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The Importance of STD Screening with a Virtual Doctor

August 10, 2021
Dr. Heather Machin

Sexually transmitted diseases (STDs), also called sexually transmitted infections (STIs), are very  common, with around 25 million new diagnoses made yearly in the United States. Young  people, ages 15-24 years of age, appear to be the most prevalent group to acquire and spread  STDs, accounting for about half of newly diagnosed cases in 2018 per the Centers for Disease  Control (CDC). Notably, 1 in 5 people in the United Stated have had an STD.  

Oral, vaginal and anal sexual encounters are the methods of transmission and these infections  vary greatly in their symptoms, severity, curability and prognosis. Treatment has improved over  the years and some lifelong conditions now do not preclude a good quality of life. However,  some of these diseases can be quite quiet in terms of initial symptoms, and screening tests, or  tests to check if a disease is present even when symptoms are not, are a critical way to help  reduce transmission and consequences of these infections.  

Bacterial Vaginosis

Bacterial Vaginosis, not categorized itself as a sexually transmitted disease, is a condition  named for alterations in the normal balance of bacteria in the vagina, which can lead to an  increased risk for susceptibility to STDs, as well as preterm labor. A fishy odor may be noted  after vaginal intercourse, and pain, itching and burning in this area or during urination, as well  as thin, grey-white vaginal discharge, are among associated complaints. Although many cases  of bacterial vaginosis clear on their own, antibiotic treatment may be needed at times.  Currently, there is no recommendation for routine screening for BV. 

Chlamydia and Gonorrhea

Two of the most predominant, but easily treatable STDs, include chlamydia and gonorrhea.  Both can spread through oral, vaginal or anal sex. Though either condition may be  asymptomatic, some suspicious findings include abnormal vaginal or penile discharge, burning  while urinating and pain or swelling of the testicles. Chlamydia and gonorrhea can also reoccur  if infectious sex continues, despite prior treatment. Also, having these infections increases a  woman’s risk to develop pelvic inflammatory disease (PID), which is damage to the internal  reproductive organs, making future fertility a challenge. If infected during pregnancy, risk for  miscarriage, preterm labor, low birth weight or an infection in the fluid surrounding the fetus,  called chorioamnionitis, increases. Newborns of untreated mothers may also suffer postnatal  complications such as eye infections and pneumonia. Pregnant women < 25 years of age, or  older pregnant women at increased risk of exposure to gonorrhea or chlamydia, are typically  screened at their first prenatal visit. Similarly, it is recommended to screen all sexually active  women < 25 years of age, yearly, for gonorrhea and chlamydia, and older women who have  multiple sexual partners. All sexually active gay or bisexual men, should also be screened at  least yearly, but more often depending on frequency of new sexual encounters/multiple  partners. Testing for these diseases can be as simple as a urine sample ordered by a virtual  physician, however it is prudent to discuss symptoms and history to determine the best course  of screening.  

Herpes Simplex Virus (HSV)

According to the CDC, every 1 out of 6 people in the United States has herpes simplex virus  (HSV) infection, oftentimes without knowing it. HSV can be divided into HSV 1, more  commonly known as oral herpes, and HSV 2, known as genital herpes. Although designated  as such, either can occur orally or genitally. Many people are infected with HSV 1 in their  childhood, through non sexual mediated contact with infected saliva. Oral herpes results in  cold sores or fever blisters, around the lip and mouth area. Genital herpes, likewise, can  demonstrate sores throughout the genital region of infected individuals. Lack of active sores  however does not negate infectious activity and the disease can still spread through  unprotected oral, vaginal and anal routes. There is no curative treatment for HSV and the virus  can go into a dormant phase where no symptoms occur for years, though patients are at risk  for recurrent outbreaks, where an antiviral medication may be prescribed. Devastating effects  can occur if left untreated during pregnancy, including life-threatening infection to the newborn.  If there is history of infection or active infection at the time of labor, a Cesarean section may be  indicated. The United States Preventive Services Task Force does not recommend routine screening for HSV in asymptomatic sexually active adolescents or adults, including pregnant  women.  

Syphilis

Syphilis is a bacterial infection spread through sexual contact, and is divided into distinct  phases, first beginning as painless mouth/oral, genital or anal sore(s) several days to several  months after initial exposure. This sore or sores will resolve after a few weeks, even without  medication. Then a body rash develops, sometimes with swollen lymph nodes, general fatigue  and a fever, later. There can be a long period of “latency”, or no symptoms, followed by the  last stage classified by neurological, ocular and cardiac symptoms. This is a curable condition,  but can cause life-long consequences if untreated, including dementia and blindness, and can  lead to death. Screening is indicated for sexually active individuals on a yearly basis, but more  often such as every 3-6 months for high risk features, such as multiple partners. This can be  performed through a blood test, which may be ordered through a virtual physician’s visit.  

Hepatitis B and C

Although there are other methods of transmission, typically hepatitis B may be acquired  through the sexually transmitted routes mentioned above. Hepatitis C is less commonly  sexually transmitted, but spreads through exposure of infected blood, such as in activities like  sharing needles in illicit IV drug abuse. Both conditions, though incited by different viruses,  have the same impact on the liver and symptoms can overlap, with fever, fatigue, yellowing of  the eyes and skin, abdominal pain and changes in urine color. With the exception of  individuals living in extremely low prevalence areas, it is recommended that hepatitis C  screening be given to a person at least once after the age of 18 years. Additionally, although  hepatitis B is a vaccine preventable illness, the USPSTF recommends screening by blood test,  those individuals at high risk such as those who inject drugs or share needles, men who have  sex with men and immunocompromised patients, such as those with HIV, as well as those  living in areas with a 2% or higher prevalence of the hepatitis B surface antigen, regardless of  vaccination status. This is especially important given that hepatitis B is a chronic illness that  will need lifelong treatment and both viruses present a higher susceptibility to liver cancer. 

Human Immunodeficiency Virus (HIV)

HIV, or human immunodeficiency virus, eventually progresses to acquired immunodeficiency  syndrome (AIDS). Fortunately, through screening and early detection, appropriate prophylactic  and supportive agents can be provided to help maintain CD4 counts and stable immune status  in order to prevent, or at least slow, this advancement. It is generally recommended that  adolescents beginning at 13 years, through adulthood, into the 60s, be screened via blood  test, at least once as part of routine health maintenance. For those in higher risk categories,  such as individuals with multiple sexual partners, men who have sex with men and those who  share needles, screening may be advised yearly or with more frequent intervals depending on  individual circumstances. Once again, this is a blood test that may be ordered through a virtual  doctor visit. 

Schedule a STD Screening with a Virtual Doctor

While prevention of any illness is optimal through regular visits with a physician, screening tests  have proven to be useful in early detection of otherwise asymptomatic diseases, allowing for  quicker treatment. In particular, sexually transmitted diseases are relatively easy to screen for  through blood or urine samples. If you have questions or concerns regarding your need to be screened for these conditions, it is quite simple to schedule a virtual visit with one of our physicians at My Virtual Physician, and we can help determine which testing is right for you. In addition, depending on the results, oftentimes follow up guidance or medication can also be  provided! Schedule a visit today!

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