Roundups Sexual Health

This Week in Sex: At-Home STI Tests, New Virus-Killing Condom, and More

Martha Kempner

This week, LA County is reviving an at-home STI testing service, a new study shows that male circumcision can reduce rates of HIV among women as well as men, and an Australian company gets approval to produce a microbicide condom.

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

LA Considers Bringing Back At-Home STI Tests

With both chlamydia and gonorrhea rates on the rise, the Los Angeles County Health Department is once again trying to promote the availability of at-home testing for sexually transmitted infections (STIs). The program began in 2009 when the department bought 10,000 kits for about $450,000 and advertised their availability to women ages 12 to 25. The goal was to increase testing and treatment among young women who did not have easy access to clinics or other health-care providers. About 9,000 kits were distributed. Most were sent back to the department for testing, and of those sent back about 10 percent tested positive for chlamydia and 3 percent for gonorrhea. But a health department official told the Los Angeles Daily News that after the first few years, interest in the program waned.

Since that time, rates of both STIs have increased in the county. Between 2009 and 2013, cases of chlamydia rose by 8 percent, while gonorrhea rose by 45 percent. These changes show that the STI epidemic in the county is worse than in California as a whole; during the same time period statewide, cases of chlamydia actual fell slightly and rates of gonorrhea rose by 13 percent.

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Both chlamydia and gonorrhea are bacterial infections that are spread through genital secretions during oral, anal, or vaginal sex. They often have no symptoms, though they can cause some discharge and/or burning during urination in both men and women. Both can also be treated with antibiotics but if left untreated can cause pelvic inflammatory disease (PID), which in turn can cause scarring in the reproductive tract and infertility, mostly in women. An estimated 2.86 million cases of chlamydia and 820,000 cases of gonorrhea occur each year in the United States. Between 10 and 15 percent of chlamydia cases in women cause PID. Because most cases are asymptomatic, the Centers for Disease Control and Prevention (CDC) recommends annual chlamydia screening for all sexually active females 25 and under and for women older than 25 with risk factors such as a new sex partner or multiple partners.

At-home testing can be done by collecting a urine sample or using a cotton swab to collect secretions from the upper vagina. The sample is then sent to a lab. In the LA County program, women get their test results either through a website or via text message. Those who test positive are then told where they can go to get the antibiotics they need. Dr. Jonathan Fielding, director for the LA County Department of Public Health, told the LA Daily News, “This is a good approach for those who don’t feel comfortable going into a facility.”

For now the program remains limited to women because the county has not found a good home test for men, but Fielding did say they would look at that in the future.

Study: Male Circumcision Can Prevent HIV in Women

The results of a new study presented last week at the International AIDS Conference show that male circumcision can help reduce the spread of HIV among women as well as men. There have already been a number of studies that have shown that men who have been circumcised are at lower risk of contracting HIV. These results have led to interventions designed to increase the number of circumcised men in areas of Africa with a high prevalence of HIV. But until now, researchers were not sure whether such interventions also affected HIV rates in women.

This new study looked at women in Orange Farm, a town of 110,000 people outside of Johannesburg, South Africa. (One of the studies on male circumcision had taken place there as well.) Researchers surveyed 4,538 sexually active women ages 15 to 49 in three waves, in 2007, 2010, and 2012.

Participants were asked a number of questions about their sex lives, including the age at which they’d first had sexual intercourse, the number of lifetime partners they’d had, whether they’d always used condoms, and whether their partners were circumcised. Researchers also took blood to test the women for HIV. Among the 1,363 women who reported only having had circumcised partners, the HIV prevalence was 22.4 percent, compared with 36.6 percent among the remaining 3,175. According to analyses conducted by the researchers, this means that having only circumcised partners reduced these women’s risk of contracting HIV by 16.9 percent. Moreover, when researcher looked only at women under 29, they found a risk reduction of 20.3 percent.

Kevin Jean of the French National Institute for Health and Medical Research conducted the study and presented the results at the conference. He told the audience that the results provide a “compelling argument” to speed up interventions that provide voluntary male circumcision in areas with high rates of HIV.

Australia Approves Condom With STI-Killing Microbicide

Australian condom manufacturer Ansell, which makes LifeStyles brand condoms, has just won approval to start mass production in its home country on a condom lubricated with a microbicide that inactivates sexually transmitted viruses. Called Viva-Gel, the microbicide binds to viruses, preventing them from interacting with human cells. Viva-Gel has been shown to disable 99.9 percent of herpes, HIV, and human papillomavirus (HPV) cells on contact.

While this the gel should add extra protection for couples using condoms, many are still hoping that something will be released as a vaginal gel to help women—especially those whose partners refuse to wear condoms—protect themselves from STIs. It is not yet clear when such a product would be available, but Viva-Gel is in phase 3 clinical trials in the United States for use as a cure for bacterial vaginosis, a common infection caused by an imbalance of “good” and “bad” bacteria in a woman’s vagina. Though not an STI on its own, there is some evidence that sex, new sex partners, and multiple sex partners can contribute to an imbalance of bacteria in the vagina. More importantly, however, bacterial vaginosis can leave women more vulnerable to infection with other STIs.

The condom will be sold in Australia under the name LifeStyles Dual Protect. A Japanese condom-maker has also been approved to begin adding this microbicide to its condoms.

HPV Vaccine Rates Still Too Low

New data on vaccines among adolescents shows that despite a modest increase in overall vaccination coverage from 2012 to 2013, estimated coverage for the HPV vaccine remained low. In 2013, 57.3 percent of girls had received one dose of the HPV vaccine, compared to 53.8 percent the year before. More girls had received all three recommended doses in 2013 than in 2012 (37.6 percent, compared to 33.4 percent), but the CDC says this is still too low. In fact, the agency notes that if all pre-teen and teen girls got the HPV vaccine when they got other recommended vaccines for their age group (such as the vaccine for meningitis), 91.3 percent of all 13-year-old girls would have at least gotten the first dose. The actual numbers fall far short of that.

Vaccine coverage for young boys is even lower, but there was a bigger increase (13.8 percent) in the number of boys who got at least one dose of the HPV vaccine—it went from 20.8 percent in 2012 to 34.6 percent in 2013. There was also an increase in the percentage of boys ages 13 to 17 who had received all three doses (from 6.8 percent in 2012 to 13.9 percent in 2013).

The CDC pointed out that these data reflect great variation in vaccine rates between states. For example, only 39.9 percent of girls in Kansas received at least one dose, compared to 76.6 percent of those in Rhode Island. Similarly, only 11 percent of boys in Kansas received one dose, compared to 69.3 percent of boys in Rhode Island.

The slow uptake of the HPV vaccine is disappointing, as it has been shown to be very effective in preventing the strains of the virus that are most likely to lead to cervical cancer. A 2013 study, for example, found that the proportion of girls infected with the strains of the virus addressed by Gardasil (the first of the two HPV vaccines introduced) dropped from about 12 percent before the vaccine was available to 5 percent, which represents a drop of 56 percent. The drop applied to all teens, whether or not they were vaccinated. This may be a result of what public health experts refer to as “herd immunity”—if enough of the population is protected by a vaccine, that protection extends to the unvaccinated as well. Among girls who had gotten the vaccine, however, the drop in HPV infections was even higher, at 88 percent.

We can only imagine how far we could go in preventing HPV and cervical cancer if more young women and men were vaccinated. Unfortunately, some people still see the HPV vaccine as controversial since it protects against a disease that is sexually transmitted and because the recommendations suggest girls and boys get it as young as 9 to ensure that they’ve received all three doses before they become sexually active.

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.