Safer Sex & STIs: What You Need To Know

Happier Couples

Safer Sex & STIs: What You Need To Know

36:46

 

• How often should you get tested?
• What are the risks of oral sex?
• What are the risks of giving oral when you have a cold sore?
• How can you reduce the risk of STI transmission?
• What do STI tests entail?
• Can you get any STIs from a toilet seat or bed sheets?
• How soon should you get tested after potential exposure?

Dr. Ina Park, author of Strange Bedfellows, Adventures in the Science, History, and Surprising Secrets of STDs joins us to answer all of our questions about making sex safer and de-stigmatizing STIs. You can follow Ina on Instagram to learn more!

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Rough Transcript:

This is a computer-generated rough transcript, so please excuse any typos. This podcast is an informational conversation and is not a substitute for medical, health or other professional advice, diagnosis or treatment. Always seek the services of an appropriate professional should you have individual questions or concerns.

Safer Sex & STIs: What You Need To Know

Participant #1:
You're listening to the Sex with Dr. Jess podcast. Sex and relationship advice you can use tonight. Welcome to the Sex with Dr. Jess podcast. So I'm your co host, Brandon. We're here with my lovely other half, Dr. Jess. Hey. Today's show is brought to you by Adam and Eve.com. They offer everything from Dillos to vibes to butt plugs to lingerie. All the saucy stuff you can imagine. To spice up your bedroom, Adam and Eve.com use code doctorjesd Rjess to save 50% off almost any single item. Plus free shipping and some free goodies. What do you want, Babe? I know you get. You get stuff in the mail every day. You don't get it. What, do we not have any dogs looking around? I don't even know what we need for me. Sure. Another cock ring? Another one? Okay. Why not? Ready for sure. You have enough. You know what? Maybe I'll wear it on my hand. Put it on a couple of fingers. Actually, there is a maker in Toronto that makes these beautiful leather straps or leather cuffs, but they also double as you can put your hands. Please don't tell me it's a penis ring. No, they're harnesses because I was like, that would go on my wrist. Well, you have a very big wrist. Oh, my. What? I could put this somewhere else. No, they're harnesses, so they have like a built in harness so you can put your strap on. Okay, very cool stuff. Actually, today we are going to be talking about STIs, safer sex herpes when to test how to have safer oral sex. What testing entails. And we have solicited the help, the insights of the ultimate STI expert to help us facilitate this conversation. Dr. Ina park is a physician and professor in the Department of Family and Community Medicine at UCSF. She's the medical director of the California Prevention Training Center and a medical consultant for the Division of STD Prevention at the Centers for Disease Control and Prevention, also the author of Strange Bedfellows Adventures in Science History and Surprising Secrets of STDs. You just came back from promoting your book in London. Was it great to be across the pond again? It was incredible. I can't tell you, Jess, after two years of doing almost nothing in person, it was just so exhilarating to be with people again and people who also love sexual health and STIs. So it was fantastic. It feels so good. You just want to get out there and lick people. But I don't know. Should we be licking people? You are the expert in just that. Where to lick, when to lick. Exactly how to protect yourself. Really excited to dive into your book and all of that. All of the great information. But let's start with the language of STDs versus STIs. Do you use these terms interchangeably? Why do we use one versus the other?

Yeah, I would have to say that the trend is generally moving towards using STI because it's a little bit more scientifically accurate. So many infections that we can get through a sexual activity are just infections that don't actually cause disease. And so STI sort of encompasses all of those that both the ones that cause disease and the ones that are just silent infections that just come and go and you might not even notice them. And then it's definitely a far cry from what we use in the 70s, which was VD or venereal disease. Right. And that word venereal implies as well that immoral sexual behavior is involved. So I think we're just trying to make the language less stigmatizing. In the US, we use STD for public health. The public health agency, CDC uses STD because they actually study the infections that are most likely to cause disease, which are like Chlamydia and gonorrhea and syphilis. So those are the ones that they are mostly keeping tabs on. So they have still stuck with STD. Okay, so sexually transmitted disease versus sexually transmitted infection, definitely. There is a destigmatizing piece, I think, around infection versus disease. Now tell us from the get go, what should we know about? I'm going to use the word I'm going to use STIs. What should we know about STIs in terms of the symptoms we should be looking for, how to reduce risk? When should we be testing all of those pieces that I think as part of a bigger conversation, help to destigmatize STIs. Yeah. So the first thing I want to do, Jess, is really normalized back that pretty much every sexually active person is going to get exposed to something at some point. So if we just start from there, then it becomes not something to be ashamed of or something that like, oh, you're a slut because you got an STI or that only certain people get. It's really a universal thing, especially with the viruses such as human Papillomavirus or HPV, really almost like a universal human condition of being sexually active that you're going to get exposed to that particular one. So the thing is, though, is that other infections tend to be more tightly concentrated in sexual networks. So right now, for example, with syphilis, it is not as common not nearly as common as something like HPV. It is concentrated more in networks like in the US of folks that are using Crystal meth, for example, as well as men who have sex with men and transgender and gender diverse people who have sex with men. So there are certain groups that do have higher rates of infection for certain STIs. And then something like Chlamydia, which is a bacteria, actually happens to lots and lots of young people. But it's not quite as common as HPV hierarchy. You know what I mean? In terms of some are extremely common, some are much less common. And so in order to sort of cover all your bases. Right, you need to like, if you're a person in the US if you're under 25, really, you should be getting checked once a year if you're having any kind of sex at all. And what happens is we up the frequency because as we know, just like people are sometimes changing partners frequently and relationships may not be lasting very long, sometimes they're lasting one night or whatever. And so typically what I say to patients is if you're switching partners, let's put you on a regular schedule. So let's check you every three months. And so I have lots of folks coming in on a quarterly schedule to do that. But I also have folks that say like, oh, my God, I was with somebody, we had vaginal sex. There was no condom involved. I'd like to see if I caught anything from that encounter. And then I have people wait a couple of weeks, come in and get tested. So there's not really like a set frequency other than I really would like people who are sexually active to get tested once a year. But then beyond that, you can sort of flex it up or flex it down depending on what's going on in your sex life. When somebody says, oh, I had sex without a condom, and that wasn't my intention.

Right. And you said you'll have them come back in a couple of weeks. So what is that incubation period? How long should you wait after an exposure that is concerned you before you get tested? Right. And I actually did an Instagram post about this recently. Each bacteria, parasite, virus, they all have a slightly different incubation period. But for your bacteria like gonorrhea and chlamydia and a parasite like Trichomonas, I say two weeks is a pretty good time, you know what I mean? To wait for those bacteria to show up, but when we're talking about something like herpes. So let's say you had a sexual encounter and let's say the person didn't disclose beforehand, but you found out afterwards. Sometimes it will take some people twelve weeks to actually see if they actually became positive for herpes type two, for example. So that's why when people are switching partners frequently, I just put them on a regular schedule instead so they don't have to think about the timing for each individual bacteria or virus. It's very complicated that way. But yeah, I think if you just had sex with someone and you want to know whether or not you caught a bacteria, typically two weeks should be good enough. Okay, so you've mentioned bacterial, viral parasitic. We have these different categories of STIs. What are the differences between bacterial, viral, parasitic, St? So bacteria, as you know, respond well to antibiotics. And so when we're talking about things like chlamydia, gonorrhea, syphilis, Mycoplasma, those are all things that can be easily cured with antibiotics and then the parasites as well, like Trichomonas, which only affects people who have a vagina that also can be cured with an anti parasitic medication pretty easily when we get to the viruses, that's a different category. We're all very familiar with COVID-19, like the virus of the century or whatever. And we also know that once you get COVID-19, really you're relying on your immune system to clear it. Right. And that's the case with HPV, for example. As I told you, it's sort of that universal STI that we all get from being sexually active. And most of the time our bodies are going to clear it on our own by about two years after getting infected. And then things like herpes and HIV are with you forever. You will always have antibodies to the viruses if you get exposed. So as you can see, like Jess, it runs the whole gamut from you can cure me with one dose of antibiotics to I'm living with this for the rest of my life. So it really does run the whole range. So I can't just say you get an STI. It has different meaning for every person, depending on which bug they catch and how their body responds. And when you say living with it for the rest of your life, that doesn't mean that it's a death sentence. That doesn't mean that it has to take a toll on your overall life. Many of us live with viruses in our bodies forever and ever, and we live happy, healthy, sexual, pleasurable lives. And that's a big part of the work you do in Destigmatizing. I was also thinking about stigmas and how they intersect with identity. You had mentioned, for example, just one example of groups who are more susceptible at this time to a specific STI. But over the years, and especially since the onset of HIV in the 80s in North America, there has been so much stigmatization that has stereotyped and adversely impacted specific communities, communities who are already forced to the margin, like queer communities, like black communities. And so what we also have to do is remind people that all populations are susceptible. Right. To STI's. When we look at straight white women, young white women rates being on the rise, there is no one group that is at risk for STIs. We are all at risk. And risk also sounds so dangerous because you're also normalizing that if you're going to have sex, you might get an STI, right? Exactly. If you go out and get on a train or go out to a restaurant, you might get coveted. It's the same thing, like by living. Okay, so this just happens to happen when your clothes are off, you know what I mean? But just by living and existing with each other, we run into viruses and bacteria in the course of our daily lives. This is nothing different. It just happens to affect, you know what I mean? Your genital tract or your anal region. And so obviously those are sensitive areas. And that's why I think they have more of a taboo than other infections. But I'm so glad that you brought up this idea of intersectionality and the fact that these infections really are already stigmatized, but they are going up in North America among all populations. And I'm talking about people over the age of 52 who people think, like, you get a pass because you're older, but it's not true. So just you're right. Really, if you think like, well, I'm not a person of color, I'm not a queer person. No one gets a pass. We all really have some susceptibility or risk to getting an STI if we're going to be sexually active. So it's like the cost of doing business. We just need to accept it. Right. And anatomy can make a difference as well. Right. If you're having vaginal intercourse, this is a big I don't want to say big, but it's a larger space of open membrane. Right. Once you get inside of there. So that has to be, I presume, a higher risk for viral STIs. Is it also a higher risk for bacterial STIs versus a penis, which is on the outside and it's not a mucous membrane? Absolutely. It's greater risk and greater susceptibility because you just have much more of a target, you know what I mean? For points of entry that will also vary if we think about guys who are circumcised versus those that are not.

You know what I mean? When you're circumcised, there's a bunch of tissue and membrane that you've removed. Right. So that actually reduces your susceptibility even more to certain viruses, like HIV, for example. Interesting. Okay, let's talk about the most common STI. And I don't know how to say it. Is it Trichomonas? Oh, so Trichomonas is the most common nonvirus. So the most common STI overall is HPV. But Trichomonas is a parasite that is the most common nonviral STI. It's definitely more common than any of the bacteria. And what are the symptoms? How do we get tested? How do we treat? Yeah. So the thing is, it's really only for people who have a vagina and it can cause discharge. It can cause, like, a fishy odor. And these little, little organisms that have these projections coming out of the top of the organism that split around and actually make it look like it's twerking under the microscope. It's really kind of funny, actually, to see it. It's really gratifying when you diagnose it because you can see it right away. And some women will have Brady discharge, and they'll say something is definitely wrong. And some people will just say, you know, my odor is just a little bit off, but they don't actually notice anything different with their discharge. And so we now have PCR based tests which you guys are very familiar with because of COVID. We have really good PCR based tests for this organism. So you can look at it under a microscope. You can also do a PCR test and you can detect it and then again, you can treat partners and treat the patient and usually eradicate it completely. Okay. And what does the PCR test for trick look like? Is it a swab of the vaginal swab? Yeah. Don't put it up your nose. Please don't do that. Don't stick it in your butt. Don't put it up your nose. It could be a vaginal swab if somebody was doing a pelvic exam on you anyway, they could stick it in your cervix if they wanted to. I actually think the vaginal swab is easier, and patients can do it themselves. And you can also just pee in a cup. It's not quite as accurate because the organism is not in the urinary tract. It's really in the vagina. But you can also look at the urine as well. Okay, great. I want to talk about what to do when you're changing partners and what precautions to take. But quickly, before that, how do we test for STI's? Because you've mentioned urine. You've mentioned swab. I imagine definitely there's blood looking at the serum level. So what do STI tests look like? And so for your annual exam, what would it look like? And is that different than if I said, you know what, I had sex with somebody two weeks ago when my condom broke. So what test would you recommend? Yeah. So I think yes, it would differ. So let's say you said I had sex a couple of weeks ago, my condom broke. Now I'm having something going on. You know what I mean? I'm having burning, I'm having new discharge or whatever, we would probably test for more things than we would just if you are having your annual routine visit and nothing is going on. So if you had symptoms, like especially vaginal discharge in my clinic, we would be testing you for gonorrhea and chlamydia and Trichomonas. And then we might also be testing you for something called Mycoplasma, which is another bacteria that we discovered in the 80s, even though it's not related. If we think you have an STI, we'll probably check you for other STI's. So we'll draw your blood for syphilis, we'll check you for HIV. So that's typically what we would do if you came in with symptoms for the person who just comes in off the street saying, like, I've got nothing going on. I just am here for my annual for young people under the age of 25, we typically just check gonorrhea and chlamydia and in some places where they're having a big syphilis outbreak, also checking syphilis and HIV. And are those blood tests or urine tests? Yes, the syphilis and HIV or blood test. Okay. The gonorrhea and chlamydia can be a swab or a urine test. And if you are telling me, for example, like, oh, I'm performing oral sex on a penis, then you can swap your throat. If you say that I'm having anal sex, then you can swap your butt. And then if you're having vaginal sex and you can swap the vagina or use the urine. But right now, I don't know how the Canadian guidelines are, but in North America, most of the people who are getting a swab of their throat or their bottom are people who are either gender diverse trans or cisgender men who are having sex with men.

Why is that? Is it the types of activities? Because it's not the bodies that are necessarily putting you at risk. Is it the types of activities? Exactly. It's not the bodies. It's not the gender identity or the sexual orientation. No, it's the network. It's the networks. You know what I mean in terms of the sexual networks, people who are having sex like men who are having sex with men, for example, there are just higher rates of STIs in those networks. And so there is now a universal kind of recommendation to test all of the sites of exposure. But I want you to know the trend that I would like to see and what I do see happening. And the CDC in the US actually just put out a statement saying that we really should consider that type of testing of the throat or the butt for anyone who's having those types of sexual activities. So oral sex or anal sex, which is really everyone, which is. I know. Right. A lot of people. I'm also curious, when you talk about rates being higher in some communities, I wonder if these communities are also getting tested more because so many straight people who think they're in monogamous relationship are not even bothering with testing. And we're seeing STI rates that are similar for people who are supposedly monogamous versus those who are consensually non monogamous. So I wonder if there's an overrepresentation it's both. And of course. Yeah, right. I don't want to stigmatize because again, we always go back to HIV being associated with gay men when in fact, we see HIV rates really on the rise in straight people. Yes. Right. Yeah. We see certainly among straight women, especially black women in the United States, we see increasing rates like the proportion of cases of HIV that are like new cases of HIV that are in black women compared to women of other races is really stark. And so, yes, some people the only risk factor for HIV, it's like I had a monogamous relationship and my partner had other partners and I didn't know. Do you know what I mean? And so, yeah, I'm not to stigmatize any particular community because I'm just sort of stating the facts in terms of where we find the highest rates of inspection. And part of it is because people are testing more often. And part of it and part of it is that's definitely part of it, because if you look more, you'll find more. And it's also because in certain communities, communities switching partners more frequently is more of a normalized behavior. You know what I mean? And we just know from national studies, for example, that certain communities of men have sex with men, change partners more frequently than the average person, like the same age person who happens to be in a heterosexual network, for example. So more openness, perhaps sexuality and pleasure and honesty and relationships. And so then when we also talk about rates by race, we have to look at the fact that so many of our outreach programs are run by white, old medical professionals and they are not reaching other populations. The way we're disseminating information is failing populations. Right? Again, it's not your race that puts you at risk. It's the way the medical system has historically and continues to interact with different communities. Yes. And just so this happens both for people of color as well as for people who don't identify, you know what I mean? As male or female. So I think both of those people from any of those communities have often experienced judgment discrimination.

They have medical mistrust because they've had negative experiences with the healthcare system. So I think for those of your listeners who are in the helping professions, who are clinicians, creating a welcoming environment is so important, understanding that people are going to come expecting to be, you know what I mean, having a negative experience or having had one in the past, you have to work that much harder to make your environment welcoming and to say you belong here, we're happy to see you. We want to help you because I don't think the trust is naturally there. Of course not because we've eroded the systems have eroded at that trust. So definitely an important piece. And I think everyone for everyone to think about, not only in that welcoming environment, but also in our training to make sure that we are really are equipped to support gender nonconforming people, to support nonbinary people. All right. So I definitely want to talk about the considerations we should take when having sex with new or multiple partners. So I get a lot of questions from Swingers and other consensual non monogamous folks. They want to know what are the risks for unprotected sexual activity, like oral sex, kissing, fingering, hand jobs and the like. So they tend to use condoms for intercourse. Yeah. So penis and vagina intercourse and penis and anal intercourse, but not for other activities. Most people I know, let's be honest, are not using dental dams. That's just the reality. I know. So what should we be doing in terms of protecting ourselves? I think especially with hands and mouths in general, I really think things like fingering hand jobs are pretty low risk. If somebody happened to have syphilis, for example, on their penis and you give them a hand job, could you end up with a syphilis sore on your hand? In theory, yes. It just really does not happen very often. So I feel like those manual sort of mutual masturbation hand jobs bingering. That's really pretty low risk, I have to say, especially if you look at your hands like, hey, if you have a cut, don't do it. You know what I mean? If you have broken skin. Right. This is like logical stuff. But when it comes to oral sex, a lot of my patients have this idea like, oh, oral sex is safer sex. And I say it's true for HIV, but not for anything else. You know what I mean? Like, syphilis is very easily transmitted through oral sex. Same with gonorrhea and Chlamydia, just as examples. Herpes as well, very easily transmitted. So I also don't want my patients to laugh at me because they have when you ask about using barriers for oral sex because I'm sorry, it just doesn't work. No, people aren't doing it. You know, I mean, dental Dan's and condoms. My commercial sex workers will sometimes use condoms with clients for oral sex. But I'm talking about not folks that are doing commercial sex work. Most of the time, condoms are not involved with oral sex, whether or not you're performing it on a vulva or on a penis. So that's the thing is that oral sex certainly isn't safer from that standpoint, but it does. You know, it's a good harm reduction approach to avoid getting HIV. Okay. And then using barriers for anything with penetration, I think is a great rule of thumb because honestly, you can be Poly and actually manage the sort of risk very well. And there are many Poly communities who are organized communities who actually have people testing regularly. And actually, we don't have necessarily lots more outbreaks of disease in Poly communities because many times people are on it in terms of getting tested regularly, and they're open with each other about the fact that they're having concurrent relationships.

So testing is an important piece of prevention. Right? It's very important because if I get Chlamydia and I test, I'm going to take this is it a week of antibiotics now? I can't remember. It's changed. Yes. You either get a week or sometimes you would get a single dose. It just sort of depends on the circumstance. But most of the time now, Canadians and folks in the US are recommending a week of antibiotics. Okay. So if I test positive for Chlamydia, I take that antibiotics and it clears my system and then my risk of transmitting that to somebody else becomes basically eliminated. Correct. It's completely eliminated. But then, of course, you can catch it again. You could catch it again the next week. So it's just something to think about. Like it doesn't give you any sort of long lasting immunity. Right. But it does completely clear the decks and then you're ready to go again. And that's the thing is like, well, you didn't avoid getting permitted adjust, but you prevent it spreading it in your community. Exactly. And so that's what we're talking about from a prevention standpoint. It didn't actually prevent testing doesn't prevent anything in you, the individual, but it prevents spread throughout the community and spread through your sexual network. And it also prevents any of the long term repercussions that could occur. Right. So if I get chlamydia and I test, I take some pills and I clear it like easier than the common cold, right? Oh, yeah. And so I take that. And then if I don't get tested and I don't know, I have chlamydia because is it still true that the most common symptom of an STI is no symptom at all? Yeah, it certainly is true for chlamydia and for HPV. Yes, I would say that for most of the STIs, yes. The most common symptom is not having a symptom. And in the case of folks who can become pregnant, as you know, these little infections can crawl right up into your reproductive tract and cause scarring, even if you never felt a thing. So you might find out ten years later, oh, my gosh, my tubes are blocked. How did that happen? Well, it turned out you actually had idea ten years ago and you didn't know. And just you know, this because you do a lot of work with couples is that there isn't always communication or openness about who's doing what with whom and whether or not the relationship is closed or open. And people thinking that it's closed when it's actually open on one end. And this is why I do say if you're having sex, even if you are monogamous with your partner, get tested. You just don't know. Okay, so if you are in a monogamous relationship and you're sexually active in that relationship, should you still get tested every year? I think it depends on you and your partner in general. When you're younger and people are changing partners more frequently in general, I say regardless of your relationship status, if you're under 25, I say get tested as you get older. If you're really like, I really don't suspect my partner has other partners. That's fine if you want to forgo testing. But just as you know, people can get burned and people do have there's infidelity there's cheating. It happens. So when someone says to me, it's possible my partners or their partners, I'm not sure. I said, you know what? We should test. You should go ahead and test, because there's actually in California on this. And people who said their partner might have other partners had the same exact risk of chlamydia than people who knew their partner was with other people. So interesting, even if you suspect, it's probably happening.

Okay. So for oral sex to recap, some people are using condoms. It's far more likely that sex workers are using condoms than people who are not doing sex work, because sex workers are just more responsible about sex than other folks is also more likely, like sex performers, for example, are getting tested regularly, tested to go on set. And so if you are having oral, you can use a condom if you don't use a condom or a dental dam, because depending on what type of genital you're performing oral on, you do want to make sure you're getting tested regularly because that can reduce your risk. If you're performing oral on a penis, should you be having your throat swabbed? In my opinion, yes. And for a long time, our guidelines here in the States were not going along with me. But now there's much more wiggle room to say, consider swabbing that. So I think but right now, a lot of providers and clinicians are not in the habit. So I do think that people will need to advocate. And I think eventually clinicians will get into the habit of swabbing everywhere that's exposed. But for a while, people were really only offering that to gay men, for example. And so I think, you know, women who are performing oral sex on a penis, we're not asking for it and we're not being offered it. So I think it's a good idea to ask. And that is because HPV can show up. Yeah. Hpv can show up in the throat, but you can't actually test for it. But gonorrhea and chlamydia are very easily transmitted through oral sex. So good idea to swap your throat. How do you test for HPV in the throat? Because we've heard about HPV and throat cancer. Yes. And in fact, HPV related throat cancer is more common than cervical cancer in certain developed countries, including the US. And there's no PAP smear or other tests for the precancer. So Unfortunately, I have nothing to offer you right now in terms of a good test to look for oral HPV. Outside of a research study, there's nothing that's being used clinically. So right now, the best prevention is getting the HPV vaccine. Okay. And you can get that if you're under the age of 45. That's right. And you're based in Canada. Is that the same in Canada? That's the same in Canada. And I think the listenership is heavier in the States anyways. Yeah. Public Health Agency of Canada. The CDC tend to be fairly aligned. They tend to be very aligned on many things, except you're allowed to leave a home earlier if you test positive for Kova. But that's a whole different discussion. That involves probably Delta Airlines and last, the CDC. But Public Health Agency in Canada, I believe it's still ten days. Anyhow. Okay. I have a question about cold sores. So I get cold sores. Actually, I have a small one on my lip right now, presumably HSV one. I've been getting them for, I don't know, 40 years of my 42 years on Earth. So this is for folks who don't know the same virus that causes general herpes. So you mentioned HPV, which is a virus that comes in many different forms. Right. There are many strains. There's over 200 strains that have been identified, and about 30 or so of them are sexually transmitted. Yeah. About 30 to 40 can be sexually transmitted. And then there's a smaller subset of those that can actually cause cancer. Okay. And so HPV is a virus that can also lead to genital warts, correct? Yes. And HSV is the herpes virus. So Brendan and I were talking about this the other day because he went for a full physical and this was a day long special physical that he invested in. And they did not ask about his sexual health at all. And I thought, wow, how can you cover all of these areas? But he came home and they had thrown around like HSV HPV, but they didn't explain what it was or why he should be talking about it. So HPV is the one that there are 200 strains and some of them can lead to genital warrants. Hsv is HSV one, which tends to occur on the mouth. Cold sore. That's right. And HSV two, which is more likely to occur on the genitals. And we call that genital herpes, which sadly, has been the butt of every joke for a long, long time. And there are many people really working to destigmatize that. I'll just shout out Courtney Brain, who hosts the Something Positive for Positive People podcast, who is absolutely fabulous. But let's talk about genital. Or let's talk about, I guess, HSV one.

So I get cold sores. Brandon also gets cold sores. What precautions should I take when I have a cold sore? So should I not be kissing branded? Should I not be having oral, I presume? Should I be careful not to touch my lip and then touch my generals? Like, is that auto inoculation common where I can spread it from one part of my body to the other? What do I do when I have a cold sore? I'm so glad you're asking this question. So just to set the stage, almost half of people, based on studies done in the US, actually have HSV one, including myself and including both of you. And so if you know that you have it sort of in your relationship, you really don't need to take any precautions. So you're not going to be able to pass it back and forth. You both already have it. You both already have antibodies. So, in fact, even if you have a healing cold sore, you can still perform oral sex and vice versa. The time when you can auto inoculate yourself in two different locations is when you first get it and your body has no antibodies. You could infect yourself in multiple sites at the same time, your first breakout, your very first exposure because you don't have any antibodies now that you already have antibodies, even if you had a cold sore and you touched your mouth and then touched yourself, you're not going to spread it from your mouth to your genitals. Oh, okay. Yeah. Interesting. So I'm so careful, like with the QTIP, putting the policies on it to keep it. Okay. If I were to give oral to Brandon, is there any risk when I have a cold sore because he already gets cold sores because he already has the antibodies. And you can obviously, if you want to check, you know what I mean? You could get your antibodies checked and just make sure we both have antibodies to HSV one, and then you really don't need to worry. Oh, interesting. Okay. And should I be changing toothbrushes when I get a cold sore? Like I'm all parent, I got a throw at the toothbrush. No, not at all. I mean, because the thing is that that's a virus that you've had for 40 years or whatever, and you'll have it till you die and you'll be shedding some virus at any time. Even when you don't have a cold sore, every once in a while, the virus will come up with the skin. If you were to kiss somebody new, if you were to perform sex on somebody, oral sex on somebody new, you could transmit it to them if they didn't have antibodies. But if you're with somebody who already is positive, there's no way to pass it back and forth again. The same with HIV as well, by the way. But once you're positive, you're positive and that's it. Okay. You don't have to take additional precautions. Interesting. Okay. Yeah. All right. We learned something for sure there. Yeah. No, that was great.

When you're done, I have a question. I was seeing Dr. Park's Instagram, and the age old question of I can get an STI from a toilet seat. Oh, yeah, I know. I love that. And all the reasons why they got it from the toilet or bed sheets. Any thoughts? So I'll tell you what you can get is like, yeah, if you're sleeping in someone's bed and you guys don't actually have sexual contact, you could absolutely end up with something like Lice or Scabies, for example. But something like, gonorrhea, you're not going to catch it from a toilet seat. Like someone's going to say, well, what if the person ejaculated on the toilet seat? And then I rubbed my Volvo on it and I was like, first of all, if that's what's going on, you're too drunk. You know what I mean? If you just sat in someone's like Semen or whatever, an accident, that's when you have other problems. But it's one of the most common excuses I hear for why people don't want to admit infidelity like they'll say, oh, no, there's no way you got an STI from me. You must have gotten it from a toilet or a tractor. You know what I mean? Yeah, it must be from a movie while I'm thinking a tractor. Okay. It'll be from a country song. So the pelvic floor therapists are going to tell us not to Hover above the pelvic toilet. Me I'm still going to pick hovering over the public toilet, but not because of STI is because of other things that are on there. Exactly. They're not pleasant anyway. But really, it's not a high risk, I would say, oh, someone said, well, what if someone I put on someone else's underwear that had discharge in it. And I was like, well, first of all, don't do that. But if they had like a raging Trichomonas infection and they had all this discharge and you put on someone else's underwear. In theory, yes. But really, the most common way that you're going to get an STI is by you or your partner having sex with somebody. Right. Rubbing yourselves on other people's bodies on the outside, exchanging bodily fluids with an open membrane, with exception, I guess, as you said, of those parasitic ones. Like. Yeah, like scabies and lice or whatever. But honestly. Right. I think the point is, though, is that penetration of any kind does not have to happen. That some stage you can get just from rubbing it. Right. Like HSV, which is the virus that causes perfect example, like HPV, which is the virus that can lead to genital warts. And then I think the last piece I want to just leave people with is this need to destigmatize. Like if you get a cold, you do not hang your head in shame. Right. If you're not doing well in some other way. We don't have the same stigma with the exception of STI's, because it's sexual, because also there's so much racism and homophobia and transphobia that is attached to STI stigmatization and antisex workers stigma all of these pieces. So if you leave people with just some Sage advice you mention from the get go, get tested. If something changes or feels uncomfortable, get changed, get tested once a year. Anything else you want people to know about STI? And of course, they can learn more in your book Strange Bedfellows, Adventures in the Science, History and Surprising Secrets of STDs.

Anything you want to leave us with? Yeah, just I mean, what I would leave you with is just saying STIs are universal and we all get them. And what I'm trying to do here is normalize the fact that we all get STIs, myself included. You know what I mean? And I have had probably one of the most vanilla sex lives ever. My point is that we all get STIs regardless of what we do, how many partners we have. And so let's just all accept it and let's not judge each other for having sex, because we all want to do that. We all want to experience joy and pleasure, and we all deserve that. And if you get an STI, if you get an STI that happens to be chronic, you still also deserve joy and pleasure and fulfilling relationship. Absolutely. Thank you so much for that. I really appreciate it. Hoping people will check out your book. Follow along on Instagram as well whether you are sexually active or whether you're working in the field because I've learned so much from your Instagram like I could just ask you all the questions from your Instagram and your IG is ina Park, Mdina and we'll put those in the show notes as well as a link to your book. So thank you so much for chatting with us today. Thank you guys. Have a good day and thank you for listening here's to hotter sex but also always safer sex wherever you're at have a great one. Bye if you're listening to the sex with Dr. Jess podcast improve your sex life. Improve your life.