Despite sexually transmitted infections being widespread, there are still misconceptions. It’s imperative that we understand how to manage and prevent life-altering (and sometimes life-threatening) infections — including HPV, meningitis, and HIV.
Our sexual health expert, Dr. Evan Goldstein, busts five of the most common myths about STIs:
Myth #1: The HPV vaccine is only meant for preteen girls.
According to the Centers for Disease Control and Prevention, the human papillomavirus is the most common STI. Nearly 80 million people — about one in four Americans — have HPV. The CDC recommends the HPV vaccine for young women through age 26 and young men through age 21 — except for men who are gay, bisexual, trans, or HIV-positive, in which case the vaccine is also recommended through age 26.
Full HPV evaluation should be standard during everyone’s yearly physical examination. The virus can be detected with either an anal swab or pap smear. There are numerous subtypes of HPV, and the Gardasil vaccine currently has nine subtypes of protection, including high-risk types 16 and 18 — the two linked to the development of anal cancers. If you test negative for any subtypes in the vaccine, the vaccine will be protective, even if you test positive for other subtypes.
Here are some additional factors to consider when determining whether the HPV vaccination is right for you:
• If you are a bottom, you may have an elevated risk, since the added friction can lead to tears and other injuries, enabling the virus to enter your bloodstream.
• How old and sexually active you are may determine not only your risk of contracting HPV, but also the risk of developing issues associated with being HPV-positive, like certain cancers.
• If you are in an open relationship, you may have increased risk of contracting HPV and increased exposure to different HPV strains.
Your two biggest obstacles to obtaining the three-shot vaccine series may be a doctor’s lack of knowledge on the subject, and the costs (between $200 to $300 a shot), especially if you are older, since insurance companies only cover the HPV vaccine for those under 26. That being said, you have a right to demand a better understanding of HPV and its impact, and should still seriously consider getting a vaccine if you have heightened risks.
HPV examinations should be part of your yearly medical checkups. If your doctor only tests via vaginal or anal swabs, you should request an oral test as well. Doctors should do a yearly surveillance in all areas.
Myth #2: Only those under the age of 23 should receive the vaccine for meningococcal disease (meningitis).
While infants, preteens, teens, and young adults have the highest rates of meningococcal disease in the United States, anyone can get meningitis. Outbreaks have increased among men who have sex with men, and people who are living with HIV have increased risks of contracting the disease.
What’s key about the bacteria that causes meningitis is it can be easily spread through saliva (an innocent kiss can transmit it.) Symptoms — including fever, body aches, stiff neck, headache, and rash — can be mistaken for other illnesses. Several urban areas and their corresponding departments of health have issued warnings identifying the following as potentially contributing to increased risk, based on studies of those affected in recent clusters:
• Regularly having close or intimate contact with multiple partners. Simply put, the more people you swap saliva with, the higher your chances of exposure.
• Using dating apps (Grindr, Scruff, etc.). Those who use these apps are generally more likely to have multiple sexual partners, and are therefore more likely to contract (and transmit) infections.
• Regularly visiting crowded venues, such as bars and parties, as well as sharing cigarettes, marijuana, cocktails, drugs, etc. (again, any shared item through which you could have contact with someone else’s saliva).
• Living with HIV. Doing any of the above as an individual living with HIV increases your risk
The meningitis vaccine is safe and effective, with a single dose for those without HIV and two doses for people living with HIV. After five years, you may need a booster dose to stay protected. Meningococcal disease is still (thankfully) rare in the U.S. The CDC reports there were only about 370 cases in 2016. But meningitis is a dangerous disease that can progress quite rapidly, even leading to death in otherwise healthy individuals in as little as 24 hours. So if any of the above risks relate to you, the vaccine could save your life.
Myth #3: Viral hepatitis A and B aren’t sexually transmitted.
Men who have sex with men have a higher chance of getting viral hepatitis, which includes hepatitis A, B, and C — all diseases that affect the liver. According to the CDC, about 10 percent of new hepatitis A and 20 percent of all new hepatitis B diagnoses in the United States are among gay and bisexual men. Many men have not been vaccinated against either, even though a safe, effective vaccine is available.
Hepatitis A can be spread through sexual activity, like rimming, fingering, sharing dildos, and any other possible anus-to-mouth contact. The virus can also be spread through contact with objects, food, or drinks that have come into contact with the feces of a person who has the virus.
Hepatitis B spreads through bodily fluids, such as semen or blood, therefore the hep B virus is very infectious and is easily spread during sexual activity. Hepatitis B can also be spread through sharing needles, syringes, or other equipment used with injection drugs (including hormones).
If you’ve already been vaccinated, you should get checked annually to ensure you still have antibodies to hepatitis A and B, which infers immunity. If not, you need a vaccination to stay safe.
Myth #4: A vaccine for herpes is simply not possible.
According to the World Health Organization, over two-thirds of the global population have herpes simplex virus 1 (commonly known as oral herpes, the infection that causes cold sores), and more than 10 percent have HSV-2 (genital herpes). Herpes is able to evade your immune system so well that it can hide in your body for an entire lifetime, which makes it easy to transmit. One of the most common STIs out there, HSV-2 may never produce symptoms, and people might not know they have it. This also makes finding a vaccine very difficult. Most attempts have failed. However, a vaccine may finally be on the horizon thanks to Harvey M. Friedman, a professor at the University of Pennsylvania, whose vaccine, the subject of a recent successful study, could be tested in humans within two years.
Myth #5: PrEP can only be taken via a daily pill.
A daily regimen of Truvada, used as PrEP, nearly makes it impossible to contract HIV — it is 99 percent effective in preventing HIV transmission when used as prescribed. But that caveat is an important one, since many people struggle to keep up the daily dosing, which obviously translates to lower efficacy. Fortunately, longer-lasting PrEP strategies are also on the horizon, which will help solve the problem of inconsistent daily use. A long-acting injectable PrEP using the medication cabotegravir has been developed and is currently going through phase III clinical trials.
Dr. Evan Goldstein is the Founder and CEO of Bespoke Surgical, the leading private practice specializing in an elite standard of sexual health and wellness care for the modern gay male. As the preeminent leader in the field and with offices in both New York and Beverly Hills, Dr. Goldstein offers concierge-style medical and surgical expertise to the gay community and is dedicated to not only bringing the important issues surrounding gay sexual health to the forefront, but also eliminating stigmas around gay sexuality.