STD/STI: Cytomegalovirus (CMV)

If you are worried about cytomegalovirus, don’t. I decided to include CMV in this posting series because more information is good, but when it comes to CMV, there isn’t all that much you can do with the information. Nor (for most people) is there any real need to do anything.

CMV is transmitted sexually, but you wouldn’t know it to read about it on most websites. Doctors are far more worried about transmission from mother-to-child during pregnancy. Why? Because for most people (and it is estimated that about 50% of adults are infected by age 35) CMV is a silent infection. It hangs out in your body, not doing much of anything except hiding from your immune system. Unless your immune system is weakened somehow, you won’t even know you have it.

Babies, on the other hand, are born with a weakened immune system (or rather, and immune system that isn’t fully developed) and are at greater risk of actually getting sick from a CMV infection.

Prevention: Preventing CMV infection is a bitch. It is transmitted through contact between bodily fluids and mucus membranes. Like a lot of STD/STIs, right? Well, not exactly. If you shake hands with someone who is having an acute CMV flare up, then rub your itchy eyes, you can get infected. Most infections occur between 10 and 35 years old. Sexual contact is only one of the ways this infection spreads.

However, if an infected person is not having an acute flare up, standard barrier methods should work to prevent transmission during sex. Try to avoid direct contact with bodily fluids and the other person’s mucus membranes, and wash your hands when play time is over.

Treatment: Like chickenpox (CMVs close relative), once you are infected, the infection is permanent. There is no getting rid of this bugger. If an acute infection develops. the normal course is to treat the symptoms. Pain killers and salt water gargles are common recommendations.

People with severely weakened immune systems may be treated with antivirals.

Symptoms: For adults, CMV infection can take 3 forms: dormant, acute or CMV infection in immunocompromised systems. Dormant CMV is when you are infected and the virus just sits there, not doing much of anything. There are no symptoms and no problems.

In acute CMV, a generally healthy person will get a CMV flare-up when their immune system is weakened–such as when they are under a great deal of stress. Acute CMV mimics mononucleosis, with long-term malaise, swollen lymph nodes, and general aches and pains. Like mono, it can last up to 6 weeks and will clear up on its own.

CMV in immunocompromised persons can be scary. Flare-ups can cause pneumonia, encephalitis and more. Some of these dangerous manifestations of CMV are among the AIDS-defining infections

Diagnosis: CMV is usually diagnosed based on symptoms. There is a blood test available to detect the virus, but it is expensive and not widely available. During an acute flare-up a simpler blood test can detect antibodies.

Complications: In a dormant infection, complications aren’t an issue. They are rare in acute infections and usually involve the infection spreading to other areas of the body. CMV in immunocompromised persons is basically one big (and dangerous) complication, with untreated results ranging from blindness to death.
Overall, CMV is not an infection you need to really worry about unless you have HIV, recently had an organ transplant or otherwise have a compromised immune system. That said, there is around a 50% possibility that you are already infected, and getting diagnosed outside of an acute flare-up is nearly impossible. Take precautions when interacting with people who are experiencing flare-ups, and otherwise try not to stress about it.

STD/STI: Crab Lice

Pthius pubis

Also known as pubic lice, or the crab, the crab lice are a parasite that infects the course hairs of the human body. Normally this means pubic hair, but they can also infect armpit hair, chest hair, eyelashes, and other coarse hair. Most countries don’t require incidences crab lice to be reported, so there is no reliable statistics on how common they are. The best available estimate is that they infect approximately 2% of people worldwide.

Prevention: Not having intimate contact with people who are infected is the best protection. As life can be transmitted through bedding, towels, and other fabrics this is not 100% protection, but it’s definitely your best bet. Several sources recommend practicing safer sex to prevent transmission. I can only assume that this is a default recommendation for all STD/STI’s, as the only barrier method which might provide some protection against lice is female condoms. Basically, unless you are wrapping the entire general area in a plastic bag and having no direct contact, crabs can be transmitted. I do not know of any commercially available protection which actually does cover the entire genital area. And that doesn’t even count the possibility of infection being transmitted from someone’s armpit hairs or sheets.

Treatment: Lice can be gotten rid of with an over-the-counter or prescription shampoo. Eggs are removed by combing with a fine toothed comb. In order to prevent possible reinfection, bedding and towels and any clothing which comes into contact with the infected area should be washed in hot water.

Symptoms: The main symptom of crab lice is a persistent itching in the pubic area, which is usually worse at night. Itching is caused by a reaction to the crab lice saliva. Sometimes, though not always, the skin around the bites will turn blue-gray. A careful examination will find eggs, small white dots, attached to the hair.

Diagnosis: Crab lice are one of the few STD/STIs that don’t require an official diagnosis. If you see the eggs on your pubic hair, you can go down to the drug store and get an over-the-counter treatment. If you do go to a doctor, they will diagnose based on the presence of eggs, itching and if necessary they will look at your hair under a microscope to see the crabs themselves.

Complications: The main complication of a lice infection is scratching yourself or on developing an infection in the scratches. The US National Health Institute recommends that anyone who has crabs be tested for other STD/STI’s, as apparently they are often transmitted together.

Overall, crab lice are more of an annoyance than a serious concern, but I still wouldn’t want to play host to them. For more on STD/STIs, check out the Long List of STD/STIs.


STD/STI: Chlamydia

Chlamydia is the most common bacterial STD/STI in the US, with over 1 million infections reported each year. Given the silent nature of this infection it is likely that it is just as common in other parts of the world. The US Centers for Disease Control and Prevention (CDC) recommends that all sexually active adults be tested for chlamydia at least once a year and more often if they have multiple sex partners.

Prevention: Both male and female condoms can prevent the spread of chlamydia. Chlamydia can be spread through vaginal intercourse, anal intercourse and rarely through oral intercourse. Therefore using barrier methods during any form of sexual interaction is recommended. If you have been diagnosed with chlamydia it is best to avoid sexual contact until you have completed your course of treatment.

Treatment: Chlamydia is treated with a course of antibiotics. At this time, there are no known antibiotic resistant strains of chlamydia. Due to the silent nature of the infection, if someone has been diagnosed with chlamydia all their sexual partners will usually be prescribed antibiotics as well, to prevent any possibility of a cycle of reinfection.

Symptoms: Only 30% of women and 75% of men who are infected with chlamydia will develop symptoms. This means that more than half of those infected will have no indication of their infection.

Symptoms for both men and women include abnormal discharge from sexual organs or rectum, and burning during urination. Women may also experience pain during sex and develop symptoms of pelvic inflammatory disease. Men may develop painful or tender testes.

Diagnosis: Chlamydia is diagnosed through taking cell samples from any and all possible infected areas (penis, cervix, urethra and rectum) and sending them out for testing. In some cases, Chlamydia may be diagnosed with the urine test.

Complications: The most common complications from chlamydia are infection of the urethra or cervix. This can develop into more severe complications for women, untreated cervical infection can spread to the uterus and fallopian tubes leading to pelvic inflammatory disease, and possibly infertility and/or an increased risk of ectopic pregnancy.

If a woman is infected during pregnancy additional possible complications can affect the child. Doreen birth infection can spread to the eyes or throat of the newborn, which can lead to blindness or chlamydial pneumonia.

Chlamydia is one of those infections that makes STD/STI testing so important. If undetected it is easily spread and can have significant long-term consequences. However it is easily detected and easily treated if it is caught before problems develop.
Back to the Long List of STD/STIs

STD/STI: Chancroid

Chancroid is a bacterial infection that is only transmitted through sexual contact. It is rare in the US and other parts of the world with good access to antibiotics. It tends to be very common in developing nations and other parts of the world where antibiotics are difficult to get a hold off.

A white sore with red borders on the head of a penis.
Penile chancroid sore (Image is public domain from CDC)

Prevention: Chancroid is transmitted by direct skin to skin contact of the genitals. Male or female condoms should be effective prevention. If you choose not to use condoms, then do not engage in direct genital contact with anyone who has any kind of sore on their genitals. (That last really should be a ‘Duh’.)

Treatment: Chancroid infections can clear up on their own after a few weeks, but are painful and have potential complications. A single course of antibiotics will normally clear the infection up without any problems. Some chancroid strains have developed a resistance to specific antibiotics, but there is no known strain which is resistant to all antibiotics.

Symptoms: The main symptom of chancroid is a circular sore which develops between three days to two weeks after infection. The sores are round, with clearly defined edges. On the vagina, the source can be found on the outer labia, usually the inner surface but occasionally the outer surface. Sores can develop pretty much anywhere on the penis, including the opening of the penis, or on the scrotum. Chancroid sores resemble the typical sort of primary syphilis. After the sores develop, the lymph glands in the genital area often become swollen.

Diagnosis: Chancroid is usually diagnosed off of a visual examination. If there is some uncertainty as to the diagnosis, sores may be swabbed for testing.

Complications: Urethral fistulas and scarring may develop on the foreskin of an uncircumcised penis. If the infection goes untreated, abscesses from swollen lymph nodes may develop scarring. A chancroid infection may leave you vulnerable to infection by other STD/STI’s, including HIV and syphilis.

Given its restricted geographic range, and very visible symptoms, chancroid is not an STD/STI that many poly-folk need to worry about. If you live in an area where chancroid is common, use condoms and avoid genital contact with people who have open sores. If you don’t live in an area where chancroid is common, you should be doing the exact same thing anyway.


STD/STI: Bacterial Vaginosis

Vaginal cells with ‘bad’ bacteria on them. Called ‘Clue cells’.

Bacteria love warm, wet places. Which means at any given time there are millions of them in every vagina on the planet. The good news is that the vast majority of these bacteria are ‘good’ bacteria – that is they help us stay healthy and eat the bacteria and viruses that would make us sick. Sometimes, things go wrong, and we end up with fewer good bacteria. Then the ‘bad’ bacteria start having a field day, and things get icky. This is bacterial vaginosis.

Not all medical authorities consider bacterial vaginosis an STD/STI – but that is largely because we don’t actually know how people get it. What we do know is that it is more common among people with multiple sex partners, and right after the first encounter with a new sex partner. So if it isn’t directly transmitted by sex, sex is definitely involved.

Prevention: Don’t douche. Don’t have lots of sex partners. (That’s pretty much all medical science can tell us.)
Treatment: Usually clears up on its own in a few days, otherwise antibiotics.
Symptoms: Sometimes, there aren’t any. When there are they include itching, smelly discharge, burning urination.

So if the symptoms are mild, and it usually clears up on its own anyway, why do we care?

There is one major complication of BV that is actually a little scary: it puts you are greater risk for getting other STD/STIs, like HIV, Hep, Chlamydia and all the other stuff we actually worry about. It also increases the likelihood of your partners being infected with an STD/STI if you are infected.

If you have any symptoms of BV, and they don’t clear up on their own in a day or two, see your doctor about getting an antibiotic. To protect yourself against other STD/STIs, don’t have sex if you or your partner have any of the symptoms of BV.

Back to the Long List of STD/STIs

The Long List of STD/STIs

How many STD/STIs are there? I’ll bet more than most of you were aware of. The following list was compiled through a combination of health related sites, including Planned Parenthood, the CDC and the American Social Health Organization. No one site contained all the STD/STIs in this list.

Links current as of March 9, 2015

If you want to keep up with all the STD/STI posts, your best bet will be to bookmark this page, so you can come back and check for new links.

Normally I try to keep this blog safe to read at work and around the kids. Fair warning: I will be adding pictures where appropriate, some of this stuff will be NSFC, NSFW and not something you want to look at while eating.

STD/STIs: How often should I get tested?

So far we’ve looked at, why STD/STI tests are important, where you can get them and how much they cost, and what testing involves. The one important question about STD/STI testing we haven’t looked at yet is how often we should get tested. So that’s what were going to do today.

No matter what your relationship status, it’s probably a good idea to get tested at least once a year. Partly because there are some STD/STIs that you can get from kissing a family member or friend or sharing a glass of water. Partly because getting in the habit of being tested is an important part of protecting yourself and your partners.

For any parents who may be reading this, I highly recommend that you make it a routine to take your teenage children to get tested once a year whether or not you are aware of them being sexually active. It is very likely that your children will become sexually active without you being aware of it. It is likely that they will not discuss their sexual practices with you. Making it a yearly routine to get STD testing and telling them: “I am not asking, and you do not need to tell me, but I am going to make sure that if you are active you are safe;” can be an important step in helping your children establish healthy and safer sex practices.

Okay, so that covers the bare minimum, at the very least get tested once a year, just in case. Let’s look past the bare minimum. A fairly standard medical recommendation is that you should get tested about three months after getting involved with a new sexual partner. This recommendation assumes that you and your new partner are exclusive. So if you both get tested once, and you both test negative, then as far as conventional wisdom is concerned there is no reason to get tested again until and unless you get a new sexual partner.

Closed Poly Relationships
This advice can work well for closed poly relationships or poly-fidelitous relationships. If you are not getting new sexual partners, and your partners are not getting new sexual partners, then in theory there is no way for STD/STIs to enter your polycule. If you bring a new partner into your polycule, you can all go out and get tested after three months, and if everyone’s clear just go with the minimal once a year testing.

Okay, I hear you, I hear you, open, closed or sauerkraut, what happened to getting tested before getting involved with a new partner and exchanging test results? Why am I saying get tested after a new partner is involved rather than having a check before hand?

You are right, the standard advice and a lot of poly communities is to exchange STD/STI tests before getting sexually involved. And it’s advice that I repeated earlier in this series when I was going over the basics of safer sex. Yes, it is a good idea to exchange STD/STI testing results with a new partner before becoming sexually active with them. It just may not be enough.

Even if your new partner got their test results back the day you became sexually involved, they could have been infected with an STD/STI that did not show up in the test. HIV is notorious for the fact that tests will not return an accurate result for at least a month after you’ve been infected. There are several other STD/STIs that can take several weeks to show up in testing. So even if you are in a closed relationship, and even if you exchange test results before getting sexually involved, getting tested again after you get sexually involved with a new partner is a good idea.

Open Relationships
If you are in an open relationship, or are in a situation where you and/or your partners are getting involved with new sexual partners on a frequent basis, it is a good idea to get tested regularly once month or once every three months. Even if neither you nor your partners are entering new sexual relationships, if your metamours frequently have new sexual partners or really if anyone in your poly network frequently gets involved in new sexual relationships, you are best off getting tested at least every three months.

Again, it is still a good idea to exchange STD/STI tests before becoming sexually active with the new partner. Also again, exchanging STD/STI tests does not protect you hundred percent from the possibility that to your new partner may have STD/STIs that just didn’t show up in the test. It also (and I hope obviously) does not protect you from the possibility in an open relationship that your partner may get an STD/STI in the future from one of his or her new partners. Which is why regular testing is still important.

Condoms, Fluid Bonding and STD/STI Testing
I want to take a minute to address the idea that if you use condoms you don’t need to worry about getting test. This idea is prevalent enough that a few years ago when I took part in a research study on polyamory, I told the interviewer that my triad had an agreement to get regular STD/STI testing and she automatically assumed we were fluid bonded. The assumption, of course, being that if we were using condoms there would be no reason for us to be tested regularly.

If you’ve been following along in this series on STD/STIs, you may remember the post on barrier methods and the list of specific STD/STIs that condoms do provide some protection from. It’s important to remember though, that condoms do not protect against all STD/STIs and do not provide 100% protection against any STD/STI’s.any STD/STI’s.

Using a barrier method to protect yourself against STD/STIs is a very good idea. Barrier methods are not failproof. They are also not foolproof. If you use barrier methods, it is still a very good idea to get tested regularly.

And that wraps up our section on STD/STI testing. Next week, I’ll start going over the various STD/STI’s: how they infect you, but their symptoms are, long-term medical effects, available treatments and ways to protect yourself against each one.

Bonus Post: Custody Update and Important Legal Precedent

Hey all

For those of you who have been following my messed up custody situation, the appeal court returned a decision last week returning custody to my children’s father and ruling that polyamory should not have been used as a reason to take the children away because there was no evidence that poly was harming them in any way. (In fact, though the appeal court doesn’t mention it, there was evidence that poly was NOT harming them, since the kids therapist testified that it was not affecting them.)

On a personal level, this is good news – the kids are away from my parents and back with their father, and I will be getting proper visitation over the summers instead of the measly week I got this year.

On a legal level, the court’s decision is being entered in Pennsylvania case law, which means the ruling about poly not being a reason to take the kids is official legal precedent in Pennsylvannia. For a great review of the decision and what it means legally, check out Nancy Polikoff’s write up.

(Originally posted Sept 2012)

What Does STD/STI Testing Involve?

Like anything medical, if you’ve never had an STI test before, it can be a bit nervous making. Especially since no one ever bothers to explain anything. STI tests can actually take several forms depending on exactly which STI is being tested for. So if you are being tested for multiple STIs, there may be a couple of different tests.

There are four ways STIs are tested for:

  • Blood testing – includes HIV and Hep, so is part of just about every STI test on the planet
  • Physical Exam – looks for crabs, herpes sores and other obvious signs of STIs
  • Swabs – checks for bacteria such as gonorrhea and chlamydia, and used to test possible herpes sores
  • Urine testing – alternate method for testing for gonorrhea and chlamydia, and a few others.

Every clinic and lab will handle their testing a bit differently, but in general (and depending on what STIs you are being tested for) you can expect something like this:

When you first arrive you fill out any necessary paperwork. The desk may give you a cup to get a urine sample while you wait. When it is your turn, you get called back to see a nurse or med-tech. They’ll have you take off your clothes so they can do a physical exam. They may swab any sores you have or swab the inside of your genitals. After you get your clothes back on they’ll draw blood. Then you head home and you’ll get the results of your tests in a few weeks.

Polyamory and STD/STIs: Getting Tested


The two big questions everyone asks are where to get tested and how much will it cost. Unfortunately, there is a common idea that STD/STI testing is horribly expensive. This keeps many people from getting tested, even though there are many inexpensive options for STD/STI testing. Obviously your options depend a bit on where you live, so I’ll try to break it down a bit. However the default here is US info.

Where to get tested? And what does each cost?

The easy answer here is ‘ask your doctor’. If you have health insurance (or live in a place with universal health care – you lucky bastards) you can get ask your doctor about how and where to get tested for STD/STIs.

If going to your doctor is not an option – for reasons of cost or privacy – there are several other options.

Health Clinics

Your local health department has an interest in keeping STD/STIs under control and treated. In the US, municipal health departments offer STD/STI testing either at special once a month clinics or at special offices set up specifically for STD/STI testing (which depends on how many people they expect to need testing and what they can afford). Their tests are either free or at a nominal fee (usually around $10, though I have seen as high as $30).

Outside of the US, I know that Great Britain, Australia and Canada all offer STD/STI testing centers in addition to the ability to get tested by your doctor. I do not know about the rest of the world, but it is (at least theoretically) easy enough to call your local health department and ask or look them up online.

In the US, these clinics rarely cover all STD/STIs, but they will always cover HIV, Hep B, syphilis and these days gonorrhea. They will rarely test for herpes unless you have a sore of some sort – testing for herpes is unreliable at the best of times and is unlikely to be worthwhile unless you have an active outbreak.


There are also places such as Planned Parenthood where you can get tested (some charge for STD/STI testing, some do not).

Mail Order and Medical Labs

You can also pay out-of-pocket for STD/STI testing. ‘Anonymous’ testing where you send samples by mail order, or you can go down to a local medical lab. The advantage of this is you can get tested for any STD/STI you can afford. However, they will typically charge you over $300 for what you can get for less than $30 from your health department. While it is true that health departments don’t test for all STD/STIs, if you really want to be tested for ‘all’ STD/STIs (I have never seen any lab or for pay program that actually covers all STD/STIs, hell there is no HPV test for men) you are probably best off getting tested by the local clinic for whatever they cover and only paying out-of-pocket for what they don’t cover.

So there you go – finding where to get tested, and affording to pay for it, isn’t nearly as bad as you may have thought.