April is STI Awareness Month-Kayla Matteo, Des Moines University Student Doctor

My high school sex ed class can be summed up as playing “toss the testicle” with rubber body organs. Sexual health was an awkward topic that my well-meaning health teacher seamlessly avoided — in hindsight, many would have had a difficult time rallying a class of 15-year-olds who could barely keep it together at any mention of “vagina.” One would assume that my college education would make up for the experience of only learning how to throw a curveball with a rubber testicle, but I never fully received that knowledge. Sure, we had some optional talks at the club fair's Planned Parenthood booth, but many other college students and I moved through our teenage and early adult years without foundational knowledge about sex, and the reality of the not-so-fun additions to sex: sexually transmitted infections. 

Now I find myself here in medical school, finally learning the hard facts of STI prevention that I never fully picked up in all my 20 years of education. April is STI Awareness Month, and I am determined to ensure that knowledge about STIs and how to prevent them CANNOT only be reserved for medical students. Adolescents need to be armed with such knowledge to protect themselves and others, and have confidence in advocating for their own bodies and health when the time comes. So here are some common facts and myths about STIs that I wish I knew back then during health class, and what we need others to know now.

·        Fact vs myth: Syphilis is an STI that was only prominent during the 1400s-early 1900s.

o   MYTH: In fact, right here in Iowa, there has been a huge rise in syphilis cases based on data from 20211. So how do we protect ourselves from contracting syphilis? The only way to protect yourself from syphilis is to use condoms to prevent contact with sores. However, some syphilis sores are not fully covered by condoms, and syphilis can be contracted by contacting these sores 2. The best thing to do is use condoms, and stay aware! If you’re unsure where to get condoms, don’t feel comfortable buying them, or cannot afford them, here is a condom locator that shows places to get free condoms!

·        Fact vs myth: There is a cure for syphilis.

o   FACT: A single injection of Penicillin G can cure the earlier stages of syphilis2. If you need to be treated for syphilis, wait until the sores are completely healed before having sex again, and tell your partner so they can get treatment too! 

·        Fact vs myth: You can give someone genital herpes if you perform oral sex on them with an active cold sore.

o   FACT: Oral herpes is usually caused by HSV-1 and genital herpes is usually caused by HSV-2. While these two strains of herpes prefer to hang out in different locations, they can sometimes change teams when exposed to the other location. If someone performs oral sex while having an active cold sore (aka an HSV-1 infection), it is possible for HSV-1 to pop up on the genitals. If someone has an active HSV-2 infection on the genitals, it is possible for HSV-2 to show up around the mouth 3,4.

·        Fact vs myth: You can only give someone genital herpes with an active, symptomatic infection.

o   MYTH: People can still spread herpes infections without any symptoms due to “viral shedding.” In fact, most people are infected with herpes during this asymptomatic shedding period5. Therefore, it is extremely important to keep barrier methods like condoms and dental dams in your back pocket (or wallet, whichever you prefer)!

·        Fact vs myth: If you don’t have any symptoms, you don’t have an STI.

o   MYTH: There are several STIs that can be asymptomatic, so it’s important to get tested when you are sexually active. Untreated STIs can cause infertility, chronic health problems, and more. Here are some of the most common asymptomatic STIs and possible health risks if they are left untreated, and how to prevent them 6,7.

1. STI: HPV (Human Papillomavirus)

Risks If Untreated- Cervical cancer (and others)

How to Prevent If Sexually Active-

• GET VACCINATED!

• Routine cervical cancer screening 

• Condoms

• Monogamy

• Getting tested before and after each new partner

2. STI: Chlamydia & Gonorrhea

Risks If Untreated- Pelvic Inflammatory Disease (scarring of fallopian tubes), which can lead to infertility

How to Prevent If Sexually Active-

• Condoms

• Monogamy

• Getting tested before and after each new partner

3. STI: Trichomoniasis  

Risks if Untreated: Increased risk of getting other STIs and HIV

How to Prevent if SexuallyActive:

Condoms

Monogamy

Getting tested before and after each new partner

4. STI: Herpes

Risks if Untreated: Spreading to sexual partners

How to Prevent if Sexually Active:

• Condoms

• Monogamy

• Getting tested before and after each new partner

*Keep in mind that while condoms are the most effective form of STI prevention other than abstinence, they are not 100% protective. Even though the risks are low, you could be doing everything right and still might contract an STI.

        Fact vs Myth: Having a sexual relationship is not possible if I contract an STI.

o   MYTH: There is a ton of shame and stigma associated with contracting an STI, which can often make people feel like sex in the future is out of the question. However, not only are STIs quite common, most of them are extremely manageable. For example, chlamydia, gonorrhea, and syphilis can be treated with a course of antibiotics. Herpes and HIV may be incurable, but their infectiousness can be significantly lowered with antiviral medications. It may be difficult to tell your partner about your STI status, but letting your partner know before you have sex allows both of you to make informed choices about having sex. Open and honest communication creates a safe environment for you and your partner to decide how to proceed8.

Talking about STIs can often be uncomfortable, but arming yourself with the knowledge early on can make all the difference when it comes to prevention. To learn more about STIs and how to prevent them, chat with a trusted healthcare provider — they’ve got your back.

Sources

1.  Iowa Public Health Tracking Portal, Syphilis Data, 2021. https://tracking.idph.iowa.gov/Health/Sexually-Transmitted-Diseases/Syphilis-Data

2. Center for Disease Control and Prevention. Syphilis & MSM Fact Sheet, 2022. https://www.cdc.gov/std/syphilis/stdfact-msm-syphilis.htm#:~:text=Using%20latex%20condoms%20the%20right,sores%20can%20still%20transmit%20syphilis

3. Center for Disease Control and Prevention. Genital Herpes Fact Sheet, 2022. https://www.cdc.gov/std/herpes/stdfact-herpes.htm#:~:text=Yes.,are%20due%20to%20HSV%2D1

4. Planned Parenthood. Oral & Genital Herpes. https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/herpes

5. Mount Sinai Health Library. Herpes simplex. https://www.mountsinai.org/health-library/report/herpes-simplex#:~:text=Genital%20herpes%20is%20contagious%20from,not%20present%20(asymptomatic%20shedding)

6. Michael Cackovic, MD. Ohio State University Wexner Medical Center. STIs you can have with no symptoms, 2019. https://wexnermedical.osu.edu/blog/stis-without-symptoms

7. Center for Disease Control and Prevention. Sexually Transmitted Infections Fact Sheets. https://www.cdc.gov/std/healthcomm/fact_sheets.htm

8. Center for Disease Control and Prevention. STI Awareness Week: Conversation Tips, 2022. https://www.cdc.gov/std/saw/pbyt/conversation.htm

September is Suicide Prevention Month

September is Suicide Prevention Month. Suicide can affect anyone, and is the second leading cause of death for young people ages 13-24.  Research shows that LGBTQ+ youth are at higher risk for suicide attempts than their straight and cisgender peers--lesbian, gay, bisexual, and queer youth are 3-4x more likely to attempt suicide, and trans and gender non-conforming youth are up to 8x more likely. According to The Trevor Project, at least one LGBTQ+ youth attempts suicide every 45 seconds in the US.

These numbers are alarming, yet can be understood through knowing the challenges young people face because of their identities and expression. Queer and trans youth may experience bullying at school and online, or come from invalidating, unaccepting home environments. They are more likely to experience physical, emotional, and sexual violence as well as houselessness or unstable housing. All these issues contribute to depression, anxiety, and other mental health concerns.

It's important for adults to know the signs of depression and potential suicidality in young folks:

·      Withdrawing from friends and family

·      Not keeping up with their personal hygiene or general self-care

·      Decreased school performance

·      Talking about dying or being suicidal

·      Quitting activities or hobbies they usually enjoy

·      Engaging in non-suicidal self-injury (cutting, burning, bruising)

·      New or increased substance use

Note: these behaviors may show up outside the context of depression or suicidal ideation, but knowing the signs and keeping communication lines open is a vital step for prevention.

 What are some other ways to prevent LGBTQ+ youth suicide?

Show support through your words and actions!

This can look like showing up for LGBTQ community events, using people's correct pronouns, and not assuming every person you encounter is cis or straight.

Representation.

Kids need and deserve to see themselves reflected in the media they consume and in what they learn in school. This includes learning about LGBTQ+ historical events and figures, reading books by and about queer and trans people, and receiving inclusive sex education. Inclusive education helps to affirm LGBTQ+ young people's identities and make school safer and more enjoyable. Not only that, it reduces the risk of suicide attempts and completed suicides.

Access to gender and sexuality affirming health care.

LGBTQ+ young people have unique health care needs--both mental and physical. By seeing inclusive and affirming providers, their needs are more likely to be met, and will result in better health outcomes.

Suicide is a daunting topic, but it's necessary to talk openly and honestly about it. This breaks down the stigma and lets young people know they are not alone. It just takes one caring adult to make a difference.

 Local and national LGBTQ+ resources:

 EyeOpenIowa

The Trevor Project  – hotline, live chat, and live texting

Trevor Project Crisis Hotline 1-866-488-7386

The Trans Lifeline – hotline run by and for trans people, plus other resources

877-565-8860

Iowa Safe Schools – LGBTQ+ resources for students, caregivers, and educators

LGBTQ Iowa Archives & Library

Primary Health Care – affirming and inclusive sexual and general health care

One Iowa – resources for finding LGBTQ inclusive mental health counselors and LGBTQ advocacy

Elliott Nassif, Lead Implementation Specialist at EyesOpenIowa

Building Social Media Literacy: An Unconventional Experiment

Last year, during the pandemic, my husband and I gave into our nine-year-old and let her open an Instagram account.

I know, I know.

But there are important things to explain about this decision. First, she has a grand total of 10 followers to her private account. Each follower is a friend or family member, someone we trust. Second, with a few exceptions at the end (more about that later), we did not let her post pictures of herself.

Third—and most important—she was actually asking to open the account and discuss it with us as she went. It was, essentially, an invitation to a sacred and rare parent-child communication space that we couldn’t pass up. And with all the togetherness of the past year, it was easy enough to do.

We also made the decision because we are fully aware that in five or six years, our daughter will not be inviting us so willingly into her social media space.

In general, I am of the belief that, just as in sex education, we must start communicating with our children about challenging topics far sooner than we think.

And so I figured that while we were stuck at home together, allowing her to post pictures of puppies to Instagram and then chatting about her account was a great and gentle place to introduce her to the concepts of privacy and safety and overall the purpose of social media.

Here are a few things that came up during our experiment (which, BTW, only lasted a few short months before she grew bored and moved onto drawing cartoons from a series of tutorials on YouTube):

- She received requests from people we didn’t know, who wanted to follow her on Instagram. This allowed us to chat about why we don’t accept requests from strangers, especially as a child or teen. Over time, she would increasingly report when she rejected a request, telling me with pride, “I don’t know this person, so they don’t get to see my posts!”

- One day, she wanted to post a picture of her newly pierced ears. I said yes, which led to a series of posts from her that were clearly modeled after so many staged Instagram posts—“duck lips” and all. This led to a really important conversation about how and why there is so much staging on Instagram, as well as what is real and what is not real, etc. We also talked about body image and social media content. Ultimately, we removed the posts together.

- She posted a ton of cute puppy pictures she found online. From this I learned that puppy pictures make people really happy.

This tactic of working through social media together with children is not for everyone. But I do believe there are lessons to be learned from my experiment.

Too often, we give children far too little information to prepare them for real life: in sex education, in financial literacy, in social media safety, etc. Then as they become young adults, the bulk of our preparation entails telling them, “You’re about to do X thing. As you do, please just remember not to do the “wrong” things like get pregnant or go into debt or engage in unsafe online behavior.”

This type of “preparation” does not work. If we truly want to prepare children for adulthood, then we have to educate them fully. And sometimes that means going against the grain and allowing your nine-year-old to have limited access to social media. I’m hopeful our experiment served as just one of many important building blocks for the future.

We’re curious: what experiences have you had in bucking traditional wisdom in order to prepare your kids for the larger world? Or for the social media world? We’d love to hear from you!

Gail Cowan, MSW, is EOI’s Director of Development. A former therapist, she also runs her own coaching business. Find her at www.gailcowan.com or gail@eyesopeniowa.org.