More than 65 million Americans are infected with an incurable sexually transmitted infection (STI also known as sexually transmitted disease or STD), while an additional 19 million new infections occur each year. Fortunately, most of the new STIs are treatable with antibiotics. However, not all STIs have a cure available. There are currently four STIs that lack any cure: Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Herpes Simplex Virus (HSV), Human Immunodeficiency Virus (HIV), and Human Papillomavirus (HPV).

There are many troubling statistics surrounding these incurable STIs. One in 5 adults are infected with herpes. Almost three-quarter of women have been infected with genital HPV at some point in their lives, while 1 in 4 HIV positive pregnant women will pass HIV to their newborn child prior to or during delivery if they are not taking antiretroviral medications. Despite the fact that a vaccination for Hepatitis B exists, 12 million people (1 in 20) in the United States are infected with it. There is a 4 percent risk of transmission of Hepatitis C from mother to child right before or after birth.

Methods of Transmission

Despite the detrimental health effects from all four of these STIs, many infected people are living healthy lives that include successful intimate relationships. Living with an incurable STI is not an easy task. There are many challenges that infected people face, but infection is not a death sentence as long as people take care of themselves. The first step in overcoming these challenges is to know how these STIs are passed from one person to another. 

HBV and HCV are transmitted through the blood of an infected person and can occur during sex, when sharing needles or syringes, or through a needle stick at work, or during the birth of a baby from an infected mother. While both strains of the hepatitis virus are in the blood of infected people, transmission of HCV is very rare during sexual intercourse.

HIV is transmitted via bodily fluids from an infected person during sexual intercourse, sharing of needles or syringes, during blood transfusions (which is very rare in places where blood is screened for antibodies to HIV), or from needle sticks, as well as from mother to child before or during birth, or during breastfeeding.   
 
HPV is transmitted through contact with any part of the genital region of an infected person. The majority of the transmission is via sexual intercourse; however, any contact with the infection has the potential to spread it.

HSV is transmitted via contact with an active sore or through contact with body fluid from an infected person. There are two types of herpes: type 1 and type 2. Type 1 usually causes oral herpes, also known as cold sores. Type 2 causes genital herpes. However, both strains can result in lesions on the genitals.
 
Methods of Prevention

Since none of these STIs are curable, infected persons need to be vigilant about preventing transmission between themselves and their sexual partners. There is much overlap in the strategies for preventing the transmission of the different STIs.

Abstinence is the first and only 100 percent effective method of prevention of transmission of any STI. However, since abstinence is not a realistic option for many healthy adults, there are other options that can be utilized to reduce the chances of transmission.

Vaccinations for both Hepatitis B and HPV (for women 9-26 years old) are available and both of these vaccines are the most effective method of preventing the transmission of these viruses, after abstinence.

Symptom treatment is available in the form of antiviral medication for both herpes and HIV. Neither medication will cure the infections, but they can reduce the symptoms. The treatments can decrease the frequency of herpes outbreaks and lower the amount of HIV in the blood.

Consistent condom use is another important method of infection prevention. Condoms should be used every time sexual intercourse occurs to prevent transmission of HIV as well as HBV and HCV. Dental dams should be used during oral sex. Condoms are particularly important for couples that are both HIV positive. Unfortunately, HIV-positive couples are at risk for re-infection with HIV. This re-infection occurs when an HIV-positive person is infected again with a different strain of HIV. This can lead to problems with antibiotic resistance because the 2nd HIV infection may be resistant to medications. Therefore, HIV-positive couples need to make consistent condom use an integral part of their sex life. Condoms can also help prevent the spread of herpes and HPV, but both viruses can be passed on via physical contact and both viruses can live in areas of the genitals that aren’t protected by condoms, so condoms alone will not prevent passing on the infections.

Other transmission methods exist as well. It is important to avoid sharing needles, as well as razors or toothbrushes. All of these items may contain blood that is contaminated with HIV, HBV or HCV. There is also the possibility of infection during tattooing or body piercing if the tools are contaminated with someone else’s blood.

Avoiding outbreaks of herpes is additional strategy for transmission prevention. Many people infected with herpes can tell when an outbreak is about to occur, and sexual intercourse should be avoided both before and during an outbreak to help ensure that the virus is not passed to any sexual partners.

Dating strategies

For people infected with an incurable STI who do not have a current partner, dating provides additional challenge. Amidst the rollercoaster of emotions that encompass dating, infected people need to figure out the best time and place to tell their dates about their STI. Different people opt for different methods of sharing the information. Some people believe in being upfront and honest, and telling a potential partner right at the beginning that they have an incurable STI. The logic behind this immediate honesty is: Why spend time getting emotionally involved with someone who does not want to date a person with an incurable STI? Other people choose to wait for a while, have a few dates, and when it becomes clear that the relationship has some future potential, then talk about the STI.

Being honest about personal STI status is the best tactic an infected person can use when disclosing their status to a potential partner. While there will be people who respond negatively to the information, eventually someone who appreciates the honesty will give a relationship a chance. Along with honesty, it is important to provide information to potential partners about the STIs. Educating potential partners about the actual risks of incurable STIs can help reduce their fears and allay their concerns. Information is power—the power to know what chances they may be taking with their own health.

Pregnancy, Birth and Breastfeeding Risks

While certain STIs make maintaining a pregnancy difficult, many women with incurable STIs have safer and successful pregnancies. The first thing any couple with an STI should do when a pregnancy occurs is to talk to a doctor about how the STI can affect the pregnancy, birth and breastfeeding.

Pregnant women should consider antiviral medications if they are infected with HIV or herpes since the treatment for both may help decrease the symptoms. A doctor can explain how the treatments will affect the baby. These women should also talk to their doctor about their options for giving birth.

A cesarean section can help decrease the risk of transmission of both herpes and HIV from the mother to child. A cesarean section may be a consideration for mothers infected with HPV; however, mothers should talk with their doctors to weigh the risks of transmission versus the risks of a cesarean section. Children born to women with HBV should receive a hepatitis B immunoglobulin (for prevention of Hepatitis B transmission) and a vaccination for Hepatitis B within 12 hours of delivery. Children born to women with HCV should be tested for Hepatitis C when they are 18 months old, as there is no way to prevent transmission of HCV during birth. After the birth, breastfeeding is the next issue of concern.

If herpes sores are on any part of the breast, breastfeeding should be avoided because contact with the sores can pass herpes to the baby. If a mother chooses to pump breast milk, it is important that she ensures that the sores do not touch the parts of the pump where the milk goes. Any contact between the breast milk and areas touched by the sores could result in transmission of herpes. If a mother is HIV positive, she should not breastfeed her baby because the virus can be passed to the baby via the breast milk. Mothers should be sure to talk to their doctor about how any medications they are taking can affect their breastfeeding baby. Breastfeeding when a woman has Hepatitis B or C is not a risk. However, since HCV and HBV are in the blood, women who have cracked or bleeding nipples should also avoid breastfeeding.

Not a Death Sentence

Living with an incurable STI is not by any means a death sentence or an end to future relationships. Awareness, prevention, and education can go a long way to helping people infected with incurable STIs, who can lead healthy and safe lives and maintain intimate relationships and pregnancies.