What I learned about STIs the hard way (and what else kept me up at night)

[Content warn­ing: sex­u­al assault. If that’s a hard top­ic for you, skip #5.]

[Image: tears streaming down near an open mouth with one white pill in it. There's a cotton swab, an orange pill bottle, and a cup of yogurt next to the mouth on a blue and orange background]

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

It’s not the infec­tion that ter­ri­fies peo­ple, but the stig­ma of sex­u­al abnor­mal­i­ty. It’s the scar­let let­ters that I can’t erase from my 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 as scared and heart­sick and nau­seous as I was when I test­ed pos­i­tive at 19 and 22. 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

1 Most people with chlamydia or gonorrhea have no symptoms

I did­n’t know what I did­n’t know when I was 18. 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.”

So when I briefly broke the habit of get­ting test­ed for STIs every oth­er month, I assumed I was fine. I did­n’t have any symp­toms. I was walk­ing to my final exam for Calculus II, tex­ting the guy who saved my name in his con­tacts with heart emo­jis and told me at the end of our pre­vi­ous date, “Thank you for being you.”

[Image: a woman in a white V-neck lying in bed, covering her face with her hands]

“You gave me chlamy­dia,” the bomb dropped. I don’t remem­ber how I apol­o­gized, but he respond­ed, “I’m not livid. You’re young, and I want you to live your life how­ev­er you see fit. I fell in love with you the night we met. But if you’re going to be with oth­er peo­ple, maybe we should­n’t talk.”

My plans for that night:

  1. Hold in my tears for just long enough to ace the cal­cu­lus exam
  2. Lie in bed lis­ten­ing to Comatose by Skillet on repeat
  3. Maybe die?

Until I vent­ed to my friend in England, 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 him, 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. There was no sign the first time. The sec­ond time, I was fuck­ing relieved to get a pos­i­tive test result, because at least I could do some­thing about it. (And no, it did­n’t “feel like a real­ly bad UTI.”)

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.

It was­n’t worth it to dwell on who I might have got­ten the STI from, or whether some­one lied to me when I did­n’t have any proof. That was in the past and not in my con­trol. But I could get treat­ed, tell my recent part­ners to get test­ed if nec­es­sary, and note their results if they report back to me.

Why might someone get a false negative STI test result?

[Image: a hand holding a white clock]

For one, 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. 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.

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

[Image: a woman whose hands form a heart shape with her thumbs and index fingers, in front of her lower abdominal area]

“Oh, chlamy­dia is like catch­ing a cold,” an old­er friend told me. 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 had wreaked hav­oc on my repro­duc­tive organs the whole time I did­n’t know?

“Look, hon­ey,” the 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 get­ting treat­ed, and you’re fine.”

Looking back, I under­stand that, even in 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 tak­ing the antibi­ot­ic that day.

4 The treatment for chlamydia might fuck with your digestion

[Image: a cup of yogurt with strawberries and blueberries]

If your doc­tor pre­scribes 1 gram of azithromycin, maybe don’t take it short­ly before you have plans. You might sit in the near­est bath­room for a half hour, tex­ting your friend you hooked up with, “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 I did. But don’t say I did­n’t warn you.

5 Chlamydia has about a 95% cure rate with azithromycin

[Image: an assortment of pill bottles of different colors on shelves]

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 met up 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, my treat­ment (or his 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%)

I was cured. 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?

They’d be pre­scribed anoth­er course of antibi­otics, of course. Doxycycline, when tak­en cor­rect­ly, is more effec­tive. The main rea­son that azithromycin is usu­al­ly the first choice for chlamy­dia treat­ment, though, is because 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…

[Image: an infographic from the CDC about antibiotic-resistant gonorrhea. Find out more at cdc.gov/std/gonorrhea/arg ]

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

[Image: a diagram of the structure of ceftriaxone, one of the antibiotics used to treat gonorrhea]

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 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

I took a pill to cure the STI that I could­n’t even feel. But there’s no pill to treat the heartache or to shield me from some­one’s ver­bal and phys­i­cal wrath. It does­n’t take away the sink­ing feel­ing in my chest when I 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 (twice) before, but if this post makes one per­son feel less alone, and anoth­er chal­lenge their assump­tions, it’s worth it.


Heads up!

This post was spon­sored by STDcheck. As well, there are some affil­i­ate links in this post, which bring me a com­mis­sion at no extra cost to you.

[Image: STDcheck.com logo]

Image credits:

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

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

1 Response

  1. November 14, 2019

    […] into what makes your per­sona unique. Is it your scathing sense of humor? Your sto­ry­telling and per­son­al expe­ri­ences? Your down-to-earth advice? Distill your best traits, who you’d like to reach out to, and what […]

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