Dear Dr. Jeff: I've been dating the same woman for over six months now, and we're both committed to not sleeping with anyone else. She's on the pill, and we've both been tested for STDs. Do we need to keep using condoms? K.C.
Dear K.C.: You're raising a great question! I think 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 as 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 even recognized by patients or diagnosed by clinicians. In fact, one in five HSV infections causes no symptoms whatsoever. And because viral shedding does occur between outbreaks, most transmission of HSV takes place in the absence of warning signs or symptoms.
HPV is by far the most prevalent of the sexually transmitted infections. It is thought that as many as 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 genital HPV that is transmissible, and over 5.5 million people are newly infected annually. Over half of those new infections occur in the first six months of sexual activity, almost always through intimate contact with someone who had no idea they themselves were infected or infectious.
The consequences of herpes infections are generally minor and relatively short-lived. The vast majority of HPV infections are overcome by our immune systems and resolve within a year or two without treatment and without further complications. Infection with certain subtypes of HPV, though, can have more serious consequences, causing cellular changes which can lead to cancer. Fortunately, regular screening Pap smears very effectively pick up early, pre-cancerous changes, and treatment at these early stages is curative. Equally fortunately, infection with the two most common cancer-causing strains can be prevented by vaccination with the new HPV vaccine, Gardasil.
So, K.C. It can be difficult to know with certainty that both of you are completely free of infection. Condoms will definitely help protect you both against these unknowns.
On the other hand, maybe you should think through the risks of unprotected sex, versus the benefits of safer sex, like we do other risks in life, such as driving a car. A certain number 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 or in bad weather.
Safer sex is about figuring out your 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.
So keep talking it over, and take good care of yourselves?and each other!
Jeff Benson, M.D.
Dudley Coe Health Center