Sexually Transmitted Diseases:
What's Your Risk?

It only takes on time of unprotected sex and you can have a sexually transmitted disease like AIDS or herpes for life. How are STDs spread?

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BRIAN BOYLE, MD: They can be spread through genital-to-genital contact, genital-anal contact or genital-oral contact. Any of those can spread disease and spread it very effectively, especially if there are other STDs or sores or problems present. So any of the ways that people commonly have sex can spread these diseases, which means, basically, that you have to use a condom or a dental dam or something else to protect yourself from having a mucous membrane contact -- your mouth or your genitals -- contacting someone else's genitals or mucous membranes.

DAVID FOLK THOMAS: Can you spread sexually transmitted diseases such as gonorrhea through kissing?

ADAM STRACHER, MD: : Some of those infections can be spread from oral-genital infection for sure, and some can be spread from one person's mouth to another person's mouth -- certainly herpes can, certainly gonorrhea can -- and in rare situations they can be spread from one skin site to another skin site that is not a genital or an oral area.

DAVID FOLK THOMAS: What about sitting on a toilet seat?

BRIAN BOYLE, MD: Those are the stories that people hear about or that some people would like to be able to tell their partners, but that's generally not true and really doesn't occur.

DAVID FOLK THOMAS: As far as the different contacts -- you said genital-to-genital, oral, et cetera -- is there any one scenario that's more risky than the other?

ADAM STRACHER, MD: : They're all risky and, again, it's very difficult to rank them. Genital-anal contact, anal intercourse, is particularly risky because of the conditions under which that occurs. Normal vaginal intercourse is a little less risky.

DAVID FOLK THOMAS: Can you go back? What conditions, because it's more likely to be unprotected?

ADAM STRACHER, MD: : In particular, speaking of HIV, again, because that can lead to mucous membrane rupture that can make infection with HIV much more likely. So anal intercourse can make HIV spread much more likely because of the nature of it. Usual vaginal intercourse is a little less likely to spread disease, although it has spread HIV, although, as far as the other pathogens are concerned, it's equally likely.

BRIAN BOYLE, MD: And oral-genital, again, a little less likely to spread disease than the others, but still possible, and recent studies have shown that even HIV -- although many HIV specialists thought that oral sex was relatively safe -- recent studies are showing that, in fact, a significant number of infections of HIV have occurred through unprotected oral sex.

DAVID FOLK THOMAS: Dr. Stracher, do you have something to add?

ADAM STRACHER, MD: : I don't have much to add. I think Brian covered it all. I think that in homosexual men, the risk of anal intercourse does increase the risk of infection, both because of the increased rate of infection and also because of occasional bleeding and that sort of thing that may increase the risk of developing infection or of spreading infection and, as Dr. Boyle pointed, that's true for HIV infection, but all of those intercourse methods may spread other infections equally.

DAVID FOLK THOMAS: Is there any way to tell -- say you have one partner who is infected, whether it be with HIV, herpes, gonorrhea, what have you -- they have unprotected sex with the other partner, who has a clean bill of health. Is there any way to determine the likelihood that they will pass the disease?

ADAM STRACHER, MD: : We do have some estimates of what the rate is with each episode of intercourse or other contact for many types of illnesses. The rate varies. It depends on many factors, as Dr. Boyle mentioned, whether there are other sexually transmitted diseases and sores and the stage of infection that people have and whether they're symptomatic or asymptomatic infection, so there are estimates, and the range is from very common to very uncommon. I think that's probably enough.

BRIAN BOYLE, MD: It's sort of a crap shoot. It's Russian roulette. You may be infected, you may escape. It's not guaranteed.

ADAM STRACHER, MD: : The risk may be 1 in 300 for episode, for instance. That means that you may just have sex once and spread the infection and develop the infection, so I think it's not fair to look at it and say, "I have a very low chance. I can do it and be risky and I'm probably not going to get infected," because it really only takes one episode.

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BRIAN BOYLE, MD: We've had several patients who have come in with HIV who have been monogamous with one person who is not HIV infected and reported that years and years ago they had a single encounter -- perhaps when they were in college or in some other circumstance -- and yet they're infected with HIV. As Adam just pointed out -- and as you pointed out -- it's a crap shoot. You may get lucky and the odds may be 1 in 300. You may be that unlucky one where one encounter leads to your getting infected.

DAVID FOLK THOMAS: In a little bit I want to go back to the issue of being monogamous. But symptoms, we have some pictures next to you, I believe. What are these? Syphilis? To show sometimes you have no symptoms, but a lot of times you do. What have you got over there?

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Last updated: 10/05

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