Sexually Transmitted Diseases: The Downside of Sex

Because of the AIDS crisis, we hear a lot in the media about safe sex. When it comes right down to it, most information isn't as explicit as it needs to be. We still have a Puritan streak, which often keeps us from talking about the actual mechanics of sex. But that doesn't help anyone because there are important issues that need to be explained, such as which diseases we are really at risk of contracting or how to use a condom properly.

The safest sex is with a disease-free partner in a mutually monogamous relationship......High-risk groups include men who have sex with men, intravenous drug users, and former prisoners and their sex partners—no matter what their sex..... Remember, too, that younger partners aren't necessarily less risky. Quite the opposite. Two-thirds of STDs are diagnosed in people under age thirty-five.

Although AIDS is clearly the biggest worry, we shouldn't forget about other diseases as well. The Centers for Disease Control estimates that 20 million Americans will contract some form of STD each year. Others estimate a more conservative 12 million. A study by the Allan Guttmacher Institute in the early 1990s estimated that one in five, or over 50 million Americans, have had some kind of STD.

How much does having an STD age you? Statistically, only 0.9 years. But this statistic is misleading. Contracting HTV is a way of becoming old overnight. A thirty-five-year-old man who contracts HTV experiences twelve years of ageing from the disease in a short period and more ageing as the disease progresses. His risk profile changes to that of a much older man as soon as HTV is diagnosed. In light of the current improvement in treatment for HTV, the ageing effect correlates directly with the quality of care. Other diseases are more uncomfortable than life threatening, but they can lead to long-term ageing of the immune or cardiovascular system.

Unfortunately, data on the relationship between safe sex and ageing is hard to correlate, partly because STDs are so different. One of the biggest problems with getting statistics on STDs is that it is virtually impossible to do controlled studies on sexual behavior. Researchers can't create the kind of double-blind study populations that we can create for studies like drug tests. We can't tell a group of people that half of them should have lots of casual sex and the other half should be monogamous. We can't even divide the monogamous group into two subgroups and tell one to have sex only once a week, and the other to have sex every day.

More important, statistics are only general trends. For example, although the group having the highest incidence of STD infection consists of unmarried people under age thirty-five, STDs can affect anyone. Either through divorce or widowhood, a lot of people find themselves back on the 'dating scene' when they hit their forties and fifties. If this is you, play it 'safe.' Don't risk an STD.

AIDS-HIV infection is clearly the biggest risk, as it is a fatal disease for which we have not found a cure. Although the new, better drugs have made it possible for many HIV-positive patients to live symptom-free for years after infection, it appears that these drugs only delay the onset of full-blown AIDS; they do not prevent it. Moreover, this delay is achieved only when HIV-positive patients rigorously maintain a complicated and expensive medication schedule. If you believe that you may have been exposed to the disease or are changing sex partners, it's a good idea to get an HIV test. If you think you've been exposed, early treatment can prevent permanent infection (by early, I mean within one to four hours).

Although HTV is a fairly difficult disease to contract, exposure to other STDs reduces the immune system's defenses and increases the likelihood that HTV will actually infect a person who has been exposed. Estimates are that a person with genital lesions (for example, from syphilis or herpes) is one hundred times more likely to contract HIV during a single sex act than someone who has never had an STD......

If you are in a monogamous relationship and making the decision to switch from condoms, first talk about it. Then, both you and your partner should go to a doctor for a full workup of tests. That way each of you will know the facts. If one of you tests positive for an STD, then you can make an informed decision about the best way to proceed.

Women who are pregnant or considering getting pregnant should get checked for the presence of any STDs, since these diseases can sometimes be harmful to the developing fetus or newborn. Usually, an STD doesn't interfere with pregnancy; rather, extra precautions are taken to prevent mother-to-child infection.

Wear It, Wear It Right

Studies of condom use consistently show that people just don't get it right. There are six essential steps to using a condom properly, but most people perform only three or four of the six steps correcdy. Don't assume you know. I admit I felt a little silly when I used a banana to show my son how to use a condom, but, silly or not, I am reassured that he now knows exacdy what to do.

Buy only latex condoms and use a new condom for each episode of intercourse—even if you don't ejaculate each time. Make sure you use condoms that say they protect against STDs. Joke or novelty condoms may not provide protection. Make sure that the condoms have not passed their expiration date, that the foil pack is intact, and that the condoms have not been left too long in some place where they could get damaged (for example, in the sun—or in a wallet!).

Open the package carefully and be sure to avoid damaging the condom with either your fingernails or any other sharp object.

Place the condom on the erect penis prior to any intimate contact (some STDs, such as gonorrhea, can be transmitted even without penetration). Roll the condom down to the base of the penis, where the penis connects with the body. Make sure the fit is snug.

Leave a space at the tip of the condom and remove any air pockets from that space.

Use only water-based lubricants, such as KY jelly or spermicidal foam or gel. Never use oil-based lubricants, such as petroleum jelly (for example, Vaseline), lotions, or mineral oil, because they destroy the latex. Also, many condoms are treated with nonoxynol-9, a spermicide and lubricant that seems to provide some added protection against HTV and other types of STD infection. It is probably a good idea to use this type of condom, since it will give you some added protection just in case.

Withdraw immediately after ejaculation, while the penis is still erect, holding the condom firmly against the base of the penis.

The following are the most common sexually transmitted diseases:


Human immunodeficiency virus infection—the infection that causes or is presumed to cause AIDS—has traditionally been associated with gay men and intravenous drug users. However, its incidence is growing in other sectors of the population. Between half a million and a million people in the United States are infected with HTV, with six times as many men being infected as women. Infection rates are higher in the African American and Latino communities, presumably because of other associated risk factors, such as higher rates of poverty and drug use. In nine major American cities, AIDS is the number one cause of death for women aged twenty-five to forty-four. Since women are more susceptible to contracting the disease than are men, experts expect AIDS to increase among women.

The reason that AIDS spread so quickly among gay men in the 1980s was that many had sex with multiple partners without using condoms, and many engaged in practices that are now known to increase the likelihood of disease transmission, notably anal sex. Studies consistently show that people who have sex with HIV-infected partners but use condoms are at minimal risk of contracting the disease.....HTV-AIDS is a two-stage disease. A person who is infected with HTV can remain virtually symptom-free for years, but nevertheless is infectious. AIDS is the disease stage of HIV infection. By rendering the immune system basically useless, the disease destroys the body's primary line of defense. Infections, cancers, and other immune diseases then can attack the body, causing horrible and painful illnesses. A person goes from a young healthy adult to a disease-ridden old person in a matter of months or years.

Because of recent advances in HTV treatment, people who are infected with HTV who get a proper regimen of medications can stay virtually symptom-free for years. If you discover that you are HIV-positive, seek medical care immediately. Proper management of the disease can add years to your life. Each year, more effective treatments for the disease emerge, so the longer an infected person survives, the better the odds of living until a cure is discovered.


Chlamydia is the most common bacterial STD in the United States. The greatest problem with chlamydia is that its symptoms are largely 'silent.' Seventy-five percent of those who are infected show no symptoms. Primarily affecting women, chlamydia can cause internal scarring of the fallopian tubes, ectopic pregnancy, and infertility. Symptoms, when they do occur, include painful urination, vaginal discharge, and abdominal pain. Although men are usually not affected by the disease, they should seek treatment if they are exposed because they can transmit the disease to their partners. Ask your gynecologist or general physician to include a chlamydia screen in your routine battery of tests, particularly if you have recently changed sex partners. Fortunately, chlamydia can easily be treated with antibiotics.


'The clap' can affect anyone. Although as many as two-thirds of women and 40 percent of men who are infected with gonorrhea are asymptomatic, painful urination, unusual vaginal discharge, and menstrual spotting can be signs of infection. Gonorrhea is highly contagious and can be transmitted simply through genital contact, even without penetration. It can cause ectopic pregnancy or infertility in women and seems to increase a person's susceptibility to HTV. Nonoxynol-9, the spermicide most often used on condoms, helps block the transmission of gonorrhea. Untreated, the disease can cause cardiovascular ageing. Gonorrhea can usually be treated with antibiotics, although some antibiotic-resistant strains are appearing. Infections from these strains can be cured with a more vigorous and difficult series of treatments.

Hepatitis B

Hepatitis B is not officially classified as an STD, but its most common mode of infection is through intercourse. Hepatitis B can cause severe damage to the liver. There is no effective treatment, although many people recover on their own. A hepatitis B vaccine is available (see Chapter 12), and getting vaccinated is a quick, easy way to help yourself stay young, particularly if you are sexually active and plan to have more than one sex partner in your lifetime.


Estimates are that one in five sexually active Americans has genital herpes, an increase of 15-20 percent since the mid-80s. This increase has occurred despite 'safe sex' education and programs that encouraged the use of condoms. Many people who have been infected remain asymptomatic and unaware of the disease, yet they are still infectious and spread the disease to their partners. Within the first week or two after infection, symptoms can include fatigue, muscle aches, and itching. Ten days or so after infection, a small blister usually emerges in the genital region. The blister can burst and remain for several weeks, causing pain and discomfort. Once the initial outbreak heals, victims remain infected for the rest of their lives and may suffer recurrent outbreaks. Although herpes can be both painful and embarrassing, it is not life threatening and has no particular long-term health consequences. Creams and antiviral medications can treat the symptoms and reduce the number of outbreaks but cannot cure the underlying infection, which remains within a person for life. Although transmission is most common during outbreaks, transmission can occur between outbreaks as well, in a process known as 'viral shedding.' Women are more likely than men to contract the disease from an infected partner, and herpes can cause more serious consequences if they become pregnant.

Human Papillomavirus

Human papillomavirus is the most commonly transmitted STD. Some experts have estimated that as many as 80 percent of the sexually active population is infected with the virus. However, little is ever said about this disease. In general, the virus is benign. Since it increases a woman's risk of developing cervical cancer considerably, we can say it accelerates ageing of the immune system. Some strains cause small genital growths or warts that can be uncomfortable, but these growths can be easily removed. If you have had more than two sex partners in your lifetime or your partner has had more than two sex partners, chances are you have been exposed to the virus. In general, human papillomavirus infection doesn't do much, and there are no treatments. Once you have it, you have it.

Women who have been exposed to the virus are more likely to develop cervical cancers. In fact almost all women with positive results on a Pap smear show evidence of having been exposed to the virus. For men, exposure seems to have little effect, and penile cancers are rare. Men can transmit the virus to their partners and can develop growths or warts, sometimes inside the urethra, which can cause discomfort. Recent studies have found that the virus may be implicated in some anal and rectal cancers, as well as in some oral cancers. Women should remember to get annual Pap smears, which can detect precancerous cells. Treatments can then be given to prevent the development of full-blown cervical cancer. Positive Pap smear results do not mean you have cancer. Most positive results merely identify an increased risk of developing cancer. If you do get a positive result, you will want to be especially careful about having the condition monitored. Your gynecologist may recommend biannual or quarterly Pap smears or treatments to remove precancerous cells.


If gonorrhea is the 'sailor's disease,' syphilis is the disease of kings. Famous in the eighteenth and nineteenth centuries because of its ravages on the European aristocracy, syphilis is once again on the rise. The incidence of syphilis has doubled since the early 1980s. Symptoms include genital lesions, aches, fevers, rashes, hair loss, and skin and mouth sores. If untreated, syphilis can infect the eyes, heart, brain, and other organs, causing irreparable structural damage. In addition, it accelerates the rate of arterial ageing. Syphilis is easily treated with antibiotics and, if detected early, leaves no lasting damage.

Sex is a great thing. The more, the better. There's no way to get younger that's more fun! Just remember: Be safe. Use a condom, get tested, and pick your partner carefully.

Illegal Drugs: Staying Young Without Them

Illicit drugs may be illegal, but that doesn't mean that people aren't taking them. About 40 to 50 percent of Americans aged fifteen to fifty-four admit to having tried an illegal drug at some point in their lives, and over 15 percent say they have done so in the past year. Estimates suggest that 5 to 10 percent of the population use illegal drugs regularly, and many admit being addicted. The more than $3 billion spent each year on drug rehabilitation programs is just a small part of the major impact that drug use has on our society. Although we tend to associate drug use with teenagers, rock stars, or inner-city poverty, it's not an accurate picture. People from all segments of society use and abuse drugs. And drug use, it is not surprising, accelerates ageing.

Drug addiction is a serious problem that has physiologic and mental effects. The problems associated with drug use are complicated and warrant more discussion than I can provide here. For the purposes of this book, there is only one question: How does illicit drug use contribute to ageing?

Most hard drugs are illegal for a reason: They're dangerous and addictive. Cocaine, crack, heroin, and a whole array of hallucinogenic (mind-altering) drugs can cause serious health problems. Unnecessary ageing associated with drug use can be as much as eight years. Drugs like heroin and cocaine top the list. They can kill a person almost instantaneously. An overdose, if not fatal, is always serious and puts a person's life at risk. Although trying a drug once probably won't do much damage by itself, it may cause addiction. Many people crave more and then are on the path to drug addiction. Addiction affects a person's physiology, making him or her more likely to suffer real physical ageing that is manifested in many ways. The mental effects of drug use tend to disrupt social ties, often causing users to lose their friends, families, and jobs.

People who use drugs are more likely to make bad decisions. They are more likely to get into accidents and have unsafe sex. For example, cocaine and crack use are associated with higher rates of HIV transmission, not because using the drugs increases susceptibility to the HIV virus, but because users take risks (unsafe sex, needle sharing) that make them more likely to be exposed to the virus.

Marijuana, by far the most popular illegal drug, is less immediately dangerous or addictive than other drugs. Smoking 'pot,' even if you 'didn't inhale,' makes your RealAge older. Marijuana contains 50 percent more carcinogens and four times as much tar as cigarettes. Studies show that the heavy use of marijuana can cause residual neurologic effects that decrease cognitive functioning. Heavy users actually experience ageing less from the drug itself than from the behaviors it tends to induce, most notably a lack of motivation. For example, users are less likely to exercise or eat a healthy diet or to maintain the kinds of social networks that can help protect against stress. They are also more likely to engage in risky behaviors, such as unsafe sex or driving under the influence of either drugs or alcohol.


When it comes to illicit drugs, the best advice is not to start. If you do use drugs, consider quitting. If you find you can't stop 'cold turkey,' you have an addiction problem and need to seek help. Although overcoming a drug addiction is difficult, addiction is one of the most pernicious agers of the body, and ending a habit of drug abuse will make you younger and, consequently, feel better. It could even save your life.



Keith Hunt