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STI Myths & Realities, Building Trust in Sexual Health Care
Discover the hidden truths about sexually transmitted infections (STIs) that could save your health and the health of others. Join host Cami Smith as she reunites with Tiffany Little, head of patient education, and Lance Dorsley, head of infection prevention at Centra. They provide an eye-opening discussion on the silent yet prevalent nature of STIs like chlamydia and gonorrhea and delve into the disparities affecting minority groups.
Tiffany and Lance emphasize the critical role of education in countering misinformation and underscore the importance of proactive health measures. Don't miss this essential conversation that could change how you view STI prevention and education.
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Hi and welcome to, and so Much More. I am your host, cami Smith, and I actually have two guests who I love that they're here right now. They've both been on before. We have Tiffany Little, who is over patient education here at Centra, and then we have Mr have Mr Lance Dorsley, who we don't get to spend as much time with very often but he is over infection prevention. Thank you guys both. I know you're so busy and I'm so thankful that you're here. Thank you for having us Happy to be here. So we're going to have a super awkward conversation and we're not going to make it awkward. We're going to be talking about sexually transmitted infections today and it's like the thing that nobody wants to talk about. But it's also so impactful in our community, so much more so than I think anybody realizes or wants to admit. So we just kind of want to educate and bring things to the surface and so just kind of join in the conversation with us. But first, why don't you?
Tiffany Little:guys, tell me both a little bit about what you do at Centra really briefly before we jump in Sure, I'm over patient education.
Lentz Dorsley:So anything that goes out, we make sure that it is relevant to our communities and that it is meeting health literacy standards and translation standards. So we would just want to make sure that everything we put out there is really approachable and meaningful.
Cami Smith:Yeah.
Lentz Dorsley:I love that.
Tiffany Little:And I'm over at the Infection Prevention Department for Centra. Really, what we aim to do is make sure patients aren't leaving the hospital with anything they didn't come in with, preventing hospital-acquired infections, preventions during surgery, and just making sure that we're following all the best practices when it comes to creating a sanitary environment in the hospital.
Cami Smith:Yeah, I love that. And then I feel like both of you also are very good at staying in front of some of these information and sometimes misinformation based things that are floating through the media and social media, and so, like you know, I think everyone thought monkeypox was going to be the next COVID, and I know we had a conversation about that a few years ago Um, and, but then, like the whole West Nile and the mosquitoes, and I mean it, these are things that are a concern, but it's, how do you pull the frenzy away from? Um, what is real and what do we need to know? And and what can we, you know, let fall away? What information is just not true?
Cami Smith:Um and so, and this is also one of those topics that, um, you don't really see floating around so much on social media, but, tiffany, I know that, um, one of our business partners had let us know that you don't really see floating around so much on social media, but, tiffany, I know that one of our business partners had let us know that you were talking about just how prevalent this is in our community. So can you share a little bit about?
Lentz Dorsley:that it is. Actually, I'm going to give this conversation over to Lentz, because we create a lot of our education based on the main reportable diseases or reasons that people come into the hospital. Because we want to get ahead of that. If people are coming in and they're sick, how can we prevent them from being sick in the first place?
Lentz Dorsley:Like how can we help people live their healthiest lives? So, based on the 2023 most reportable diseases, which I'll let Lance talk about, that's where we create our material and that's why we decided that we really needed to start talking about STIs.
Tiffany Little:Okay, yeah, really, as Tiffany mentioned, when it comes to reportable diseases STIs, chlamydia, gonorrhea they're always one of the top four, top three throughout our state, along with other things you know that are on the rise alpha-gal right now, something that just became a reportable that we're seeing a lot of it in the community. We're learning it's a lot more prevalent than we thought. But when it comes to stis, particularly chlamydia, gonorrhea, those are our top two um top two top three reportable diseases for our region. Again, a lot of it. We find, you know, asymptomatic infections a lot of times. So folks aren't necessarily presenting with symptoms every time they get infected. So they might pass it down to multiple partners on the road and by the time they end up in the hospital they might just be at high risk and then end up getting screened and find out that they're positive for an STI.
Tiffany Little:So it's definitely prevalent in the community. Even just looking at some of the Virginia Department of Health data, you'll really get a good idea of you know how prevalent it is a lot more than we like to think that is. Again, even looking at the data, you see disparities across minority groups as well. You see high-risk individuals as well showing up and being the ones with the highest burden of a lot of these diseases. So we definitely have a lot of work to do. I think education what Tiffany's team does is critical to really get in front of those.
Lentz Dorsley:Yeah, many of these diseases are also silent. They go undetected, so a lot of times, people may not know about them and, because of the sensitive nature of a sexually transmitted infection, people don't want to talk about it, or they talk about it with someone that they love or they know pretty well. This may not be a health care professional, so that's where some of the misinformation comes from. You can look up anything on the internet, but it doesn't mean that it's true.
Cami Smith:Yes, and also it can lead to a rabbit trail of you know, a direction that may not even be helpful for you. So I want to talk about the data that you mentioned because, as as I was doing some research, it's growing, like the data, the numbers are growing. What is the most recent data pool for what we're, what we know right now concretely, is that like 2022, 2023, so usually, about 2022.
Tiffany Little:2023 is where we're at. Um. We report, you know, stis, most of them gonorrheahea, chlamydia, hiv. They're mandatory reportables for pretty much every health department in the country. But they then go, they collect that data, aggregate it by zip codes and make sure that they are not duplicates and whatnot, and then there's really a little gap not duplicates and whatnot, um, and then it takes. There's really a gap. So right now, the most recent data we have is really 2022. 2023 data might have a little bit of 2024, yeah, um, but what? The virginia department of health? They publish an annual report for us for stds, um chlamydia, gonorrhea, syphilis, um, congenital syphilis as well, and I think maybe one or two others, and this usually shows a five-year trend. And if you do look at those five-year trends what I encourage you to do you see it's been on the rise. No-transcript yeah.
Cami Smith:Will we ever see the end of the impact of COVID?
Lentz Dorsley:We may be looking for these answers for years.
Cami Smith:Yes, yes, it's unbelievable. And I mean, some of the things that we're talking about are, like you said, they're silent. And so when it comes to starting, like when because the numbers or the ages, rather 15 to 49, like I don't think the average 15-year-old is thinking I should probably get tested for something. And so when you talk about the need for education, like what does that look like? Where do you start?
Lentz Dorsley:So by educating and putting education out there. That's really the first step, because we really should be having these conversations with our healthcare providers and our loved ones about what we're seeing and feeling and what we're experiencing. Syphilis, gonorrhea, chlamydia those are our top threes. We really try and hit those hard, but they can be silent and one of them actually has a latent period that can last 10 to 30 years. It stays completely silent in your system and you may not know you have it. Can you pass it on while?
Cami Smith:you can storm it.
Lentz Dorsley:You can pass it on to your children or you can pass it on to your partners. And so, starting with the conversations about having safe sex, no matter how, what type of sexual activities you're engaging with, having that safe conversation with your partner and talk about your history, you know, talk about the things that that really matter, not just sexually, but also, you know, talk about the things that really matter not just sexually, but also you know the potential for diseases and for infections.
Cami Smith:Yeah. So because we're talking about some really young ages. If there are any parents who are watching, what does that look like? I mean, do you take your child to the pediatrician and have this conversation? Do you take them somewhere else? Have this conversation? Do you take them somewhere else? Are there some tactics in place for providers to maybe have these conversations with younger patients outside of maybe having a parent present, where they may not be so inclined to share? So how is that?
Lentz Dorsley:addressed. Yeah, you know it can be a really sensitive topic because you know we can feel very insecure about our sexuality or our gender, and these conversations have traditionally not been ones that you have around the dinner table, you know. Yeah, so there are places that you can go and there are places for our providers to go as well, to help them have those conversations with their patients or their loved ones, with their patients or their loved ones. So the health department does a really amazing job, not only equipping people to have safe sex, but also to give them information and dismantle some of that misinformation that's out there. The World Health Organization and the CDC both put out information on how providers can have conversations with their patients and with family members of patients too, because these topics can be hard to navigate, but they don't have to be.
Cami Smith:So there is also education on how to have the supportive conversations, because we do want to open the doors, because as we open doors and have conversations, we are eliminating risks yeah, this might be a bit of a rabbit trail, but I mean, you think of our patients, and it's never just one area that is touched by a patient when they come in.
Cami Smith:It's often different service lines that they may interact with.
Cami Smith:But also, ahead of it, like I think about, I would hope that my kids would be able to talk to me about these things.
Cami Smith:But something that we've chosen to do is we don't have a lot of family in the area, but we have chosen and really developed relationships with adults that we trust and we have very intentionally encouraged relationship between them and our kids as well. So, you know, maybe they may not be so comfortable coming to me about something, but maybe they'll go to Ms Carrie, or maybe they'll go to mr peter or these people in their lives who, um, you know, we want, we want there to be a safe space somewhere, and so, as you are talking to, you know people who could be potential patients. There's so much education there, but what about some of that ahead? I mean, I guess that might fall under prevention in a way. But like what does that look like? Like to start, because I know you do a lot of encouraging conversation in the community like let's talk about this more and encourage all of us together. So how would you encourage that type of environment?
Lentz Dorsley:There is a lot of freedom in being evidence-based and data-driven, because you don't have to make up the answers. Then you don't have to make up storylines or even feel afraid that what you're saying is incorrect, because we know that the evidence supports that not talking about things does not lead to prevention. So having open conversations, you know, even if they feel uncomfortable, it's okay. You can come at it from a clinical standpoint, you can have the data behind you and you can say I'm not here to judge anything that's going on. You know who you are is who I love and we're just going to have this conversation.
Cami Smith:Yeah, I love that so much, um, and it's so important, no matter what age that you are, that, whether it is an adult, like a trusted adult in your life, or your parent, or or if it is your provider you know, we talk on this podcast all the time about the importance of a direct relationship with your primary care, um, and and telling them what's going on, and we had actually a great conversation with one of our primary care physicians and they talked about, like, tell us the truth, please, like you know we want to be a part of, like your growth and your life and your healthy aspects of your life.
Cami Smith:But we can only help you as much as you let us in and so, yeah, those conversations are so vital and early. You know you can catch things a lot earlier if your primary care provider is already on that journey with you. They can notice the changes that are happening. Is already on that journey with you, they can notice the changes that are happening.
Lentz Dorsley:So sorry, go ahead. They can also help support you in wherever you're going from here.
Cami Smith:Yes.
Lentz Dorsley:If they know the truth, they can help support you and how to prevent whatever risk factors might be coming with that, or help support you in how to navigate it better. Yes, yes.
Tiffany Little:And I think those relationships with providers is key because there's a lot of misconception out there, especially among younger individuals at 15 to 24 age group. You know a lot of it. They think, hey, you know, I'm a virgin, I've never, you know, had sex before, so I'm not at risk for an STD.
Tiffany Little:But, you know, provider can be there and say, hey, wait, let's define what being a virgin actually means to you, because you know oral sex and anal sex and there's just cons for sexual contact can lead to transmission of diseases and be asymptomatic at all. So, yeah, a lot of these stds, we like to think of them as just affecting, you know, our reproductive systems, our genital area, but they can spread to our throat, our mouth. Gonorrhea in particular can can spread from the mucous membranes down to other body sites, even causing arthritis, showing up as arthritis in some cases, or meningitis or other parts of the body. So, being able to have a provider where you can have go-to as a true source of hey, I can trust this individual. He's my primary care physician.
Tiffany Little:I seek care from him and establishing that trust. I think that's important as well.
Cami Smith:Yes, and that was going to be one of my questions Like what are the symptoms? Like what do you look for? And I know the answer is like have the conversation, but you know, for people who are like you know this, this isn't that big of a deal, like I'm not, I'm gonna wait or like what are the symptoms? What can you look for? And then, maybe, what are some things that are mistaken as symptoms or as things that you shouldn't worry about?
Tiffany Little:so it's uh interesting you bring up symptoms. The majority of STI infections are asymptomatic, right?
Tiffany Little:crazy like you were talking about the silent so, uh, when we do talk about symptoms, we're talking about the minority of individuals that do get infections um other. Add to that too, a lot of the symptoms, um, you know they they're the same across most of the diseases gonorrhea, chlamydia and you get the discharge as well. In men, particularly, gonorrhea may not be as men and women. Actually both might not be as symptomatic at all. So the usual that folks are used to hearing about the penile discharge or the vaginal discharge, um, burning, um, but you know those are some of the common pretty rare yeah, but you know, we can also have a fever, you know, and you might think, oh, you know and how many times do we shrug off a fever?
Cami Smith:you know?
Lentz Dorsley:you get tylenol exactly exactly take a nap it can look like a lot of things. You will have the discharge, you will have the burning with urination, but that's not always. And then syphilis it can be a sore or an ulcer somewhere on your body. That may not hurt at all and that's only in the first stages and they may not happen right away. So a lot of people think that they've had sexual contact, that something might happen right away, they'll know right away. So a lot of people think that they've had sexual contact, that something might happen right away, they'll know right away. And that can oftentimes be two, three weeks, sometimes months, before they actually demonstrate any symptom at all.
Cami Smith:Yeah, so is the message. If you're choosing to be sexually active, no matter your age, start testing. And how do? Like? If I'm a patient, do I just go to my primary care and say, hey, I would like to be tested? What does that process look like? Just to kind of break it down for someone who needs a very simple what do I do right now?
Lentz Dorsley:So, always practice safe sex, always Any sexual contact and, like Lentz was saying, it's not always, you know, it's not always the sexual activity that you expect you know it can be oral sex.
Tiffany Little:It can be oral sex, it's not always intercourse Right.
Lentz Dorsley:It can be any means by which we have it. So practice safe sex anyway. If you do want to be tested, there are lots of appointments available through the Virginia Department of Health.
Lentz Dorsley:And we have a location here in Lynchburg and some of our surrounding areas. You can go there for testings no questions asked. They will even help equip you with condoms, dental dams or whatever you need to stay safe. And then you can also go to your primary care provider. Now, sometimes those appointments can be far off. You can go to urgent care or to our clinics and be seen right away if you have concerns about being tested. But have those conversations early with your partners. You know about, you know what is safe and what is. You know where your boundaries are. It's always healthy to have boundaries. Yes, yes.
Cami Smith:That's so good. We talked a little bit about this earlier, but when it comes to like treatment and you and what you all actually both of you said is, um, some of this will stay a part of your life for years, whether you know that you have it or not. So, are there treatments? Are they? Are they, um, what's the word I'm looking for? Sorry, effective?
Tiffany Little:effective.
Cami Smith:Yes, yes so are there treatments? Are they effective? Um what? What can somebody do if they find themselves?
Tiffany Little:Yeah, so there are treatments. Gonorrhea, chlamydia there's antibiotics that we can give that work very well. Hpv we have vaccinations to prevent HPV disease, which could lead to cervical cancer down the road, syphilis as well. You can pass it down to the baby as well. So we do have treatments that are effective not for all STDs, you know. Hiv again, we have treatments that are effective, but we don't necessarily have a cure to cure something. It's a lifelong disease that you'll be battling with. But the difficult part is a lot of these infections again are asymptomatic. So folks don't necessarily say I'm fine, it's been three months.
Cami Smith:They shrug it off, shrug it off.
Tiffany Little:You know it's been three months shrug it off. So they go a lot of times without seeking treatment until by the time they eventually make it to see a provider, you know, the disease might have already progressed or this might be more difficult to treat at that point than if they would have caught it early. The other thing we're seeing as well is, you know, there's emerging resistance with a lot of our existing antibiotics for STI. So you know what's effective today may not always be effective down the road. So that's kind of where we're at with the treatment right now.
Cami Smith:It's kind of an ever-evolving situation. It sounds like, as with most, I think that you know it's. Things are just changing and and, but I think that more conversation can only help. Um, what, what type of research if you, if you guys can speak to it is being done? If things are changing and treatments are becoming ineffective over time, what types of research is being done surrounding this?
Lentz Dorsley:anything that's being treated by antibiotics can develop resistance. Any bacteria bacteria are very smart. They know how to continually adapt and it's actually really fascinating what bacteria can do. But because anything that's treated with an antibiotic can develop resistance, we're always vigilant.
Cami Smith:There's a lot of research being done on how to stay ahead of the bacteria and what they can adapt to yeah, um, so we're kind of covered everything, but I do want to ask either of you like is there anything like pressing, like that would be important to share, or something we haven't covered that you think should be a part of the conversation?
Lentz Dorsley:um, I think the most important part of this conversation is that by not talking about it, you're not preventing it. The evidence never demonstrates that Talking about things actually helps eliminate some of the risks.
Cami Smith:Yeah.
Lentz Dorsley:Because with knowledge is empowerment right. We become more empowered to know what we can and cannot do to stay safe and to stay healthy. We do know in our area that there is a massive uptick in STIs, syphilis being one of them. The Virginia Department of Health does put out information pretty frequently about the uptick in. You know, just syphilis alone is at a 5,000% uptick in Virginia, which is really a lot. And I keep thinking if somebody had had a conversation, if someone had been open and talked about it or had known how to practice safe sex and felt comfortable with it. You know, setting those boundaries and saying you know this isn't for me, you know how much could we have prevented. But now you know, when we know about syphilis, oftentimes it's very late stages because, as I said before, it's silent.
Cami Smith:Yeah, and it's when they can no longer ignore it, they can no longer push it aside. They have to come in. And that's too late to come in, still come in, but I think that's important for, I think, our listeners to really take note of those who are watching in Virginia, like it is here, like this is not something that's happening in California. This is not something that's happening outside of where it can impact you. It is here, it is prevalent, it is growing. So it's important to educate and prevent and to be a part of these conversations.
Tiffany Little:Yeah, and I think kind of off the heels of what Tiffany was saying, even us in health care, it's really just changing that perspective, removing that stigma around, talking about it going from more of a disease model to more of a health model, like let's promote sexual health. Outside of the individual impacts that STIs have, there's a big public health impact that they have. They facilitate transmission of HIV throughout our community. They have dire consequences for babies and maternal health as well. So it has a lot of negative impacts to our public health throughout our communities. And the more we can remove that stigma and stop looking at it oh, you know these are diseases, diseases, right, these are. You know these are infections.
Tiffany Little:You know a lot of times just Asymptomatic infections that can have consequences. So how do we promote better Sexual health? The same way you know we've done the shift around mental health and talking about that more how do we get sexual health to more of that state? And I think that's a challenge for us in health care right and public health workers and community health workers as well, especially with our younger population.
Cami Smith:Yes, and when I think about that younger population, I think about where, even where we are geographically Like, we are in a more religious area where sometimes these conversations are either taboo or they're just rejected because they're like, no, we don't need to talk about that. And it's so important to equip our kids who are going out into the world to know what to do in these situations, and so thank you both. You guys have just given us so much information and I hope those of you who are listening dig in on this. And what are some resources that we can share? I know you mentioned World Health Organization, cdc. Where can people find the most accurate information at this time?
Lentz Dorsley:If you're looking for information about what's happening here in Virginia, the Virginia Department of Health has some really great resources. I really think that the Centers for Disease Control and Prevention, CDC, has really approachable materials to not only help you have these conversations from either a provider or a parent standpoint, but also has information there too for finding out a little bit more about how you can protect yourself.
Tiffany Little:Yeah, and I think the CDC they do a good job of having a good social media presence, especially for our younger population. Cdc has Instagram pages, twitter pages where they give out a lot of good information. I love that. Which is how a lot of our youth right now gets.
Cami Smith:Their information is from social media. That's so true. If it feels taboo to type it into Google, then just follow them on Instagram and let that just be a part of your scroll periodically and stay informed Awesome. Thank you, guys so much. I really appreciate your time. Thank you for having us and thank you all for joining us on and so Much More.
