More Than Two: A Practical Guide to Ethical Polyamory (55 page)

STI TESTING

Another fact: Verifying negative test results is highly effective protection against the most common STIs. That's one of the reasons why testing is the go-to method for STI prevention among poly people. Most poly people get tested at regular intervals, typically ranging from every six months to every year, depending on the stability of their immediate network. Asking to see copies of test results doesn't typically raise eyebrows among poly people: "Trust but verify" is a phrase you'll often hear. Making verification a standard procedure protects everyone against the possibility of dishonesty or NRE-addled poor judgment while not pointing any fingers.

Different STI tests have different windows of effectiveness.
The chart below
provides information on testing windows as of 2014, but STI testing is something to discuss with a medical professional, who can provide you with up-to-date details about the types of tests and their
effectiveness
. Don't be afraid to ask questions about the details of the tests you'll be receiving! Our chart includes types of tests and testing windows for various STIs. We created the chart by compiling research on the prevalence of various STIs and the risk of transmission from various types of sexual activities. The information here represents a survey of the current literature in North America. Of course, risk factors and prevalence may vary geographically and change over time; this chart should be used as a starting point for talking about sexual health and doing your own research.

One unfortunate fact of poly life is that there are a small number of polyamorous people who don't engage in STI testing or prevention at all, because they have fallen victim to conspiracy memes and do not believe that medical conditions like AIDS exist. Fortunately these people are rare, but unfortunately, they are out there. This is another reason why talking to a prospective partner about STI testing, sexual health and sexual history is important.

SHAME AND STIS

STIs and STI testing are often surrounded by stigma and shame. This can play out in poly relationships in many ways. Some sexual health clinics, particularly in small towns, have been known to shame people (women more often than men, from our anecdotal observations) who seek regular STI testing. Many poly people do regular screening, yet there is a perception even among some health care professionals that testing is unnecessary for people in stable relationships. We believe it's important to be open with your health care professional about being polyamorous, but at the same time, we recognize that some people in the medical community are capable of being prejudiced and judgmental about nontraditional relationships.

It's helpful to remember that your doctor works for you. You can always fire him and get another. Wherever possible, if you encounter stigma or shaming from health care professionals, speak up. Say that the behavior is inappropriate. If possible, consider filing a formal complaint, switching health care professionals, or both. The resources section of this book includes information on finding a poly-friendly health professional.

Some people are too embarrassed or ashamed to seek STI testing. Some people see asking others about it, or being asked, as a mark of distrust. But anyone can carry STIs and not know it. Asking for testing doesn't mean you don't trust your partner; it means you recognize that microbes don't care about human values of right and wrong or trust and distrust.

People consider STIs shameful in ways we don't consider other medical conditions shameful. In part this is social conditioning. Shame around STIs, like fear of STIs, can be a component of negative attitudes about sex. As a result, many people who do have STIs, especially herpes, are treated poorly by others—even if, as often happens, the infection was not acquired sexually.

This is, sadly, just as common among poly people as among monogamous people. Many people react with horror to a disclosure that someone has something minor like herpes. We have both heard many people say, "I would never even consider a partner with herpes!" even though, ironically, perhaps half (or more) of the people who say that actually
have herpes themselves
and just don't know it.
^*
Many of these people are asymptomatic or have one outbreak, easily missed, and never have an outbreak again. A friend of Franklin's, for example, once wanted to start dating a woman who was positive for HSV-2, but his wife objected. Finally, the three agreed to get tested for HSV together—whereupon the wife discovered that she had herpes herself, and had simply never known.

A person with an STI is not dirty or promiscuous. Nor is such a person necessarily a risk. Franklin has had a partner with HSV for more than a decade as of this writing and is tested regularly for it himself, but has never tested positive.

Because so many of us fear STIs, and because protecting sexual health is a legitimate and reasonable concern, fear of STIs can become a "back door" way to control our partners for our own purposes. We might find it difficult to say "I don't want you having sex with Susan because I am jealous of her," but find it easier (more reasonable?) to say "I don't want you to have sex with Susan because I'm concerned about STIs." When we do that, fear of STIs becomes a cover for other concerns we are not addressing honestly.

Such manipulation may not even be intentional. Because of the emotional attachments we have to STIs, a person we don't like may trigger STI fear more than a person we like. This fear can subtly influence the way we feel about a partner's sexual decisions and evaluation of risk. Of course, STI risk does not affect everyone equally. Even relatively non-threatening STIs can be more dangerous to people with compromised immune systems, say, or to expectant mothers. But the same is true of other risks as well. A rational approach to STI risk must include the idea that STI shame is unreasonable.

Speaking of driving cars, isn't it strange that we are willing to risk dismemberment or death by driving over to a lover's house, but we are frequently terrified of STIs that, to most of us, are not nearly as potentially damaging? Deadly STIs exist, but they are rare, especially in poly networks. These are generally the ones that are very preventable with condoms, as
the chart
shows. Common STIs such as herpes (which statistically will affect about 60 percent of the people reading this book) are, for most people, an annoyance at most, far less serious than the
possible consequences
of a car crash. We'll risk gruesome death to visit a partner, yet we are too afraid to express physical intimacy with that partner when we get there. This should not suggest that we, your authors, are cavalier about STIs. We simply believe that research and rational risk management are better than blind fear.

*   
While about 60 percent of North Americans have HSV-1 or HSV-2, between 80 and 90 percent of those are not aware they have it
.

NEGOTIATING RISK TOLERANCE

When talking about safer-sex boundaries and risk tolerance, remember there's no one right answer. Everyone's threshold of acceptable risk is different, and people use different metrics for assessing risk. It might seem like a simple calculus—look at the numbers, decide where your threshold is, act accordingly—but human decisions are never quite this tidy.

We all must decide on the degree of risk we are willing to accept in our sex lives. This decision is an important part of acting with agency. Each of us is responsible for protecting our own sexual health, and that includes making decisions about what risks we will accept. Part of that decision will be emotional, and that's okay.

Just as you have the right to choose your own level of acceptable risk, so do others. Shaming other people for their choices is not good behavior. This includes shaming people for making choices that are not only more conservative than yours, but also less conservative. We've heard people say "So-and-so can't be trusted, because she does things that I think are risky." It's fine to choose not to be sexually involved with someone whose risk threshold is higher than yours, but that doesn't make such a person untrustworthy, reckless or foolish. The degree of risk we're talking about here is relatively small even for someone who has comparatively relaxed boundaries.

SEXUALLY TRANSMITTED INFECTIONS: THE FINE PRINT

We're now going to go into detail about bugs that are considered sexually transmitted infections, their transmission routes, effects and treatment options.
The chart below
sums up the numbers, with the rest of this chapter going into greater detail. The information here is specific to the North American context and assumes you have access to a basic level of medical care (for example, you have access to condoms, testing and antibiotics).

Note that the numbers given here represent averages across the population, but certain
subpopulations are at much greater risk
than others. For example, in 2010 the U.S. Centers for Disease Control and Prevention estimated that "1.92% (one in 52) of Hispanics/Latinos would receive HIV diagnoses during their lifetimes, compared with an ELR [estimated lifetime risk] for HIV diagnosis of 0.59% (one in 170) for whites and 4.65% (one in 22) for blacks/African Americans." And nationwide, half of HIV diagnoses are in
men who have sex with men
.

The state of knowledge around many STIs is changing rapidly, and some of the information here is likely to become out-of-date quite soon. Because of all this, we debated whether to include detailed STI information in this book at all. We decided to include it with this disclaimer, because for many people, the level of fear greatly outweighs the access to actual facts. We hope that the information below can help you understand what's out there and get an idea of what your real risk level is.

If there's one thing we'd like you to take away from this information, it's this: STIs are both rarer and more ubiquitous than most people imagine. They are rarer in that the nasties that come to mind when most people think of STIs, such as HIV, are actually much less common and much harder to get than typically believed. Usually minor infections that are a major cause of stigma and shame, such as HSV (herpes), are actually so common that
half the population of North America or more
is infected with oral or genital herpes and doesn't know it. And the most common STI of all, HPV, is one that not very many people are even aware of.

Taken together, we hope that this information, rather than creating fear, will help you understand that some STI risk is both unavoidable and manageable. With reasonable precautions, such as testing, disclosure, vaccinations and the use of barriers, you can protect yourself very well from nearly everything that might cause you serious harm. At the same time, it's a near certainty that an STI will enter your poly network at some point or another. It may be an extremely common one such as HSV, or it may be a less common but still widespread (and completely treatable) infection such as chlamydia. Protect yourself, by all means: be smart and stay safe. But don't freak out about sex, and there's no reason to shame or ostracize people who have contracted an STI.

THE USUAL SUSPECTS

When people say things like "I've been tested" or "I'm clean," they're usually referring to a specific set of STIs, the ones we'll call "the usual suspects": HIV, chlamydia, syphilis and gonorrhea. These are the infections that most STI clinics will test for as a matter of course when someone goes in for a routine screening. If you say "I've been tested for everything," there's a good chance you haven't: you've probably been tested for these four. They're not the only sexually transmitted infections, and there are some STIs that it's rare to test for. We discuss those others later in the chapter.

Chlamydia
.
Affecting about a million people in the United States at any given time,
chlamydia is a very common sexually transmitted
infection, with up to 1 in every 200 people diagnosed each year in the United States. It's caused by a bacterium that infects the mucous membranes. Because it doesn't need to enter the bloodstream, it is easily transmitted through intercourse, shared sex toys or other forms of fluid exchange. Chlamydia can also infect the rectum, throat or eyes through anal or oral sex.

As with most other STIs, most people with chlamydia are asymptomatic, so the only reliable way to know you have it is through testing, which is done by taking swabs from the cervix in women or urethra in men. People who have symptoms may notice an unusual discharge or burning during urination. Chlamydia can remain undetected for months or years, and in women, it can eventually develop into pelvic inflammatory disease, which can cause internal scarring with reproductive effects up to and including infertility.

Chlamydia is generally easily curable with antibiotics. When a person is diagnosed with chlamydia, it's common medical practice to
treat all of their sexual partners
, without necessarily even testing those partners for chlamydia as well.

Gonorrhea.
Another bacterial infection, gonorrhea has been causing trouble to humans since medieval, possibly even biblical times. About 1 in 1,000 people are diagnosed each year in the United States. Gonorrhea is easily transmitted during vaginal and anal sex. It's also possible to get gonorrhea in the throat from oral sex. Condoms are highly effective at preventing transmission.

Gonorrhea is diagnosed with a swab culture. It is treatable with antibiotics, although it has become resistant to many drugs. In recent years, some cases have been found that are resistant to multiple antibiotics, making infections with these
strains
extremely hard to treat. Half of women who are infected do not have symptoms, but those who do have discharge or vaginal pain. Most infected men will have pain with urination and unusual discharge. Left untreated, gonorrhea can cause pelvic inflammatory disease or spread through the body to affect the joints and heart.

Syphilis.
An easily curable bacterial infection, syphilis is rare, at least in high-income countries. That wasn't always the case; syphilis is one of the oldest recognized sexually transmitted infections, and was once a deadly scourge that affected many high-profile people. Symptoms include sores and rashes, progressing, if untreated, to neurological damage and death.