STIs (sexually-transmitted infections)
Types
Let’s first address the lingo: an STD and an STI are essentially the same thing. STD stands for sexually transmitted disease while STI stands for sexually transmitted infection. We used to call them STDs but they aren’t, for the most part, diseases but are instead infections. So STI is the new term.
STIs describes any infection that is spread primarily through sexual contact (oral, anal or vaginal). Some infections like yeast and BV (bacterial vaginosis) CAN be spread by sexual contact but they are more often caused by something else, so they aren’t considered an STI.
There are a few main types of STIs. Bacterial STIs include gonorrhea, chlamydia and syphilis. Viral STIs include genital herpes, HPV (which causes genital warts, cervical cancer, penile cancer and throat/mouth cancer) and HIV. Parasitic STIs include trichomoniasis and pubic lice.
The good news is that STIs can be avoided! Barrier protection (condoms and dental dams) and vaccines can help prevent spreading or catching an STI. Regular testing (see section below) can catch STIs that you might not know you have.
Am I going to pass on HSV1 without a coldsore present?
To directly answer your question, yes, it’s possible but less likely than if you had a coldsore present. But before I go into detail I want to explain your terminology to those who are unfamiliar.
HSV1 is a herpes virus that generally causes coldsores of the mouth, while HSV2 is a herpes virus that generally causes herpes lesions of the genital region. While the majority of HSV1 infections are of the mouth and the majority of HSV2 infections are of the private area, it IS possible to swap (meaning you can have HSV1 of the private area or HSV2 of the mouth). This happens through oral sex.
The second thing to address is that herpes is, duh, a virus. Generally speaking, viruses are not “treatable” (meaning we don’t totally get rid of the virus once we catch it) but they are manageable. Sometimes our own immune systems keep the virus in check while other times it’s necessary to take a medication to keep the virus under control. Herpes infections generally “flare” with triggers (like stress) — our bodies are pretty good at controlling the virus until our immune systems allow a “flare.” This is when you have coldsores or genital lesions. It’s also worth mentioning that you never have a herpes infection without first having a coldsore or genital lesion, so don’t worry that you have herpes and don’t know it.
Now, back to the question. There’s something called “viral shedding” that can happen whether it’s HSV1 or HSV2, which describes spreading the virus without an active lesion. So while it’s much more common to spread HSV infections while you have active lesions (coldsores or genital sores), it is possible to spread the virus without any sores at all. For HSV1, to avoid spreading, avoid kissing when you have an active lesion or use barrier protection when performing oral sex. For HSV2, talk with a doctor about a regular medication that can help reduce the risk of spreading to your partners
Symptoms
To keep it simple, you might never know if you have an STI. Many people have symptoms (below) but many do not. For that reason it’s really important that you get testing regularly as recommended by the CDC.
For those with female anatomy, symptoms might include abnormal vaginal discharge, abnormal vaginal odor, pain with sex, pain with peeing, belly pain, genital rash, genital lesions, genital warts, painful swallowing or lesions in the mouth.
For those with male anatomy, symptoms might include discharge from the penis, pain with peeing, pain in the testicles, genital rash, genital lesions, genital warts, pain with swallowing or lesions in the mouth.
Or symptoms might include...none at all! So get tested (next section).
What’s involved in an STI test?
Most STI testing is accomplished with a pee sample (for those with male anatomy), a vaginal swab or pap smear (for those with female anatomy). The vaginal swab is the preferred method through the age of 21 and is SELF-ADMINISTERED — meaning you do it yourself! After the age of 21, vaginal samples are usually collected by the doctor with a pap smear (which also checks for HPV of the cervix).
The important exception is HIV and syphilis testing. Those are checked with a blood sample, usually only the first time you get tested.
Testing
Adolescents are a special population for sexually transmitted infections (STIs). Due to some unique aspects of puberty and development, those under 25 are more likely to catch and transmit STIs. This is why testing recommendations may seem intense, but it’s only for your safety.
Here’s the rundown:
If and when you start having sex it’s recommended that you have a blood test to check for HIV. In some regions of the United States it is also recommended to check for syphilis.
Females having vaginal sex should be tested for gonorrhea and chlamydia every year they are sexually actively.
Males who have sex with men should be tested for gonorrhea, chlamydia and syphilis every year they are sexually active.
If you are symptomatic, seek treatment as soon as possible. For females this might be vaginal itching, pain or discharge. For males this might be penile discharge or pain with urination.
If you have sex with multiple partners or use IV drugs you should be checked more often than once a year.
Your PCP (primary care physician) should be able to perform testing confidentially. Planned Parenthood also provides STI testing. Find a location near you.