It spreads in ways you don’t expect and antibiotics don’t kill it. What you need to know.
Hey, you know what word should never have “super” in front of it? “Gonorrhea.” But super-gonorrhea is here. It’s far scarier than our former adversary, and it’s a serious threat, emerging from Japan and beginning to cross the world. News first started breaking in the public health community about super-gonorrhea years ago, but it’s finally hitting the mainstream, as for example in this recent article at RH Reality Check by Martha Kempner: “No Clapping Matter: Antibiotic-Resistant Gonorrhea Is On Its Way, and We Are Not Prepared.”
As I think about super-gonorrhea, my mind inclines towards condoms and oral sex, and my experiences as a sex educator. As Kempner’s article notes, many gonorrhea tests wouldn’t detect an infection that came from oral sex. And plenty of people don’t realize that you should use condoms during oral sex to prevent disease transmission. The risks for most diseases usually aren’t as high as they are during vaginal sex, and certainly not as high as the risks during anal sex. But the risks are there.
I know this as well as anyone; I’ve worked as a sex educator both in the USA, and in HIV-rich populations of sub-Saharan Africa. Living in an area with an overall HIV rate of 25% taught me a lot about the statistics and issues surrounding safer sex, and also scared the hell out of me. But I’ve still taken occasional unwise risks when it comes to condoms and oral sex — or, when I was younger, other types of sex. And plenty of other health educators I know have taken unwise risks, too. The dirty little secret of sexual health promotion is that while health educators may be better at health stuff (?), we’re nowhere near perfect at the ideals we espouse. (Just watch for people standing, smoking like chimneys, outside the doors of public health conventions.)
Why do people risk their lives for a heated moment? One reason was articulated by Kerry Cohen at Role/Reboot, as she wrote movingly about her past experience:
Unless he reached for [a condom] — and he so rarely did — I was never going to put my physical health over the intoxication that came from owning him, from losing myself, from letting him lose himself in me. … as he moves toward me, I won’t think about my body as anything other than something that could hook him, reel him in, and make him mine. I won’t catch an STD that time, but I might the next time. And if I catch something, I will still strip down to my core, exposing everything to the other person, even the STD. The shame I have about that runs deep — for the desperation, for the selfishness, for the utter lack of care for anything other than my need.
The reasons people don’t use condoms (or dental dams) frequently start and end with physical pleasure. But there’s often an emotional component as well, with people associating lack of condoms with trust or intimacy — or hating to “break the moment.” There is also the self-conscious agony of disclosure, when one partner knows that they have a disease. This was recently shown in an interesting, anonymously-written piece at The Hairpin, “The Perks of Herpes.” The author talks about how uncomfortable it is to disclose her herpes infection to every partner, every time. She ends up concluding that herpes (which she contracted from oral sex, by the way) actually has an up side: it’s deepened her love life by forcing her to only date men who are committed to her despite the disease. But I will point out that she’s in the sought-after position of being an educated young lady. Her trade-offs might feel very different for other people.
Indeed, when people are poor or marginalized enough, the human motivations around these diseases can become hard for privileged people to understand. For example, there are cases of people deliberately contracting HIV. At one point, it was because France — in an attempt to contain the spread of HIV — extended citizenship to undocumented HIV-positive immigrants; some immigrants then commenced to deliberately seek HIV, reasoning that being undocumented was worse than HIV. Lest anyone think that this can’t happen in the USA, it’s been described in Detroit, albeit for different reasons.
When people talk about HIV in Africa, they often like to focus on the differences between various African cultures and USA culture. (They also like to talk as though Africa is one big country instead of an incredibly diverse continent, which I am trying to avoid in this piece; I apologize if I’ve failed.) Yet although culture matters — it matters a lot — humans are humans all over the world. The USA has better overall health than the hardest-hit areas of Africa simply because we have more resources, but as I’ve already shown you above, marginalized USA people can end up making health decisions that privileged ones find unthinkable. And even privileged USA people will screw up our condom usage, like in Kerry Cohen’s story (she notes in the piece that her mother is a doctor).
People want to believe that sexually transmitted infections can’t happen to them, saying that HIV or whatever only happens to “those other people.” But the truth is that although stigma, marginalization, and cultural differences make some groups much more vulnerable to disease, people also have sex with other people from all walks of life … and global networks are more interconnected than ever. The history of HIV shows millions of people dismissing it as “the gay disease,” or “that epidemic that’s storming across Africa,” etc. But plenty of folks have caught it who were straight, in the USA, or even believed they were in a monogamous relationship. Gonorrhea has always been easier to catch than HIV; with no treatment, super-gonorrhea will ravage us. I can only hope that some of us will keep in mind not just the physical risks at hand, but the emotional ones. I hope we will consider how to manage the risk-reward tradeoffs that everyone makes.
UPDATE: A recent New Yorker article apparently stated that super-gonorrhea is actually bred in the throat, which means that oral sex may actually be riskier, STI-wise, than other forms of sex. Food for thought.
This article was originally published at Role/Reboot.