Ologies with Alie Ward

Venereology (SEXUALLY TRANSMITTED INFECTIONS) with Ina Park

February 11, 2026

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  • The terminology shift from Sexually Transmitted Diseases (STDs) to Sexually Transmitted Infections (STIs) reflects the scientific understanding that many infections are asymptomatic and do not cause disease. 
  • Regular STI testing frequency depends heavily on individual sexual behavior, risk factors, and population guidelines, with recommendations ranging from annual to every three months for high-risk individuals. 
  • Bacterial Vaginosis (BV) is now understood to be potentially sexually transmissible, necessitating a paradigm shift where treating male partners concurrently with the patient is crucial for preventing recurrent BV episodes. 
  • The HPV vaccine is highly recommended due to its excellent safety record and its protection against multiple cancers, including head and neck cancers, which are now more common than cervical cancer in the U.S. 
  • Untreated STIs are a primary cause of tubal factor infertility in women, emphasizing the critical need for regular STI screenings analogous to dental checkups. 
  • HIV is no longer a death sentence; the 'Undetectable Equals Untransmittable' (U=U) status combined with PrEP has created a paradigm shift, significantly reducing stigma and transmission risk between positive and negative individuals. 

Segments

STI Terminology Shift Explained
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(00:05:59)
  • Key Takeaway: The term STI replaced STD because many infections are asymptomatic and do not cause observable disease.
  • Summary: The evolution from Venereal Disease (VD) to STI reflects expanded knowledge, as many infections like HPV do not manifest as disease. A disease implies bodily damage, whereas an infection can exist without causing symptoms or problems. HPV, for example, can be present and clear without ever causing pre-cancer or cancer.
Stigma and Cultural Attitudes
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(00:09:22)
  • Key Takeaway: Societal taboos surrounding sex and moralistic views often fuel the stigma associated with acquiring STIs.
  • Summary: Talking about sex is often harder than having sex due to the vulnerability involved in intimate exposure. Historically, religious influences have framed infections outside of traditional marriage as punishment for immoral behavior. This attitude persists, suggesting that acquiring an STI implies personal fault rather than being a normal consequence of sexual activity.
STI Testing Frequency Guidelines
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(00:14:02)
  • Key Takeaway: Testing panels and frequency are highly dependent on individual sexual networks, gender, and partner count, not a one-size-fits-all rule.
  • Summary: Cisgender men with multiple partners are recommended to test for gonorrhea, chlamydia, syphilis, and HIV up to every three months, including throat and rectal swabs if applicable. Generally, individuals under 25 having sex should test annually for bacterial infections, and everyone should have an HIV test between ages 13 and 64. Uncertainty about a partner’s fidelity, even in seemingly monogamous relationships, warrants getting tested.
Curable vs. Lifelong Infections
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(00:19:13)
  • Key Takeaway: Bacterial STIs like gonorrhea and syphilis are curable with antibiotics, while viruses like HSV and HIV require lifelong management.
  • Summary: Bacteria such as gonorrhea, chlamydia, and syphilis are typically cleared with short courses of antibiotics, though Mycoplasma genitalium is concerning due to growing resistance. Viruses like Herpes Simplex, HIV, and Hepatitis B are lifelong conditions, though Hepatitis C is now curable. Viral shedding for HSV can occur asymptomatically, making disclosure and barrier use important.
Herpes Simplex Virus Types and Shedding
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(00:27:00)
  • Key Takeaway: HSV-1 can infect genitals and mouth, often causing milder, less recurrent outbreaks than HSV-2, which primarily affects the genitals.
  • Summary: HSV-1, commonly associated with cold sores, infects about half of U.S. adults and can be transmitted to the genitals, sometimes mimicking HSV-2 outbreaks. HSV-2 affects up to 20% of the population and causes more recurrent outbreaks. Viral shedding, which transmits the virus, declines over time but can still occur on about 10% of days after 10 years of having HSV-2.
Managing Herpes Transmission Risk
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(00:31:08)
  • Key Takeaway: Reducing herpes transmission involves barrier use, disclosing status, and taking suppressive antiviral medications, which cut transmission risk by about half.
  • Summary: Using barriers during penetrative sex significantly reduces transmission risk, especially if the infected partner has lesions on the penis. Daily suppressive therapy, like Valacyclovir, reduces transmission risk by approximately 50%, though it is not as completely suppressive as HIV medication. Outbreaks can be triggered by physical trauma, such as friction from activities like getting a Brazilian wax.
Pubic Lice and Genital Grooming
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(00:37:41)
  • Key Takeaway: Pubic lice (crabs) are still present, and removing pubic hair creates micro-trauma, increasing vulnerability to infections like HPV.
  • Summary: Pubic lice, though less frequently seen by some clinicians now, require hygiene measures like hot machine washing for treatment. Pubic deforestation (full waxing) creates micro-trauma, which can create open areas making the skin highly vulnerable to acquiring infections like HPV. Shaving over existing warts, for instance, can cause the virus to spread rapidly to surrounding skin.
Bacterial Vaginosis Paradigm Shift
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(00:45:29)
  • Key Takeaway: Recurrent Bacterial Vaginosis (BV) is often caused by sharing bacteria with a partner, requiring simultaneous treatment of both partners to restore the vaginal microbiome.
  • Summary: BV is an imbalance where anaerobic bacteria overgrow, creating a coating on vaginal walls that resists treatment and causes recurrence. New clinical evidence shows that treating the male partner with both oral and topical antibiotics significantly reduces recurrent BV episodes in their female partners. This finding mandates a complete paradigm shift toward offering partner treatment for BV.
HPV Vaccine Importance and Efficacy
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(00:58:03)
  • Key Takeaway: The HPV vaccine is a major cancer prevention breakthrough, with new data suggesting a single dose may soon be sufficient for long-term protection.
  • Summary: The HPV vaccine prevents cancers including cervical, penile, anal, and oropharyngeal cancers, the latter of which is now more common than cervical cancer in the U.S. Current schedules allow for two doses for those vaccinated under age 14, and recent research suggests one dose might provide long-term protection against high-risk strains like HPV 16. The vaccine has an excellent safety record across hundreds of millions of administered doses.
HPV Vaccine Benefits and Age Extension
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(01:00:59)
  • Key Takeaway: The HPV vaccine protects against multiple cancers, including penile and anal cancer, and its licensed age range has been extended up to 45 years old.
  • Summary: The HPV vaccine prevents cervical, penile, anal, and head-neck cancers, with HPV 16 being responsible for many of these. Oral pharyngeal cancers, preventable by the vaccine, are now more common than cervical cancer in the U.S. The vaccine has an excellent safety record, and future doses may only require a single shot.
Sexism in STI Screening Awareness
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(01:03:21)
  • Key Takeaway: Cis women are more susceptible to catching STIs, and untreated infections frequently cause pelvic inflammatory disease leading to fertility issues.
  • Summary: Patron feedback highlighted that STI screenings are less advertised for heterosexual cis men, despite them being potential asymptomatic carriers that can cause fertility damage in women. Untreated STIs can spread, causing damage and scarring in the uterus and fallopian tubes (Pelvic Inflammatory Disease). A 2017 study indicated that most cases of tubal factor infertility are attributable to untreated STIs.
Symptoms of Gonorrhea and HPV
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(01:05:00)
  • Key Takeaway: Gonorrhea (the clap) and Chlamydia often present with no symptoms, necessitating regular testing, while HPV symptoms vary by gender.
  • Summary: Gonorrhea symptoms can include frequent urination, burning during urination or ejaculation, and abnormal discharge, but often there are no symptoms. HPV symptoms can include genital warts, itching, or discomfort, and for those with a vagina, pain during sex or unusual bleeding. Chlamydia, meaning ‘flower of the military cloak,’ can also be asymptomatic, requiring testing.
STI Transmission During Pregnancy Planning
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(01:06:51)
  • Key Takeaway: STIs can be transmitted during birth, requiring both sperm-producing individuals and pregnant/pre-pregnant people to get screened before conception.
  • Summary: STIs can be transmitted from parent to child during birth. Individuals planning to become parents should get tested before trying to conceive. Pregnant and pre-pregnant individuals should also ensure they are screened.
STI Risk Across Sexual Orientations
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(01:07:10)
  • Key Takeaway: While cis lesbians may have a lower overall STI risk compared to other populations, the risk is not zero, and CDC screening guidelines remain the same for women who have sex with women.
  • Summary: Risk for STIs exists if partners exchange fluids, especially if one partner has outside partners, even in lesbian relationships. HPV transmission between women can occur via hands or oral sex, meaning cervical cancer screening remains necessary even without penile contact. For those who are asexual (ACE) with no genital contact, the risk for HPV is very low.
Impact of Political Funding on Sexual Health
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(01:11:02)
  • Key Takeaway: Current political uncertainty and proposed budget cuts threaten public health services, potentially leading to reduced clinic services and elimination of support staff positions.
  • Summary: Losses in grant funding, particularly for research, are being observed on the ground, leading to reduced services at sexual health clinics. Support roles like navigators and social workers are being eliminated due to funding instability. If insurance coverage for services like PrEP disappears, there will be increased pressure on the public safety net, such as Planned Parenthood.
HIV/AIDS, U=U, and PrEP Advancements
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(01:14:44)
  • Key Takeaway: Modern HIV treatment means that if the virus is suppressed (undetectable), it cannot be sexually transmitted (U=U), and HIV-negative individuals can use PrEP for near-complete protection.
  • Summary: HIV infection no longer universally leads to AIDS if treatment is accessed early enough to suppress the virus. Undetectable status means the virus cannot be sexually transmitted, creating a major paradigm shift. PrEP options include daily pills and injectables (with a 12-month injectable expected soon), which facilitates sexual interaction between positive (undetectable) and negative (on PrEP) partners without transmission risk.
Overlooked STI Symptoms and Syphilis Signs
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(01:19:57)
  • Key Takeaway: Painless sores, especially around the genitals, anus, or mouth, must be checked as they can indicate syphilis, which progresses if ignored.
  • Summary: Chlamydia and gonorrhea can easily infect the eyes if semen enters them, requiring immediate washing. Overlooked symptoms include painless sores (a sign of primary syphilis) that disappear on their own but allow the infection to spread internally. A non-itchy, full-body rash or patchy hair loss can signal secondary syphilis and warrants immediate testing.
Genital Irritation and Grooming Safety
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(01:22:09)
  • Key Takeaway: Recurrent, undiagnosed vaginal irritation might be genital herpes, and shaving should be followed by several hours of abstinence to mitigate micro-trauma risk.
  • Summary: If routine yeast infection treatments fail, getting a swab for Herpes Simplex Virus PCR is prudent, as herpes can manifest as simple irritation. Seeing a doctor for any genital or rectal anomaly is better than self-diagnosing via Google, even if it turns out to be a normal variant or ingrown hair. Shaving creates micro-trauma, increasing STI risk if sex occurs immediately afterward; a waiting period of several hours is recommended.
Myths About STI Transmission and History
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(01:24:46)
  • Key Takeaway: The most common myth busted is that STIs are transmitted via toilet seats; a partner claiming this usually indicates infidelity.
  • Summary: Skeletal evidence suggests Columbus brought syphilis back to Europe from the New World, debunking myths about its origin. Sex with animals (SWA) is a documented behavior associated with rural areas and specific demographics in Brazil. The expert’s favorite myth to bust is the toilet seat transmission claim, which often masks infidelity.