Sexually transmitted infections — STIs for short — they’re common opportunistic infections characteristically defined as acquired or transmitted through one of the most intimate of human experiences: sex. And it’s no secret that STI rates have indeed been increasing in Australia.
Cases of STIs in men have been steadily rising over the past decade. Overall, the total number of cases of the big three — syphilis, chlamydia and gonorrhea — more than doubled between 2006 and 2016. It’s been a steady, continual growth trend from just over 25,000 cases to more than 52,500 cases during that period — though these figures represent all of the men in Australia, gay, bisexual, straight or otherwise.
We should add, context for statistics is everything. STI numbers are up but testing for STIs is up too. In fact, 2016 saw a record proportion of gay and bisexual men show up for comprehensive STI testing: 45 per cent (bravo and thanks!).
More testing means more opportunities to detect and treat STIs, helping curb their spread. So a rise in STI rates must also be considered in the context of increased STI testing. And for the most part, common STIs are straightforward to detect and treat.
For many guys, they present enough of a health concern and/or inconvenience to warrant avoiding them. But given that STIs are on the rise, what are some pragmatic approaches for managing them in an era where we have more HIV prevention options that help us enjoy the sex many of us are having?
The state of play
In addition to a majority of self-reported consistent condom users among sexually active men with casual partners, Australia now has an estimated 17,000+ people using PrEP. Opting in to a PrEP program involves checking in with a GP at least once every three months for comprehensive STI testing; and treatment, if required. Choosing to use PrEP is a great way to prevent HIV acquisition, facilitate frequent STI testing and reduce the opportunity to transmit STIs.
Although PrEP users are an important part of the solution for preventing and managing both HIV and STIs, they’re not the complete solution. People living with HIV who maintain an undetectable viral load for six months or more do not sexually transmit the virus. And according to The Annual Report of Trends in Behaviour 2017, men living with HIV are more likely to go for comprehensive STI testing than most of their HIV negative counterparts, partly due to their regular engagement with healthcare professionals.
No matter what choices any of us make, what really makes a difference is taking some form of action to prevent and manage STIs. Regardless of how anyone helps to prevent them, testing at least twice a year is recommended for anyone who’s sexually active, or at least four times a year for those who have a few different sexual partners or don’t always use condoms.
“No matter what choices any of us make, what really makes a difference is taking some form of action to prevent and manage STIs.”
You can discover more about figuring out how often and where to go for testing in Eight reasons why you should get an STI test, even if you don’t think you need one.
Condom and biomedical combos
Biomedical HIV interventions are highly effective at preventing HIV acquisition, as well as treating people living with the virus, but they don’t offer any direct protection from other STIs — that’s why combining biomedical strategies with condoms and regular testing is the key for anyone who wishes to maximise their protection.
Remember that no single strategy offers complete protection against STIs. That includes condoms. They’re a great tool for helping to prevent STIs, but they don’t completely eliminate the risk of getting them. Condoms don’t always fully cover affected areas of skin, and unless you’re using a barrier for oral sex — including rimming — you might still get an STI. That’s why going for regular sexual health tests is essential no matter what.
You can discover more about choosing and combining strategies in Wanna compare tools? Here’s how safe sex choices measure up down under.
Opting in and taking action
The most reliable way to avoid STIs is total abstinence — which means not having any sex at all. But that’s neither practical nor realistic for most of us considering our natural desires for intimacy, connection and pleasure. Enjoying an active sex life comes with the need to recognise that STIs might be a part of it.
Opting in to a sexual health strategy that involves preventing and managing STIs is a demonstration of anyone’s investment in their own wellbeing, as well as the wellbeing of other people they interact with. Even when our methods for managing STIs differ, we’re all still choosing to do something about STIs instead of leaving them unmanaged.
“Enjoying an active sex life comes with the need to recognise that STIs might be a part of it.”
As is the case with any strategy, using condoms is a personal choice to manage STIs in ways that work for each of us. Even if you don’t use condoms for anal (and oral) sex every time, using them sometimes can still offer some protection on the occasions that you do. If the possibility of having an STI is a concern for you, condoms are best for helping to reduce the likelihood of getting any.
Different strokes for different folks
Sometimes we may find ourselves in sexual situations where we don’t chat about how everybody involved manages STIs. If that’s familiar territory, condoms could be a good choice for the moment — even if you’re not usually using them with regular partners or in other situations.
Although some people aren’t using condoms for casual sex, there’s still a majority of guys who do. So if you only choose one reason to use condoms, why not make that out of courtesy for someone else who wants to use them.
In a rapidly emerging world of biomedical sexual health strategies, safe sex means different things to each of us. While we all navigate choosing suitable methods, what’s most important is to be respectful of other people’s choices. Because at the end of the day, making a choice to prevent and manage STIs and HIV in ways that work for each of us is part of a culture of care we would all want to play a part in.