Episode 46: STI or not STI?

Dr. Sophia, ObGyn:
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, and welcome to the Doctor Sophia Obgyn podcast. All right, so we're gonna just dive right in. I am so excited as always to be here with you and especially to discuss a topic that I basically feel is bread and butter. Definitely a part of my everyday life is going through the confusion of whether or not things like BV are an STI, meaning is it sexually transmitted or how can I avoid it, or how do I treat it? And actually two other bacteria that are less talked about, but also can cause BV like symptoms,

Touseef Mirza:
BV being?

Dr. Sophia, ObGyn:
Bacterial vaginitis. And the last one on the topic that I'd like to cover today is HPV. And so without further ado, I am joined by my good friend and co-host Touseef Mirza.

Touseef Mirza:
So this conversation around STIs, which is sexually transmittable diseases.

Dr. Sophia, ObGyn:
Or sexually transmitted infections,

Touseef Mirza:
Or STIs or D for the disease part. And when we started to talk about it, Sophia was telling me about a couple of issues that seems like STIs or not STIs, but because when we think about STIs, a lot of us think about maybe chlamydia, gonorrhea, herpes, like those, those are the, the typical bag. But she talked about, for example, BV, HPV, and I was like, well, usually we don't consider that as STIs. And you're like, well, this is where it's interesting how you start to look at what they actually are and how they actually come up. So it's going to be a little bit of an exploration on how to talk about this because as she said, every single time she needs to explain it to other patients. But I think it's important for all of us, including myself, to understand, like, what are these nuances that we wanna talk about? So we're gonna go over three main ones, right?

Dr. Sophia, ObGyn:
So part of the reason why I really wanted to do this episode is because every single day I treat someone in the office for something like BV and BV being bacterial vaginitis. A woman comes in, she's complaining of vaginal discomfort, maybe a little bit of discharge, and usually some form of vaginal odor.

Touseef Mirza:
And vaginal discharge.

Dr. Sophia, ObGyn:
Like a little bit of discharge, it doesn't necessarily mean that it has a different color. It could just be a little bit white. It just may be a little bit more of it. But nonetheless, she notices some type of a change in what her vagina is normally like. And so the first thing I usually go to is, well, have you changed anything about your normal routine? Have you used a brand new soap? Did you go on vacation? Have you been to a pool? Only because anything that changes the vaginal flora or the fauna, meaning the normal bacteria that we expect to be there, can cause an infection like BV.

Touseef Mirza:
So this could be, for example, you're changing laundry detergent?

Dr. Sophia, ObGyn:
Even as simple as changing laundry detergent. Yes. And it's hard to, like, it's almost sometimes like, it's like mind blown. But our bodies are really that sensitive and especially our vaginal area. So when we do have these little changes, the bacteria that causes BV is actually a bacteria that is always in the vagina.

Touseef Mirza:
So it means that just because you have the BV bacteria doesn't mean that there's necessarily a problem.

Dr. Sophia, ObGyn:
Right. In the sense that BV, we, when we think of it as bacterial vaginitis, is when we think about an overgrowth of a particular bacteria that's in the vagina.

Touseef Mirza:
So it means if, I guess, the concentration of that bacteria is in check, then there's no problem.

Dr. Sophia, ObGyn:
That is correct. That's a great way to put it. Okay. Yeah. Keep it in check. We have other bacteria, it's like these little armies that are constantly fighting each other in the vi in the vagina . And that's how they kind of keep each other in check. And by keeping each other in check is what we call balance. And in that balance, there's the pH balance or the pH level in which the vagina likes to have everybody be in check and stay happy. And when the pH level of the vagina is increased, this is when you have a susceptibility for certain bacteria to overgrow.

Touseef Mirza:
So is it similar to yeast?

Dr. Sophia, ObGyn:
Yeast is different. Yeast is a fungus. And again, also lives in the vagina. However, again, it's also about how much.

Touseef Mirza:
So, but the yeast, again, can stay in our bodies without being a problem.

Dr. Sophia, ObGyn:
We have yeast, we have it on our skin, we have it in the vagina. However, when yeast gets to a critical point in terms of growth is when we have a yeast infection.

Touseef Mirza:
All right. When it's kind of like overgrown or outta control. Then it has all these different symptoms.

Dr. Sophia, ObGyn:
That is correct.

Touseef Mirza:
What is typically if somebody has now an excess of the bacteria of bacterial vaginitis, do we know the name of the bacteria?

Dr. Sophia, ObGyn:
It's usually Gardnerella.

Touseef Mirza:
Okay.

Dr. Sophia, ObGyn:
That usually is one of the ones that we think about when we are thinking about BV. But the whole reason for bringing this point up is because women often get tested for BV. But there are two other bacterias that come to mind that women probably don't even know about and are less frequently tested for. One of them is called urea plasma. Urea plasma, and the other one is called mycoplasma.

Touseef Mirza:
See, I have never heard of either of these words before we started to talk about this together today. So like I've never heard of those.

Dr. Sophia, ObGyn:
Right. And so these are bacteria that also can be in the vagina and also can kind of cause a BV like syndrome or symptoms, or they are what we consider as can be part of the flora, so to speak, but either in certain quantities or what happens is we don't really test for them. And so a woman comes in, we test for BV, we treat her for BV, but we don't test for mycoplasma urea plasma. And so a few weeks or a few months later, she comes back and she has another BV infection. And the reason why I'm even bringing it up is because these other bacteria can sometimes kind of live synergistically with BV.

Touseef Mirza:
So BV, what are the typical symptoms that a woman can feel with BV?

Dr. Sophia, ObGyn:
Again, she's gonna have like discharge, she's gonna have perhaps a smell,

Touseef Mirza:
But is there itchiness? Is there burning during urination?

Dr. Sophia, ObGyn:
Maybe, maybe not. They can have burning UR urination. They can have itchiness, but it's not like itchiness in the same sense that we often think about as a yeast infection that is pretty much hallmarked by this vaginal itching. Right. Associated with discharge. I think the one with BV is a little bit more subtle, and it can, most of the time they just say that they just feel, have a sense of discomfort. Granted, they can definitely have itchiness, but I wouldn't necessarily say that itchiness is like

Touseef Mirza:
Hallmark. Okay. So it's more the smell and the discharge.

Dr. Sophia, ObGyn:
Usually it's the discharge discomfort. Okay. So they know something's off. They don't always know what is off.

Touseef Mirza:
You just feel it.

Dr. Sophia, ObGyn:
You just feel it. Yeah, exactly. And smell, no smell. It could be a smell that they are used to. It could be a smell that they're really not used to. But I would say those are the things that they would probably more so complain of.

Touseef Mirza:
As you're, you're talking about this, especially if there's no itchiness. Like me, I'm wondering if women who probably have BV don't even come and see you because they just think, oh, you know, it's just a little discomfort here and a little different here. But it's not something necessarily that is a physiological ailment per se. So do you find that that can go even under the radar? A lot of times?

Dr. Sophia, ObGyn:
I definitely think it can go under the radar. I, like I said, because it's almost like it has to get to this critical point. You know, where they may feel a certain level of discomfort or a certain amount of discharge that then becomes bothersome, so to speak. Many times I will have a woman come in for her routine exam. So she's coming in for what we call an annual. She's maybe having a pap smear done. And in the middle of that exam, I'm like, Hmm, okay, your discharge looks a little bit weird or different, you know? And I ask before I, I say that, what I'm thinking, I'll ask, were you feeling a little different? Did you feel like you had a little bit of more discharge this week? Do you feel like you may have a little bit of a different smell? Are you having any smell after sex, for example? Are you just noticing any changes? And I would say maybe about maybe 75% of the time they'll be like, oh yeah, I kind of felt a little off. But it's not necessarily what brought them in. And so I'll test them and then the swab will come back positive for, you know, BV.

Touseef Mirza:
And that's usually an antibacterial treatment.

Dr. Sophia, ObGyn:
And so for BV, yes, the treatment for BV is typically given in some form of an antibiotic, whether that's a vaginal antibiotic or an antibiotic that they have to take by mouth. But usually the treatment is an antibiotic. The thing though to note is that when we diagnose somebody with BV, all they can in fact have these other bugs present as well.

Touseef Mirza:
Bugs meaning bacteria, meaning it's another-

Dr. Sophia, ObGyn:
Other Bacteria. Bacteria, yeah. The urea plasma and mycoplasma. Okay. And so that is what makes it so critical that we actually test for it. Because when a woman is experiencing symptoms of BV, it's quite possible that she's also then beco have a critical amount of urea plasma or mycoplasma that could also be causing symptoms. And the interesting thing is, is that like you ask, oh, does it cause burning when they urinate, does it cause a different kind of system or, or symptom? And in fact, it may tend to have a little bit more like of the itchiness associated with it, or a burning sensation

Touseef Mirza:
For the urea plasma and-

Dr. Sophia, ObGyn:
For like the PLM or mycoplasma, it may have a sensation of dryness more, it may have a sensation of burning, you know with urination despite not having an actual urinary tract infection. Hmm. And I think the thing that really sets them apart, or why it's so important to understand is because of the fact that in the case of urea plasma and mycoplasma, there's a couple of other things that they are associated with. So things like preterm labor, preterm birth, these are bacteria that are often found after culturing let's say the placenta or the amniotic fluid of women who have had preterm labor or preterm birth.

Touseef Mirza:
If I understand correctly, you're saying mic mycoplasma and urea plasma. I'm just learning how to say these words, so I'm pronouncing them very well. Good job. Well, thank you for these two bacteria, if they are left undetected and that they are at a high sort of concentration and a woman is pregnant, then it can actually cause the delivery of a premature child.

Dr. Sophia, ObGyn:
Yeah. It has increased. It carries the increased risk of preterm labor and preterm birth. So it's significant, actually, I would consider it significant because it can significantly increase. And that's BV as well. Let me, let me just be clear. We're talking really bacterial vaginitis and then the concomitant bacterial infection with urea plasma or mycoplasma, and that increases your risk of a preterm birth. And that's one aspect. But the other aspect, and the real reason why we're having this conversation is because I've already said that, okay, well these are bacteria that can be normally found in the vagina, but there is an aspect of it that can be considered sexually transmitted. Now, we don't really think about it as being an STD or an STI, however, we know that, for example, women who get these infections constantly, that it may be because their partners are actually carriers. Oh, I know, I see your face. I saw the light. I saw the light going, ding, ding, ding, ding, ding, ding, ding, ding, ding.

Touseef Mirza:
Because the thing is, it's called bacterial vaginitis and lives in the vagina. And men don't have vaginas. So where is the bacteria on the man?

Dr. Sophia, ObGyn:
I mean, on his penis, like a girl, I'm not a man doctor. Yeah. But what I will say is, what happens is that, I mean, this is what makes this so confusing and so hard to even have the conversation when I'm talking about it with my patients. And part of the reason why as always, there was a patient story associated with this, right? I had a woman who came to see me and she's happily married and she's coming to me and it's like month after month after month, I'm treating her for BV.

Touseef Mirza:
Meaning she's coming, you're giving her the medication, she takes the medication, she comes back, she-

Dr. Sophia, ObGyn:
Feels better. Well, what happens is that she feels better for a couple of weeks and then she comes back with it again, and then she feels better, and then she comes back with it again. Hmm. And so we were, we were both kind of like, huh, what is it? What, what haven't we checked? Because we've checked everything. You don't have an, you don't have a quote unquote STD, this is not chlamydia, this is not gonorrhea, this is not

Touseef Mirza:
A yeast infection.

Dr. Sophia, ObGyn:
Not a yeast infection. This is, this is not what we would typically check. And the light bulb went off like, Hey, did you do a comprehensive swab? Does it also have mycoplasma and urea plasma? And I was like, you know what? It doesn't have that, you know, let's check. And sure enough, she had mycoplasma.

Touseef Mirza:
So even if you were treating her for BV, since you weren't treating, I mean, we don't know if she had BV also?
She had

Dr. Sophia, ObGyn:
BV and-

Touseef Mirza:
She also had mycoplasma.

Dr. Sophia, ObGyn:
And she had mycoplasma.

Touseef Mirza:
Okay. And since you were only treating the, the BV, the mycoplasma just wasn't resolved.

Dr. Sophia, ObGyn:
The mycoplasma wasn't resolved. And I don't know, I'm not gonna, you know, act like I'm an infectious disease doctor. I'm not. But I will say that what it seems is that there's something about mycoplasma and BV that kind of works synergistically. And so it's like the presence of mycoplasma made it easier or more susceptible for her to continue to keep getting BV. And the real thing here was the fact that she actually did not get better A, until I treated her for mycoplasma, and B, that I not only treated her, but treated her husband.

Touseef Mirza:
For mycoplasma. Not BV.

Dr. Sophia, ObGyn:
And so the thing was, is that the antibiotic that we use to treat BV is different from the one we used to treat mycoplasma. And so until we treated both things and until we treated her husband, she did not feel better. And the thing is, her husband was not having any kind of symptoms at all.

Touseef Mirza:
And did you test the husband?

Dr. Sophia, ObGyn:
No, we did not test her husband. Honestly, I don't even know how one tests men for these things. I, you know. Yeah. I guess it's like a Q-tip similar to what we do for women. But I'm sure that men are not being tested for this. This is not, again, because it's not your typical, like STI, it's not your typical, and it, and in all honesty, this is not like it's a foreign, it's unlike chlamydia. Right. Which is completely foreign. Chlamydia does not live in the vagina. It's not gonorrhea. Gonorrhea doesn't live in the vagina. These are foreign. So when we think about a sexually transmitted disease, it's easier to understand the concept of, okay, I, I had sex with someone who had this thing and therefore gave it to me.

Touseef Mirza:
So I think this is a very important distinction that when we talk about STIs in terms like chlamydia, herpes, gonorrhea, is that it is an external organism that was not in your body that has now entered your body and is causing all this havoc.

Dr. Sophia, ObGyn:
That's correct.

Touseef Mirza:
Versus what we're talking about in terms of BV, mycoplasma, urea, plasma, these organisms already live in the US, but in a controlled fashion. And if they go, if they're uncontrolled, then they can cause problems.

Dr. Sophia, ObGyn:
Yes. And the, the other thing is, is that not everybody has it.

Touseef Mirza:
Not everybody has what?

Dr. Sophia, ObGyn:
So not everybody has urea plasma. Not everybody has mycoplasma. You don't always have it. You don't always express it. You know what I mean? It's not like, so again, this is why it gets the nuance. The nuance, yes. And the real reason that I even really wanted to talk about this is because of their relational or relationship with BV, which is a very common infection in women. I mean, up to 30% of women around the world experience BV at some point. That's a lot. And if you have BV, you can have a recurrence of BV after being treated for BV in like up to 50% of the time in the next six months.

Dr. Sophia, ObGyn:
So given that fact, knowing that you have a 50% recurrence rate of BV, knowing that 30% of women experience BV at some point, it makes you wanna understand, well, what else could be involved or around why this is so common? Now? Like I said in the very beginning, the real reason is because we've done something, we have changed something purposefully, not purposefully. Women are like honed into our vagina many times. So we wanna make sure it's always fresh, make sure it's always this and always that. And we sometimes in changing our normal routines in order to make it smell more like flowers ,

Touseef Mirza:
Which I don't understand, but okay.

Dr. Sophia, ObGyn:
You know, we always wanna get the latest and greatest from Bath and Body Works or whatever. And so we inadvertently will have a change in our pH balance.

Touseef Mirza:
It could also be the diet.

Dr. Sophia, ObGyn:
It's so many things. Your diet is definitely involved in our vaginal flora because your diet isn't involved in your gut bacteria. And that gut bacteria then influences your vaginal bacteria. And so for sure your diet influences it. Like I said, your normal personal hygiene regimens influence it. If you travel influences it, like you're going to latitudes going into different waters, not because there's something wrong with the water, but the way your body responds to it stress. Hmm. Stress has an impact on what's going on with your vagina. And so, so many things have effects on our normal vaginal flora.

Touseef Mirza:
So just so I'm clear, when it comes to urea plasma mycoplasma and what's the bacteria associated with? BV

Dr. Sophia, ObGyn:
Gardenella?

Touseef Mirza:
Gardenella. So those three, all women have it. Not the bacteria.

Dr. Sophia, ObGyn:
We have the potential to have it. It might be a part of my normal flora, Uhhuh . Okay. But maybe it's not yours. Oh, okay.

Touseef Mirza:
So not everybody necessarily even has it.

Dr. Sophia, ObGyn:
Right. Okay. But just because you have it doesn't make it an infection.

Touseef Mirza:
Okay. So there's three levels. This is what I'm understanding , some of us have this bacteria, some of them in the US don't. And then some of us who do have it, sometimes we stay always within balance. So everything's fine. And the third one is the women who have it. Sometimes it is imbalanced and they have too much of it. And then that causes problems.

Dr. Sophia, ObGyn:
Now you got it.

Touseef Mirza:
Now I have learned so much today.

Dr. Sophia, ObGyn:
But the thing is mycoplasma urea plasma, I would say is not the most common of the bugs. Okay. And so it is one of those that when I do see it, especially in association with a woman who's having BV and is having recurrent BV, it does lead me to think if they have a partner who is a regular partner for them, that partner may be a carrier. And when I say a carrier, it's that sometimes it benefits them for themselves, the woman to be treated as well as their partners to be treated in order to completely eliminate the bug.

Touseef Mirza:
So do many doctors actually or OBGYNs treat women for urea plasma and mycoplasma? Since we don't really, I've never heard of that before. I've heard of BV, but not the two other ones.

Dr. Sophia, ObGyn:
Okay. So here's the thing. I would say that it's not a part of our normal panels. It's not a part of, like if you go to your doctor and you're like, oh, I think I have BV. And then they're gonna check for all of these things, especially if it's like the first time you've ever had BV.

Touseef Mirza:
Hmm. But if you go, for example, if you go to your doctor on the yearly checkup and they say, you know, do you wanna be tested for STDs? And they say, okay, do you wanna test for everything? And you test for everything. They're not gonna test for BV usually, or mycoplasma re or plasma? No.

Dr. Sophia, ObGyn:
Okay. No, because we don't think of BV as an STI. Right. Right. It's just a change usually in your pH balance. That causes BV and then urea plasma mycoplasma. Like I said, we think of that more when we're considering recurrence. Like could this be at play in terms of what's causing the recurrent BV?

Touseef Mirza:
So when you are able to treat BV and or mycoplasma urea plasma, is it usually a successful treatment?

Dr. Sophia, ObGyn:
I would say yes. It is usually a successful treatment once we know what we're treating, the treatment course usually is successful. And especially when we do treat the partners, when we treat the partners, we treat the patient, we treat the partners, we have them abstain during the time of treatment in order to completely eradicate the bacteria, we find that they don't come back with recurrent symptoms and their cultures are usually negative.

Touseef Mirza:
Alright, well that's good news.

Dr. Sophia, ObGyn:
That is good news.

Touseef Mirza:
So when you finally actually do the right test and get the right treatment, it works.

Dr. Sophia, ObGyn:
It works. Okay. It works. But here's the caveat to all of this: trying to explain to women that you have bacteria. I actually want not only you to be treated, but I also want your partner to be treated. They're like, well, what do you mean my, my boyfriend gave me something, my husband gave me something. And then I have to be like, well, no, not exactly. I just think that maybe they are, again, the best word that I can use is something called a carrier. Meaning that they have something that doesn't affect them, but they have the potential to keep reintroducing it to you. And so that's why I treat both people. And the explanation then is, well, we are in close contact. You are my partner. We are in close contact. And so in order for me to feel better, I have to treat both of us so that I can always feel better.

Touseef Mirza:
And usually the issue of mycoplasma urea plasma or BV, usually it does, I guess start from a woman's side, but then a man could be a carrier of it.

Dr. Sophia, ObGyn:
Yeah. The thing is, is that when we, when we're thinking about mycoplasma, ureaplasma, a man could be a carrier for this. You know, a woman, like I said, not all women have it.

Touseef Mirza:
Like let's say a man has never had sex before, they're not gonna have that in their bodies.

Dr. Sophia, ObGyn:
It's unlikely.

Touseef Mirza:
Okay. So usually how do the men react to that? Are they pretty positive about it?

Dr. Sophia, ObGyn:
This is where it can get a little hairy . Because when you're trying to explain something that you're like, well, this is not really an STI, but it is 'cause it can be sexually transmitted. Meaning that it's because your partner is carrying it, therefore reintroducing it to you sexually. That's why you keep having it. Like, okay, so is it an STD or isn't it an STD?

Touseef Mirza:
We almost need a new categorization for it.

Dr. Sophia, ObGyn:
And the reality is, is that it, it kind of is. Yeah. Because it can be sexually transmitted, but it kind of isn't in the sense that it's not a foreign bug. . It could literally be part of the normal flora. It's a gray zone. .

Touseef Mirza:
So that keeps you on your toes as a No. Always. Honestly.

Dr. Sophia, ObGyn:
Always keeps me on my toes. Always keeps me on my toes. And the other thing that kind of resembles that in my daily practice, like part of my bread and butter, is probably HPV or the human papilloma virus.

Touseef Mirza:
Please say that a little slowly. Oh

Dr. Sophia, ObGyn:
Right. You know the New Yorker, it's not my fault.

Touseef Mirza:
I didn't know, I know my fault. You're like boom, boom, boom.

Dr. Sophia, ObGyn:
HPV, human papilloma virus. Now the reason why I bring it up is because it's similar in the sense that it's a hard conversation to have when with a woman to explain to her, okay, you have H-P-V-H-P-V is in fact sexually transmitted and is a sexually transmitted infection, and why it's a sexually transmitted infection because it is something that is foreign. We are not born with it. It's not gonna be something that we are just living with.

Touseef Mirza:
It's like in the category of chlamydia, gonorrhea.

Dr. Sophia, ObGyn:
Yes. It is in the same category as chlamydia and gonorrhea. However, unlike chlamydia and gonorrhea, where it can also cause symptoms in men, like acute symptoms in men, the same way it causes acute symptoms in women. So in women, those bacteria, chlamydia, gonorrhea, they'll cause cervicitis, they'll cause inflammation of the cervix. They cause significant discharge. They cause discomfort. They cause pain with, with sex. They cause vaginal odor. There is something happening with a woman when she has chlamydia or gonorrhea, although, mm. Chlamydia is also a little bit more tricky. However, still relatively, I would say acute

Touseef Mirza:
Meaning that it is happening all of a sudden.

Dr. Sophia, ObGyn:
Okay. Meaning there's, there is some type of a change that's happening. And it usually is all of a sudden.

Touseef Mirza:
So if, if some, if you are within your partner a week ago and then all of a sudden this is happening, you can associate it with that most likely. Yeah.

Dr. Sophia, ObGyn:
Okay. Yeah. There's gonna be a strong correlation that that's the person who gave you. Right? Like the concept is is that somebody gave you this-

Touseef Mirza:
Transmitted.

Dr. Sophia, ObGyn:
Transmitted the virus to exactly the bacteria in this case chlamydia or what have you. And for the purposes of this conversation, we're talking about HPV, which is a virus. Now the funny thing about HPV is that first of all, there are 150 different types of HPV.

Touseef Mirza:
Do you mean 150?

Dr. Sophia, ObGyn:
What I just said, there's over 150 different types of HPV and not all of it causes symptoms. Not all of it. Like HPV or human papillomavirus also causes warts. Like who knew, you know what I mean? Like well, I knew Yes, of course . Yes. But I like, you know, when you went to college, they're like, make sure you wear your flip flops if you're in the, using the communal bathroom, for example, Uhhuh, because of communal showers, because you don't wanna get something called plantar warts. Plantar warts are caused by one of the 150 different types of HPV.

Touseef Mirza:
So it's not just associated sexually or around the vulva area? It's just a guy that's all over the place.

Dr. Sophia, ObGyn:
There are 150 different types that affect different parts of the body. When we talk about it as far as sexually transmitted, we're talking about what it can cause in the genital area. And oftentimes it causes zero symptoms. They have, they don't even, people don't know that they have HPV, but women, 80% of women will be exposed to some type of HPV at what we call sexual debut. Meaning the first time they even have sex.

Touseef Mirza:
A sexual debut.

Dr. Sophia, ObGyn:
Sexual debut.

Touseef Mirza:
In the spotlight.

Dr. Sophia, ObGyn:
Yeah. It's not such a great spotlight if you have an 80% chance of getting something.

Touseef Mirza:
But so you're saying that women have a tendency to get HPV the first time that they have sex?

Dr. Sophia, ObGyn:
Yes.

Touseef Mirza:
Like 80% of them.

Dr. Sophia, ObGyn:
You have an 80, 80% of women who are exposed to HPV are exposed to it the first time that they even have sex.

Touseef Mirza:
Got it. So if you have it, most likely it started with the first time.

Dr. Sophia, ObGyn:
Most likely. But you can get it at any point. Okay. So the problem with HPV, it has no symptoms really, unless you get one of the types that causes something like genital warts. But the reason why HPV is so important to know is because there are certain high risk HPV types that can lead to something very dangerous called cervical cancer. So you can go on for years. No symptoms. No symptoms, no symptoms. But HPV is working
on the background at the level of your cervix causing changes to the cells of your cervix.

Touseef Mirza:
So are you saying, when I go and get a PAP smear and you're getting a swab to check if I have any issues on my cervix from a cancer perspective, it could be caused from HPV. Yeah.

Dr. Sophia, ObGyn:
I'm checking. When I do a pap smear, I'm looking at both the cells and if you have it, and if you have HPV,

Touseef Mirza:
Are there many causes for cervical cancer aside from HPV or is it mostly caused by HPV?

Dr. Sophia, ObGyn:
So the thing is, cervical cancer is caused almost 90% of the time by HPV.

Touseef Mirza:
Oh, wow. Well now the plot thickens . Now it's like now we're talking about sexual debut and then we have the HPV and now we're talking about pap smears and now we're talking about cervical cancer. I mean.

Dr. Sophia, ObGyn:
I know it's confusing. That's why I felt the need to have this conversation because I have to have it all the time with my patients. And it's hard to explain it when you say, oh, well it is an STD, so it is an STD, but I can't go back and test my partner. And it makes it so like illogical.

Touseef Mirza:
And why can't they go test a partner?

Dr. Sophia, ObGyn:
We don't have a test for men for HPV. We're not checking. There's no test. We are not, there is no marketable exam or anything that's testing men for HPV. No. And I mean, yes, for certain penile cancers can be related to HPV and HPV exposure, but again, there is no widespread screening that's happening for men. . Checking to see who has HPV and who doesn't. And I get it. One of the reasons why is even for women who have HPV, our bodies are so smart that they fight HPV, our bodies fight HPV. And if we give our body good nutrients and have a good immune system, then the likelihood is that our body's gonna fight HPV and HPV is not going to be able to wreak the kind of havoc that it wants to.

Naturally if we give our bodies enough time and all the good things that it needs in order to be able to do that. So it's like, huh, yes, it's a sexually transmitted infection, but even without any treatment at all, our bodies are gonna take care of it. And so if our bodies are gonna take care of it, then what's the big deal? Right. But the big deal is that for women, it has the potential to cause cervical cancer. And so thank God we have a screening test called the pap smear that allows us to look to see if we're having changes on our cervix changes that can eventually lead to cervical cancer. So that way we have an opportunity to intervene.

Touseef Mirza:
So is there another way to test the HPV virus levels? Aside from a swab, from a pap smear.

Dr. Sophia, ObGyn:
It doesn't necessarily need to be exactly a pap smear. Okay. It can be just a Q-tip or a swab in order to test for HPV.

Touseef Mirza:
Are you having symptoms if you just have HPV without necessarily the long term sort of effects of potential cervical cancer? Like does a woman feel uncomfortable in the vaginal area or something like that? If she has HPV?

Dr. Sophia, ObGyn:
So this is where it makes HPV one of those outliers. Right? Because the thing with HPV is that there are zero symptoms for the woman. A woman can have HPV and never know she has HPV. The only reason why a woman will know that she has HPV is because it came back positive on her pap smear. Okay. It's not because she's having symptoms of HPV, unless she has one of the strains that causes genital warts and now has a genital wart. And I will say that that is a reason why a woman would probably come in and say, Hey, I feel like I have a little growth, or I, I see something on my vulva area. Can you tell me what that is? And then you either test it, biopsy it, you know, remove it, and then get it tested in the pathology. And you recognize and you see, and you see that it's a genital wart and it's related to HPV. Otherwise no, a woman would not have symptoms of HPV.

Touseef Mirza:
Okay.

Dr. Sophia, ObGyn:
You know, she's not having, it's not like even the other ones that we talked about, like those that can cause bacteria like, like a BV that actually can cause symptoms, discharge, smell, et cetera.

Touseef Mirza:
I can see now the importance even more of pap smears because Yes. Right. Because there is no symptom of HPV, aside from the genital warts. Therefore, how will you know if you have the progression or the start of cervical cancer if you don't show any symptoms? That's correct. There's no test. That's correct. So you have to go do the pap smear. Yes.

Dr. Sophia, ObGyn:
Because of the fact that we actually do pap smears is the reason why the incidence of cervical cancer is so low before the start of routine screening with pap smears. Women were dying all the time of cervical cancer. A disease that is actually quite curable, preventable, et cetera. The fact that we screen women for HPV and by screening women by doing pap smears, that were able to pick up whether or not they have an HPV exposure has dramatically affected the concept of cervical cancer, especially here in this country. I will say that in developing countries where they don't have wide screening programs, unfortunately women are still dying of cervical cancer. It can, it's still one of the leading causes of female cancer deaths in the developing world.

Touseef Mirza:
And do men have any type of cancers associated with HPV?

Dr. Sophia, ObGyn:
There are some penile cancers that are associated with HPV. I guess because of the fact that HPV, like I said, is a virus and it's a virus that mostly our body's clear, therefore it's probably why there's no big screening. For men, even for HPV. But it's an STD. How do you really prevent it?

Dr. Sophia, ObGyn:
Like, yes, of course prevention is key. Wearing condoms is extremely helpful in preventing the transmission of HPV. But take for example, a woman. She's getting married, she's, you know, been with her husband for the last five years and has HPV, does that mean that her husband was stepping out on her? Does that mean that she was stepping out on him? No, not necessarily. HPV also has that little caveat and also forgot this part. HPV has the capability of laying what we call dormant in the body. What does that really mean? It means that yes, there's a point in your life where you may express it or you may never express it, or it can show up, then goes away and then shows up again. And so that's something that also makes HPV so confusing. I can't say if you're a woman and you've had, let's say four lifetime partners, one of your partners actually gave you HPV with no way of telling that.

Dr. Sophia, ObGyn:
So it's like, oh, okay, I maybe had it before then it completely went away. Like you did my pap smear and you don't see that I have HPV, but here I am 10 years later and I have HPV again. So yeah, this is the part that makes HPV frustrating. Hmm. And very frustrating both as an STD, from an STD standpoint, as well as from a, a standpoint of, wow, this is a virus that can potentially live in my body and could always cause me to have an increased risk for let's say cervical cancer. So what is the age that women need to start having pap smears to check on?

Dr. Sophia, ObGyn:
So women typically start getting pap smears. The age now is 21. And one of the things that we do know about HPV is that your body will clear it. Or again, the confusing this , yes, it clears it, but yes, it can stay dormant. But yes, the reality is that for the majority of women, they will clear HPV and they will never express HPV again. And so from the ages of 21 to 24, we check to see if you have any changes on your cervix in terms of the cells. And not everyone is checking to see if you also have HPV. The reason why, because we know you will likely clear it. And so it takes anywhere from 18 to 24 months to clear it. And if we just give your body time, then you won't be susceptible to having to get invasive testing that you really don't need. And so when we think about it in terms of younger women, we know that like 90% of younger women are gonna clear the HPV because they're young, they're healthy, their bodies are gonna do what they're supposed to and it's not gonna be a problem for them.

Touseef Mirza:
It's almost like the immune system.

Dr. Sophia, ObGyn:
It's totally like the immune system. It is your immune system.

Touseef Mirza:
It's an immune system. Okay. So there was a treatment for BV because it's a bacteria, there's a treatment for mycoplasma and neoplasma because it's a bacteria. But when it comes to HPV, there's no treatment. You can only be treated if you have been found to have those cervical cancer cells.

Dr. Sophia, ObGyn:
There's really only treatment of the abnormal cells. Yes. Okay. Right. So what we'll do is we'll do some kind of, if it's at a point where those abnormal cells are dramatically abnormal, then yes there's an excisional procedure that can happen in order to try to clear away or cut away those abnormal cells.

Touseef Mirza:
You literally remove them.

Dr. Sophia, ObGyn:
We literally remove them. Your cervix gets like, it's like having a fresh start.

Touseef Mirza:
Well, at least there's a solution. I'm happy to hear that.

Dr. Sophia, ObGyn:
Yes, there is a solution. I think the most important thing to know when it comes to HPV is HPV is very immune sensitive. The healthier you are, the less likely HPV is gonna be a problem for you. Your body's gonna keep fighting it and take care of it and do what it's supposed to do. And then I would say primary prevention is always key. Be picky with your partners getting something called the HPV vaccine. It does have right now on the market, there's the one that has nine of the potentially most high risk types,

Touseef Mirza:
Including the one for the cervical.

Dr. Sophia, ObGyn:
Yes. Okay. Including the ones that can lead to cervical cancer in order to help your body to either fight it or prevent you from even getting it.

Touseef Mirza:
So then being healthy, getting pap smears on a regular basis. Yep.

Dr. Sophia, ObGyn:
Vaccination.

Touseef Mirza:
Vaccination and wearing condoms. Condoms. Having protection.

Dr. Sophia, ObGyn:
Having protection.

Touseef Mirza:
So by having all of these like where we're in a good place. Yes. Where we're trying to figure out the deal with HPV, well I think you did it Doctor Sophia. You were able to go through this nuanced road of all these different aspects.

Dr. Sophia, ObGyn:
I hope I didn't make people more confused, honestly. But like I just get these questions or have to talk to women so often about these particular things. So BV, yes. Requires an antibiotic urea, plasma mycoplasma, yes. Requires an antibiotic and maybe an antibiotic for your partner. HPV, pap smears, pap smears, pap smears. Healthy, healthy, healthy and healthy is for everybody. This is not even just only for HPV, this is for your BB people, your everybody, right. The, your better food choices, exercise, et cetera. All of that leads to a better immune system, which is gonna help you to not have these fluctuations or changes in your body that lead to changes with your microbiome. But when we talk specifically about HPV, it's really like being healthy, staying away from things, smoking, a total modifiable risk factor for HPV, like if you smoke, really don't smoke. These are ways in which we can just continue to hone in on how to keep ourselves healthy, safe, feeling good, living a sexual life where you feel armed with information and can protect yourself and still have fun.

Touseef Mirza:
The the, the last thing I just wanted to mention is, so we know that for example, the HPV, it, it's sort of like more standard with the pap smear, but when it comes to mycoplasma and urea plasma, since you say that not all providers will test for it. Can a patient actually ask for that? If the provider, the healthcare provider has said, okay, maybe it's BV and since they don't necessarily associate right away with mycoplasma urea plasma, that the patient could bring that up?

Dr. Sophia, ObGyn:
Yes, absolutely. Okay. Absolutely. You can certainly ask, Hey, is it okay? Do you think you can test me also for something called urea plasma and mycoplasma and I that's absolutely fair game. At the end of the day, I'm just glad we were able to have this conversation so that way we can provide some clarity in an area that can seem like a gray zone. And just by giving a little bit more information and education will continue to allow women to really do exactly what we want them to do here on Dr. Sophia, which is always embrace your body and embrace yourself.

Bye for now. Bye 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.