Dear Patrick: I went to a film festival in Europe last month and had an affair with another journalist there. Condoms weren’t readily available (it was a very hetero event), and it didn’t seem very romantic to ask about them. Now I have a problem with my girl parts, it looks as if I am growing a few extra little clitorises next to the main one. What should I do?
NEVER WAIT FOR AN ADVICE COLUMNIST TO TELL YOU WHAT IS WRONG WITH YOUR PRIVATE PARTS AFTER YOU HAVE UNPROTECTED SEX!! I try to send an e-mail back as soon as I get it, but there can be delays. So please call your doctor instead, or visit a public clinic that specializes in sexually-transmitted infections (STIs). If you have an itch, a rash, a bump, a bad smell, pain when you pee, blood when you poop, pus or some other questionable discharge, or bluebirds flying to the moon—see somebody who can test and treat.
PLEASE BE AWARE THAT MANY STDS HAVE NO SYMPTOMS. This means that you need a general practitioner you can be honest with about how many sexual partners you’ve had and what you did with them. If you are having unprotected sex, get tested at least twice a year for gonorrhea, syphilis, hepatitis in all its alphabetic permutations, HIV, HPV, herpes, etc. Even if you think you are in a monogamous relationship, you should get tested once a year.
I’m not a doctor and can’t see your problem, so I can’t accurately diagnose it. But there is at least a good possibility that you have contracted the human papillomavirus (HPV) or genital warts. For the benefit of readers who might also be at risk of this STI, let me talk about it a little bit while you go off and dial your doc or clinic and get in ASAP.
HPV is caused by a virus. Fortunately, we have a vaccination that can prevent it, but for some unbelievably stupid reason, this vaccine is only being made available, at least in the US, to people under the age of 26, and is often limited to those who have fewer than four sexual partners. It should be made available to people of all ages and especially marketed to gay men, who erroneously assume that this is a virus that only impacts women. The virus that causes HPV also causes cervical cancer, and it has been discovered that it causes rectal cancer as well. There are a number of different types of HPV. The type that causes genital warts is a different strain that the one that causes cervical and rectal cancer. However, many people who have one type of HPV are carriers for multiple strains. HPV is so common that it is estimated that most sexually-active adults will eventually contract it. Because of its link to many types of cancer, including cancer in the head and neck, cancer, this makes it very important to prevent as many exposures as possible.
HPV is transmitted by contact with an infected site. Usually, that means you can look at the person’s genitals or orifices and see if there are any growths that look like tiny pink tongues or cauliflowers, and if you avoid those sites (or their owner), it’s all good. However, HPV also grows inside the rectum and vagina, and on the cervix, where it is much more difficult to spy. Whether it can be transmitted orally is controversial. But it can definitely be transmitted on the fingers if an infected area is touched and then an uninfected area is touched. Sex toys can also transmit the virus.
The transmission of HPV is similar to herpes. For decades we were all told that herpes could only be transmitted during a visible outbreak of sores. Then it became clear (during studies of couples in which only one person had herpes) that some people continued to shed the virus or infective particles of it even when they did not have sores. Likewise, it may be true that HPV can also be transmitted if the site of infection has been cleared of visible warts. Certainly, the maximum sites of infection are those where warts can clearly be seen. And some doctors believe that a person who has gone three years without the appearance of new warts is in remission and is no longer at risk of infecting others.
The only way to reduce the risk of infection is to use male or female condoms and other viral barriers like plastic wrap, as appropriate. However, be aware that, like herpes or syphilis, the infection sites may not always be on the genital areas that are covered by a condom. If the wart is between the buttocks, for example, or on the clitoris or testicles, you may have to be creative when it comes to creating protection.
Treatment consists of removal of the warts. This can be done surgically or with caustic chemicals that burn them off. This feels about as good as it sounds, so don’t be afraid to request pain medication; some doctors seem to think that patients with STIs deserve to get hurt as a punishment for having “naughty” sex. Unfortunately, the warts can grow back, so be sure to monitor your bits. Go back ASAP if you see new tiny visitors.
While I certainly don’t want to punish anybody for having unprotected sex, I do want to urge you to reconsider the idea that condoms are not romantic. Every time you travel, include a little Ziploc baggie of lube and protective latex or plastic goods in your checked baggage. Make sure you have these with you because you may not be able to shop for these things in a country where you don’t know the language or you don’t have time to leave an event when it’s a busman’s holiday (in other words, you are traveling for work). The thing that is not romantic is sitting for a couple of hours in a public-health clinic, waiting for a harassed-looking doctor to see you and shake her head; that is what ruins Technicolor memories of a cinematic European romance. Having the necessary goods to protect yourself is what a grownup does to make sex run smoothly and happily, before and after the deed is done.
Truth to be told, I think a lot of women avoid carrying condoms because they wish the man would take care of this. So all a rascally scoundrel has to do, if he wants to avoid safer sex, is to leave the damn things at home and just proceed as if it’s not 2014 and there weren’t a ton of incurable or deadly STIs out there. Unless she is super-assertive, she won’t stop him. The fact that it’s a heterosexual event is not much of a barrier against disease-causing microorganisms, as you sadly discovered. I think there can also be a fear that if you pull out a condom, he is going to make a fuss. And that could very well be true. But then you have to think to yourself, Why would he do that? See the comment above and the term “rascally scoundrel.” A guy who doesn’t care where he puts his penis is bound to have put it in a few places where you would not want to share.