HIV, the power of fear

What are the chances of getting HIV? Take a guess. What if you use a needle of an HIV patient? What is the risk when having unprotected sex with an HIV infected person? The answer will follow, but I am 99,7% to 99,9% certain your percentages were too high.

What people used to fear

In the 80’s and 90’s people feared HIV. You get a megaload of viruses in your blood at once and your immune system gets severely beaten up. In the next 5-7 years of your life one by one your immune cells get killed by the virus, making it impossible to fight any infections. You get a pneumonia from a fungus that you normally don’t even notice. You die from the “simple” infections that seize any opportunity to make you sick (opportunistic infections). And you would die, weaker than an Autumn tree leaf.

Rules in how to get infected 

There are some “easy” ways to make sure you get HIV is you really want to (why would somebody try to get infected you ask now, just keep reading).
HIV is transmitted by blood and sex. The hospitals and blood transfusion banks test any donated blood for HIV (amongst other infections) so a blood transfusion won’t get you infected. When you are a big fan of injecting drugs don’t use clean sterile needles, same for tattoos. If you have sex with somebody you don’t know the HIV status of, never use a condom. If you do all this, you have a certain risk. Yay! Just kissing somebody won’t get you HIV and neither will hugging, touching or sitting on their toilet seat.

You might think I am crazy. Please understand, some people are really not afraid anymore. They no longer fear it. In some scenes it’s even a matter of “waiting until I get the infection” and they go have sex with HIV positive people to “just get it over with”.

Why people still get infected

Don’t they have self-control? Why is it so difficult to follow the “easy rules” not to get it? (read the previous part and add “not” in every sentence)
There are multiple possible answers to that.

First of all, people are not saints. Even the girls of All Saints asked for Booty Calls, and we all know what that stands for. You didn’t follow the rules all the time. For not following some easy rules, let’s call them mistakes, in life, well, be grateful you didn’t end up getting a horrible disease.

Secondly, using a condom is a bit of a nuisance. You’re in the middle of “something” and then you have to stop, find the condom, free the condom, lock the condom and then probably start the “something” all over again and finish the messing around until there is some unloading in the condom. Not really romantic, so yes, I understand that people in the heat of the moment skip that step.

But the actual answer why people still get infected is not about having self-control or if it is too difficult. It is about having a lack of fear. If smoking one cigarette today would lead to certain death tomorrow, people wouldn’t smoke. If having unprotected sex today would kill you within a week, well, I tink you’d do your utmost to find those condoms.

Low risk, not lethal

What are the chances of getting HIV? The actual risk to infection, and mind you these are rough numbers and very much influenced by the amount of virus in the blood, is actually not so high. If you use the needle from an HIV positive person (not on medication), your risk is approximately 0.3%. I know, you thought it was higher. If you have sex with an HIV positive person (with no medication), that chance is even lower. Depending if the woman or the man is infected it’s around 0.1%. Yes, it’s possible to get infected if you just have sex one time, but you are a very unlucky person. And of course the risks increase if you have sex with more people and especially with anal sex or other ways that give minor (or even major, still not judging) tears in anus or anywhere else getting blood involved.

What is really happening: unprotected sex, low chance of getting HIV, and if getting HIV, you don’t die tomorrow, you probably won’t even die within seven years, in fact: you might just die of old age. Almost overnight, HIV went from this terrible lethal disease to a chronic disease that’s easier treated than some types of diabetes. Some diabetes patients need three tablets three times a day. HIV patients take one tablet, once a day for the rest of their lives, with hardly any side effects.

Why use a condom? There is nothing to Fear.

Second wave of HIV infections?

This change in prognosis for the HIV infected patients was, and still is, great news. The number of newly infected patients with HIV is still declining. Also, great news. However, I predict a downfall, or upfall.

In the beginning of HIV, people were scared. They knew that they would die a horrible disease if they didn’t take care of themselves. They started to use more condoms. The rate of HIV infections went down, as well as for the other STD’s.

These days people are not fearing HIV. They’re less likely to use condoms, increasing their risk to all STD’s. We are already witnessing increases in STD’s like Chlamydia and Gonorrhea. These STD’s are easier to transmit then HIV. That might explain why we don’t see an increase in HIV infections, … yet.
I’m afraid we will be seeing a second spike in HIV infections in the near future. And then we’ll be living in a world with more complicated infections and an ongoing war against bacterial resistance.

It’s ok to be a little bit afraid sometimes. It might save your life.

Next time: the near future of HIV…

 

 

Image: http://www.dailytrust.com

Syphilis, a social disease

Napoleon Bonaparte, Al Capone, Adolf Hitler, Friedrich Nietzsche and Vincent van Gogh. All well-known men that seem to be unrelated in every way. But on closer look we understand that they all changed the world as we know it. And no, not always for the best. I am indeed talking about Nietzsche with his endless nagging about the apparent relationship between the Apollonian and Dionysian juxtapositions in one’s endless struggle trying to create order in one’s chaotic life, … , you know what I mean. But what these men also had in common, they all suffered from Syphilis. Probably not a big shock, looking at the title of this blog. Can we maybe state that, to change the world, you might need a nice little psychosis due to neurosyphilis?

Syphilis is a disease that has been amongst us for many years now and used to be referred to as a “social disease”. Now don’t be afraid, you can still like a Facebook post, play Monopoly with friend or even go to a birthday party. Just wear a condom when you are doing it! You know why? Because unlike what my patients try to convince me of, you don’t get Syphilis from a toilet seat. Syphilis is an STD.
We now know that the bacterium Treponema pallidum thrives through intense relationships of mucous membranes from different persons, or to state it in plain language: penises, vaginas and anuses having fun with each other. The bacteria end up in the blood leading to rashes on your skin, festers on the already mentioned penises, vaginas and anuses and could lead to severe neurological problems… now take a look at the list of names again…

Back in the Middle Ages they didn’t know what the cause was. To investigate the disease and see if it maybe was blood transmittable, some clever men (always those guys) started a “very ethical” study amongst prostitutes, by far the most social people in that time. The researchers found some ladies with syphilis and took their blood. This blood was then given to another group of prostitutes, let’s call them the “I am really not volunteering for this” ladies. All the IARNVFT-ladies got injected with the infected blood and became ill. Voilà: the clever men knew Syphilis was blood transmittable. That’s what you call empirical research.

Unfortunately for them, there was no cure. One of the treatments that was practiced from the 11 century onwards was using Mercury. It wasn’t a cure, merely treating some symptoms if any. The Mercury was rubbed on skin, patients swallowed it, it was vaporized or applied in a plaster. For your reference, using Mercury as a medicine is probably comparable to taking 13 XTC pills, swallowing them away with detergent and smashing yourself on the toe with a hammer. Not something to look forward to. Another idea was to induce high fever in neurosyphilis patients using a Malaria parasite. This led to some patients death but also for the Nobelprize in 1927. Imagine you are paralyzed and psychotic and then getting Malaria, I wouldn’t be the biggest fan.

So, what did they know: Syphilis was blood transmittable, it gave you severe neurological problems … and there was no cure from getting sick after a social event! And if there’s no safe cure, people try crazy stuff to think of ways to prevent it. Flashback to 1717. An English doctor Daniel Turner was sitting in a bar, had some drinks and saw some beautiful ladies. He felt his manhood swelling and he knew he couldn’t resist the action. As a doctor he knew that the last thing on his wish list was getting Syphilis, so with his almost exploding man parts he jumped out of the bar, ran into a greenfield, saw a sweet little lamb … and butchered it. He immediately wrapped the sheep’s intestines around his penis, ran back to the bar and started a social intercourse event with one of the remaining lovely ladies. And guess what? He didn’t get Syphilis. In fact, he didn’t catch any STD. Daniel Turner, through his act of explosive desperation changed our lives drastically, the Condum (old English for hide) was born! To his great disappointment however, not everyone was enthusiastic at the time. We get that now because there probably wasn’t an ultrathin condum or one that glows in the dark or had funky flavours (unless you really like intestine flavour of course… not judging).

Luckily, in 1928 Alexander Flemming opened his window to start the discovery of Penicillin and a cure for Syphilis and many other diseases was finally there. But don’t think you can live like the Prince of Bel-Air. Syphilis is back in the game. After the start of the HIV pandemic, people became more scared about free sex with everyone they met and started either using condoms or having less contacts. This resulted in a huge drop of all STD’s, hooray! But HIV is not so terrifying anymore. That’s of course good news but people are getting back to their old habits, thus increasing STD rates and also Syphilis rates. That’s crazy, almost like … already have … some severe neurological problems … because of Syphi… probably not.
Ok, you can have sex with as many people as you’d like, even at the same time for all I care, but please take care of yourself and wear protection, it’s not a sheep intestine anymore!

My personal takeaway: I do want to change the world, but I’ll try to do this without Syphilis… I’ll try.

When sex becomes more than just fun

Sex is fun, well, it should be, at least most of the time. That first moment when everything is new and exciting. You get caught in the moment and before you know it: a) you’re back on the street at 01.00 at night and the hangover just started b) you wake up at 7.30, smelling the others breath and think Why o Why? Or c) you fall in love and 15 years later have two children and write a blog on infectious diseases…

But although the sex was fun (most of the time), sometimes you’re reminded that you forgot something. Maybe it was the last thing on your mind, maybe you trusted the person you were with. What did you “forget”: a Condom. What is the name of that kind reminder: Sexual Transmitted Diseases, in short STD. 
Most of us are lucky we didn’t attract them, some are still thinking they were lucky and others, well they were less fortunate and got infected.

Let’s look at the STD’s/infectious diseases you don’t want to get after your fun night of sex and what the risk of getting it is. And for your benefit: I ranked it from most to least common.

1. Genital Human Papilloma Virus (HPV)

In first place, winner of the golden medal during the Ugliest STD-Olympics, leading the charts of the most common STD has to be: Genital Warts. Dreaded by all of us (if not, you have a rare fetish). But most of us are actually already infected with this without having any symptoms. Worse yet, this is a virus that can cause cervical cancer in women and anal cancer in men (who got the infection by having sex with another man, the virus doesn’t travel from your penis to your anus). Bad news: once you have it, you never lose it. Good news: we have a vaccine nowadays so we can protect our children from getting these cancers through this virus. Vaccines save our day!

2. Chlamydia

A very contagious runner up which most of us will know. It gives you discharge (for women different than normal, for man: you will know it is not semen). Women are the unlucky ones, because they can become infertile without ever having had symptoms. So, men and women: if you find out you have this, please let each other (or when you had a “busy” month: all of them) know. Easily cured with antibiotics, one pill and you’re done!

3. Trichomoniasis

The bronze medal goes to…Tri…Trichomo… Trichomonisch… sorry what? Trichomoniasis. This STD is unkown by many, but good chance you or someone you know has had it without even knowing it. Not deadly, no infertility, bad itchings and smell, but most don’t need medication. So boring, NEXT!

4. Gonorrhea

Good old Gonorrhea, just missed the top 3 but that doesn’t ruin the fun for this fella. Men come with a nice discharge from the penis or pus – big surprise coming up – in their knee, I know, their knee…. This doesn’t mean they did something like “Kneeing” somebody, but the bacteria likes to travel to a joint. We can treat this with antibiotics, for now at least.

5. Genital Herpes

Ouch. Just so painful to even look at this. Really contagious, just think of the cold sore a lot of people suffer from, it’s the same virus. The thing with Herpes is that if the lesions are located on a different spot than what the condom covers, you can get infected. But the infected person will know he has lesions – crusted spots – so if he/she is really as nice as you say, they will tell you… Maybe check it while you’re down there… Cause you can never get rid of it, it will go away for a while, … until it’s back again.

6. Syphilis

The great mimicker who actually is getting back in the race now that people aren’t scared of attracting HIV any more. Classically, you get sick in 3 stages. First stage is an ulcer that doesn’t hurt and goes away eventually. Some will not even notice this first stage. Second stage is a skin rash that also involves your palms and footpad, will also go away in time. If that doesn’t lure you to a doctor yet, stage 3 is neurosyphilis: when it hits your brain. Yep, this little guy deserves a blog of his own. For now, let’s just say that if you have it (tested in blood), antibiotics will cure you.

7. Hepatitis B

Depending on where you live this virus can be anywhere in the top 10. For example, most developed countries won’t have a lot of patients. There is a high chance of getting this, especially when there’s blood involved, easy peasy anal sex will do. Why? As you may know, the anus is not made to be stretched that way. Micro tears will turn up and they bleed. Blood contact with someone who is infected with hepatitis B gives you about 30% chance of getting it. This virus infects your liver and turns you yellow. Difficult to treat if you get the chronic version of the infection. So maybe at least wear a condom when doing anal sex or when your partner is menstruating? (or maybe without the question mark).

8. Human Immunodeficiency Virus

And last but certainly not least. HIV. Most famous, but actually you have a very small chance of getting. And with modern medicine it is even less. Why is it still so nasty: it is incurable. Not a death sentence anymore – especially in the Western countries – like it was in the 80’s, more like a very nasty chronic illness that requires you to take medication. For some easy with one pill once a day, every day, for the rest of your life, for others more troublesome.

There you have it, the 8 most common Sexual Transmitted Diseases. Some are easily attracted, but also easily cured. Others are more complicated in every way. The bottom line is that you have to know you have it.
Let’s not judge each other, none of us are saints. If you had an “accident”, just go see your doctor and get tested. Nobody will think you’re a slut or stupid, trust me, we’ve seen it all many times (and far worse). Let’s make sex just about fun!

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