Dear Dr. Jeff: I've been involved with the same guy for over six months now, and neither of us is interested in sleeping with anyone else. I'm on the Pill, and we've both been tested for STDs. Is it safe to stop using condoms?-S.H.
Dear S.H.: You're asking a great question and one that we discuss frequently at the Health Center. There are a number of issues to consider.
STD testing can tell you whether or not you have chlamydia, gonorrhea, or syphilis. An HIV test can tell you whether you were infected with the virus at least six months ago but is not very reliable for evaluating more recent possible exposures. If you've been vaccinated against Hepatitis B, then you don't need to worry about that STD.
Then, there's herpes (HSV) and human papilloma virus (HPV). Both viruses can lay dormant and inapparent for long periods of time. There are no good blood tests for either of these viruses. Eighty percent of us have had HSV Type 1 (in the form of cold sores and fever blisters), and HSV-1 now causes about 40 percent of genital herpes infections (transmitted via oral sex). Most cases of genital herpes (whether Type 1 or Type 2) do not present with typical signs and symptoms.
The majority of infections are not recognized by patients or diagnosed by clinicians. One in five HSV infections cause no symptoms whatsoever. And because viral shedding does occur in between outbreaks, most transmission of HSV takes place in the absence of warning signs.
HPV is by far the most prevalent of the sexually transmitted infections. It is thought that a staggering 75 percent of sexually active people contract HPV at one time or another, even though the great majority never know it. At any given point in time, over 20 million Americans have transmissible genital HPV. Each year, over 5.5 million people get HPV, almost all through intimate contact with someone who had no idea they themselves were infected.
The consequences of herpes infections are generally minor and relatively short-lived. The vast majority are overcome by our immune systems without further complications. Infection with certain subtypes of HPV, though, can have far more serious consequences. Two strains cause cellular changes, which can lead to cancer. Fortunately, regular Pap smears effectively pick up early, pre-cancerous changes, and treatment at these early stages is curative.
So S.H., it can be difficult to know with certainty that both of you are completely free of infection. Condoms will definitely help protect you.
On the other hand, maybe you should think through the risks of unprotected sex and the benefits of safer sex like we do other risks in life, such as driving a car. Some of us choose not to drive for fear of getting hurt in an accident. Most of us seem willing to accept some level of risk and try to find ways to reduce it. We wear seat belts, maintain our cars, drive defensively, and avoid driving after drinking.
Safer sex is about figuring out our own "risk limits" and then avoiding activities that fall outside of them. Safer sex practices require self-reflection, at least some basic understanding of the risks and consequences of different infections, and a great deal of communication between partners.
Think hard for yourselves, keep talking it over, and take good care of yourselves-and each other!
Jeff Benson, M.D.
Dudley Coe Health Center