On Sexual Health
"I know where I've been. But I don't know where you've been."
As my Feeld profile explained, I was regularly STI tested, HPV vaccinated, and vasectomised. Sacrifices I made so that I could indulge in and sustain moments like these. And I could tell that Maya was leaning into these credentials too. Of course if I’m low risk, then partners are more likely to choose me again and again.
After a protracted, multi-encounter conversation with Stephania, I started to grow upset that she didn’t want to elevate the experience with me after knowing that each other had had many encounters with other people, years before we met each other and months after, all without issue. So the conversation becomes, based on what we know about each other’s activity and choice of partner, is the momentary pleasure going to outweigh the grief that an STI would bring both people, multiplied by the probability of contracting one tonight.
STIs aren’t inherently part of psychology, but they are the second and final universal reason supporting the pitch for monogamy. There are a few emerging facts about STIs, so let’s catch them all.
Sex experts in London suggest that people on the scene should get tested after 3 months or barrierless encounters with 5 different people, whichever comes first. This rate is enough to control and even drive down the infected population rate given the current rates in London in 2025. Which are as follows, where most of these figures come from the World Health Organisation, UK Health Security Agency, and UK Genitourinary Medicine Clinic Activity Dataset surveillance systems.
Human Immunodeficiency Virus
Global Rates — In 2023 there were 40 million carriers, 1.3 million new diagnoses, and 630,000 related deaths. The receptive partner in sex faces a much higher risk of transmission.
London Rates — 38,680 carriers in 2022, 1,543 new diagnoses up 11% from 2022.
Symptoms — causes Advanced Immune Deficiency Syndrome which reduces the body’s ability to fight infection from other pathogens.
Lasting Damage — Chronic inflammation persists increasing the risk of multiple comorbidities such as high blood pressure, type 2 diabetes, bone mineral density loss, organ Stress, Neurological Impacts (Between 30% and 50% of carriers suffer HIV-Associated Neurocognitive Disorder), Nerve Pain, Immune Vulnerabilities.
Chronic inflammation, historical immune damage, Fewer than 12 individuals are ever documented to have fully cleared the virus, through stem cell transplants for cancer. 3 more have been documented having a natural immune clearance. Men experience faster disease progression before effective treatment.
Prevention — Pre-exposure prophylaxis are options for sero-negative people in the form of tenofovir disoproxil fumarate and emtricitabine 99% effective at preventing transmission of HIV when taken daily.
Cure — anti-retroviral therapy
Test Method — takes 7 weeks to show up in blood
Human Papillomaviruses
Symptoms — Primarily none. Occasionally genital warts.
Lasting Damage — opportunistic flare-ups during immuno-compromise (illness, exercise, drug use, stress, aging). Major cause of abnormalities on cervix which are indicators of cervical cancer, so is far more serious in women. Can lead to anal and penile cancers in men, and is linked to oropharyngeal cancers which are now more common in men than cervical cancer is in women in some Western countries.
Prevention — Vaccination against the 4 most aggressive forms (11, 16, 18, 96) and the next 5 (31, 33, 45, 52, 58) which cause 20% of cervical cancers, which in many countries is administered as a national program.
Cure — Much like common cold, which can be caused by over 200 strains of virus, there are more than 200 strains of HPV. Like with adenovirus, there is no viable way to eradicate these viral DNA lying latent in basal cells.
Test Method — collecting a sample of cells from the cervix detect the genetic material of the virus
Hepatitis B-causing Virus
Global Rates — 254 million sufferers, 1.2 million new infections, and. 1.1 million deaths attributed in 2022.
London Rates — 26,000 in 2022. 3,882 new.
Symptoms — fatigue, appetite loss, nausea, abdominal, dark urine, pale stools, jaundice, fever, aches,
Lasting Damage — Hepatocellular carcinoma, cirrhosis. Men are more likely to progress to chronic infection and hepatocellular carcinoma than women.
Prevention — Vaccination
Cure — The viral DNA lies latent in liver cells and there is no viable way to eradicate it.
Test Method — takes 12 weeks to show up in blood
Syphilis
Global Rates — 8 million new infections in 2022 and rising
London Rates — 4,300 in 2023, up 11% from 2022.
Symptoms — a painless chancre, wart-like lesions in mucous membranes, swollen lymph nodes, fever, fatigue, hair loss.
Lasting Damage — In the early 20th century, syphilis was often more devastating in men due to delayed diagnosis and neurological complications like tabes dorsalis and general paresis. Today, differences are mainly epidemiological and more men, particularly men who have sex with men, are affected. Is congenital.
Prevention — Clinical studies have shown that taking 200mg of doxycycline as a post-exposure prophylaxis can significantly reduce the risk by 73–87%.
Cure — benzathine penicillin G injection.
Test Method — takes 12 weeks to show up in blood
Trichomoniasis
Global Rates — 156 million new infections in 2020.
London Rates — 3,300 in 2023, up 17% from 2022.
Symptoms — vaginal discharge and itching, dysuria, dyspareunia,
Lasting Damage — pelvic inflammatory disease and fertility issues.
Prevention — None
Cure — antimicrobial therapy
Test Method — Rapid Antigen tests detect specific proteins from the parasite and can provide results in 15 minutes.
Gonorrhoea
Global Rates — 82 million new infections in 2020
London Rates — 71,000 in 2024, down 16% from 2023.
Symptoms — dysuria, dyspareunia, urethral discharge, epididymitis testicles, vaginal discharge and bleeding, abdominal pain.
Lasting Damage — Pelvic Inflammatory Disease, Infertility in men and women.
Prevention — Clinical studies have shown that taking 200mg of doxycycline as a post-exposure prophylaxis can significantly reduce the risk by 51–60%.
Cure — ceftriaxone, gentamicin injection, azithromycin pill.
Test Method — takes 2 weeks to show up in urine
Chlamydia
Global Rates — 129 million new infections in 2020.
London Rates — 52,000 in 2023, up 3% from 2022.
Symptoms — vaginal discharge, dysuria, dyspareunia, pelvic pain,penile discharge, epididymitis
Lasting Damage — Pelvic Inflammatory Disease, Infertility in men and women.
Prevention — Clinical studies have shown that taking 200mg of doxycycline as a post-exposure prophylaxis can significantly reduce the risk by 73–87%.
Cure — azithromycin, doxycycline pill
Test Method — takes 2 weeks to show up in urine
Herpes Simplex Virus-2
Global Rates — 520 million aged 15–49 suffering in 2020.
London Rates — 7,200 in 2023
Symptoms — Genital warts. HSV-1 causes oral warts (whereas ‘mono’ is caused by Epstein-Barr Virus, and impetigo is caused by strep or staph)
Lasting Damage — men can suffer more visible genital lesions due to anatomical differences. neonatal transmission risk (during childbirth) makes it far more dangerous in women of childbearing age.
Prevention — acyclovir, valacyclovir.
Cure — The viral DNA lies latent in ganglia cells and there is no viable way to eradicate it.
Test Method — Polymerase Chain Reaction test swabs an active sore to detect the virus’s DNA.
Interestingly, immune clearance tends to be slower in men, and general vaccination rates are lower, as they are more skeptical or stubborn or busy. In 2023 there were 128,000 new STI diagnoses among London residents, a 7% increase over 2022 which in turn saw a 21% increase from 2021.
British Association for Sexual Health and HIV guidance promotes repeat testing for condom users every 12 months, people with 2+ skin on skin partners every 3 months, and by extrapolation people that are in the community every month. If someone of poor sexual health hygiene sees 4 partners every month and who in turn see 3 more each then that 1st degree of separation means that 12 people are at risk. It is recommended to communicate negative results to recent partners too. Knowledge is power. It’s sad that ‘unprotected sex’ and particularly ‘unsafe sex’ are sloppy terms. Protection comes not from a pill nor a latex sleeve, but from discernment in partner selection.
In every handshake, hug, kiss, and sharing air on a bus, we put ourselves at risk, and STIs must be placed on the spectrum of probability of contraction and risk of negative effects.Both partners are responsible for knowing their bodies and their past, and should be coming to skin on skin encounters as an open book. So asking for a barrier with our playmate is akin to saying “I’ve recently been sleeping with some people that I don’t trust” which is fine. And turning up to an encounter, secure that we are clean, and still asking for a barrier is akin to saying, “I don’t trust you”, which is equally fine, so long as that’s the unspoken understanding, and in time after multiple clean encounters with the same person, the benefit that the barrier adds dwindles.
In the end, sexual health should be approached with the same calm pragmatism that we apply to every other area of health. We can remain informed on the prevalence of all diseases in random clothes-on encounters and in the curated company we keep so as to take reasonable precautions, and act responsibly toward ourselves and others. STIs deserve the same maturity. Through honest communication, regular testing, thoughtful partner selection, individuals greatly reduce risk while still enjoying one of the most natural forms of human connection. Fear thrives in ignorance; confidence comes from knowledge. When sexual health is treated as a shared responsibility, people are empowered to make informed choices and build relationships founded on trust, openness, and mutual care.
