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The Dose Transcript for May 30, 2024

Host: Brian Goldman

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. Sexually transmitted infections are on the rise everywhere, including Canada. That's according to the World Health Organization. STIs can affect anyone who is sexually active, regardless of age or sexual orientation. And you may not know you have one because they're not always symptomatic, and having one can definitely affect your health and your fertility. So this week, we're asking, what do I need to know about sexually transmitted infections? Hi, Nolan. Welcome to The Dose.

NOLAN HILL: Thank you for having me, Brian.

BRIAN GOLDMAN: What are some of your go to ways to reduce discomfort that clients may have talking about sexually transmitted infections?

NOLAN HILL: I think the biggest thing is just normalizing that they're an infection just like anything else. So think of it like a common cold, the flu, something you might get from, you know, touching a doorknob. Just because we're talking about sex doesn't mean we have to be all uncomfortable about it, and think about it just as any other infection that you might get in the day to day life that you live.

BRIAN GOLDMAN: I love your answer, normalizing it. That is exactly why we are doing this episode of The Dose, so can't wait to get into it. But before we begin, can you give us a hi, my name is? Tell us what you do and where you do it.

NOLAN HILL: Hi, my name is Nolan Hill. I use him pronouns. I'm a training centre facilitator at the Centre for Sexuality here in Calgary, Alberta. We're a non-profit organization dedicated to healthy sexuality for all.

BRIAN GOLDMAN: What is a sexually transmitted infection or STI?

NOLAN HILL: Yeah. So sexually transmitted infections are simply infections. So those are, you know, medical health concerns caused by little organisms, whether they're bacteria, viruses or parasites. And they can be passed on between people typically through sexual contact.

BRIAN GOLDMAN: I can remember when we used to call them STDs, sexually transmitted diseases, but we don't call them that anymore because disease implies that you have symptoms. And you can certainly be infected without having symptoms, right?

NOLAN HILL: Exactly. Yes. And we see an evolution of language all the time. And I know that we often talk about STIs pretty commonly. And now we're even shifting the language into STBBIs or sexually transmitted and bloodborne infections, just recognizing that some of these infections that we're talking about can also be passed on through bloodborne transmission that actually has nothing to do with sex at all, even though they're still in the same category of infection. So language is always evolving and something to be paying attention to.

BRIAN GOLDMAN: What are the different ways that sexually transmitted infections can be spread?

NOLAN HILL: Yeah. So when I think about STBBIs or STIs, we're thinking about sexual transmission typically through exchange of bodily fluids. So those are things like semen, vaginal fluids, anal fluids as well as blood that can be passed on between people through different body openings. So typically, you want to think about a body fluid plus a body opening means that there's a possibility of transmission occurring. And those typically are the warm, dark and moist places of our bodies that are used during sexual contact. So things like the urethra, the vagina, the rectum, as well as the back of the throat. And we also can think about when people are having sexual contact, that these infections, some of them can also pass on through skin to skin contact. It's not bumping up against someone in an elevator and that somehow, an STI is going to pass on through that. It's really about that direct skin to skin contact that is made when people are having sexual activity.

BRIAN GOLDMAN: What are some of the infections that can be spread by skin to skin contact?

NOLAN HILL: Typically, we're going to think about things like human papillomavirus or HPV, herpes, both types one and two, as well as syphilis.

BRIAN GOLDMAN: Let's talk first about symptoms, because that's one way of knowing that you have one or might have one. What are some of the most common symptoms? You know, I realize that it depends on where you're infected and how, but what are some of the common symptoms that people are going to notice?

NOLAN HILL: Typically, when we're talking about STBBIs, the most common symptom is no symptom at all. So the number of people who have symptoms is actually relatively low, and we're often dealing with folks who won't have any symptoms at all. But if someone does develop symptoms in that less common case, we're usually talking about things that are a difference from normal. So most people know their bodies pretty well, so they know what their bodies, such as their genitals, look like if they can see them on a day to day basis, but also what things feel like. So any sort of absence of things like a burning sensation or swelling or pain or anything like that, and then visually looking if there's anything different. So new lumps, bumps, sores or any changes to the size, shape of things, particularly in the genital area. So if people develop something that is different from their normal, that's typically a sign or a symptom that could be linked to an STBBI. So that's a really good time to seek out some testing or some medical attention.

BRIAN GOLDMAN: And obviously, if people have symptoms, a new sore, new pain, maybe some constitutional symptoms like fever, burning on urination, those kinds of things are burning in their throat, that's going to be a trigger for them to seek medical attention. Now, I know it depends on the STI or STBBI, as you called it, but how often, roughly speaking, do people have an infection without symptoms?

NOLAN HILL: I don’t have the exact number off the top of my head, but I know that for a number of people, they're most likely going to get diagnosed when they're doing more routine screening. And that's why we talk about routine testing as so important, because if we relied on people to get tested only if something developed into pain or something that was different from their normal, we'd often have people not detecting these infections early, which can lead to problems with things like fertility and other sort of issues down the road, as well as that continued onward transmission to sexual partners.

BRIAN GOLDMAN: So walk us through the process of getting tested. What does that involve?

NOLAN HILL: So testing is a pretty routine procedure that lots of people do and has a lot of sort of myth and mystery around it, but it's quite an easy and straightforward procedure. Typically, when people are getting tested for STBBIs, they're going to have to talk with their medical provider, whether a nurse or doctor, to talk about their sexual behaviour and get a bit of a sexual health history, just to make sure that the provider knows what types of tests to order. The full panel of testing typically will include things like a urine sample for most people, depending on the type of sex they've had, as well as things like swab. So that could be a virginal swab, a rectal swab and or a throat swab, again, all depending on the types of sex that people are having, whether they're receiving or performing the sexual activity. And all of those tests for swabs and urine will be testing for things like chlamydia and gonorrhoea. Then we also have things like a blood test. So a small amount of blood is drawn from the arm. And that will test for things like syphilis, HIV and hepatitis A, B and C. Now, in addition to those routine tests, there are some other tests that can be done typically only if people have those signs or those symptoms. So things like a new sore might be swabbed directly off of the sore to test for things like herpes, as well as it can test for syphilis in some cases. And really, those tests only are performed if someone has a new sign or symptom that's developed. But typically, all those tests can be done in one visit. They'll send those off to the lab. The lab will test those samples and report the results back to the provider, who can then report those results and tell someone whether or not any of the results came back positive or reactive for certain infections. And if they are positive or reactive, they can look at getting them connected with any treatment or supports that that person might need.

BRIAN GOLDMAN: Now, regarding the people who seek testing because they've had a sexual encounter and they want to know if they've been infected, the timing of the testing is different for the different infections, am I right?

NOLAN HILL: Exactly. And what you're talking about, yeah, is that window period that some people will be familiar with. They might Google and try to learn about these things and come up with a term called window period. And that's the time between someone is potentially exposed to an infection and the time that someone's results will come back accurately. And that can vary quite greatly between the different infections, as short as, you know, two to seven days for some infections, all the way up to, you know, three months and even longer for some infections. Typically, that's why that conversation with the health care provider is going to be so important to determine if someone will need to come back for retesting. If someone came maybe one month after a sexual encounter that they had some concerns about, there may be a recommendation or an ask of that health care provider to the patient or the client to come back for testing at the three month mark, just to rule out any of those window period infections that might be missed. And that's why we're also often talking about routine testing for folks. So typically, if folks are testing routinely, that kind of captures the majority of infections within those window periods, but then also can catch any that might be just outside of that window period, let's say a six month period, or sometimes even up to a year for some infections.

BRIAN GOLDMAN: There are people who should get tested, you know, on a one off basis, and there are people who should have routine testing. So let's start with people in the general population who should know that it's time that they should be tested. You know, what are some of the indications for coming in and getting tested, regardless of whether or not they have symptoms?

NOLAN HILL: Typically, if someone is sexually active in maybe a monogamous relationship that they aren't maybe having any concerns or worries about, we’ll typically say even to test once a year just to get everything, get a negative result panel for all infections just to be sure. So within that sort of one year period for sort of the general population of folks who are sexually active. Some folks also do choose to test in between sexual partners. So they might only have two sexual partners in a year. And after their first partner, they wait a few weeks or a couple months, get tested before they have sex with another person. But typically, within that one year period, for the general population, getting tested at least once, even without, you know, signs or symptoms, is a usually pretty good indication.

BRIAN GOLDMAN: And I'm willing to bet that if we did a population study right now, a survey, we would find that a very small percentage of the population actually follows that guideline.

NOLAN HILL: That is probably correct. We know that access to STBBI testing can be a challenge depending on where people live, depending on the hours that are available for accessing health care. But we know that a lot of people aren't getting tested regularly, which is why we sort of advocate and talk a lot about that. Even if people don't have signs and symptoms, just add it on to maybe get an annual check-up with a family physician, or make a visit to a sexual health clinic at least at that once a year mark.

BRIAN GOLDMAN: What about more high risk individuals? How often should they be tested and who are we talking about?

NOLAN HILL: It really depends on every individual’s circumstance, but typically, we're talking about folks who may have multiple partners, anonymous partners or partners whose status is opposite or unknown to their own. And with those individuals, regardless of their age, gender, sexual orientation or background, there may be a recommendation from health care providers or a plan set up to test people a little bit more frequently. So that can be every three to six months. For some people, it's every month, depending on a number of factors and really a conversation with their health care provider. To give them the sort of best outcomes for taking care of their health, really, is making sure they're tested at those routine intervals to potentially detect those infections and make sure that people's health is really taken care of so that if they are detected, every infection that we're talking about here is either treatable or curable, so that we can get people connected with those resources to help treat and or cure those infections.

BRIAN GOLDMAN: So we're going to talk about the treatment of sexually transmitted infections, STBBIs, and how to prevent them. Let's start with prevention. How do you prevent them?

NOLAN HILL: So when it comes to prevention, I like to think of the three Bs is how I talk about them. So those stand for barriers, biomedical tools and behavioural interventions. I'll start with barriers. Those are some of the most commonplace things that people think of when it comes to preventing STBBIs. And that's things like condoms, both external and internal condoms, as well as dental dams. And what those tools do, all three of them create a physical barrier, just as it sounds, between a body fluid coming into contact with a body opening. And it can also prevent some of that skin to skin transmission that I talked about as well. These are super common, super accessible in most cases. People can buy them. People can pick them up for free from organizations, from sexual health clinics, and they are used again to prevent those fluids from exchanging between individuals. And with barriers, I think the biggest thing is that they're only as good as the people who use them, and for lack of a better term, in the sense of they can slip, they can break. Sometimes, people forget to use them. So they are not without their faults, but they are incredibly effective at doing what they do. When it comes to biomedical tools, we also have things like HIV PREP, pre-exposure prophylaxis, as well as PEP or post-exposure prophylaxis. We have things like vaccinations for some infections. Like the HPV vaccine is quite commonly advertised, but also things like hepatitis A and B. And we also have treatment for infections. So that just means treating infections using the medicines that we have to treat them, to either cure them or manage them to reduce the possibilities of them being passed on. And finally, when it comes to behavioural interventions, those are different tools that people can use or make different decisions about their sexual behaviour to prevent those infections. That could be changing the types of sex they have with different partners, to choose different activities that might carry lower chances of passing on an infection. But it could also mean things like abstinence. For some people, that's a choice that they make. Sometimes, it's a short term choice, sometimes, it's a longer term choice, but it is an option that people do have because it's really the most foolproof way to prevent an infection would be to not have sex. But we know that for lots of people, they're wanting to have sex, so they're often making maybe other choices or using some of those other tools that I mentioned to prevent STBBIs.

BRIAN GOLDMAN: You know, it's interesting when you mentioned the biomedical interventions, all of them are used to prevent viral infections. For instance, PEP or PREP is using antiretroviral HIV medications to prevent individuals from being infected with HIV. That's a virus. Vaccines are used for HPV, for instance. Hepatitis B, hepatitis A, those are viruses. And for the treatment of herpes, that's drugs like Zovirax and Valacyclovir.

NOLAN HILL: Yeah, absolutely. And as things have evolved, I think we're also seeing new interventions that are coming up. I know that there's one that's being talked about a lot in sort of the sexual health research community is doxycycline PEP and doxycycline PREP, which is still sort of coming up in the research world, and there's still some studies being used to find out exactly how effective it is at preventing things like syphilis. But we are seeing some of those biomedical tools even expanding beyond those viral infections, which is pretty cool as well.

BRIAN GOLDMAN: So that's prevention. Three interventions with three Bs, which I'm not going to forget, thanks to you. Let's talk about how STIs are treated in the here and now.

NOLAN HILL: So as I mentioned, any infection that we're talking about when it comes to STBBIs is either treatable or manageable or curable. So for things like chlamydia, gonorrhoea, syphilis, the bacterial infections that are quite common and often on the rise, we have antibiotics that can be used to cure the infection that clears it from the body. For some of the viral infections, there can be treatments that can also help get rid of that infection in the body, including the hepatitis. For other infections, particularly in the viral field, we're often dealing with management or treatment to manage. So that's things like herpes. Herpes is not a curable infection, but we have different tools, including medical interventions like the medications that you mentioned to treat herpes, which can help prevent it from being transmitted, and also manage the impact of that infection on the individual. For things like HIV, we also have highly active antiretroviral treatment, which is used to manage the amount of HIV in someone's body. And that both benefits the person living with HIV, and it helps make sure that their immune system is functioning and that person is healthy. But it also has the added benefit of something called u equals u or undetectable equals untransmittable, which means when someone is HIV positive or living with HIV and they maintain an undetectable viral load just as the amount of HIV in their bloodstream. When someone is undetectable, they actually can't pass that on to their sexual partners. And that has been a huge game changer in the STBBI world in the last maybe decade or so.

BRIAN GOLDMAN: Suppose you fear that you might have a sexually transmitted infection but don't want to go to your regular health care provider, does that ever happen? What should you do?

NOLAN HILL: Absolutely. I think there's a lot of stigma and a lot of fear about talking about sexual health and STBBIs with health care providers, especially if they are regular health care providers. They might not know certain aspects of our life. We might not feel comfortable discussing all the things that we might want to with them. And in those cases, we’re often looking at the more specialized sexual health clinics that might exist in different communities. So for example, here in Calgary, we have the STI clinic, which is just exactly what it sounds like. It's a clinic dedicated to testing, treatment and management of STIs. But we also have other clinics that specialize in sexual and reproductive health broadly for young people. There are community based clinics. People can even just go to a walk in doctor to maybe get a requisition. So they're seeing a different health care provider who can provide them with the requisition to go to a lab. And then that doesn't necessarily have to mean talking to their family doctor about their sexual health.

BRIAN GOLDMAN: Last question I want to ask you. Whose job is it to disclose the existence of a sexually transmitted infection to sexual partners?

NOLAN HILL: When it comes to someone being diagnosed with an STBBI, in many jurisdictions, there are teams of health care providers who can help connect with previous sexual partners to say, hey, someone has named you as a contact. It would be a good idea to maybe access some testing. We can get you treated. We can get you the support that you need. But it's also about those tools that people can have to have those conversations with their partners as well as individuals. In some cases, particularly for HIV, as it currently stands, there are some requirements to disclose HIV status prior to sexual contact, and that has very specific implications in that setting. But for others, there's not necessarily a maybe legal requirement, but it's ultimately just about maintaining those healthy relationships between people where folks can have those open conversations with partners to say, hey, I recently got tested and this came back positive. It was important for me to let you know so that you can take care of your own health. So we have sort of multiple tools that we can use, including our public health system, which can reach out on people's behalf. But it's also great if people can have those conversations with their partners and have those really open and healthy relationship conversations with each other.

BRIAN GOLDMAN: Well, Nolan Hill, you have certainly normalized the conversation around a very important subject, and I want to thank you for coming on The Dose to talk about STBBIs.

NOLAN HILL: Thank you so much for having me, Brian.

BRIAN GOLDMAN: Nolan Hill is a training centre facilitator with the Centre for Sexuality in Calgary. Here’s your dose of smart advice. STIs are very common. The newer name is STBBI, which stands for sexually transmitted and bloodborne infection. More than 30 kinds of bacteria, viruses and parasites cause STBBIs, but the majority can be chalked up to syphilis, gonorrhoea, chlamydia, trichomonas and viruses, hepatitis, HPV, HIV and herpes. At least seven out of every 10 sexually active adults in Canada have been infected with human papillomavirus or HPV. More than 100,000 cases of chlamydia are reported each year in Canada, and as many as one in seven Canadians age 14 to 59 May be infected with herpes virus. Those figures are from the Public Health Agency of Canada. STBBIs are transmitted through oral, vaginal and anal sex. Some are transmitted through skin to skin contact, some through sharing of blood contaminated needles, and some are transmitted from mother to child during pregnancy, childbirth and breastfeeding. STBBIs may cause symptoms that depend on the type and location of infection, but it's most common to have no symptoms. If you think you might have been infected, do not wait until you get symptoms. See a health care provider right away because you may need to start treatment before testing confirms you've been infected. In fact, testing may come after you've been treated. For gonorrhea, results are most accurate seven days after sex. For chlamydia, it's two weeks after sex. For HIV, results are 95% accurate six weeks after sex, but are most accurate after three months. In general, it's recommended that you get tested every time you switch partners. If you've been with the same partner for a long time, consider getting tested once a year. Those who engage in high risk sex with multiple partners should get tested more frequently. STBBIs are largely preventable. Condoms should be used in all vaginal and anal sex. Keep in mind that condoms do not protect from STIs like syphilis and genital herpes that cause skin ulcers that aren't on the genitals. Safe and highly effective vaccines are available for hepatitis A, B and HPV. HIV can be largely prevented through pre or post-exposure prophylaxis, PEP or PREP. Several vaccines are in early stage trials that may protect against genital herpes. Studies are also underway to see if bacterial infections like gonorrhoea and chlamydia can be prevented by taking antibiotics before or after sex. Left untreated, sexually transmitted infections can affect fertility and increase the risk of serious complications, including cancer. The stigma surrounding these infections is real. Talking openly with a health care provider can save many people a lot of potential harm. If you have topics you'd like discussed or questions answered, our email address is thedose@cbc.ca. If you liked this episode, please give us a rating and review wherever you listen. This edition of The Dose was produced by Sameer Chhabra and Isabelle Gallant. Our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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What do I need to know about sexually transmitted infections? - Transcript

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