Episode Transcript
Dr. Charles Shaffer:
The toughest thing with STIs is a lot of them are completely asymptomatic. And so you might have these symptoms, but if you don’t have those symptoms, that does not mean that you don’t have a sexually transmitted infection that you can potentially give to other people. And so that’s why a lot of this is just going to come back to, hey, you know, if you’re kind of practicing these behaviors, it’s really responsible for you to get tested in a relatively frequent, regular fashion.
Cassie Alvine (announcer):
This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about understanding sexually transmitted infections or STIs. Our guest is Dr. Charles Shaffer with Sanford Health Park Rapids Clinic. Our host is Alan Helgason with Sanford Health News.
Alan Helgeson (host):
Welcome Dr. Shaffer.
Dr. Charles Shaffer (guest):
Absolutely. Thanks for having me.
Alan Helgeson:
So, as a family physician, can you share how you came to this area of medicine?
Dr. Charles Shaffer:
Yeah, good question. I have a long and complicated history. Coming out of medical school, you do these rotations and I really had a great time in trauma surgery and really enjoyed that and really enjoyed obstetrics as well, and kind of looked into both fields and then found family medicine of just this cradle to grave and being able to do procedures and being able to do obstetrics if I wanted to and those sort of things. And so that’s kind of what drew me in and have grown to love it since. So, yeah, true believer in the family medicine, primary care job. Really liking it.
Alan Helgeson:
Okay, so you get to hang out in such a great part of the country as a physician in around the community Park Rapids. Why don’t you tell us a little bit about that area?
Dr. Charles Shaffer:
Yeah, I’m maybe not the greatest ambassador because I’m pretty new to these shores. I’ve worked in the area for a while. We just moved here like Thanksgiving of this last year and had our first just kind of coming out of completing our first summer and yeah, the Park Rapids area, kind of a resort-ish area. We actually get a good number of people from other places in the Sanford family like Sioux Falls that come over to camp and go to resorts and the lake in general, so we got a bunch of lakes over here. And so that part is pretty fantastic. We spend a lot of time outside. We’ve got the Heartland Trail over here that runs for forever. Nice paved trail for bikes and rollerblading and stuff. And so if you are outdoorsy or lake inclined, it’s a really cool place to be.
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Alan Helgeson:
Alright, well let’s talk about our topic today, Dr. Schaffer. It’s about STIs – or is it STDs – or the same thing, and what do those letters mean?
Dr. Charles Shaffer:
Yeah, great question and yes, the nice thing <laugh> great when you get an answer and you can just give, do a straight answer, yes, they’re the same. So synonyms, STD is an acronym standing for sexually transmitted disease and STIs, sexually transmitted infections. But yes, synonyms. And so when people are using those terms, they should be able to be used interchangeably.
Alan Helgeson:
Dr. Schaffer, the news and statistics may indicate that post pandemic, some of the STI numbers are rising. So what might be behind that?
Dr. Charles Shaffer:
Your reference to the pandemic is well taken. You know, a lot of the STD/STI testing and screening and even treatment is done by public health departments and things like that. And so when the pandemic came around, obviously those resources got largely diverted to all things pandemic and places shut down. And so that was kind of the only blipper we saw of, oh, maybe, maybe these infections have gone down a bit. And it was basically just because we weren’t counting.
And so <laugh>, we came back online and you know, people had been cooped up for a while and some of some of these things actually had blossomed a bit more. One of the main ones being syphilis. Just kind of seen more of that than we have in a long time. And so that one’s kind of caught the attention of the medical establishment here and something we always kind of try to keep an eye out for. But yeah, they’re fairly common, and numbers like you said are going up. It’s not at a crazy rate, but it’s definitely something that we should be aware of.
Alan Helgeson:
Are there statistics that give an idea of just how many people are affected?
Dr. Charles Shaffer:
Yeah, good question. And most of the stuff that I’ll be citing as far as like numbers and statistics and things come from the CDC and that data is up to date as of like 2022. So this stuff is always kind of changing and those big things that they compile run a couple of years behind.
But the kind of headline of that is about one in five people in the US have a sexually transmitted infection. They’re fairly common and that includes HPV, which is the most common sexually transmitted infection. And I think we’ll get to some of that here in a minute that the number on that is about 26 million new STDs, STIs per year diagnosed. Some that we hear a lot about like 1.6 million cases of chlamydia, 650,000 or so cases of gonorrhea from like those 2018, 2022 numbers. So, pretty common, like maybe more than you’d think.
Alan Helgeson:
Dr. Schaffer, you’ve talked about a few of the types of STIs, but how about sharing some of the others that might not be as common?
Dr. Charles Shaffer:
There’s quite a few. HPV infection is the most common. Gonorrhea and chlamydia kind of behind that. Next to that is like herpes, general herpes virus.
And so those are ones that a lot of us have heard about – gonorrhea, chlamydia, herpes, HPV, maybe, maybe not one that people have heard about quite as much sometimes as far as putting it in that box of sexually transmitted infection. You know sometimes we hear that in context with Pap smears more and we don’t kind of put the two together.
Syphilis, which we mentioned briefly is kind of gaining some more ground and becoming more common than it was. Other ones to be a little more complete include mycoplasma genitalium, and then trichomoniasis. Ones that people are more scared about and should be cognizant of include HIV and hepatitis C technically being sexually transmitted with hepatitis C. So that’s a fairly comprehensive list of the more common ones that we see.
Alan Helgeson:
Are there STIs that are more specific as it might relate to gender and or specific groups of sexually active people?
Dr. Charles Shaffer:
One thing to bear in mind in general is a lot of these things as far as, you know, maybe we’ll get into some of kind of the screening tempos and things like that. The one thing that I would say, kind of common sense, right? But the easiest way to prevent all things sexually transmitted infection is to be abstinent from sexual activity, right? So there’s thing one, but doesn’t fit for a lot of us.
Thing two is really talking with your partner and agreeing that like, you’re only going to have sex with one person and that person agrees that they’re only going to have sex with you. And these are great ways to limit the STIs in general as far as specifically your question on gender and things like that.
Some are more common specifically with relation to HIV and syphilis and those things that they actually kind of run together sometimes much more common in men who have sex with men. And so the new cases of syphilis are seen more often in men, and the predominance of those cases are in men who have sex with men. And so there’s definitely some trends that way. But then, you know, of course if people are contracting it in one form of sexual activity and then also having sex with women, then it can spread to the female population as well.
Alan Helgeson:
So are there specific age groups where those numbers are greater?
Dr. Charles Shaffer:
Yeah, great question. And back to the statistics and things about half of those, you know, we talked about 26 million new infections. About half of those are seen in individuals between 15 and 24. And so the predominance of screening and things, recommendation-wise falls in that timeframe of if you’re sexually active and especially if you’re younger, reasonable to get screened.
Alan Helgeson:
When you were talking about several STIs, what are some of the more common types being treated?
Dr. Charles Shaffer:
Sure. Yeah, so HPV – probably the most common, and we can spend a little time on that one by far and away. And then gonorrhea and chlamydia are kind of behind that with genital herpes sort of being maybe a fourth one to include in pretty common. More than half a million cases a year for all those. And chlamydia being a little above a million and a half cases.
Alan Helgeson:
With all of this information, Dr. Schaffer, awareness of signs and symptoms has got to be pretty important. Can you talk about those?
Dr. Charles Shaffer:
Absolutely. Yeah. I think a lot of it is fairly common sense. You know, if you are someone who is sexually active, and certainly if you’re someone who has more than one partner or the partner that you have is potentially seeing other people, things that you want to watch out for, any kind of changes in anywhere that you are potentially having sex.
So in your genitalia, anal area or a pharyngeal area, if you were having more irritation, bleeding you know, so penile discharge, vaginal discharge, irritation when you pee, you know, is a common one that you hear. So when you urinate, you’re having burning and things like that.
For ladies, one that sometimes gets missed is bleeding between periods. Like if you’ve always been really regular and all of a sudden, you’re having some bleeding kind of between your periods, those are all reasons to get tested.
That said, the toughest thing with STIs is a lot of them are completely asymptomatic. And so you might have these symptoms, but if you don’t have those symptoms, that does not mean that you don’t have a sexually transmitted infection that you can potentially give to other people. And so that’s why a lot of this is just going to come back to, hey, you know, if you’re kind of practicing these behaviors, it’s really responsible for you to get tested in a relatively frequent, regular fashion.
Alan Helgeson:
OK, Dr. Schaffer, what should I do if I think I might have an STI?
Dr. Charles Shaffer:
The big thing is get tested, right? And so there’s a lot of different ways to do that. There are some at-home methods now a lot of times that is going to be taking a sample and then sending it to a laboratory.
Obviously, we’re on this Sanford podcast; hopefully there’s a Sanford Health facility near you where you can get tested for all these, which a lot of times is urine and sometimes blood depending on the STIs that we’re screening for. But oftentimes not these very invasive tests that people might be scared of.
So urine testing and blood testing for a lot of this. And then really good resources as well are your local health departments and Planned Parenthood. There’s a lot of STI testing and treatment and education. So those are always great resources.
Alan Helgeson:
Can STIs go away? And maybe that leads to some fear that, well, I don’t want to go in because I don’t know if it’ll be treatable and it’ll go away.
Dr. Charles Shaffer:
Yeah, absolutely. And they definitely can go away depending on what they are. And so, you know, when we break down these different types, some of them like gonorrhea and chlamydia are from bacterial infections. They can be treated with antibiotics and then go away.
Kind of common-sense stuff, but you can also reacquire them. And so that comes into the thing of when you get tested, talking to your health care providers and to kind of park there for just a second and reel it back in.
One thing that I hope very much for myself here in Park Rapids and for Sanford providers and hopefully health care providers everywhere is the doctor’s office should be a safe space, right? That should be the place that you can come and be honest with your health care provider and tell them all these things and not feel judged or have to be hesitant about that.
And so that’s a very important thing that I always want to get across is this is a safe space for you. And especially when you’re talking about getting a sexual history from a patient, sometimes that’s obviously somewhat embarrassing for people sometimes, or they’re hesitant to tell their provider, yeah, you know, I am, you know, I am a man and I do have sex with men and this is the frequency and this is, you know, the kind of, the kind of sex that I practice.
Those things are difficult conversations sometimes, and this should be the safe place for you to have those conversations. And so I hope that you are getting that in your current health care environment. And if you’re not, I would encourage you to keep looking. I think health care departments, Planned Parenthood and all the Sanford providers that I know are a safe place to have those conversations.
That’s the first thing is being very honest and open with your sexual history and having a provider that can take a good sexual history and then kind of making recommendations based off of that as far as the most common STIs that are possible for you and what to test for. And kind of back to the question, gonorrhea and chlamydia, bacterial infections, they can be treated with antibiotics and cured, but you should be then telling your provider, “Hey, these are my partners.”
If you have a regular partner, you need to get that partner treated as well because otherwise you guys can reinfect each other. And so being honest about who your partners are and being honest with them about getting treated so that you don’t just continue to reinfect each other. And that’s where some of these numbers get kind of high is reinfection rates and infections in smaller communities that get pretty prevalent sometimes.
Alan Helgeson:
So with that then, Dr. Schaffer, are there some that don’t go away?
Dr. Charles Shaffer:
Yeah there are, and that’s why the front end of being responsible with your sexual practices really matters because the kind of fourth most common when we talked there of genital herpes, that is a lifetime infection. It can be treated and reduced, but that is something that is going to be with you for the rest of your life. And some people are quite bothered by outbreaks that they have and things like that that do require treatment with antiviral medications.
HPV infection, human papillomavirus is another one that, hey, once you get it, you have it. There’s a lot of different types of that virus. Some are more serious than others as far as potentially causing cancers in genital areas. But yeah, those, those are two good examples of very, very common ones that don’t go away even with treatment.
Alan Helgeson:
So we talked about can they go away and you went over what you can do and it led to some of those treatments and what they might be. But let’s get into more treatment options for some of those more common STIs.
Dr. Charles Shaffer:
Yeah, and so with gonorrhea and chlamydia specifically, a lot of times when people come in with symptoms and with a history that’s consistent with, yeah, you very well might have an STI. We will test, but we’ll also a lot of times treat empirically and that can oftentimes be done with a single dose of antibiotics. In the case of gonorrhea, in a shot form for chlamydia, it’s a number of days of medication and pill form. Doxycycline is the recommended antibiotic for chlamydia treatment right now. And so fairly common antibiotics and relatively well tolerated, but definitely something that’s worth getting treated if you have it.
Alan Helgeson:
Dr. Schaffer, with any of these STIs, is part of this telling or having to contact sexual partners about things or if they’ve contracted something, sharing that with them?
Dr. Charles Shaffer:
So gonorrhea and chlamydia would be what we call reportable diseases. So we should be contacting, your health care provider should be contacting, look for health departments and reporting. This individual had this infection and the health department then is usually reaching out and asking you about your partners and contacting them. Good question. But those things would be reportable for the sake of trying to limit the spread of some of these diseases if possible.
Alan Helgeson:
So is that a huge barrier to people coming in? Do you think people are afraid or is there some shame? And what do you say to people that are going and saying, Hey, I don’t want to come in?
Dr. Charles Shaffer:
I think it definitely can be. I mean, I think that’s an obvious barrier. You know, people don’t want to come in and talk about their business or potentially put somebody else’s business out there. That’s kind of that lead in of, hey, listen, this ought to be the safe place for you to go.
And part of this is just being responsible – if you don’t treat your partner as well, and if that person’s potentially seeing other people, sometimes this is also pretty emotional, right? You know, if you think that you’re committed to this person and they’re committed to you and from some side you know that your behavior’s been appropriate, but something’s been introduced into your relationship from outside, you know, you might be just angry and not want to talk to that person or have much of anything to do with them.
We see that sometimes, but it is still responsible to like, you know, OK let’s even have the health care providers reach out to this person and get them treated. Some options that way that some people do take advantage of. This is one of the very rare cases in medicine where depending on where you live and some of the laws, you can potentially get treatment for your partner without them having to come see any kind of health care provider. So in the case of chlamydia, it could be like, hey, listen, we’re going to give you a prescription for your partner as well for you to give to them. And so that person isn’t even necessarily identified. So there are options that way.
Alan Helgeson:
Well, this kind of leads me to my next question and I think it’s fairly obvious as we’re talking to you and as a family medicine physician, but how and where do you get care for STIs?
Dr. Charles Shaffer:
Certainly, your primary care provider should be able to provide you that. So family medicine doctors, internal medicine doctors and then the Planned Parenthood like we talked about. They’re a great resource for a lot of that stuff and services as well as your local health care department.
Alan Helgeson:
Dr. Schaffer, are there some STIs that may require more testing or repeated testing? So I guess my question would be how often should you get tested for STIs?
Dr. Charles Shaffer:
One thing with that is back to what we talked about of going to see your provider, being honest with your sexual history and having them talk about what STIs are more prevalent for your current sexual practices and how often you ought to get tested. So that’s kind of the first thing to say, right?
Your testing, your mileage may vary a little bit. Your testing might be a little individualized. You might need to get tested a little more frequently depending on your sexual activities.
But in general, yearly testing, because we talked about that predominance of infections being in that 15 to 24 year timeframe, folks that are sexually active and younger than 25, it’s reasonable to get screened for this stuff every year. So once a year with the caveat of certainly if you’re having any symptoms, that’s a good time to go in and get tested, right?
If you’re having any kind of burning with urination, bleeding between periods and vaginal discharge, penile discharge, OK, we’ll get tested. Otherwise, yearly is reasonable like at just a normal yearly health physical visit, which hopefully people are having. And if not, that’s a great idea, even if it’s just to discuss sexual health.
And then after 25 years old, it’s kind of more with risk factors. So multiple sexual partners, any sexual partner that’s had a sexually transmitted infection and then back to men having sex with men, oftentimes that does include some more sexually transmitted infections that we need to screen for and be cautious about.
Alan Helgeson:
Dr. Schaffer, you mentioned this and touched on it briefly earlier regarding the testing options. Can you go into it a little more in depth on the, in-clinic and at-home options?
Dr. Charles Shaffer:
You know, full disclosure, a little less familiar with some of the at-home stuff. I haven’t used that much personally. Like we don’t send testing stuff home with patients that I’m aware of but I think some of the Planned Parenthood clinics do, and a lot of that came out of COVID. At-home options exist, which may include some of the things we already talked about as far as urine or swabs in your general, anal, throat area. Those sort of things that then you package off and send up to a lab, you know, per their instructions in the clinic.
Gonorrhea and chlamydia most commonly is tested with a urine sample. Some of these other things, including syphilis, herpes can be blood tests, but rarely do we need vaginal swabs or anal swabs. Sometimes that’s appropriate, but that’s something to talk about with your provider in case you’re having symptoms in those areas.
Alan Helgeson:
I know we talked about this earlier on in the podcast too, but it bears repeating. How do you go about preventing STIs?
Dr. Charles Shaffer:
Yeah, no, I’m glad we circled back to that. So this is kind of straight from the CDC website, but I like the way that some of this is worded. And so obviously the number one thing that you can do to prevent sexually transmitted infections is be abstinent from sexual activity. So abstinence, if you’re not having sex with other people, you don’t have to worry as much about these sexually transmitted infections.
And there’s some misinformation there as far as like getting things from a toilet seat or a doorknob and these sort of things that doesn’t have any basis in fact as far as we can see, right? And so abstinence from sexual activity, great, you don’t have to worry about this stuff.
The second thing is really just in general, having fewer partners. So being selective with your partners and then potentially getting into this relationship where you are agreeing to only have sex with this person and they’re agreeing to only have sex with you. So that’s kind of the second thing.
And the next thing is really if you have several partners having conversations with them about any history of sexually transmitted infections and potentially coming to some kind of agreement on testing and getting tested together. So going to one of these clinics, getting tested together, sometimes those results take a couple of days to come back. But if this is somebody you’re going to see on a regular basis, really reasonable thing to do.
And then the last one that is really probably the most important is condoms. And so condom use, using condoms the right way every time. The CDC website, if people go there, they do have a tool there for where you can put in your ZIP code and like potentially get free condoms around your area. Really, really reasonable and responsible thing to do as far as using them correctly, the biggest thing is using them every time.
So like spotty use doesn’t do you a whole lot of good. If you feel a condom break or if you notice that a condom is broken, you need to change it out right away. And then even some of the lubricants you use, so like recommended to use water-based lubricants and things with latex condoms whereas, you know, petroleum jelly, like even Vaseline and stuff is potentially a little more damaging to latex and can make it break easier.
So educating yourself on a couple of those things and being responsible with the condom use is the number one thing you can do to prevent sexually transmitted infections behind all these other things that we talked about.
Alan Helgeson:
Probably something we need to share also. And I think we’ve talked about some of the things as STIs and STDs, but even going unchecked or untreated, what are some additional complications of the STIs if they don’t come in and see a medical professional?
Dr. Charles Shaffer:
Yeah, good, good question. And so one thing that we haven’t touched on at all, and I should have worked in here at some point, is a lot of these sexually transmitted infections and especially the sequela of them, like the bad stuff that can happen with them is worse for pregnant people, people who are pregnant, people that are going to have a baby or while they’re delivering.
So I would make that one carve out, that if you are pregnant and you’re not sure of the possibility of having a sexually transmitted infection, or you’ve had some new partners, you definitely need to get tested with regular prenatal testing. That’s part of it.
But if you haven’t seen a provider, and you haven’t gotten health care, you’ve had more than a couple of babies and you just feel like you don’t need to go see the doctor, that’s a really good reason to go is to at least have that sexually transmitted infection testing and make sure you’re not passing something along to your baby. So that’s a huge one, especially with herpes and syphilis. And some of these can really be harmful to the baby or even result in the death of the baby. So that one’s massive.
The other ones that we see pretty commonly in clinic and things – gonorrhea and chlamydia like we talked about – they may or may not have any symptoms. So if you have this infection and you’re not having any symptoms and you are not having that yearly visit or getting screened at all, you might not even know that you have it.
And for young ladies, one of the things that can happen is what’s called pelvic inflammatory disease, and they get inflammation from that bacterial infection in their uterus, fallopian tubes, ovaries, and they can have pelvic pain that lasts for quite some time. They can have damage to their fallopian tubes that makes them infertile or causes more ectopic pregnancies. So like really, really bad health outcomes from this thing that maybe you didn’t even know that you had. And so the greatest thing is trying to not get a sexually transmitted infection in the first place, followed by, boy, if you have one, you probably ought to get it treated.
Alan Helgeson:
Earlier when we were talking about statistics on the variety of different sexually transmitted infections, you talked about HPV being at the top of the list as the biggest one out there. We should devote some time to talking about that. So what are the benefits of the HPV vaccine?
Dr. Charles Shaffer:
Yeah so benefits of the HPV vaccine. The current HPV vaccine offered in the United States is a vaccine called the Gardasil nine, and it does a very good job of preventing a number of HPV subtypes. So HPV stands for human papillomavirus. There’s a bunch of different types of that virus. And the ones that this particular vaccine prevents are 6, 11, 16, 18, 31, 33, 45, 52, and 58. So if you need some lottery numbers to play, there you go. 16 and 18 are the big ones implicated in cancer. And so those are very, very important for us to guard against. And this HPV vaccine prevents up to 90% of cancers from HPV, which is just massive and starting to kind of be born out in the numbers.
And so, as you know, we started with HPV vaccines in the United States in 2006, and so as we’re seeing some of these kids grow up, the numbers of a HPV infections from these cancerous subtypes are down, you know, sometimes 80, 90%, which is great if the numbers are lower, but what you really care about is the cancers. And so the cancers are down over 40% in vaccinated individuals, which is kind of massive. And so it’s this really great thing that’s come along and a very important thing for us as health care providers to kind of be on top of.
Alan Helgeson:
Is this the vaccine, Dr. Schaffer, that is the regimen of three shots over a period of time?
Dr. Charles Shaffer:
It can be. So it’s a little confusing, the dosing regimen for some folks. So if you start between, it’s recommended to start at 11 and 12, you can start as young as nine years of age with offering this vaccine. If you start between 11 and 15, you only need two doses. And if those doses are between six and 12 months apart, if they’re closer than that, you need a third dose. If you’re above 15 or so when you start, you need a third dose. If you are an immunocompromised individual, we recommend a third dose, but yeah, two to three doses depending on when you start.
Alan Helgeson:
Dr. Schaffer, you’ve talked a lot about STDs, STIs, and we’ve learned they’re one and the same. And STI is really what the CDC is saying we call it. A lot of information here. But as we get ready to wind down this episode, any last things as far as takeaways?
Dr. Charles Shaffer:
Yeah, I think, you know, if there’s one thing to take away from it, it is for me again that your medical home should be a safe place for you. I’m going to try to not get emotional. There are issues, you know, around gender identity and things right now that are so polarizing and political and difficult. I see medicine as this, like this beacon in this lighthouse and this safe place that you can go no matter who you are or who you love or what your sexual practices are. And if you don’t have that in your current medical facility, you should go find it somewhere else. But I hope that you know, Sanford’s a good place for folks to find that.
Cassie Alvine:
This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, listen on Apple, Spotify and news.sanfordhealth.org.
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Posted In Bemidji, Children's, Family Medicine, General, Gynecology, Health Information, Immunizations, Symptom Management, Women's
