"Can you imagine," says Jane Collins, "being 18 years old and being told you can't go to the bar?"
The nurse manager of Saint Mary's University shakes her head. She's talking about mumps, but her words could equally apply to the sheer impossibility of "quarantining" students who have contracted a sexually transmitted infection.
The back-to-school period, Collins says, is a prime time for students to spread viruses, particularly students who are out on their own and enjoying the many nightlife amenities in Halifax for the first time.
"That first-month frenzy throws caution to the wind," she says. "With alcohol, you go out with the best intentions, but when your inhibitions are low, you're just not as likely to put on a condom. You just don't know your partner, you don't know the sexual history—you're not thinking responsibly."
Every year at SMU, Collins sees a wide variety of sexually transmitted infections. She names them off like items on a grocery list: gonorrhea, chlamydia, herpes and even a couple of cases of syphilis last year. And every year she tells another student, "It's your call," when it comes to being sexually responsible, and not spreading an infection to a new partner. Collins operates from a standpoint that is professional and instructive, but also realistic: She's well aware that students will hit the bars doggedly, and many will make their share of bad decisions.
This is exactly what happened with the mumps outbreak in the middle of March this past year. "People need to remember that after nine days, the mumps are no longer contagious," Collins says. "The reason the mumps kept spreading was because people who were quarantined went out anyway. All you can tell people is that they have to take responsibility for their health, and for other people's health. It's their call."
Sexually transmitted infections spread with a similar ease, and can often lie dormant for long periods of time. And many of the STI carriers don't get their infections in school. They bring them along—on move-in day.
"A lot of students who arrive here in Halifax have been active for four or five years," says Collins. "I've seen students coming in with HPV, hepatitis, chlamydia and even some who were born with hepatitis B and moved here. Then, these kids from smaller towns, they're flocking to the Dome and the Palace, and that's when the infections can be spread."
The most common virus Collins has seen at SMU, however, is even more seditious than syphilis or chlamydia because it can be virtually invisible, and if left unchecked, can lead to cancer. "HPV is our main concern," she says.
You've most likely read about the human papilloma virus, or HPV, through articles chronicling the proposed inoculations programs for grade six girls in Newfoundland, Prince Edward Island and Nova Scotia, starting this fall. A quick check of the American Center for Disease Control and Prevention's website, cdc.gov, reveals that not all strains of HPV are sexually transmitted, but genital HPV is transmitted as one might expect—through genital contact. And as most of us know by now, if the virus is left untreated, it can cause cervical cancer. In Nova Scotia, where cervical cancer rates are highest in the country, nurses like Collins are on the lookout. The most difficult part of HPV, she says, is that often there are no visible symptoms. "It's very difficult to treat something that's nearly invisible. Students don't realize if you have HPV or an infection like chlamydia, you don't always look sick."
HPV doesn't necessarily arise from multiple partners either—you can be with the same person for years and pass the infection on anyway. "Warts can even appear on one partner, and not the other," Collins says. But it can be managed with drugs like Gardasil, which is currently being piloted to the grade six girls. The cost, if you're not part of a government initiative, can be a bit daunting: Collins says that a single dose can cost $140. She acknowledges that for a university student already strapped for cash, drug treatment is not necessarily the best option. Common sense reigns in this case, and Collins affirms that regular Pap smears are the way to go, particularly as the virus will often first register as an abnormal Pap.
"If a woman continues coming in for testing, she'll be fine," Collins says. "You don't necessarily need to take the drug."
She says once a woman has contracted HPV, abnormal Pap cells should be checked out once every six months. Men have a more difficult time with the virus because there's no test specifically designed to detect HPV for them.
"Male students could pick up the virus and have it for years, and they'd have no idea," she says.
In the meantime, though, people are still having sex. Collins and Charlene Nelson, a nurse who works for the Halifax Sexual Health Centre, agree that people generally don't go for their check-ups until infection symptoms manifest themselves. At Nelson's workplace, patients are tested for virtually every conceivable infection, including anonymous HIV testing.
"People usually come in when there's a symptom," Nelson says. "Painful urination for men, odour, maybe a discharge and in these cases, the symptoms are showing up a few days after the encounter. So they just want to have a check." She says that chylamidia is probably the STI that shows up most often—it's easier to trace than HPV, can generally be dealt with immediately, and is often cleared up in a few days by taking a pill. "Knowing when exactly you have the HPV virus is a little different than if you're out on the weekend, had a few drinks and slept with somebody, and the symptoms of chlamydia manifest," says Nelson.
Collins says that at SMU, she sees more women than men.
"Guys will usually only come in for a checkup once something's wrong," she says.
This knowledge is a little disconcerting, particularly when one scans the burgeoning lineups outside the walls of Halifax's biggest pick-up joints. It's difficult for nurses like Collins and Nelson to pinpoint the incidence of infections when many will often hide dormant for years. The comfort is that young people with symptoms are easily treated, according to Nelson, who says she sees more appointments with people who had a wild night and just want to ensure everything's OK.
Along with the available treatment for some of the big-name STIs, Nelson says she's seen a higher incidence of sexual education and awareness during the back-to-school period than ever before. "I think some information is increasing, like during frosh week. Condoms are being handed out. People seem to be more interested in practicing safe sex."
During back-to-school time, Nelson and Collins say they are busy with students getting checkups, and women filling out birth control prescriptions and getting their Paps. In that sense, the realistic approach to sex education amongst students seems to be working.
"In the end, all we can advise students to do is to just be honest," Nelson says. "If you know you have something, talk about it once you've established trust. Either that or wait until the relationship gets stronger before things become sexual—we advise that too. Half the time people are simply too intimidated to ask about old partners, or they worry about the other person gossiping to their friends."
Of course, personal responsibility is one thing. Yet infection and illness can also come from more sinister practices, where young, inexperienced bar-goers lose that crucial sense of judgement through activities beyond their control. There is a terrifying practice that Collins has seen on the rise recently that leaves women wide open to STIs—sexual assault and drugging at nightclubs and bars. "A lot of people think having a doorman at these bars means things are safe," she says. "It's not so." Collins says she has seen a number of young female patients who spoke of being removed from bars by two or three men after being plied by a date rape drug slipped into their drinks. "For every forensic I've done—for a patient who claimed she was assaulted—40 out of 45 of them involved alcohol," she says. "It's horrifying that you could go into a bar, be assaulted, and not know who did it."
Collins says she advises all her young female patients to never let their friends out of sight if they are out in a group, and head off a bad experience before it happens, whether it's going home with the wrong person or getting too drunk to practice safe sex.
Make no mistake—these nurses do not operate under any illusions. They know young people well, and they have seen all the stupid things students do in the early days of university. Still, they continue to emphasize prevention above all else. STIs may be treatable, but it's not something you want to deal with in the first place, especially during a crucial, emotionally trying transitional period such as year one of university.
"Sure, it's fun to play and drink," Collins says. "But if you're not responsible, you pay the price."