalent STI, with most people having been infected at some point. “HPV can cause genital warts and, in severe cases, penile and cervical cancer,” Dr. Redelinghuys said. “Vaccination before exposure is crucial, and it’s worth noting that HPV can spread through non-sexual contact as well, such as touching surfaces in public places.”

There are over 100 types of HPV, with about 40 strains affecting the genital area. While most HPV infections are harmless and resolve on their own, certain high-risk types can lead to cancers of the cervix, anus, penis, throat, and mouth. The introduction of the HPV vaccine has significantly reduced the incidence of these cancers.

Unusual infections: The hidden threats

Some unusual infections that are transmitted via sex might be unfamiliar, but they can pose hidden threats. Ureaplasma Urealyticum can cause symptoms like urethritis but often remains asymptomatic. “It can cause inflammation without discharge and may hang around without causing noticeable symptoms,” Dr. Redelinghuys said.

Ureaplasma is part of the normal genital flora in many individuals but can become pathogenic under certain conditions. It is associated with bacterial vaginosis, infertility, and preterm labor in women.

Mycoplasma Genitalium is another challenging STI, affecting both sexes and often going unnoticed. “It can cause fertility issues by creating webbing in the fallopian tubes or scarring the tube connecting the testes to the urethra,” Dr. Redelinghuys said. “It is rare and usually asymptomatic, making it difficult to detect.”

Chancroid: It’s going to hurt

Chancroid, caused by Haemophilus Ducreyi, presents with distinctive symptoms. “It causes painful ulcers in the genital area that can turn into a bacterial infection elsewhere in the body, scarring, and other secondary infections,” Dr. Redelinghuys explained.

It’s all quite concerning, and it underscores the importance of practicing safe sex. “There is just no excuse not to practice safe sex, and intimacy for that matter,” said Dr. Redelinghuys.