An excerpt from Seductive Delusions: How Everyday People Catch STIs.

Dear Ashley,

Your blood count and mono test did not show any signs of mononucleosis infection. Unfortunately, however, your throat swab was positive for gonorrhea. Please schedule an appointment today in urgent care so you can be treated with the appropriate shot of antibiotics. We have openings at 10:50 a.m., 11:20 a.m., and 3:30 p.m. Let us know what works best with your schedule. I will be available to answer any additional questions that you might have when you come in.

Sincerely, Dr. Belk

Ashley’s mouth dropped open in shock — and disgust. “I have gonorrhea in my throat? Are you kidding me?” Ashley involuntarily gagged at the thought. “And my friend Sabrina, who goes down on every guy she meets, has never caught a thing? This is so unfair!”

Ashley glanced at the time and started walking as fast as she could to the health center, responding to the secure message as she walked and claiming the first opening at 10:50 a.m., which was in less than ten minutes. She was trembling and felt like she was on the verge of losing control. “Please let that counselor be available today. I will definitely talk with her now,” she thought.

Very quickly Ashley was back in the same exam room as the day before. The assistant took her vital signs and assured her that the doctor would be right in. Ashley stared again at the “THIS GIRL” poster, shaking her head in disbelief. “I am ‘this girl,’” her thoughts echoed.

Dr. Belk stepped in the room and sat down. “Ashley, thank you for coming in so quickly. We are going to give you a shot of ceftriaxone, which is a cousin of penicillin, to cure your throat infection from gonorrhea. We will also follow the CDC guidelines and give you an oral antibiotic, azithromycin, in a single dose, which will completely cover you for a possible secondary infection with chlamydia. These antibiotics treat gonorrhea and chlamydia in any location on your body. I know you said you didn’t believe you had been sexually assaulted, but obviously this is a sexually transmittable infection in your throat.”

Ashley mumbled her agreement, or, at least, indicated that she was following what the doctor was saying, “Mm, hmm.”

“I can’t imagine how frightening this is for you, since you don’t have any memory of that night. I really hope you will talk with one of our counselors today. They help students every day who have had similar experiences, and I think you will find they are not only compassionate, but very knowledgeable about the medical, emotional, and legal aspects of your situation. Meanwhile, I want to encourage you to have an HIV and syphilis test, so we can complete your STI screen.”

“Oh my gosh, do you think I have HIV?,” gasped Ashley.

“No, no. But anytime someone has contracted or been exposed to one STI, they are obviously potentially at risk for any STI, so we recommend full testing,” explained Dr. Belk. “Do you have any other questions for me?”

“I’m not sure.” Ashley paused. “I guess I just want to be certain that this shot and the other medicine you’re giving me will definitely clear up anything I might have caught. Is that correct?”

“The shot and pills will cure gonorrhea and chlamydia in your throat and anywhere else in your body,”  reiterated the doctor. “The viral sexually transmitted infections include HIV, HPV, and herpes, and while I have no indication that you are infected with any of these, I do want to be clear that they are not treatable with antibiotics.”

Ashley nodded, gripping her crossed arms tightly as the doctor continued.

“Additionally, since people are understandably most concerned about HIV, please know that it is too early after your potential expo- sure last week for an HIV test to indicate a positive result. We will repeat your blood tests for both HIV and syphilis in six weeks, three months, and six months. Testing you today for HIV will hopefully confirm for us that you were not previously infected. You mentioned yesterday that you are sexually active with a long-term boyfriend. Have you both been tested for STIs?”

“No, because we were both virgins when we got together,” replied Ashley.

“And do you use condoms?”

“Again, no, because I’m on the pill, and we weren’t worried about STIs,” answered Ashley.

“For the future, I would encourage you to always use condoms, both as extra protection for birth control and as a barrier protection against STIs — even for oral sex,” noted Dr. Belk. “And of course, you should encourage your boyfriend to get tested.”

“Frankly, I don’t want to have any kind of sex in the near future,” Ashley sobbed. Dr. Belk stood up and nodded to the nurse. “Let’s get you treated now, and I will ask the counselor to come and talk with you to answer any further questions you might have.”

Ashley clenched her jaw and nodded. She had a ton of questions. Perhaps not as many for the counselor as for her friends and for that rugby guy. And for herself. What would she tell her boyfriend? Would she tell him?

Jill Grimes is a physician and author of Seductive Delusions: How Everyday People Catch STIs.

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