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: A Nursing Home With a Healthy Attitude Toward Sex

Martha Kempner

A nursing home understands that its elderly residents are still sexual beings; New York City is amping up its youth sexual health outreach with emojis of eggplants and monkeys; and if forced to choose between eating and sex, a good number of people pick food.

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

Sex Is Not Just for the Young

The New York Times recently profiled a nursing home with a sex-positive attitude for its residents. The Hebrew Home at Riverdale adopted its “sexual expression policy” in 1995 after a nurse walked in on two residents having sex. She asked her boss, Daniel Reingold, what she should do. He said, “Tiptoe out and close the door.”

Reingold, the president of RiverSpring Health (which runs the nursing home), said that aging includes a lot of loss—from the loss of spouses and friends to the loss of independence and mobility. But he believes the loss of physical touch and intimacy does not have to be part of getting older.

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The policy acknowledges that residents have the right to seek out and engage in consensual acts of sexual expression with other residents or with visitors. The policy ensures that staff understand that their role is not to prevent sexual contact. In fact, some of the staff like to play cupid for residents. Audrey Davison, an 85-year-old resident, said that the staff let her sleep in her boyfriend’s room, and one aide even made them a “Do Not Disturb” sign for his door. She added: “I enjoyed it and he was a very good lover.”

Still, there are complicating factors to dating in nursing homes or assisted-living facilities. Some residents may be married to people who don’t live in the facility, and others may be suffering from memory loss, dementia, or Alzheimer’s, which can raise issues of consent. Hebrew Home’s policy states that Alzheimer’s patients can give consent under certain circumstances.

Though not all nursing homes have formal policies about sex, many acknowledge that their residents are or want to be sexually active and are working to help residents have a safe and consensual experience. Dr. Cheryl Phillips, a senior vice president at LeadingAge, an organization which represents nursing homes and others who provide elder care, also told the New York Times that this generation of older adults is different: “They’ve been having sex—that’s part of who they are—and just because they’re moving into a nursing home doesn’t mean they’re going to stop having sex.”

Of course, not all residents are lucky in love when they move in. Hebrew Home says that about 40 of its 870 residents are in relationships. Staff are trying to help the others. They set up happy hours, a prom, and have started a dating service called G-Date (for “Grandparent Date”). So far it hasn’t been too successful in making matches, but the staff is convinced that someday their efforts will pay off with a wedding.

Can Emojis Connect Youth to Sexual Health Services?

New York City’s public hospital system, known as Health & Hospitals, provides confidential sexual health services—including pregnancy tests, contraception, and tests for sexually transmitted diseases (STDs)—for young people 12 and older regardless of their ability to pay, immigration status, or sexual orientation. Health & Hospitals served 152,000 patients last year, but its leaders think it could do even more if more young people were aware of the services offered.

As a way to speak the language of young people, Health & Hospitals launched a campaign starring emojis in July.

The emojis are expected to reach 2.4 million young people in New York City through social media including Facebook and Instagram. The emojis include an eggplant, a monkey covering his eyes, and, of course, some birds and bees. The online ads read, “Need someone to talk to about ‘it’?”

When young people click on the emojis, they will be taken to the Health & Hospitals youth website, which explains available services and how to find accessible providers.

Dr. Ram Raju, president and CEO of NYC Health & Hospitals, said in a press release that the organization provides nonjudgmental services to youth: “Whether it’s birth control, pregnancy testing, emergency contraception or depression screening, the public health system has affordable services in local community health centers, where we speak your language, understand your culture and respect your privacy.”

But some worry that these emojis are confusing. Elizabeth Schroeder, a sex educator and trainer, told the New York Times that while she applauded the effort, she questioned if the images chosen were the best to convey the message.

We here at This Week in Sex have to agree and admit the images confuse us as well. The monkey is cute, but what does it have to do with STDs?

Choosing Between Appetites, Many Pick Food

Good food or good sex? These two sources of pleasure are rarely at odds with each other, but if they ever are, which would you choose?

A new survey, by advertising agency Havas Worldwide, posed this very question to almost 12,000 adults in 37 countries across the globe. The results show that about half of adults (46 percent of men and 51 percent of women) believe that food can be as pleasurable as sex. And one-third would choose a great dinner at a restaurant rather than sex; women were more likely to make this choice (42 percent compared with 26 percent of men).

Millennials were also more likely to make this choice than those slightly older Gen-Xers (35 percent to 30 percent). Of course, it’s hard to tell whether this says more about their sex lives or their eating habits.


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.


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