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Basics about Sexually Transmitted Infections(STIs) By Dr. Yutaka Matsuda

In the first place, what is a sexually transmitted infection (STI)?
➡An STI is an illness that’s passed from person to person primarily by sexual contact

How are STIs transmitted through sexual contact?
1. Mucousal infection:
STI pathogens are transmitted through contact between the mucous membranes (ex. penis, vulva, mouth, throat) of two people
Ex. Syphilis, Gonorrhea, Chlamydia, Herpes, etc.

2. Infection from anal-oral contact (rimming):
Through licking the other person’s anus (rimming), fecal matter may enter the mouth and then the digestive system
Ex. Hepatitis A, amoebal dysentery, etc.

3. Infection from blood:
If your partner’s blood comes into contact with your own blood stream, the pathogens inside the blood may be transmitted
Ex. HIV/AIDS, Hepatitis B, Hepatitis C, etc.

?? But how can an STI be transmitted by blood during sex?
➡Through the friction caused by rubbing your bodies against one another, very small cuts (invisible to the eye) may appear, and small amounts of blood from one person may enter into the other person’s blood stream.

What’s the risk of infection from one case of unprotected sex?
Risk of mucousal membrane infection (10~50%) >> Risk of infection from blood (0.1~5%)
However, STIs transmitted by blood – like HIV/AIDS – are often very hard to treat.

*Note: What does a probability of 0.1% mean?
If 1000 people had unprotected sex without a condom, one of them would become infected. You might be that 1 person!! The 0.1% figure also assumes that your mucous membranes are healthy to begin with and don’t have any pre-existing cuts. If your mucous membranes are weakened from having either Gonorrhea or Chlamydia, then the probability of catching an STI from blood infection rises about 5~20 times!

Secondary prevention
You can strengthen your protection against HIV transmission through receiving regular STI exams and through the early detection and treatment of Gonorrhea and Chlamydia.

Vaginal infections
Although vaginal infections are not STIs, they can still be caused by organisms that are passed from person to person. Your risk of infection increases when your immune system is weakened through lack of sleep, overwork, an irregular lifestyle, a lack of nutrition, or stress.



What you can see with the naked eye

There are many sex industry businesses where you can use a condom if a customer has an STI or phimosis (when the foreskin of the penis doesn’t retract). You can use the tips in this guide to do a quick visual examination of your customer so you can decide whether to use a condom or not. In cases in which using a condom might be difficult, try some of the alternate ideas for prevention.



Chlamydia

In men, a whitish discharge may come out of the penis (discharge may also come out if you squeeze the penis from the base). Symptoms may include itching, painful urination, and other light symptoms, but there are also many cases in which symptoms do not appear.







In women, the amount of white vaginal discharge will increase. Some women may notice light symptoms, but there are many cases in which symptoms will go unnoticed. Chlamydia can also be transmitted to your throat.Incubation period: 1~3 weeks
Treatment: 2 weeks of medication (throat infections can also be treated with medication).
With women, because it's a vaginal infection and not an inflammation of the urethra, there may be no symptoms at the beginning, but as the illness progresses, the Chlamydia bacteria may enter the pelvis or vagina and eventually cause infertility through mucousal inflammation or Fallopian tubal obstruction.



Gonorrhea

In men, a yellow discharge may come out of the penis. It will be painful and the opening of the penis will be red. Recently, however, cases without symptoms have been on the rise.









In women, a yellow discharge will come from the vagina. It will smell like fish, and your urine may be cloudy when you pee. Gonorrhea may also infect the throat.
Incubation period: 2~10 days
Treatment: One week of medication. If you decide to receive a shot, you can be treated in one day. Recently, the appearance of Gonococcus bacteria, an antibiotic-resistant bacteria, has been increasing, so early and prompt treatment is critical.





Genital Herpes












In men, genital herpes will appear as blisters or eczema either on the genital area itself or on the surrounding skin. They may be painful, itchy, and/or feel warm. Blisters that pop may become infected.

In women, genital herpes will appear as blisters or eczema on or inside the vagina or on the surrounding skin. They will be painful, and the symptoms will be especially heavy the first time the illness appears, becoming lighter the next time. 80% of women infected with genital herpes will not show symptoms.
Incubation time: 1~2 weeks
Treatment: the symptoms can be treated by either liquid medication or a topical cream applied for one week. Without treatment, the symptoms will disappear in 3~4 weeks, but you can infect your sexual partner(s) during that time.


Genital Warts

In men, sharp, dry warts may appear on the glans or shaft of the penis, on the testes (the “balls”), or around the anus, and will range in size from a sesame seed to the tip of one's thumb. The warts may resemble cauliflower or a cat's tongue in their appearance. Touching the wart may result in further infection.






In women, sharp, dry warts may appear on the labia minora, the vaginal opening, or the area around the anus, and will range in size from a sesame seed to the tip of one's thumb.
Incubation period: 1~6 months (usually 2~3 months)
Treatment: Removal of warts by laser treatment. The anti-cancer drugs that you rub onto the affected parts after the laser removal are strong medications, and the area may become inflamed if you overdo them. Until the affected area heals completely, you may want to consider taking a break from work.


Syphilis











In both men and women, in the first stage of the illness, painless open sores of about 1 cm in diameter will develop on the genitals, in the crotch or anal area, or in the mouth. In the second stage (approximately 2~3 months later), a rash may develop over the entire body and some hair may fall out. The symptoms will disappear on their own after some time, but, if left untreated, the illness will continue to progress.
Incubation period: 10 days~3 months (~3 weeks is average)
Treatment: Either a shot or a liquid medicine will heal the illness in about 2~3 weeks


Pubic Lice









In both men and women, a rash or bug bites will be visible in the pubic hair region, with intense itching. Adult pubic lice are about 1mm, and their eggs may be visible at the root of the pubic hair. There may also be excrement (small black- or brown-colored dots) visible in your underwear.
Incubation period: 1 day~1 month
Treatment: Shaving your pubic hair or using either the “Sumisurin Powder” or “Sumisurin Shampoo” – which you can buy at a pharmacy – every three days for ten days (administered on days 1, 4, 7, and 10). For individuals who want to undergo treatment while continuing to work, if you take the medication every day before work, you can avoid infecting others.


What you can’t see with your naked eye




Hepatitis (Viral hepatitis A, B, or C)

Besides feeling sluggish there are often no symptoms, although a very small percentage (1~2%) of individuals may experience the sudden onset of heavy symptoms. Liver cirrhosis or liver cancer are common (future) complications. Hepatitis A is transmitted through fecal contact, so you need to be careful during rimming and anal sex. Hepatitis B and C are transmitted through blood and semen, so you can be infected through oral sex or intercourse.
Incubation period: Hepatitis A: 2~6 weeks, B: 1~6 months, C: 2~16 weeks (there are also people in whom the outbreak can take much longer or who never experience symptoms)



HIV/AIDS


HIV (Human Immunodeficiency Virus) is transmitted when a mucuous membrane or damaged tissue comes into direct contact with the semen, blood, vaginal secretion, or breast milk of an infected individual. HIV gradually weakens the immune system and causes AIDS.
Incubation period: Without treatment, from the time of infection to the outbreak of the illness, about 10 years.
Treatment: Although no treatment has yet been developed that will completely get rid of the virus, the sooner you learn of your infection, the sooner the progression of the illness can be slowed down with treatment.




Things without symptoms


Trichomoniasis: Men will show no symptoms, but women will experience a strong-smelling discharge (the discharge will smell like fish or squid!). In men the urethra will be infected, and in women the vagina will be infected.
Incubation period: 3 days~1 month
Treatment: With either liquid medication or a pill (which you place inside the vagina), the infection will heal in about 10 days. After 2 days of treatment, you won’t be contagious anymore.









Non-illnesses Fordyce's Spot(in the fatty flesh of the penis)















*This isn't a disease, so you can't be infected. But the early symptoms are similar to those of genital warts, so if you're suspicious about it, it's best to avoid directly touching the penis or putting it in your mouth.




Medicine
The antibiotics prescribed to you for treatment by a doctor should be taken as the doctor directed, until they are all finished. In other words, don’t stop taking your antibiotics when the symptoms disappear. There are some antibiotics and medications which work for both throat and genital infections, so please be sure to tell the doctor what medications you are on before you receive your consultation.

Exams
Throat STD exam:
Not all clinics do exams for Chlamydia and Gonorrhea, so be sure to check before you go whether your clinic will do the exam. In case you want to test just the throat, you can also go to some ear, nose, and throat clinics.
Free clinic:
Depending on where you live, your local free clinic may have free testing for Chlamydia, Gonorrhea, Syphilis and Hepatitis B. You can receive free HIV testing anywhere in the country.
Antibiotic sensitivity test:
There are many different types of antibiotics, and hospitals may prescribe any number of these. In order to find out which antibiotics are most effective for you, you can take an antibiotic sensitivity test.

Insurance Card
Your insurance will cover your STI test if you say that you have symptoms of an STI; your insurance will not cover your STI test if you simply say that you want to be tested (just like if you ask for a health exam without any symptoms). Because it’s sometimes up to the individual clinic to decide whether throat symptoms will be covered, it’s best to ask beforehand whether your insurance will cover it or not. For those of you who either don’t have insurance or who don’t want others who share coverage with you (for example, family members) to know what type of clinic you went to, you can also see a doctor without using your insurance. In this case, you can also use a fake name, but you will have to pay the full amount yourself.


If you think a customer might be infected

…there are several things you can do!

Use a condom
There are lots of sex industry businesses which allow you to use condoms if a customer is infected or if he has phimosis (where his foreskin doesn't fully retract) – there are also some stores where you are always allowed to decide whether to use a condom or not. If you're unsure, it's always safer to use a condom during oral sex. But it's not always easy to know what to say to a customer, so here are some suggestions from a SWASH survey.

■“It's store policy.”
You can say that you're just following your store's policy. To keep your customer from getting upset, be sure to communicate this with a smile and a cheerful manner. OR “Normally I could service you without a condom, but if there's any sign that a customer might be infected, we have to use a condom – sorry. You might be totally fine, but if one of us (employees) gets infected, the symptoms will take a while to show up and we might infect other customers… so please understand. If you're upset about it, please let the staff know.”

■“I'm worried about STDs.”
You can say that you're concerned about STDs. Rather than saying that you don't want to get sick, it's usually easier to tell the customer that you want to look out for him. OR You can say that it's better for both of you to have peace of mind – us workers are people too, after all. OR Put on the condom while saying “this way we can both sleep soundly tonight.”

■Put on the condom without breaking the mood
While touching or kissing his upper body, you can put the condom on the tip of his penis, and then use your mouth to put it on all the way. OR After asking permission, put the condom on with your mouth during oral sex. OR Put on the condom while kissing him. OR Put on the condom without him noticing while giving him oral sex. Don't go down on him until the condom is on.

■“I have an ulcer in my mouth.” “I'm going to the dentist today.”
Tell the customer that you have an ulcer in your mouth and use that as an excuse. OR Say that you're going to the dentist today so please use this condom.

■“My store will support me if you refuse.”
Cheerfully but firmly tell the customer that the store will be on your side if he doesn't wear a condom. If the customer still refuses, give him his money back and let him leave the store. OR Talk to him frankly. If he still doesn't cooperate, call the staff (“boy”) and have him explain the rules to the customer.


When you can't use a condom…

Avoid areas that are red or have a rash on them, warts, and open wounds – don't put these in your

●Focus on the shaft of the penis or the balls
Try to especially avoid the area around the opening of the penis and any pre-cum (pre-ejaculate). There are lots of pathogens for Chlamydia and Gonorrhea in the pre-cum.

●Use a lot of spit while performing oral sex
Perform oral sex with lots of saliva – this will help to rinse the pathogens out of your mouth. It will also feel good for the customer.

●Don't let him climax (“cum”) in your mouth
If the customer's semen touches the inside of your mouth – and your tonsils in particular – the risk of becoming infected increases. If he does cum inside your mouth, catch the semen with the back of your tongue so that it doesn't reach your throat. Or, use your hands or your hair to block his view and then catch the semen in the side of your mouth (in your cheeks).

●When you have a mouth ulcer
If you have an ulcer in your mouth, apply either a “Mouth Ulcer Patch Taishou A” or “After Touch” patch to the affected area

●While doing sumata (dry-humping), use your thighs as much as possible
Use your thighs while doing sumata so that your genital area touches the customer's genitals as little as possible.

●Wash both his genitals and yours after servicing him
Don't scrub too roughly, or the customer might get offended. Wash him gently using lukewarm water and, if you have them on-hand, a soap with collagen in it or baby shampoo. Urinating will also help to flush out the pathogens from your urethra.

●Also:
When you have a cavity, you're at a greater risk of catching a periodontal disease from a customer when kissing. You'll be able to smell it.
For anal sex or rimming, stimulate the anal area as much as possible, and use condoms and/or finger condoms. If the customer insists that you lick his anus, try to use a condom on your tongue or a dental dam .


Q&A

Q: My mucous membranes are weak and I easily get vaginal infections…?

A:A: Your genitals are very sensitive to humidity, so you need to be careful of them drying out. We recommend oronine cream for people with weak mucous membranes (the cream is very good for this purpose). Just be careful that you don't apply too much because that can lead to the growth of bacteria!

Q: What about a red, shiny penis…?

A:A: It might be caused by something like athlete's foot or another microorganism (such as staphylococcus).

Q: What can I do before work or in my daily life to protect myself?

A:A: When you brush your teeth before work, don't brush your gums too hard or you might cause small cuts or abrasions. Do any shaving the day before (shaving with a razor causes your blood vessels to be more exposed). Lead a healthy daily life, and be sure to eat nutritious meals (including lots of vegetables!) and to get plenty of sleep.