Why should parents talk specifically to well-behaved, conscientious kids about sexually transmitted diseases? Isn't it enough to teach them that their bodies should be respected, and that sexual intimacy is a gift to be cherished? If our families and religion promote abstinence, isn't it simply stirring the pot to bring up STDs?
Sadly, the statistics in the United States regarding STDs tell us that the prevalence of these diseases is staggering. Twenty million Americans have active HPV (Human Papilloma Virus, which causes genital warts and cervical cancer), and although most are unaware, 1 in 5 Americans has genital herpes. The time to ignore this large elephant in the room has passed! As the numbers imply, and any primary care physician can attest to, STDs occur across all economic, racial, educational, and social boundaries.
Our media suggests that hookups are carefree fun. We see superstars switching partners as often as the rest of us pay bills. What we do not see is that sexual intimacy of any type—even so-called safe sex—can leave a disease like herpes or genital warts that can have painful recurrences for years. Even worse, a single instance of unprotected sex can result in a partner contracting a silent disease that may lead to serious consequences such as infertility.
When we teach our kids not to smoke, we give them age-appropriate facts. Teens are taught about bad breath or yellow teeth, and then progressively learn about cancers, death, and the oxygen-dependent impaired quality of life that comes with emphysema and chronic bronchitis. Why is it, then, that we simply say, "Don't have sex" and consider that appropriate education?
Our kids are smart—give them some credit. Let's arm them with all the facts that they need to make intelligent, safe decisions about their sexual health. Trust that their religious or personal upbringing provides a solid base, and that learning accurate facts about risks regarding both coital and non-coital intimacy will be complementary, not contradictory.
Remember that regardless of age, youth tend to feel fully mature and capable of making major decisions. Who among us, though, can't look back five or more years and wish we could change a significant choice that we made? It is less than helpful to tell your adolescent that the heartache or passion that they feel is "only puppy love" and that they'll look back on this relationship and laugh in later years. You may be right, but they are not in a place to hear those words. Instead, they will be convinced that you do not understand their feelings, and they may disregard additional advice.
So what can you do? Empathize with their hurt, and caution about their surges of hormonal passion and "true" love. Consider pointing out the number of adult friends that you have who began dating in high school and are happily married. It happens, but not too often. Talk about both emotional and physical consequences to sexual intimacy. Of course, to discuss these things, you have to first know the facts!
Which diseases can be transmitted via skin-to-skin contact, without intercourse? Herpes and HPV are commonly spread in this manner. Pubic lice can be spread directly or through infected bedding or other linens. Syphilis, though far less common, can also be transmitted directly through skin-to-skin contact.
Which diseases are spread by oral sex (meaning one person's mouth on the other person's genitals)? Herpes, herpes, herpes! Herpes Simplex types 1 and 2 are very commonly transmitted through oral sex, and that is true whether or not the person on the mouth end has visible herpes sores. In addition, many other STDs are spread this way, including chlamydia, gonorrhea, and less commonly hepatitis A, B and C, HPV, and HIV.
Why can't condoms fully protect against all these diseases? There are several reasons. The first is basic-male condoms cover one thing, so if the disease is spread outside that area (which is the case for herpes, HPV, pubic lice, and syphilis) obviously the condom cannot help. Secondly, while condoms greatly reduce transmission of STDs transmitted via body fluids (including Chlamydia, gonorrhea, trichomoniasis, and HIV) they have a breakage rate of roughly 11 percent per year, and a failure rate of up to 20 percent in real usage (because people forget them or put them on incorrectly or too late during intimacy).
Why are STDs a big deal? Can't doctors cure most of them? We happily do have cures for the bacterial STDs, which include Chlamydia, gonorrhea, and trichomoniasis. The trick is knowing that these diseases are THERE, because many are silent! How many? Fifty percent of men and 75 percent of women with Chlamydia have no symptoms. Ten percent of men and 30 percent of women show no signs of gonorrhea. A staggering 90 percent of men (and a large number of women) are unaware of having trichomoniasis. The problem is that up to a third of untreated Chlamydia and gonorrhea infections cause pelvic inflammatory disease, which leads to chronic pelvic pain and infertility. Antibiotics can cure the infection, but cannot fix scarring and damage to the reproductive tract that may have occurred if the infections went unnoticed for months or years.
Most people know that herpes, HPV, and HIV are caused by viruses, and at this time, while we can treat outbreaks, we cannot cure anyone of these diseases. Prevention, such as the Gardasil vaccine, is our best protection against these viral illnesses.
Let's give our children all the facts they need to protect themselves. Help them to understand that alternative forms of sexual intimacy may not "count" for pregnancy, but they certainly count for STDs. One moment of unanticipated passion can cause a lifetime of challenges. Ask your doctor for a reliable source of information about STDs, or visit the CDC.gov or NIH.gov websites to find our most recent national data.
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Jill Grimes, MD (www.jillgrimesmd.com), is author of Seductive Delusions: How Everyday People Catch STDs (The Johns Hopkins University Press) and a board-certified family physician practicing in Austin, TX. She is on the faculty at UMass Medical School, and is an associate editor of the 5-Minute Clinical Consult medical textbook.