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Sexually Transmitted Infections (STIs)

In May 2008, our guest expert in Le Club's Ask the Expert segment was Dr. Tuhina Biswas, MD, a clinical associate with the department of family medicine at Women’s College Hospital in Toronto.

Dr. Biswas is a family doctor who works at the Bay Centre for Birth Control and its Special Treatment Clinic, which is run by Women’s College Hospital in partnership with the City of Toronto Public Health.

The Special Treatment Clinic offers confidential, comprehensive health services for both women and men, including testing and treatment for sexually transmitted infections, safer sex practices, HIV antibody testing and hepatitis B immunization.

Dr. Biswas completed a women's health fellowship at Women's College Hospital in 2005. She also practices low-risk obstetrics, and teaches and supervises medical students and residents.

Here are Dr. Biswas’s answers to your questions on Sexually Transmitted Infections (STIs):

Q: If two people test negative for sexually transmitted infections, and are having unprotected sex with only each other, is it still possible for them to get a sexually transmitted infection?

A: The short answer is no. The long answer would be that there are other genital infections such as HPV that are spread by casual (not necessarily sexual) contact.


Q: I have an embarrassing problem I am hoping you can help with. My long-time boyfriend recently had a vasectomy, and so we have been having sex without a condom for the first time since we have been together. We had been looking forward to this. But unfortunately it turned out to be quite uncomfortable for me. His semen left an itching and burning sensation on the inside of my vagina, and later that night I experienced a terrible redness, swelling and itching to the outer area, which lasted almost a week. It was so uncomfortable it was almost unbearable! I had to keep reapplying anti-itch cream just so I could go to work.

Have you ever heard of a woman being allergic to her partner's semen? Or is this likely just a really bad yeast infection, with coincidental timing? Or could something else be going on, another STI perhaps? There were no sores or odour, just the itching and swelling. Please help!

A: I would suggest that you see your family doctor to make sure that this is not a vulvovaginal yeast infection or genital herpes. Once these conditions have been ruled out, then you might consider looking into the possibility of a semen allergy, which by the way is a rare condition.


Is HPV actually an STI? I am confused because I have been told both 'yes,' but it is not reportable; and 'no,' it is a virus that some women carry. If it is an STI can I pass it on?

A: Yes, certain types of HPV can be transmitted by sexual contact and cause genital infections, including genital warts and cervical cancer. No, it is not a reportable infection. It is a very common STI, up to 75 percent of people will acquire this infection at some point and not even realise it because most of the time the infection is asymptomatic. HPV can also cause non genital infections, such as warts on hands or plantar warts on the feet.  If you have a genital HPV infection, it is possible to transmit it sexually until the infection is cleared.


Q: I have genital herpes, and had it when I gave birth to my son who is now 13.  It was not active when he was born, and in fact it only comes when I get my period, and not every time.  My son seems to get cancers in his mouth quite often.  Could this be herpes?  Also can I hope that once I go through menopause the virus will stay inactive in me?

A: I assume that you meant "cankers" which are not related to oral herpes infection. Herpes is a lifelong infection, however, with time the outbreaks will happen less frequently but it is still possible to have outbreaks after you go through menopause.


Q: What do you recommend for a recurrence of genital warts?   I have a patient with very small warts on her labia, and wonder what your opinion is.  What information do I offer her to help her make an informed choice about treatment?  Her last outbreak (and only outbreak) was 10 years ago and were removed with cryotherapy. Would you suggest Aldara, letting her own immunity deal with the warts, or cryotherapy again?  Just wondering.

A: It is unlikely that this is a recurrence of her earlier genital warts infection; rather it is another HPV type that has manifested itself as warts.  Aldara (imiquimod cream) helps with clearance of the infection, but it is quite costly.  Also, she would have to apply the cream to the area without applying it to the healthy skin and wash it off in six hours.  It is usually applied three times a week and can be used for up to 16 weeks. I would suggest Aldara if she had extensive genital warts.  The health-care provider application methods include cryotherapy and 85 percent TCA (trichloroacetic acid), which is an effective method as well. The only disadvantage is that the patient will need to have repeat office visits to complete treatment.


How can I be sure that my partner does not have AIDS, if this is too confidential and I cannot even ask our family doctor about it?

A: I think it comes down to trust and having a dialogue with your partner about getting tested. If your partner agrees to share the information and show you test results, then that is one way of being sure. Keep in mind that there is a three-month window period for the HIV test - which means that if there were any recent exposures less than three months ago, then the test will not necessary pick up a recent infection that happened in the last three months.


Q: I was recently diagnosed with herpes and now my husband won't speak to me because he thinks I must have had an affair. I swear I have been faithful to him. We have been together for two years and I have not been with anyone else, but only recently noticed symptoms. Is it possible that I had herpes all these years and never knew it? Or maybe I should be the one suspicious of him of being unfaithful...maybe that's how I caught it? I don't know what to think anymore.

A: Yes!! It is very likely that you had a genital herpes infection and you never had an outbreak to this point, probably because you did not get an outbreak with your initial infection. It is quite possible for the infection to be dormant for a long time, even five to 10 years before you have an outbreak. You are not the first couple to which this has happened.


Q: Is genital herpes likely to flare up when a person suffers from stress/anxiety?

A: Yes, stress, illness, menstruation...outbreaks are more likely to occur with physical or emotional stressors.

Q: Is actual sexual intercourse the only way to contact STIs? Due to some other health problems, I don't have sex and probably won't again but do I need to be concerned / careful that I will ever contact a STI?

A: By "actual" intercourse, you must mean vaginal intercourse? Some STIs are transmitted by vaginal sexual activity, like Chlamydia and gonorrhea. Gonorrhea and Chlamydia can also be transmitted through oral-genital contact. Some infections, such as HPV (human papilloma virus) can be transmitted via skin to skin contact and do not require direct genital intercourse for infection.


Q: I have been diagnosed as having HPV. My question is, have my boyfriend and I just been giving the virus back and forth for the past two years?

A: No, I don't think you have been passing the virus back and forth, if your boyfriend was exposed to the same strain of HPV he is likely clear of the infection.

Usually HPV does not give you a chronic infection like genital herpes. Most HPV infections will clear, especially the types that cause genital warts.  The types that are higher risk types, such as types 16 and 18, can persist and cause cervical cell changes which can cause abnormalities on the Pap smear.


Q: Would you encourage an HIV-positive woman to have a baby? What are the odds that the baby will get HIV? I’m a school nurse and a grade 8 student at our school knows someone who was diagnosed with HIV and worries about the risk of HIV transmission to the baby. I read on the subject and learned that the mother must take anti-HIV drugs, give birth by caesarean and not breastfeed. I wonder how many babies contract the disease.   

A: I would be cautious about encouraging an HIV-positive woman to have a baby.  While there are anti-viral drugs available, there is no way of guaranteeing that the risk of transmission will be 0%. Breastfeeding an infant of an HIV positive mother has high rates of transmission of the virus which is why breastfeeding is contraindicated.


Q: If someone had tested positive for m. Chlamydia on a PCR test, does this just indicate past exposure at some time or does it point to it still being active?

A: A positive Chlamydia PCR test indicates an active infection.


Q: I was diagnosed with pelvic inflammatory disease in 1980 following an emergency admission to hospital. I was hospitalized for close to two weeks and treated with IV antibiotics.  At the time and in the years that following during (what I came to call) flare-ups, I was told that my illness was stress-related and not communicable. I was directed to avoid sexual intercourse during my menstrual cycle and to practice safe sex. As well, I was told there was a good chance I would not be able to bear children as a result of the illness.

Eventually, by about 1985 (after one pregnancy which I terminated by abortion and one childbirth), I was experiencing nearly monthly bouts of intense pain and was being prescribed oral antibiotics by my gynecologist. For some time, my doctor was talking to me about stress and how it was related to the PID and suggested that I take steps to change my life to reduce the stress. I did so in June 1985, with a major work / job change and I've never since experienced a recurrence of the pain and never since needed to seek medical attention or treatment for the illness.  Recently, however, I attended a presentation about sexually transmitted illnesses and was shocked to see PID listed among them.

I'm interested in learning your understanding of this illness and whether or not it's transmitted through sexual contact. If so, I feel dreadful - I've never once warned a partner, never knew I needed to!

A: PID or pelvic inflammatory disease is considered an STI since it is usually triggered by cervicitis (infection of the cervix) by either gonorrhea or Chlamydia. Once it is treated with antibiotics, there is no risk of transmission to your current or future sexual partners so you should not feel guilty about not telling your partners about it. One of the consequences of PID is chronic pelvic pain. Another condition that can cause intermittent pain is endometriosis, which is usually diagnosed by a surgical procedure called a laparoscopy. I hope this helps to clarify your concerns.


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