Sexually Transmitted Infections (STIs)

Youth need information and services about sexually transmitted infections (STIs) because untreated infections can lead to serious health problems and increases risk for getting and spreading other infections, including HIV.4  Reducing stigma around STI testing, treatment and communication reduces barriers to accessing STI information and services.

STBBI rates are often higher in youth than the general population.

Rates are even higher in street-involved you who are more likely to engage in high risk behaviors like sex without a condom, sex with many partners, and the use of alcohol and drugs.1

For many of these youth, meeting the basic needs of life is more important than preventing possible health problems, so street-involved youth don’t always take the actions needed to prevent STIs and BBIs.2

JEN’S STORY…

Last week, on my way to work, I suddenly had really bad stomach pains. It was terrible — it honestly felt as though my guts were being squeezed out. My BF took me to the ER. The doctor said I had PID from chlamydia – I can’t believe it! I had no symptoms up ’til then and we’ve been together for almost six months. My boyfriend says he doesn’t want to go to the doctor ‘cause he says the test really hurts for guys.

What are STIs and BBIs?

Sexually transmitted infections (STIs) and blood-borne infections (BBIs) are infections, or sicknesses, that people can catch from someone who has that infection. Together, STIs and BBIs are sometimes called STBBIs.

Sexually Transmitted Infections (STIs)

  • infections spread through sexual contact with the genital area, semen or vaginal fluid of someone who has that STI. They’re sometimes called sexually transmitted diseases or STDs. There are many types of STIs. All are treatable. Some are curable.4

  • infections spread through contact with the blood if someone who has that BBI. Some BBI are also spread through contact with semen, vaginal fluid, rectal fluid or breastmilk. All BBI are treatable. Some are curable. 

Good to know

Although some sexual activities may be lower risk for BBIs, they may still be high risk for STIs. Any skin to skin sexual contact with someone else’s genital area, including hand, oral, vaginal and anal sex, is high risk for STIs. So is contact with another person’s semen, pre-ejaculatory fluid, vaginal fluid or anal fluid.

Types of STBBIs

Sexually transmitted and blood born infections are caused by microscopic organisms entering the person’s body. Sometimes these infections are classified based on the type of organism causing the infection.

Parasitic

STIs caused by parasites (e.g. pubic lice/crabs, scabies, trichomoniasis) are usually easy to detect, treat and cure. Without treatment, they spread easily and cause uncomfortable symptoms like itchiness, rash and irritation.

Bacterial 

STBBIs caused by bacteria (e.g. chlamydia, gonorrhea, syphilis) may not always have symptoms, but can be detected through STI testing. They can be cured with medication. Untreated bacterial STI can cause very serious health problems.

Viral

STBBIs caused by viruses (e.g. herpes, HPV, Hep B & C, HIV) may not always have symptoms. Some can be difficult to detect while others can be detected through testing. All can be treated; some cured; some can be prevented with vaccine. Some untreated viral STBBI can cause very serious health problems. HPV and herpes (HSV) are the most common STBBI.

For detailed information about specific STBBI, go to https://www.sexandu.ca/stis/

Good to know

People cannot tell if someone else has an STBBI. They might not even be able to tell if they have it themselves, because the most common STBBI symptom is having no symptoms at all. Other STBBI symptoms include:

  • rash, sores, lumps, bumps, itchiness or irritation at the site of sexual contact
  • pain or bleeding during or after sex, orgasm or peeing; pelvic or genital pain.
  • unusual discharge or smell in the genitals or area of sexual contact.
  •  feeling unwell or fatigued.

Testing and Treatment

All STBBI are treatable: most are curable. But, many people who have STBBI don’t know it because they don’t have symptoms.7 The only way to know for sure if someone has an STBBI is to get tested. Regular STBBI testing is an important part of staying healthy for people who are sexually active.

Good to know

Pap tests screen for changes to the cells of the cervix caused by HPV infection as these can lead to cancer. Everyone with a cervix, regardless of sexual orientation or gender, needs a Pap test 3 years after first sex or at age 25, whichever is later.

STI testing may be done by:

  • urine sample
  • blood draw
  • swab
  • visual exam
  • skin or tissue sample

People can get STI testing at:

  • their family doctor’s
  • walk in clinic
  • Sexual health clinic
  • Teen clinic
  • Sexually transmitted infection clinic
If someone is sexually active, it’s important to get STBBI testing:
  • At least once a year
  • Every 3 to 6 months if they have new partners or if their partners have other sex partners
  • If there was sex without a condom or the condom broke
  • If they or partners have symptoms
  • If they are contacted by a health care provider to be tested
  • If there was sex with someone known to have an STI.5
It’s also important to be tested for STBBI after sexual assault.

Good to know

Some STBBI are “reportable”. This means that when someone tests positive for the infection, it is shared with Public Health to help prevent and manage outbreaks of serious STBBI. Even if you have a reportable STBBI, your health information is kept private. To learn more about reportable STI and your privacy, click here.

Tip

Youth are more likely to go for STBBI testing when they know what to expect. Let youth know where to get tested (e.g. family doctor’s, walk in clinic, sexual health, teen or STI clinics) and what to expect. Reassure youth that they can talk with the health care provider about what tests to expect, why those tests are needed and what they are comfortable with.

All STBBI can be treated. Untreated STBBI can cause very serious health problems. Treatment is generally free. If cost might be a concern, supportive adults can help youth advocate for access to free treatment programs.

  • Treatment for STBBI may include medicine that is swallowed, put on the skin or injected by a health care provider or surgical or freezing treatments.
  • Sometimes people need to be tested again after treatment to make sure the treatment worked.
  • Sometimes people need to not have sex for a certain amount of time during or after treatment to make sure they don’t give the STI to someone else.

For more information, see https://myhealth.albertahealthservices.ca/sexual-reproductive-health/sexually-transmitted-infections

Tip

Pregnant youth may need a variety of supports access medical care, including STBBI testing and treatment, and to follow the directions of the health care provider. STBBI can cause serious problems for a pregnancy and baby. Even with treatment, some STBBI can change what method of delivery (vaginal vs caesarean section) and feeding (breast or formula) is safe.

Prevention

There are risks and benefits to every activity, sex included. STBBI is a risk that comes with having sex. When provided with comprehensive information about a variety of ways to eliminate or lower the risk of  STBBI, they’re more able to make choices to reduce their risk of STBBI in their specific situation.3

Abstinence

Abstinence means not doing something. When it comes to STBBI prevention, abstinence means not having sex – or more specifically, not having any contact with another person’s genital area, semen, pre-ejaculatory fluid, vaginal fluid, anal fluid, blood and breastmilk. This is the only way to eliminate the risk of STBBI. People abstaining from sex might choose lower risk forms of sexual activity such as mutual masturbation, sensual massage, video sex or phone/text sex.

For those who are sexually active, abstaining from vaginal, anal and rough sex can lower the risk of some STBBI. It also lowers the risk of STBBI infection if people abstain from sex:

  • if partners have any STBBI symptoms
  • until after all partners have finished STBBI treatment and the health care provider says it’s ok to have sex again
  • until all partners have tested negative for STBBI

Tip

 Many youth are used to hearing the word abstinence in a values based way and may “tune out” if they fear being judged if they are sexually active. Presenting abstaining from sex as one tool they can choose to lower their risk of STBBI can help youth feel respected and encourage them to engage in talking about STBBI prevention.

Vaccination

There are vaccines available to reduce the risk of HPV and Hepatitis B. In Alberta, these are part of the routine childhood vaccination program and are given in Grade 6.6 Adults can get these vaccinations, generally at a cost, through their health care provider at a cost – coverage may be available through private or group health insurance plans.

For information on HPV vaccination, see: https://myhealth.alberta.ca/Alberta/Pages/immunization-human-papillomavirus.aspx

For information on the Hep B vaccination, see: https://myhealth.alberta.ca/Alberta/Pages/immunization-hepatitis-b-vaccine.aspx

Good to know

Some youth may not have received their routine childhood vaccinations. Youth with access to their Alberta Health Care Insurance Card can call 811 to find out their vaccination history and may be able to get these vaccines at their local health unit at no cost.

Avoid sharing sex toys.

If sharing sex toys, cover with a new condom before contact with another person. Clean sex toys according to the manufacturer instructions before each use.

Limit the number of sex partners. 

Statistically, the lower the number of partners, the lower the risk of STBBI. It’s important to remember that even if a person only has one partner, if that person has STBBI, there is a risk of getting it.

Communication. 

Communication with sex partners about sexual history, testing, treatment and STBBI protection can lower the risk of STBBI. This works best if the communication happens before sex starts.

Communication with health care providers about sexual and medical history and sexual practices can help the health care provider provide good care and information to lower the risk of STBBI transmission and can support early detection and treatment.

To learn more about healthy communication, click here.

Avoid contact with someone else’s blood.

It’s important for people to use their own separate drug works (needles, pipes, straws), toothbrushes and razors. If getting tattoos or piercings, choose licensed businesses that follow public health regulations and are regularly inspected.

Regular STBBI testing.  Treatment if needed.

Consider PrEP

Pre-Exposure Prophylaxis is a medication that helps prevent HIV in people that are at high risk of getting it. It can be available for free for some people. People can get more information about PrEP and find out if it’s right for them and how to get it here: prepalberta.ca

Correct and consistent use of condoms and dental dams.

Good to know

Stigma is a negative attitude or judgment towards something. When a person experiences stigma, they may feel shame, have lower self esteem and avoid accessing services. STBBI is often stigmatized, as is youth sexual activity and substance use. When supportive adults reduce stigma, they increase youth engagement and can reduce the harms of any behavior. Supportive adults can help reduce stigma related to STBBI by not using the term “clean” to refer to those without STBBI, by talking about STBBI using matter-of-fact, inclusive language and by challenging myths and stereotypes. To learn more about reducing stigma, click here.

Condoms and Dental Dams

Condoms and dental dams offer very good protection from many STBBI. Condoms also offer protection from pregnancy. Condom use decreases with age.8 Becoming comfortable accessing, using and communicating about condoms and dental dams increases the chance that youth will continue to use them. 

Condoms

Condoms are thin pouches or tubes that stop the penis and semen from coming in contact with another person’s body. Some condoms fit tightly to the penis. This type is usually just called ‘condom’, but are sometimes called ‘external’ or ‘male’ condom. Some condoms fit inside of the vagina and are held in place by the vaginal muscles. This type is called a ‘vaginal’, ‘internal’ or ‘female’ condom. Condoms come in a wide variety of condom styles, colors, features and materials. 

Dental Dams

Dental dams are thin pieces of material that cover the vulva or anus during oral sex that stop the mouth from coming into contact with the other person’s body, vaginal fluid or rectal fluid. Pre-made dental dams are rectangular and are made from latex. People can make dental dams by cutting condoms or surgical gloves.

Tip

 Youth may benefit from these reminders about using condoms and dental dams:

    • use a new condom or dental dam for each sex act
    • avoid doubling up on condoms or dental dams
    • only use water based or silicone based lubricants with condoms and dental dams – oil based lubricants break down the material
    •  avoid products made from animal skin or membranes as they do not protect from STBBI

 Supportive adults can increase the likelihood that youth will use condoms and dental dams by reducing barriers to use and addressing common reasons for hesitancy. Reasons youth may have for not using condoms and dental dams include:

      • embarrassment
      • being on birth control so thinking condoms aren’t needed
      • not having one at the time
      • a partner that doesn’t want to use them
      • substance use impairing the ability to get or use them
      • thinking they’re in a monogamous relationship so it’s not needed
      • being in an abusive relationship
      • not knowing how to negotiate condom use
      •  cost or lack of access

Talking with Partners about Using Protection

Communication is an important part of STBBI prevention. Talking about STBBIs with partners is easy for some, more challenging for others. Access to information and communication strategies can help youth have these conversations. 

Some people are embarrassed to start a sexual conversation. Others are intimidated by their partner, feel they need to comply in order to “keep” a partner (or the peace), or simply believe the excuse a partner gives for not wanting to use condoms.

Strategies that can make talking about using protection easier:
        • Set personal values and boundaries about condom use.
        • Talk about your values, boundaries and protection before intimate activity begins
        • Be willing to start the conversation
        • Carry condoms
        • Make sexual decisions when sober
        • Be willing to walk away from the activity
        • Have comebacks or suggestions ready for the most common reasons why people might resist using protection

Example Comebacks

Excuse: “I don’t have a condom.”

Comeback: “Don’t worry. I do!”

Excuse: “It takes away from the fun.”

Comeback: “We can use it as foreplay!”

Excuse: “It gets in between us and I want to be close to you.”

Comeback: “If we don’t use one, there’ll be even more space between us!”

Excuse: “My penis is too big for condoms.”

Comeback: “I can fit a condom over my hand and arm. If your penis is that big, we shouldn’t do this…”

Tip

 It’s important to acknowledge that sometimes youth may not have the choice to use condoms and dental dams, or even to talk about safer sex. In abusive relationships, people may be directly or indirectly intimidated, threatened or coerced into not using protection or fear the loss of the relationship if they bring it up. Supportive adults can share resources about healthy relationships and remind youth that in healthy relationships, people can set limits and expect to be able to make choices that keep themselves safe.

Good to know

Some people find that latex condoms negatively impact their experience. People allergic to latex can choose non-latex condoms. For those that find condoms decrease sensitivity, using an ultra-thin condom or putting a small drop of water-based or silicone-based sex lube in the tip of the condom before application can help. The drop of sex lube in the tip before application can also help if the condom feels to small, as can using non-latex or vaginal condoms.

For STI testing, treatment, education and support in Calgary or Alberta, youth can go to an Alberta Health Services Sexual and Reproductive Health Clinic. For information on community resources, click here. (link to resources page).
 For youth living outside of Alberta, to find a sexual health service: https://www.actioncanadashr.org/resources/services
YOUTH CAN ALSO GET HELP AT:
      • Walk-in clinics.
      • A family doctor.
      • Urgent care facilities.

For information on STIs and BBIs, click here

1Lokanc-Diluzio, W., & Reilly, S.M. (in press). Enhancing the personal skills of service providers to promote the sexual health of street-involved youth. In A. R. Vollman, E.T. Anderson, & J. McFarlane (Eds.) Canadian community as partner: Theory & multidisciplinary practice (5th ed.). New York: Wolters Kluwer Health.
2Lokanc-Diluzio, W. (2014). A mixed methods study of service provider capacity development to protect and promote the sexual and reproductive health of street-involved youth:
An evaluation of two training approaches. (Doctoral dissertation). Available from http://hdl.handle.net/11023/1507
3Public Health Agency of Canada. (2017). Summary of key findings from Y-Track: Phase 6 (2009-2012). URL= https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/y-track-2002-2009/y-track-2009-2012-eng.pdf
4Public Health Agency of Canada (PHAC). (2020). Canadian guidelines on sexually transmitted infections. Retrieved from http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/index-eng.php
5Government of Alberta, & Alberta Health Services. (2013). Getting tested & treated. Retrieved from http://sexgerms.com/getting-tested
6 Lokanc-Diluzio, W., & Troute-Wood, T. (2019). Sexually transmitted and blood borne infections. In L. L. Stamler, L. Yiu, & A. Dosani (Eds.) Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Education.
7Public Health Agency of Canada (PHAC). (2013). Human Immunodeficiency Virus: HIV screening and testing guide. Ottawa, ON: Author. Retrieved from http://www.phac-aspc.gc.ca/aids-sida/guide/hivstg-vihgdd-eng.php
8Rotermann, M. (2012). Sexual behaviour and condom use of 15- to 24-year-olds in 2003 and 2009/2010. Health Reports, 23(1).