Roundups Sexual Health

Sexual Health Roundup: CDC Say Hormonal Methods Don’t Increase HIV Risk and Cheaters Less Likely to Have Safe Sex

Martha Kempner

In this week's sexual health round up: a CDC review of available evidence found that hormonal contraception (including Depo-Provera) does not increase a woman's risk of contracting or transmitting HIV; a new study found that cheaters were less likely to practice safer sex than those in open relationships; an online club will send you condoms for as little of $1 a month; and a man steals a vibrator for a reason.

CDC Concludes that Hormonal Birth Control Does Not Increase HIV Risk  

Recent studies raised some concerns about whether hormonal methods of contraception, including birth control pills and injectable contraceptives, increase a woman’s risk of contracting HIV. Last week after reviewing all available evidence, the Centers for Disease Control and Prevention (CDC) concluded that there is no clear evidence of such a link and that women at risk of HIV infection or those who already have the virus “can continue to use all hormonal contraceptive methods without restriction.” 

Specifically, the study concluded that the “evidence does not suggest” any link between increased HIV risk and the birth control pill or oral contraceptives. The research on injectable contraception — sold under the brand name Depo-Provera — is less conclusive. In fact, it was a study published last October in the Lancet Infectious Diseases which spurred these doubts. That study of women in areas with high rates of HIV found injectable contraception could double the risk of women contracting HIV and that hormonal contraceptive use in women who have the virus could double the risk that they transmit it to a male partner though it is unclear why this would be the case.

The CDC’s review determined that the evidence about Depo-Provera and HIV transmission is inconclusive but said in the absence of more definitive research the shot is still considered safe. As a result of this review the CDC did add a clarification to its Medical Eligibility Criteria for Contraception in which it says that when treating women at high risk for HIV infection who use progestin-only injectables providers should “… acknowledge the inconclusive nature of the body of evidence regarding the association between progestin-only injectable use and HIV acquisition.” One of the authors of the review explained: “Because we can’t say from the evidence that there is an increased risk, they [hormonal contraceptives] are all still considered safe, including the injectables.”

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The CDC strongly encourages the use of condoms as a precaution against HIV for all women at risk. The criteria say: “All women who use contraceptive methods other than condoms should be counseled about the use of condoms and the risk for sexually transmitted infections.”

The World Health Organization also conducted a review of the evidence and came to similar conclusions. 

Cheaters Less Likely to Use Condoms than Those in Open Relationships

A new study in the Journal of Sexual Medicine found that individuals who had been secretly unfaithful to their partner were less likely to use condoms than those who had their partner’s consent to have sex with another person. Researchers from the University of Michigan surveyed 1,647 individuals who responded to an online advertisement. About half of them said they had had sex with someone other than their primary partner. Of these, 493 said they had the knowledge and consent of their primary partner to be non-monogamous while 308 said they were in a monogamous relationship but being unfaithful. 

One of the more upsetting findings of the survey was that these individuals, the ones who were being unfaithful, were 27 percent less likely to use condoms when having vaginal sex  and 35 percent less likely to use condoms when having anal sex with a non-primary partner than those who had their primary partner’s permission to be non-monogamous.

Monogamy is often touted as a way to reduce transmission of STDs, but this obviously only works if both partners enter the relationships having tested negative for all STDs and then both partners remain faithful. These individuals who are being unfaithful and not using condoms are putting themselves, their primary partners, and any other partners at significant risk of STDs. The author’s note that the open relationships—where partners have permission to have sex outside the relationship — seems to pose less risk:

“If people do not find monogamy appealing or feasible, they clearly need to think about the risk this poses to their partner and consider whether an open relationship would suit their needs better, and better protect their relationship partners.”

Rubber-of-the-Month-Club

These days we can pretty much avoid stores altogether — my books come from Amazon, my movies from Netflix, my groceries from Fresh Direct, and my shoes from Zappos. Now we can get our condoms that way as well. Though not the first mail-order-condom service, the founders of the Dollar Rubber Club say that their monthly service is “the best bang for your buck.” Sign up for the “Traveling Salesman,” and the club  will send you three condoms each month for $1 (plus $2 shipping and handling).  If that’s not enough to cover your monthly sexual encounters you can choose “The Zen Master” package with six condoms a month at $5, “The Swordsman,” with 12 condoms for $9, or the “Weekend Warrior,” with a variety pack of 12 condoms for $10. Shipping and handling prices vary for each package. For those prices you have a choice of Trojan or LifeStyle brand condoms.

The founders explain that they were tired of the embarrassing trip to the drug store to buy condoms and even more tired of not having condoms in the night table drawer when they needed them. So they dreamed up the monthly club and as they say on their about us page

“So, we bought a ton of Trojan™ and LifeStyles™ condoms to keep prices as low as possible and pass on the savings to you.  Better than that, our products are the same you’d buy in the store, just cheaper and less embarrassing to purchase. AND, each of our whopper-wrappers is tested according to International standards and safe for your man-junk.”

You can sign up for the service, which began this month, on the site’s home page using a PayPal and you can cancel or switch plans at any time.

Vibrator Thief Tells Police: My Wife and I Needed It!

Police were recently called to a Walgreens in Florida when a clerk caught a man taking a “personal massager” from the shelf and bringing it into the bathroom. The man bolted throwing the Trojan Twister (a five-speed, battery-powered device that twists into four possible positions and sells for about $50) into a nearby garbage pail where it was later found by police. When he was found by police he explained that he and his wife were having marital issues and needed the vibrator. While the officers may have been sympathetic to his plight, they arrested him nonetheless. He has since been released on his own recognizance and given a court date.  

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

Commentary Sexual Health

Fewer Teens Are Having Sex, But Don’t Pop the Champagne Yet

Martha Kempner

The number of teens having sex may be less important than the number having protected sex. And according to recent data from the Centers for Disease Control and Prevention, condom use is dropping among young people.

Every two years, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC-DASH) surveys high school students to gauge how often they engage in perceived risky behaviors. The national Youth Risk Behavior Surveillance (YRBS) is wide ranging: It asks about violence, guns, alcohol, drugs, seat belts, bicycle safety, and nutrition. It also asks questions about “sexual intercourse” (which it doesn’t define as a specific act) and sexual behaviors.

Started in 1991, this long-running study can provide both a picture of what high school students are doing right now and a historical perspective of how things have changed. But for more than a decade, the story it has told about sexual risk has been the virtually the same. Risk behaviors continually declined between 1991 and 2001, with fewer high school students having sex and more of them using condoms and contraception. But after the first 10 years, there has been little change in youth sexual risk behaviors. And, with each new release of almost unchanging data, I’ve reminded us that no news isn’t necessarily good news.

This year, there is news and it looks good—at least on the surface. The survey showed some significant changes between 2013 and 2015; fewer kids have ever had sex, are currently sexually active, or became sexually active at a young age. More teens are relying on IUDs and implants, which are virtually error-proof in preventing pregnancy.

In 2015, 41 percent of high school students reported ever having had sexual intercourse compared to 47 percent in 2013. The researchers say this is a statistically significant decrease, which adds to the decreases seen since 1991, when 54 percent of teens reported ever having had sexual intercourse.

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Another change is in the percentage of students who had sex for the first time before age 13. In 2015, 4 percent of high school students reported this compared to almost 6 percent in 2013. This is down from a full 10 percent in 1991. As for number of overall partners, that is down as well, with only 12 percent of students reporting four or more partners during their lifetime compared to 15 percent in 2013 and 19 percent in 1991. Finally, the percentage of students who are currently sexually active also decreased significantly between 2013 (34 percent) and 2015 (30 percent).

These are all positive developments. Delaying sex can often help prevent (at least temporarily) the risk of pregnancy or STIs. Having fewer partners, especially fewer concurrent partners, is frequently important for reducing STI risk. And those teens who are not currently having sex are not currently at risk for those things.

While I want to congratulate all teens who took fewer risks this year, I’m not ready to celebrate those statistics alone—because the number of teens having sex is less important to me than the percentage of teens having sex that is protected from both pregnancy and sexually transmitted infections. And that number is lower than it once was.

Among sexually active teens, there were no significant positive changes in measures of safer sex other than an increase in the number of sexually active high school students using the IUD or implant (up to 4 percent from 2 percent in 2013).

Moreover, some results indicate that today’s teens are using less protection than those who were teens a decade ago. The most telling finding might be the percentage of teens who used no method of contraception the last time they had sex. This decreased between 1991 and 2007 (from 17 percent to 12 percent), inched up to 14 percent in 2013, and stayed the same in 2015 (14 percent). There was also little to no change in the percentage of high school students who say that either they or their partner used birth control pills between 2013 (19 percent) and 2015 (18 percent) or those who say they used the contraceptive shot, patch, or ring (5 percent in 2013 and 2015).

For me, however, the most distressing finding is the backward progress we continue to see in condom use. The prevalence of high school students who used a condom at last sex went up from 45 percent in 1991 to 63 percent in 2003. But then it started to drop. In 2015, only 57 percent of sexually active high school students used condoms the last time they had sex, less than in 2013, when 59 percent said they used condoms.

It’s not surprising that teens use condoms less frequently than they did a decade ago. In the 1990s, the HIV epidemic was still front and center, and condoms were heavily promoted as a way to avoid infection. As this threat waned—thanks to treatment advances that now also serve as prevention—discussions of the importance of condoms diminished as well. The rise of abstinence-only-until-marriage programs may have also affected condom use, because these programs often include misinformation suggesting condoms are unreliable at best.

Unfortunately, some of the negative messages about condoms inadvertently came from public health experts themselves, whether they were promoting emergency contraception with ads that said “oops, the condom broke”; encouraging the development of new condoms with articles suggesting that current condoms are no fun; or focusing on teen pregnancy and the use of highly effective contraceptive methods such as long-acting reversible contraceptives (LARC). The end result is that condoms have been undersold to today’s teenagers.

We have to turn these condom trends around, because despite the decreases in sexual activity, young people continue to contract STIs at an alarming rate. In 2014, for example, there were nearly 950,000 reported cases of chlamydia among young people ages 15 to 24. In fact, young people in this age group represented 66 percent of all reported chlamydia cases. Similarly, in 2014, young women ages 15 to 19 had the second-highest rate of gonorrhea infection of any age group (400 cases per 100,000 women in the age group), exceeded only by those 20 to 24 (489 cases per 100,000 women).

While we can be pleased that fewer young people are having sex right now, we can’t fool ourselves into believing that this is enough or that our prevention messages are truly working. We should certainly praise teens for taking fewer risks and use this survey as a reminder that teens can and do make good decisions. But while we’re shaking a young person’s hand, we should be slipping a condom into it. Because someday soon (before high school ends, for more than half of them), that teenager will have sex—and when they do, they need to protect themselves from both pregnancy and STIs.