No, I’m not clean (and you’re not either)

If you are sexually active, there’s a high chance you’ve asked or have been asked “Are you clean?” Safer sex is important so what’s wrong with asking the question?

My first issue with this question is the language. I don’t think talking about disease in terms of clean and dirty is helpful but if we are going to use that language, why do we only use it for STIs? We don’t say a person isn’t clean when they have the flu, tonsillitis or chickenpox. Why is it any different if the infection is below the belt? I find the language stigmatising and unhelpful, and I know I am certainly not the only one. Clean, to me, speaks of purity, and has some religious connotations (‘ceremonially unclean’ springs to mind). It reminds me of a more sexually repressed time, when sex was shameful, and for those reasons, I will not use it.

Some people need to get off their high horse!
Some people need to get off their high horse!

My second issue is the stigma which is attached to the question. People look down on those who aren’t “clean”, despite the fact that the majority of the “clean” people will have had or have a sexually transmitted or transmissible infection (I will explain this in a minute).

My third issue is that it leads to people not being fully risk aware. A battery of negative STI tests can lead people into a false sense of security. If both/all parties have negative STI tests, it doesn’t necessarily mean they are free from STIs. This is for several reasons:

  • Currently there is no way a person can be certain they do not have an STI unless they have never been sexually active (and even then, they may have a sexually transmissible infection).
  • There are some STIs that have no symptoms and are not tested for, some which can only be detected on certain tests during a very short period, and some which could be tested for but the NHS chooses not to.
  • If a person tests during the window period (the time between unprotected sex and the infection being detectable), they could get a false negative result.
  • STI tests only show a person is negative for the STIs they were tested for at the time of testing. If they have sex at any point after, they may no longer be negative.
  • Sexual health services often test for different things on their standard battery of tests. I’ve known clinics that only test for chlamydia and gonorrhoea as standard.

Let me give you an example of someone who would probably answer yes when asked “Are you clean?”:

Natasha has had three sexual partners. Kate was her first. They did not use barrier methods as they were both virgins. Mark was her second. They had a one night stand. They used condoms and had PIV sex. David was her third partner. Before they slept together they both got tested. Their tests were negative. They had unprotected oral and PIV sex. Although she had no symptoms, Natasha got tested after they broke up. Her tests were negative.

Despite the negative tests, Natasha has two STIs. She caught genital HSV1 (herpes) from Kate (it was passed from Kate’s mouth to Natasha’s genitals during oral sex) and genital and oral HPV from David (it was passed to her during PIV sex and oral sex, although she could also have been infected by Mark even though they used condoms). If Natasha was to meet a new partner she would be telling them she does not have any STIs when really, she just does not have any symptomatic STIs or STIs which are routinely tested for.

Natasha is not in the minority having these two infection. In fact, I hate to break it to you but, on the balance of probabilities you probably have one of these too (I do).

Herpes is incredibly common
Herpes is incredibly common

By the age of 25, 70% of people in the UK will have HSV1 and/or HSV2  but the majority of these people aren’t even aware they have it. These people are asymptomatic carriers and they are responsible for the majority of genital herpes infections. The majority of these people got HSV1 (the cold sore virus) in childhood from kissing friends and relatives, but HSV1 can be passed on to partners genitally during sex so, although cold sores are rarely a sexually transmitted infection, they are definitely a sexually transmissible infection and should be taken into account when considering safer sex practices. Although remember, if both you and your partner have the same type of herpes (even if in different locations), you can’t give them it again.

Around 80% of sexually active people will become infected with HPV at some point in their life. There are many strains of HPV. Some strains can cause genital warts and, more seriously, other strains cause cervical, anal and oropharyngeal cancers. In the UK, HPV testing is not routine. It has now been introduced as part of the cervical screening programme (smear test), but samples are only currently tested if there are abnormal cell changes. There is currently no reliable test for men, although men at high risk of having anal HPV and developing anal cancer can be offered an anal smear test.

When you look at these statistics, the idea that most people think they are “clean” seems absurd. When someone decides to have unprotected sex with another “clean” person, they are rarely thinking about these hidden STIs. Herpes is usually a minor skin condition but HPV can cause cancers. I’m not sure how we got to the point where we only care about STIs that have symptoms or can be tested for but I think we need to reevaluate.

I will fully admit that I haven’t always taken HPV seriously. The first I heard of it was when they brought out a vaccine I was too old to have. By then I was sexually active so I assumed I’d already been exposed to it and it didn’t really matter. I now realise that even if I have been exposed to some of the strains, it is still best to try avoid the others.

STI testing and talking about testing are very sensible things to do, but negative test results don’t mean there are no risks and having an STI doesn’t necessarily mean high risk. Whenever we have sex, there are always risks but by understanding the risks we can decide which ones we consider worth taking.

So no, I’m not “clean” (and you’re not either) because “clean” is a value judgement and what really matters is being risk aware.

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    • Screw Taboo
        • Screw Taboo

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