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Pierre-Paul Tellier: What you need to know about STI Symptoms, Risks and Treatments

The most common sexually transmitted infections are chlamydia, gonorrhea and HPV. Dr. Pierre-Paul Tellier, Associate Professor at the Department of Family Medicine, shares why screening is critical and how prevention reduces cancer risk.
Marie Moucarry, Ms. | 20 Apr 2023

spoke with Dr. Pierre-Paul Tellier, an Associate Professor at the Department of Family Medicine, and expert in adolescent medicine . He is also a family physician at Montreal’s Clinic Medic Elle and CLSC Cote-des-Neiges where he developed the new Clinique Mauve that offers care to racialized patients, immigrants, and sexual and gender diverse individuals.

Tell me about the most common STIs, chlamydia and gonorrhea and HPV.

Dr. Tellier.: Chlamydia and gonorrhea are very similar bacterial infections that are transmitted usually through penetrative sex, depositing the bacteria within a warm environment where the bacteria flourish. HPV is a range of viruses that cause a variety of diseases. You might not realize, for example, that the wart on your finger is caused by HPV. But it’s a different kind of HPV that we’ll find in the genitals where you can develop genital warts. It’s transmitted through contact, although you don’t necessarily need to have penetration. It’s extremely common. Studies that were done at ÎÛÎÛ²ÝÝ®ÊÓƵ with the team that I’m part of have found that somewhere between 60 to 80 per cent of individuals will pick up HPV during their lifetime.

What are the symptoms?

Dr. T.: Unfortunately [for these three], which is what makes life difficult for physicians and individuals who are sexually active, is that the major symptom is no symptom. In other words, people will be carriers and will not be aware that they’re infected and will pass it on to somebody else.

Chlamydia can have symptoms that are very much like gonorrhea, but gonorrhea symptoms are more severe with their manifestation. So a common manifestation would be burning on urination, which is more intense in people with gonorrhea than it is in people with chlamydia. If you’re having oral contact, then sore throat will possibly present.
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Young women can also have an increased vaginal discharge, or unusual spotting or bleeding in between their period. The rule of thumb is that, for example, if you’re on a birth control pill and your pill is well-established, there should be no reason for bleeding in between your periods. So if you have bleeding that’s sudden, that’s unexpected, then that could be a sign — it means that you should be tested, especially if you’ve had sexual intercourse with somebody.
With HPV, you can develop genital warts [a bump or group of bumps in the genital area].

How do people develop chlamydia, gonorrhea and HPV? What are the health risks?

Dr. T.: Sexual activity is the major risk factor. If people don’t have symptoms early, that infection keeps going. With chlamydia and gonorrhea, young women can have some pain and could develop something called pelvic inflammatory disease that will give you marked pain in the area of the uterus. Upon examination by a physician, or even during intercourse, when the cervix is hit, the pain is made worse. For a young woman who has never had pain during intercourse, who suddenly has vivid pain, that’s something that needs to be checked. In young men, they’ll have the pain in the scrotum.

You need to treat these things because, especially for young women, the infection can potentially lead to long-term complications. Some women can have infection in the Fallopian tubes without realizing it, caused by chlamydia. They can develop infertility if they live with this infection for a long time and chronic pain in the abdomen. In young men, you have a similar situation in that the tubules [that transport sperm from the testicles] can be scarred. As I mentioned, chlamydia and gonorrhea are very prevalent; 20- to 25-year-olds have the highest incidence of these infections.
And with HPV, some forms are linked to development of certain cancers. So in women, cancer of the cervix and cancer of the vulva. Man can have cancer of the penis or anus.

Are there lifestyle choices that can help prevent STIs?

Dr. T.: We have to remember that a large group of people who are infected are young people. And young people are at a stage in their lives where they are trying to find a partner. That’s part of what you do when you’re in your late teens and early 20s, or even a younger teen. Within the finding a partner is the intimacy that comes with it. So if you get into a relationship and you think that you want to have sex, then talk to your partner about STIs.

I’ve had young couples who were in many ways very responsible and would come in together as a new couple to be tested before being sexually active. Not everybody works like that. And that’s the problem with online meeting sites and things of that nature is that you chit-chat with somebody and you don’t really know what they’re saying to you and whether any of it is real. Then you agree to meet somewhere and you might end up having sex and that puts you at risk because you don’t know what their status is. This can also happen in people in their 30s and older who may be dating, so it’s not only young people who need to be aware.
With HPV, the vaccine has become very important, protecting people from strains that cause cancer and some of the strains that cause genital warts. So we’ve seen a dramatic drop in genital warts. I see warts now once every few months in the genitals whereas they used to be seen daily in the clinic.
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There’s a reason why the vaccine is for school-age kids. It prevents new infection, but it doesn’t get rid of current infections. So if you’re walking around with HPV, getting a vaccine isn’t going to help you get rid of it. It will help protect against new strains, but it will not help you get rid of what you’ve picked up already.
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Screening is important. We’re looking at replacing the Pap smear with an HPV sample. And that HPV sample, much like the gonorrhea culture and chlamydia sampling, can now be done with a self-swab.
Also, make it a habit to use condoms. They work very well for protecting with penetration, but try to ask somebody whether they use condoms when they have oral sex. Without protection, you’re at risk.
So if you’re getting into a relationship, I think the thing is to ask, ‘Have you been vaccinated?’ It may not be the most romantic thing to do over a martini, but nonetheless, it is a question to ask. And if people say they have been vaccinated, then that decreases your chance of picking it up.

What about treatments?

Dr. T.: Chlamydia and gonorrhea are both bacterial. And what that means is essentially that both of them are treatable using an antibiotic. So that’s the major point, if we identify them, then we can essentially treat them and prevent transmission. With gonorrhea, the more complicated thing is that although we are developing some resistant strains with chlamydia and with gonorrhea, we’re getting to a point where we now have difficulty finding an effective antibiotic. We need to get rid of the infection. As a result, we’re using a combination of antibiotics that have to be taken over several days instead of just one pill.

Anybody who is diagnosed with gonorrhea should come back and have a followup test. The initial test is based on looking for certain particles of the bacteria that are recognized by chemical reactions. We don’t routinely do what’s called a culture. So we encourage people to come back for the second test which will be a culture sample to make sure that we have properly treated them and that they are not still carrying the infection.
And if someone has an oral infection in the throat, you would just repeat the culture of the throat much like a strep test. If it’s anal, then you take a culture. Now we’re able to use self-swab techniques for the tests that are just as effective.
For HPV, it depends on how advanced those lesions are. There’s no cure for HPV but if the genital warts don’t go away on their own, they can be removed. In women, we’re looking at the cervix with essentially a pair of binoculars that magnify the cervix, and then identifying the areas affected. Then those areas are sampled to either confirm the diagnosis or completely remove the lesion. None of these treatments ever rids the patient of the virus. So it doesn’t mean that you don’t have to continue having Pap smears. In fact, in women who’ve had these procedures, the Pap smears have to be done much more frequently. At this point, we’re doing Pap smears every three years, whereas in somebody who’s HPV positive, it will become yearly to track the HPV. In men, we can do similar testing when we’re talking about anal infection.

What’s one piece of advice for someone with chlamydia and gonorrhea? And for HPV?

Dr. T.: For chlamydia and gonorrhea, do your treatment and follow the instructions that you’ve received, and then go back and be tested to make sure you’ve gotten rid of it. And avoid having sexual contact during the time you’re being treated. Make sure that your partner has been tested and is not infected, because if you continue having sex during that period with somebody who’s infected, you can take all the antibiotics, but the infection will come back.

If you have HPV, be open about it so that your partner makes an informed decision. You can easily transmit it, and both partners are probably infected and people should be aware of that so that there’s less anxiety about it. If you discuss it and say, ‘Well, I’ve had HPV,’ that partner can choose to continue or not at that point.
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