When Prevention Fails: Life After an STI

By Osefame Ewaleifoh, PhD/MPH Candidate

As health workers, our default position in the fight against sexually transmitted disease is prevention – as it should be. This focus on prevention influences everything we do. From health policy, to health education and health outreach, our entire vocabulary on sexually transmitted diseases is rooted in the prevention of disease. Still, despite our best efforts, we must accept the reality that prevention programs and campaigns don’t always work. Accepting this reality is not a submission to failure to ending the spread of sexually transmitted diseases. On the contrary, it is a step toward approaching the conversation on STI more holistically – focusing on both prevention and management. As a result of the current focus on prevention, a lot of young people know “how to prevent an STI” but very few know where to even begin “if” they get an STI, almost as though no one actually ever gets infected. Perhaps while we continue to focus on prevention it might be worth asking – what do you do when prevention methods fail or were just never applied?

Reality: STI’s (including syphilis) still happen.

First, we must establish: STI’s do happen.  From more moderate conditions like yeast infections, to more complicated situations like HIV, gonorrhea and syphilis, young people still do get infected. To drive this point home, in 2012 there were 18,501 cases of gonorrhea, 1500 cases of syphilis and 67701 reported cases of chlamydia in Illinois (figure 1). Yes syphilis is still a real threat – even in 2014. On a much local level there were 172 cases of gonorrhea in Lakeview and Lincoln Park  Chicago alone for men and women between the ages of 15 and 44. These numbers are worth emphasizing for several reasons – first, the fact that you have not heard of someone you know getting infected does not mean infections don’t happen.

STI IllinoisData: City of Chicago: https://data.cityofchicago.org/browse?q=sti&sortBy=relevance&utf8=%E2%9C%93

Second, if you are infected with a sexually transmitted disease, you are not alone. While seemingly trivial, this knowledge is important because it affects your approach to seeking treatment and care knowing that others have walked the same road and there are tools and resources to guide you to recovery. This is assurance is important because, while STI’s can dramatically change your life, life does go on and an STI is not a death sentence.

Briefly, we here consider specific steps to both know your STD status and to manage that knowledge. We begin by listing the advantage of getting tested and providing a list of local centers and clinics where you can get tested. Next we review the cost associated with getting tested, insurance options and follow up treatment. Finally we briefly outline available support resources, your rights and privileges (to employment and privacy), as well as your responsibilities (partner disclosure and City Department of Public Health STI tracking) to help manage and contain the STI in your community.

Reality: Stuff happens.

Most people never have to think of the multi-layered consequence of getting a sexually transmitted disease – they don’t have a reason to. For many however, the reality of sexually transmitted diseases begins perhaps with a fun summer night out in the city. A glass of wine, maybe some shots here and there. Hung over the next morning, fuzzy memories from the night before that might include a broken condom and end with strange looking rashes a few weeks later. For the really brave this all leads to a nervous call to the doctor’s office and the awkward waiting room silence and sweaty palms. And then the long lonely wait for the test results. Three days or more of wondering – what would I do if I am actually infected?

For most people this awkward wait is eventually resolved with a negative test result and a deep sigh of relief – all clear! Occasionally, however, the dreaded call from the doctor’s office comes with a positive STD test result. For most, this call marks a major inflection point in life as suddenly everything changes. Relationships, career, school , family, everything that matters seems suddenly uncertain as hope rescinds into the dark distance, where do I go from here, who do I talk to?

Starting at the very beginning – “know thy status”

A few studies on credit score knowledge suggest that people who know their credit scores are more likely to make smarter financial decisions. While there is currently no empirical public health corollary to this study, it is reasonable to speculate that knowing your comprehensive STD status might provide increased incentive to protect your health. This point is particularly relevant to men who almost never go for annual health checkups, unlike women who have annual physicals. Fortunately for most people the result of a comprehensive STI checkup will be negative. A negative empirically confirmed test can provide a powerful incentive to protect your greatest investment – yourself.

Convenience: An STI center next to you

For most people a major limitation to getting an STI test done is simply convenience. Considering the awkwardness involved in dealing with any sexually centered health conversation, most people would just rather not deal with it. To get around the convenience challenge, the City of Chicago has distributed several clinics throughout the city (see our list below). In the city alone there are 5 specialized sexually transmitted disease centers. These STI centers are different and unique from clinics in three major ways: 1) Speed of care – you don’t need an appointment; you can just walk in at any time. 2) Cost of care – all services are free. 3) Specialization and privacy – unlike your typical doctor’s office they focus on just STI’s – testing, tracking, and counseling, and no one will ever know you were there. In addition these centers often offer freebies like free condoms!

Complications that come with STI’s

While most will never deal with the dread of getting a sexually transmitted disease, for those who do we now have incredible amount of resources to track, treat and manage sexually transmitted diseases. With a few exceptions, most sexually transmitted diseases are now either completely treatable or manageable. What is more, there are now laws to protect you from discrimination based on your health status. While these laws vary by states the basic provisions are mostly the same. While protecting you from discrimination based on your health status, each state in turn expects you to play a part in reducing the spread of sexually transmitted diseases. To this end states have made laws to both track and curtail the spread of STI’s. While these laws vary from state to state, the basic objective is the same: to track disease spread and to prevent or reduce deliberate spread of disease. If you suspect you might be exposed in any way, it is essential that you familiarize yourself with both the tracking and reporting regulations around STI’s in your state.

Beyond treatment – Finding support

While the obvious first step and immediate need following an exposure is treatment, exposure to a sexually transmitted disease often leads to chronic conditions that might need extended care. To this end it is essential that you seek and invest in a solid support network, which may or may not include your friends or families. Dealing with a sexually transmitted disease is inherently a very lonely experience that is only confounded by the associated stigma and shame. These factors make a solid support network absolutely essential to navigating the days and weeks ahead. Often your primary care provider can make recommendations about available support groups and sessions that might be helpful during your treatment. Ultimately as health workers and consumers, it is increasingly essential that we approach the conversation on sexually transmitted disease on both a prevention and management front – focusing on preventing infections but also making sure that people know what to do when they become infected.

Additional resources:

According to the city of Chicago: The following CDPH clinics are drop-in specialty clinics that diagnose and treat sexually transmitted infections (STI) including HIV, Syphilis, Gonorrhea and others. They also provide information about condom use and other prevention methods. Services are offered at no cost, and on a first-come, first-serve basis, no appointment is necessary.

Englewood STI Specialty Clinic
641 W. 63rd St., Lower Level
Phone: 312.747.8900
Fax: 312.747.5275
Mon., Wed., Fri.: 8 am – 4 pm
Tue., Thu.: 9 am – 5 pm

South Austin STI Specialty Clinic
4958 W. Madison
Phone: 312.746.4871
Fax: 312.746.4637
Mon. and Wed.: 8 am – 4 pm
Tue., Thu.: 10 am – 6 pm

Lakeview STI Specialty Clinic
2861 N. Clark, 2nd Floor
Phone: 312.744.5507
Fax: 312.744.2573
Mon., Wed., Fri.: 8 am – 4 pm
Tue., Thu.: 10 am – 6 pm

West Town STI Specialty Clinic
2418 W. Division
Phone: 312.744.5464
Fax: 312.744.5516
Fri.: 8 am – 4 pm

Roseland STI Specialty Clinic
200 E. 115th St.
Phone: 312.747.2831
Fax: 312.747.2841
Mon.: 8 am – 4 pm
Thurs.: 9 am – 5 pm

Services eligibility:
Individuals 12 years of age and older are eligible for services. No one is turned away if unable to pay- when fees exist. Fees are on a sliding scale basis.

Services provided at the clinics:
• Evaluation, testing & treatment for sexually transmitted infections & HIV
• HIV Counseling
• HIV Rapid Testing (same day results)
• STI & HIV Education
• Partner Notification (without implicating you)
• Treatment Services
• Free Condoms
• Rapid on site lab testing and dispensing of medications

In addition free condom distribution sites in the city can be found at https://data.cityofchicago.org/Health-Human-Services/Condom-Distribution-Sites-Map/jytx-u9

References:

http://www.cityofchicago.org/city/en/depts/cdph/provdrs/sti_hiv_aids/svcs/get_yourself_evaluatedforstihivaids.html

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About NPHR Blog (223 Articles)
The is the blog of the Northwestern Public Health Review journal. The blog and journal are both student run and contain research articles, opinions, interviews and other content pertaining to public health.

1 Comment on When Prevention Fails: Life After an STI

  1. It is important, as health care professionals, to educate as much as possible of the topic on STI’s. However, education may not be enough to prevent incidents for a number of patients who have been through education on STI’s. It seems a significant part of education towards STI’s are prevention methods. “As a result of the current focus on prevention, a lot of young people know how to prevent an STI but very few know where to even begin if they get an STI, almost as though no one actually ever gets infected” (Ewaleifoh, 2014). It is true, from personal experience, I have never heard of any steps towards living with STI’s in many education I have been a part of. According to Osefame Ewaleifoh, in just the state of Illinois, in 2012 there were 18,501 cases of gonorrhea, 1500 cases of syphilis and 67,701 reported cases of chlamydia. It may be possible that an everyday person will interact with another with one of these conditions, and without proper precaution will surely contract an STI. It is quite convenient for a person who has an STI to seek attention at sexual transmitted disease centers. As stated by Ewaleifoh, “These STI centers are different and unique from clinics in three major ways: 1) Speed of care – you don’t need an appointment; you can just walk in at any time. 2) Cost of care – all services are free. 3) Specialization and privacy – unlike your typical doctor’s office they focus on just STI’s – testing, tracking, and counseling, and no one will ever know you were there”. These facts should relieve some doubts, and hesitation, for those who choose not to seek help. In addition, I strongly believe this information should be integrated in the education of STI’s, and not just prevention.

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