Episode 24: STD/STI testing even when you’re in a relationship

Dr.Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an ObGyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone. It's me, Dr. Sophia, and I'm so glad to have you back with us as we talk about a very important subject called STDs.

Touseef Mirza:
Also known as?

Dr.Sophia:
STIs.

Touseef Mirza:
Which means?

Dr.Sophia:
Sexually transmitted diseases and sexually transmitted infections. So we'll be using those two terms kind of interchangeably to mean basically the same thing. I had a patient that made this topic come to light. As always, I am joined by my good friend and co-host Touseef Mirza.

Touseef Mirza:
Let's dig in. Hi everybody. The reason why we wanted to talk about this is obviously STDs is a big subject, right? We were going to eventually talk about this because it's an important subject in sexual health. But that being said, Sophia talked to me about this patient she had, and we said, you know what? Let's just really talk about a patient's journey in terms of different things that happen to them from an STD standpoint. So we're gonna start with the story and then really sort of connect all different aspects of STDs from there. So, Dr. Sophia, can you tell us a little bit about the patient that you mentioned to me?

Dr.Sophia:
So every single day I treat, test, and discuss with patients, things about sexually transmitted diseases and infections. But I had a long-term patient of mine who came to me. She is a woman of a certain age, so I'll say she's in her forties. She's been my patient, like I said, for a long time, and she kind of came to me a little distressed. She'd been in a relationship for about four years, and she was super happy.

Touseef Mirza:
A monogamous relationship?

Dr.Sophia:
A monogamous relationship, and she came to find out that her partner/boyfriend/significant other was cheating on her.

Touseef Mirza:
Oh boy.

Dr.Sophia:
Not only was he cheating on her, he was cheating on her with multiple women. So she came to me kind of a nervous wreck and said to be honest with you doctor, I need to make sure I haven't contracted anything. Please, can I get testing? I said to her, of course, and I asked her, I said, well, are you having any symptoms, signs, anything that would make you feel like you have contracted anything?

Touseef Mirza :
So when we say contracted, it means that you have received, or that you've been?

Dr.Sophia:
That a sexually transmitted infection was transmitted to you.

Touseef Mirza:
Okay. Since he was with other women, the probability of that obviously increases.

Dr.Sophia:
That is correct. Multiple partners increases your risk of sexually transmitted infections. In her case, she was unaware, you know, that he had multiple partners. So because she thought she was in a monogamous relationship, they were having unprotected sex or sex without a condom. Rightfully so, she came to me very concerned. She came to me extremely ashamed. That's a really big part of why I wanted to do this podcast, because yes, she was angry at the fact that this guy could do that to her. But moreover, she felt ashamed and embarrassed, frustrated with herself that somehow she let this happen. But the concept is she didn't let anything happen. She thought she was in this wonderful relationship, and it's a reminder that we only know what we know, and we can only control what we can control.

Touseef Mirza:
I mean, number one, the fact that she didn't even do anything wrong. Right? The guy is the one who's fooling around and did not say anything to her.

Dr.Sophia:
That's correct.

Touseef Mirza:
Now we have the woman feeling bad. Meanwhile, she hasn't done anything wrong. She's going with the trust that she has built

Dr.Sophia:
Exactly.

Touseef Mirza:
With the man-it's kind of crazy, like what we do to ourselves as women, you know, it's like we're not even the person that did the wrong thing, but we are so quick to always blame ourselves.

Dr.Sophia:
Exactly. To feel guilty, to be embarrassed. Yet in this particular situation, she honestly was going on faith and the trust and the bond that she thought she built with this person who completely betrayed her. Our visit was more so a visit of reassurance and rebuilding her sense of worth and confidence.

Touseef Mirza:
You needed to reassure her.

Dr.Sophia:
I did. I needed to reassure her, I needed to rebuild her sense of self, that she did not do anything wrong. That she was actually doing the right thing by coming into my office, first of all, to get tested.

Touseef Mirza:
What did she say that she felt she did wrong? That she should have known better or somehow that she should have known somehow?

Dr.Sophia:
She just couldn't believe that this was happening to her at this point in her life. That she needs to be worried or nervous about contracting an STD. You know, people think about STDs and we always think it's a young person's disease. As such, because we always think that it's a young person's disease, we are like, oh, if it didn't happen to me in my twenties, I'm out of the woods, kind of a thing. But even people in their sixties are getting STDs.

Touseef Mirza:
In their sixties?

Dr.Sophia:
Yes. In their sixties.

Touseef Mirza:
Like in senior homes?

Dr.Sophia:
Yes. Especially in senior homes. In senior homes, unfortunately, STDs can run rampant because of the fact that there's this notion that somehow I'm older, it can't happen to me. So when you are a little bit older and you think you're in a trustworthy relationship, you can sometimes be a little bit more, I don't wanna say lax, it's just that you're perhaps more confident in your relationship.

Touseef Mirza:
And you want to believe.

Dr.Sophia:
And you really want to believe that all is well.

Touseef Mirza:
And that this is the real deal.

Dr.Sophia:
And that this is the person, this is the future. This is your forever. So it makes it really hard to conceptualize that you still have to do things like an STD check that seems so unnecessary. Let's just put it that way. Because if it's only you and it's only your partner, then-

Touseef Mirza:
You shouldn't even be thinking about those things.

Dr.Sophia:
It's just that it's a thing of the past. Especially if it's not early into your relationship, perhaps. You know, I oftentimes would advise women early in their relationships if they're going to start seeing someone seriously, or even if it's not serious, but they're definitely going to have an intimate or sexual relationship with them that they get tested before. So that way they have that clean bill of health and can walk into a relationship, a sexual relationship, knowing exactly what their status was going into it and how best to protect themselves, which is of course, using condoms. But this particular story, this particular patient just kind of brings back to mind that we always still have to be diligent. Understanding that sense of diligence just means regular testing.

Touseef Mirza:
Even if you're in a committed relationship.

Dr.Sophia:
Even if you're in a committed relationship. And when I say regular testing, you can figure out what the interval is for you. We typically say once a year. But there are a lot of women who say, oh no, what, you know, I'll ask at every visit, would you like STI testing? Would you like STD testing today? They're like, no, it's okay. Because they feel so confident. In the fact that they are in a committed relationship that is monogamous.

Touseef Mirza:
If anything, you are saying that right now, it's almost like a stamp that says, of course, I don't need it because I'm in a committed relationship. You know what I mean? It's like a stamp. That says, no, I don't need it, because-

Dr.Sophia:
How could I need it? Why would I need it? I'm in a committed relationship.

Touseef Mirza:
It feels good to say that, and it feels good. Or could women who want this type of relationship- I'm not sure saying everybody does, but for those of us, those of us women who do that is almost like, I'm not gonna say a seal of approval, but it just feels like, that feels good to say it.

Dr.Sophia:
It feels good to be able to say, I don't feel like I need STD testing because I know I'm in a committed relationship. It gives you a sense of self-worth and self-confidence. But that self-worth and self-confidence should be there regardless of the type of relationship that you're in. Therefore, the routine checking of, let's say STDs or doing it routinely is simply a part of your health. It's simply a part of your healthcare. Hmm. It's simply a part of preventative medicine.

Touseef Mirza:
So it's almost like we want to disassociate those two things. We should just look at it from a health perspective. Not like, oh, this means that I am in a committed relationship.

Dr.Sophia:
Or I'm not in a committed relationship.

Touseef Mirza:
Right. Like health is just health. And that's it. Because when you think about it, that's the only thing we can control.

Dr.Sophia:
Yes. So the concept really needs to be that it's simply a part of my healthcare, my prevention, and it should not have a negative connotation to it, so to speak. I think many women feel like just by the ask, that it somehow implies some negative aspect of it. It implies that they're not monogamous, committed, trustworthy, faithful, you know? When that's not it at all. Of course, in this particular situation with this woman and this story, she asked for it rightly so, because she realized that there was a potential that she was exposed.

Touseef Mirza:
But if I hear you correctly, what you're saying also is yes, that was the right and responsible thing for that woman to come and say, I wanna get tested because she's taking responsibility of her body. But beyond that, this is something that she could more routinely do regardless of the situation.

Dr.Sophia:
Yes. I'm not saying whether she did or didn't do it routinely, it's more so the concept of letting it be a part of your preventative care. Let it be a part of your annual testing when you go to your primary care doctor, or when you go to your gynecologist, regardless of how old you are. Unless the last time you were tested, you were negative and you've not had sex since then. Like, that's the only way that it makes sense to not get tested.

Touseef Mirza:
I would say also, and we touched a little bit on that, yes, there is this sort of not wanting to even think about the fact that, you know, maybe there was somebody that was unfaithful, which is very hard to grasp when you're in a committed relationship. But the second part is when we do talk about from an STD perspective, it does have negative or taboo connotations, you know, like even in, in the twenties or thirties, because it's, it's like-

Dr.Sophia:
Promiscuous, you're dirty, you are sleeping around. Of course we can think about all of the bad things that are associated with it. But a major part of the problem as far as STDs are concerned is the fact that so many of them have no symptoms. It doesn't mean that you are promiscuous. Many women, a lot of women are exposed to STDs or STIs at their first sexual encounter. So it's the first time that they've ever had sex. Of course, this is partly why we always think of it as a young person's problem. But the reality is that it's an every body problem. Because so many of these illnesses don't even have symptoms. So, for example, if we think about what's the number one STD chlamydia, oftentimes women and men do not know that they have it. They do not know that they have it. By the time that they figure out that they have it, oftentimes they may have had another partner, they may have been with someone else. This is why things can spread.

Touseef Mirza:
So some people might say, well, if they didn't know that they had it, it means that there are really no symptoms. So why is this even an issue?

Dr.Sophia:
It's an issue because it can lead to other issues or problems like infertility, or it can lead to other infections that are more serious.

Touseef Mirza:
That would eventually come down the line.

Dr.Sophia:
Yes. So for women, for example, chlamydia can lead to an infection called pelvic inflammatory disease, which at its worst forms, the woman can then end up in the hospital and need IV antibiotics and can even end up with something called sepsis. Which is a very severe infection that can affect all of your organs. So yes, of course, there are a lot of STDs that have no symptoms at all or have varying degrees of symptoms. But at the end of the day, the number of times that a patient would've come in for a routine test, and then at that routine test is when they find out that they actually have an STD. So it's not always that the patient walks in and says, oh, I feel uncomfortable. I am having discharge. My discharge is yellow. It's heavy, it's smelly. Part of that problem is that it is so nonspecific. So I guess the fact that they come in because they have some discomfort.

Touseef Mirza:
Or something's different?

Dr.Sophia:
Or just something's off, something's different, could lead to more questions and then lead to, well, let's just make sure and do some STI testing.

Touseef Mirza:
So I just wanna go back to your patient, that came to see you that we just talked about. I think this is a very different way of looking at it in terms of just going and doing your routine checkup. Like when we go get our pap smear, and at the same time we can do all our tests. You can also do that when you're doing your annual with your primary care, with your primary care as well. The only exception to that would be if you're not having sex at all. So maybe a way to look at it, unfortunately, because it deals with sex and there's stigma associated with it. We don't necessarily want to accept it as something that is that objective. But we need to sort of like change our mindset towards that. One of the things I was thinking about, you know, it's like if you have certain health issues with your cholesterol, but you say, well, you know, I've been eating fabulous since the past year, but you're still gonna get it tested, right?

Dr.Sophia:
Absolutely.

Touseef Mirza:
Because that's just part of the checkup.

Dr.Sophia:
It should just be part of the checkup at any time, at any phase with whoever your provider is. It's just that, I think for most people, they feel uncomfortable with even having the conversation.

Touseef Mirza:
It's reminding me of, you know, how people are uncomfortable signing a prenup.

Dr.Sophia:
I dunno how you got there, but okay.

Touseef Mirza:
Because you wanna be in a committed relationship. You have full faith in it, but at the same time, you putting yourself protections.

Dr.Sophia:
Yes.

Touseef Mirza:
You're putting a certain mechanism to protect yourself. So even if it's uncomfortable, even if we never wanna think about the fact that it might disintegrate, we still are saying, but how am I gonna protect myself?

Dr.Sophia:
And the best way to protect yourself is to get tested. That's just the best way to protect yourself outside of actually physically protecting yourself with condoms.

Touseef Mirza:
So basically, I guess what we're saying is that if you feel uncomfortable about that, if you are in a committed relationship and you say, well, you know, I'll still get tested. We understand that that might feel uncomfortable, but it's still worth doing.

Dr.Sophia:
Yes, absolutely.

Touseef Mirza:
So how did it go with, for, for that patient? Was she okay?

Dr.Sophia:
We reviewed her results a couple of days later and through her blood tests, because she did not have any symptoms of anything. So through blood tests, she did have HSV or what we call herpes.

Touseef Mirza:
Genital herpes?

Dr.Sophia:
Well, she had HSV type one. HSV type one is what we usually associate with cold sores on the lips. It's a form of herpes. It can present on the genitalia. That herpes conversation is coming, everybody, don't worry, we're not diving into it now. We will have this conversation later, we promise.

Herpes-type one can affect both the mouth and the genitals. In this case, we did just a simple blood test because she had no symptoms and her test was positive for type one and was negative for type two. Now, I like to explain to patients if they get tested for herpes, and it comes back as type one, it's an incredibly common virus and you can get it. Type one is oral and can happen just from kissing. So this is not what I like to include, per se, as your typical STI or STD such as chlamydia, gonorrhea or herpes type two, which predominantly affects the genital area. But it still brings about a sense of distraught. It still brings about a sense of how could this happen to me?

But when we think about herpes type one, or oral herpes, or oral HSV type one, HSV, I'm just using all of the terms here, cold sores. This is truly something that we are normally exposed to either as children, because we can get it from our parents, we can get it from other kids in our class. In class, like in kindergarten, you're kissing your friends and this is so insanely common. I tried my best to reassure her because I couldn't even tell her when she got it. She could have had or from whom. The fact that she's never had a single symptom of it is typical.

Touseef Mirza:
So when you told her that, did that reassure her or confuse her even more?

Dr.Sophia:
I think it made her feel on the one hand, because I said, listen, you have the virus that can lead to cold sores in your blood. It doesn't mean that you've ever had a cold sore. It doesn't mean that you ever will have a cold sore. I can't say to you that you got this from this particular partner. You may have gotten it from four partners ago. You may have had it from when you were five. I can't tell. I think knowing that there was a possibility that she could have had it from way back, even as a kid, gave her a small sense of reassurance that it's not this lying, cheating dog of a person who gave her this thing and that she was relieved that she didn't have anything else that's more serious. I do think that it gave her a sense of, I'm just always gonna check myself out like-

Touseef Mirza:
Like more regularly no matter what.

Dr.Sophia:
Like no matter what, like a sense of no matter what,

Touseef Mirza:
I'm not going through what I just went through.

Dr.Sophia:
Again, no matter what the thing is that we're all human. We all wanna feel that human connection. We all wanna feel that sense of intimacy. To have always lingering in the background in the back of your mind, oh my God, I can catch something. Oh my God, I can catch something is not healthy either. True. But I do think that having periodic regular tests can at least give you a baseline and can certainly give you a sense of reassurance. If anything does change, well, you have proof to say that it's changed. You know, like, hey, I got tested six months ago before I met you buddy.

Touseef Mirza:
Right.

Dr.Sophia:
Now all of a sudden I've got chlamydia. Hmmm, and the only person that I know that I've been with is you. So one of us is telling the truth, and one of us is not.

Touseef Mirza:
Well, there's that part. The other part is, again, just taking care of yourself to make sure that things don't aggravate, don't get worse in the progression of a certain disease.

Dr.Sophia:
I mean, I think it's a sense of your own responsibility, your own taking care of yourself.

Touseef Mirza:
Is there something that we can do in terms of the stigma associated with what STDs are, connected with, what we talked about, you know, about sleeping around and all that? There's this sort of default connotation associated with that. Like, is there anything that you've dealt with, even with patients to reassure them that this is not about something that's taboo, it's just what happens with sex in this day and age?

Dr.Sophia:
It's what happens with sex, not just in this day and age. It's been happening since the beginning of time. This is not today only. I think there are certain things that are very prevalent. Chlamydia being one, herpes being one, syphilis being one in terms of prevalent diseases that are gonorrhea out there, gonorrhea. But I can't say this enough, always know your body, and really have a good understanding of what's going on in your body. Because you'll be the person who will come to your doctor and say, hey, I don't feel right. Something's going on, can you please check?

Know your instincts, trust your instincts. If you feel like something may be not right between you and your partner, or you're noticing some changes in the kind of level of intimacy that you have with your partner or the relationship, well, that may be a trigger. Lastly, just taking care of yourself. It's just a part of taking care of yourself.

Touseef Mirza:
And when you said that you were trying to reassure her, were you able to achieve that with her? Like did, did she feel a sense of peace eventually, would you say?

Dr.Sophia:
I think knowing that we are literally all in the same boat, at the end of the day, we only have control over ourselves. We only know what we are doing. We don't know with a hundred percent certainty what our partners are doing-

Touseef Mirza:
Or anybody else.

Dr.Sophia:
Or anybody else for that matter. I think it's important to have regular conversations with your partner or partners for, this is not a judgment. You know, the point of this conversation is not to cast any judgment. I think sharing with her, that these things are extremely common. That this is not a reflection on her and her behaviors, but that of course, her coming to be examined when she knew that there was something going on, and she's not, she doesn't know the information and then is like, oh, well, let me just get a new person and then, you know, just keep the thing going. You know, the possibility of risk.

Instead, she took matters into her own hands as we all should.I think I was able to reassure her and from that standpoint that she's not alone. That she's able to trust her body and trust herself-

Touseef Mirza:
And she doesn't need to feel shame.

Dr.Sophia:
That she really absolutely does not need to feel ashamed for something that she had no control over.

Touseef Mirza:
That is so important because we just take that on and we don't have to.

Dr.Sophia :
We don't have to. The most important thing she did that day was come in.

Touseef Mirza:
I would say also, you know, it's easier said than done. I think that living in this society, and especially, we're not even talking about religious influences and so forth, sometimes we don't, some of us will not even realize that shame is so rampant inside of us because it's just omnipresent. It's just there. So I think part of this is to become aware of it and realize, okay, shame, we're gonna put you in a box right here, Right now I need to take care of myself. But it's easier said than done. I know. But I think this is why it's good to have these conversations to be able to say that we can separate that.

Dr.Sophia:
Yeah. We have to dissociate, we have to dissociate taking care of ourselves by getting checked or asking to be checked from the judgment of the act itself. I think being able to separate, I am simply going to take charge, make sure that I'm okay before I further engage with anyone in a sexual way that is in the way that they feel comfortable. So I think as far as the STD conversation goes, we need to remember prevention is key. Those of us who are having sex, those of us who are thinking about babies, those of us who are in these committed relationships, right? You want to feel like you can be close to your partner and have those types of relationships. Getting an STD test getting checked is simply part of prevention.

Touseef Mirza:
We just do it on a yearly basis.

Dr.Sophia:
Just do it. That's it. Then obviously if you do feel uncomfortable, you do have symptoms, you do have anything, yes. That you come in sooner, that you get tested, that you get checked. Then if you find out that you actually do have something, that you share it with your partner, hey, I was just diagnosed with X, Y, and Z and I'm letting you know because A, you need to get tested and treated and let's have a better, a bigger conversation on how did this happen.

Touseef Mirza:
So usually I feel like when we have a conversation or I've heard conversations about STDs, people talk about the symptoms, people talk about the treatments, people talk about prevention.

Dr.Sophia:
That will be in STD 101. When we can go into each and every one. We can go into the nitty gritty there. It was more so taking away the stigma of just getting tested. The shame that women can feel, or men, I'm not leaving the men out of this. It's just this particular conversation that relates to a woman. It's more so the understanding that getting tested is just a part of taking care of yourself

Touseef Mirza:
And the feelings surrounding this whole subject that one person can go through.

Dr.Sophia
Definitely. That just the mere mention can trigger certain feelings and emotions and that if we make it into a routine, then it doesn't have to do all of that. The other real point here is to understand that no one is above it. So it doesn't matter whether you're 60 or you're 20, we all still need to get tested as long as we're sexually active, because that's just a part of our preventative care. It's still just taking care of ourselves. It's still about honoring our own bodies, quite frankly, that we care about, so we check. If there's anything that may be awry, that we are able to then take care of it.

Touseef Mirza:
Awesome. So I think that the next time we'll dig more deeper into all the different STDs, and talk about them in more detail.

Dr.Sophia:
We will talk about them in more detail. This was not the podcast for that. This was the, remember that we still all need to be tested. There's no shame in it. Trust yourself because you're the only one you can trust.

Touseef Mirza:
That's very true.

Dr.Sophia:
Until next time, thank you for joining us on the Dr. Sophia ObGyn podcast. See you later. Bye.
This is General Medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.