All the talk about this past summer being the 40th anniversary of the famous “summer of love” got me thinking. Do you actually remember the “summer of love,” or at least the years surrounding it? The invention and availability of “The Pill,” and the then-new practice of “free love” (remember, “Make Love, Not War?”) led directly to the sexual revolution for which our generation became famous.

What you maybe did not hear so much about was the increase in sexually transmitted infections (STIs) as a result of that revolution. Take genital herpes (HSV) infection for example. The levels of the total number of cases in the North American population increased by over 30% in the late 70\’s, 80\’s and 90\’s. Similarly, data on first-time treatment-seekers for genital warts (caused by Human papillomavirus – HPV) show an increase (in their presenting for medical care) of about 500% over the past three decades.

What does that mean for us now? We came of age sexually at the same time that many of the STIs were increasing; therefore, there\’s a good chance that we may have been exposed to one of these infections in the past thirty or so years that we\’ve been sexually active. And since several of these infections can stay in the body indefinitely but cause no symptoms, there\’s also a chance we might not even know that we\’ve been infected.

Which of the STIs am I specifically referring to in the above paragraph? The so-called “persistent viruses,” which include herpes virus, Human papillomavirus, the viruses which cause hepatitis B and hepatitis C, and the Human immunodeficiency virus that causes AIDS. Exactly how long can these viruses remain in the body after you become infected with them? Forever. And how long can they remain “hidden” and cause no symptoms? The first four of the viruses listed above may never cause symptoms, or alternatively, can cause symptoms at any time after you\’ve been infected. The HIV virus can remain silent and cause no symptoms for up to 15 years. In addition, you can become infected with syphilis and have no symptoms for several years as well.

Think about the import of that. It means that if you don\’t know your current, or past, sexual partner\’s (or partners\’) sexual history, you could be at risk for getting one of these infections, or for currently – and unknowingly – having it Even if you haven\’t seen the person who gave it to you in 15 years! If you don\’t think any of this applies to you, please read a list of the known factors which put people at risk for acquiring an STI. These have been extensively studied and are well known.

They include:

1) young age (teens and twenties),
2) a history of being sexually active with multiple partners, and
3) a history of having had even one STI in the past.

Even though the first risk factor doesn\’t apply to us now, the other two definitely do. Even if you have not had multiple partners, do you know that about your partner(s)? Or do you know if your partner(s) have ever had an STI, and perhaps doesn\’t even know it?

I am not being Chicken Little here. In a recent article of the Journal of the American Geriatrics Society, researchers report that adults aged 50 and older account for increasing proportions of HIV/AIDS cases. Specifically, when the trends of people infected with HIV were studied in the state of New Jersey, it was found that in 1992, people aged 50 and older accounted for only 6% of the HIV/AIDS cases; in 2004, this had increased to 26%! The conclusion of the authors of this article states that health care providers need to routinely discuss HIV and other STI\’s with this “older population” (that\’s us) in order to be able to offer prevention or care earlier. And we all know that getting care early in any disease means a better long term prognosis, or a better chance for a cure.

In addition to the above infections, you could be at risk from a more recent sexual encounter of acquiring other of the STIs, such as Chlamydia or gonorrhea. Although infection with gonorrhea usually presents itself with a discharge from the vagina or urinary symptoms – as can Chlamydia – infection with Chlamydia can also remain silent. Also important to know is that you can become infected with gonorrhea even if you\’ve had a hysterectomy; in this case, the major symptoms would be urinary and would include burning or frequency. Although these latter symptoms are usually due to a plain old run-of-the-mill urinary tract infection, if your urine cultures are negative and your clinician cannot find a reason for your symptoms, think back on any recent sexual activity.

So what can you do to protect yourself if you are newly dating after a divorce, or if you just realized that you don\’t know your partner(s)\’ sexual history?

1) Ask your gynecologist to test you for STI\’s when you get your routine pelvic exam or sooner; diagnosis involves extra samples taken from your cervix at the time of your Pap smear and blood tests.

2) Be open and honest with your partner(s) about this issue, and ask directly about their sexual history; if they have not been tested recently (or ever), ask them to get tested for STIs;

3) Use protection during sexual activity; although in recent years it has been found that unfortunately condoms do not protect 100% against getting infected, they do lessen the risk, as do vaginal/dental dams. Only latex and polyurethane condoms should be used.

For further information, go to the CDC\’s website on STIs:

http://www.cdc.gov/std/default.htm

Janet Horn, M.D. Physician