STIs | Sexually Transmitted Infections

Sexually Transmitted Infections (STIs) and Blood Borne Infections (BBIs) are more common in street-involved youth than in the general population. Many of these youth engage in risky behaviours such as sex without a condom, sex with many partners, and the use of alcohol and drugs.1

Furthermore, for many of these youth, meeting the basic needs of life is more important than preventing possible health problems. As a result, street-involved youth do not always take the actions needed to prevent STIs and BBIs.2

JEN’S STORY…

Last week my partner was driving me to work when all of a sudden I had bad stomach pains. It was terrible — it honestly felt as though my guts were being squeezed. He took me to the Emergency and I was told that I had PID, caused by chlamydia. I never thought this could’ve been caused by a sexually transmitted infection. I had no symptoms up until 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.

 In a study of Canadian street involved youth ages 15-24, 8.7% tested positive for chlamydia; 1.0% tested positive for gonorrhea; and 0.9% tested positive for HIV. 3

This is important because if not treated, chlamydia and gonorrhea, can cause pelvic inflammatory disease (PID), which can lead to chronic pain, ectopic pregnancy, or infertility.

Untreated infections can lead to testicular infections, infertility and/or chronic pelvic pain. Also having an STI increases a person’s risk for getting or spreading HIV.4

Tip

 Service providers should encourage youth to get tested for STIs:

  • At least once a year. Every 3 to 6 months if they have a new sexual partner, or if partners have other sexual partners.
  • If a person is having symptoms or problems.
  • If there was sex without a condom, or the condom broke.
  •  If there was sex with someone known to have an STI.5

What are STIs and BBIs?

are types of infections that are spread through sexual contact. STIs are sometimes called sexually transmitted diseases or STDs. There are many types of STIs. Some are easily cured with prescribed medication; others have no cure.4

are infections that are spread by the blood and other high risk body fluids such as semen, vaginal or rectal fluid.

Types of STIs

 Sexually transmitted infections are classified as:

If detected early, bacterial and parasite STIs are generally easy to treat. Viral STIs can be treated, but are more difficult to cure. Some viral STIs are not curable at this time.

Good to know

The most common symptom of STIs is having NO symptom. If a person experiences any problems (e.g., burning when peeing, unusual bleeding or discharge, pain, lumps, bumps, sores or rashes) they should see a healthcare provider ASAP.

Bacterial STIs

 The most common reportable STI is chlamydia, followed by gonorrhea.

Chlamydia and gonorrhea are most often spread through unprotected (sex without a condom) vaginal and anal sex, and less often through unprotected (sex without a condom or dental dam) oral sex. Infections can also pass from mother to newborn baby during delivery.Syphilis is a bacterial STI that progresses in three stages and is infectious during the first year. Syphilis is spread through unprotected (sex without a condom or dental dam) vaginal, oral, or anal sex with an infected person.4

Good to know

If a person has a positive chlamydia or gonorrhea test, all partners within the past 60 days need to be tested for infection. People should abstain from all sexual contact for 7 days after everyone (the person and all partners) have finished treatment. For more information, see https://myhealth.albertahealthservices.ca/sexual-reproductive-health/sexually-transmitted-infections

Viral STIs

 Common viral STIs include human papillomavirus (HPV) and genital herpes.

HPV is easy to spread and difficult to detect and prevent. HPV is probably the most common STI in Canada. It is estimated that roughly 70% of adults will have at least one type of HPV infection during their lifetime.4 There are over 130 strains of HPV with about 40 types affecting the genital tract.

Genital herpes is a virus that is easy to spread and difficult to detect and prevent. Herpes type 1 is often associated with sores on the lips or mouth (cold sores), and herpes type 2 is usually associated with sores on or around the genitals (genital herpes). However, it is possible to get both types of herpes in any area (e.g., type 1 in the genitals).

Good to know

A Pap test is a screen for changes to the cells of the cervix. This is also called cervical cancer screening test (CCST). All people with a cervix need the screen regardless of sexual orientation or gender identity and expression. If a person reports spotting or bleeding between periods or spotting/ bleeding after sex, it is important that they see a healthcare provider.

There are three types of vaccines available to prevent different strains of HPV: Gardasil, Cervarix, and Gardasil 9. In Alberta, girls and boys are given Gardasil vaccinations in grade 6 as a part of the routine childhood vaccination program.6 For information on HPV vaccine, see https://myhealth.alberta.ca/Alberta/Pages/immunization-human-papillomavirus.aspx

Parasites

 Parasites are also known as ectoparasites and include pubic lice (crabs) and scabies.

Pubic lice bite their host to feed on blood and lay eggs in the genital and surrounding hair. The eggs hatch within 5-10 days.

Scabies are parasitic mites, which burrow under the skin. Scabies prefer warm places (e.g. folds of skin on elbows, wrists, buttocks, knees, armpits, breasts, and penis).

Types of Blood Borne infections (BBis)

Human immunodeficiency virus (HIV) is a virus that attacks the immune system and makes it hard for the body to fight diseases and infection. There is no cure for HIV. However, with early diagnosis and treatment people can live long, healthy lives. HIV can lead to a condition called AIDS. This happens when the immune system gets too weak to fight infections and gets HIV-related infections.4

 Hepatitis B is another BBI. It is a liver infection caused by the hepatitis B virus and is more infectious than HIV.

Good to know

 A person can have HIV and not know it. A blood test is the only way to know if you have HIV. It is estimated that about 25% of people who have HIV, do not know it.7

Tip

 All household contacts and sexual partners of people who have hepatitis B should be immunized to prevent infection. For more information about hepatitis B immunization, click here.

STI and BBI Prevention

 Ideally, youth should be encouraged to consider or re-consider abstinence. Abstinence means avoiding vaginal, anal, oral intercourse and behaviours that expose a person to semen, vaginal or rectal secretions, and blood.

Abstinence may not be an option for all youth given their life circumstances. For those who do not abstain, condoms and dental dams should be considered.

Tip

Service providers can educate youth about preventing STIs and BBIs. Some key messages for prevention include:

  • Abstinence is the best way to prevent STIs and BBIs.
  • Partners can engage in lower risk forms of sexual activity or sexual simulation such as mutual masturbation or sensual massage.If sexually active, the best way to prevent STIs and BBIs is to use condoms and/or dental dams for oral, vaginal, and anal sex.
  • Limit the number of sexual partners.
  • Partners should have open and honest communication with each other.
  • If either partner has symptoms, they should not have any sexual contact.
  • Don’t share sex toys, clean between use, and cover with a new condom before each use.
  • Get tested for STIs at least once a year and when symptoms are present.
  • Consider getting tested every 3 to 6 months if there is a new sexual partner, or if partners have other sexual partners.

Dental dams

Dental dams are square pieces of latex, similar to the material condoms are made from.  They are used to cover the vulva or anus during oral sex to lower the risk of STIs.

 For tips on how to use dental dams, see MyHealth.Alberta.ca

 For a dental dam demonstration, click here.

Condoms

Condoms reduce the risk of STIs and BBIs.  It is recommended that people use a condom every time they have vaginal, anal, or oral sex, and genital to genital contact. Even though using condoms are important for reducing the risks of STIs and BBIs, not all youth use them because:

  • They are embarrassed to get condoms.
  • They are on a hormonal method of birth control.
  • They may not have a condom at the time of sexual activity.
  • Their partner may not want to use condoms.
  • The use of substances such as alcohol or drugs may impact their ability to get or use them.
  • They may think they are in a monogamous relationship.
  • They may be in an abusive relationship.
  • They may not know how to negotiate the use of condoms.
  • Condoms may be too expensive.

Good to know

Condom use tends to decrease with age.8 Even when condoms are used, there is risk for condom failure. Common causes of condom failure are that they are not used consistently (e.g. with every act of intercourse) or correctly. Misusing condoms are a common reason for condom breakage or slippage.

Tips for condom use

  • Male and female condoms should not be used together as this may cause them to break or slip.
  • Using two male condoms together (“double bagging”) may cause condoms to break.
  • Air should be squeezed out of the tip of the male condom before putting it on.
  • Oil-based lubricants should not be used with male (latex) condoms (water based lubricants are fine).
  • Male condoms made from latex or polyurethane are recommended. Condoms made from natural skin (lambskin) do not protect from STIs and BBIs.

How to Talk to a Partner about Condoms

For some people, discussing STIs with a partner comes easy. Others struggle with having this conversation, especially those reluctant to use a condom.

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.

Service providers can support youth to negotiate condom use. Service providers can recommend the following strategies for youth:

  • Set personal values and boundaries regarding condom use.
  • Have a discussion about condom use before intimate activity begins…ideally long before it begins as one of the steps in getting to know each other and setting personal boundaries and limits.
  • Be willing to start the conversation.
  • Carry condoms to avoid the excuse “I don’t have a condom so we can’t use one.”
  • Make sexual decisions when sober so that it is easier to consider and communicate values and limits.
  • Be willing to walk away from the activity if a condom will not be used (as long as this does not put a youth in harm).
  • Have comebacks or suggestions ready for the most common reasons why partners resist using condoms. Take a look at our conversation box below for example,

I DON’T HAVE A CONDOM: DON’T WORRY, I DO

IT TAKES AWAY FROM THE SPONTANEITY: WE CAN USE CONDOM AS PART OF FOREPLAY

CONDOMS GET IN BETWEEN US: IF WE DON’T USE A CONDOM, THERE WILL BE A GREAT DEAL OF SPACE BETWEEN US

MY PENIS IS TOO BIG FOR CONDOMS: THIS CONDOM FITS OVER MY FIST AND DOWN MY ARM

Condom Problem Solving

For some youth, using latex condoms may negatively impact their sexual experience. Here are some suggestions.

For those allergic or sensitive to latex:

  • Use a non-latex condom that is still tested to lower the risk of STI or HIV infection (lambskin or animal membrane condoms do not provide protection against STI or HIV transmission or lower protection against pregnancy).
  • Use a vaginal condom.

For those who feel the condom is too small:

  • Try different brands of condoms (this can be used if the whole condom or just the ring feels too tight). Note: a loose fitting condom can result in a less secure fit and provide the potential for pregnancy and/or STI transmission.
  • Use a non-latex condom (these retain body heat better than latex and may feel less restrictive).
  • Use a vaginal condom.

For those who find condoms decrease sensitivity:

  • Recognize this may prolong sexual activity in a positive way.
  • Use a small drop of water or silicone based lubricant in the tip of the condom before applying it.
  • Try an ultra-thin style of condom.

Other ways to Prevent STIs and BBIs

There are other ways to prevent STIs and BBIs besides abstinence, using condoms and dental dams.

  • HPV Gardasil vaccinations are routinely given to grade 6 boys and girls in Alberta. Gardasil protects against four common strains of HPV.
  • Hepatitis B vaccinations are routinely given to grade 6 boys and girls in Alberta. The vaccine may be given during the first year of life, if parents were born in an endemic area or if they are carriers of the disease.6
  • HIV and hepatitis B can also be prevented by not sharing drug equipment (e.g., needles, pipes, etc.) or toothbrushes, razors or sex toys.
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).