Why It’s Important to Talk About Your Sexual History
A nurse practitioner explains why having open conversations about your sexual history can improve your overall health and well-being.
In recent months, reports of increases in some sexually transmitted infections (STIs) have been cause for concern. The latest data from the Centers for Disease Control and Prevention (CDC) showed more than 2.5 million cases of chlamydia, gonorrhea and syphilis in the U.S., with new syphilis infections at the highest rate since 1950. A rise in transmission of mpox is also occurring in New York City and Los Angeles, and the CDC announced it is increasing surveillance on a new strain of the virus.
The good news is there are more tools than ever to protect your sexual health — from vaccination to medication to screenings. The first step, according to Caroline Carnevale, a nurse practitioner at NewYork-Presbyterian/Columbia University Irving Medical Center, is to talk about your sexual history with a healthcare provider.
“There is power in knowing all of the options that are available to have a healthy sex life,” says Carnevale, who is also a clinician for the NewYork-Presbyterian Comprehensive Health Program (CHP). “What I try to get across to my patients is, whatever you are doing in your private personal life is your private personal life; I am here to make sure you can do it in a healthy way.”
Health Matters spoke to Carnevale about why it’s important to have open conversations about your sexual history and how to prevent STIs.
Why should sexual history be a part of routine health care?
Carnevale: Sexual health is so important to our overall health and well-being. There are ways to have sex in which you can maintain optimal health, and there are ways that could possibly be causing more harm than good.
Many people have never been asked, “What do you want for your sex life?” Having an open conversation can be uncomfortable, so I quickly try to normalize it — especially with patients who are used to being discriminated against for who they love or have sex with. Discussing your sexual history with a trusting provider will also improve your overall health, and it reduces stigma.
What screenings are associated with sexual health?
We need universal HIV screening — it should be as normal as checking your cholesterol, getting a colonoscopy, or making sure you’re up to date on vaccinations. And if everybody’s getting an HIV test, it’s free of judgment. It should not be targeting specific groups.
In addition to HIV, other screenings associated with sexual health include chlamydia, gonorrhea, syphilis, herpes, HPV, hepatitis B, and hepatitis C. The CDC publishes recommendations for STI screenings, which is a useful resource.
What to Know About PrEP, PEP and Doxy-PEP
PrEP
PrEP (pre-exposure prophylaxis) is a medication that is up to 99% effective against preventing HIV infection. “Since PrEP became available in 2012, we have seen a significant reduction in new HIV diagnoses in New York City,” says Carnevale. “It has provided many people with relief from worrying about HIV in their sex lives.
“PrEP is safe to use during and after pregnancy, so it is a great option if you have an HIV-positive partner. Remember that it only prevents HIV, not other STIs or unintended pregnancy.”
PrEP comes in three forms: daily pill, injectable (a single shot given every two months), and on-demand (a person takes two pills two-to-24 hours before sex and then one pill the day after sex). “Studies are still evaluating the efficacy of on-demand PrEP for cis women, so right now it is recommended only for cis-men and transwomen,” says Carnevale.
PEP
PEP (post-exposure prophylaxis) is for patients who don’t have HIV but may have been exposed. “It’s a four-week course of medication that should be started within three days (72 hours) of potential exposure, but the sooner you start, the better,” says Carnevale.
Doxy-PEP
Doxy-PEP (doxycycline post-exposure prophylaxis) is an antibiotic taken after sex to prevent bacterial STIs. “Right now, Doxy-PEP is recommended for men who have sex with men and transgender women,” says Carnevale.
Doxy-PEP consists of two pills, taken within 72 hours of condomless sex. In clinical trials, Doxy-PEP reduced infection rates of chlamydia and syphilis up to 80% and gonorrhea almost 60%.
“It’s an exciting option, but there is concern about antibiotic resistance,” says Carnevale. “Doxycycline has been used for years to treat many different kinds of bacterial infections. If Doxy-PEP is taken too often, the bacteria may adapt, making the antibiotic no longer effective at fighting other infections. It’s a conversation to have with your healthcare provider because the science is evolving.”
How else can you protect yourself from STIs?
I talk to every patient about condoms. They are easy, free and available in New York City for everybody who wants them. They are highly effective in preventing HIV and other STIs.
Vaccinations, including mpox, HPV, meningitis, Hepatitis A and Hepatitis B, can also protect against STIs. The mpox vaccine is two shots and it’s a little different in that it’s given subcutaneously, just under the skin — instead of an injection straight in the arm, like you’re used to.
What advice do you have for someone who needs sexual health care?
Most people don’t know where to go to talk about sexual health, but I want everyone to know there are places that provide access to high-quality sexual health care. At NewYork-Presbyterian we have clinics across the city, and we recently launched the Sexual Health Mobile Medical Unit which brings comprehensive sexual health services to underserved communities.