Greetings from Fenway Health and The Fenway Institute. It seems like many social topics have awareness days, weeks or months. Some of these may seem trivial (for example, Grilled Cheese Sandwich Day was Friday April 12, 2013), while others remind us of our community’s histories of struggle and triumph, and the lessons we should not forget (e.g., Black History Month, World AIDS Day, the Transgender Day of Remembrance, International Holocaust Remembrance Day, etc.).
April is STD awareness month. And while not as laden with as much pain and triumph as the events mentioned above, there is something timely about it.
I was chatting with a friend earlier and I was talking about a current uptick in gonorrhea cases and how it was something important to highlight for STD Awareness Month, and he said—“’Like people need to be aware of the clap?’ ‘It is like a spike up your…’”
And while my friend may have been clever, the truth is that many cases of gonorrhea are asymptomatic. The type of this common bacterial infection men are the most familiar with is of the urethra——the opening at the tip of the penis. These infections tend to inflame the genitals causing burning during urination, discharge, and often perpetual pain in the groin. The symptoms are not something most men would ignore, and although treatment is simple—an injection of ceftriaxone—a visit to a medical provider is necessary to resolve the situation. Gonorrhea (GC) can also spread to others from the vagina, rectum, and throat. Vaginal/urethral GC diagnosed by way of a simple urine test. Pharyngeal (throat) and rectal GC diagnoses require the use of site-specific collection swabs, an extra step for medical providers. And a really comprehensive screening for GC includes resistance testing. More on that shortly.
In the last 3 months, diagnoses of gonorrhea at Fenway Health have increased by 35% among men who have sex with men (MSM). Most of these were rectal GC and were asymptomatic. It is likely that enhanced screening at Fenway medical appointments and through our free STD clinic has caused these numbers to increase. More screening equates to more diagnoses, but, even with increased site-specific testing for GC, it is troubling that the disease seems to be gaining momentum, with an estimated 5-10% of sexually active MSM in the Boston area carrying it.
MSM with multiple partners are encouraged to get a comprehensive STD screening every 4-6 months. If, based on sexual history, swabs for GC and chlamydia (CT) are called for; sometimes it may be necessary to inform medical providers of this fact. In many medical practices, just the urine test is often used. And that is not enough for many MSM.
OK, so you’re a gay guy and you get some action here and there. Maybe you have an asymptomatic case of GC or CT, or as commonly happen, both. Why should you care if it isn’t causing you any symptoms? There are a few answers to that question. For starters, you can give it to your partner, your partner can give it back to you in your mouth or penis, and then everyone you hook up with might get it, passing it around over and over. It becomes a personal problem, an interpersonal problem and then a community problem. And perhaps more compelling, GC, CT, syphilis, and herpes infections can make an HIV negative person more likely to contract HIV, and an HIV positive person more likely to transmit it.
There is good news: bacterial diseases like GC, CT and syphilis can be treated and cured with antibiotics. Condoms are not always successful in preventing these diseases, so a rule of thumb: if you’re hooking up outside of a monogamous relationship, get checked out, and if need be, get treated and cured. What if gonorrhea starts to get more complicated? In some areas of the world, there are versions of GC that are resistant to antibiotics. Although these cases are rare in the US, it is of major concern because the cure is no longer simple and the last line of defense in the form of antibiotics is failing. By adopting safer sex practices and eliminating existing infections, we are doing our best to prevent resistant GC from becoming entrenched in our community.
If you have symptoms of a known or unknown exposure to gonorrhea, chlamydia or syphilis, your provider may treat you right away, before tests results are back.
Fenway Health offers comprehensive sexual health screenings by appointment with your provider. If you don’t have health insurance, if you can’t use your health insurance for privacy reasons, or if the co-pays are too high, Fenway will test and treat you for free. Call 617.267.0159 to talk to a friendly neighborhood counselor.