Unraveling the Modern STI Epidemic in America

This episode tackles the alarming rise of sexually transmitted infections (STIs) in the United States, exploring our hidden epidemic and the multitude of factors leading to this increase. We delve into the impact of COVID-19, the necessity for comprehensive sex education, the influence of cultural norms, and the importance of destigmatizing conversations around sexual health. Tune in to learn about:

• One Health and its relevance to STIs 
• How the COVID-19 pandemic affected public health services around STIs 
• The role of inadequate sexual education in exacerbating STI rates 
• The impact of dating apps and hookup culture on sexual health behaviors 
• Specifics on the rising rates of syphilis and other STIs 
• Importance of proactive testing and screenings for all individuals 
• The call for inclusivity in sexual health discussions and education 
• The need to destigmatize conversations around sexual health 

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Episode Transcript

Speaker 2 (00:09):
This is a podcast about One Health the idea that
the health of humans, animals,plants and the environment that
we all share are intrinsicallylinked.

Speaker 1 (00:17):
Coming to you from the University of Texas Medical
Branch and the GalvestonNational Laboratory.

Speaker 2 (00:21):
This is Infectious Science.
Where enthusiasm for science?

Speaker 1 (00:25):
is contagious.

Speaker 3 (00:32):
Welcome to another episode of the Infectious
Science podcast, your monthlydose of critical trends in
infectious diseases and publichealth insights.
I'm one of your hosts, drDennis Benter.
Imagine a silent epidemicspreading through our
communities, affecting millions,yet often going unnoticed.
That's exactly what's happeningwith sexually transmitted

(00:54):
diseases in the United States.
Despite our advanced healthcaresystems, STIs rates are soaring
, and the reasons might surpriseyou From the unintended
consequences of an HIVprevention methods to the
far-reaching impacts of theCOVID-19 pandemic, we're facing
a perfect storm of factorsdriving this alarming trend.

(01:17):
Add to that a cocktail of socialdisparities, risky behaviors
and underfunded public healthprograms and you've got a recipe
for a public health crisishidden in plain sight.
In today's episode, we'll peelback the layers of this complex
issue, exploring why STIs are onthe rise and what it means for

(01:38):
our collective health.
We'll dive into the surprisinglink between COVID-19 and STI
rates, uncover the socialfactors fueling the spread and
discuss why the little pillpreventing HIV might be a
contribution to a surge in otherinfections.
Get ready to challenge yourassumptions and gain a new
perspective on sexual health inAmerica.

(01:58):
This is the Infectious SciencePodcast, where we take the pulse
of infectious diseases, onecritical issue at a time.

Speaker 4 (02:06):
All right, this is Camille.
I'm super excited to be backwith you all today.
We also have an original memberof the Infectious Science
Podcast.
We have Dr Matt Dasho joiningus Very excited.

Speaker 2 (02:20):
Yeah, thanks for having me back.
Thanks for letting me back intothe podcast club.

Speaker 4 (02:25):
And we also have Dr Caitlin Cotter joining us today.

Speaker 5 (02:29):
Hey, thanks for having me.
Glad to be here and happy tosee how you do this.

Speaker 4 (02:32):
Yeah, absolutely.
All right, let's dive into this.
I think that was an excellentintroduction to what we're
getting into today, and so Ithink let's just jump right in
with what's really driving therise of STIs in the United
States.
So I have a couple pointswritten down here.
But, dr Dasho, if you seepeople in the clinic, what would
you say is really driving thisrise when you talk to patients?

Speaker 6 (02:53):
Yeah, Also, it's Christina here, Just want to say
hey, and I do just want to addto Camille's question Dr Dasho,
what exactly is an STI?

Speaker 2 (03:02):
All right, a sexually transmitted infection.
So this is a broad categorythat encompasses any kind of
infectious pathogen that can betransmitted by sexual contact,
which is usually a pathogen thattransmits in blood or body
fluids.
So that's the overall umbrellacategory of STIs.
We do see this.
There are certain.

(03:23):
Obviously, epidemiologically,there are certain populations
that are at higher risk andwe're going to probably get into
how those trends are changingover the, especially the last
couple of few decades.
But yeah, no, typically I thinkwe tend to see sexually
transmitted infections inyounger people, sexually active
people.
There are certain populationsthat are at higher risk, people

(03:43):
who are not using protectionpeople.
There are certain populationsthat are at higher risk, people
who are not using protection.
Men who have sex with men areat higher risk of acquisition of
certain STIs because of theparticular tissues that are
involved and the fluids that areinvolved.
It really sort of runs thegamut of not only the pathogens
but the risks.

Speaker 4 (03:59):
Yeah, no, and I think that's a great place to start
and I'm glad you started withthis.
But one of the first points Ifound as I was diving into this
topic is that a potential driverof this rise in sexually
transmitted infections in theUnited States is that a lot of
the sex education we have inschools is abstinence, only
focuses on preventing pregnancy,but not necessarily on

(04:21):
preventing infection.
And, of course, if you're onlylooking to educate people on
preventing pregnancy, you missgroups.
That might be the portion ofthe population that's men who
have sex with men, that might beother people in the LGBTQIA
community, but also somethingthat we see.
If you think about the rate ofsexually transmitted infections
in like Florida, it's very highand it's often among people that

(04:43):
are like 65 and older andthere's not a risk of pregnancy,
and so people end up not usingprotection and then you see a
greater increase in STIs.
You looked like you wanted tojump.

Speaker 6 (04:53):
Oh no, I was just going to mention NY, florida,
camille, but good old Boca RatonSeems to be a great place to
spend your latter years in life.

Speaker 2 (05:05):
Yeah, I think that's well taken.
That's where I was going withthe first statement that I think
clinically we tend to say it'syoung people who are having sex
with each other and that's wheresexually transmitted infections
are happening.
But we know that we're aspecies just like any other
species and sexual relationshipsare part of the propagation of

(05:25):
the species.
Right, this can happen anywherealong the lifespan, and what's
happening in especially elderpopulations as the population
ages, more people are movinginto group living situations,
and it's not something thatpeople are always comfortable
talking about or thinking aboutis that elder people are still
sexually active, or thinkingabout is that elder people are
still sexually active.
We've developed a variety ofinterventions that help

(05:48):
potentiate the sexual lives ofpeople into their 70s, 80s and
90s.
There are some drugs to helppeople to achieve erections when
the natural propensity toachieve erections goes away and
people move into group homes andthey form relationships and
maybe they don't use protectionbecause they're not worried
about getting pregnant.
And so it is actually inelderly populations that we do

(06:11):
see spikes in risk for sexuallytransmitted infections.

Speaker 4 (06:16):
Yeah, for sure, for sure, and I think sort of what's
interesting to think about thisis that I do think sort of the
ecology of how these infectionsare transmitted has changed,
probably even within the last 25years, with the rise of like
hookup apps and just anaccessibility to like casual sex
culture that certainly likecasual sex cultures are always
been there, but it's changed andit's altered, like people's

(06:38):
accessibility to that and justalso the normalcy of it, and
that most young people areactive on these apps and
protection isn't often somethingthat's talked about, or even
just knowing the status of yourpartner.
And I think something that mightalso be unique to the United
States that we've never reallygotten into on the podcast is
that we have a very interestingway of covering healthcare costs

(07:00):
here in the US.
That's very kind of unique.
You know money moves throughdifferent pathways.
I know that there are someinsurances will only cover STI
testing once a year, and sopotentially for people that are
trying to be responsible and ifthey're changing partners are,
getting STI testing once a yearmay not be that often for them,
and so not having it covered byinsurance is also an aspect that

(07:23):
I think can definitely becontributing to it and also just
the normalcy of are we testingfor these?
And I think there's a lot ofstigma about talking about it,
which is why we're doing apodcast episode on it.

Speaker 2 (07:34):
Yeah, I think you mentioned a lot of different
things, camille.
One of the things I think weget real excited about kind of
new things the dating apps.
Stis have been with us reallysince the dawn of man, right.
These pathogens startedappearing from ancient Egyptian
times.
There were documentations ofpeople suffering from symptoms
and signs of sexuallytransmitted, various types of

(07:57):
sexually transmitted infections.
There's stories of some of thegreat composers of music
suffering from and even dyingfrom likely prematurely from,
sexually transmitted infections,given the nature of their work
and where they.
So I think, yes, we want to besensitive to the change in
conditions that may be drivingthe spread of sexually

(08:18):
transmitted infections,especially as we've seen over
the last five years, a prettyhigh, I think.
For me, it's less aboutsexually transmitted infections
have been with us forgenerations.
I think what's very interestingare the particular conditions
that we find ourselves in now,and I think it's some of the
things you've mentioned theeducational part, the preventive

(08:40):
behaviors, the cultural aspect,the potentially the prohibitive
cost of detection or testing,health-seeking behavior.
I think we can't point to onething and say that's the smoking
gun, it's the dating apps,that's what's doing it.
It's the old folks' homes,that's what's doing it.
It's the focus onabstinence-only education.
That's what's doing it.

Speaker 3 (09:01):
It's always an amalgam of all of these things,
plus the sort of natural cadenceof what these pathogens do
throughout society althoughinitially the STIs went down in

(09:27):
the beginning of the pandemic,things have changed quite a bit
due to COVID, and so thepandemic actually helped with
the increase or the surge of theSTIs right.

Speaker 5 (09:35):
Yeah, we were looking into this and it really looks
like there was a disruption ofSTD services during the pandemic
.
That really contributed a lotto that.
Additionally, there was areallocation of resources right,
everybody was focused onCOVID-19 instead of anything
else.
Then there was a decreasedtesting associated with that and
then, in addition, there wasincreased test positivity.

(09:56):
So what that means is thenumber of tests that we did have
.
The proportion of those teststhat were positive was higher.
So what that means is thatpeople were tested because they
were symptomatic, right, and sowe went from a screening
philosophy to testing only whenpeople were symptomatic, because
we had this reallocation ofresources and this disruption of

(10:19):
STD services.

Speaker 2 (10:20):
I love that you mentioned that, caitlin, because
you know I think we can'temphasize that enough.
I think there's alwayssensationalization of the
numbers, right, and you have totake into account what were we
doing before the pandemic andthen what we're doing during the
pandemic and that we're redoingafter.
Tell us that people who areunder the age of 24, who are

(10:43):
sexually active, should bescreened regularly for sexually
transmitted infections.
We know that everybody shouldhave the right to at least one
HIV test.
Sexually active people shouldprobably get tested pretty
regularly and there arepopulations over the age of 24
or 25 that then would getscreened.
But, as you mentioned, duringthe pandemic, fewer people going
for routine screenings, muchless focus on those routine

(11:07):
screenings and we saw a lot ofother conditions in the US start
to become a little bit more outof control because we were so
focused on COVID-19.
I think we're only now startingto see the sequelae of those,
of those interventions.
Of course, emergencyinterventions were needed during
the emergency.

Speaker 4 (11:27):
Oh yeah, I just want to touch a little more on that
point and I just want to saythat I think that that's
absolutely right.
We haven't quite found out whatall the side effects of COVID
has had on the rest of ourhealth system.
We're still sort of unravelingall of that.
But I think what's interestingthat I just want to make a note
of here, like early in thepodcast, unraveling all of that
but I think what's interestingthat I just want to make a note
of here, like early in thepodcast, is that a lot of times
when anyone in the infectiousdisease field or in the public

(11:49):
health field talks about STIs,they're talking about linking it
to promiscuity and that's notreally necessarily true.
It can be, but certainly a lotof these diseases might end up
being like silent infections.
People might not know and it'sprobably not the norm for people
to ask for necessarily theirpartner's sexual history, even
though it could be right andthat's something that could

(12:10):
change and that's something that, if it did change, would help
people maintain their health.

Speaker 5 (12:14):
I have a question for Matt about that, about the
promiscuity idea, because I'mwondering if, in your practice,
or maybe back in medical school,did you learn that the number
of sexual partners is a riskfactor, right?
So then, as a clinician, whatdo you think about?
How do you think about that interms of promiscuity?

Speaker 2 (12:33):
Yeah, I think that's a great question.
For me, I think even the wordlike promiscuity has this sort
of stigma attached to it and Ithink has this sort of stigma
attached to it, and I think wehave a tendency in society to
stigmatize sex.
It's like this thing that weshouldn't talk about.
We shouldn't do it unless we'rein very ideal circumstances.

(12:55):
But it is a natural behavior,right, and so the way I approach
it is that everybody gets asexual history.
We talk about it, and whetherwe are a young person, a
middle-aged person or an oldperson, people tend to be
nervous about talking abouttheir sex lives.
They feel that the system orthe clinician is going to judge

(13:16):
them.
They feel that if they'reengaging in sexual activity,
they're doing something wrong.
This is a problem, right, andthat limits our ability to
engage in good public healthpractice as clinicians, because
then we're not able to applywhat we know from the
epidemiology in the clinicalpractice.

Speaker 4 (13:37):
I think that's absolutely so.
True, those are difficultconversations to have.
It's like having conversationsabout mortality, and I say it's
like there's like thisresistance to talking about it,
and I think, though, that isfair to say, that there is still
like stigmatization occurringand people don't necessarily
know when that's going to happen.
I can think of a very closefriend of mine who's gay and is

(13:57):
not promiscuous in any way, butcontinue to go to like one
healthcare provider, and when hechanged partners would get STI
testing, and he was told that hewas high risk, he wasn't being
promiscuous, he was usingprotection, he was just having
the testing done because hewanted to know his own health
status, and that definitely canget bound up in emotional

(14:18):
reaction of being judged, and Ithink that these things do still
occur, particularly in certainpopulations.
There's this judgment on thetype of sex that's happening.
So I think that's a really goodpoint.

Speaker 2 (14:29):
Well, I think one of the things that we have to
emphasize, then, is that part ofharm reduction, right part of
we're not going to stop peoplefrom having sex.
It's a thing, it's going tohappen.
So what we have to do is wehave to create environments in

(14:52):
which people feel comfortablesharing details that can
sometimes feel reallyuncomfortable, right, and that's
about the training that weoffer to our clinical students,
the opportunities that we createfor them to practice those
skills, and creating the type ofenvironment for the people we
take care of, where they feelcomfortable.
I've taken care of young people, taken care of elderly people,
I've taken care of same-sexcouples, I've taken care of
hetero couples, and theconversation is always the same.

(15:15):
It's a very open conversation.
People should feel comfortablesharing those things with their
clinician.
They should feel like that's asafe space.
They should not feel judged.
They should feel that becauseif we don't have the information
, if we don't know what ishappening, where it's happening,
with whom it is happening andthe various mechanisms in which

(15:35):
it is happening, we actuallycan't have a conversation about
the potential risks and help ourpatients make good decisions.

Speaker 4 (15:42):
I feel like that could be a good goal though
no-transcript For sure, and Ithink, jumping off that,
expectations around what medicaleducation looks like, what good
health care looks like, arealways shifting and I think
what's interesting I had notthought about this until a
friend brought it up with me,but we do have every year.

(16:02):
Most women are encouraged andmost of the women I know go to a
well woman visit and that'softentimes like the place where
that conversation happens forwomen, because you're already
like in a super uncomfortableenvironment getting a pelvic
exam.
So it's what's the conversationon top of that, but there's not
really a male equivalent forthat of like, here's your yearly
visit where, like, you're giventhe opportunity to talk just

(16:25):
about sexual health, and so Ithink it's interesting, that's
also a norm that I think itwould be a really exciting to
like shift towards that.
Everyone got that kind of care.

Speaker 2 (16:40):
Yeah, at least in my experience and I think the data
support this men will talk aboutit a bit more freely and men
will talk about it when there'ssomething wrong.
They don't necessarily talkabout it if there's nothing
wrong, right, and if there's notsomething happening.

Speaker 4 (16:49):
But if something's wrong, aren't we already a lot
of times like too late, right,Because we could?
We have so much potential for aconversation around like
prevention, rather thanconversation around here's what
we have for something that'smaybe antibiotic resistant.
Or here's what we have forsomething that's viral that like
we can't cure you of.

Speaker 6 (17:04):
Or, at the same time, like I think Dr Cotter brought
up, you're testing for somethingthat's already symptomatic, you
know what I mean?

Speaker 2 (17:15):
Versus actually preventing the proliferation of
that infection, and that'soverall what we want to do,
right, yeah, and I think thatsort of speaks to the broader
issue which we were talkingabout a little bit earlier,
which is that it's not just whathappens in the clinic.
If you're in the clinic and it'sthe first time someone is
hearing about these things orhaving a conversation about
these things, as a public healthsystem, we've failed.
We were talking about sexeducation and destigmatizing

(17:38):
things.
I mean, the way thatinformation is presented is also
part of the public healthsystem.
There was a time where Iremember, when I teach about
public health to our globalhealth students, I would show a
picture of a like an olderposter, like a public health
poster, where it would showsomeone engaging in potentially

(18:02):
high-risk sexual activity or aperson with whom they might
engage, like a commercial sexworker or something, and say,
hey, you better get tested.
If you're frequentingcommercial sex workers, you
should get tested.
Right, it was just hey, this isa thing that happens, this is a
thing that people do.
If it's done, hey, this is apathway for you.

Speaker 4 (18:21):
Yeah, and I think I want to jump off that on, the
information people have accessto is also changing and that's
potentially also driving thissort of rise that we see in STIs
.
And something I can think aboutis there's research that the
best interventions for healthdon't necessarily occur in a
hospital, right Like they canoccur in other areas, like
whether that's education throughyour schools, whether that's
you attending here from UTMB.

(18:42):
We have different, they're likePsy Cafe talks, and I just
wanted to touch on briefly that.
Something that's really been onthe rise that might come back
to bite us later from a publichealth perspective is that
there's been a lot of movestowards banning books, and
that's banning people's accessto information that might be one
of their only sources ofinformation, and I just wanted
to talk about that.
A lot of the times these arebooks that are targeted towards

(19:05):
talking about bodies or talkingabout sex, and like books that
have been banned in Texasinclude like Safe Sex 101, an
overview for teens, and thenanother that's been banned is
Taking Responsibility teen'sguide to contraception and
pregnancy.
Neither of these and I read alot of books.
I'll be honest, I haven't readthese two, but I did look into
them, and neither of them lookedto me like things that are in

(19:25):
any way something peopleshouldn't have access to,
particularly if it's a youngperson who might not be
comfortable having theseconversations with their parents
, and they might not necessarilyhave regular access to health
care that family isn't presentat, so they might not have
someone to talk to and they needa route of information that
maybe isn't the internet.

Speaker 3 (19:42):
But, camille, what you said earlier, it sounded a
little bit contradictory to me.
You said we have greater accessto information nowadays through
the internet and so on.
Right, you can read any bookonline and access any book
online if you want to.
Exactly, yeah, but you get mypoint right, but so if we have
better access to information,shouldn't the people be more

(20:05):
informed?
And it could cause the oppositeand a decline in STIs.

Speaker 4 (20:10):
I would say that access to good information like
you have access to everything,right, but you have access to
all kinds of things and sortingout what's good information,
what's not, is, I think,something that we shouldn't put
that expectation on young peopleLike I think that's a really
difficult thing to say and youmight have more access, but even
like these two books likethey're paywalled right, like

(20:33):
you need to buy them.
Does a kid have 25 bucks to buythem?

Speaker 5 (20:37):
I think it's difficult for a child to know
that they should learn aboutSTIs True.

Speaker 4 (20:42):
Why?
Yeah, because it's not talkedabout.

Speaker 6 (20:44):
And I will just say, access does not necessarily mean
understanding.

Speaker 5 (20:48):
Yeah.

Speaker 6 (20:48):
So you might have access.
You have access to the entireNIH database.
That doesn't mean that Iunderstand everything that's
going on there, that's true.

Speaker 4 (20:55):
And I can remember like I was given books like this
by my parents and I canremember like how useful they
were and it explains everythingfor like all the cycles for like
puberty and things like that,and it was so useful to like
have that as a kid.
But I was also very fortunateto like have parents who were
willing to give me somethinglike that.

Speaker 2 (21:12):
Sounds like you were raised in the Northeast.
You would be correct.
Oh, I mean, I was raised in theSouth and I got the same books.
But I think to your point.
I think it is important.
Public education is important.
When I ask people, when we talkabout public health, we say
where did you learn abouthealthy behaviors?

(21:32):
Where did you learn about safesex?
Where did you learn aboutcondoms or about your body
changes or about differentsexual behaviors?
Right, I mean, some peoplelearn from their parents, some
people learn from books, somepeople learn from school.
Right, there's mandatory healtheducation and public education

(21:56):
education, and then some people.
Now there's any number ofplaces that you can go to find
information that some of it maybe woefully inadequate and
inaccurate.

Speaker 3 (22:01):
But, matt, I would argue, a lot of people also
learn from friends.
Yes, your social groups.

Speaker 2 (22:08):
No, absolutely no I agree with you.
And so that's where I think, ifwe are being thoughtful health
care practitioners, if we'rebeing thoughtful of public
health workers and we'rethinking about what that
ecosystem looks like, we'rethinking people are not all
getting the same information andthe system needs to address

(22:29):
this problem dispassionately.
Problem dispassionately this isnot a the system, the public
health system of prevention doesnot need to further stigmatize
or add labels to these, to thebehaviors or to the disease.
We know that pathogens arethere, we know that they have a
mechanism of transmission and weshould design
epidemiologic-basedinterventions that address those

(22:50):
risks.
And that's it, full stop.
It's not our job to legislatethe ethics or the morality of
different behaviors.
It's our job to legislate goodpublic health.

Speaker 4 (23:03):
Yeah, and a lot of this in the US gets bogged down
in morality.
I remember I think you said itin a class that a public health
campaign based on fear and shamenever, ever works, and we still
haven't necessarily picked upon that everywhere, like in some
places, absolutely, there aregreat and I don't want to
disparage that like there arepeople working to make our

(23:26):
communities healthier and doingthe best they can with that, but
there are definitely a lot ofissues with censoring people's
access to information or biasingthat information towards.
This is my viewpoint and it ismorals based, and so this is
then what you think is theepidemiologic reality.

Speaker 5 (23:43):
I'm curious how is this information shared,
especially information onsexually transmitted infections
in Germany?

Speaker 3 (23:51):
From what I heard from you guys, I think it's
similar.
Right, we have sex ed in school.
I don't know what grade it was,but it's like the basic classes
, but it also depends on whatyour parents tell you and circle
of friends and so on.
So I think it's very similar.
But I feel and this is mypersonal opinion right Growing

(24:13):
up in Europe and then moving tothe United States, the morality
aspect here is much greater.
In the US, we all know thatthere are certain taboo topics
that you don't talk about and Ihad to learn this as a European
that you don't talk aboutpolitics, you don't talk about
sex, you don't talk aboutreligion.
In the US and in Europe it'sless stigmatized than it is in

(24:39):
the US.

Speaker 2 (24:40):
I think that's really pretty important because and
thanks for that, caitlin, forthat kind of entree because I
think one of the issues that weface as we're seeing rates of
these STIs go up, we're seeingmore syphilis I'm sure that
Camille is going to tell us alittle bit about the specific
diseases in a minute but thatwe're seeing more and more of

(25:01):
these things now, and some ofthat is related to issues with
healthcare access and resourceallocation.
From the pandemic Saw itglobally, by the way, with TB
issues.
With TB, we had more MDR, wehad more uncontrolled TB during
the pandemic because fewerpeople were accessing those
services.

(25:21):
But I think, from our side,mixing the morality and the
stigma is only causing things toget a little bit worse, and so
it's really on us to figure outhow we reverse that trend.

Speaker 4 (25:34):
Yeah, let's talk about things getting a little
bit worse.
Let's talk about specificinfections.
Syphilis is actually the onethat really inspired this whole
episode.
I was shadowing in aninfectious disease.

Speaker 2 (25:43):
clinic Syphilis is inspirational.
Is that what you're saying?

Speaker 4 (25:45):
It was for this.

Speaker 2 (25:48):
That's spirochete.

Speaker 4 (25:52):
I was shadowing in an infectious disease clinic and I
got talking with a couple ofthe docs there and so I did not
know this.
I don't know that it'snecessarily talked about, but
according to the CDC, syphiliscases have increased by 80% from
2018 to 2022.
So in the United States we havethe highest case numbers of

(26:13):
syphilis since the 1950s, whichis absolutely wild If you think
about the 50s versus now.

Speaker 2 (26:21):
We were all in black and white.

Speaker 4 (26:23):
I mean Like that was pre-internet, that was yeah, it
was pre-colored TV.
So I mean, imagine everythingwas in black and white back then
yeah, so what that was alsolike before we got to the moon,
right?
So like yeah, like, I mean, likethis was you know some time ago
, but that's where we're at nowwith case numbers and I think

(26:43):
that's absolutely wild.
So just briefly, syphilis is asexually transmitted bacteria.
Unlike a lot of other sexuallytransmitted bacteria, it is not
antibiotic resistant that I knowof.
It's actually quite susceptible.
So it's pretty wild that we areseeing this rise.
You know it's bad when largepharmaceutical companies are
like, hey, this is bad.
Pfizer, which is a majorpharmaceutical company, you

(27:03):
might know them for making COVIDvaccines and all kinds of other
stuff.
Viagra, yeah, making Viagra,okay, they're part of the
problem.

Speaker 2 (27:12):
They're part of the cause and the solution.

Speaker 4 (27:13):
But in fact, pfizer blamed the penicillin shortage
on soaring syphilis cases in theUnited States.
So I think that's pretty wildthat we've gotten to this point
that syphilis is back to theselevels, and I don't know that
people necessarily think about,but that syphilis can be
congenital, and so 24.9% ofcongenital syphilis cases in the

(27:35):
United States in 2022 occurredin Texas.
Okay, that's almost a quarter.
That is a really high amount.
So, particularly in Texas,we're not keeping up on this.

Speaker 2 (27:44):
Yeah, and it's a really hard one because it can
be very subtle and the initialpresentation it's usually a
shank or it's a sore, but thenthat goes away.
So if someone can ignore it andsay this thing is kind of ugly,
but then it starts to get better, say maybe it was just a skin
infection and maybe it was justlike a rash or whatever, and

(28:04):
then it goes away.
And then some weeks later comesanother rash and they're like
maybe add a little reaction tosomething.
It's just very easy to ignoreit, right?
Especially if you don't want tobe looking for it and if you're
worried about it.
And of course, then you canhave the sequelae that's primary
and then secondary and thentertiary.

(28:25):
Syphilis is the neurosyphilis.
This is the one that getseverybody worried.
That's where behavior changes,encephalitis, blindness, all
kinds of of things, and that canbe years to decades after the
initial infection can I jump inwith an interesting pop culture
reference here?

Speaker 4 (28:40):
yes, fun fact or not.
So fun fact for al capone isthat he was actually sprung from
alcatraz because of hiscomplications with neurosyphilis
.
His wife made a case that heshould be essentially released
early, and they did release himbecause of his complications
with neurosyphilis.
His wife made a case that heshould be essentially released
early, and they did release himbecause of his complications
with neurosyphilis.
So certainly if it goesuntreated does not do good

(29:01):
things for the central nervoussystem.

Speaker 2 (29:03):
Camille, the number of famous artists that were
likely sufferers ofneurosyphilis is profound.

Speaker 4 (29:14):
I can imagine.

Speaker 2 (29:15):
You know, some of the great composers, like Schumann,
Schubert, were suspected tohave syphilis.
We were talking earlier aboutScott Joplin, the king of
ragtime, who cut his teeth inbrothels because that's where
jazz was being created and thesewere the environments, and so
these were environments in whichthe pathogen could circulate

(29:36):
very, very easily.
So a lot of artists and thenterrible people like Adolf
Hitler was suspected to also besuffering from syphilis.
So yeah, throughout history,some of the people we think of
as big figures also suffer fromthat condition.

Speaker 6 (29:52):
Yeah, and I think that it's really important, matt
, to speak about what you weresaying, how syphilis itself kind
of waxes and wanes throughoutthese phases, and so it becomes
really difficult to test forsyphilis at times, right Until
it gets to those laterprogressions and those more
dangerous phases.
I actually had no idea until Ientered medical school that

(30:17):
pregnant women are actuallypreemptively screened for
syphilis as well as chlamydia,gonorrhea, hiv and hepatitis I
think it's a mix of those and itdepends, obviously, state to
state what's actually required.
But they're tested for theseinfections because of the

(30:38):
devastating effects that theycan have on the fetus or on the
child, as the child is beingbirthed, and syphilis is
particularly one that is prettyintense and the manifestations
in the newborn are prettyintense.
Just some of the things thatcongenital syphilis can cause in
a newborn is blindness,deafness, deformities of the

(30:59):
skeleton and also of the face,and then also nervous system
complications.
And I think it's important tonote that, while infections like
chlamydia and gonorrhea aretransmitted to the fetus via
vaginal delivery, syphilisitself is an infection that can
be transmitted transplacentally.
So if the mother is in a partof the world or in an area where

(31:22):
she's not tested, or let's sayshe doesn't have access to
prenatal visits and well woman'shealth care throughout her
pregnancy, and she's not testedfor this.
It's very easy to pass thatinfection on to her unborn child
, and so it just shows howimportant it is to be testing
frequently, and screeningfrequently, because it not only

(31:44):
affects the person and theirpartner, but it can also have
effects on a lot of other peopletoo.

Speaker 3 (31:51):
So, christina, for the listeners that probably
don't know what congenital meansor what placenta means and so
on, can you explain how thedisease is given from the mom to
the baby and especially thetiming?
When does the mom get infected,when does the baby get infected
?
And in rough terms, right Likeso that people can understand?

Speaker 6 (32:12):
I don't know if I know the specifics so much with
the timing.
I think I know in general thatlater the mother is infected
with syphilis.
So you want to do an earlytesting for syphilis and then
you also in the third trimester,want to do another testing for
syphilis, because the later theinfection with syphilis
apparently in the pregnancy, themore detriment it can do to the

(32:33):
fetus, which I didn't know.
Normally it's vice versa.
Normally the fetus itself isvery susceptible to infections
and to devastating effects byinfections in the earlier stages
.
But from what I think I read infrom Mass General, it's vice
versa with syphilis.
So transplacental infectionessentially means that, okay,

(32:53):
let's picture this Baby andmother is within a little pouch
and that pouch is in the uterusand that pouch is the placenta.
I hope I'm saying this right.
Okay, you're doing great, great.
Not a lot of infectiouspathogens can actually cross
this pouch and also not a lot ofantibodies but that's for

(33:14):
another day can cross this poucheither.
However, some really bigbuggers and syphilis just
happens to be one of them cancross the pouch.
And when it crosses the pouch,that's when it can really do
damage to this developing life.

Speaker 2 (33:28):
Yeah, and it tends to be sort of a slate of different
pathogens that can traversethat boundary.
We've talked about them in aprevious episode about the torch
infections and hopefullyChristina has them all memorized
and written down for her stepexams.
But we know that there are someof these pathogens that can

(33:49):
cross the placenta and causethese problems in the fetus.

Speaker 4 (33:52):
Yeah, so I think I want to get into another
infection that we are.
Are we done with syphilis?
We are.
Is there more syphilis to talkabout?
Any more syphilis facts?
No, I don't have any more funfacts on syphilis.

Speaker 2 (34:04):
I think the only thing we've left is, especially
in certain populations we'reseeing a much greater rise,
especially men who have sex withmen and other populations where
there may be more multipleconcurrent partnerships and
things like that.
And one of the things we talkedabout was whether
well-intentioned interventionsto reduce the risk of STI

(34:26):
transmission, like PrEP, rightpre-exposure prophylaxis for HIV
, have potentially increased thenumber of people who are having
unprotected sex and with morepartners and in more of a dating
app culture and the bars areback open and everything
post-COVID.

(34:47):
Now nobody's thinking about itbecause all of the funding for
education and for outreach todetect these things is down.
So multifactorial situation.
But I think especially in thosepopulations syphilis is being
seen to a much greater degree.

Speaker 4 (35:02):
For sure, and that's actually what I wanted to get
into next.
So PrEP for our listeners whoaren't familiar with it,
pre-exposure prophylaxis, yes,and so what it does is basically
reduces your risk of acquiringHIV.
So it's something that came out, I believe, in the early 2000s,
and since then there has beenthis question that you brought

(35:22):
up of.
Is this potentially increasingother infections because people
feel more comfortable or safer,because they feel that they're
protected from HIV, and so HIVis something that I think people
the world over are reallyfamiliar with by now.
Viral infection can betransmitted by sex, blood,
breast milk, but what we'reseeing in the United States,

(35:43):
where we're seeing new cases ofHIV, is dependent on where you
are geographically.
So 49% of new HIV cases in theUS in 2022 occurred in southern
states.
That includes Texas.
All of those factors we talkabout that are contributing to
the rise of STIs are likelydriving HIV, which is

(36:04):
preventable with PrEP or withsafe sex practices or just with
people knowing their status.
Probably you've been in an ER.
They've asked you if you wantedlike an HIV test or at least
they ask in Northern states.
Like anybody who walks in, itdoesn't matter if you're walking
in for an allergic reaction.
You've broken your arm.
They're like would you like tobe tested for HIV?
I've never I've been to an ERdown here and I don't think they

(36:26):
ever asked, but up there theydo.

Speaker 2 (36:27):
It's happening.
It's definitely there's more ofthat happening of HIV screening
taking place in emergencysettings.
But you're right on, camille.
I mean the HIV research worldis always about prevention,
right.

Speaker 4 (36:40):
Oh yeah.

Speaker 1 (36:41):
Or mitigation yeah.

Speaker 2 (36:42):
And people have been trying to study PrEP for a long
time.
It's really only in the lastfive to 10 years that there has
been really solid data that PrEPworks when deployed at a
population level.
And it's become very commonplaceto see PrEP and for people to
be looking for PrEP, and it'snot just for men who have sex
with men, it's for anybody whomight be at increased risk and

(37:05):
it's something that anybody whois sexually active that is
thinking to have sex withmultiple different people in
given years it's something thatpeople should ask about because
it is extremely effective.
It's a very good, effectiveintervention to help mitigate
HIV transmission, as istreatment.
So treatment is prevention.

(37:25):
We learned that in the last 15years that when people get their
viral load suppressed, whenthey get their CD4 counts up,
the risk of transmission goesdown profoundly, you know, by
between 90 and 95%.
When people are well controlled, it's harder for them to
transmit this.
So all of these things, it'snever one thing right, it's all

(37:46):
of those interventions together,taken as an amalgam, that help
impact the health population.

Speaker 4 (37:52):
Yeah, and I work in a lab that we do substance use
research but also HIV research,because those are comorbid
issues in the United States atthe moment and I just think it's
so important to point outbecause I feel like people don't
know this.
The CDC actually recommendseverybody anybody get tested for
HIV at least once in theirlifetime.
It's not just if you feel atrisk.

(38:13):
They recommend it for anyone atleast once, just their lifetime
.
It's not just if you feel atrisk, like they recommend it for
anyone at least once, just toknow your status, and so it's
not in any way linked to whatthey see as just like sexist
anymore.
It's anybody get tested once.
So we're doing an STI episode,but just worth throwing out
there.
That's the public healthrecommendation.

Speaker 2 (38:29):
So I like it.

Speaker 4 (38:31):
All right, let's talk about a infection that's
ubiquitous.
I'd be curious if people canguess what this is.
According to the CDC, nearlyevery sexually active person
will get this infection at somepoint in their lives.
Do we have any Jeopardy buzzers?
What is HPV?

Speaker 5 (38:48):
The human papillomavirus.

Speaker 1 (38:50):
The human papillomavirus.

Speaker 4 (38:52):
So HPV is a viral infection spread by sex that can
cause cancer and really thedrive to prevent it is really to
prevent the cancers that thisinfection can cause Anyone who's
ever had a pap smear.
Really, what they're lookingfor is, like coelocytes, so
they're looking forabnormalities, so they're
looking for cellularabnormalities, but you're

(39:13):
looking specifically forcoelocytes, which are these
cellular abnormalities that youget around the cervix when
someone has had an HPV infection, and we test for those because
we are trying to prevent cancer.
But there's now a vaccine forHPV.
It's not new.
I say that like it's new.
It's not new.
I remember getting this vaccinewhen I was 11, I believe.

(39:34):
So it's been out.
Yeah, it's been out like atleast 10 years.
It's been out a while.

Speaker 2 (39:39):
Yeah, dennis and I are looking at each other
because we were too old by thetime the vaccine came out for us
to get it.
Otherwise, I think we wouldhave probably both wanted to get
it, because we love vaccines.

Speaker 1 (39:49):
Yes, all vaccines.

Speaker 4 (39:51):
I love all vaccines.

Speaker 2 (39:51):
I tried to find an excuse to get it.
You can get it up to the age of45 with certain risk factors.

Speaker 3 (39:58):
So maybe next time we see each other we'd say hey,
what's the latest vaccine yougot?

Speaker 2 (40:08):
Exactly.
I have something I want to sayabout HPV.
A lot I want to say about HPV.
It is the most common sexuallytransmitted infection.
It is across species, so it hasmanifestations in many animals,
including humans.
There are animal transmittedpapillomaviridae and there are
human transmittedpapillomaviridae.
That's the HPVs there are.

(40:28):
The reason that it becameextremely important is because
this became a vaccinepreventable cancer, right, and
that's why it's so important.
Is because this became avaccine-preventable cancer,
right, and that's why it's soimportant.
There was a time where peoplewould get cervical cancer,
they'd get oropharyngeal cancer,nasopharyngeal cancers, some

(40:49):
actually skin cancers that arerelated to HPV, and there was
nothing you could do about it.
But now there's a vaccine.
If you get the vaccine, youreduce profoundly your risk of
getting a particular type ofcancer, which is amazing.
If you told people 30, 40 yearsago, hey, if you get this
vaccine, you're going to reducethe risk of cancer.

(41:10):
It's amazing, right, and it'sone of those amazing
technological advancements Ithink we've made.
And it's not just cancer.
It's not just cervical canceror penile cancer or
oropharyngeal cancer, but it'salso certain types of warts
venereal warts, skin warts.
Most of the warts that you seethat people get that are on the
fingers or on the body areactually HPV.

(41:32):
So they're all some subtype ofHPV and the majority of the
types that both cause cancer andskin warts.
Venereal warts especially, arecovered by the vaccines that are
commercially available and thatare recommended for young
people and adolescents.

Speaker 3 (41:49):
So, Matt, as a virologist, I have to ask you a
question.
It sounded like when you saidpapillomaviruses are
cross-species, but I think whatyou want to say is that there
are papillomaviruses for everyspecies, but they're normally
very species-specific, just likepox viruses for example yes,
absolutely.

Speaker 2 (42:08):
Yeah, so a bird species can spread a bird
papillomavirus.
It infects the skin cells andso it causes them to heap up and
replicate, and there's a whole,probably other episode you
could do just aboutpapillomaviridae.

Speaker 5 (42:24):
Because I know that you guys like to talk about One
Health a lot and you like to mixmessages or talk about the
interdisciplinarity betweenveterinary medicine and human
medicine.
Any listeners out there withpuppies that go to a dog park
and then the dog ends up with alittle kind of cauliflower piece
of tissue on its lip or gums?
That is papillomavirus.

(42:44):
It's really not dangerous,though.
What you can do is actually goto the veterinarian and they'll
physically take it off and thenthe immune system will take care
of it and it'll go away.
So interesting.

Speaker 6 (42:58):
Is that DPV Dog?
Oh my gosh, that's funny.

Speaker 4 (43:02):
Something I do want to mention about the Gardasil
vaccine, though you touched on,but just to make it really clear
to anyone who's listening isthat it's a fantastic vaccine,
but it's most effective whenit's given before someone is
exposed to the virus and, as Ipreviously stated, at least
according to the CDC, nearlyevery sexually active person
will get HPV at some point intheir life.
So it works best when you catchpeople before they become

(43:25):
sexually active and are exposedto HPV.
So that's why this vaccine isrecommended for 11 to 12 year
olds.
That's why I ended up gettingit when I was 11.
I think it was two or threedoses, but that's why it's given
so young.
It's because it's mosteffective but again, prevents
cancer.
That's so cool, it's fantastic.

Speaker 2 (43:41):
And it's not just girls, it's boys too.

Speaker 4 (43:42):
Yes, my brother got it same time as I did.

Speaker 2 (43:49):
They lined us up and they were like here's a huge
dose.
And again it's one of thesewhere the episode.
But about 58.5% of eligiblepeople are vaccinated, which is
great, and that means thatthere's about 41.5% of people in
the state that are notvaccinated against HPV.

Speaker 4 (44:07):
And essentially every single one of them will be
exposed.

Speaker 2 (44:10):
Yeah, it's the most common sexually transmitted
infection worldwide.
The most common.

Speaker 3 (44:15):
All right, and I think one of the issues with and
I think that you were trying totouch on that is, I think, if
you bring up the topic ofgetting vaccinated, I think you
bring up the topic of beingsexually active and I think
that's why so many parents areagainst it, right?
I don't know if that's genderspecific, but it seems like not

(44:37):
a lot of boys get the vaccinecorrect.

Speaker 4 (44:40):
I didn't look into males versus females on who gets
vaccinated.
I remember getting it at thesame time as my brother.
They just lined us up in thepediatric thing.
They were like here's your shot.
But I think people can behesitant and that's something we
see around many vaccines in theUnited States and there's a lot
of reason for that, butcertainly everything we talked
about earlier on what's drivingthis rise in STIs in the United

(45:01):
States.
A lot of it is that peopledon't want to talk about it.
But this is something thatanyone who's sexually active is
pretty much guaranteed to getand it prevents cancer and I
think it doesn't really getbetter than that.

Speaker 6 (45:14):
Absolutely, and I think, dennis, just like going
towards what you were talkingabout, I feel like a way that
we're making the topic of theHPV vaccine more accessible to
parents, or at least presentingit in a way that is more
acceptable, is also by justexplaining its other benefits.
So, for example, I spent alittle bit of time working in a

(45:37):
dermatology clinic recently andwe saw multiple children who had
presented with hand warts Supercommon, very common and with
each one of those parents andthose children we had a
conversation about the Gardasilvaccine, because not only does
it help prevent the sexuallytransmitted HPV, does it help

(45:57):
prevent the sexually transmittedHPV, but it also has a cross
effect, apparently, withproviding at least increased
immunity towards other strainsof HPV, like Matt talked about
that are passed through justphysical contact, right, and
that's what causes those handwarts.
So by maybe relaying the otherbenefits that the vaccine could
potentially have, that we couldopen up the conversation a

(46:19):
little bit more with parents andjust try to get them to feel
more comfortable with the ideaof setting their children up for
success in the future andpotentially avoiding something
that could be life-threatening.

Speaker 2 (46:31):
The first HPV vaccine only prevented against two
subtypes and it was four.
Now it's nine Gardasil 9.
So Gardasil 9.
And that encompasses both thecancer-causing ones and the
skin-worked-causing ones.
All right, what's next, camille?

Speaker 4 (46:47):
Yeah, so let's talk briefly about MPOX, because
that's something we're seeing inthe news and we are a One
Health podcast, so it's alwaysimportant to talk about, like,
how infections move around, andso I think that, briefly again,
another virus we're talkingabout spreads through close
contact.
That can include sex, but notnecessarily, and this is one of

(47:08):
the diseases that we've seenarise and because of our global
interconnectivity, so previouslyit was endemic only in certain
places, but we're seeing itspread and I know the WHO just
put out that this is somethingto be mindful of globally.
And what's interesting is we dohave a vaccine, but there's
certainly been issues getting itinto places that need it, which

(47:29):
is not a new narrative.
We saw that with COVID.
We certainly saw that withother aspects, but I just wanted
to briefly bring that one upbecause I think it's important
to talk about, because I thinkthere is a lot of fear mongering
around any sort of new diseasethat we see and it's not new,
but maybe new in certain places.

Speaker 2 (47:46):
Yeah, From my end.
I think when we had the initial2021, 2022 outbreak, I think
there was a very good publichealth campaign to vaccinate
populations that were atincreased risk and then there
was a very good public healthcampaign to vaccinate
populations that were atincreased risk and
epidemiologically those were,you know, men who have sex with
men, other folks that might haveincreased sexual contact,

(48:10):
skin-to-skin contact.
What's interesting about themost recent experience with
clade 1b, which is the cladethat's now emerging I think
that's the whole issue is thatthis is a more virulent strain
and it's crossing populationsand they've now found it outside
of where it started tooriginate, in DRC.
There's been cases in Swedenand some other countries as well

(48:33):
.

Speaker 3 (48:33):
In some other countries as well.
The way I understand it is thatclade 1b has been endemic in
the DRC for a long time for atleast two decades, maybe longer
than that and that is the morevirulent, the more aggressive
one.
But the outbreak that we saw in2022 was clade 2b, which is the

(48:54):
less virulent one, and that'swhy it was able to spread,
because the symptoms are subtleand it's more.
I think, from what I understand, it's also the what do you call
it?
the postules, what do you callit, that you see, are more
localized in the genital regionand not more visible in any
other part of the body.

(49:15):
That's why it was able tospread more in certain groups of
society, but the outbreak thatwe've seen now is the clade 1b,
which is the more virulent one.

Speaker 4 (49:27):
All right, yeah, that's really all I want to say
on mbox.
Any kind of closing thoughts onwhat we can do to reduce the
stigma around STIs is justtalking about it.

Speaker 5 (49:38):
I did have one thought while you all were
talking about HPV, and that'sthat I was speaking with a
physician one time, and whatthey said was oh, I don't even
consider HPV to be an STI.

Speaker 6 (49:49):
And I think that's an interesting consideration just
to think of it as a human virus,because it's so common and
because it's so diverse in itspresentation because of the
numerous amount of strains thatHPV has, and each strain has a
different presentation.
So I think that's a reallyinteresting way to view it.

Speaker 4 (50:09):
I think that's interesting because it also
applies to most of what wetalked about.
All of the other infections wetalked about can be spread other
ways besides sex, so I thinkthat that's a really good point,
that the language that we usearound it and the labels yeah.

Speaker 2 (50:20):
Yeah, I think for me, the take home, whether we're
talking about HPV or we'retalking about syphilis, we're
talking about chlamydia,gonorrhea, hiv, herpes, simplex
whatever we're talking about isthat we have to be aware we have
to do more to destigmatize it.
People need to be able to talkabout it.
People need to be able to asktheir doctors or their nurses or

(50:42):
their other health workersabout it.
Public health needs to be ableto do the things that public
health does well, which isinform the public, create
interventions that reduce therisk of spread.
And if we continue to endorseor embrace a system in which
these things continue to bestigmatized where we accept that

(51:04):
it's okay for them to bestigmatized, where it's not okay
to talk about them then we'regoing to be having the same
conversation in a year or twoyears.
We're going to be looking atcharts with these numbers going
up even more, because justbecause it's in one population
doesn't mean it's not going toget into another population,

(51:25):
right?
Infectious diseases areinfectious diseases.
They spread in populations thatare at risk and you know.
You can think that you are themost safe and most puritanical
and the most low-risk populationever, but the truth is that you
never know, and it's superimportant for us to create an

(51:45):
environment in which thesepathogens can be talked about,
can be screened for and can beaddressed before they continue
to rise in the population.

Speaker 5 (51:54):
Absolutely.

Speaker 3 (51:54):
I think my take-home message is very similar to
Matt's message.
To me.
The evidence is clear, right?
We have so much evidence thatshows that we have prevention
methods, we can take care ofcertain things and it will stop
the spread.
And to close your eyes towardscertain things and to limit

(52:14):
access and to say it will goaway if we don't look at it,
that just doesn't work out.
We've tried that many times inthe last thousands of years and
it doesn't work.
And just one thing we touchedon but I think we should
emphasize is the HPV vaccinecampaign is one of the most
successful campaigns.
That has reduced the cancernumbers dramatically.

(52:38):
And think about all the othercancers that we have.
We wish we would have a vaccineagainst melanoma or against
pancreatic cancer or somethinglike that, and we don't.
We do have a vaccine for HPVand for the related cancer and
it's working and it's workingreally well and we should
celebrate that and we should useit as a model and not just the

(53:01):
information is not promoted asmuch, I think.
Caitlin, what's your takeaway?

Speaker 4 (53:06):
I have two.

Speaker 2 (53:07):
Oh wow, yeah you're only allowed one.

Speaker 4 (53:11):
I think just one last time.
We're emphasizing that thathigh risk has no connection to
morality.
So I think that's an importantone.
But I think something I alsowant everyone to think about
that just popped into my head asyou were talking is when I
think about COVID.
I was a contact tracer in NewYork and people didn't want to
get tested because they didn'twant to know.

(53:32):
They were like, oh, I might besick, but if I don't get tested
for COVID, I don't have positivetests, I don't know.
It's out there, it's not a realtangible thing.
And I get that mentalitybecause when I first got COVID I
was like, yeah, I'm sick andthis is probably what it is, and
I took the test very quickly.
But I was like, oh, my God,it's like.
Now I know that this is what itis and it then affects your

(53:53):
life.
You have to make a decisionbased on that and, I think, just
understanding that that's avery human reaction but that
it's also the discomfort of youknow.
But then you can do somethingabout it and I think that's the
take home message.
I want people to get around STIs.
If that can happen.
For something like COVID, whichpeople did not see as a
morality issue.
They just saw it as like I'mnot sick, I'm not going to have
a positive testing, I'm sick,sick, I'm not going to have a

(54:16):
positive testing, I'm sick.
I think people can definitelystill get into that sort of
mentality of like oh, if I justdon't know, then it's fine.
But like, know for yourself,know for your own health status,
and there's so many wonderfulpeople that work in this field
that can connect with freetesting or testing that fits
into schedules or whatever, andI think that that's worth
pursuing.

Speaker 6 (54:31):
Yeah, absolutely.
I just want to echo whatCamille said there, for sure,
and I think that, as healthcarepractitioners and as people with
the privilege to have access tohealthcare and to work in the
field of healthcare, I thinkit's also our job to do what we
can to make this testingaccessible to everyone and these

(54:52):
treatments as accessible as wecan.
I know that right now there's alot going on in our world and
this one line isn't going to doanything, probably, but I just
think that it's important to putout there that there are so
many resources that are beingtaken away from people who don't
have necessarily the privilegeto go and visit a physician if

(55:13):
they feel like they do havesomething going on.
And I think that, just asfigures I don't want to sound
self-important, but as figuresof influence maybe it's our job
to just make sure that weadvocate for the populations
that can't really advocate forthemselves, especially when it
comes to STIs and healthcare ingeneral.

Speaker 4 (55:31):
Yeah, All right.
Thank you to all of ourlisteners, especially for coming
this far.
You've also done your part todestigmatize SDIs.
Thanks for clicking on thisepisode.
Thanks for listening.

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