December 4, 2025 • 29 mins
- Neil Scott and Dr. Tom Walsh welcome Dr. Santiago Neme, Medical Director at the University of Washington for a frank and informative discussion on Sexually Transmitted Infections (STI); what to do, and where to go!
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Episode Transcript
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Speaker 1 (00:00):
Welcome to Men's Health Matters with doctor Tom Walsh, director
of the University of Washington's Men's Health Center and Associate
Professor of Urology at UW, featuring important topics dealing with
men's health, including prostate cancer and erectiledysfunction. Now here's your host,
Neil Scott.
Speaker 2 (00:19):
Men's Health Matters now more than ever. Welcome to another
edition of Men's Health Matters, coming to you from the
Ihearts Studios in Seattle. My co host is doctor Tom Walsh,
director of the University of Washington's Men's Health Center. He's
a surgeon, professor, and a staunch advocate for matters that
deal with men's health. Men's health matters in so many ways.
(00:40):
I mean, it matters to you first and foremost, but
it also matters to your family, your friends. Men's Health Matters.
How are you doing, doctor Walsh? How are things over
at the Men's Health Center?
Speaker 3 (00:50):
Neil, thanks for asking. I'm doing great. I'm enjoying sort
of a reprieve in our Seattle weather. It's cold, but
I feel like the rain has let up a little bit.
We are is he as.
Speaker 2 (01:00):
Ever In this edition of Men's Health Matters, We're going
to take a new look at STD's and the latest
information on HIV AIDS. And we have an exceptional guest
with US doctor Santiago and Neme. He is the medical
director of the University of Washington. What do men need
to know about sexually transmitted diseases? How do you avoid them?
How do you know if you have one? And what
(01:22):
do you do if you become infected? And what is
the most common std All this and more coming up,
But first, as we do in every edition of Men's
Health Matters, we take anonymous questions on any subject dealing
with men's health. Listeners can submit questions anonymously. Our first
question is from Bill in Tuckwilla. Is it possible to
find out if I'm at high risk for colon cancer
(01:44):
through genetic testing? If so, I'm wondering if you can
suggest a website. Would twenty three in me provide any information? Bill?
Speaker 3 (01:53):
The answer about twenty three in me is that I
don't think so. You know. Twenty three in me is
a screening test to help you understand something about diseases
you may be a carrier for. And these are really
not the predominant things that are going to affect your
risk for colon cancer. There is not an immediate direct
genetic screening for colon cancer. However, what we do know
(02:17):
is that colon cancer is easily detected. There are a
couple of different ways, but the gold standard remains colonoscopy,
which currently is recommended at age forty five. Unless you're
carrying a risk factor and if you have a first
degree relative who had colon cancer died of colon cancer,
these are reasons for you to consider being referred by
(02:40):
your doctor to a gastroinrologist at an earlier age.
Speaker 2 (02:44):
Next question, Doctor Walsh, I heard you discussing telehealth on
the recent edition of your program. Can that be done
with mental health issues? Can I do it with my
camera off? And does your clinic offer that service?
Speaker 3 (02:58):
The quick answer is yes, yes, and in general no,
the men's health center is generally not a place where
we consider ourselves experts in mental health. I think in
this era of the practice of medicine, almost every doctor
has learned something about mental health and it pervades every
(03:18):
aspect of how we deliver care. To the extent that
mental health impacts men's health, absolutely, but can you get
mental health care via telemedicine? Absolutely? Can you do it
but in a way that's comfortable for you in the
privacy of your home. Absolutely, and there are many different
ways to do that. If you don't know where to start,
(03:39):
I always say starting with UW medicine is a great place.
Speaker 2 (03:41):
And William from Edmunds what role does nutrition play in
the prevention of disease? I try to eat well. I
take plenty of vitamin supplements, including a probiotic. My friends
say that's a bunch of nonsense. I'm in my early
twenties and I'm a bit paranoid about my health.
Speaker 3 (03:57):
I think there's really something behind what what my grandmother
used to say, which is you are what you eat.
And it is absolutely true that nutrition is pivotal for
so many areas of disease and in performance medicine. And
you and I know, Neil, we've had a director of
performance nutrition here as a guest, and this is a
good reminder to us it might be time to bring
(04:19):
back a discussion of nutrition. Does nutrition necessarily cure disease
or prevent all disease? Probably not, but it certainly is
one of those really critical exposures that plays a big
role in how we age and how good we feel
and some diseases.
Speaker 2 (04:35):
You know.
Speaker 3 (04:35):
Obviously I am not a pivotal expert in telemedicine, mental
health or nutrition. Do you want to weigh in on
any of those things.
Speaker 4 (04:41):
The only thing on nutrition that I would add is
that what you eat can also lead to you being obese.
Obesity we know is associated with multiple cancers, cardiovascular disease,
early death. It is important to watch what you eat
to also watch your calories, and if you want to
build muscles, you want to eat protein.
Speaker 2 (05:01):
Remember you can send your questions anonymously on any health
issue to Men's Healthmatters at iHeartMedia dot com. We will
not retain or share your email address. This is one
hundred percent anonymous. Our guest is the medical director at
the University of Washington, doctor Santiago Neme. He is also
the Associate Dean of the University of Washington School of Medicine.
(05:22):
Doctor Nem has been with us before during the COVID
pandemic when he was on the front line of treatment
and research in our state. Welcome back, doctor Neme, Thank
you Neil. Each year, there are some twenty million cases
of STDs in the US, according to the Centers of
disease control over seven thousand cases in King County alone,
and certainly STDs can be embarrassing, but they can also
(05:44):
be extremely serious and must be dealt with. What are
the most common STDs and what to men who are
sexually active need to know?
Speaker 4 (05:53):
Thank you, Neil, that's an excellent question. I would like
to start by reframing the phrase STD which implies that
we are symptomatic and we're having a disease. Most are STIs.
That means sexually transmitted infections. Most of them can have
no symptoms. This is why we are now referring to
them as STIs. What are the most common STIs? We
(06:15):
have different types of STIs. They include viruses like the
herpes virus. We know genital herpes is quite common. We
also have in the bacterial category we have chlamydia and gonorrhea,
which are very common. Chlamydia is often silent. There's also
other STIs like hepatetis B or HIV, which can be
(06:38):
completely asymptomatic for many, many years.
Speaker 2 (06:41):
That sounds troubling being asymptomatic.
Speaker 4 (06:43):
Absolutely, while we see that with infectious diseases. For instance,
in COVID, we learned that forty percent of people may
have COVID without any symptoms, the same with STIs. Can
be infected with HIV for many, many years until you
present symptoms.
Speaker 3 (06:59):
Doctor Walsh, I love it that we're talking about this topic.
What interests me about this, Doctor Nema, is that we
often have young, asymptomatic but concerned men who come into
the Men's Health Center, and that's how we arrived at
saying this is something we need to talk about. So it's,
you know, that guiding principle we have of looking for
(07:21):
an entry point into better health. This is a huge
entry point.
Speaker 2 (07:26):
Are the vaccines available for common STIs.
Speaker 4 (07:29):
So Neil great question. The vaccine for hepatitis B, which
is transmitted sexually. We also have the vaccine a very
important series, which is the HPV vaccine that would protect
individuals from anal cancer from WARTZ and also penile cancer,
throat cancer, and multiple other cancer diseases associated with that.
(07:53):
We also have, although we don't have hepatitis C vaccine,
we have effective treatment meant that basically cures the infection.
Now for HIV, although we don't have a vaccine yet,
we have very effective prevention of HIV through medications.
Speaker 2 (08:11):
What is the most common of the sdis.
Speaker 4 (08:13):
If you think about including asymptomatic and symptomatic, would be chlamydia.
It's typically silent, followed by herpes. That's extremely common, but
with herpes you usually develop symptoms, especially the first episode.
And I would say currently we're seeing a very significant
rise of syphilis cases that we're seeing not only the
(08:35):
population of men who have sex with other men, but
also in women who are pregnant.
Speaker 3 (08:40):
What immediately comes to my mind is this idea of
the asymptomatic nature of many of these cases. And you know,
when you don't know you have something, you know, it
doesn't drive you to do something. So my immediate question
is who should be seeking out STI investigations or testing
and where should they be doing it.
Speaker 4 (09:01):
This is a critical question. I would say the answer
is pretty easy. If you're sexually active, you meet the
criteria to be screened. We don't need to wait for symptoms.
If you're sexually active, you should be screened. How often
it depends on your activity, and it depends on the
number of partners you have at the beginning of any relationship.
It is really advised for both partners or more than
(09:25):
two partners to get tested and see and check their
baseline and then provide with appropriate treatment or therapies or vaccines.
So this has to be done early on when we
start to be intersexual relationships, and then when we change
partners or we might be in a relationship that's open.
(09:45):
This is not about your symptoms. Obviously, when you have symptoms,
you have a more pressing need to seek that testing
and treatment not only for your well being, but also
the well being of others, because treatment secures that you're
not going to transmit this infection to others.
Speaker 2 (10:01):
And talk a little bit about the testing process. Where
do people get tested? What does testing mean? I assume
it's a blood draw.
Speaker 4 (10:08):
The STI testing panel typically includes the collection of blood.
For instance, we test for syphilists through blood sample and
for HIV the same. But if I want to detect
chlamydia gonorrhea, I take samples that could be urine, it
could be from the throat, it could also be anal.
So these are swaps that detect bacterial or viral DNA,
(10:32):
and then we proceed with treatment, and not only the
treatment for yourself but your partners. Again, it's about prevention
of others as well.
Speaker 2 (10:39):
How long does the test take I mean, how soon
does a person get the results.
Speaker 4 (10:43):
Yeah, I would say two to three days you usually
have results. At the University of Washington, we have a
very robust STI program where you have basically most of
the test results within twenty four to thirty six hours.
And if someone is having symptoms. It's really important for
every man to know that if you have symptoms, you
(11:05):
can be treated what we call empirically, meaning that I
treat you right away while I'm waiting for results.
Speaker 2 (11:12):
What is the cost of testing.
Speaker 4 (11:14):
There's many avenues for testing. One, if you go to
your primary care provider and you have insurance, that should
be STI test is routine and that should be covered
by most insurance plans. Now in King County and at
the University of Washington, we could test folks for free.
King County has a very large STI clinic on Ninth
(11:37):
and Jefferson Here in Seattle, also, the University of Washington
will see patients regardless of their ability to pay.
Speaker 2 (11:44):
Doctor Walsh, doctor Namy.
Speaker 3 (11:46):
I'm going to put myself in the seat of I'm
imagining a young listener hearing all of this, and I
know that there's still this tremendous fear about a couple
of things. Number one, the private see that surrounds this.
The reality is is that we still live in a
US society still puts a lot of taboo associated with
(12:07):
these types of infections. I'm also thinking about the experience
of the testing, I mean, and the treatment. Is it painful?
Do we have to worry? Dispel some myths for me
about the pain and the confidentiality and all of these things.
Speaker 4 (12:21):
It's a rather straightforward procedure, I would say, test why
because one is a lab draw to test for certain
things that we talked about. And then the swabs at
the University of Washington, where we discover because of that stigma,
because patients don't sometimes you know, don't want to have
other members of the team really collect samples on them.
(12:43):
What we do we do is self collection where the
individual goes into a bathroom with the swabs and then
depending on their sexual practices, we indicate okay, you need
a throat swab, or you need an anal swab, or
you need a sample of urine, and that's some that
the individual can go into a bathroom and collect and
(13:03):
then give us the samples. What I would say is
that it's always kind of nerve racking when you're waiting
for that result. And back in the day when I
started getting tested, you had to wait a few days.
Now HIV testing can be done in one minute, Doctor Walsh.
Speaker 3 (13:19):
I still remember a time in both my medical training
and my career where this was a really, really scary disease,
and I remember living through that period of time when
the treatments were frightening and the certitude of treatment was
you know, there wasn't that certitude, and I was just
wondering if you could walk us through the evolution of
(13:40):
this disease a little bit and the change in how
we perceive HIV and its treatments.
Speaker 4 (13:47):
When we first saw the first cases of HIV, and
I would say of AIDS back in the day, it
was around nineteen eighty one when we started seeing young
men quickly die of HIV infection leading to AIDS, which
is the definition of HIV that it's really advanced. Today,
we don't talk that much about AIDS. We talk about
(14:08):
HIV as a spectrum of symptoms over time. It's really
important to highlight that we went from an era of
no treatment to a really highly pundent treatment that initially
involved multiple drugs, and now most of my patients are
only on one pill a day, and actually we now
have an injectable treatment that you get injections every two
(14:31):
months without taking any pills. It's been really one eighty
in terms of the development of HIV medications and how
powerful they are and how friendly they are to people.
Initially you had all these nutrition requirements for certain drugs.
Now it's something you just put in your mouth, you drink,
just the same way you would consume a vitamin. The
(14:52):
other thing Neil and doctor Walsh. Nowadays people who live
with HIV have a normal lifespan. In the past, people
with HIV, as you know, didn't live long, and then
they lived a bit longer. But now it matches the
life of a person who's not living with HIV, and
that's really critical and monumental. If you think about the
(15:16):
millions of people who died over time associated with HIV,
and I would say, there's still people who die from
HIV today, and it's typically because they didn't really get
diagnosed early, they didn't get on medications early. This really
highlights why it is important to get tested not only
(15:38):
once but frequently, depending on your sexual practice.
Speaker 2 (15:42):
Our guest this month on men's health matters, doctor Santiago Neme.
He is the medical director of the University of Washington,
which is the number one medical center in the state
of Washington and in the top twenty nationally. We're going
to continue our discussion about Sti's and what men who
are sexually active need to know. We'll do that right
(16:02):
after this.
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Speaker 2 (17:02):
We're back on men's health matters. I'm Niel Scott. My
co host is the director of the Men's Health Center,
doctor Tom Walsh. As we continue our visit with doctor
Santiago Neme, Doctor.
Speaker 3 (17:12):
Walsh, Doctor Nemo, you know, it's phenomenal to have you here,
and I'm using this as my own clinical consultation. If
that isn't obvious and apparent. One of the things that
really commonly I hear from my patients is they'll describe
to me their particular sexual preferences and use that as
a platform to say, hey, you know, this is my
sexual preference. I don't need to be screened. I often
(17:34):
just don't know the answer, and so I'm asking.
Speaker 4 (17:37):
You that's a really important question. Why, because I think
that over time we've learned that there's so much stigma
with certain practices, and then there's a lot of labeling.
I stop asking folks whether they're gay or straight, or
bisexual or pan sexual. All I'm asking my patients now
(18:01):
is what they do, What is the activity they do,
and I don't care really if they call themselves gay
or straight or by I just want to know, if
you're a man, are you also having sex with other men?
Regardless of what you think that means. Practically speaking, that
helps me realize, Okay, what are the risk factors? Because
(18:24):
if you're a man having with other men, especially more
than one man, then that puts you at risk for
certain STIs, including HIV for instance. So I think it's
important to take that shift and the way we ask
questions as doctors, so then we remove the label and
we talk about what actually happens. I can be a
(18:44):
straight man, but I could have been a victim of
sexual abuse or something that happened to me, So it
doesn't really matter who you are in terms of sexual categories.
I think it's important to understand what people do.
Speaker 2 (19:00):
It's the action, not the identity exactly.
Speaker 4 (19:03):
So this is why it's not that something's for gay
men or stray men or bisexual men. It's really what
they do.
Speaker 2 (19:10):
If a man has a symptom of an STI and
decides to ignore it, maybe out of fear, maybe out
of embarrassment, maybe out of denial, what happens.
Speaker 4 (19:23):
Well, I have to say most men who are concerned
about an STI, it's a recurrent feeling. The symptoms may
get better, but the worry may stay. By understanding or
remembering that a lot of the sdis can have very
very long asymptomatic periods, I might not treat my own
(19:46):
STI early enough, and I may also give my SDI
to all of my partners even though the symptoms are
not there, they're better than minimized, or they come and go.
If I have genital herpes, the symptoms can come and go,
and it doesn't mean that I'm not posing any risk
to others at that time, or that I shouldn't seek treatment,
(20:10):
because again, if someone's ever had genital herpes, it could
be pretty painful. So it's important to really know that
you acquired an STI and then what are the steps
to make you feel better, to treat you better, to
give you tools, so then you can make your own
decision according to your sexual life at that time. Again,
(20:31):
sexual activity changes as we age, as we grow, as
we find ourselves, so it's important to equip ourselves with tools.
Speaker 2 (20:40):
In other words, put on your big boy pants and
get tested.
Speaker 4 (20:43):
Exactly, Doctor Walsh.
Speaker 3 (20:45):
This is again. HIV, for example, is this disease that
used to be deadly. But what I'm hearing you say
is that in a private, secure, high fidelity way, people
who are at risk have this opportunity to enter the
healthcare system, learn something about what they've got, have painless testing,
(21:06):
painless intervention, and have no essentially ill effects that are
of great consequence. My objective is to motivate those who
are out there worried about this to make a change
and to do something different, and to translate this into
perhaps other behaviors too, whether it's acting on how much
they're exercising, improving their diet like we discussed earlier and
(21:29):
their nutrition, or checking their blood pressure or their blood
glucose for diabetes, or getting a PSA for broadstay cancer screening.
All of these things fit together, and this may be
a great place for some of our listeners to start.
Speaker 2 (21:42):
What about the issue of confidentiality and all of this testing.
Speaker 4 (21:45):
Well, all testing is confidential. You can actually have completely
anonymous testing when you go to some of the clinics
in the community, for instance, Gay City, the Health Project
here in Seattle, or Nathan Jefference, you can actually have
anonymous testing. You basically go in and you can have
instead of your full name, you can have a code,
(22:08):
and then the results are given to a code as
opposed to a person. Should you need additional testing at
that point, then situations can change where you're going to
have to enter Let's say, if you diagnose with HIV
or you need PREP or other strategies, you're going to
have to enter some personal information at some point, but
(22:29):
initial testing can be done completely.
Speaker 2 (22:31):
Anonymous, What are some takeaways for men who are sexually active?
Speaker 4 (22:36):
I think it's important to know your status. You want
to get tested for not only HIV, but other STIs
and particularly I would say it's really important because I
would say about eight years ago, all we had for
prevention was actually using a condom. And we know that
men if given the choice of using a condom and
(22:59):
not using a condom, we know that we all prefer
not to wear a condom. So, but what's available now,
so you have a key strategy for prevention that has
to do with pharmacology, has to do with the treatment
men at risk for HIV meaning having more than one
sexual partner, having sex with other men. More than that,
(23:19):
we know that there's a treatment now that is prevention.
So I could give this person a pill one day
that's ninety nine percent effective at preventing HIV even without
wearing a condom.
Speaker 2 (23:34):
So basically it's like a birth control pill.
Speaker 4 (23:37):
Absolutely, And the beauty of this is just like birth control.
It's a tool that you can use while that activity
is happening. It doesn't mean that if I get put
on Truvada for PREP, I'm going to be on PREP
for the rest of my life. Maybe at some point
I settle and say, you know what, I'm just gonna
have sex with one person, you drop PREP. But PREP
(23:59):
has as a key place for all of us who
are sexually active with more than one person. The other
thing Neil is important to know is that a person
who is effectively treated for HIV and has undetectable of
our load that is, zero amount of virus in their blood,
cannot transmit HIV to anyone, even without a condom. So
(24:24):
this is why there's PREP where you get put on
this medication daily and then when you encounter the infection,
you don't get it. It's ninety nine percent effective. Amazing.
Then you have the treatment as prevention, which is if
I'm having sex with someone with HIV who has effectively
zero virus because they have an undetectable viur load. From
(24:48):
that person, I will never get HIV never, and then
so there's zero risk in that situation. And then the
other prevention is let's say I'm not on PREP, i
haven't been taken in my med my Troubada daily, or
I'm not having sex with a person who's known to
have HIV and effectively treated, I'm having sex with an
(25:10):
unknown Let's just say I went to a party, I
had a few drinks and ended up having sex with
a stranger. I have up to seventy two hours to
get started on PEP, which is post exposure profile axis,
So basically after the sexual act, if I come, let's
say to any UW medicine er or urgent care. Obviously
(25:33):
they closer to the event the better, but you have
up to seventy two hours to get put on meds
that treat HIV for four weeks. That treatment is very
efficacious at preventing you from getting HIV from that encounter
that you're not sure about, or it could have been unwelcome,
or it could have been not consented. Those three tools
(25:55):
are really important to know, but obviously this couple with
the freak when testing depending and we like to treat
sexually active folks with more than one partner. We like
to test them every three months, so then we can
pick up that possibility and also get them started, or
at least have the conversation around PREP. I think that
(26:18):
a key part of this is that for anybody who's
sexually active, no matter their orientation, their identity, you have
to get a baseline test. And also for everyone entering
a new sexual relationship with anybody, no matter who you are,
what you do, you want to get tested. So then
(26:40):
you enter that relationship with the information and the precautions
and the treatments and the vaccines that you need to
have a successful relationship, not only from a loving perspective,
but also from a sexual perspective.
Speaker 3 (26:53):
So let me clarify there, because even if I am
a straight individual embarking on a relationship with another straight individual,
I should get tested.
Speaker 4 (27:03):
Yes, every time new relationship get tested.
Speaker 2 (27:07):
What about the partner?
Speaker 4 (27:08):
Likewise, they both get tested.
Speaker 2 (27:10):
That's an interesting conversation to have, but.
Speaker 3 (27:13):
An important one. So there's your call to action.
Speaker 4 (27:16):
Basically, if you google CDC PREP, HIV you're going to
have a lot of information for King County. You can
google King County HIV prep and you're going to have
that and a lot of programs make HIV prep completely
free and covered even if you don't have insurance.
Speaker 3 (27:34):
Let me just say that I think this program has
been a terrific public service message. I know that there
is somebody out there listening and that this is going
to make a difference. This is an opportunity for that
person to make a more global change. You know, learn
about your status, get a test. If you're at risk,
(27:56):
consider being on prep. If you're exposed, consider getting post
exposure profile access. This is where science and art have
really come together to make a difference in human life,
and in this case, men's lives and all the loved
ones around them. Do what doctor Neme said, you know,
go to the go to the website, go to the clinic.
(28:17):
Do what you need to do.
Speaker 2 (28:18):
Doctor you are from Argentina, what message would you give
to our listeners who speak Spanish?
Speaker 4 (28:24):
Paris important, persona lando preva, I'll come inso de la
vidaxual and a personata comes to relacion as importante forchemperal
in juda Medison parakamos, arvisios and epanolo proverer provincion, parasu
(28:53):
relation sexual and import as identifica como gay bsexual implemented
KA and you W Madison para e tolo sodusalud anderal
pta minsexual which Ahead asked us.
Speaker 2 (29:09):
That wraps up this edition of Men's Health Matters Special
thanks to our guest doctor Santiago Neme and remember to
send your questions on men's health to Men's Healthmatters at
iHeartMedia dot com. I'm Neil Scott on behalf of my
co host, doctor Tom Walsh. Thanking you for listening to
Men's Health Matters and wishing you good health and good
sense and matters relating to men's health. Stay healthy, live
(29:30):
in gratitude, and be kind to one another.
Speaker 1 (29:33):
You've been listening to Men's Health Matters with doctor Tom Walsh,
Associate Professor of Youurology at the University of Washington and
director of you W's Men's Health Center, and your host
Neil Scott on Sports Radio ninety three point three kJ
r FM.
Welcome to Men's Health Matters with doctor Tom Walsh, director
of the University of Washington's Men's Health Center and Associate
Professor of Urology at UW, featuring important topics dealing with
men's health, including prostate cancer and erectiledysfunction. Now here's your host,
Neil Scott.
Speaker 2 (00:19):
Men's Health Matters now more than ever. Welcome to another
edition of Men's Health Matters, coming to you from the
Ihearts Studios in Seattle. My co host is doctor Tom Walsh,
director of the University of Washington's Men's Health Center. He's
a surgeon, professor, and a staunch advocate for matters that
deal with men's health. Men's health matters in so many ways.
(00:40):
I mean, it matters to you first and foremost, but
it also matters to your family, your friends. Men's Health Matters.
How are you doing, doctor Walsh? How are things over
at the Men's Health Center?
Speaker 3 (00:50):
Neil, thanks for asking. I'm doing great. I'm enjoying sort
of a reprieve in our Seattle weather. It's cold, but
I feel like the rain has let up a little bit.
We are is he as.
Speaker 2 (01:00):
Ever In this edition of Men's Health Matters, We're going
to take a new look at STD's and the latest
information on HIV AIDS. And we have an exceptional guest
with US doctor Santiago and Neme. He is the medical
director of the University of Washington. What do men need
to know about sexually transmitted diseases? How do you avoid them?
How do you know if you have one? And what
(01:22):
do you do if you become infected? And what is
the most common std All this and more coming up,
But first, as we do in every edition of Men's
Health Matters, we take anonymous questions on any subject dealing
with men's health. Listeners can submit questions anonymously. Our first
question is from Bill in Tuckwilla. Is it possible to
find out if I'm at high risk for colon cancer
(01:44):
through genetic testing? If so, I'm wondering if you can
suggest a website. Would twenty three in me provide any information? Bill?
Speaker 3 (01:53):
The answer about twenty three in me is that I
don't think so. You know. Twenty three in me is
a screening test to help you understand something about diseases
you may be a carrier for. And these are really
not the predominant things that are going to affect your
risk for colon cancer. There is not an immediate direct
genetic screening for colon cancer. However, what we do know
(02:17):
is that colon cancer is easily detected. There are a
couple of different ways, but the gold standard remains colonoscopy,
which currently is recommended at age forty five. Unless you're
carrying a risk factor and if you have a first
degree relative who had colon cancer died of colon cancer,
these are reasons for you to consider being referred by
(02:40):
your doctor to a gastroinrologist at an earlier age.
Speaker 2 (02:44):
Next question, Doctor Walsh, I heard you discussing telehealth on
the recent edition of your program. Can that be done
with mental health issues? Can I do it with my
camera off? And does your clinic offer that service?
Speaker 3 (02:58):
The quick answer is yes, yes, and in general no,
the men's health center is generally not a place where
we consider ourselves experts in mental health. I think in
this era of the practice of medicine, almost every doctor
has learned something about mental health and it pervades every
(03:18):
aspect of how we deliver care. To the extent that
mental health impacts men's health, absolutely, but can you get
mental health care via telemedicine? Absolutely? Can you do it
but in a way that's comfortable for you in the
privacy of your home. Absolutely, and there are many different
ways to do that. If you don't know where to start,
(03:39):
I always say starting with UW medicine is a great place.
Speaker 2 (03:41):
And William from Edmunds what role does nutrition play in
the prevention of disease? I try to eat well. I
take plenty of vitamin supplements, including a probiotic. My friends
say that's a bunch of nonsense. I'm in my early
twenties and I'm a bit paranoid about my health.
Speaker 3 (03:57):
I think there's really something behind what what my grandmother
used to say, which is you are what you eat.
And it is absolutely true that nutrition is pivotal for
so many areas of disease and in performance medicine. And
you and I know, Neil, we've had a director of
performance nutrition here as a guest, and this is a
good reminder to us it might be time to bring
(04:19):
back a discussion of nutrition. Does nutrition necessarily cure disease
or prevent all disease? Probably not, but it certainly is
one of those really critical exposures that plays a big
role in how we age and how good we feel
and some diseases.
Speaker 2 (04:35):
You know.
Speaker 3 (04:35):
Obviously I am not a pivotal expert in telemedicine, mental
health or nutrition. Do you want to weigh in on
any of those things.
Speaker 4 (04:41):
The only thing on nutrition that I would add is
that what you eat can also lead to you being obese.
Obesity we know is associated with multiple cancers, cardiovascular disease,
early death. It is important to watch what you eat
to also watch your calories, and if you want to
build muscles, you want to eat protein.
Speaker 2 (05:01):
Remember you can send your questions anonymously on any health
issue to Men's Healthmatters at iHeartMedia dot com. We will
not retain or share your email address. This is one
hundred percent anonymous. Our guest is the medical director at
the University of Washington, doctor Santiago Neme. He is also
the Associate Dean of the University of Washington School of Medicine.
(05:22):
Doctor Nem has been with us before during the COVID
pandemic when he was on the front line of treatment
and research in our state. Welcome back, doctor Neme, Thank
you Neil. Each year, there are some twenty million cases
of STDs in the US, according to the Centers of
disease control over seven thousand cases in King County alone,
and certainly STDs can be embarrassing, but they can also
(05:44):
be extremely serious and must be dealt with. What are
the most common STDs and what to men who are
sexually active need to know?
Speaker 4 (05:53):
Thank you, Neil, that's an excellent question. I would like
to start by reframing the phrase STD which implies that
we are symptomatic and we're having a disease. Most are STIs.
That means sexually transmitted infections. Most of them can have
no symptoms. This is why we are now referring to
them as STIs. What are the most common STIs? We
(06:15):
have different types of STIs. They include viruses like the
herpes virus. We know genital herpes is quite common. We
also have in the bacterial category we have chlamydia and gonorrhea,
which are very common. Chlamydia is often silent. There's also
other STIs like hepatetis B or HIV, which can be
(06:38):
completely asymptomatic for many, many years.
Speaker 2 (06:41):
That sounds troubling being asymptomatic.
Speaker 4 (06:43):
Absolutely, while we see that with infectious diseases. For instance,
in COVID, we learned that forty percent of people may
have COVID without any symptoms, the same with STIs. Can
be infected with HIV for many, many years until you
present symptoms.
Speaker 3 (06:59):
Doctor Walsh, I love it that we're talking about this topic.
What interests me about this, Doctor Nema, is that we
often have young, asymptomatic but concerned men who come into
the Men's Health Center, and that's how we arrived at
saying this is something we need to talk about. So it's,
you know, that guiding principle we have of looking for
(07:21):
an entry point into better health. This is a huge
entry point.
Speaker 2 (07:26):
Are the vaccines available for common STIs.
Speaker 4 (07:29):
So Neil great question. The vaccine for hepatitis B, which
is transmitted sexually. We also have the vaccine a very
important series, which is the HPV vaccine that would protect
individuals from anal cancer from WARTZ and also penile cancer,
throat cancer, and multiple other cancer diseases associated with that.
(07:53):
We also have, although we don't have hepatitis C vaccine,
we have effective treatment meant that basically cures the infection.
Now for HIV, although we don't have a vaccine yet,
we have very effective prevention of HIV through medications.
Speaker 2 (08:11):
What is the most common of the sdis.
Speaker 4 (08:13):
If you think about including asymptomatic and symptomatic, would be chlamydia.
It's typically silent, followed by herpes. That's extremely common, but
with herpes you usually develop symptoms, especially the first episode.
And I would say currently we're seeing a very significant
rise of syphilis cases that we're seeing not only the
(08:35):
population of men who have sex with other men, but
also in women who are pregnant.
Speaker 3 (08:40):
What immediately comes to my mind is this idea of
the asymptomatic nature of many of these cases. And you know,
when you don't know you have something, you know, it
doesn't drive you to do something. So my immediate question
is who should be seeking out STI investigations or testing
and where should they be doing it.
Speaker 4 (09:01):
This is a critical question. I would say the answer
is pretty easy. If you're sexually active, you meet the
criteria to be screened. We don't need to wait for symptoms.
If you're sexually active, you should be screened. How often
it depends on your activity, and it depends on the
number of partners you have at the beginning of any relationship.
It is really advised for both partners or more than
(09:25):
two partners to get tested and see and check their
baseline and then provide with appropriate treatment or therapies or vaccines.
So this has to be done early on when we
start to be intersexual relationships, and then when we change
partners or we might be in a relationship that's open.
(09:45):
This is not about your symptoms. Obviously, when you have symptoms,
you have a more pressing need to seek that testing
and treatment not only for your well being, but also
the well being of others, because treatment secures that you're
not going to transmit this infection to others.
Speaker 2 (10:01):
And talk a little bit about the testing process. Where
do people get tested? What does testing mean? I assume
it's a blood draw.
Speaker 4 (10:08):
The STI testing panel typically includes the collection of blood.
For instance, we test for syphilists through blood sample and
for HIV the same. But if I want to detect
chlamydia gonorrhea, I take samples that could be urine, it
could be from the throat, it could also be anal.
So these are swaps that detect bacterial or viral DNA,
(10:32):
and then we proceed with treatment, and not only the
treatment for yourself but your partners. Again, it's about prevention
of others as well.
Speaker 2 (10:39):
How long does the test take I mean, how soon
does a person get the results.
Speaker 4 (10:43):
Yeah, I would say two to three days you usually
have results. At the University of Washington, we have a
very robust STI program where you have basically most of
the test results within twenty four to thirty six hours.
And if someone is having symptoms. It's really important for
every man to know that if you have symptoms, you
(11:05):
can be treated what we call empirically, meaning that I
treat you right away while I'm waiting for results.
Speaker 2 (11:12):
What is the cost of testing.
Speaker 4 (11:14):
There's many avenues for testing. One, if you go to
your primary care provider and you have insurance, that should
be STI test is routine and that should be covered
by most insurance plans. Now in King County and at
the University of Washington, we could test folks for free.
King County has a very large STI clinic on Ninth
(11:37):
and Jefferson Here in Seattle, also, the University of Washington
will see patients regardless of their ability to pay.
Speaker 2 (11:44):
Doctor Walsh, doctor Namy.
Speaker 3 (11:46):
I'm going to put myself in the seat of I'm
imagining a young listener hearing all of this, and I
know that there's still this tremendous fear about a couple
of things. Number one, the private see that surrounds this.
The reality is is that we still live in a
US society still puts a lot of taboo associated with
(12:07):
these types of infections. I'm also thinking about the experience
of the testing, I mean, and the treatment. Is it painful?
Do we have to worry? Dispel some myths for me
about the pain and the confidentiality and all of these things.
Speaker 4 (12:21):
It's a rather straightforward procedure, I would say, test why
because one is a lab draw to test for certain
things that we talked about. And then the swabs at
the University of Washington, where we discover because of that stigma,
because patients don't sometimes you know, don't want to have
other members of the team really collect samples on them.
(12:43):
What we do we do is self collection where the
individual goes into a bathroom with the swabs and then
depending on their sexual practices, we indicate okay, you need
a throat swab, or you need an anal swab, or
you need a sample of urine, and that's some that
the individual can go into a bathroom and collect and
(13:03):
then give us the samples. What I would say is
that it's always kind of nerve racking when you're waiting
for that result. And back in the day when I
started getting tested, you had to wait a few days.
Now HIV testing can be done in one minute, Doctor Walsh.
Speaker 3 (13:19):
I still remember a time in both my medical training
and my career where this was a really, really scary disease,
and I remember living through that period of time when
the treatments were frightening and the certitude of treatment was
you know, there wasn't that certitude, and I was just
wondering if you could walk us through the evolution of
(13:40):
this disease a little bit and the change in how
we perceive HIV and its treatments.
Speaker 4 (13:47):
When we first saw the first cases of HIV, and
I would say of AIDS back in the day, it
was around nineteen eighty one when we started seeing young
men quickly die of HIV infection leading to AIDS, which
is the definition of HIV that it's really advanced. Today,
we don't talk that much about AIDS. We talk about
(14:08):
HIV as a spectrum of symptoms over time. It's really
important to highlight that we went from an era of
no treatment to a really highly pundent treatment that initially
involved multiple drugs, and now most of my patients are
only on one pill a day, and actually we now
have an injectable treatment that you get injections every two
(14:31):
months without taking any pills. It's been really one eighty
in terms of the development of HIV medications and how
powerful they are and how friendly they are to people.
Initially you had all these nutrition requirements for certain drugs.
Now it's something you just put in your mouth, you drink,
just the same way you would consume a vitamin. The
(14:52):
other thing Neil and doctor Walsh. Nowadays people who live
with HIV have a normal lifespan. In the past, people
with HIV, as you know, didn't live long, and then
they lived a bit longer. But now it matches the
life of a person who's not living with HIV, and
that's really critical and monumental. If you think about the
(15:16):
millions of people who died over time associated with HIV,
and I would say, there's still people who die from
HIV today, and it's typically because they didn't really get
diagnosed early, they didn't get on medications early. This really
highlights why it is important to get tested not only
(15:38):
once but frequently, depending on your sexual practice.
Speaker 2 (15:42):
Our guest this month on men's health matters, doctor Santiago Neme.
He is the medical director of the University of Washington,
which is the number one medical center in the state
of Washington and in the top twenty nationally. We're going
to continue our discussion about Sti's and what men who
are sexually active need to know. We'll do that right
(16:02):
after this.
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Speaker 2 (17:02):
We're back on men's health matters. I'm Niel Scott. My
co host is the director of the Men's Health Center,
doctor Tom Walsh. As we continue our visit with doctor
Santiago Neme, Doctor.
Speaker 3 (17:12):
Walsh, Doctor Nemo, you know, it's phenomenal to have you here,
and I'm using this as my own clinical consultation. If
that isn't obvious and apparent. One of the things that
really commonly I hear from my patients is they'll describe
to me their particular sexual preferences and use that as
a platform to say, hey, you know, this is my
sexual preference. I don't need to be screened. I often
(17:34):
just don't know the answer, and so I'm asking.
Speaker 4 (17:37):
You that's a really important question. Why, because I think
that over time we've learned that there's so much stigma
with certain practices, and then there's a lot of labeling.
I stop asking folks whether they're gay or straight, or
bisexual or pan sexual. All I'm asking my patients now
(18:01):
is what they do, What is the activity they do,
and I don't care really if they call themselves gay
or straight or by I just want to know, if
you're a man, are you also having sex with other men?
Regardless of what you think that means. Practically speaking, that
helps me realize, Okay, what are the risk factors? Because
(18:24):
if you're a man having with other men, especially more
than one man, then that puts you at risk for
certain STIs, including HIV for instance. So I think it's
important to take that shift and the way we ask
questions as doctors, so then we remove the label and
we talk about what actually happens. I can be a
(18:44):
straight man, but I could have been a victim of
sexual abuse or something that happened to me, So it
doesn't really matter who you are in terms of sexual categories.
I think it's important to understand what people do.
Speaker 2 (19:00):
It's the action, not the identity exactly.
Speaker 4 (19:03):
So this is why it's not that something's for gay
men or stray men or bisexual men. It's really what
they do.
Speaker 2 (19:10):
If a man has a symptom of an STI and
decides to ignore it, maybe out of fear, maybe out
of embarrassment, maybe out of denial, what happens.
Speaker 4 (19:23):
Well, I have to say most men who are concerned
about an STI, it's a recurrent feeling. The symptoms may
get better, but the worry may stay. By understanding or
remembering that a lot of the sdis can have very
very long asymptomatic periods, I might not treat my own
(19:46):
STI early enough, and I may also give my SDI
to all of my partners even though the symptoms are
not there, they're better than minimized, or they come and go.
If I have genital herpes, the symptoms can come and go,
and it doesn't mean that I'm not posing any risk
to others at that time, or that I shouldn't seek treatment,
(20:10):
because again, if someone's ever had genital herpes, it could
be pretty painful. So it's important to really know that
you acquired an STI and then what are the steps
to make you feel better, to treat you better, to
give you tools, so then you can make your own
decision according to your sexual life at that time. Again,
(20:31):
sexual activity changes as we age, as we grow, as
we find ourselves, so it's important to equip ourselves with tools.
Speaker 2 (20:40):
In other words, put on your big boy pants and
get tested.
Speaker 4 (20:43):
Exactly, Doctor Walsh.
Speaker 3 (20:45):
This is again. HIV, for example, is this disease that
used to be deadly. But what I'm hearing you say
is that in a private, secure, high fidelity way, people
who are at risk have this opportunity to enter the
healthcare system, learn something about what they've got, have painless testing,
(21:06):
painless intervention, and have no essentially ill effects that are
of great consequence. My objective is to motivate those who
are out there worried about this to make a change
and to do something different, and to translate this into
perhaps other behaviors too, whether it's acting on how much
they're exercising, improving their diet like we discussed earlier and
(21:29):
their nutrition, or checking their blood pressure or their blood
glucose for diabetes, or getting a PSA for broadstay cancer screening.
All of these things fit together, and this may be
a great place for some of our listeners to start.
Speaker 2 (21:42):
What about the issue of confidentiality and all of this testing.
Speaker 4 (21:45):
Well, all testing is confidential. You can actually have completely
anonymous testing when you go to some of the clinics
in the community, for instance, Gay City, the Health Project
here in Seattle, or Nathan Jefference, you can actually have
anonymous testing. You basically go in and you can have
instead of your full name, you can have a code,
(22:08):
and then the results are given to a code as
opposed to a person. Should you need additional testing at
that point, then situations can change where you're going to
have to enter Let's say, if you diagnose with HIV
or you need PREP or other strategies, you're going to
have to enter some personal information at some point, but
(22:29):
initial testing can be done completely.
Speaker 2 (22:31):
Anonymous, What are some takeaways for men who are sexually active?
Speaker 4 (22:36):
I think it's important to know your status. You want
to get tested for not only HIV, but other STIs
and particularly I would say it's really important because I
would say about eight years ago, all we had for
prevention was actually using a condom. And we know that
men if given the choice of using a condom and
(22:59):
not using a condom, we know that we all prefer
not to wear a condom. So, but what's available now,
so you have a key strategy for prevention that has
to do with pharmacology, has to do with the treatment
men at risk for HIV meaning having more than one
sexual partner, having sex with other men. More than that,
(23:19):
we know that there's a treatment now that is prevention.
So I could give this person a pill one day
that's ninety nine percent effective at preventing HIV even without
wearing a condom.
Speaker 2 (23:34):
So basically it's like a birth control pill.
Speaker 4 (23:37):
Absolutely, And the beauty of this is just like birth control.
It's a tool that you can use while that activity
is happening. It doesn't mean that if I get put
on Truvada for PREP, I'm going to be on PREP
for the rest of my life. Maybe at some point
I settle and say, you know what, I'm just gonna
have sex with one person, you drop PREP. But PREP
(23:59):
has as a key place for all of us who
are sexually active with more than one person. The other
thing Neil is important to know is that a person
who is effectively treated for HIV and has undetectable of
our load that is, zero amount of virus in their blood,
cannot transmit HIV to anyone, even without a condom. So
(24:24):
this is why there's PREP where you get put on
this medication daily and then when you encounter the infection,
you don't get it. It's ninety nine percent effective. Amazing.
Then you have the treatment as prevention, which is if
I'm having sex with someone with HIV who has effectively
zero virus because they have an undetectable viur load. From
(24:48):
that person, I will never get HIV never, and then
so there's zero risk in that situation. And then the
other prevention is let's say I'm not on PREP, i
haven't been taken in my med my Troubada daily, or
I'm not having sex with a person who's known to
have HIV and effectively treated, I'm having sex with an
(25:10):
unknown Let's just say I went to a party, I
had a few drinks and ended up having sex with
a stranger. I have up to seventy two hours to
get started on PEP, which is post exposure profile axis,
So basically after the sexual act, if I come, let's
say to any UW medicine er or urgent care. Obviously
(25:33):
they closer to the event the better, but you have
up to seventy two hours to get put on meds
that treat HIV for four weeks. That treatment is very
efficacious at preventing you from getting HIV from that encounter
that you're not sure about, or it could have been unwelcome,
or it could have been not consented. Those three tools
(25:55):
are really important to know, but obviously this couple with
the freak when testing depending and we like to treat
sexually active folks with more than one partner. We like
to test them every three months, so then we can
pick up that possibility and also get them started, or
at least have the conversation around PREP. I think that
(26:18):
a key part of this is that for anybody who's
sexually active, no matter their orientation, their identity, you have
to get a baseline test. And also for everyone entering
a new sexual relationship with anybody, no matter who you are,
what you do, you want to get tested. So then
(26:40):
you enter that relationship with the information and the precautions
and the treatments and the vaccines that you need to
have a successful relationship, not only from a loving perspective,
but also from a sexual perspective.
Speaker 3 (26:53):
So let me clarify there, because even if I am
a straight individual embarking on a relationship with another straight individual,
I should get tested.
Speaker 4 (27:03):
Yes, every time new relationship get tested.
Speaker 2 (27:07):
What about the partner?
Speaker 4 (27:08):
Likewise, they both get tested.
Speaker 2 (27:10):
That's an interesting conversation to have, but.
Speaker 3 (27:13):
An important one. So there's your call to action.
Speaker 4 (27:16):
Basically, if you google CDC PREP, HIV you're going to
have a lot of information for King County. You can
google King County HIV prep and you're going to have
that and a lot of programs make HIV prep completely
free and covered even if you don't have insurance.
Speaker 3 (27:34):
Let me just say that I think this program has
been a terrific public service message. I know that there
is somebody out there listening and that this is going
to make a difference. This is an opportunity for that
person to make a more global change. You know, learn
about your status, get a test. If you're at risk,
(27:56):
consider being on prep. If you're exposed, consider getting post
exposure profile access. This is where science and art have
really come together to make a difference in human life,
and in this case, men's lives and all the loved
ones around them. Do what doctor Neme said, you know,
go to the go to the website, go to the clinic.
(28:17):
Do what you need to do.
Speaker 2 (28:18):
Doctor you are from Argentina, what message would you give
to our listeners who speak Spanish?
Speaker 4 (28:24):
Paris important, persona lando preva, I'll come inso de la
vidaxual and a personata comes to relacion as importante forchemperal
in juda Medison parakamos, arvisios and epanolo proverer provincion, parasu
(28:53):
relation sexual and import as identifica como gay bsexual implemented
KA and you W Madison para e tolo sodusalud anderal
pta minsexual which Ahead asked us.
Speaker 2 (29:09):
That wraps up this edition of Men's Health Matters Special
thanks to our guest doctor Santiago Neme and remember to
send your questions on men's health to Men's Healthmatters at
iHeartMedia dot com. I'm Neil Scott on behalf of my
co host, doctor Tom Walsh. Thanking you for listening to
Men's Health Matters and wishing you good health and good
sense and matters relating to men's health. Stay healthy, live
(29:30):
in gratitude, and be kind to one another.
Speaker 1 (29:33):
You've been listening to Men's Health Matters with doctor Tom Walsh,
Associate Professor of Youurology at the University of Washington and
director of you W's Men's Health Center, and your host
Neil Scott on Sports Radio ninety three point three kJ
r FM.
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