The Science of STDs Part I: Gonorrhea, Syphilis, and Preventative Care

Every day when I came home from school in the 1990s, I’d turn on the TV to watch deliciously trashy talk shows. I was desperate to see gay people, freaky folks, club kids and other weirdos like myself, and delighted in the horror of studio audiences. But whether the topic was married swingers or cross-dressing priests, inevitably an audience member would stand up to ask: “Don’t you worry about AIDS?” The question seeped into my brain, and I started to become, like so many from my LGBT generation, terrified of contracting HIV.

That changed in 2011, when doctors began prescribing PrEP (short for ‘Pre-Exposure Prophylaxis) as a HIV prophylactic. As PrEP took away my fears over HIV, my love life expanded in exciting ways. But more frequent encounters meant more visits to the doctor to be tested and treated for other STDs. Suddenly, old fears about HIV were replaced by more common STD scares: rumored horror stories of STD strains called “superbugs”, which were resistant to conventional treatments.

To find out about the wider research behind STDs (and uncover the truth about superbugs) I went to the office of Future Method’s Dr. Evan Goldstein for an in-depth discussion on STD prevention and treatment. 

The interview evolved into a three-part series, kicking off with a deep dive into the treatments for gonorrhea and syphilis (as well as how you can best equip yourself with the right preventative care). 

Adam Baran: Continuing on from our last discussion, what do recent studies show you can do to lower the risks of STDs?

Dr. Evan Goldstein: Well, showering after playing is super important. We think most people do, but the reality is that some people don't. You can actually wash off HPV. You can wash off some external aspects of other STDs, too. 

Another option is mouthwash. There are studies involving Listerine that showed 30-seconds of gargling decreases the incidence of STDs. Also Goldenseal, which is typically used to clean out traces of weed, has a chemical called Berberine which mitigates your Giardia risk. 

Overall, my goal is to use our Future Method platforms to empower bottoms. If you get your butt eaten out and you love that–awesome! But take the right preventative approach so that you aren’t second guessing yourself, thinking every ache and pain is something related to a sexual disease. We want to help you avoid that. 

Doxycycline prep, as we’ve discussed, can help prevent syphilis and chlamydia. Is there a recommendation for how often or when you should use it? 

I don't think there's a right answer. If you test positive for an STD, you need to find out how that occurred. You won’t always pinpoint it, but if it was a play party, or one-off stranger on a particular weekend, you can start to identify situations where you should be taking it.

It's before you engage that you need to assess the risk because once that connection happens, then all of the steps leading after that are mitigated from those factors.

What about STDs like syphilis, that are hard to recognize because symptoms can take months to show up?

For some people, they don’t have the primary symptom of a rash so they don’t know exactly what’s wrong. That's where screening regularly is best, because if it’s asymptomatic, you don’t know without a test. 

Testing is essential. From there, people need to understand that it's such a simple, straightforward treatment, especially with the use of doxy from a preventative perspective. 

I get it, using condoms doesn’t feel as good. But the reality is that you need to look at those situations and try to decide the best choice for you. 

There needs to be a big push for that. In 2011, when doctors began prescribing PrEP (short for ‘Pre-Exposure Prophylaxis) as a HIV prophylactic, it sparked a revolution of not using condoms, leading to a huge uptick in STDs. I get it, using condoms doesn’t feel as good. But the reality is that you need to look at those situations and try to decide the best choice for you. 

Sometimes when I get a diagnosis, different doctors prescribe different things depending on their observations. Do you have a guideline for your doctors on prescriptions for each STD? 

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Well, the CDC (the Center for Disease Control) has guidelines. I'm not a primary doctor, but when people come in for treatments the standard is to give them a shot versus sending them home on doxy. 

When someone comes to me with a positive STD for something like gonorrhea, syphilis or chlamydia, I treat everything at the same time because I find there's a crossover between those diseases. 

It’s hard to diagnose fast because we typically send it out to a lab. If a patient is in pain, I’ll treat everything until we get an answer. Valtrex, doxycycline, azithromycin...and then once we get a positive, we’ll hone in on the right treatment. I am very heavy [in how I prescribe] up front because I want you to see results right away and then slowly come off as we see progress. If I think everything is totally normal and looks pristine, I would wait for the results before offering treatment. 

When my doctor prescribed me doxycycline for chlamydia, I was directed to take doxycycline for a week. Some guidelines say that you have to wait another whole week to hook up with someone.

Most doctors prescribe about seven days of treatment, and then waiting five days post-treatment. It just depends on the circumstances. 

There has to be some element of a protocol so that we’re not only treating people, but also confirming they are negative with post-results. 

A lot of people also don't have a post-treatment check, even though the CDC is asking for records of individuals who are testing positive. There has to be some element of a protocol so that we’re not only treating people, but also confirming they are negative with post-results. The question is: how do we make this all a faster, easier, and less costly process for everybody? 

I’ve had issues with my doctor not fully examining me, or not prescribing something appropriate, how much of that is due to a lack of education or perhaps concern to understand gay people's lives?

I think a lot of it stems from a lack of training and broader, continuous education in the medical community. But at the end of the day for doctors, it depends on who your clients are, what your exposure is, and what you feel comfortable doing. 

We’re starting to see medical schools and residencies broaden curriculums to understand these sensitivities and communities. My recommendation is that you find a doctor who is understanding of who you are, if not part of your community. Someone who uses that understanding to deliver the best, appropriate care. 

With the rise of social media and online platforms, you can interact with people all over the world who provide quality service or telemedicine. Even with direct-to-consumer companies providing new solutions, the reality is that they can take your insurance.

You need to do your research and due diligence–you should shop around, look online and determine the best care for you. Future Method aims to educate people that their lives and their habits are the most important, so they’re empowered to get the best care and quality of service. 

Stay tuned for The Science of STDs Parts II and III as we discuss herpes, HPV, the importance of regular pap smears and whether STD superbugs are fact or fiction.