July 1, 2026 • 29 mins
HPV is one of the most common sexually transmitted infections in the world, yet many people know surprisingly little about it. This week, Hari and Dr. Priyanka break down how HPV spreads, why most sexually active adults will encounter it at some point, and the differences between low-risk and high-risk strains. They discuss the link between HPV and cervical, throat, and other cancers, the importance of screening and vaccination, and why reducing stigma around sexual health leads to better outcomes for everyone.
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Speaker 1 (00:00):
This podcast is for information purposes only and should not
be considered professional medical advice. Almost all cases of cervical cancer,
as far as we know, are caused by high risk HPB.
Speaker 2 (00:14):
She got into the science of it, but she never
explained sex.
Speaker 1 (00:18):
You're probably going to have a better time with this
person if you trust them.
Speaker 3 (00:26):
I'm Hurrycandibolu, I'm doctor pre uncle Wally, and.
Speaker 2 (00:29):
This is health stuff.
Speaker 1 (00:33):
We were just talking before we started recording about I'm
a little sleep deprived just because childcare man. So we
just had a phrenectomy procedure and frizzle listeners. It's where
if you have a mouth tie, like a tongue tie,
you get a procedure to kind of cut the fashion
and the tongue. And so it was really really intense
(00:56):
to see my little one go under this procede as
a parent and just pray that everything comes out okay,
and fortunately everything did.
Speaker 3 (01:06):
But it's so vulnerable. They're so vulnerable.
Speaker 1 (01:10):
You know.
Speaker 2 (01:11):
I couldn't because my kid had a tongue tayetoo and
I wasn't there when they clipped it. Just that I
wouldn't be able to handle that. Like he got stitches
when he was I think when he was three, he
had a pretty bad cut, three or four, and I
was holding his hand while they were putting the stitches in.
But part of me is like, I'm holding your hand
because I need to hold someone's hand. Yeah, as much
(01:34):
as this is for you, I'm freaked out of my
mind seeing your hand open like this and them having
to stitch you up.
Speaker 3 (01:41):
So I know, it's like, who's the patient here?
Speaker 2 (01:45):
You know what I mean.
Speaker 1 (01:46):
And even as a medical provider, you think that I
know what's going on or I have a sense, but
you can't escape the vulnerability. Like I feel just as helpless,
you know, in those situations. And if anything, because I
know more, it makes me more anxious because there's more
things that I am thinking could potentially be an issue.
Speaker 2 (02:08):
And so.
Speaker 1 (02:09):
Parenting, man, parenting is hard. It's like the it's the
hardest thing I've ever done. Yeah, I've done like a
lot of pretty hard things.
Speaker 2 (02:18):
And you're still you're still early days.
Speaker 3 (02:21):
I know, I know. Tell me it gets.
Speaker 2 (02:23):
Better, It'll get better. It'll get better.
Speaker 3 (02:26):
That's good to know.
Speaker 2 (02:27):
I mean, they new problems arise.
Speaker 1 (02:32):
Yeah, like I guess, uh, eventually, you're gonna have to
have the talk with your son. And that sort of
is a segue to another sexual health episode here on
health stole. Oh you're talking about the talk, Yeah, like
the talk, right, Like eventually you're gonna have to have
the talk, right.
Speaker 2 (02:50):
I mean, my parents never gave me the formal talk.
My mom only talked about sperms and eggs, and I
had no idea how they got there and how it worked.
She got into the science of it, but she never
explained sex.
Speaker 1 (03:03):
Totally same experience here. My talk was do not get pregnant?
Speaker 3 (03:10):
That was it? Like no, no.
Speaker 1 (03:12):
Like how does that work or anything like that. So
I'll be honest, I learned the most about STDs as
a medical student in med school. I remember opening the
books and learning all about contraception, and I remember turning
to a friend and being like, I didn't know any
(03:33):
of this, like they did. They don't teach you this,
Like there's like a laundry list of contraceptives that you
can use. Everyone just has used condoms, but no one
talks about there's so many other alternatives out there that
that you can choose from. So and then, of course
learning about STDs prior to medical school, whatever I learned
(03:54):
about STDs was you know, in elementary school, they would
put us in a classroom room and then show us
photos of basically the worst possible STDs you can ever imagine,
and then they just tell us like, this is what
happens when you have sex, and it just scared the
crap out of me basically, you know.
Speaker 2 (04:15):
Yeah, showing images of people that are completely untreated, like
what likely would not happen, like end.
Speaker 1 (04:22):
Stage versions of these diseases, you know, like someone they
have like a cauliflower like growing out of their genitals.
You know, It's like something I've never seen in like
fifteen plus years of practice, you know what I mean.
I mean it was a very effective campaign, but it
was so unrealistic about just the reality of things.
Speaker 2 (04:42):
Yeah, because people still are having sex and having children
and life is continuing. So clearly that's not the most
effective way to talk about it exactly.
Speaker 1 (04:51):
And that's why today's topic, which is HPV or human
Peppelloma virus, it's one of the STDs that I think
is important that we talk about because it's not only
is it super super common, it's super super contagious because
you can get it super easily. I can remember I
mean at one point this is I think back when
(05:14):
I was a resident many many years ago. I remember
being told I had HPV, and I remember being like
completely in shock around it, especially because like there were
only like I knew exactly where I got it from
as well and who and that person sucks and they
(05:37):
still suck to day. But I remember just feeling so
many different kinds of emotions around just wow, I can't
believe that this is happening. Later you learn it's actually
incredibly common, and fortunately it can clear on its own,
and fortunately that was my case.
Speaker 3 (05:56):
It dead clear on its own.
Speaker 1 (05:57):
But a lot of people don't know that they have
the virus even though they have it because it doesn't
necessarily cause symptoms, and then you can't test it in men.
Speaker 2 (06:06):
And there's so many strands of the virus too, so
it's not just a simple like you have HBV. There's
so many different types that have different impacts on the body,
and some that are easier to clear than others.
Speaker 1 (06:19):
Right, absolutely, there's some that are high risks, some that
are low risks. There's yeah, tons and tons of different
strains and they can cause no symptoms, they can cause
genital symptoms, they can cause even symptoms on your fingers,
believe it or not, like orts and stuff. So we'll
get into all of that and hopefully to our listeners
demystify what is HPV and all the things you need
(06:40):
to learn about it.
Speaker 2 (06:42):
Can we talk about the difference between STDs and STIs
because you know, growing up, STD was the term that
I think a lot of us heard, and that at
some point STI was introduced and I was a little confused.
STI is less stigmatized. Is that the reason we're using
that or is there an actual difference?
Speaker 1 (07:00):
So an STI stands for sexually transmitted infection, So this
is when there's a virus or bacteria or a parasite
and it's present in the body. Now, an STD is
a sexually transmitted disease, So this happens when the infection
(07:21):
or the STI is causing symptoms or harm to parts
of your body and it's leading to some sort of ailment.
So a lot of STIs never get to the STD,
the disease stage. A lot of people may not even
know that they have an STI. And again, you're right,
(07:44):
like they use the terms interchangeably, but really the reason
we've started using the term STI was to reduce the
stigma because not all infections cause disease, right.
Speaker 2 (07:57):
Kind of like HIV and AIDS.
Speaker 1 (08:00):
HIV is the infection and AIDS is the disease. Yeah,
But with HPV, many people have the STI, they have HPV,
but they may not have disease from the HPV. That
being said, it's important to talk about HPV because it
can cause some serious diseases, which we'll get into in
(08:21):
a minute now.
Speaker 2 (08:23):
Because it's a virus, HPV can't be cured, is that right, right?
Speaker 1 (08:27):
Right?
Speaker 3 (08:27):
Antibiotics are for bacterial infections.
Speaker 2 (08:30):
Yeah, And more than ninety percent of all new HPV
infections become undetectable within two years, even without treatment. Some
last longer and can lead to complications. But there is
that possibility, a high likelihood that you'll have it and
it'll pass through the system.
Speaker 1 (08:45):
Right Exactly, You may not even know that you had
it and it passed because you would have to, like
in the case of female bodies or people with cervixes,
you would have to get tested for that, right. So
unless you get tested, you won't know, which is the
dilemma with men because they can't test right now.
Speaker 2 (09:05):
There's no way for men to be tested, or it's
just not there's.
Speaker 3 (09:08):
No way right now.
Speaker 1 (09:09):
The only way is if a man and actually I
know someone, this is actually someone I know, if a
man develops let's say throat cancer, right, and then you
culture the throat cancer and you can test the tumor
cells for HPV, and then it comes back positive, then
(09:30):
you know they have HPV.
Speaker 2 (09:35):
More to come on health stuff. I feel like part
of the stigma with HPV too, is that it's seen
as a female illness, a female STI because it has
greater impacts on women because of cervical cancer and you know,
(09:55):
penile cancer, as we're going to discuss later, is also
a potential resis result of HPV, but it's less likely
and as a result, I think there's a degree of
sexism when we talk about HBV and why it's not
given more priority, even though the majority of cases of
cervical cancer are caused by HPV. Is that right?
Speaker 1 (10:14):
Yes, Basically, almost all cases of cervical cancer as far
as we know, are caused by high risk HPV.
Speaker 2 (10:21):
I just can't imagine if this was something that was
focused on men, if it was like ninety percent of
penile cancer is caused by HPV and that's how you
get it. Like, no way, there isn't a big campaign
around it, right, I just can't imagine it.
Speaker 1 (10:36):
Yeah, And you know, it's really unfair that there's so
much shame associated with STIs and STDs because to your point, right,
like women can only get tested, women get affected by
it with cervical cancer. So it's like this default that
the shame just automatically goes to women, as if women
(10:59):
in our society like don't already have enough things to
deal with, right, Yeah. Yeah, So here's the thing though,
Like literally it's estimated that nearly all sexually active people,
all sexually active people will contract HPV at some point,
and that includes both genders. And this is not to
(11:21):
say this point because then if you're thinking, well, if
we're all going to get it, what's the point in
even caring if we have it? No, Like, this doesn't
mean that we shouldn't prevent the spread. It's very important
to prevent the spread and to take precautions and then
if you have it, to get extra screening to prevent
you don't develop any diseases as a result of it.
(11:42):
But I also want to demystify that it's extremely common.
Speaker 2 (11:47):
Yeah, well, it's part of that is because of how
easily it spreads right from skin to skin contact easily
through vaginal anal or oral sex or without penetration. So
condoms can be helpful, but there's still skin to skin
contact even when you're wearing condoms, so you could still
be transferred to that, right, Yeah.
Speaker 1 (12:06):
I mean basically, if you just mess around, you could
get it, you know, and it's like it happens, it's okay.
And the other catch is that it's not like you
could develop symptoms. Seventeen to ninety percent of infections have
no symptoms, and you can have multiple strains at once
(12:26):
and still get reinfected. And the thing is you might
not even know you had it, and then you clear
it on your own within one to two years.
Speaker 2 (12:35):
There are over two hundred types of HPV, with over
forty affecting the general area. What about the rest of them?
What are they?
Speaker 1 (12:44):
Yeah, so there are other low risk types that can
cause genital warts. Usually when you get tested, they'll give
you a number of which HPV number it is, So
number six and eleven cause majority of genital warts, but
the ones linked to cancers are the number sixteen and eighteen.
Like HPV sixteen causes seventy percent of cervical cancers alone.
(13:08):
And then the other types of cancers that high risk
HPV can cause are anal cancer, penile cancer, vaginal cancer,
vulver and throat cancer. And speaking of throw cancer, who's
that guy married to Catherine Zita Jones?
Speaker 3 (13:22):
He had throw cancer? Yeah, Michael, So that's like a.
Speaker 1 (13:24):
Really famous example, right, Michael Douglas had throat cancer. I
remember I used to work in the small group private
practice and one of my colleagues ended up getting throw
cancer and HPV positive, and he went through the chemo
and radiation and everything, and he survived it and came
(13:45):
back to work. And then one day he was on
his way to work and he just got hit by
a car and.
Speaker 3 (13:52):
Died in staring.
Speaker 2 (13:53):
Oh my god.
Speaker 3 (13:54):
Yeah, And it.
Speaker 1 (13:54):
Was just like crazy to me because he spent all
this time like successfully battling throw cancer and then it
was just like someone who took a bad left turn
that ended up like God, yeah, So life is really
weird like that, I guess.
Speaker 2 (14:08):
I mean with Michael Douglas, the joke was that he
liked oral sex too much heaving oral sex. Now, is
that is that even true that you can get throat
cancer through oral sex or is that like an urban.
Speaker 3 (14:21):
Myth It could happen.
Speaker 1 (14:22):
Yeah, because again that's enough to spread HPV. So if
he if he went down on someone who was HPV
positive with the high risk version, yeah, that could have
that could have been it. And so we don't know,
like if it was Catherine or a prior partner. Wow,
if you know your HPV positive, I think it's really
(14:43):
important that you let your partner know because then they
can make an informed choice about what they want to do.
That's the right thing to do, even though it's still
very spreadable and all that stuff, I think it's really
important to share that information. Now, if you're a woman
and you get a papsmerror, generally when they do the paps,
(15:03):
they will tell you if you have HPV because they
can screen for it at the same time, and when
they tell you you have HPV, if you're positive, they'll
screen for what numbers and they can tell you if
you have high risk version or non high.
Speaker 2 (15:20):
Risk HPV, like we were saying, can linger silently in
the body for decades. So even though like the vast
majority does go through your system and it kind of
passes through. It could also stay there for quite some time.
It can lead to cell changes dysplasia that may become
cancer over time. It can cause cervical cancer, but it
(15:42):
can also take ten to fifteen years to develop. HPV
is responsible for nearly all cervical cancers, over ninety percent
of anal cancers, and the majority of several other genital cancers.
Oral HPV is now linked to sixty to seventy percent
of throat cancers in the US.
Speaker 3 (15:59):
Yeah.
Speaker 1 (16:00):
Now, this is why, at least for cervical cancer, getting
screened is so important, because cervical cancer is one of
those types of cancers where if you get diagnosed early,
you can take measures to eradicate the cancer. Throw cancer
is tricky because by the time someone presents with throw cancers,
(16:24):
they might have had symptoms for a while that are
really you know, you would shrug it off, like, oh, yeah,
my voice was hoarse, or my throat was sore, or
I was you know, sometimes I would have trouble swallowing,
but I just thought it was you know, because of
the weather, I had acid reflex or something like that,
you know, and it's very subtle, and then by the
(16:45):
time it presents it might be a little bit more advanced.
But that's not to say that you can't do anything.
It is very treatable, especially if found quite early.
Speaker 2 (16:57):
So let's say you had like a sore throat and
it's not STRAP, it could be HPV.
Speaker 3 (17:05):
Yeah.
Speaker 1 (17:05):
So let's say you have a sore throat and you
got treated for STRAP but it didn't go away, or
you kept trying all these treatments and it's not going away.
That would be a great reason to go see your doctor,
ask for a referral to see your nose and throat specialists.
They would probably want to take a look inside and
see are the cells looking different? Is there any concern
(17:29):
for that? And if not, they could still put you
on like a watch list or something where they can
monitor you on a regular basis. Well, yeah, we will
see you right after this break. So, I mean, the
point here is not to scare the crap out of people,
(17:51):
because I think it's important that we talk about preventing HPV.
There might be some listeners here who are on the
younger side, like you know, less than twenty six, and
they've been talked to about the vaccine and all of that.
So let's talk about preventing HPV.
Speaker 2 (18:09):
So condoms are still important, but they can't completely eliminate
the risk. PAP smears detect abnormal cervical cells, including high
risk HPV strains. So with pap smears, that's not preventedive
at that point, right, because at that point it would
just let you know whether you have it or not.
Is that right?
Speaker 1 (18:27):
Yes, yes, and you would be in sort of like
a I'm going to be screened more frequently track, got you.
Speaker 3 (18:33):
Yeah, But you.
Speaker 1 (18:35):
Know, here's the thing, right, like, even if let's say
you haven't had a new partner, you don't have symptoms,
maybe you aren't even sexually active, or you haven't been
for a very long time, even years, it's still really
important to stay up to date with your pap smears
because that is what's going to prevent cervical cancer. And
(18:59):
if you have a pap smear and it comes back
up normal, there's a couple of different options. So again,
like how when years ago when I found out at
HBB and it was through a pap smear, and the
doctor was like, you know, just will repeat it in
a year, and will We'll like see if it goes away. Basically,
(19:21):
so sometimes waiting is an option, especially if the strains
are not high risk, because they can clear on their own.
But sometimes you have to look a little bit closer
than what a pap smear shows, and that's a procedure
called a colposcopy, which is basically they take a really
(19:42):
really ten ten tiny biopsy of the tissue to see
are there changes in the cells already that are concerning
for cancer. And sometimes if that colposcopy procedure shows that yes,
there are cellular changes that are concerning and this is
a high restraint of HPV, the next step would be
(20:04):
doing a procedure called a leap procedure, where they basically
just take those cells out of the cervix, which is
a fantastic way of catching and effectively eliminating one's risk
of cancer with a simple leap procedure, which I know
can probably sound scary at the time, but if you
(20:28):
want to think about things like in a long term
preventive way, you want to get rid of those concerning
cells now instead of waiting around for them to possibly
grow to further parts of the body. I remember once
in residency I had a case of a person who
(20:49):
actually died from metastatic cervical cancer because they basically never
got a peraps mirror like ever.
Speaker 3 (20:57):
And it was.
Speaker 1 (20:58):
Really really hard to see that because it could have
definitely been prevented with screening.
Speaker 2 (21:07):
Yeah, I mean, you know how with both HIV and
with herpes, there's medication that you can take that prevents
the spread. Yeah, is the same true with HPV.
Speaker 1 (21:22):
So to answer your question, no, there's nothing. There's nothing
like that, Like there's no anti retrovirals or antivirals for HPV.
But one of the things that I ended up taking
is something called AHCC, which stands for active hexos correlated compound,
which just full disclosure, like this is not recommended by
(21:43):
any major medical society. But there was a very small,
randomized controlled trial with about fifty women older than the
age of thirty who had hyris HPV for more than
two years so it was persistent, and this group, one
group got the HC and the other group got placebo,
and basically it showed that the group with the HCC
(22:08):
sixty four percent of them cleared the HPV, whereas the
placebo only fifty percent cleared it. So it was like
a small increase, but again, this is like a very
small study. But I ended up taking HCC and the
HPV ended up clearing. Now would it have cleared on
its own, probably, But I just was doing everything that
(22:28):
I could do. You know, I thought there was very
little harm to take the AHACC. How long have you
got to take it for?
Speaker 2 (22:35):
Oh?
Speaker 3 (22:35):
I took it for at least a year. It was
a long It was a long time.
Speaker 1 (22:38):
And then I got retested over a year later, and
then it was clear that is a very like experimental
sort of off label thing that's not an official recommendation.
I think the best thing is to get vaccinated for HPV,
and I think it's also important to know I did
get the vaccine, so this was even with vaccination.
Speaker 2 (22:57):
But you got the vaccine before you got.
Speaker 1 (23:00):
It, or yeah, yeah I was vaccinated, but I still
ended up getting HPV. Anyway, the vaccine is helpful for
preventing you getting it, but if you've already gotten it
before you got vaccinated, it can't get rid of what
you've already gotten.
Speaker 3 (23:15):
So in my.
Speaker 1 (23:16):
Story, I think I basically got like screwed over by
this whole ex boyfriend. So I think I had it
before and just didn't know got vaccinated and then eventually
got tested and was like, oh, I actually have it,
but then it cleared.
Speaker 2 (23:33):
That's the reason why it's recommended that children ages nine
to twelve get the HPV vaccine before you hope that
they're having sexual contact sexual encounters and therefore you know
it'll actually work for them.
Speaker 1 (23:46):
Right right, I mean I was definitely not age nine,
stove when I got vaccinated.
Speaker 3 (23:52):
Did you get the vaccine, the HPV vaccine? No?
Speaker 2 (23:55):
I didn't get it. Okay, okay, should I still get it?
Even I most likely have it since everyone seems to have.
Speaker 1 (24:02):
It well, so they recommend it for everyone through age
twenty six.
Speaker 2 (24:08):
We are we talking about me or the kiddo?
Speaker 1 (24:11):
Oh?
Speaker 3 (24:11):
I was talking about you? Oh okay, yeah, I mean.
Speaker 1 (24:15):
Yeah, I think it would be a good idea for
your kiddo to get it too. Yeah, yeah, when he
turns nine or twelve or whatever.
Speaker 2 (24:22):
Right, I haven't. I haven't gotten it. Feels like I should.
Speaker 1 (24:25):
So it's recommended for everyone through age twenty six. But
then if you're between the age of twenty seven to
forty five, they don't recommend it, but you can still
like talk to your doctor about whether there's a benefit
to doing it. I personally don't think there's any harm
to doing it. The only reason they stop recommending it
after age forty five is because the studies stopped after
(24:49):
age forty five. And I think they also assume most
people after forty five are if they're supposed to be exposed,
like they already would have been exposed. But I think
people are sexually active throughout their entire lives, especially if
you're older. So I would say, if you think you
(25:09):
might want to get it, I would I would say,
just do it.
Speaker 2 (25:12):
Vaccination rates lag in men despite the rising cancer risk.
Speaker 1 (25:16):
Why is this Well, because you can't test men, so,
like you know, men won't have symptoms unless they have
like a genital wart that would be a symptom, right,
But many men don't get symptoms, so they don't think
they have it. There's no problem, And so that's why
(25:38):
women are three times more likely to get the vaccine
compared to men.
Speaker 2 (25:43):
I mean, and that also has to do with I
guess sexism in addition to the fact that you can't
test for men, the assumption being that women are more
affected by it, So why do I need to take it?
Why do I need to get the vaccine?
Speaker 3 (25:55):
Yeah?
Speaker 1 (25:55):
I mean, but the thing is, we are seeing sort
of real life ramifications of this kind of thinking. For example,
seventy five percent of new throat cancer cases are in men. Yeah,
so I think it's one of those vaccines that if
you're a man you should consider getting. If you're sexually active,
you should just consider getting vaccinated for this period, Like,
(26:17):
it doesn't matter what types of partners are, how many partners, like,
it's just something that you should do.
Speaker 2 (26:23):
If you feel like you already have it. Is it
still valuable? Well, there's so many strains, right, so it'll
at least cover some of them.
Speaker 1 (26:32):
Yeah, i'd say why not? What's the harm? I mean,
the younger you do it, the better because then you
get more coverage. But if a person's sexually active, they
should just get it. You know, it's out there.
Speaker 2 (26:45):
So, as we've discussed, there's a stigma about STIs and
STDs that can impact mental health relationships and getting tested
and treated. And I know that stigma is there, but
you need to get tested and treated, Like you can't
just you know, because you're afraid of it not do
those things. Many people carry these infections without knowing it.
Frequent testing and open communication with any and all sexual
(27:08):
partners can reduce the spread. You should not feel shamed
for contracting HBB. It's very common and often invisible. You
shouldn't feel shamed for contracting anything. This is part of
being a human and having a body. We need to
reduce the fear of avoidance and shame to protect each other.
And remember that if you are not prepared to talk
to your partner about STIs and vaccinations, you're probably not
(27:32):
ready to have sex with them.
Speaker 1 (27:33):
Yeah, this is a big point, right, Like, I think
this is really important. There's no reason to feel pressured
to withhold so screening vaccination communication before sex. It makes
a difference, and it creates a more intimate experience, Like
you're probably going to have a better time with this
(27:55):
person if you trust them.
Speaker 2 (27:58):
Yeah, I mean, look, the conversation and is going to
be a little awkward about going through your test results,
but it's a lot easier to at least have the
conversation ahead of time and everyone you know, put their
cards on the table and have a discussion so you
can be mentally a lot more free.
Speaker 1 (28:14):
Yeah, and you know, if you are wondering how do
I start the conversation. It can be something really sort
of simple and straightforward, like, hey, do you mind if
we take a minute to talk about safe sex practices?
It doesn't have to be awkward, it's just cool and frankly,
I think that is a really cool thing to have
confidence to talk about these things and to be very open,
(28:37):
because vulnerability is the key to creating intimacy.
Speaker 2 (28:40):
Anyway, I mean asking the question when was your last
test and what did it say? I don't think is unreasonable, No,
not at all.
Speaker 1 (28:48):
That should be standard communication relationships stuff one on one,
you know.
Speaker 2 (28:54):
Greed, absolutely agreed.
Speaker 3 (28:55):
So folks, we hope this was helpful today.
Speaker 1 (28:58):
Remember I love your listenership, so if you like the show,
please share this with a.
Speaker 2 (29:04):
Friend, and also please give us reviews, give us five stars.
All of that actually helps keep our show alive and
gets more people to listen to it. So please, we'd
love your support. Thank you for listening, and we'll see
you next week.
Speaker 1 (29:24):
Health Stuff is a production of iHeart Podcasts. The show
is hosted by Me, Doctor preancle Wally, and Harrikonnebolu. Producers
are Rebecca Eisenberg, Jenna Cagel, Christina Loranger, Maya Howard, and
Katrina Norvel. Our researcher is Maria Tremarki and our intern
is Katya soobel Lejayala. To send us a question, you
(29:45):
can email us a voice memo at health Stuff Podcast
at gmail dot com. Thanks so much for listening
This podcast is for information purposes only and should not
be considered professional medical advice. Almost all cases of cervical cancer,
as far as we know, are caused by high risk HPB.
Speaker 2 (00:14):
She got into the science of it, but she never
explained sex.
Speaker 1 (00:18):
You're probably going to have a better time with this
person if you trust them.
Speaker 3 (00:26):
I'm Hurrycandibolu, I'm doctor pre uncle Wally, and.
Speaker 2 (00:29):
This is health stuff.
Speaker 1 (00:33):
We were just talking before we started recording about I'm
a little sleep deprived just because childcare man. So we
just had a phrenectomy procedure and frizzle listeners. It's where
if you have a mouth tie, like a tongue tie,
you get a procedure to kind of cut the fashion
and the tongue. And so it was really really intense
(00:56):
to see my little one go under this procede as
a parent and just pray that everything comes out okay,
and fortunately everything did.
Speaker 3 (01:06):
But it's so vulnerable. They're so vulnerable.
Speaker 1 (01:10):
You know.
Speaker 2 (01:11):
I couldn't because my kid had a tongue tayetoo and
I wasn't there when they clipped it. Just that I
wouldn't be able to handle that. Like he got stitches
when he was I think when he was three, he
had a pretty bad cut, three or four, and I
was holding his hand while they were putting the stitches in.
But part of me is like, I'm holding your hand
because I need to hold someone's hand. Yeah, as much
(01:34):
as this is for you, I'm freaked out of my
mind seeing your hand open like this and them having
to stitch you up.
Speaker 3 (01:41):
So I know, it's like, who's the patient here?
Speaker 2 (01:45):
You know what I mean.
Speaker 1 (01:46):
And even as a medical provider, you think that I
know what's going on or I have a sense, but
you can't escape the vulnerability. Like I feel just as helpless,
you know, in those situations. And if anything, because I
know more, it makes me more anxious because there's more
things that I am thinking could potentially be an issue.
Speaker 2 (02:08):
And so.
Speaker 1 (02:09):
Parenting, man, parenting is hard. It's like the it's the
hardest thing I've ever done. Yeah, I've done like a
lot of pretty hard things.
Speaker 2 (02:18):
And you're still you're still early days.
Speaker 3 (02:21):
I know, I know. Tell me it gets.
Speaker 2 (02:23):
Better, It'll get better. It'll get better.
Speaker 3 (02:26):
That's good to know.
Speaker 2 (02:27):
I mean, they new problems arise.
Speaker 1 (02:32):
Yeah, like I guess, uh, eventually, you're gonna have to
have the talk with your son. And that sort of
is a segue to another sexual health episode here on
health stole. Oh you're talking about the talk, Yeah, like
the talk, right, Like eventually you're gonna have to have
the talk, right.
Speaker 2 (02:50):
I mean, my parents never gave me the formal talk.
My mom only talked about sperms and eggs, and I
had no idea how they got there and how it worked.
She got into the science of it, but she never
explained sex.
Speaker 1 (03:03):
Totally same experience here. My talk was do not get pregnant?
Speaker 3 (03:10):
That was it? Like no, no.
Speaker 1 (03:12):
Like how does that work or anything like that. So
I'll be honest, I learned the most about STDs as
a medical student in med school. I remember opening the
books and learning all about contraception, and I remember turning
to a friend and being like, I didn't know any
(03:33):
of this, like they did. They don't teach you this,
Like there's like a laundry list of contraceptives that you
can use. Everyone just has used condoms, but no one
talks about there's so many other alternatives out there that
that you can choose from. So and then, of course
learning about STDs prior to medical school, whatever I learned
(03:54):
about STDs was you know, in elementary school, they would
put us in a classroom room and then show us
photos of basically the worst possible STDs you can ever imagine,
and then they just tell us like, this is what
happens when you have sex, and it just scared the
crap out of me basically, you know.
Speaker 2 (04:15):
Yeah, showing images of people that are completely untreated, like
what likely would not happen, like end.
Speaker 1 (04:22):
Stage versions of these diseases, you know, like someone they
have like a cauliflower like growing out of their genitals.
You know, It's like something I've never seen in like
fifteen plus years of practice, you know what I mean.
I mean it was a very effective campaign, but it
was so unrealistic about just the reality of things.
Speaker 2 (04:42):
Yeah, because people still are having sex and having children
and life is continuing. So clearly that's not the most
effective way to talk about it exactly.
Speaker 1 (04:51):
And that's why today's topic, which is HPV or human
Peppelloma virus, it's one of the STDs that I think
is important that we talk about because it's not only
is it super super common, it's super super contagious because
you can get it super easily. I can remember I
mean at one point this is I think back when
(05:14):
I was a resident many many years ago. I remember
being told I had HPV, and I remember being like
completely in shock around it, especially because like there were
only like I knew exactly where I got it from
as well and who and that person sucks and they
(05:37):
still suck to day. But I remember just feeling so
many different kinds of emotions around just wow, I can't
believe that this is happening. Later you learn it's actually
incredibly common, and fortunately it can clear on its own,
and fortunately that was my case.
Speaker 3 (05:56):
It dead clear on its own.
Speaker 1 (05:57):
But a lot of people don't know that they have
the virus even though they have it because it doesn't
necessarily cause symptoms, and then you can't test it in men.
Speaker 2 (06:06):
And there's so many strands of the virus too, so
it's not just a simple like you have HBV. There's
so many different types that have different impacts on the body,
and some that are easier to clear than others.
Speaker 1 (06:19):
Right, absolutely, there's some that are high risks, some that
are low risks. There's yeah, tons and tons of different
strains and they can cause no symptoms, they can cause
genital symptoms, they can cause even symptoms on your fingers,
believe it or not, like orts and stuff. So we'll
get into all of that and hopefully to our listeners
demystify what is HPV and all the things you need
(06:40):
to learn about it.
Speaker 2 (06:42):
Can we talk about the difference between STDs and STIs
because you know, growing up, STD was the term that
I think a lot of us heard, and that at
some point STI was introduced and I was a little confused.
STI is less stigmatized. Is that the reason we're using
that or is there an actual difference?
Speaker 1 (07:00):
So an STI stands for sexually transmitted infection, So this
is when there's a virus or bacteria or a parasite
and it's present in the body. Now, an STD is
a sexually transmitted disease, So this happens when the infection
(07:21):
or the STI is causing symptoms or harm to parts
of your body and it's leading to some sort of ailment.
So a lot of STIs never get to the STD,
the disease stage. A lot of people may not even
know that they have an STI. And again, you're right,
(07:44):
like they use the terms interchangeably, but really the reason
we've started using the term STI was to reduce the
stigma because not all infections cause disease, right.
Speaker 2 (07:57):
Kind of like HIV and AIDS.
Speaker 1 (08:00):
HIV is the infection and AIDS is the disease. Yeah,
But with HPV, many people have the STI, they have HPV,
but they may not have disease from the HPV. That
being said, it's important to talk about HPV because it
can cause some serious diseases, which we'll get into in
(08:21):
a minute now.
Speaker 2 (08:23):
Because it's a virus, HPV can't be cured, is that right, right?
Speaker 1 (08:27):
Right?
Speaker 3 (08:27):
Antibiotics are for bacterial infections.
Speaker 2 (08:30):
Yeah, And more than ninety percent of all new HPV
infections become undetectable within two years, even without treatment. Some
last longer and can lead to complications. But there is
that possibility, a high likelihood that you'll have it and
it'll pass through the system.
Speaker 1 (08:45):
Right Exactly, You may not even know that you had
it and it passed because you would have to, like
in the case of female bodies or people with cervixes,
you would have to get tested for that, right. So
unless you get tested, you won't know, which is the
dilemma with men because they can't test right now.
Speaker 2 (09:05):
There's no way for men to be tested, or it's
just not there's.
Speaker 3 (09:08):
No way right now.
Speaker 1 (09:09):
The only way is if a man and actually I
know someone, this is actually someone I know, if a
man develops let's say throat cancer, right, and then you
culture the throat cancer and you can test the tumor
cells for HPV, and then it comes back positive, then
(09:30):
you know they have HPV.
Speaker 2 (09:35):
More to come on health stuff. I feel like part
of the stigma with HPV too, is that it's seen
as a female illness, a female STI because it has
greater impacts on women because of cervical cancer and you know,
(09:55):
penile cancer, as we're going to discuss later, is also
a potential resis result of HPV, but it's less likely
and as a result, I think there's a degree of
sexism when we talk about HBV and why it's not
given more priority, even though the majority of cases of
cervical cancer are caused by HPV. Is that right?
Speaker 1 (10:14):
Yes, Basically, almost all cases of cervical cancer as far
as we know, are caused by high risk HPV.
Speaker 2 (10:21):
I just can't imagine if this was something that was
focused on men, if it was like ninety percent of
penile cancer is caused by HPV and that's how you
get it. Like, no way, there isn't a big campaign
around it, right, I just can't imagine it.
Speaker 1 (10:36):
Yeah, And you know, it's really unfair that there's so
much shame associated with STIs and STDs because to your point, right,
like women can only get tested, women get affected by
it with cervical cancer. So it's like this default that
the shame just automatically goes to women, as if women
(10:59):
in our society like don't already have enough things to
deal with, right, Yeah. Yeah, So here's the thing though,
Like literally it's estimated that nearly all sexually active people,
all sexually active people will contract HPV at some point,
and that includes both genders. And this is not to
(11:21):
say this point because then if you're thinking, well, if
we're all going to get it, what's the point in
even caring if we have it? No, Like, this doesn't
mean that we shouldn't prevent the spread. It's very important
to prevent the spread and to take precautions and then
if you have it, to get extra screening to prevent
you don't develop any diseases as a result of it.
(11:42):
But I also want to demystify that it's extremely common.
Speaker 2 (11:47):
Yeah, well, it's part of that is because of how
easily it spreads right from skin to skin contact easily
through vaginal anal or oral sex or without penetration. So
condoms can be helpful, but there's still skin to skin
contact even when you're wearing condoms, so you could still
be transferred to that, right, Yeah.
Speaker 1 (12:06):
I mean basically, if you just mess around, you could
get it, you know, and it's like it happens, it's okay.
And the other catch is that it's not like you
could develop symptoms. Seventeen to ninety percent of infections have
no symptoms, and you can have multiple strains at once
(12:26):
and still get reinfected. And the thing is you might
not even know you had it, and then you clear
it on your own within one to two years.
Speaker 2 (12:35):
There are over two hundred types of HPV, with over
forty affecting the general area. What about the rest of them?
What are they?
Speaker 1 (12:44):
Yeah, so there are other low risk types that can
cause genital warts. Usually when you get tested, they'll give
you a number of which HPV number it is, So
number six and eleven cause majority of genital warts, but
the ones linked to cancers are the number sixteen and eighteen.
Like HPV sixteen causes seventy percent of cervical cancers alone.
(13:08):
And then the other types of cancers that high risk
HPV can cause are anal cancer, penile cancer, vaginal cancer,
vulver and throat cancer. And speaking of throw cancer, who's
that guy married to Catherine Zita Jones?
Speaker 3 (13:22):
He had throw cancer? Yeah, Michael, So that's like a.
Speaker 1 (13:24):
Really famous example, right, Michael Douglas had throat cancer. I
remember I used to work in the small group private
practice and one of my colleagues ended up getting throw
cancer and HPV positive, and he went through the chemo
and radiation and everything, and he survived it and came
(13:45):
back to work. And then one day he was on
his way to work and he just got hit by
a car and.
Speaker 3 (13:52):
Died in staring.
Speaker 2 (13:53):
Oh my god.
Speaker 3 (13:54):
Yeah, And it.
Speaker 1 (13:54):
Was just like crazy to me because he spent all
this time like successfully battling throw cancer and then it
was just like someone who took a bad left turn
that ended up like God, yeah, So life is really
weird like that, I guess.
Speaker 2 (14:08):
I mean with Michael Douglas, the joke was that he
liked oral sex too much heaving oral sex. Now, is
that is that even true that you can get throat
cancer through oral sex or is that like an urban.
Speaker 3 (14:21):
Myth It could happen.
Speaker 1 (14:22):
Yeah, because again that's enough to spread HPV. So if
he if he went down on someone who was HPV
positive with the high risk version, yeah, that could have
that could have been it. And so we don't know,
like if it was Catherine or a prior partner. Wow,
if you know your HPV positive, I think it's really
(14:43):
important that you let your partner know because then they
can make an informed choice about what they want to do.
That's the right thing to do, even though it's still
very spreadable and all that stuff, I think it's really
important to share that information. Now, if you're a woman
and you get a papsmerror, generally when they do the paps,
(15:03):
they will tell you if you have HPV because they
can screen for it at the same time, and when
they tell you you have HPV, if you're positive, they'll
screen for what numbers and they can tell you if
you have high risk version or non high.
Speaker 2 (15:20):
Risk HPV, like we were saying, can linger silently in
the body for decades. So even though like the vast
majority does go through your system and it kind of
passes through. It could also stay there for quite some time.
It can lead to cell changes dysplasia that may become
cancer over time. It can cause cervical cancer, but it
(15:42):
can also take ten to fifteen years to develop. HPV
is responsible for nearly all cervical cancers, over ninety percent
of anal cancers, and the majority of several other genital cancers.
Oral HPV is now linked to sixty to seventy percent
of throat cancers in the US.
Speaker 3 (15:59):
Yeah.
Speaker 1 (16:00):
Now, this is why, at least for cervical cancer, getting
screened is so important, because cervical cancer is one of
those types of cancers where if you get diagnosed early,
you can take measures to eradicate the cancer. Throw cancer
is tricky because by the time someone presents with throw cancers,
(16:24):
they might have had symptoms for a while that are
really you know, you would shrug it off, like, oh, yeah,
my voice was hoarse, or my throat was sore, or
I was you know, sometimes I would have trouble swallowing,
but I just thought it was you know, because of
the weather, I had acid reflex or something like that,
you know, and it's very subtle, and then by the
(16:45):
time it presents it might be a little bit more advanced.
But that's not to say that you can't do anything.
It is very treatable, especially if found quite early.
Speaker 2 (16:57):
So let's say you had like a sore throat and
it's not STRAP, it could be HPV.
Speaker 3 (17:05):
Yeah.
Speaker 1 (17:05):
So let's say you have a sore throat and you
got treated for STRAP but it didn't go away, or
you kept trying all these treatments and it's not going away.
That would be a great reason to go see your doctor,
ask for a referral to see your nose and throat specialists.
They would probably want to take a look inside and
see are the cells looking different? Is there any concern
(17:29):
for that? And if not, they could still put you
on like a watch list or something where they can
monitor you on a regular basis. Well, yeah, we will
see you right after this break. So, I mean, the
point here is not to scare the crap out of people,
(17:51):
because I think it's important that we talk about preventing HPV.
There might be some listeners here who are on the
younger side, like you know, less than twenty six, and
they've been talked to about the vaccine and all of that.
So let's talk about preventing HPV.
Speaker 2 (18:09):
So condoms are still important, but they can't completely eliminate
the risk. PAP smears detect abnormal cervical cells, including high
risk HPV strains. So with pap smears, that's not preventedive
at that point, right, because at that point it would
just let you know whether you have it or not.
Is that right?
Speaker 1 (18:27):
Yes, yes, and you would be in sort of like
a I'm going to be screened more frequently track, got you.
Speaker 3 (18:33):
Yeah, But you.
Speaker 1 (18:35):
Know, here's the thing, right, like, even if let's say
you haven't had a new partner, you don't have symptoms,
maybe you aren't even sexually active, or you haven't been
for a very long time, even years, it's still really
important to stay up to date with your pap smears
because that is what's going to prevent cervical cancer. And
(18:59):
if you have a pap smear and it comes back
up normal, there's a couple of different options. So again,
like how when years ago when I found out at
HBB and it was through a pap smear, and the
doctor was like, you know, just will repeat it in
a year, and will We'll like see if it goes away. Basically,
(19:21):
so sometimes waiting is an option, especially if the strains
are not high risk, because they can clear on their own.
But sometimes you have to look a little bit closer
than what a pap smear shows, and that's a procedure
called a colposcopy, which is basically they take a really
(19:42):
really ten ten tiny biopsy of the tissue to see
are there changes in the cells already that are concerning
for cancer. And sometimes if that colposcopy procedure shows that yes,
there are cellular changes that are concerning and this is
a high restraint of HPV, the next step would be
(20:04):
doing a procedure called a leap procedure, where they basically
just take those cells out of the cervix, which is
a fantastic way of catching and effectively eliminating one's risk
of cancer with a simple leap procedure, which I know
can probably sound scary at the time, but if you
(20:28):
want to think about things like in a long term
preventive way, you want to get rid of those concerning
cells now instead of waiting around for them to possibly
grow to further parts of the body. I remember once
in residency I had a case of a person who
(20:49):
actually died from metastatic cervical cancer because they basically never
got a peraps mirror like ever.
Speaker 3 (20:57):
And it was.
Speaker 1 (20:58):
Really really hard to see that because it could have
definitely been prevented with screening.
Speaker 2 (21:07):
Yeah, I mean, you know how with both HIV and
with herpes, there's medication that you can take that prevents
the spread. Yeah, is the same true with HPV.
Speaker 1 (21:22):
So to answer your question, no, there's nothing. There's nothing
like that, Like there's no anti retrovirals or antivirals for HPV.
But one of the things that I ended up taking
is something called AHCC, which stands for active hexos correlated compound,
which just full disclosure, like this is not recommended by
(21:43):
any major medical society. But there was a very small,
randomized controlled trial with about fifty women older than the
age of thirty who had hyris HPV for more than
two years so it was persistent, and this group, one
group got the HC and the other group got placebo,
and basically it showed that the group with the HCC
(22:08):
sixty four percent of them cleared the HPV, whereas the
placebo only fifty percent cleared it. So it was like
a small increase, but again, this is like a very
small study. But I ended up taking HCC and the
HPV ended up clearing. Now would it have cleared on
its own, probably, But I just was doing everything that
(22:28):
I could do. You know, I thought there was very
little harm to take the AHACC. How long have you
got to take it for?
Speaker 2 (22:35):
Oh?
Speaker 3 (22:35):
I took it for at least a year. It was
a long It was a long time.
Speaker 1 (22:38):
And then I got retested over a year later, and
then it was clear that is a very like experimental
sort of off label thing that's not an official recommendation.
I think the best thing is to get vaccinated for HPV,
and I think it's also important to know I did
get the vaccine, so this was even with vaccination.
Speaker 2 (22:57):
But you got the vaccine before you got.
Speaker 1 (23:00):
It, or yeah, yeah I was vaccinated, but I still
ended up getting HPV. Anyway, the vaccine is helpful for
preventing you getting it, but if you've already gotten it
before you got vaccinated, it can't get rid of what
you've already gotten.
Speaker 3 (23:15):
So in my.
Speaker 1 (23:16):
Story, I think I basically got like screwed over by
this whole ex boyfriend. So I think I had it
before and just didn't know got vaccinated and then eventually
got tested and was like, oh, I actually have it,
but then it cleared.
Speaker 2 (23:33):
That's the reason why it's recommended that children ages nine
to twelve get the HPV vaccine before you hope that
they're having sexual contact sexual encounters and therefore you know
it'll actually work for them.
Speaker 1 (23:46):
Right right, I mean I was definitely not age nine,
stove when I got vaccinated.
Speaker 3 (23:52):
Did you get the vaccine, the HPV vaccine? No?
Speaker 2 (23:55):
I didn't get it. Okay, okay, should I still get it?
Even I most likely have it since everyone seems to have.
Speaker 1 (24:02):
It well, so they recommend it for everyone through age
twenty six.
Speaker 2 (24:08):
We are we talking about me or the kiddo?
Speaker 1 (24:11):
Oh?
Speaker 3 (24:11):
I was talking about you? Oh okay, yeah, I mean.
Speaker 1 (24:15):
Yeah, I think it would be a good idea for
your kiddo to get it too. Yeah, yeah, when he
turns nine or twelve or whatever.
Speaker 2 (24:22):
Right, I haven't. I haven't gotten it. Feels like I should.
Speaker 1 (24:25):
So it's recommended for everyone through age twenty six. But
then if you're between the age of twenty seven to
forty five, they don't recommend it, but you can still
like talk to your doctor about whether there's a benefit
to doing it. I personally don't think there's any harm
to doing it. The only reason they stop recommending it
after age forty five is because the studies stopped after
(24:49):
age forty five. And I think they also assume most
people after forty five are if they're supposed to be exposed,
like they already would have been exposed. But I think
people are sexually active throughout their entire lives, especially if
you're older. So I would say, if you think you
(25:09):
might want to get it, I would I would say,
just do it.
Speaker 2 (25:12):
Vaccination rates lag in men despite the rising cancer risk.
Speaker 1 (25:16):
Why is this Well, because you can't test men, so,
like you know, men won't have symptoms unless they have
like a genital wart that would be a symptom, right,
But many men don't get symptoms, so they don't think
they have it. There's no problem, And so that's why
(25:38):
women are three times more likely to get the vaccine
compared to men.
Speaker 2 (25:43):
I mean, and that also has to do with I
guess sexism in addition to the fact that you can't
test for men, the assumption being that women are more
affected by it, So why do I need to take it?
Why do I need to get the vaccine?
Speaker 3 (25:55):
Yeah?
Speaker 1 (25:55):
I mean, but the thing is, we are seeing sort
of real life ramifications of this kind of thinking. For example,
seventy five percent of new throat cancer cases are in men. Yeah,
so I think it's one of those vaccines that if
you're a man you should consider getting. If you're sexually active,
you should just consider getting vaccinated for this period, Like,
(26:17):
it doesn't matter what types of partners are, how many partners, like,
it's just something that you should do.
Speaker 2 (26:23):
If you feel like you already have it. Is it
still valuable? Well, there's so many strains, right, so it'll
at least cover some of them.
Speaker 1 (26:32):
Yeah, i'd say why not? What's the harm? I mean,
the younger you do it, the better because then you
get more coverage. But if a person's sexually active, they
should just get it. You know, it's out there.
Speaker 2 (26:45):
So, as we've discussed, there's a stigma about STIs and
STDs that can impact mental health relationships and getting tested
and treated. And I know that stigma is there, but
you need to get tested and treated, Like you can't
just you know, because you're afraid of it not do
those things. Many people carry these infections without knowing it.
Frequent testing and open communication with any and all sexual
(27:08):
partners can reduce the spread. You should not feel shamed
for contracting HBB. It's very common and often invisible. You
shouldn't feel shamed for contracting anything. This is part of
being a human and having a body. We need to
reduce the fear of avoidance and shame to protect each other.
And remember that if you are not prepared to talk
to your partner about STIs and vaccinations, you're probably not
(27:32):
ready to have sex with them.
Speaker 1 (27:33):
Yeah, this is a big point, right, Like, I think
this is really important. There's no reason to feel pressured
to withhold so screening vaccination communication before sex. It makes
a difference, and it creates a more intimate experience, Like
you're probably going to have a better time with this
(27:55):
person if you trust them.
Speaker 2 (27:58):
Yeah, I mean, look, the conversation and is going to
be a little awkward about going through your test results,
but it's a lot easier to at least have the
conversation ahead of time and everyone you know, put their
cards on the table and have a discussion so you
can be mentally a lot more free.
Speaker 1 (28:14):
Yeah, and you know, if you are wondering how do
I start the conversation. It can be something really sort
of simple and straightforward, like, hey, do you mind if
we take a minute to talk about safe sex practices?
It doesn't have to be awkward, it's just cool and frankly,
I think that is a really cool thing to have
confidence to talk about these things and to be very open,
(28:37):
because vulnerability is the key to creating intimacy.
Speaker 2 (28:40):
Anyway, I mean asking the question when was your last
test and what did it say? I don't think is unreasonable, No,
not at all.
Speaker 1 (28:48):
That should be standard communication relationships stuff one on one,
you know.
Speaker 2 (28:54):
Greed, absolutely agreed.
Speaker 3 (28:55):
So folks, we hope this was helpful today.
Speaker 1 (28:58):
Remember I love your listenership, so if you like the show,
please share this with a.
Speaker 2 (29:04):
Friend, and also please give us reviews, give us five stars.
All of that actually helps keep our show alive and
gets more people to listen to it. So please, we'd
love your support. Thank you for listening, and we'll see
you next week.
Speaker 1 (29:24):
Health Stuff is a production of iHeart Podcasts. The show
is hosted by Me, Doctor preancle Wally, and Harrikonnebolu. Producers
are Rebecca Eisenberg, Jenna Cagel, Christina Loranger, Maya Howard, and
Katrina Norvel. Our researcher is Maria Tremarki and our intern
is Katya soobel Lejayala. To send us a question, you
(29:45):
can email us a voice memo at health Stuff Podcast
at gmail dot com. Thanks so much for listening
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