It had been almost three years since Maria last had sex when she went in for her first women’s health checkup at Student Heath. Like most 21-year-old women, she was going in for what would be the first of a lifetime of yearly exams. She couldn’t help but find the whole thing somewhat uneventful.
Just over a week later, Maria missed a call from Student Health. Something came up in her tests — she needed to call Student Health as soon as possible. When she did, she discovered something she hadn’t even considered possible. For the past three years, after having sex only one time, Maria had been living with chlamydia.
She made her way back to Student Health that day. Maria, who knew little about the sexually transmitted infection that lived inside her, barely knew what to ask. The physicians at Student Health explained the disease and its implications and took care of all the details.
“You know when you have absolutely horrible days,” said Maria, now a senior, whose name has been changed to conceal her identity. “That was one … I’m a good person. These things shouldn’t happen to me. I will never forget that day.”
Despite going untreated for almost three years, Maria would suffer no long-term side effects thanks to the prescription of antibiotics she picked up later that day. According to the Center for Disease Control, chlamydia, which is sometimes referred to as a “silent” disease because about 75 percent of women and 50 percent of men show no symptoms, can cause serious reproductive and other health issues when it goes untreated for too long.
Maria is among 54 students who were diagnosed with chlamydia at Student Health last year according to Deborah Mathis, the chief administrator at Women's Health. This number is on the rise. In the mid ‘90s “we were having maybe 15 cases of chlamydia” per year, said Mathis. In Philadelphia, this increase is more dramatic. In 2007, Philadelphia County had the third highest number of cases in the country.
Overall, chlamydia is representative of the overall trend both at Penn and in the United States. According to the CDC, many diseases whose prevalence had been decreasing for some time have been on the rise in the past few years. These diseases include chlamydia, gonorrhea and syphilis. And these increases are especially important among the college-age population. According to the Guttmacher Institute, almost half of all new STI cases every year occur among 15-24 year olds.
Mathis says the prevalence of STIs at Penn is low, but rising. It is difficult to access the overall number of students affected because many students are diagnosed and seek treatment outside of the University system, and many STIs go undiagnosed.
To date, over 3,000 members of the Penn community have been tested for STIs at Student Health. But testing rates vary dramatically by gender. The vast majority of those tested are women, thanks to regular yearly exams where screenings are offered. Meanwhile, only about 700 are men. That number is up significantly from previous years — in the 2005-2006 academic year, the number of men screened at Student Health approximately doubled, said Mathis.
Lilly, a junior whose name has been changed to conceal her identity, hadn’t even heard of the disease she contracted while having unprotected sex until the day she was diagnosed with it. According to Student Health, it’s called molluscum contagiosum and is a disease that many contract by simple skin-to-skin contact. It leaves small papules (which somewhat resemble pimples) on the skin. While Lilly recognized that “this could be way worse,” the thought of having an STI was unsettling. “Thinking of yourself like a carrier of something you can spread is really weird,” she said.
As with all other students at Penn who contract an STI, Student Health explained the importance of contacting her previous sex partners. She called one of her previous partners and e-mailed the other, who she didn’t know as well. “Both of them were grateful that I told them,” she said.
Lilly’s treatment, which involved regular to trips to Student Health to have the papules frozen off, lasted four weeks. During that time, she turned down sex with a partner she was interested in to avoid spreading the STI to others.
Mathis estimates that 95 percent of the time, students who contract STIs contact previous partners. At times, she is asked to contact the partners on the student’s behalf, a request she generally obliges.
But contacting past partners or preventing current partners from being infected is not always so easy. Maria, who met her sex partner while out of the country, had been out of touch with him for three years and was unable to contact him.
When senior Stephanie was diagnosed with human papillomavirus, she had already been having unprotected sex with her boyfriend for about a month. A procedure she had undergone a couple years before suggested that she may be infected with the virus. But it wasn’t until an abnormal pap smear at Student Health that she knew for sure that she had contracted HPV from a high-school boyfriend who had engaged in unprotected sex prior to their relationship.
For Stephanie, whose name has been changed to protect her identity, the worst part of the diagnosis, which she described as being “mildly traumatizing,” was having to tell her current boyfriend that she might have given him HPV.
As with 95 percent of women diagnosed with a high-risk HPV strain, Stephanie’s STI cleared up within the year. For the other five percent, however, HPV can cause cervical dysplasia, according to Mathis. While dysplasia can lead to cervical cancer if untreated, cancer is very avoidable. “It’s the people that fall out of the system that don’t come back” who tend to get cervical cancer from HPV, said Mathis. “Penn students are compliant. We don’t let them fall out.”
Mathis estimates that about 50 percent of Penn students are exposed to HPV — a number in line with the national average for the age group. According to Guttmacher, HPV infections comprise about 50 percent of STIs diagnosed in the 15-24 year age group.
A growing majority of women at Penn, however, are now immunized against the HPV strains most likely to lead to cervical cancer or cause genital warts thanks to the vaccine Gardasil.
The rate of vaccination among men, however, remains low despite the vaccine’s ability to prevent genital warts. As of last month, Student Health began administering Gardasil to men and covering it under the University’s insurance plan.
While Student Health Director Evelyn Wiener recommends that all men and women receive the vaccination, she notes that "HPV is especially recommended for men who have sex with men because they are at higher risk for genital warts."
According to Office of Health Promotion and Education Director Susan Villari, approximately 85 percent of Penn students are sexually active. Of these students, not everyone practices safe sex.
Only 66 percent of Penn freshmen “always or mostly” use condoms, according to the 2008 Penn Health and Wellness Survey. This number goes up slightly by the time students graduate — going up to 73 percent for Penn seniors.
It’s not that students don’t know how to protect themselves from contracting STIs, said Lilly. “I think it’s just a matter of people not being proactive about it. People our age think they’re invincible.”
Villari agrees. She thinks Penn students allow their perception of other students’ sex health behaviors to dictate their practices. “Students over-perceive the safe sex practices of their peers,” she said. College sophomore and Queer Student Alliance co-chairman Thad Dowad concurs. “People think ‘I’m not hooking up with people outside of Penn so I’m being safe,’” he said.
But Counseling and Psychological Services Director Bill Alexander thinks it goes further than that. “It’s not only this normal invincibility of youth,” he said. “There’s this attitude of ‘we can fix it.’” Thinking that all the latest pharmaceutical advancements and technologies will fix any problem, students may not be taking STIs as seriously as they should.
What Dowad finds most alarming about STIs at Penn is the lack of discussion about them. The 2008 Survey shows that students who received abstinence-only education have higher rates of STIs than the average. Though, according to Penn HIV Counselor Erin Taylor, “we have very educated, informed students,” many international students, including Maria, receive little or no formal sex education.
As Dowad points out, sex education isn’t just about knowing that you need to use a condom; it’s about knowing how to use one properly. He notes that this is especially important for men who have sex with men because condom use during anal sex can be more difficult. This is a conversation that he doesn’t see happening often at Penn.
Unsurprisingly, being diagnosed with an STI can be a very emotional ordeal for students. For Maria, the diagnosis led to feelings of anger and shame. “I was so upset that I let that happen and was stupid enough to think nothing could happen,” she said. According to Alexander, this response is common. Students who are diagnosed with STIs “fall into two categories,” he said. “There are people who feel shame and repulsion of this virus or illness … It’s also mixed with an anger toward their partner. It all gets mixed up together. There are a few students — statistically this would not be [huge — for whom] it triggers a much larger psychological issue.”
Deciding whether to discuss an STI with family can add to the anxiety and emotional stress of the diagnosis. For students who are not comfortable discussing sex with their families, Student Health works to provide the highest levels of confidentiality — for students on private insurance plans, where their parents would be able see all healthcare costs, Penn allows students to pay in cash at the reduced Penn insurance rate. Furthermore, any amount charged to bursar accounts by Student Health, be it an STI screening or crutches, come up as “healthcare assessment.”
STIs that are considered incurable, Alexander added, cause more extreme and complicated emotional reactions.
Among the most common STIs on college campuses, herpes is often considered the most stigmatized. Though over 50 percent of Penn students would test positive for type-one herpes, according to Mathis, the incurable and visible nature of the disease makes it difficult for students to cope with. “It’s going to be part of their identity,” said Alexander. “Part of their whole sexual life … [students] have been told that once you have herpes, you have it for life. It’s the permanence of it that freaks them out.”
The most common transmitter of herpes on campus is oral sex, according to Mathis. And 99 percent of students on campus do not practice safe oral sex, meaning they do not use condoms or dental dams.
Dowad notes that it’s not always realistic to ask students to use latex protection during oral sex, though QSA co-chairman Quintin Marcus adds that, while it’s not extremely common, “people shouldn’t feel they shouldn’t — there are people that will.”
For Stephanie, avoiding herpes is something she is especially careful about. When she noticed a large cold sore developing on her partner’s lip, she refused to kiss him, or otherwise make any contact with his lips, to avoid contracting the STI. (This didn’t, however, stop them from having sex.)
Contrary to popular belief, herpes is not only contagious when someone is having an outbreak — the infection can be transmitted when someone is asymptomatic.
Of course, the most severe emotional response generally comes when students are diagnosed as HIV positive. Because death is associated with the diagnosis, it is difficult to compare the response to that with other STIs. According to Weiner, the prevalence of Penn students with HIV is about consistent with age group nationally — “about 2 or 3 per 1,000.”
Students diagnosed with HIV receive a strong support system through the University but generally seek care through more specialized resources in the city.
The real issue, Alexander said, is what the practitioners at CAPS don’t see: with the exception of HIV, few students come to CAPS to seek help for the emotional response associated with an STI diagnosis. Rather, they come to CAPS for other reasons — such as emotional trauma over a partner's infidelity — and the issue eventually comes out through regular therapy sessions.
More importantly, Mathis fears that students who contract STIs don’t typically learn to have safer sex. “They put it not so much on behaviors as on partner selection,” she said.
For Maria, Lilly and Stephanie, though, it has certainly taught them to be more careful about contracting STIs when having sex. “It’s ironic that it took something like this to jolt me and really protect me,” said Lilly. But “it’s one of those things that’s changing my outlook and my actions in the future.”
