Advice from an STI Expert

Although a recent rise in sexually transmitted infections has been making news in the U.S., there’s nothing new about STIs (or STDs — two ways of saying the same thing). Viruses and bacteria have been uninvited participants in human coupling since forever, and exposure to them should be an expected part of having sex. So why, in 2020, is there so much silence and stigma surrounding these commonplace sexually transmitted infections? That’s what Dr. Ina Park set out to understand (and help solve) in her cheerfully titled new book Strange Bedfellows: Adventures in the Science, History, and Surprising Secrets of STDs. Nurx chatted with Dr. Park about why STIs are on the rise, how often to get tested, and why she’s proud her children ask adults about syphilis.

As an academic and researcher, what inspired you to write a book about STIs aimed at regular people?  

About 5 years ago my son, who was 7 at the time, was hit by a car — thankfully he’s totally fine now, but he was pretty badly hurt with a broken skull and femur. We were in the ICU when the neurosurgeon came by and my son asked him, “Have you ever had herpes? Mom can tell you all about it.” The doctor started laughing and my son realized, “Hey, what my mom does is funny to other people!” He started asking the hospital staff about syphilis, HIV, and other STIs, including asking the chaplain whether he knew anything about chlamydia. As a young child he was so comfortable talking about these concepts and it made me wonder why it’s so hard for adults to talk about STIs, and what could I do to encourage a larger conversation? I felt a sense of mission to demystify and destigmatize the topic of STIs so I decided to write this book. It was a really challenging time in my life, with two young children and one injured in this traumatic way, and I had no idea how long it would take to write the book but decided I had to get started. 

In some ways now is the perfect time for the book, because STIs are on the rise, and because of COVID-19, a transmissible virus is in the news. 

I guess in that way it is good timing. There’s a whole chapter devoted to contract tracing, which is very challenging and important work, and wasn’t something people outside of the infectious disease community had heard of before COVID-19.

What’s behind the rise in STIs?  

There are multiple forces at play. It could be in part the use of dating apps like Tinder and Grindr, which allow the mixing of sexual networks that never would have occurred had those apps not existed. Otherwise you would have met sex partners through friends or through bars that you go to regularly, but with the geosocial networking apps you can meet someone who just happens to be nearby who you ordinarily wouldn’t be in a social or sexual network with. The apps may mix higher-risk people with lower-risk people.

I do also think that condom use is declining. For men who have sex with men, the rise of PrEP may lead to less condom use, because there is less fear of HIV. I’m happy that anxiety is down but there needs to be awareness that PrEP doesn’t protect against other STIs. It’s not just gay men, though. I sometimes spend time on Reddit answering questions on the STD subreddit and based on the questions I get I know there are plenty of people still having unprotected sex.

But the underlying reason for the rise in STIs is stigma. Because these infections are still so stigmatized people want to pretend they’re not happening, and they don’t ask their doctors about testing. Then too many providers have their own stigma and discomfort with the conversation so they don’t raise the topic.The goal of this book is to change all of that. 

How do you take the stigma out of STIs while also emphasizing that they’re serious?  

I try to normalize STIs but also normalize testing and treatment. If you have sex, you will get something from somebody at some point, it’s just a question of when. It’s normal — it’s simply the cost of doing business in the sexual marketplace and testing and treatment is just another component of your overall health. It’s nothing to be panicked about but not something you should blow off either. The implications of blowing off STI treatment can be huge, especially for people with cervixes and uteruses who want to have children one day. 

So how often do you suggest people get tested? 

At least once a year is a good benchmark, but it depends on how sexually active you are and the gender(s) of your sex partners. If you are having a fast rate of partner change I wouldn’t wait a whole year to get tested. My friend who studies sexual networks says he looks at it as “every 3 months or every 3000 miles.” One person’s three months are different from another’s.  

And if you have had an STI in the past you should probably be tested more frequently going forward. In terms of protecting female fertility the issue is not just how long the chlamydia is there before it gets detected, but the higher the number of infections you have had the higher the likelihood of pelvic inflammatory disease and ectopic pregnancy. One key to avoiding repeated infections is making sure your partners get treated as well. 

We’ve recently written about how adults up to age 45 should get the HPV vaccine if they haven’t already.  Do you agree?

Definitely all adolescents and adults up to the age of 26 should get the vaccine.  Getting it between the ages of 26-45 could also be helpful; it’s good to ask your healthcare provider as insurance companies might not cover it for folks in that age range. It’s worth getting vaccinated even if you’ve already tested positive for HPV and even if you’ve had cervical dysplasia or genital or anal warts. That’s a sign that your body has trouble clearing HPV, and vaccination can protect you against any strains you haven’t encountered yet. 

One of your children was the inspiration for this book, so how to you recommend parents talk to kids about sex and STIs?

Well the most important thing to remember is it’s not one big “talk.” It’s dozens of short talks. Give small amounts of information at a time and answer the questions they ask. A lot of parents build it up into this huge one-time conversation, but I try to reframe that. It has to be a series of ongoing conversations that happen over and over again. It can be difficult, but try to have a casual tone without embarrassment and don’t use code words.  My kids know the proper names of anatomy, like the difference between a vulva and a vagina. 

My whole mission around STIs is a desire to reduce stigma and empower people to take charge of their sexual health. As a society, having smart, sex-positive sex education is such an important part of that. 

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Nurx offers STI Home Test Kits, PrEP for HIV prevention, HPV Home Test Kits, and treatment for oral and genital herpes.

About Ina Park

Ina Park MD, MS is a sex-positive STD researcher, public health champion, speaker and author of Strange Bedfellows: Adventures in the Science, History and Surprising Secrets of STDs. She is an Associate Professor at UCSF’s Department of Family and Community Medicine and Medical Director at the California Prevention Training Center. You can pre-order Strange Bedfellows here.

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