Let’s talk about S**

When I started this newsletter, I promised it would be on a range of topics. In this issue, I am pivoting from personal finance to STDs. With my son leaving for college next year, I found myself researching STDs to provide him advice grounded in facts. After discussing the topic with a few friends, it became clear that we all had a similar lack of knowledge on the subject.

Growing up, my parents had a simple message as it relates to sex—no sex before marriage. My father seldom broached the subject, while my mother preferred scare tactics. She would bring home AIDS pamphlets from the hospital and review them with us in meticulous detail. I remember her telling me that I was not allowed to attend the 7th grade sock hop because I would get AIDS. Though my mother was extreme, I can’t complain. She introduced me to my wife of 24 years with whom I have two amazing children. 

We were more proactive in talking to our kids about sex than our parents. Stanford has a great program called Heart to Heart that many local parents attend to educate their kids. The program consists of a detailed two-part series, each lasting two hours, covering the intricacies of the birds and the bees. My wife accompanied our daughter, and I attended with our son. After each session we would take them out for dinner to see if they had any questions.  

While Heart to Heart was a great resource, I don’t recall any discussion about STDs. As my son prepares for college, we have been contemplating what advice to offer him.  Everyone has different opinions on what’s best for their kids from a religious, mental health or moral perspective. While my wife and I have shared our views with our children, I will not delve into the specifics here. Rather my focus will be on discussing STDs from a quantitative and analytical perspective. The subject is relevant to any parent—as well as anyone not in a monogamous relationship.  

STDs in the US are very common. According to a 2021 CDC report, an estimated one in five, or 68 million people in the US, were living with an STD, with an estimated 26MM new infections per year. Over half of these new infections occurred in individuals under the age of 25. While the available data is limited, it appears that the prevalence of STDs among college students is higher than the population at large.

Doing simple math, if you have intercourse with 5 different partners, you are likely to have had sex with someone with an STD. However, the symptoms and risks of each STD vary greatly (see chart below). The two that I found the scariest were genital herpes and HIV as they are both incurable. Genital herpes is especially troubling as the disease is quite common. 12% of Americans (16% of women) between the ages of 14-49 are infected. The risk of transmission is especially high since many that are infected do not exhibit symptoms. Making matters worse, genital herpes can be transmitted even while wearing a condom. 

Fortunately, the long-term impacts of many STDs can be significantly mitigated with early detection and treatment. I didn’t realize that most people infected with STDs do not exhibit any symptoms. If you are sexually active with multiple partners or one of your partners is sexually active with multiple partners, it's extremely important to get tested at least once a year. Diseases such as gonorrhea and chlamydia, if left untreated, can result in infertility, while others such as HIV and syphilis can be fatal. Should you test positive for an STD, consult with your doctor before resuming sexual activity. Make sure to inform recent partners of your test results, urging them to get tested as well, even if they have no symptoms.

After digesting the research, here are my conclusions and recommendations for my son. 

1. Get tested before intercourse: It's essential for both partners to get tested for STDs before initiating sexual intercourse with someone new. While this is obviously an inconvenience, there is really no way around it. Skipping testing may lead to contracting an STD that may accompany you for the rest of your life.

2. Get tested annually: If you are sexually active with multiple partners, it's important for you and all of your partners to undergo STD testing at least once a year.

3. Intercourse with numerous sexual partners is extremely risky: The statistics are clear—if you're engaging in sexual activities with numerous partners, the probability of contracting an STD, many of which are incurable, is extremely high.This is particularly true in college.

4. Condoms are not a panacea: While practicing safe sex is essential and can greatly decrease the risk of STDs and pregnancy, it's important to remember that condoms are not foolproof. Many STDs can be transmitted while using a condom, and even when used correctly, condoms have a 2% failure rate.

Below is a quick summary of the most common STDs in the US. The facts that I thought were most surprising or important to know are in bold.

Sangeeth Peruri - Jack of Many Trades, Master of None
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Disclaimer 
I am not a medical expert. This article's recommendations are based on my interpretations of research from the below sources. Please consult with a healthcare professional to discuss the appropriateness of any advice given here, tailored to your specific circumstances.

• CDC - genital herpes

• CDC - HPV

• CDC - Chlamydia

• CDC - Chlamydia Fact Sheet

• CDC - 2022 National Overview of STIs

• CDC - The State of STIs

• CDC 2021 Fact Sheet

• CDC - Trichomoniasis

• How effective are condoms

• Mayo Clinic - genital herpes

• Mayo Clinic - syphilis