STIs & What I Wish More People Knew About Them

[Content warn­ing: this post con­tains rec­ol­lec­tion of sex­u­al assault. If that's a hard top­ic for you, skip #5.]

I wish we talked about chlamydia the way we talk about strep throat.

It's not the infec­tion that ter­ri­fies peo­ple — a cold is an infec­tion — but the stig­ma of sex­u­al abnor­mal­i­ty. It's the scar­let let­ters that they can't erase from their his­to­ry. "Dirty." Damaged. It's the fear of being undesirable.

Even after all these years of blog­ging about sex­u­al­i­ty, I instinc­tive­ly opened Incognito tabs to research for this post.

But I know that there's some­one out there who just got diag­nosed with an STI, who is scared and heart­sick and nau­seous. This post is for them. (And for any­one who thinks sex ed in America is shit. Which is all of you.)

Table of contents (click to jump to a section):

1. Most peo­ple with chlamy­dia or gon­or­rhea have no symptoms
2. False neg­a­tive (and false pos­i­tive) STI test results do happen
3. Don't dis­miss how seri­ous an STI can be, but also don't assume the worst
4. The treat­ment for chlamy­dia might fuck with your digestion
5. Azithromycin for chlamy­dia has about a 95% cure rate
   • What if chlamy­dia treat­ment fails?
6. Gonorrhea is devel­op­ing antibi­ot­ic resistance
   • Having a peni­cillin aller­gy poten­tial­ly makes treat­ment more difficult

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1. Most people with chlamydia or gonorrhea have no symptoms

Like many Americans, I didn't get "the talk" from my par­ents, and my high school's sex ed failed me. The brief "talk" that I got was my old­er broth­er telling me that chlamy­dia "basi­cal­ly feels like a real­ly bad UTI."

Nobody ever told me that chlamy­dia is asymp­to­matic in 70% of vagi­na own­ers and 50% of penis own­ers who have it. It sound­ed basic AF to my friend in England when I was 18, and he was 19, but plen­ty of grown-​ass American adults don't know, either. And hav­ing symp­toms one time doesn't mean that you always will or vice versa.

2. False negative (and false positive) STI test results do happen

No test is 100% accu­rate. False neg­a­tives for chlamy­dia occur up to 14% of the time, depend­ing on the lab, and false pos­i­tives are odd­ly more com­mon in preg­nant folx. So con­sid­er calm­ing down, giv­ing a part­ner or ex-​partner the ben­e­fit of the doubt about their most recent result, and maybe retesting.

And once you get more accu­rate results, you can get treat­ed, tell recent part­ners to get test­ed if nec­es­sary, and note their results if they report back to you.

Why might someone get a false negative STI test result?

It takes time for an STI to incu­bate and show up on tests. The main thing you need to know is that the soon­er after poten­tial expo­sure you get test­ed, the less like­ly the result is to be accurate.

For exam­ple, a neg­a­tive test result for chlamy­dia means you didn't have that infec­tion two weeks ago, but it's not a guar­an­tee that you didn't have it at the time of test­ing. You can get test­ed for chlamy­dia two days after play­ing with a new part­ner, sure. But the clin­ic might rec­om­mend you retest in two to six weeks.

Another pos­si­ble rea­son for a false neg­a­tive STI test result is not wait­ing long enough between the time you last peed and the time you leave a urine sam­ple. Generally, an hour is enough, but wait­ing 2, 3, 4, or more hours yields more accu­rate results. Collecting a sam­ple from your first piss in the morn­ing is ideal.

And final­ly, there's no such thing as a per­fect test. While mod­ern tech­niques are fan­tas­tic, there's always a trade-​off between sen­si­tiv­i­ty and speci­fici­ty. Some tests are bet­ter at detect­ing who does have an infec­tion. Some are bet­ter at rul­ing out infec­tion among those who don't have it.

Tl;dr

While some peo­ple say, "The only way to be sure of your STI sta­tus is to get test­ed," even that's not a guar­an­tee. You have to get test­ed at the right time. I have my rea­sons for often want­i­ng to get test­ed and retest­ed, despite oth­ers think­ing it's overkill.

3. Don't dismiss how serious an STI can be, but also don't assume the worst

"Oh, chlamy­dia is like catch­ing a cold," I've heard before. Which is most­ly true. Chlamydia, when detect­ed and treat­ed ear­ly, isn't a big deal. Chlamydia left untreat­ed can cause pelvic inflam­ma­to­ry dis­ease (PID), infer­til­i­ty, and death.

Ever go down the Web MD rab­bit hole and think you might die soon? Yeah, 18-​year-​old me was more than a lit­tle freaked out when she read that PID, like chlamy­dia, can be asymp­to­matic. What if it wreaked hav­oc on my repro­duc­tive organs and I didn't know?

"Look, hon­ey," a clin­i­cian reas­sured me. "I can tell from just look­ing at you that you don't have PID."

"Why's that?"

"Pelvic inflam­ma­to­ry dis­ease is more when you're in pain and have a fever, and you find out that the cause was chlamy­dia. You're fine."

Looking back, I under­stand that, even on the off chance that I had asymp­to­matic PID:

1. It's not like I could get diag­nosed with some­thing I had no signs of.
2. You can have a his­to­ry of PID, recov­er, and be healthy and able to have kids.
3. The best thing to do was what I was already doing: prompt­ly get­ting help and, where applic­a­ble, tak­ing any pre­scribed meds ASAP.

4. The treatment for chlamydia might fuck with your digestion

If your doc­tor pre­scribes 1 gram of azithromycin, maybe don't take it short­ly before you have plans. A friend sat in his bath­room for a half hour, tex­ting me, "Duuuude, my stom­ach huu­ur­rrts." And, with­out get­ting TMI, there's a rea­son you might need to rehy­drate lib­er­al­ly afterward.

What the fuck, man? See, azithromycin kills a vari­ety of bac­te­ria— not just Chlamydia tra­choma­tis. I've tak­en it for a res­pi­ra­to­ry infec­tion before, too. But the col­lat­er­al dam­age is killing good bac­te­ria in the gut, which might fuck lit­er­al shit up.

Here's my advice for getting through the side effects of azithromycin:

• Take your azithromycin with food. You'll feel a lot bet­ter overall
• Take some pro­bi­otics or eat lots of yogurt before and after
• Stay hydrat­ed to replace lost fluids
• Have the rest of your pro­bi­otics bot­tle ready for recent partners

Every body is dif­fer­ent, and if you're ever in that sit­u­a­tion, you might not expe­ri­ence what my friend did. But don't say I didn't warn you.

5. Chlamydia has about a 95% cure rate with azithromycin

95% sounds fan-​freaking-tas­tic to peo­ple with aver­age luck.

But my luck wasn't aver­age when I was 22, was it? I told an ex-​partner (who insert­ed bare with­out ask­ing, I should add) that I test­ed pos­i­tive, and I got treat­ed. A month lat­er, when we saw each oth­er again, he forced him­self on me with­out pro­tec­tion. In the after­math, I had more than one night of scour­ing PubMed and over­an­a­lyz­ing num­bers on my phone screen at 3 AM.

I found the prob­a­bil­i­ty of, for exam­ple, treat­ment fail­ing AND me get­ting a false neg­a­tive after­ward. It wasn't ratio­nal to fix­ate on that esti­mat­ed half of a per­cent — a 1 in 200 chance. (I assumed that the chance of treat­ment fail­ure was 5% and false neg­a­tive was 10%)

But giv­en my cir­cum­stances, it was hard not to imag­ine that I had freak­ish­ly shit­ty luck and should pre­pare myself accordingly.

So what happens if someone's in that 5% where chlamydia treatment fails?

Of course, they'd be pre­scribed anoth­er course of antibi­otics. Doxycycline, when tak­en cor­rect­ly, is more effec­tive. The main rea­son that azithromycin is usu­al­ly the first choice for chlamy­dia treat­ment, though, is that there's only one dose. Doxycycline for chlamy­dia is 14 dos­es over a week, a hard­er sched­ule to stick to.

On that note: for fuck's sake, fin­ish your antibi­otics. Don't stop tak­ing them just because you feel bet­ter. If you're not cured, the sur­viv­ing bac­te­ria can come back and repop­u­late with a vengeance.

6. Gonorrhea is developing some serious antibiotic resistance...

I've nev­er had gon­or­rhea, but after my assault, a doc­tor rec­om­mend­ed I go through with the treat­ment, just in case: one pill and one shot.

Why two antibi­otics? Because one isn't enough any­more to make sure that gon­or­rhea is dead. And again, if it's not dead, the sur­viv­ing bac­te­ria can mul­ti­ply and thrive, stronger than before. Most of the treat­ments pre­vi­ous­ly used against gon­or­rhea are no longer effec­tive. You might want to buy some con­doms after read­ing that.

…and having a penicillin allergy makes treatment more difficult

The doc­tor looked at my chart and asked, "What reac­tion did you have to the penicillin?"

"Well, I don't per­son­al­ly remem­ber. But I was a baby, and accord­ing to my par­ents, I got a rash all over."

"That does com­pli­cate things— the shot we usu­al­ly use is in the same fam­i­ly as peni­cillin." There's some debate in the med­ical com­mu­ni­ty about the cross-​reactivity between peni­cillin and cef­tri­ax­one. Nevertheless, aller­gic reac­tions are unpre­dictable. We didn't want to risk me going into ana­phy­lax­is to pre­emp­tive­ly treat some­thing I prob­a­bly didn't have.

It would take some time for the clin­ic to acquire the alter­na­tive treat­ment, a gen­tam­icin shot, so the doc­tor decid­ed to wait for the test results to come back first.

They all came back negative.

Final thoughts on the stigma against STIs

You can take a pill to cure the STI that you can't even feel. But there's no pill to treat heartache or to shield from someone's ver­bal and phys­i­cal wrath. It doesn't take away the sink­ing feel­ing in one's chest to start a sen­tence, "I've had chlamy­dia—" watch the oth­er person's reac­tion, and fin­ish, "—years ago, and I got treat­ed for it."

I know I'm not immune to the stigma.

And nobody wants to shout that they've had an STI before, but if this post makes one per­son feel less alone and anoth­er chal­lenge their assump­tions, it's worth it.

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Heads up!

This post was spon­sored by STDcheck. It also con­tains some affil­i­ate links, which earn me a com­mis­sion at no extra cost to you.

Image credits:

The fea­tured image and ban­ner at the top are my designs.

Here's where I got the rest of the graphics:

• Di_​An_​h on Unsplash
• Olliss on Unsplash
• Peter Hershey on Unsplash
• Joshua Coleman on Unsplash
• STD pre­ven­tion info­graph­ic from the CDC
• Ceftriaxone mol­e­cule from Wikimedia Commons