Friday, November 13, 2009

Sexually Transmitted Infections (STI’s)

“No amount of money can replace your life. Men like to offer more money for no condom. Be healthy and stay safe.”

If you provide sexual services that involve contact between you and your client, you must take precautions to prevent STI transmission. STI’s are formerly known as “sexually transmitted diseases” or “STD”’s.

The following information comes directly from two sources: Stella’s “Dear Client” handbook, and the BC Centre for Disease Control.

HIV

Acquired immunodeficiency syndrome (AIDS) is characterized by a set of symptoms provoked by a virus that we call the human immunodeficiency virus (HIV), which attacks the immune system (the body’s natural defense system).

HIV can be transmitted through blood, sperm, pre-ejaculatory fluid, vaginal secretions, and breast milk. These biological fluids need to be infected by HIV, then enter into contact with an opening on the skin where it can reach a non-infected person’s blood to make transmission possible.

The activities that put a person at risk for HIV are:
- vaginal or anal penetration without a condom;
- sharing dildos or sex toys without using condoms;
- sharing needles or injection materials (syringes, spoons, filters, etc);
- tattooing or body piercing equipment that is not sterilized.

HIV can be present in the body for years before it shows symptoms. These symptoms occur in various and general ways: fever, night sweats, major weight loss, persistent diarrhea, intense and inexplicable fatigue, cough, and skin rashes.

After HIV has reached the AIDS phase, the immune system becomes very weak and cannot defend itself from simple infections. These infections take advantage of the weakness of the immune system and settle in the body. This is why we call them opportunistic infections. These can be pneumonia, toxoplasmosis or an infection of the brain membrane, or neurological problems. There are very strong medications that slow down the replication of the virus and delay the arrival of the AIDS phase. The result: a sero-positive person can live longer.

However, these medications are extremely costly and carry severe side effects. As well, taking these medications is very complicated. In reality, we are far away from any a “miracle pill”. These medications only slow down the progression of the disease.

Two HIV+ people having sex should still be using condoms to avoid catching another strain of HIV, or one that is resistant to medications. It can make treatment much more difficult and complicated to catch another strain.

It is easier for HIV positive folks to catch other STI's like syphilis, chlamydia, etc, and these infections can be more severe. There has been an increase in HIV positive men who have sex with men catching Hep C through sex. It’s a good idea for HIV+ folks to still get regular STI checks.

The Human Papilloma Virus (HPV)

HPV is a widespread viral infection. In Canada, we estimate that between 20 and 40% of the sexually active population carries HPV.

There are different types of HPV. The most frequent is warts—highly contagious genital warts that are transmitted through direct contact. For example, if there are warts present on the vulva or the inside of the vagina, the transmission to the penis is very likely if there is vaginal penetration.

Warts can also be transmitted by other body parts (fingers, mouth, etc.), or by sex toys that have been in contact with warts. Transmission can also take place through infected genital secretions (pre-ejaculatory liquid, sperm, vaginal secretions), even without penetration.

The shape, size, and colour of warts can vary: they can resemble little cauliflowers, a rooster’s comb, small pimples, or flat lesions, with a head ranging from the size of a hairpin or a nut. They can be pink, red, or the same colour as the skin. Warts can be found at the head of the penis, the shaft of the penis, the testicles, on the inside or the outside of the vagina or anus, in the pubic area, or more rarely in the mouth and on the lips. They can cause an irritating sensation, itching or pain.

If you have symptoms similar to the ones listed here, it is essential that you see a doctor.

Herpes

There are two different types of herpes that affect the mouth and the lips (cold sores); and the penis, the vagina, and the anus (genital herpes). Herpes creates lesions, small ulcers or sensitive wounds that are painful to the touch. The herpes virus is sexually transmitted through direct contact with a lesion through oral, vaginal, or anal sex. For example, during oral sex, a cold sore on the mouth can transmit the herpes virus to the penis. The reverse is also true: herpes on the penis can transmit to the lips of a person who is giving fellatio.

Herpes can also be transmitted if your fingers or hands have been in touch with a lesion and they then touch your partner’s genitals, anus, or mouth. Even if there are no lesions, the risk still exists, because the herpes virus remains in the body for life. There are medications to reduce the intensity and time duration of symptoms of herpes, but they do not eliminate the virus in the body. It is essential to see a doctor if you have any of the herpes symptoms mentioned above.

Hepatitis A and B

Hepatitis is a disease of the liver. Symptoms include yellow-coloured eyes and skin, diarrhea and dark urine, stomachaches, appetite loss, and headaches.

The Hepatitis A virus can be found in feces and can be transmitted through sex that involves licking the anus, penis, or a toy that has been in contact with the anus.

Scat play is a high-risk activity for catching Hepatitis A. As well, if the client or worker does not wash hands after using the washroom, feces particles can remain on the hands and infect someone with Hep A.

Hepatitis B is transmitted through sperm and vaginal secretions. Sexual activities that are most likely to transmit Hepatitis B are the same as the ones that transmit HIV: vaginal or anal penetration without a condom and sharing dildos or sex toys. Hepatitis B is also transmitted through blood and saliva by sharing syringes, razors, toothbrushes, non-sterilized needles for tattooing and body piercing, etc.

Hepatitis A and B Vaccinations

Hepatitis A: 2 vaccines, 6 months apart will make you immune. STI clinics offer this free for men who have sex with men, otherwise buy it at the travel clinic.

Hepatitis B: 3 vaccines at 0, 1 month, 6 months. People born after 1980 probably got this in Grade 6 or as babies. Other people can get it at STI clinics or travel clinic.

Hepatitis C Virus (HCV)

HCV is a virus that attacks the liver, causing inflammation of the liver. Because the liver performs many important body functions, this can have a large effect on health and quality of life. HCV is passed by blood-to-blood contact, like sharing needles, tattoo equipment, razors or toothbrushes.

HCV is quite a hardy virus and can live outside the body (on a needle, razor, etc) for days. HCV is very common in injection drug users. There has been some sexual transmission of HCV, especially if sex involves blood (sex during menstrual period, rough sex, fisting).

People with HCV should use condoms. There has recently been a rise in HIV positive men who have sex with men getting HCV from rough sex or group sex.

Twenty-five percent of people who get HCV get rid of the virus on their own. There is a test to find out if this is what happened to your HCV. People with HCV should avoid alcohol, eat a balanced diet, and have regular monitoring with a doctor.

There is a treatment for HCV. It takes six months to one year and can be tough to get through but it usually works. You cannot get immune to HCV. There is no vaccine and even people who have had the virus in the past have no protection from getting it again, or getting a second strain.

Five percent of HCV positive pregnant women give HCV to their babies.

Syphilis

After the discovery of penicillin in 1943, syphilis had nearly disappeared. Unfortunately, over the past years, syphilis has been on the rise.

This infection is transmitted through oral, vaginal and anal sex. Transmission of syphilis through oral sex is much more common than with HIV. Syphilis has various symptoms throughout its stages of development. These symptoms can easily go unnoticed. In the first stage, syphilis causes a painless ulcer that, for men, can be found on the head of the penis, on the shaft of the penis, the base of the penis, or the pubic area. Indeed, it can be found anywhere on the body of a man or a woman: anus, rectum, lips, vulva, vagina, tongue, tonsils or throat.

The symptoms go away on their own after a few weeks, even without treatment, but the infection continues to progress and the individual is still contagious. Undiagnosed and untreated, syphilis continues to evolve and can create severe complications that can result in infertility, dementia, and cardiac problems. Only a blood test can determine the presence of syphilis. Speak with your doctor. Syphilis is easily treated with antibiotics.

Gonorrhea and Chlamydia

These STIs have the same method of transmission and present the same symptoms. Gonorrhea and chlamydia can be transmitted through oral sex or during vaginal and anal penetration. Gonorrhea is frequently transmitted through oral sex. Chlamydia does not have symptoms in 70% of infected people (7 out of 10 infected people).

Gonorrhea shows more symptoms in people (9 out of 10 infected people), but often it does not show symptoms if it is in the throat or the anus. When they do appear, the major symptoms are:

- green or yellowish discharge from the penis, usually accompanied by pain;
- burning sensation while urinating;
- pain around the testicles or swelling of the testicles.

If the infection is located in the throat or the anus (rectum) and there are symptoms (though this is rare), they will be: a pins and needles sensation, discharge, pus, pain or spots of blood.

Because a lot of people don’t show symptoms and do not know that they are infected, it is recommended that you take regular tests for gonorrhea and chlamydia. To take a test, consult your doctor. Do not forget to ask for a test in your throat and anus. These tests (specifically the tests in the urethra, the path from which both men urinate and ejaculate, and in anus test) can be unpleasant and uncomfortable. Left untreated, these infections can cause a lot of complications and infertility. Once discovered, they are easily treatable with antibiotics.

Risks of Bareback Blow Jobs and Deep French-kissing

BBBJ: Syphilis, herpes, gonorrhea, low but possible risk for HIV (especially if you have sores in the mouth, recent toothbrushing or flossing.)

Deep French-kissing: Herpes, Possible risk for syphilis.

Risks of Analingus and/or Anal Sex

Person performing analingus can get Hepatitis A, or pick up bacteria that cause gastro-intestinal problems. Herpes and syphilis can also be transmitted to either partner this way. Use a barrier and wash well.

Anal sex is a risk for HIV, Herpes, Syphilis, Chlamydia, Gonorrhea, HPV, and Hepatitis B. The person receiving (the bottom) in anal sex is at more risk for HIV. Use condoms.

Infections and How They’re Spread

Genital skin-to-skin contact: Herpes, HPV (the virus that can cause genital warts, or lead to cervical cancer), syphilis, gonorrhea, chlamydia

Any body part skin-to-skin: Staph, crabs, scabies

Saliva: Not many STI's are spread by saliva. There is a very low risk of passing Hep B through saliva. It is a good idea for all sex workers to get vaccinated for Hep B. It also is possible that Herpes may be transmitted by saliva. Meningitis and Mono can be passed this way, as well as the common cold, flu, and strep-throat.

Semen and vaginal fluid: HIV, Hep B

Blood: HIV, Hepatitis B and C

Airborne: Tuberculosis, colds and flu.

STI Testing Options

Blood test: Will test for HIV, Syphilis, and Hepatitis. Usually takes a week or two for results. These tests are not done automatically whenever you do a blood test. Ask for them. There is a rapid test for HIV available now. It can tell you your HIV result in one minute. BUT this test still has a 3-month window period like the regular HIV test. You may still need to get a blood draw done for syphilis/ hepatitis.

Urine test: Will test for Chlamydia and Gonorrhea in men. It's important not to pee for two hours before this test. Women who don’t want a pelvic exam can also request a pee test for gonorrhea and Chlamydia, but it’s not as accurate as the pelvic.

Pelvic exams: Can test for cervical cancer (the “pap” test), and for gonorrhea, Chlamydia, trichomoniasis, yeast, and bacterial vaginosis. These tests are not always done with a pap test. Again, ask for STI tests.

If you have anal or oral sex you may also want to get swabs from your throat and rectum to test for STI’s there.

Guys do not usually need the dreaded urethral swab anymore.

Window periods
(time between catching an infection and showing positive on a test)

HIV - 100% in 3 months, 80% in 6 weeks.
Syphilis - 9-90 days
Hep C - 4-6 months
Chlamydia – 2-6 wks
Gonorrhea - 2 wks to 2 months
Herpes – 3 months on a blood test (this test is not done often as almost everyone is positive)

This can become a little complicated, as there are window periods and incubation periods, which is the time between infection and symptoms. The bottom line is that many STIs never show symptoms, and the best practice is to get routine testing every few months in order to cover possible window periods. Sex workers should test three to four times a year.

If you have a risk (like a condom break), get tested for chlamydia and gonorrhea in two weeks, and get a blood test for HIV and syphilis in three months.

Mandatory STI Testing – Adult Film and Sex Work

Depending on the area of the sex industry you work in, you may be subject to mandatory STI testing from your employer. Some people consider this a violation of their rights because the workers are being tested when it is the patrons who request unsafe sex. Others believe it is responsible management of a business with obvious risks.

Regardless of how you feel about it, your employer may require it of you if you are a sex worker or you work in adult film. This is not a requirement of exotic dancers or other workers (peep shows, phone sex operators, etc) who generally do not have intimate contact with clients or colleagues in the course of their working days.

In Adult Film, you can decide to refuse to do non-condom scenes. That is your right at all times.

1 comment:

  1. Re:There is a treatment for HCV. It takes six months to one year and can be tough to get through but it usually works.

    Treatment success rates vary according to strain, with about an average of 50% "cure" rate on treatment.

    ReplyDelete