5 FAQs on sexually transmitted diseases that you better know the answers to!

With silent giggles and nudges, everything about sex is usually discussed, except…. Sexually Transmitted Diseases (STDs) and Sexually Transmitted Infections (STIs). We usually pretend like we know it all. But do we really know the answers to all those awkward and uncomfortable yet important questions about sex? We hear about safe sex. What is this safe sex and why is it important to have safe sex? Answering these questions and more, Being Positive, a non-profit organisation organises monthly in-person sexual health meetings in Bangalore. Below are the five most frequently asked questions to the doctors of Being Positive:

1. Do any Sexually Transmitted Diseases (STDs) spread through smooching/ saliva? Does oral sex have higher risk for Sexually Transmitted Infections (STIs)?

Yes, STIs such as syphilis, herpes, gonorrhea and chlamydia can be transmitted during smooching/saliva/oral sex. Rimming can also transmit hepatitis A and B, intestinal parasites like Giardia, and bacteria like E. coli. The chances of an HIV-negative person will get HIV from oral sex with an HIV-positive partner are extremely low. However, it is hard to know the exact risk because a lot of people who have oral sex also have anal or vaginal sex. The type of oral sex that may be the riskiest is mouth-to-penis oral sex. But the risk is still very low, and much lower than with anal or vaginal sex. Though the risk of HIV transmission through oral sex is low, several factors may increase that risk, including sores in the mouth or vagina or on the penis, bleeding gums, oral contact with menstrual blood, and the presence of other sexually transmitted diseases (STDs).

The risk of HIV transmission through oral sex is even lower if the HIV-negative partner is taking medicine to prevent HIV (pre-exposure prophylaxis or PrEP) or the HIV- positive partner is taking medicine to treat HIV (antiretroviral therapy or ART) and is virally suppressed.

2. This might sound silly, but we have extra thin condoms in market, are they safe to use?

Ultra-thin condoms aren’t more likely to break than regular condoms — like all condoms you can find in a drug store or health center, they’ve been rigorously tested for quality, and wouldn’t be on the market if they were more likely to break (that would make them defective).

There are lots of different kinds of condoms out there, in styles like ultra-thin and ribbed, and made of materials like latex, polyurethane, and polyisoprene. They all protect you from pregnancy and STDs, except for natural condoms like lambskin ones, which don’t protect so well against STDs. Condoms are much less likely to break when they’re put on correctly, and used with plenty of lubrication (natural or store bought) to reduce friction. So if you’re concerned about the possibility of the condom breaking, you can prepare by learning how to put on a condom, and buying some lube like K-Y, Astroglide, and ID Glide, which you can get in most drug stores.

Following these guidelines when using any kind of condom will help avoid blowouts or slip-ups:

  •  Keep the condoms out of direct sunlight and away from exposure to high temperatures.
  •  Check expiration dates.
  •  Make sure the package is sealed and has no holes — make sure you can feel an air pocket in each package.
  •  Open the package right before you need it, and use your fingers (not your teeth, which can tear the condom).
  •  Stick with water- or silicone-based lubes rather than oil-based ones.

3. Heard frequent anal sex leads to anal cancer, is it true and how to identify its symptoms?

Yes. Anal sex can lead to infection with human papilloma virus (HPV). HPV infection isn’t cancer but can cause changes in the body that lead to cancer. HPV infections usually go away by themselves but having an HPV infection can cause certain kinds of cancer to develop. These include cervical cancer in women, penile cancer in men, and anal cancer in both women and men. HPV can also cause cancer in the back of the throat, including the base of the tongue and tonsils .All of these cancers are caused by HPV infections that did not go away. Cancer develops very slowly and may not be diagnosed until years, or even decades, after a person initially gets infected with HPV. Currently, there is no way to know who will have only a temporary HPV infection, and who will develop cancer after getting HPV.

Certain men are more likely to develop HPV-related cancers:

  • Men with weak immune systems (including those with HIV) who get infected with HPV are more likely to develop HPV-related health problems.
  • Men who receive anal sex are more likely to get anal HPV and develop anal cancer.

However, some healthcare providers do offer anal Pap tests to men who may be at increased risk for anal cancer, including men with HIV or men who receive anal sex. If you have symptoms and are concerned about cancer, please see a healthcare provider.

There are two steps you can take to lower your chances of getting HPV and HPV- related diseases:

  • Get vaccinated
  • Use condoms

The HPV vaccine is recommended for the following men (2 doses 6 to 12 months apart)

  • All boys at age 11 or 12 years (or as young as 9 years)
  • Older boys through age 21 years, if they did not get vaccinated when they were younger
  • Gay, bisexual, and other men who have sex with men through age 26 years, if they did not get vaccinated when they were younger
  • Men with HIV or weakened immune systems through age 26 years, if they did not get vaccinated when they were younger.

4. What are the chances of getting HIV for men who have Sexually Transmitted Diseases?

If you get an STD you are more likely to get HIV than someone who is STD-free. This is because the same behaviors and circumstances that may put you at risk for getting an STD can also put you at greater risk for getting HIV. In addition, having a sore or break in the skin from an STD may allow HIV to more easily enter your body.

Activities that can put you at risk for both STDs and HIV:

  • Having anal, vaginal, or oral sex without a condom;
  • Having multiple sex partners;
  • Having anonymous sex partners;
  • Having sex while under the influence of drugs or alcohol can lower inhibitions and result in greater sexual risk-taking.

5. Safe sex would help prevent from getting HIV, however are there any vaccinations that may help preventing getting STDs?

There are safe and effective vaccines recommended against hepatitis B, human papilloma virus (HPV), and hepatitis A. Kindly speak to your doctor to see if you can receive them.

Note: Currently, there is no vaccine against HIV, but there are some antiretro viral medicines that are used as PrEP (pre exposure prophylaxis). PEP (post exposure prophylaxis) to be taken within 72 hrs of exposure and to be continued for a month.

Editor’s note: Being Positive next meeting is on relationships and sexual problems on July 15, 2017 between 5.30-7.30pm. 

Venue: HRC clinic, #J97, New no 27, Anjneya Block, 2nd cross Sheshadripiram , Bangalore -20

For more details, you can write to them at  hivinfohealth@gmail.com or call on 8826452691

Where to get an abortion and other sexual and reproductive health services in Kolkata?

Recently Hidden Pockets set out to find different sexual and reproductive health (SRH) services in the city of joy, Kolkata. A primary research of the different health services provided in the city was done before the mapping exercise was undertaken. This research included Internet research and conversations with different individuals, activists and organisations working in the space of public health. The research showed that the status of public health services was inaccessible, unhygienic and crowded. So we decided to picked out a few of the available public health service providers in the city to understand the state of SRH services in the city. Since Family Planning Association of India (FPAI) usually features on our list of recommendations in the cities that we map, we decided to start with FPAI.

What happened to Right to Information?

The FPAI centre in Kolkata is located in Etally. The nearest bus stop is located at 5 minutes walking distance. The centre is located on the inside of a market road. It is a rather old building with a board outside that says Family Planning Association of India and lists all the services provided at the centre. It was hard to miss the strong smell of urine on entering the building premises. It wasn’t the cleanest of centres that we have been to so far, in the country. The first floor has the ward and the office is on the second floor.

On requesting for information about the services provided at the centre, the categorical response given by the medical officer was “Go to the Kolkata headquarters for any information about the services provided here. We will not give you any information.” The staff seemed clearly quite unapproachable. It was quite strange considering that the list of services provided at the centre is listed on the name board displayed outside on the door.

With FPAI off the list, it became important to look into other sexual and reproductive health service centres in the city that were approachable and also provided different services at a reasonable cost. More importantly, were there any reasonable government hospitals in the city providing SRH services?

How good are the government hospitals?

In an attempt to find some answer to that question, SSKM hospital, (located about half kilometer from Rabindra Sadan metro station) was chosen as the next destination. This is a referral hospital along with a medical college attached to it. Reason enough, the hospital is quite large and also usually crowded throughout the day. Located in the centre of the hospital campus, the gynecology department is difficult to locate without any support from the hospital staff. The guard at the gate was quite helpful giving directions to the gynaecology department. Gynecology department is located opposite to the Eye department and diagonally opposite to the Ronald Ross block. However, even with help, it was hard to locate considering the constant crowd on the hospital campus. It is a large department that has a separate building for the neonatal services provided at the hospital.

The cost of acquiring an OPD card in the hospital for all departments is Rs. 2. On checking the OPD registration desk on the ground floor of the building for services provided by the gynecology department and cost involved, we were told to check directly with the gynecology OPD. The administrative staff did not seem approachable. That said, the OPD registration had a constant queue throughout the day. The gynaecology OPD is a clean ward with air conditioning. On requesting from a doctor on duty (an intern), we were asked to talk to the Head of the Department (HOD) of Gynaecology whose office is in the Ronald Ross block. Though Ronald Ross block sounded easy enough, locating the HOD’s office in the building was not easy. The staff and interns that we spoke to, on the ground floor of the building either refused to give any information or said that they are not aware of the office. Being utterly confused in the large hospital, we had to check with several departments including Eye and ENT to be doubly sure of the HOD’s office. Due to sheer exhaustion of locating the different departments and heavy rains, we decided to meet the HOD on day 2.

Eventually on day 2, the HOD’s office was located on the second floor of Ronald Ross building. On landing up at the HOD – Dr. P.S.Chakravorthy’s office, we were asked to come the next day to have a conversation to understand all the sexual and reproductive health services provided in the hospital. Unlike other staff, the HOD was quite approachable and friendly. On day 3, an interview was conducted to understand the different SRH services provided in the hospital. The doctor was willing to answer all questions that were put forth.

Excerpts from the interview conducted:

Sexual and reproductive health services available for men:

“There is a STD clinic in the hospital close to the skin clinic that includes STI and RTI services as well.”

Process of accessing these services:

“The person has to go to the OPD STD clinic and register and see the doctor.”

Most common concerns for men:

“Mostly urethral discharge, burning sensation and gentile ulcers.”

HIV testing centre:

“There is one HIV testing centre that is attached to the blood bank, one to the microbiology lab, one to pathology department and there’s another attached to the antenatal clinc. There may be even more.”

Cost of accessing these services

“Buying the OPD card at Rs. 2 gives access to all services in the hospital including HIV testing centre at no additional cost, for both services and medication.”

AIDs & HIV related services:

“When we find that a person is HIV positive, we send them to the ART centre where they are provided counseling, both the patient and the spouse, medications, lifestyle advices, health education.”

Sexual and reproductive health services available for women

“Same as men and in addition, gynaecology OPD, skin OPD (because of wart). There is an adolescent clinic also – usually for teenage girls related to reproductive problems – menstruation – regular, irregular, pain, discharge etc.”

Medical Termination of Pregnancy (abortion): (Both married and unmarried women)

“We definitely provide abortion services to both married and unmarried women. To us, they are all patients. Irrespective of whether they are rich, poor, no matter the caste or creed, we try to help them.”

Cost of accessing this service

“Even MTP is included in the OPD charges of Rs.2, for MTP involving both medication or surgical intervention.”

SRS services

“The Plastic Surgery department runs the SRS service. It is again, free. In West Bengal, all services provided by the government are free. This also means that we have a lot of crowd here for all services.”

Other sexual and reproductive health services provided

“Family Planning services and Adolescent Friendly Health Clinics are also available.”

A reality check!

Though the doctor confirmed the availability a wide range of sexual and reproductive services, the concerns raised and expressed by people we spoke to accessing the services included:

  • Constant crowd
  • Need to have connections inside or outside the hospital to get access to high quality services
  • Often junior doctors or interns tend to the patient

On having spoken to the Plastic Surgery Department on the SRS service at the SSKM hospital provided in the hospital, Abhirup Kar, President of Civilian Welfare Foundation said, “The concerned person did not know what SRS was. We had to explain it to them and then  We had to explain it to them. We were then told that SRS is not done there and is only a subject of research in the hospital.”

Owing to the concerns raised about government institutions, we thought it necessary to also check with the private institutions on the different SRH services provided. Speaking to Hidden Pockets, a senior gynecologist* with 20+ years of experience said that the price of getting an abortion could range between Rs. 3,500 to Rs.30,000 in any private institution depending on the location. While the cost of getting an abortion could be anywhere between Rs.3,500 to 10,000 in Northern Kolkata, it costs Rs.15,000 to Rs.30,000 in Southern Kolkata depending on the institution and seniority of the doctor.

The senior gynecologist’s (hospital’s) cost breakdown for an abortion was as follows:

Rs. 4,000-5,000 for consultation

Rs.1,000-2,000 for the services

Rs.1,000 or so for medication

____________________

Total: Rs. 7,000-9,000  (cost estimated for his hospital’s services)

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Note: Hidden Pockets studies focus on recommending at least one SRH service provider in any city that we go out after personal assessment of the centre for different parameters. However in Kolkata, owing to the crowd and unfriendly staff, we could not go beyond 2 government service providers during our time there. 

PS: “FPA India clinics may charge, what we prefer to call as a ‘partial user fee’ to the clients for seeking abortion or any other SRH service. This fee is very subsidized and helps the Association meet some running costs. However, all FPA India clinics also have a “NO REFUSAL POLICY”, which states that no client walking into any FPA India facility is denied any service, especially if he/she is unable to afford even the subsidized fee. Thus, poor and marginalized clients can also access quality services in FPAI clinics. Only when the facility is not equipped to provide a particular service (for example some client may need a specialized service, or admission or higher level emergency care) are clients to other facilities.”