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Ask Doctor Taniguchi! Things to Know about Sexually Transmitted Infections (STIs) When You’re Working in the Sex Industry…

Ask Doctor Taniguchi! Things to Know about Sexually Transmitted Infections (STIs) When You’re Working in the Sex Industry…

Dr. Taniguchi’s Profile:
Dr. Kyō Taniguchi is director of Taiyūjichō Taniguchi Clinic in Osaka. He is also a representative for the non-profit organization Gina, established in 2006. Gina supports HIV-positive individuals and AIDS orphans in Thailand. The organization also sells items made by patients, and Dr. Taniguchi has presented his research on Thai sex workers at academic conferences. Visit the Gina website at http://www.npo-gina.org/.

Dr. Taniguchi’s Main Points:
1. If you have sex at all, it’s impossible to avoid all risk from sexually transmitted infections (STIs)…
2. You should also protect yourself against chronic infections that take a long time to treat…
3. Early detection is important even for those STIs that are easily treated…

STI-Specific Advice
It can be hard to find information about individual STIs, so let’s start with the basics!

● Things to avoid as much as possible
There are four main STIs that can be potentially fatal: Hepatitis B and C, HIV, cervical cancer, and syphilis. You can protect yourself against Hepatitis B with a vaccine. While the cervical cancer vaccine doesn’t prevent against all forms of the virus that causes it, it is effective in preventing most forms of cervical cancer. It’s important to take protective measures against Hepatitis C and HIV, but they aren’t that easy to catch. Syphilis is treatable, but if it’s discovered too late, it may reach your spinal cord and put you in a wheel chair.
It’s best to know about Hepatitis A too. Although it is uncommon, Hepatitis A may turn into Acute Hepatitis and become fatal. (I recommend that sex workers offering anal-oral services get a Hepatitis A vaccine. Even if you don’t die from Acute Hepatitis, you still have to be hospitalized for about a month.) Unfortunately, the Hepatitis A vaccine is hard to obtain at the moment.

● Hepatitis B
* Some people think that Hepatitis B is a bigger problem to worry about than HIV. Why? Because it’s so infectious. As the virus spreads through the body, it appears in saliva and other fluids, meaning that a condom isn’t enough to prevent its spread and you can easily become infected (or infect someone else). Since 2000, there has been an increase in cases of chronic (long-term) Hepatitis B, which doesn’t respond so well to treatment. When Hepatitis B becomes chronic, you have to take medications over a long period of time but even if you do this, there’s still a chance that the condition might develop into liver cirrhosis (scarring) or liver cancer. On a side note, although there are subsidies for Hepatitis B treatment, patient expenses are still very high.
* About 70-80% of people infected with Hepatitis B recover spontaneously without even knowing they had it. However, in some cases, people who appear to have recovered may have their immune system weakened through certain medications or through getting sick. In these cases, the Hepatitis B may break out again. 20-30% of people with Hepatitis B develop Acute Hepatitis (there is also a minor strain of this condition, which people sometimes mistake for a long, drawn-out cold that won’t go away). 1-2% of cases with Acute Hepatitis may develop into a severe form, which is fatal for half of those patients.
* Reading the above, it’s pretty obvious that the best thing you can do to protect yourself is to just get the Hepatitis B vaccine. The vaccine has been accepted around the world. If you’re a sex worker, you should be first in line!! In the United States, Australia, and other countries, the vaccine is even given to newborn babies – that’s how safe it is. With three doses of the vaccine, antibodies appear in 95% of individuals. For the remaining 5%, there is another vaccine that can be administered. Once antibodies appear, you are protected for a long time.
* Some of those people who recover from Hepatitis B without knowing they had it already had antibodies to protect them. There is no need for those people to get the vaccine again. However, once you’ve been infected, the virus doesn’t go away (it just stops making you sick). So, if you were to get cancer in the future and take anti-cancer medications, the virus might take advantage of your weakened immune system and come back.

● Cervical Cancer and Genital Warts
* There are many subtypes of the human papillomavirus (HPV), but the one that causes cervical cancer is transmitted through sexual intercourse. About 70-80% of Japanese women are exposed to HPV (at least) once in their life. Most women fight off the virus without any consequences, but the virus may cause cervical cancer in a few of these women.
* A cervical cancer vaccine is about 80% effective, but because it can’t prevent all forms of the HPV virus, it’s important to get regular cervical cancer screenings once every 1-3 years. On the other hand, the “Gardasil” vaccine is 100% effective against genital warts. (There are a few cases of adverse reactions to Gardasil, so please consult with your doctor when getting the vaccine.)
* With early detection, cervical cancer is 100% treatable. There’s no need to take out the uterus, so you can get pregnant, have a child, and have sex.
* Getting the HPV virus isn’t necessarily related to how many partners you’ve had. It’s even possible for women who have only had sex with one person to get the HPV virus!
* Genital warts are highly contagious and a condom won’t protect you from infection. In cases where warts appear inside your vagina, you won’t be able to check them yourself. Even if you haven’t had anal sex, warts may also develop in the area around your anus. 90% of cases are treatable with liquid nitrogen. Surgical means (either laser or electrical scalpel) are also available. In some cases, application of a medical cream (such as Beselna) to the external genital and anal areas is also effective. If you use one of these medical creams, you have to keep on applying it consistently throughout your treatment. Some people may develop swelling through use of the cream, but most peoples’ skin heals nicely.

● STIs that are Preventable effectively through Condom Use
* HIV, HCV (the virus that causes Hepatitis C), and HTLV-1 (the virus that causes adult T-cell leukemia/lymphoma) are 100% preventable through condom use. Of course, there may be times – such as with a partner or when doing oral sex – that it’s difficult to use condoms…
* The downsides of condoms are that they can break and that some people have latex allergies (if the inside of your mouth itches when you eat avocados or kiwis, you may have a latex allergy – in this case, it’s best to use polyurethane condoms).

● Genital Herpes
* Genital herpes is not 100% preventable, and once you have it, it may come back throughout your lifetime. It’s also possible to infect your partner, even if you don’t have symptoms or any subsequent breakouts. The disease isn’t fatal, but you should avoid passing it on to your child when you’re pregnant or giving birth.
* To avoid re-occurrences (breakouts) of genital herpes, the best thing to do is to lead a healthy lifestyle, meaning, get lots of sleep, don’t drink too much alcohol, and avoid stress. Of course, it can be difficult to avoid stress, so the most realistic approach is to take medication the moment you notice it coming back (or think it’s coming back). For people with frequent breakouts, you should always keep some medication close, such as in your purse or in a first-aid kit, where it’s easy to get to. In this way, you can decrease the number of breakouts you get. For those people who still break out once or more every two months, you should consult with your doctor about other methods for preventing breakouts.
* There are cases of ten years passing before a new breakout, so it’s difficult to make predictions.

● Other Health Risks that Sex Workers May Face
* Among the other health risks that sex workers may face are the common cold, the flu, gastroenteritis, physical injuries, pregnancy (look into emergency contraception), skin trouble, issues relating to second-hand smoke (such as asthmatic responses), and mental health issues such as insomnia, anxiety, irritation, or depression.
* Isodine (and iodine-based disinfectant) has strong sterilizing properties, but it might also harm good germs in your mucous membranes (mouth, etc.) that protect you, so there’s recently been a trend against using it in medical care. Instead of watering the isodine down and gargling before and after you meet a customer, it’s better to just use water instead. But you should NOT gargle with unclean water.

Questions for Dr. Taniguchi

● About STIs generally
Q: I’ve heard that HIV isn’t that easy to catch. Are there STIs that I should be more concerned about?
A: There are many infections other than HIV that you should be aware of. HIV gets so much media coverage that it’s easy to think, “Just as long as I can avoid getting HIV…,” but this is a big mistake. You should be protecting yourself against other STIs as well.

Q: What can you tell us about treatment costs?
A: Depending on what you have, the treatment and the out-of-pocket expenses are so different that I can’t give just one answer. For example, you can treat a minor illness like a yeast infection with a one-time application of cream. Similarly, pubic lice can be treated with one shampoo treatment. But then there are also conditions like Hepatitis B or Hepatitis C where you have to continue treatment over a long period of time.

Q: Can you tell us about STIs that are preventable with vaccines? How much do they cost?
A: There are three main STI viruses that can be prevented with vaccines: HBV (the Hepatitis B virus), HPV (the virus that causes cervical cancer and genital warts), and HAV (the Hepatitis A virus). Each of these requires three doses (shots) for the full vaccine. Because vaccines are not covered by health insurance, you have to pay fully out of your own pocket. Different clinics have different fees. At my clinic, for example, individual doses cost the following: ¥4,200 for one dose of the HBV vaccine; ¥16,000 for one dose of the HPV vaccine; and ¥8,000 for one dose of the HAV vaccine. If you wanted the full HBV treatment, the costs would include an initial antibody test, an antigen test, three doses, and a post-injection antibody test. The total would amount to ¥18,600.

● Having Sex with Hepatitis B
Q: I’ve started interferon treatment for Hepatitis B. Can I have sex?
A: If your partner has been vaccinated for Hepatitis B and has responded positively on an antibody test, it’s no problem.

Q: Can I continue working as a sex worker if I get Hepatitis B?
A: Depending on how sick you are, you may infect customers. In that case, it’s best to quit. If there’s a lot of virus in your body, it’ll show up not just in vaginal secretions or semen, but also in sweat, tears, and saliva. In those cases, even light services like kissing might spread the virus. On the other hand, in light cases, the virus might not show up in saliva or semen. It really depends case-by-case, so I can’t just simply say you’ll be okay if you use a condom.

● Working while Pregnant
Q: What about finger fucking (putting a finger in the vagina)?
A: Putting a finger in the vagina may excite the uterus and lead to a miscarriage or premature birth. Also, no matter how thoroughly a customer washes his hands, there will still be some bacteria on his hands that may penetrate the uterus and cause a miscarriage.

Q: Is it okay to have sex during pregnancy?
A: Yes, it’s fine. For hygiene reasons, however, I recommend using a condom (so that bacteria on the outside of the penis don’t enter the uterus).

● Vaginal Discharge
Q: Can you tell me what vaginal discharge looks like depending on the STI?
A: This is just meant as a basic reference, but in serious cases, the discharge will look like the following:
Chlamydia – a silky white discharge with a strong smell.
Gonorrhea – a greenish or yellowish discharge with a strong smell.
Trichomoniasis – a yellowish discharge that’s foamy and comes in large quantities. It stinks.
Yeast infection – it will look like cheese but won’t smell.
These are just for severe cases. It’s important that you remember that there are many cases in which there are no symptoms.