Are STDs a Sign of Infidelity?

Couple looking serious on the bed

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It is stressful enough to discover that you have a sexually transmitted disease (STD). Finding out that you have an STD when you're married or in a long-term relationship can be especially devastating.

You not only have to deal with the diagnosis but also have to face the possibility that your wife, husband, or partner may be having an affair. It's a natural assumption and one that will almost invariably cause conflict and tears.

But, does an STD diagnosis necessarily mean that your partner has strayed, or are there other explanations that make sense?

Hidden Symptoms

Generally speaking, if you get an STD, there will be an incubation period wherein there will be little or no symptoms follow by the acute stage when outward symptoms begin to appear. The time between exposure and the appearance of symptoms can vary by the disease type:

During this period the transmission of the STD to an uninfected partner is possible even if symptoms are nil.

However, there will be cases when an STD is entirely symptomatic (without symptoms), especially in women and gay men in whom lesions or sores may be internalized. In other instances, the symptoms may be generalized or non-specific and easily mistaken for the flu.

Among the examples:

  • HIV: HIV will typically manifest with flu-like symptoms that can appear and resolve without a moment's thought that HIV is involved. During the long latency period, a person can infect others without even realizing that he or she has HIV.
  • Syphilis: There are many cases when a primary syphilis infection will develop with few if any symptoms. While transmission is unlikely during the subsequent latent phase, infectivity can suddenly re-emerge during the tertiary phase years later.
  • Genital herpes: According to a 2016 study in Clinical Microbiology Reviews, no less than 40 percent of genital herpes infections will be symptomatic. It may be years later that the characteristic lesions suddenly reactivate (along with the risk of transmission).
  • Chlamydia: Chlamydia is especially insidious given that the majority of infections will be entirely asymptomatic, according to a 2014 review from the Washington University.

In some cases, particularly with HIV and syphilis, the general "age" of the infection can be determined with lab tests. In others, it may be harder to determine if the infection was recent or something that occurred years ago.

Treatment Failure

Another possible explanation for the sudden appearance of an STD is a failed initial treatment. You may think, for example, that an infection was cleared years ago with a shot of penicillin but then be faced with the re-emergence of symptoms years later.

This can sometimes occur with syphilis. While a single intramuscular injection of Benzathine penicillin G will almost always resolve an early infection, the risk of treatment failure will increase the more advanced the infection is.

According to a 2017 study in BMJ Infectious Diseases, there is a three-fold risk of treatment failure in people with secondary syphilis compared to those with primary syphilis. And, unless the cure was confirmed with a follow-up test, people can go for years without realizing they're still infected.

The rate of treatment failure is even higher with gonorrhea. According to research from Public Health Ontario, no less than 6.77 percent of those treated will cefixime will fail due to high rates of drug resistance.

To complicate matters even further, a great many people treated for an STD fail to return for follow-up testing. This is especially true of younger men of whom 28 percent are likely to disappear after treatment, according to a 2019 study in PLoS One.

Dilemma and Considerations

If faced with an expected STD in you or your partner, the first thing you should ask yourself is whether either of you has ever had an STD screen. If not, it can be difficult to know who infected whom or when the infection actually occurred.

Rather than pointing fingers, ensure that both you and your partner are tested for not only the STD in question but any others you have may.

This includes HIV, the infection of which is often facilitated by syphilis. gonorrhea, or other STDs. This will allow both of you to find treatment.

If both are you are infected with the same STD—meaning that one of you is likely to have infected the other—you need to sit down and talk. This can be difficult.

The truth is that unless both of you were tested before you had sex, it may be impossible to know who was infected first. Even though most cases of transmission involve a recent infection, there are exceptions and you have to be open to that possibility.

To this end, the only option you really have is to trust your heart and instincts. You are the one who can decide how you want to move forward into the future.

Keep in mind that there are ways to protect yourself if you want to stay in the relationship but don't completely trust your partner. Safe sex is not a bad idea in any case. While condoms are not infallible, they can at least provide you some peace of mind.

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