Story by Brooke Dougherty
Graphic by Jonathan Avila Flores
The screen of Madeline’s phone lights up. It’s a notification from Duke Health: “You have a new test result.”
A month ago, she began experiencing a sore throat, a fever and painful cold sores in her mouth.
At first, her dentist thought it might be canker sores and prescribed her an antiviral medication.
When her symptoms continued, Madeline went to a walk-in clinic. She was prescribed an antibiotic.
But the prescriptions weren’t helping. Nobody seemed to have any answers and the cold sores kept getting worse.
Madeline went to her primary care physician for blood work.
When she saw the notification from Duke Health, she was nervous, and logged into her patient portal. She scanned the page for her results.
Syphilis and HIV – negative.
Hepatis C, chlamydia and gonorrhea – negative.
HSV-1 – positive.
Madeline was stunned: She had just tested positive for the herpes virus.
Now, at 26 years old, Madeline has had to navigate living with her diagnosis.
The Rise of STDs Among Young Adults
Sexually Transmitted Diseases are on the rise in North Carolina.
Since 2020, in Wake and Durham counties, positive tests for HIV and syphilis have risen at an alarming rate among people ages of 15-30.
In Wake County, syphilis cases rose 15 percent — 123 in 2020 and 144 in 2021. HIV cases rose 12 percent — 66 in 2020 and 74 in 2021.
Alonza Pamplin, the communicable disease supervisor for Wake County, said that part of this is due to a lack of education about sexually transmitted diseases.
“There used to be the Wrap It Up campaigns and a lot of commercials, you don’t see those type of things anymore,” Pamplin said.
In addition, many patients are finally getting tested after not being able to during the COVID-19 pandemic, Pamplin said. Many departments only accepted patients who were symptomatic during that time. A variety of STDs can occur without symptoms.
Chlamydia, for example, is known as the “silent” infection because “most people with the infection have no symptoms or abnormal physical exam findings.”
Syphilis is known as the “great imitator” because the symptoms can present as a genital lesion herpes outbreak.
Because of this, many people have exposed their STD to others without knowing it.
One of the other culprits to the rise of STDs among young adults is the internet. Or more specifically, dating apps.
“With social media and the internet, it’s very easy for people to meet new, anonymous partners and gain multiple partners because you just have access to people at anytime from anywhere,” Pamplin said.
Navigating the Online Dating World
Before this year, it was never top of mind for Madeline, who asked that her last name not be used, to get tested for STDs.
For the past five years, she had been in a long-term relationship.
“I was in a secure, monogamous relationship before this year, and so I never was tested. I didn’t think that I needed to be tested because of that,” Madeline said.
Everything changed when she and her partner split up in October 2021.
In the following months, she downloaded several dating apps and re-entered the dating scene.
She was faced with meeting strangers unaware of their personal sexual health and she didn’t know how to talk with them about it. It was a whole new world for her.
According to WebMD, the Herpes Simplex Viruses are categorized into two different types: herpes type 1 and herpes type 2.
Herpes type 1 is more widely known as oral herpes that presents as sores, such as fever blisters and cold sores, around the lips and mouth. Herpes type 2 can cause genital herpes.
Herpes type 1, “which is transmitted through oral sections or sores on the skin, can be spread through kissing or sharing objects such as toothbrushes or eating utensils.”
This differs from the second type, that is only spread during sexual contact with someone else who already has an outbreak.
It’s important to note that the herpes virus can go through periods of being dormant and that outbreaks can be brought on by periods of unrelated illness, stress and fatigue.
“Going from that to a new relationship with someone off of a dating app who has participated in hook-up culture, that was definitely nerve wrecking for me,” Madeline said about the awkwardness surrounding bringing up personal sexual health history with a new partner.
“I didn’t want to be off-putting.”
Local health departments are working to raise awareness on social media, combat misinformation and eliminate the stigmas that surround sexual health.
At the Durham County Department of Public Health, this STD AND STI awareness is being brought straight to the dating apps.
Dennis Hamlet, the department’s communicable disease and maternal child health program manager, said that his department is conducting various social media campaigns that target dating apps, such as Plenty of Fish, Grindr and JACK’D.
These efforts are to help combat stigma and to increase education opportunities among adolescents.
In neighboring Wake County, health leaders are working with community members to figure out how they can better reach populations who are being highest affected by STDs.
“Whether they come to us or to an outside provider, (we want them) to develop the power to advocate for themselves and find a provider they are comfortable with so these things don’t go unnoticed,” Pamplin said.
Pamplin said getting tested is the first step and the county is also working with providers to make sure that they know how to screen and treat patients for the correct diagnosis.
“We’re trying to make sure that providers know what tests to order, what to screen for, and making sure that women have access to treatment,” Pamplin said.
Rampant Misinformation Regarding Reproductive Health
A lack of access to credible resources leaves people vulnerable to misinformation. Many people don’t know the correct symptoms to look for or help perpetuate information that isn’t correct.
“You could possibly have an STD or have been exposed to one and not know that you need testing and treatment,” Pamplin said. “You may have signs and symptoms of something like lower abdominal pain and (you go to) a pediatrician not knowing that you are sexually active so it may be something that is missed.”
In Madeline’s case, it was cold sores.
Even though re-entering the dating scene prompted her to get tested and put more focus on her sexual health, Madeline said that she had experienced minor cold sore breakouts during times of stress.
It wasn’t until she called her mom to tell her about her diagnosis that she discovered that she had actually had cold sore outbreaks as a child.
Madeline’s mom told her that it may have come from her dad when he would innocently kiss her and her brother goodbye before leaving for work.
“He gave it to both me and my brother. I was genuinely shocked,” Madeline said. “It was super frustrating to find that out now. I had no idea that that was a thing.”
Fighting the Stigma and Having the Tough Conversations
Upon receiving her diagnosis, Madeline said her biggest anxiety was being open with the people around her for fear of being judged. She felt guilty.
After having tested positive, she was terrified of having to navigate telling her friends, family and current romantic partner.
What if they treated her differently?
“It’s definitely something that isn’t talked about enough,” Madeline said.
“I mean, it’s like a dirty conversation. That’s how I see it. It’s a dirty, undercover conversation you don’t want to have.”
But when Madeline began experiencing symptoms of the herpes virus, she had no choice but to be open with her partner.
“I immediately thought that they would think I was disgusting, and I also was worried about them overthinking their interactions with me,” she said.
Ultimately, Madeline said that she texted her partner a long paragraph explaining everything, but that she would recommend having the conversation in-person, instead.
Looking Back on the Testing Process
For Madeline, the process of getting tested was quick and easy.
“It’s been less than 24 hours and I already have my results back and everything from the bloodwork,” Madeline said.
“It was much easier than I thought it was going to be.”
It took time, but now Madeline said that she feels more confident when bringing up these types of conversations.
She advocates for the importance of waiting to engage with a romantic partner before clarifying that they have been routinely tested.
When asked what advice she would give to someone having to navigate the conversation around STDs, Madeline said that the best piece of advice is to be ahead of the game.
“You don’t want to be caught in a position where you have to get tested or ask someone else to get tested. Keep up with it, especially if you are engaging in hookup culture,” Madeline said.
