Ologies with Alie Ward - Venereology (SEXUALLY TRANSMITTED INFECTIONS) with Ina Park

Episode Date: February 11, 2026

You’ve got junk, and we have info. The charming and hilarious researcher, professor, sex-positive health advocate, and author of the science book “Strange Bedfellows,” Dr. Ina Park, joins to talk about sores, symptoms, muffs, condoms, testing schedules, titillating vaccine developments, miracle medications, Brazilians, HIV magic, stepping out vs. opening up, toilet seats, antibiotics, new scientific shockers about bacterial vaginosis, crotch crickets, conservative obstructions, the secrets of Columbus, and most importantly how to stay horny, true to yourself, and safe. Whether you’re monogamous, open, ace, or dating, she’s giving the advice you need to communicate more openly and have more empathy for the health of friends and strangers. Visit Dr. Park’s website and follow her on InstagramBuy her book, Strange Bedfellows: Adventures in the Science, History, and Surprising Secrets of STDs, on Bookshop.org or AmazonDonations went to the University of Alabama at Birmingham Dr. C. Kirk Avent Endowed Support Fund and the San Francisco City ClinicMore episode sources and linksOther episodes you may enjoy: Sexology (SEX), Urology (CROTCH PARTS), Phallology (PENISES), Gynecology (NETHER HEALTH), Epidemiology (DISEASES), Biological Anthropology (SEXY APES), Neuroendocrinology (SEX & GENDER), Venusology (VENUS), Carcinology (CRABS), Trichology (HAIR), Eschatology (THE APOCALYPSE)400+ Ologies episodes sorted by topicSmologies (short, classroom-safe) episodesSponsors of OlogiesTranscripts and bleeped episodesBecome a patron of Ologies for as little as a buck a monthOlogiesMerch.com has hats, shirts, hoodies, totes!Follow Ologies on Instagram and BlueskyFollow Alie Ward on Instagram and TikTokEditing by Mercedes Maitland of Maitland Audio Productions and Jake ChaffeeManaging Director: Susan HaleScheduling Producer: Noel DilworthTranscripts by Aveline Malek Website by Kelly R. DwyerTheme song by Nick Thorburn Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Oh, hey, it's your top used emoji, which I just checked. And today mine is the sparkly heart rather than the usual wailing, crying one. So that's good. It's Alley Ward. This is the Ologies podcast today. We are tickling your heart by talking about testing. It's sexually transmitted infections. Let's practice some erotic medicine with an expert you're going to fall in love with mentally. But first, thank you for the patrons of Ologies at patreon.com slash Ologies, who support the show for as low as a dollar a month and who submit questions before we record. Thank you to everyone wearing Ologies merch from Ologiesmerch.com and finding each other in the wild. You can tag us on Instagram or you can DM us pictures that we can share.

Thanks, of course, to everyone who leaves reviews for the show. So many lovely ones. They help so much. Each week, I prove that I read them. I pick a new one such as A Tran R who wrote, I've listened to this podcast for like six years and I feel bad that I'm only now writing a review. This podcast is amazing. And if she reads this review in an episode, I hope is for something cool like lasers.

pirates or something. Atron R, it's about syphilis and stigmas and buttholes, so I hope you like that. Worth the wait. Also, Angie 14, long-time listener for some reviewer, I see you. Also, thank you to sponsors of the show who make it possible for us to donate two causes each week. Okay, on to this week's guest. They are the author of the wonderfully informative, hilarious, boldly authentic science book, Strange Bedfellows, Adventures in the Science History and Surprising Secrets, of STDs, a book, the cover of which features like crisp, rumpled white sheets and a stuffed crab in it. And one review for this book puts it very elegantly, whether you have an STI or not, whether you have sex or not, whether you're queer or not, this is a must-read book for

2020s America. So this guest got their bachelor's in molecular and cell biology at Cal Berkeley, then did a master's in clinical research at the University of Minnesota, got a fellowship at the University of San Francisco in obstetrics, gynaecology, and reproductive sciences and and sexually transmitted infections, and is now an associate professor in the Department of Family and Community Medicine at UCSF and is a medical consultant with the CDC Division of SDD Prevention. I was aware of their work. I fell in love with their sense of humor within a few lines of their bio, which reads, being a first-generation Asian kid in the U.S., the extent of my sex education for my parents was,

don't have sex before you get married or we will kick you out of the house. In case you were wondering, they write, I was already sexually active by the time I received this advice. And they say that their time on earth would be best spent making people feel better about their sex lives, reducing stigmas around STIs and conducting good science and sharing it with the world as best they can. And they do it so good. So slip into something more comfortable and open your ears for sores, muffs, condoms,

testing schedules, titillating vaccine development. difficult conversations, resilience, HIV magic, stepping out versus opening up, toilet seats, antibiotics, new scientific shockers about bacterial vaginosis, crotch crickets, conservative obstructions, the secrets of Columbus, and most importantly, how to stay horny, true to yourself and safe, with researcher, MD, sex positive, sexual health advocate, author, and veneerologist, Dr. Ina Park. Two of my colleagues actually got syphilis tattoos at our last scientific conference. So that's when you know that people are really devoted. Do you know what I mean? Actually, would a syphilis tattoo last longer than syphilis? You know what? It certainly could. Yeah. A syphilis tattoo could last longer than syphilis. Absolutely.

There's no treatment for a civilis tattoo, but there is treatment for syphilis, right? No, exactly. Well, there's laser tattoo removal, obviously. But yeah, you could turn it into something decorative. And I will also have you say your first and last name and your pronouns, just to make sure I say everything right. Ina Park, she her. And as I was saying before we started recording, Dr. Park, but you said if you're seeing me for a vaginal or erectile exam, then I can call you doctor. Other than that, it's Ayna. Other than that, it's Ayna. That's right.

I'm so excited to have you on. This is a topic that just fresh off of the title, I think a lot of people grew up thinking STDs, now we call them SDIs. Can you explain a little bit about that change? Sure. I mean, a little bit of it is semantics. However, you know, we actually started off calling sexually transmitted infections venereal diseases or VD. And as you may have learned in our recent Venusology episode about the fascinating planet of love with the galactically charming Dr. Vicki Hansen. Venus is, was the Roman goddess of love.

And hence, venereal means of or pertaining to sexual desire or intercourse. Hell yeah, people who have had sexually transmitted infections for untold millennia. There's this one ancient Greek royal who reportedly bagged her king's dong in a goat bladder because he had inadvertently killed his mistress with jizz containing scorpions and serpents, they thought. So listen, VD or sexually transmitted infections, they are not new. And remedies these days, they're much less sticky and stinky than a goat's bladder. Praise Zeus. The truth is is that as our awareness and knowledge of STIs has expanded, we understand that many of these are infections that are asymptomatic and don't actually even cause disease. And so we went

from venereal disease, which is already a loaded term with some judgment in it, to sexually transmitted diseases. And then when we understood that there was a lot of asymptomatic infections that never cause any problems, things like HPV, for example, can come and go. And for many people don't cause a problem. Folks felt like it was more scientifically accurate to call them sexually transmitted infections. Now, some of them still cause disease, but a lot of sexually transmitted infections are just that they're infections and they don't necessarily cause a problem. What is the difference between a disease and an infection, though? Is a disease course longer and curable? What's the deal? Well, a disease would imply that it's doing some sort of damage to your body. So whether or not that

be inflammation of your cervix or in the uterus or causing discharge, you know, that would be a manifestation of disease, but someone can have an infection. It can just sit there and, like, I'll just use HPV as an example again. You can have the infection. You can have it for a couple years. You can get rid of it. You never knew that you had it. But you did have the infection, but you just never manifested the disease, which in the case of HPV could be pre-cancer or cancer. HPV, just FYI, stands for human papilloma virus. And according to the Centers for Disease Control, there are a couple types. There's the wart causing virus, which is non-oncogenic or not cancer-causing, and then there's the oncogenic, which is cancer-causing variety, which is responsible just in the U.S.

alone for about 36,000 cases of cancer a year in areas like the cervix, vagina, vulva, penis, and the back of the throat, which is called oropharyngeal cancer, including the base of the tongue and the tonsils. Are you freaking out? Don't. Research shows that nearly everyone who is not vaccinated will get HPV at some point in their lives. And that most HPV active infections go away by themselves within two years. And we do live in the point of history where there are vaccines for this. So we're going to talk more about those in a bit.

But before your crotch, let's get back to your head. Why do you think right off the bat there is still such a stigma? As a culture, we love sex, we love sexy things. Yes. It might be a badge of honor for some people, in terms of how many partners they've had or how desire they are. Yet why is it like something that absolutely no one other than you and the people who are doing outreach in the field typically like to talk about. You know, I always say that having sex is a lot easier than talking about sex, which is so ironic. True.

So true. And I think part of it is there is a general, I think, societal taboo around talking about sex. I think sex is a very vulnerable time. People interact with each other all the time, right? And people exchange bugs all the time. We give each other colds. We give each other other other other infections. But something about being naked or partially clothed, you know, with another person and exposing your genitals and other, you know, intimate parts of your body. somehow that gives sex sort of a different meaning than our regular day-to-day interactions. And I think if we even harken back to the Bible, there's lots of different, you know, quotes that I could offer about STIs and, you know, heteronormative male-female

female relationships being the only acceptable types of sex. And that if you do anything outside of that and then an infection or some sort of disease or condition results, then that's sort of a punishment by God, do you know what I mean, for immoral behavior. So I think regardless of whether or not you adhere to Christian values or whatnot, there is still a societal influence, I think, and that kind of attitude that sex is somehow dirty unless it's occurring within the confines of traditional marriage and anything that happens to you beyond that is somehow your fault. And also that having an STI must by nature imply that you did something wrong and that you are somehow being punished for it. Do you find that that's true with other cultures or other religious bases or is it mostly

Judeo-Christian or in other parts of the world? Is there still that much stigma or that much moral oversight into sexual behavior? From what I encountered, I don't really know about any culture that sort of is open and accepting of STI as a normal consequence of being a sexually active person. I still haven't found that society or culture yet, but I would be delighted to find it. I will say, however, that there are definitely countries that are more open about sex and their messaging towards the general public is a lot more sex positive. I mean, I think the Australians are a prime example. These two feel pretty stoked right now. Is it because they just had great sex? Or because they used a condom.

Was it the chilling before that? Maybe. Or maybe they felt safe doing the best part because they regularly do the test part. Yeah, that's it. Make SDI testing your before play. A lot of their ads are fun and upbeat and sort of empowering as opposed to shaming,

which I felt that in the United States, up until very recently, a lot of what we put out in terms of messaging to the public is based in fear. Yeah. But these days, I have to tell you that I've seen some progress. I'll just take Toledo, Ohio as an example. They had a syphilis outbreak and it looked like it was being associated with commercial sex work. So they put huge billboards up all over the city that said, you know, are you paying for sex?

Get tested if so. And that might have caused some pearl clutching by the soccer moms that were driving by, but it actually increased syphilis testing rates. And they were just having an honest acknowledgement of, here's what's causing the syphilis epidemic in our particular area. Let's be honest with the public about who needs to get tested. And so I think that that gives me hope that people are moving forward in terms of communicating more openly,

but it is a very uphill battle. Yeah. It always cracks me up that like you could make out with someone at a bar, not a big deal. Absolutely. Well, you know, whatever, maybe a big deal. But you can make out with someone swathe up. all kinds of things in your wet mouths, but it's so much less stigma than if you had sex with someone

who using protection, which is so interesting to me. But again, going back to like moral stuff, but when it comes to getting tested, because like those two words are like getting tested, that's hard to talk about with partners. But also, I think a lot of people are like, for which ones, though? Which ones can you test for? Which ones are covered by insurance? How big of a panel? How often? Right. I wish I could give you a specific answer, but it's going to depend on the population that you're part of and the gender of your sex partners and how many partners you're having. I think if you're somebody who I'm just going to take a man who's having sex with others, like cisgender men, for example, and if you're having multiple partners, then the recommendation

would be to get tested up to every three months. And that would be for gonorrhea, chlamydia, syphilis, HIV, and depending on where you have sex, so if you have oral sex, you should get your throat swabbed, if you have anal sex, you should get your rectal area swabbed, and then, you know, you should pee in a cup if you're using your penis for sex. So, you know, in terms of gender expansive or queer people who have sex with men and are in those types of sexual networks, as well as men who have sex with men. There's a lot more STIs and there's higher rates of partner change and sexual networks are more dense. So there's just a lot more infections around. And so the recommendations are more frequent and there's more testing recommended. For someone who's just like a straight,

let's say I'll take a straight woman and has one male partner. If both of you are in a committed monogamous relationship and there's no suspicion that someone might be stepping out on the relationship, then there's no reason why you have to get tested regularly. But in general, we recommend that people, like, under the age of 25, get tested at least once a year. And primarily for the bacterial infections like gonorrhea, chlamydia, and syphilis. And then everybody should get an HIV test at some time in their life between the ages of 13 and 64. So the thing is, is I don't want to go into, like, all the weeds. But I will say that while you know that some parts of the CDC website,

around vaccines, for example, have been compromised. All of the recommendations around testing and screening for STIs are still completely fine. So if you go to the CDC website and look up screening recommendations, depending on who you are and what types of sex you're having and who you're having sex with, you'll be able to see how frequently. But I would say that for your younger listeners who are under 25, that they should be getting some sort of testing once a year if they're having sex. It's like an oil change for your car.

You know, it's like every three months or every 3,000 miles. If you are accumulating more partners, then you should get tested more often. So there's no limit on this. I have some patients who come in every month because they're just really busy. Sexually. But, you know, I'm curious, too. Like you mentioned if there's no suspicions of you're in a monogamous relationship, but you never know, right?

I see so many TikToks that are like, I had no idea my partner was like cheating on me of like 16 people or they're like, hey, if you've got a husband named Keith in Salt Lake City Airport, he's with his mistress. I guess that's the whole thing about cheating is like, you don't know, right? So you never know. Right? And so if you did know, it wouldn't maybe be cheating. But how, you know, how with so many apps and with just increased sort of availability to people who might also be willing, how does one really know? Well, so, okay, my advice to you on this. Well, first, of all, to touch on your point about negotiated non-monogamy, people might judge that and say, oh, you're going to put yourself at risk for STIs. In fact, the people that have an open

communication about non-monogamy, those are the people that are actually at lower risk because they often will get tested because everybody knows what everybody's doing. But coming back to this question, because the state of California, where I used to work actually did some research on this, and when we asked women, do you know if your partner might have other partners? These are women who had sex with men. Some of the women said, I know this guy sees other people besides me. And some of them were saying, I really doubt that that's happening. Okay.

And then people were in the middle to say, I don't know, but I think it's possible. Right. So there's three categories, the people that know they're stepping out, the people who are not sure, and the people who really don't think it's happening. And the funny thing is that the risk of chlamydia was the same for the people who, who knew that their partner was having other partners. And for the people that said, I don't know, but it could be a possibility, that actually put you at risk for STIs.

So I think if you're like your listener who's sitting out there saying, I'm in a relationship, we haven't really talked about it. So I think it's possible that this person could be with other partners. That is someone who should probably go in and get tested for STIs. Okay. That's good to know. And I think when it comes to sexual relationships, the more open communication, the better.

Yeah. For sure. And, you know, we're talking about bacteria, like chlamydia, gonorrhea. I understand that bacterial vaginosis has been recently classified as potentially sexually transmitted. Let's talk about it. What's bacterial? What's viral? Let's start with the ones that are wipeoutable by antibiotics.

Yeah. So bacteria, so gonorrhea, ciphilis, sometimes a single dose or a week of antibiotics. antibiotics will knock those out. I'm not saying you don't worry about them, but they're curable, and if you get one, you can get rid of it, and that's great. There's another one that we've only known about since the 80s called Mycoplasma genitalium. It is also a bacteria, and you can get rid of it, but it takes two weeks of antibiotics, and sometimes it can be really persistent. And so if you're one of these people that ends up having discharge and people can't figure out what it is. They do the regular sort of testing for gonorrhea. It's all negative. And they try to

treat you and you come back with more discharge. Mycoplasma is what they're going to test for. And that one is really concerning to me because there's growing antibiotic resistance to mycoplasma. So I just want to put it on people's radars that it's out there. And if you're having penile vaginal sex or anal sex, condoms work really well to protect against mycoplasma. But now moving on, And there's also trichomonas, which is a parasite. And that it can also be cured with a seven-day course of antibiotics. So those are the ones that are sort of containable. Then there are some that obviously you get and then you're sort of living with on a lifelong

basis. And that would be herpes simplex viruses, HIV, as well as things like hepatitis B. And hepatitis C actually is also a virus, but that's now curable. So there's a category of viruses actually like hepatitis C that is actually like hepatitis C that is actually curable. However, but quite a few of the viruses are things that you're going to be living with lifelong. There are tests for everything that I just mentioned, but in terms of what people check for routinely and how often you check depends on, again, like who you are, how you've been sexually exposed. So I can't give a blanket statement about what you should get and how often.

It's something that, you know, your provider can look up. There's like a CDC app actually for STI treatment guidelines and it has all the screening recommendations. So, and it's something that actually any member of the general public can look up for themselves. Oh, that's good. On the CDC website. I'm glad it's still there. Yep. So on our website at alleyware.com slash ology slash veneerology, we'll link the CDC's screening recommendations and considerations referenced in treatment guidelines and original sources, which is the site. And you can sort that by infection or by population. Very handy. And shortly after Donald Trump issued a post-inauguration executive order titled Defending Women from Gender Ideology Extremism and Restoring Biological

Truth to the Federal Government, which side note erroneously stated that only two biological sexes exist. You can see our neuroendocrinology episode for more on that as well as intersex individuals. The executive order demanded that all statements, policies, regulations, forms, communications, or other internal and external messages that promote or otherwise, inculcate gender ideology must be removed, which puts the entire population, including infants born with congenital infections at risk of death. The CDC was also forced to have researchers retract or pause any manuscripts in the process of publication, which included these newly forbidden terms, including gender, transgender, pregnant person or pregnant people,

LGBTQ, transsexual, non-binary, aside male or female at birth, and biologically male or biologically female. So within a few weeks of this in early 2025, a federal judge ordered that those pages be restored saying that the now banned information included more than academic references and they're vital for real-time clinical decision-making. So if you ever try to admonish me or this podcast by saying we should keep politics and science separate... You have a lot to learn. It was pulled down. It is back up. I have looked at it. It has not been compromised. I would still direct people over there. But to your point, some of the viruses, like herpes, which is one of the most common viruses out there, the test that we currently use does not perform very well. It gives a lot of false positives. Really? And so, yeah, so there's a lot of providers out there who don't use the test. But I want to give some hope to listeners because there are now quite a few new tests that are not yet sort of widely recommended, but that is something that is under discussion at the CDC. And I can't give it all away, but I think we're going to be seeing

some changes related to herpes testing, which I'm really glad about. Okay, so maybe Dr. Park can't spill any beans, but I did find an article from late 2025 titled Icuris announces phase three trial results of HSV treatment, which teased that there had been a major milestone in herpes simplex virus treatments, noting that the phase three trial of this one small molecule antiviral can inhibit this enzyme that the herpes virus needs to replicate, and it can help those who have been resistant to other forms of antivirals, including immunocompromise people. Also exciting, there's a 2024 paper in the journal Nature titled, Gene Editing for Latent Herpes Symplex virus infection reduces viral load and shedding in vivo, which the study busts out of

the gate with some real talk. It says anti-HSV therapies are only suppressive because they do not eliminate latent herpes simplex virus present in the neurons, which is the source of recurrent disease. So the antivirals work because you still have the virus, but we can turn that bummer upside down because the researchers, quote, have developed a potentially curative approach against herpes simplex virus infection based on gene editing. So yes, it's in mouse models. and in herpes simplex virus number one, but it's a step in the right direction. So while we tap our fingers impatiently for over-the-counter human gene editing, you can help out your immune system if you're prone to HSB1 or two.

So you may want to look into how much of the amino acid L-Rgenine you're taking or eating. So L-Rgenine, it's a protein builder. It also increases blood flow. So it's incorporated in some fitness supplements or for full, folks looking to get a little more blood to their nether regions to pump up their boners. So you can take it in a pill or foods like turkey and pork and chicken. Weirdly, pumpkin seeds and chickpeas and peanuts are also high in L. Arginine. But this amino acid can also help herpes viruses thrive.

And there's another form of herpes. It's herpes zoster or chicken box, which can develop into shingles later in life. And it also loves L. Arginine to replicate. And there was a 22 article in the British Journal of Clinical Pharmacology called L. Lycine. It's antagonism with L. Arginine in controlling viral infection. And it noted that while L. Arginine can give herpes viruses a leg up and replicating the amino acid Lysine can help out by, let's just say, cock blocking L. Arginine. So if you are prone to herpes outbreaks, including like cold sores or shingles or below the waist, inconveniences, you can look in your supplement cabinet to see if L.R. Janine is something you're taking

a lot of. Or you can consider some Licine. But also, remember, I'm a podcast host. I'm not your doctor, like even a little bit. You know, listener questions and just general discourse, I feel like herpes is the one that people are like, the most stigma, the most fear around. And also, from what I understand, like, really common. Can you break down herpes simplex number one and two? What can you get that wear in the body? Yes. So you can get herpesy splux one or two in either site of the body, meaning the genitals or the mouth.

But herpes simplex one, which is our traditional sort of cold sores, about half of U.S. adults actually have antibodies to herpes simplex one. Not everybody gets cold soars, but so many people get exposed to it. And in other low and middle income countries, it's closer to 80% of people.

Oh, wow. So I would say it's really, you know, almost universal in some countries. And in the U.S., let's, you know, half of people is a good sort of benchmark to think about. Again, in case you missed it, if you get cold source on your mouth sometimes from stress or other triggers, that's probably the variety of HSB1. Now, herpes two, it's a different species and it affects up to 20% of the population. Those with vaginas are almost twice as susceptible to catching it, which sucks. And it's also very evolutionarily clever. It's, ducks at a sight of your immune system. It hides in your nerve cells. And when your immune system is

weak, or you encounter certain stressors or triggers, the virus hops on the express train of your neurons, long axons, right to the skin where it causes mayhem. So which skin destinations? Let's talk. So herpes simplex one, you can also get in the genitals really easily. Oh. The thing is, is that just imagine the first time, let's say you're going out to college, you haven't had any sexual experience. And you never got exposed to herpes type one when you were younger, which you could have gotten from kissing somebody or even, you know, like sharing a toothbrush or sharing cups or whatever, the things that people do, you know, when they're younger, that can easily spread herpes type one. If you never got exposed to that and then someone performs oral sex on you for the first time, then you can get

HSV1 in your genitals. And it can look completely indistently. from a herpes type 2 outbreak. And then does that mean that that can also recur? People usually, I would say, often are one and done, is what I say. But some people do get recurrences. They're much less common. And it's a much milder kind of course of infection. And let's take a peek at the 2022 JAMA paper, viral shedding one year following the first episode

genital HSV-1 infection. And this paper found that people who had genital outbreaks of herpes simplex number one shed the virus about 12% of the days two months past their initial outbreak. Now, nearly a year later, that went down to 7% of days. But that genital shedding could be asymptomatic, so you kind of never know. But the steep decline over time in viral shedding is why Dr. Park says it's sometimes a one-and-done, meaning it's usually dormant, but you never get rid of it entirely. So not one and done, typically number two.

But herpes type two is the virus that causes most of the recurrent herpes. And primarily that affects the genitals. Occasionally it can affect the oral area, but that's much less common. So to sum it up for your listeners, herpes type one, I would think of as just as easily found in the mouth or the genitals or the anal area. But herpes type two, you're mostly going to find below the waist. and rarely are you going to find it, you know, in the head and neck area. And by the way, I'm not trying to scare anybody.

I really want people to go out there and have sex. I just want people to know that just like with anything else you do in your life, things can happen. And it's highly likely that something's going to happen to you in your lifetime. So definitely don't make anybody feel bad if something happens to them. Do you know what I mean? Because you could be next. And you probably have had something and you may not have realized it.

Yeah. And what happens, let's say that you contract harpies or you have it? Yes. Is there anything anyone can do to make sure that it doesn't recur or that they don't give it to anyone else? They don't put anyone at risk for that. Like should people be using dental dams or saran wrap or should they be getting tested or should they disclose anything or should they disclose it only if they're having an active outbreak? Let's say someone's like, oh, I get cold sores or I've had an outbreak once down. downstairs or recurring, what would be the best course of action? Because a lot of people probably

are asking Reddit and you are much more knowledgeable than Reddit. Although I have to say, I do read Reddit quite a bit from time to time. And sometimes people do give good advice. So I'm going to say that. But sometimes people say things. I said, this is totally not true. But I think disclosing is a good idea. And there are things that you can do. So first of all, for people who are having like penetrative sex, whether it's anal sex or vaginal sex, if the partner uses barriers, that can greatly reduce the risk of transmission. Even though if your lesions are on the vulva or your outbreaks are on the vulva, then that doesn't work as well.

But if the person, if it's the person with the penis and they have the lesions on the penis, using barriers can be really, really helpful in reducing transmission. And in some studies, the reduction was like over 80% in risk. The other thing that anybody can do, regardless of your gender identity, is you can take suppressive medications. And so there are drugs there that you can take once a day, like Valais-Cyclivir is just an example. And that will reduce your risk of transmission by about half. So the thing that I don't like about this, and I'm going to bring in HIV into the picture

here, is that with HIV, we have drugs that are so effective. They completely suppress the virus. and you're not actually able to transmit sexually. If your virus is suppressed, we are not there with herpes yet. And so as I was mentioning, suppressive therapy is not as effective for herpes as it is for HIV. So this is the tricky part. What I counsel patients, I say, you can tell people, I'm going to take suppression.

That is going to reduce my risk of transmission by 50%, but I can't guarantee that it's going to completely suppress the virus. And therefore, that does not instill conflict. confidence in everybody, and it helps, but it's not as good as it should be. So I think between any kind of barriers or suppression, that can certainly help your chances. How would you know if you have contracted herpes? Now, most people remain totally unaware and asymptomatic or they have mild symptoms. Now, things to look out for are pain or itching in your genies, bumps or blisters on the genital or your butt hole or mouth, painful peeing, discharge, even flu-like

symptoms like fever and aches and swollen lymph nodes in the groin area as your immune system is like, what the hell, man? And in terms of testing, there are blood tests that look for antibodies to it, or active sores can be swabbed. So that first outbreak can pop up two days to two weeks after exposure, but then subsequent on course of the sores could announce themselves like a few days or hours ahead of time with some tingling or pain in the genitals or in the legs or hip or butt. Obviously, if you feel like an outbreak is coming on, you're going to avoid having sex because, you know, honestly, those are the times when you're shedding virus the most. And clearly, if you have open lesions, you're going to avoid having sex.

But the truth is, is that, you know, the first two years of someone's journey with herpes is the time when they're having the most outbreaks and shedding the most virus. it tends to calm down over time for almost everybody. And though, you know, the fact is that after 10 years of having HSV-2, you're still shedding virus on about 10% of the days out of the year. Oh, wow. Which means 90% of the days you can't actually spread the virus, but you don't know what days those are.

Yeah, why would you randomly start shedding virus? Is it like, oh, you've got jet lag and you're worn down and... It can definitely happen. Isfee is like, yeah. Yeah. It's fine, right? Absolutely. Like if your body's run down, that could happen.

But who knows exactly what triggers, you know, those outbreaks? You know, even friction, for example, in the area. Even some people have, like, they got a bikini wax. They got a Brazilian, which I don't recommend for other reasons. But, you know, they get a Brazilian and now suddenly they get a herpes outbreak because of the friction and the trauma. Just remember, the virus, once you get it, it goes into a latent state and it actually hides out in the nerves in your spinal cord. And so anything that could cause trauma or anything that

will sort of cause your immune system to become run down could trigger an outbreak. Okay. I was going to ask about Brazilians. Oh, yes. Well, I have a whole chapter on that in my book, actually, about pubic care. Again, her astoundingly wonderful book is called Strange Bedfellow's Adventures in the Science, history and surprising secrets of STDs. And the chapter in question is called bushwhacked, untangling pubic hair and STIs. I love her. Do we need it as a, I guess they call it a muff. Do we need it as sort of a muffler, like a little, does a full bush protect you from certain frictions that could put your skin down there at risk? I have no proof, but I think so. Okay. I mean, I think it's there for a reason. And I think it provides some sort of cushioning.

And I also think, I know for 100% certain because I had a Brazilian and I saw what happened is that having a wax causes tons of micro trauma and actually tiny little open areas where if you were exposed to a virus at that point, you would be so much more vulnerable to catching things. Right. And then the other thing I was going to tell you is that a story that I've told before is that I had a patient who had a few warts, which is also caused by different virus. PV in this case, and he shaved over them with a razor, and he went from having like three or four to about 50 because the shaving caused micro trauma to the skin and that virus was just able to easily spread in all those little open areas. So yeah, there's something to be said for keeping the

cushion and not causing trauma to your genital area, especially if over time, people begin to know and understand, okay, what triggers my outbreaks, and they can then avoid those types of activities. Are we still seeing crabs in the year, 26? Oh my God, I miss crabs. I haven't seen crabs. I haven't seen crabs for 25 years. But it is the most deeply satisfying thing because someone comes in, they say something's wrong. You look at their pubic hair. You can see it. You pluck it off. And then you can look at it under the microscope. and you can see the blood meal in their abdomen. Wow.

And then you can fix it. So it's just the most satisfying type of visit, and I haven't been able to enjoy a good crab's visit for a while. Do you have to then instruct them to, like, machine wash hot, everything they have? Yes. I mean, you have to do a lot of hygiene stuff, and then you got to, you know, you have to treat it. And a lot of people also just choose to clip off hair because, you know, I talk about pubic deforestation. If there's no habitat, then there's nowhere for them to live.

This is tragically true if you're a pubic lice. But let's go back in time to the good days 3.3 million years ago when the pubic lice made its evolutionary leap to proto-humans from its former flame gorillas. According to the 2021 paper in the World Journal of Clinical Cases titled crab lice infestation in unilateral eyelashes and adjacent eyelids, a case report. pubic lice can also hit your eyes. Cases involving the eyelashes are rare, but they can be spread through sexual contact or by dirty towels or skin. If you want pubic lice and your eyelids, get eyelash extensions. Those are slightly more desirable habitat for our tiny little friends. Now another vacation destination for crabs, Mormon art pits. According to a 22 article

inquisitively titled, are Mormon college students getting pubic crabs in their armpits? And this article reports some rumors and some firsthand tales of pubic lice spreading two armpits as an intercourse alternative. Now, the pestilental past of betharius pubis, which A-plus title, that was a presentation at the British Dermatology 100th annual conference. And this paper, what a delight. It takes an endearingly pro-lice stance, lamenting all the sex in the city-induced trends of full waxing. And this poster reads, Deforestation can have devastating impact on Pythurius as they are largely fixed to the pubic hair and they move slowly. Without long-term housing, the Laos has to move on or die. But lice

are ancient and resourceful, it says, so it's likely that they will outsmart mankind and be here long after humans are gone. It says, wow, that's inspiring for lice. It's maybe a little dark for us, but they're probably not wrong. So, you know, cut bangs, text your crush, dance around in a public or pubic square. I know. You said 25 years, which to me seems incomprehensible because you were very youthful. And I understand the lore of you standing around in Berkeley, dressed as a condom. Yes. You have been in advocacy for a, a, since you're very young, was there anything that triggered that for you? Or were you like, someone's got to talk about this.

And also as a Bay Area, born bread in the Bay Area, there's just a lot of sexual freedom up there. I feel like the rest of the country lacks. There is. And I work in the sexual health clinic in San Francisco. So I have seen, I've literally, I think I've seen it all. I just stumbled into this by accident. I have to tell you, I mean, I always felt that I was somebody who could talk about sex and many people found that uncomfortable. And I did not.

And I think because I didn't feel that it was uncomfortable, I felt like maybe I should do this with my life. But the reason why I started speaking about it is because I said, all I'm doing is I'm working really hard. I'm working in public health. I'm doing research. Nothing's getting better. My patients are still stigmatized. STIs are only getting worse. So I just felt like there's tons of advocates for HIV.

Nobody's standing up for syphilis and gonorrhea. So I felt like maybe that was my role. And I'm, you know, an ally to the HIV movement as well, but the HIV movement has a lot of advocates and there's not a lot of people speaking out about STIs. And I just feel like the more that we talk about it and I don't want to normalize getting an STI as saying like, well, that's a great thing to get an STI. But I just want to say that it's a often normal consequence of being a sexually active person. If you happen to catch an infection because you happen to have sex, suddenly people, you know, have the license to call you a slut. Like, I'm really not okay with that. And it's not true.

People I know who've had one or two partners in their lifetime have ended up with multiple STIs. I know people who've gotten HIV the first time they actually had sex. So my point is, is that we need to let this go. And the way to let it go is to talk about it. And can I just give some advice to folks? Because you mentioned testing as being such a challenging, it's a challenging thing to do for many people because sometimes they don't want to know the result, right? And then you just say, I'm going to pretend that's not happening and not even look at my results. Yeah. But then how am I going to say something to people? And even if I tell them I have negative results, are they going to think, well, I must be promiscuous, you know what I mean, quote unquote,

and why am I even getting tested in the first place? So my advice to listeners is that go and get tested and then offer your own information first, if you're discussing this with a partner to say, oh, hey, I got tested just to take care of my sexual health. And here's what I got. And they were negative. You know, what about you? I think when you offer your own,

you make yourself a little bit vulnerable. You offer your own information first. I think it gives people permission to then say, oh, well, this is okay to talk about. This person is proactive. Actually, this is the type of person that you should be sleeping with. Yes. Exactly.

And then there's the other side, if I can tell you a story, which is, you know, I had a patient who was getting, you know, I mentioned the vaginal parasite trichomonas. So she was getting trichomonas. And then really the only way for her to get rid of it is the partner has to agree to take medication also because otherwise you'll just keep passing it back and forth. So her partner refused to take his antibiotics. And so she kept getting reinfected. And she said, what should I do? And I said, dump him. Yeah.

So if they, I'm telling you, this is a two-way street. If the other person will not engage, dump them. Yeah. If that is how they treat a bottle of antibiotics, like, how are they going to treat long-term relationship, finances, kids, if you have them. Yeah. Like, not a reliable person. And, you know, you mentioned that Trichia, not Trichinosis. Trichomonas.

Trigomonas. Yeah, you can just call it trick. It's easier. And it sounds, it sounds nicer also. It does. Is that the same thing as BV getting passed back and forth? Because that was so interesting to me. I've had girlfriends who have had that and been like recurrent. I luckily have not had to deal with that. But, you know, I wonder if that's something that now we know, oh, your partner should get tested for that. And it's not just like, I don't know why my vagina is doing this. Yes. I honestly think, well, we may not have time. I think you should have an entire. vaginal microbiome episode. And I recommend Rachel Gross, who's a journalist with the New York Times, who wrote a book called Vagina Obscira. I'm just promoting her, but I will, let me dip my foot into this, okay? Because this is an area, in fact, that I've been thinking about really deeply and just coordinated an educational session on this yesterday for a group of doctors and other providers. So for my entire career, we have not called bacterial vaginosis a sexually transmitted infection.

And for your listeners, bacterial vaginosis just reflects an imbalance of bacteria in the vagina where the bacteria that don't really need oxygen to survive, we call them anorobes. They grow out of control and they push out the good bacteria. The species is lactobacillus crispottis is the best one. And that maintains the acidic pH in your vagina, which is totally optimal. And think about it. It's not like super acidic like a lemon.

It's like, think like yogurt or merlo. It's lightly tangy. Okay, that's what your vagina is supposed to be like. And then if you get this overgrowth of bacterial vaginosis, it starts to smell kind of like fishy. And there are two molecules that are sort of released called putrescine and cadaverine. And they're the same, yeah, they're the same, yeah, they're the same sort of aromatic substances.

that are released with dead bodies and dead fish, which is why there's this whole thing about jokes about fishy vaginas. But it reflects a condition called dysbiosis, which means your vagina is out of whack, for lack of a better term. And so these bacteria overgrow. The whole time all we've been doing is, like, Allie, you come in, things are wrong, your vagina is fishy, I give you antibiotics, you go home, and then two months later, you're back because nothing's better.

And it's all you're thinking is, what's wrong with my vagina? Yeah. Why am I not getting better? And the thing is, is that these anaerobic bacteria are actually creating this coating, like a soap scum, like in your shower, like over the vaginal walls. Oh, dear. And over time, it can become harder and harder and harder to penetrate through that, and you are going to just have recurrences and recurrences.

So what is going on now is with this new clinical trial that just came out, this year, treating men by actually giving them antibiotics to spread on their penis and giving them antibiotics to take by mouth, actually reduced recurrent episodes of this condition in their female partners. So the women took antibiotics, and then the men had to do two kinds of antibiotics. They had to do, you know, topical antibiotics with the cream and oral antibiotics. Listen, I know hogs come in all sizes and shapes and levels of shrouding and unshrouding. And unshrouding. And if you were wondering about your specific hog, I get it. I don't have a dick or kids.

But if you have either and or complex feelings about circumcision, I get that. Some say it's mutilation of baby genitals. Others say it's a religious right of passage. Some medical professionals encourage it. Now, according to the 2010 study in JAMA pediatrics, titled Male Circumcision for the Prevention of Acquisition and Transmission of Sexually Transmitted Infections, the case for neonatal circumcision, they say that circumcision decreases HIV infection by up to 60%. Herpes 2 by up to 34% HPV by 35%. Transmission of bacterial vaginosis to vagina havers by 40%. That parasite

trachomonas by nearly 50%. Now, I have literally no skin in this game. So you do you. All dongs are beautiful and yours or your child's none of my business. thank God. But back to the recent findings about the circular relay race that is bacterial vaginosis. If you'd like to thank the specific set of researchers who discovered this, please see the 2025 paper male partner treatment to prevent recurrence of bacterial vaginosis in the New England Journal of Medicine. And it studied over 150 couples. It found a real whammy mid-trial. And it was so dramatic that they actually had to stop the study early and offer treatment to everybody. And we've known this for a while, but now this sort of proves it, is that bacterial vaginosis can be sexually transmissible.

Now, it's not a classic STI because, first of all, it's not one bug. And people can get BV without actually having sex because, you know, disturbances in your pH for other reasons can sometimes trigger things. But my point is that people with the vagina who are having recurrent BV are often thinking, this is my fault and something's wrong with me. But no, it's actually you are sharing bacteria back in front. forth with a partner. And if both of you are treated, it really looks to me, based on the evidence, that you are going to have a much better chance of recovering a normal microbiome if everybody gets treated at the same time. So it's a complete paradigm shift. It's kind of blowing things up right now in a wonderful way. And it's something that I'm really, I've done it a few times now. I'm really

enthusiastic about treating now partners and the patient at the same. time to see if we can reduce this because your friends will tell you, Allie, that you go on this treadmill of having vaginal odor and extra discharge, which, sorry, nobody wants extra discharge, Ali, it's not that fun. Yeah, it's not on my bucket list. Nope, to have copious, stinky discharge. It's not something I need to deal with on Monday. No, no. No, I mean, there's a time and a place for discharge and this is not it. So my point is is that we now have a better tool with partners treatment. And so I'm really excited and I'm glad you mentioned it. And if you want to go deeper into the vagina, you know, go talk to one of my vagina friends, but I obviously think about it a lot because I do a lot

of teaching and training. So for people out there listening, because I'm sure you have people who do, you know, who are providers or clinicians out there is I want them to think seriously about offering partner treatment to any of their patients that come in with bacterial vaginosis. Yeah, it is really amazing. One of the few good things that happened in 2025 to science and public health. One of the few good things. I'm going to pull up some questions from listeners. You cool with that? Oh, yeah.

Sweet. So we're going to proceed after a quick break from sponsors who make it possible for us to donate to a cause of Dr. Parks Choosing. And this week we'll be splitting the donation between her two favorites, the University of Alabama at Birmingham, C. Kirk Avon Endowed Support Fund, which supports research and training in STIs and other infectious diseases for students, residents, and fellows. Also, the San Francisco City Clinic, which provides free and low coffee. sexual health services, including prevention, diagnosis and treatment of STIs and HIV, and prevention of unintended pregnancy. Wonderful causes, especially in the midst of funding cuts, and we will link to them in the show notes. And thank you sponsors of the show for all the good you let us do on behalf of our ologists. Okay, let's get into questions submitted by listeners via patreon.com slash ologies,

where you can support the show for as little as a dollar a month. And you can ask your questions before we even record. So this next topic was a medical curiosity. on the minds of Natalie W. Mads, Lizzie Martinez, Earl of Gramilkin, Natalie W. Ettingum, brain shenanigans, Emily Oxford, Bjorn Fredberg. Bjoren Fredberg asks, why the fuck isn't everybody vaccinated against HPV? Oh, this is a great question. And it's from Dr. John Geis, who said, Hello, Ali, Dr. John Geis. I really enjoy your show. I would like you or your expert to emphasize the importance of the human papilloma vaccine for our young people, as it can prevent both cervical and penile cancer. I was one of the leading enrollers with my partner, Carl Boutner,

in the early trials. That vaccine has since been replaced with a much better, more effective one. Having a vaccine to prevent deadly and disfiguring cancer is a no-brainer, and its resistance around the country by people with poor scientific understandings could be better educated with a less dogmatic approach that most physicians are prone to take. Maybe you could encourage them. Can you talk a little bit about the vaccine for HPV, how important that is, and what's going on with it? I remember Gardasil came out and I remember... Yes. 2006. 2006. And I remember them being like, you can't. can't give it to underage girls, they'll go out and have sex with abandon. And meanwhile,

like literally those politicians are implicated in Epstein files. But it's like, it's horrifying to see children withheld from things that could save their lives later because of weird sexual hangups in the government. But vaccines, what's going on with vaccines for HPB? So I am so, his name was John, right? Yes. John Geis. So for Dr. John Geiss, I'm so glad. you ask this question, and this is definitely one of my greatest passions. It's actually an area of research for me. So I conduct research on the impact of HPV vaccine on cervical pre-cancer on a population level, and we've seen actually huge declines in pre-cancer for women between the ages of 20 to 24. And those data are actually published in CDC's Morbidity and Mortality Weekly Report.

but I was going to say that, Allie, you mentioned that the, you know, Gardasil vaccine came out in 2006, and that was just what we call a quadruvalent vaccine. So it had protected against four different types of HPV, the two that are most likely to cause warts and the two that are most likely to cause cancer. But things have evolved so much in the field of HPV vaccine. First of all, we now have reduced dosing schedules for people who get the vaccine under the age of 14 or younger can get just two doses instead of three. doses. Just last week, an article came out in the New England Journal of Medicine that demonstrated that maybe even one vaccine might be enough to provide long-term protection against HPV 16 and 18. And I'm going to tell you that the benefits, this is, I think, honestly,

one of the greatest breakthroughs in terms of cancer prevention that's occurred in my lifetime. And it not only protects against cervical cancer, but we think it would also protect against obviously penile cancer, as mentioned by the collar. And then anal cancer, actually, most of the anal cancer is attributable to HPV-16, which is in the vaccine. And head-neck cancer, which is actually much more common in males than in females. And right now, by the way, in the U.S., those head-neck cancers or oral-ferengal cancers are more common than cervical cancer in the U.S. And there is actually, yeah, those lines, you know, actually intersected several years ago.

those oral-ferengal cancers or head-and-neck cancers are actually on the rise. And so the HPV vaccine, because HPV-16, which is a terrible actor, is the one that is responsible for a lot of those cancers. So there's a lot of good things about getting the HPV vaccine. And it is looking like, hopefully, at least in the next few years, that maybe only one shot is what's going to be needed. And so I don't say this often as I don't want to coerce people into doing anything. But for people listening, I just want folks to know I vaccinated, you know, my own kids, and I tell people that all the time if they ask. It has an excellent safety records. Hundreds and millions of doses have been administered. And there's never been a link found to any one specific sort of adverse event.

People do faint because it does hurt. But I will say that for the most part, I really think it's a home run with very little to no downside. And then the age was actually extended up to age 45. Oh, wow. So, yes, a couple people I know in their 40s ran out and got it because they didn't know what was going to be happening for them sexually in the future. So it can prevent multiple kinds of cancers. One of them, the head and neck cancer, you can't even screen for it. So an anal cancer is no fun. And neither is, I mean, cancer is no fun, period, but anal cancer can be particularly debilitating.

So my advice is, yes, go out and get it. And the new vaccine that's available now actually has, nine types in it. So it's giving even greater protection. And it's covered by insurance. And so I don't, I just really want to strongly encourage anybody who is of the age. It's licensed between the ages of nine to 45. So go out and get it if you haven't gotten it already. Ask your doctors. Not me. Once again. But yes, patron Julia Reichelt asked about sexism and STI screenings writing, I'm not sure whether this is just my perception, but I feel like STI screenings are much less advertised for heterosexual cismen, even though they could be asymptomatic carriers of gonorrhea

or chlamydia, which can ruin a cis woman's ability to bear children. And so, yes, you are correct. People with vaginas are more susceptible to catching things. And yes, undiagnosed, asymptomatic, and untreated STIs can definitely lead to fertility issues, as an infection can spread into the uterus, the fallopian tubes, and the ovaries, which causes obviously damage, scarring, inflammation known as pelvic inflammatory disease, which could necessitate cutting out scar tissue in the fallopian tubes or running a cannula through them to clear them, like a pipe cleaner, which I'm choosing not to envision right now. Now, how big a concern is this? So a 2017 study in the American Journal of Obstetrics and Gynaecology noted that 9% of females of reproductive age are

infertile, 9% infertility rate, and that most cases of tubal factor infertility, those fallopian problems, are attributable to untreated sexually transmitted diseases. So most of those cases are untreated STIs. So get checked people. It's like dental health. Regular checkups are worth it to avoid a root canal. Are you embarrassed to go to the dentist? No. Take that same energy. Go to the urologist. And to fall in love with urology, by the way, please listen to Dr. Millhouse, your new favorite nether doctor. We'll link in the show notes. Of any gender, how do you know if you have, say, gonorrhea? You don't. So get checked. Or you might have symptoms like frequent peeing, sharp pain in your lower abdomen. You might feel some burning while you

pee or come. You can have increased or yellowish or greenish discharge, bleeding between periods if you get those, anal discharge, some blood in your stool itching around the butthole. Now that's gonorrhea, affectionately called the clap. Now, what about no? knowing if you have HPV. You don't unless you get tested. Or you might have symptoms like for people with penises, warts on the penis, scrotum around the anus, itching or discomfort in the area. Small growths or lumps, irritation or bleeding with warts, changes in skin texture around the crotch. If you have a vagina, you might have pain during sex, genital warts on your vulva, pain in the pelvic region, some abnormal discharge, unusual bleeding, like after sex. You might have a vagina.

So that is HBB. What about the infection with the most beautiful name? Chlamydia. I know we've all thought why such a beautiful name. It means the flower of the military cloak, which makes no sense to me. But you can look for symptoms such as nothing, like chlamydia can have no symptoms, so get tested. Or you might have pain or burning while you pee, unusual discharge, might smell bad from the pee-p or the vagina, swelling of the butthole, the balls, or vagina.

You might bleed between periods. You might have pain during vaginal sex. You might have lower abdominal pain. Also, anyone who's listening to this out loud or in the car on a road trip, you signed it. You clicked. You know what this is going to be about. I'm helping out.

You're learning things. Also, again, not a fun fact. SDIs can be transmitted via birth. So if you are making sperm and you're looking to be a parent, get a, tested before you're trying for a kid and pregnant in pre-pregnant people, you're looking to get knocked up, get screened too. Now, what about sexual preferences? Who tends to get what and what shall you do to make sure everyone's healthy and just having the best time? So patrons, K8 Rouse, are a Victor, Emily Burns, Joey's Wig, honey-do, Moth, Charlton, Gabia, Shimitete,

asked about demographics in straight versus queer populations and they were not the only ones. know, we did have a question about that. Honeydew wanted to know, are STIs less prevalent in cis lesbians due to the lack of risk of pregnancy and perceived lack of risk of AIDS and other sexually transmitted diseases? It seems most cis lesbians are pretty lax about protection. Moth wanted to know, they wanted to know about this too, and they think, I just think it can't be true since I've seen statistics of things like throat cancer have gone way up due to people having oral sex without protection. So, you know, things like are different kind of sexualities more at risk for throat versus other types of cancers for that. And again, this would be a good case

for getting vaccinated as well. Yeah, so I was going to say, so definitely, I'll just use an example. So men who have sex with men who have anal sex, for example, are definitely more likely to be at risk for anal cancer than, for example, a cis lesbian who never has any butt play, you know what I mean, involved in their sex lives. But I will say just to your point specifically about cis lesbians, I'm not going to say the risk is zero because folks who identify as lesbian are still exchanging fluids, right? And if there are two cis lesbians in a relationship, just like if there's two people of any gender in a relationship that's completely monogamous and there's no people entering from the outside, well, then there is no risk of STIs, right? But if folks who are cis lesbians, for example, are in a relationship and the other person has other partners, whether those partners happen to be cis men or other people, you know, other people, people of other genders. As we said, unless you're in a completely closed relationship,

there's always possibilities for STIs to enter the picture. In general, if you were to take all the cis lesbians and you compare them to other populations with higher rates of STIs, certainly the risk is lower, but it's certainly not zero. And so in terms of the recommendations by the CDC, for women who have sex with women, the screening guidelines are exactly the same. Also because some women who identify as lesbian have had sex with people of other genders at different times. Yeah, yeah. So right now the recommendations are the same. And by the way, the risk for HPV and cervical cancer doesn't appear to be any different.

And a lot of people who are cis lesbians might think, well, if there's no penis, there's no risk. And I just want to sort of debunk that myth. And people may say, well, I don't have to go in per cervical cancer screening. And I would argue that that's not true. you know, definitely get the vaccine and definitely actually still stick to your screening recommendations because HPV is something that can be easily transmitted between women because it can live under your fingernails. It can live on the surfaces of your hands. So absolutely people can transmit HPV to each other that way and it can live in the throat and, you know, people have oral sex.

And that's an easy way to transmit HPV also. That's such a good message. Magda wanted to know if they've never been sexually active and never plan to be if they're ace. Do they still need a pap smear? They're scared. Oh, got it. Well, so I think, so the thing about HPV is that you don't actually need to have any type of penetrative sex to get HPV. So I think if there's been any genital contact whatsoever, even just skin-to-skin contact, that can be enough to transmit HPV. I think if there's really been no contact whatsoever, I can't really think of a way unless they were, it doesn't sound like they'd be sharing sex toys with people or whatnot. If they're really doing nothing sexual and they've had no contact, skin to skin contact with anybody at any time, then I think the risk is really

low. And Rick Gillespie, Bjorn Fredberg, Edegum, Earl O'Gramelkin, and Zach Ever Eight, wanted to know where are we at, Rick wanted to know with the current administration, dismantling many health safety card rails with vaccines too. Like what impact do you think we're looking at in terms of STIs and their treatment? And any advice for if you don't have insurance or if something's not funded? Yeah. So, well, this is tricky, but I will say what I have seen on the ground so far is that a lot of organizations that might provide support to clinics have lost grant funding. And I think the greatest losses in grant funding, though, have actually been in research. Many clinics that I'm aware of that provide sexual health services are still running in some form or the other, but I am seeing reduced services, for example, and then I am seeing staff such as navigators or what they call, you know, social workers who are helping connect people to resources. I've seen that those types of positions be eliminated. I have to say from my vantage point, and this is putting on my budget analysis hat on, which I just had to make a budget hat this year. I'd never care about the federal budget before,

but, you know, we're operating under something called the continuing resolution, and there is no new budget passed of Trump's. The budget that is proposed would absolutely decimate, you know, a lot of public health services because it will radically change how money is given from the federal government to the states for sexual health care and for HIV care. But for now, because the Congress has been, and the president, everyone's kicking the can down the road, that things are actually stably funded in many areas for the time being. And so right now, folks that are trying to access sexual health services where I'm at still seem to be able to do that. What I think could go away is there are services like there's HIV pre-exposure prophylaxis, you know what I mean,

which is now in many forms, injectable forms, as well as daily pill forms. that are often covered by insurance, if the coverage by insurance were to go away, I do think the private sector would step up to a certain extent because they already have. Every company has a patient assistance program, and I have multiple patients who don't have insurance, who are getting medication for free from these programs. So I do think that there'll be an expansion somewhat of those programs. And I think those nonprofits that still exist are going to do their best to fill the gaps in terms of providing free or low-cost prep services.

But I think a lot of people who lose insurance are then going to have to lean on organizations such as like Planned Parenthood or going to your local free public health clinic that does STI services. So I think there's going to be a lot more pressure on the public sector and the public safety net. Yeah, that makes sense. Good news, though. The Washington Research Foundation recently awarded a big grant to continue developing M RNA therapy for folks with genital herpes. So good stuff is still happening. And on the subject of

hopeful progress for certain populations, Scott LaForce, Adi Capello, Stacey Pinkowitz, Goblin Prince, AJ Wyn, and Bennett Vastrobos, as well as Moth, had questions about HIV, AIDS, prep, and more. When it comes to HIV and AIDS, we had a few people who wanted to know, if you just don't, like Atticapelho said, can you talk about the transition from HIV to AIDS? Like, what's happening biologically and kind of like the TLDR in a nutshell of like HIV AIDS prep. How does it work? Oh, yeah. Oh, I'm excited to talk about this one, actually. So I'm Gen X. And Gen X and some millennial folks might remember that HIV was a death sentence. It was universally fatal. And there was no cure. And for a while, there was no test. So people were just running around

freaking out with like chickens with their head cut off, obviously. And we have completely evolved to say that now we're in an era of something called U equals you, which means undetectable equals untransmitable, which means that if you are diagnosed with HIV and you get treatment early enough, your virus will be completely suppressed. You cannot transmit it sexually to your partner.

There's hundreds of thousands of couples, actually, in multiple studies that were done to look at sexual transmission. If you stay on your medication and you don't have detectable virus, you will not transmit it sexually. The other thing is that you will not develop AIDS. So as we talk,

about with infection and disease, right? You'll have the HIV infection, but the whole thing about AIDS is AIDS is the development of certain diseases that only happen when people's immune systems are completely decimated by HIV. So you may never, and most of my patients will never develop AIDS. So I'm not saying that AIDS is gone, but if you take medication and you have access to that, you will not develop AIDS. So I feel like we've had a complete paradigm shift in terms of how we look at HIV. And then to add to it to make it even better is that the HIV negative people can now take HIV prep. And we have daily pills, two different kinds of daily pills. Some people can take those pills like on an event-driven basis, meaning they just take it

just around the time that they're going to have sex if they don't have sex that often. And then there's two injectables, an every two-month injectable and every six-month injectable. And in the next like year or so, there's going to be an every 12-month injectable. So you can like set it and forget it. Yeah. And the other thing is that in the past, my guys who are HIV positive would say, I'm only going to have sex with other positive people because I'm freaked out that I don't want to transmit to somebody. And then you have to have a conversation like, what's your status? You know, are you on meds?

All these things. And now that all the negative guys that I'm with are all taking prep, not all, but most. And the positive people are all taking medication, nobody has to have those conversations anymore. Sometimes they'll put on their app. There's features on the dating app to say, are you positive, are you undetectable, are you on prep? But for the most part, what I've noticed is it's created bridges between HIV positive and HIV negative people. People are dating each other and having sex again and not actually having to have a very difficult conversation because if you're positive and undetectable and you're negative and taking prep, nothing's getting through that. So it's been

really, I think, what I've seen, wonderful for the community of folks that are queer and sleeping with each other. And also, it's just reduced a lot of stigma. I mean, in a major way. For sure. I mean, to see this happen in a generation is almost magic. To see that and to see science make that leap, also to see it be accessible to so many people. It feels like magic, and it's the result of so many thousands of people with both the scientific work and the advocacy, which is why it's just so heartbreaking during one of these episodes I was crying and talking to my dog. And I'm like, they're hurting the smart people on purpose. Yeah, honestly. It just seems like we're shooting ourselves in the foot.

What keeps me up at night is the idea that we would lose any progress that we've made, Allie, because we've come. I don't mean to include myself in the we, but the world has come so far and we could maintain this and we could really be in an era where we could end the HIV epidemic, which is something, by the way, that the current administration actually supported, you know, that was one of a big initiative of theirs that they supported was called EHE or ending the HIV epidemic. Now I don't know what's going on. Yeah, and going back to that, the way that morality and how things are politicized and movements of seeing infections as a punishment is just is crazy to me. But oh, flim flam, anonymous wonders to know,

chlam. Chlamydia in the eyes. Yes, you can get it. Does that happen? Yeah, does that happen if someone nuts in your eye? What's going on? Yes, exactly. So also, I would say, like, let's say you give somebody a hand job or, yeah, if somebody ejaculates in your eye, go and wash that out. You can get gonorrhea in your eye also, which is even worse. So you absolutely can get STIs in your eye. People can also get, this is a little bit different, but folks can get different herpes virus infections in the nerves around the face and that can affect the eye. But if somebody, for example, ejaculates and they happen to have HIV and it goes into your eye, that's like less likely scenario. But chlamydia easily can get in your eyes. So go and wash it out right away. And also, right, if you give somebody

a hand job, don't rub your eyes right away. These are practical tips for you. These are practical tips for Live. TIPs. Yeah. Just like you wouldn't cut up jalapinos and rub your eyes. That's right. Don't do that either. And also, yes, I was working at the emergency department during my training and somebody

handed their partner crazy glue instead of their eyedrops and then they glued their eye shut. Don't do that either. No. Okay. And don't stab your, when you're trimming your pubic here, be careful and don't stab yourself and cause an injury. I've seen that too.

So I'm going to make a list of things. Do not do. Do not do. I do not recommend. You know, last listener questions here. Gabia, Adam Foote, Aaron Dewberry, person, Charlton, Addy wanted to know in Gabia's words, are there any common but overlooked symptoms of STIs? Oh, wow.

What soapbox would you want to be like, hey, get that checked, man? Yeah, I mean, I have to say, so let me start with syphilis because syphilis can be really subtle. And you can have just like a little open sore and you might think, oh, I had a zipper pull on it and it doesn't hurt. But the thing is, is that sore is going to go away regardless of whether or not you do anything. And I think people would much rather be in denial and say, I'm just going to pretend that that's not there and it'll go away. But then what will happen is that that syphilis will become liberated and go throughout your entire body and you're going to feel much worse. So I will say any sort of, you notice any sort of open wound in the general area. regardless of whether or not it hurts or doesn't, or the anus for that matter, by the way,

if you're having anal sex, also an open, painless sore around the mouth too. So if you have that, go in and get that checked. If you end up with a random rash all over your body and it doesn't itch, that could be a sign of secondary syphilis, go in and get that checked 100%. And if you notice hair loss, especially if it's in patches, that can also be like a florid case of secondary syphilis, which means it's gone all over the body. go get that checked. The other thing is, is that if you keep having what you think are recurrent vaginal yeast infections, but they can never diagnose you with yeast, irritation in the vagina that happens

on a periodic basis, like routinely could be a sign of genital herpes. Some people just have outbreaks that just manifest as irritation. So if you keep thinking this is a yeast infection and they've never been able to find yeast, then it would be prudent to actually try to get a swab for herpes simplex virus PCR. But just in general, I think it's better if you notice anything in your genital or rectal area to just have someone look at it and don't pretend that it's not there and have it go away. Right. How often do you have someone coming to you that is terrified and then you're like, babe, that's an ingrown hair? Oh, all the time. Yeah. I would happen every single time. But I think that's also fine. It doesn't annoy me at all. Because if someone comes in and says,

oh my gosh, I think this is X, Y, or Z. I can reassure them that, oh, that's a total normal anatomic variant that a lot of people have or they's because they looked at Dr. Google or Dr. Chat, GPT or whatever, and people, I can tell them, yes, yours looks differently than you might see online, but this is totally normal or this is not what you think it is. And then people feel better. And then now they know their own body better. So it's all, I think it's all positive.

Okay, good. especially if you're shaving or waxing. Sometimes you can get an ingrown hair that really does need antibiotics, though. So either way, good to get it checked out. It is. And I would just, my advice for shaving, because sometimes, you know, some people just don't want to have any hair. And people of a certain generation think that pubic hair is the enemy, which is fine. You know, you can do you.

But my point is, is that if you're going to shave, then it's better to do it and then leave a few hours for the skin to heal before you have sex. You shave immediately, run out the door, and then have sex. You've just created all this micro trauma in your genital area. So I believe in a waiting period of several hours. What about laser? So laser, if you do laser hair removal, if your skin is totally calm, do you know what I mean? Then that shouldn't be a problem. But laser over repeated waxing and shaving?

Oh, do I recommend? It's expensive. The practicality is that shaving is so much cheaper than anything else. Yeah. You know, I don't say that people should invest in laser necessarily, but my point is, is that shaving carries some risk. So just letting you, you know, teaching you how to mitigate that risk. Yeah, yeah. Don't go straight from the shower to a party.

Yeah, don't do it. I'm so sorry to burst your bubble bath here, but let your crotch just catch its breath for a second. And speaking of bursting, let's very quickly, so quickly, just dip into some stomach churners. So Noah Susan Goblin Prince and Nevin Lawrence asked in Nevin's words, I know there were myths involving bestiality, but like, really? And Magna Casasca opened my horrified eyes with the question, is the story about Columbus getting chlamydia from fucking a llama at all plausible? This question led me down a dark, dark Warren of the 2011 Smithsonian article. Case closed. Columbus introduced syphilis to Europe, which begins. poetically. In 1942, Columbus sailed the ocean blue, but when he returned from cross the seas, did he bring with him a new disease? And it continues, new skeletal evidence suggests Columbus and his crew not only introduced the old world to the new world, but brought back syphilis as well, the researchers say. Wow, his legacy continues. Also, for you, very quickly, I found

several studies involving contracting infections from barnyard animals. And that's really all you need to know about that. There was a 2023 study in the Brazilian Journal of Urology, and it notes that SWA or sex with animals among men and sexually transmitted infections in northeast Brazil, prevalence associated factors and behavioral aspects divulged that, yeah, it happens. And that SWA, sex with animals, was associated with increasing age, rural areas, heterosexuality, alcohol use, and the Catholic faith. So folks living out in the country, drinking beers, go to church. Don't go telling city people what to do with their junk because you got plenty of judgment that you can cast real locally. And that's enough of that. Anywho, Ariel Van Sant asked Dr. Park,

what is your favorite myth to bust? Let's say that you could have a blimp in the sky that busted some flim flam. Oh, wow. I think if my blimp in the sky would say your partner, didn't get an STD from the toilet seat, they just cheated on you. I mean, that's not always the case. Like, there's a lot of caveats to that, but I have had multiple people come in and say, my partner said that they got it from a toilet seat because they were in a public toilet and I just shake my head. No.

I'm like, how do I, where do I go with this? This is not good. That's a real, I'm going to hold your hand will I tell you this? I know, is I hate to break it to you. Yeah. Hardest thing about the job. It got to be so much. But what's, is it, it could be petty.

It could be systemic. Yeah, I know there. I mean, there's so much that's fun about the job. And I'll ask that next. What's hardest about the job is it's just this moment. It's just the funding. There's so much uncertainty. My own personal career has been on again, off again this year because of funding.

And so my entire career, I've, never worried about being funded. It's never been an issue for me. And this is the first year where I'm concerned about whether or not I can support myself, whether I can support the staff that I've worked with forever. So that is absolutely the hardest part of the job. And also just watching how the administration is trying to dismantle public health and science. Those are really, really hard things for me this year. Yeah. That's one reason why your book and your outreach and your public speaking and everything you're doing is so, so vital to this, just doing some of the best work and actually saving lives. What is it that you love the most? What keeps you going through tough headlines and the grants and all that stuff?

I mean, the people that choose to spend their lives devoted to STIs and sexual health are the most fun people that you could possibly imagine. You know, they're the ones coming to the meeting with the feather boa and the sparkly outfits. And I work with a lot of queer people. I actually work with a lot of straight people. And everybody who's in it is lively and fun and smart and interesting. And everybody looks out for each other very much. And so I could not stay in this field if it were not for the people. There's flavors, as you know, of different scientists. Right? Yes. Yes, exactly. We are the fun and flamboyant folks who are at the dance party and passing out condoms and wearing bling. That's us. Oh, my God. But, you know, two of my best friends I've known since junior high, Colleen and

Marcy both had worked years as clinicians at Planned Parenthood. Yes. As obes and stuff. And I've known them for years. And yeah, can confirm. Definitely very fun. And you can talk to them about anything. That's right. Which is great. I'm sure that you are that friend that has to take off your Dr. Park hat and put on your Ina hat for your friends who are like, hey, really quick, what is this? Oh, no, and then we're out of party and they said, can you come back into this room?

And then they're like lifting up things and showing them. And they're like, can I come into your van and pull down my pants and show you? I mean, I've done it all. Yeah, that makes you great. Thank you so much for doing this. No problem.

So ask marvelous people many questions because this is how your brain collects the info that your body is longing for. Thank you so, so much to Dr. Ina Park for not only being on ologies, but for her continued passion for her work. Highly recommend picking up her book Strange Bedfellows, which we will link in the show notes. She's so funny. She's so informative. You can follow her at Ina Park, MD, on Instagram and tell her that you love her there.

I highly encourage that. We are at Ologies on Instagram and on Blue Sky. I'm at Allie Ward. Allie has one L on both. Smologies are shorter kid-friendly versions of classic episodes. We will probably not make one out of this, but you can find all the other Smologies as their own podcast. Just search S-M-O-L-O-G-I-E-S.

Wherever you get podcasts, you can subscribe there for weekly episodes. They're free. They're classroom safe. Ologies merch is available at Ologiesmerch.com, and I'm thrilled to announce that we have some new merch coming out in the next week or two. We'll announce first on patreon.com slash ologies. But I know you will love it. Proceeds go to a very worthy charity.

Aaron Talbert Adminzeology's podcast Facebook group. Aveline Malik makes our professional transcripts. Calliard Dwyer does the website. Our lovely scheduling producer is Noel Dilworth. We are deeply committed to managing director, Susan Hale. And we have two editors, apples of our eyes, Jake Chafee, and lead editor Mercedes Maitland of Maitland Audio. Nick Thorburn electronically crooned the theme music.

And if you stick around to the very end, I may tell you a secret. And this week, it's that Valentine's Day is a big breakup. holiday and up to 10% of people have experienced a separation of sorts right before or after Valentine's Day. I spent most of my adult Valentine's Day's single for some reason or another. I highly recommend going out with friends who are single and just looking at cute people, maybe enjoying some nachos, spend the day getting yourself a present or doing what you like. You are your most important partner at the end of the day and you deserve to say, hey buddy, I love you to yourself. I myself love Valentine's Day, not at all for the romance of it,

but as an opportunity to send valentines to friends and family. Like we did in third grade and just tell them that you love them and appreciate them. For years, I would sneak around like on the night of the 13th to friends' houses

and I'd leave them valentines like under their windshield wipers or on their doorstep. One year I was giving out notes and I left like some peanut butter Reese's hearts on my friend's porch with little notes, my friends McKenzie and Catherine,

who were roommates. And in the morning, Catherine texted me to let me know that she found them. But a possum or a raccoon had found them first. And that she had oily peanut butter and chocolate smeared all over her doorstep. So that one was a miss. But it's a thought that counts. So write some notes. Tell everyone you love them.

There's no better time and it's needed greatly. Also, no better time to test that junk. Go out, take it for a spin, use it for fun. If you're both consenting and into it and safe. Okay. Bye-bye.