PEA: Dr., let’s proceed with our conversation. We’ve been discussing the advantages of sexual innocence before marriage and by implication the disadvantages of premature sexual exposure. Last week, we discussed the challenges that come with differences in sexual experience of a couple in marriage. What’s the next reason why you want us to keep our virginity or put differently preserve sexual activity until after marriage?
Dr. Caleb: Age at first sexual intercourse has been associated with risky sexual behaviours and risk of sexually transmitted infections. Some researchers have even associated age at first sexual intercourse to other risky behaviours like alcohol abuse, drug abuse, violence etc. But what is of concern to us is the risk of sexually transmitted infections. The younger the age at first sexual intercourse, the higher the risk of these infections.
PEA: Is STI really still that rampant when condoms are everywhere?
Dr. Caleb: Yes o. Thank God it is easier to deal with the very disturbing ones with better and newer antibiotics but the non-disturbing ones are worse.
PEA: You stated that the younger the age at first sexual intercourse, the higher the risk of STIs. Is this because the younger the age, the more likely the inexperience or naivety to use necessary protection to prevent infection?
Dr. Caleb: Several factors. Yes this is one of them. But also the younger, the higher the number of partners is likely to be. This is worsened by the fact that sex becomes a routine for sexually active people. This may also mean that the more the number of partners, the worse the diversities of infection he/she may carry. Some infections are quite rare these days; gonorhoea and syphilis aren’t as common again but we still see cases. No form of STI has been eradicated, they all still exist. Some viral STIs like HPV are as common as in 20-40% of the population of Adults. When STIs produce symptoms, the sufferer seeks help. If there is delay in seeking help or the care is suboptimal, the symptoms may resolve but there may be lasting damage to the organs of reproduction. Males may suffer infertility from poorly treated infections (epididymo-orchitis, post inflammatory urethral strictures).
PEA: That HPV which you said is widely carried by adults is the one responsible for cervical cancer?
Dr. Caleb: Yea. Females may suffer tubal damage, and ovarian failure from infections as well. Infections that fail to show symptoms are the worst because the individuals will not even seek treatment whereas damage is ongoing. So when the individual is ready for child bearing it becomes impossible. Even the commonly known gonorhea and syphilis may show no symptoms or symptoms spontaneously resolve. Chlamydia may show no symptoms and it’s one of the commonest agent of pelvic inflammatory disease (PID) in women. Most other bacteria infections may show no symptoms.
The ones that will eventually give symptoms will produce pain from chronic PID. At this stage of PID, the damage has happened already such that after optimal drug use there is still residual scaring which is the tubal damage responsible for infertility. Tubal damage is the commonest demonstrable cause of female infertility and it results from chronic infections most commonly.
Among STIs is HPV which causes cervical cancer. Second commonest cancer in women in Southwest Nigeria and commonest in the North. The earlier the age at first exposure to HPV, the higher the risk of cervical cancer. This risk is highest among adolescents whose cervices are undergoing some developmental changes. Having a partner that has or has had multiple partners increases the risk of contracting the virus which is a very common virus. Penile cancer is possible too but quite very rare. Of course with vaccination we can significantly reduce the risk of HPV infection and possible cervical cancer.
HIV/AIDS is still around in Nigeria with incidence now around 2% (National average).
PEA: Are the vaccines for HPV already available? Who can get them?
Dr. Caleb: Any woman can have it but recommendation is for sexually naive women especially younger than 25.
PEA: Okay, anyone of this age bracket can walk into any hospital and get vaccinated. Hope it’s not too expensive?
Dr. Caleb: Around 10-15k per shot, about 4 shots is recommended but at least 2 is good. It may be possible to find it cheaper in some places though.
PEA: Ok.. So those who may have been exposed had better go and get the vaccine quickly?
Dr. Caleb: People that have been exposed are not likely to benefit from the vaccine if they are already infected.
The vaccine prevents infections not cure it.
PEA: Ooooh, I see. So anyone who knows that her level of sexual activity is much or is about to get much should go for the vaccine.
Dr. Caleb: That’s why it’s recommended before commencement of sexual activities. Because if your partner ever had a partner, you’re at risk.
PEA: Condoms are the greatest forms of protection that people believe can save them from these infections. Does someone who uses condoms regularly also have risk of any of these infections? If yes, over 100, what’s the percentage of the person’s risk?
Dr. Caleb: Condoms with perfect use significantly reduce the risk of getting any of these infections but it does not exclude them. The value of using condom varies for different types of infections. Infections like HPV, HSVs, Pubic lice have 75% coverage with condoms as perineal skin (areas surrounding the genitals) may be heavily laden with these organisms and perineal contact is not prevented with condoms.
The risk of transmission of other STIs is present with oral sex and other forms of contact that may happen for which condom is either inappropriate or not provided. However, condoms are now available for oral sex (called oral dam). Adjustments can also be made to male condom or female condom (fendom) to suit this purpose of oral sex.
Unfortunately, unmarried people are less likely to use condom especially in some cultures because of accessibility. Anywhere there is human inter phase between access to condom, unmarried people will use condom less because of guilt, discrimination and several other factors? Access to condom is best when condoms are sold by vending machines in secret places like toilets. Sales by vending machines is not yet a reality in Nigeria.
PEA: The non-coverage of condoms for oral sex is a big window for STIs.
Dr. Caleb: Yes sir. Of course for many other infections that are only found in body fluids, condom protection with perfect use is approaching 100%. Even when condoms are available, perfect use of condom is not the common experience of many people especially younger people who are rarely schooled on how to use condom. Perfect use of condom begins with storage, how the seal is broken, how and when the condom is applied. There are possibilities of errors that may introduce micro leakages into the condom.
PEA: Very serious issues here. What kind of infections are only found in body fluids? I just want to be sure of them so we know the diseases that perfect use of condom offers close to perfect protection against.
Dr. Caleb: Perfect use of condom significantly reduce the risk of most bacteria infections like gonorhoea, syphilis, chlamydia and other common bacteria. It is still not 100% with these.
PEA: How well does perfect use of condom prevent HPV?
Dr. Caleb: 75% prevention.
PEA: What other popular STIs outside HPV aren’t bacteria diseases and unlikely to be 100% preventable by perfect use of condom?
Dr. Caleb: HIV, Hepatitis, HSVs, Scabies, pubic lice, trichomonas, yeast etc. Like I said earlier, perineal skin (areas surrounding the genitals) may be heavily laden with these organisms and perineal contact is not prevented with condoms.
PEA: Hmmm, I think the issues are very clear. Thank you Dr. for your time.
Dr. Caleb: Thank you for having me. I can only hope these information translate to meaningful decision making for all young people.
PEA: I pray so.
Peniela E. Akintujoye.
©Peniela Eniayo, Akintujoye| email@example.com