The Laura Dowling Experience
Conversations about health, science, wellness, life, love, sex and everything in-between. Laura is a Pharmacist who loves to talk to interesting people about their unique life and work experiences. See @fabulouspharmacist on instagram for more information.
The Laura Dowling Experience
Sex, STIs, and Breaking Taboos: Demystifying Genital Health with Dr. Aisling Loy
Rereleasing this podcast as it was so popular and really demystified genital health!
Dr. Aisling Loy, consultant in genitourinary medicine, debunks common misconceptions about sexual health and provides practical advice on addressing genital concerns with compassion and expertise.
In this episode, we explore some of the most common myths and overlooked truths in vaginal and sexual health. From the misdiagnosis of chronic candida to the effects of grooming habits on vulval skin, we discuss how everyday routines can impact intimate wellbeing. We cover the sharp rise in STI rates among young women, the importance of HPV vaccination for both boys and girls, and why regular testing is essential, even when there are no symptoms. We also look at conditions such as bacterial vaginosis and herpes, and how changes in condom use are influencing infection rates, all through the lens of the vaginal microbiome.
Book your STI screening at guideclinic.ie or sticlinicdublin.ie. Home testing kits are available through SH24.
Thanks for listening! You can watch the full episode on YouTube here. Don’t forget to follow The Laura Dowling Experience podcast on Instagram @lauradowlingexperience for updates and more information. You can also follow our host, Laura Dowling, @fabulouspharmacist for more insights and tips. If you enjoyed this episode, please subscribe and leave a review—it really helps us out! Stay tuned for more great conversations.
So the sexually transmitted infections. So let's start with the reason that women come to you so embarrassed Herpes it's my life's mission to try and de-stigmatise it.
Speaker 2:The biggest misconception about herpes is that herpes on the genitals is herpes type 2. The large majority of genital herpes we see is herpes type 1. And that's just cold sore bars. Okay, what we nearly all have.
Speaker 1:Chronic candida is otherwise known as thrush. Isn't that right?
Speaker 2:Yeah, what a lot of people don't realise is you know, you can keep just treating the thrush and giving them Diflucan, Diflucan, Diflucan, or you can look at the reason why they're getting it.
Speaker 1:So that's kind of where we come in. Welcome to my podcast, the Laura Dowland Experience. Many of you will know me from my Instagram page at Fabulous Pharmacist, where I love to shine a light on topics that people normally shy away from. Today I spoke with Dr Aisling. Loy Aisling is a consultant in genitourinary medicine in St James's Hospital, guide Clinic and Himaris Health. We spoke in depth about STIs such as genital herpes, warts, chlamydia, hpv and the importance of regular STI testing. We also spoke about bacterial vaginosis and how many women who think that they have thrush or chronic candida don't actually have it at all. Listen to this podcast, ladies. You're going to learn a lot. Aisling, it is such a pleasure to have you in the podcast studio. Thanks so much for coming. Thanks for having me, laura. Can you explain to everyone what your job was? Because even when I put up a question box on Instagram this morning, I said I'm speaking to an infectious disease consultant and we're talking about STIs, which are sexually transmitted infections.
Speaker 1:Do you have any questions for her? And then you come into me and the first thing you said is yeah, you call me the wrong name.
Speaker 2:So let's go for it. Yeah, we're really sensitive about this issue. So I'm a genitourinary medicine consultant, so there's a slight distinction between the two. They're two totally different specialties. They were really adjacent and work parallel with each other and in some parts of the country what I do is covered by infectious disease consultants, but we spend four years specifically dedicated to the area of sexual health and HIV.
Speaker 2:So we don't go into other areas of infectious diseases, say like malaria or COVID and things like that, and we were very targeted on sexual health and HIV and there's only there's probably less than 10 of us in the whole of Ireland. So it's important for us to kind of make sure we get out there and people know what we do and people find us, because it's sometimes hard to come by people who are quite specialised in this area and a lot of what we do can be covered by general practitioners and is so a lot of STI care can be done in the community, but there are lots of people out there that have chronic issues or have more serious infections that need to see a specialist and come to see us in a hospital setting for care of sexual health.
Speaker 1:Okay, so what information would you like to get out there today? Because we spoke about you know we're going back and forth on text we spoke about herpes and HPV and HIV and all of those other things that women get, and chronic candida infections or perceived chronic candida infections. So can we start from the start and can you give the listeners the information that you have or that you would like to tell them about sexually transmitted infections?
Speaker 2:It's like a major download of everything.
Speaker 1:I know, because there's so much to it, but there's really important points that we need to get across in this hour.
Speaker 2:Yeah, I suppose, first of all, the basic thing is about testing, and the basic thing we come across in a day-to-day in clinic settings is people saying I didn't think I had anything. They did maybe a home testing kit, which is a great thing now that we have in Ireland so we're one of the first countries in the world to have free home testing kits. With SH24, people can order online and that was introduced in 2022 in Ireland and we have about 100,000 of those go out a year and people can order them online and test at home and they're brilliant for people who just want peace of mind. They have no symptoms and they just want to make sure they're fine. And we're detecting lots of infections that way and a lot of those then can be dealt with locally with just sending out a prescription for chlamydia treatment but say, if you got gonorrhea, you would have to come in for an injection for treatment or something more serious like syphilis, hiv hepatitis. Then you would come into the hospital and you'd be linked in with our service. So that's sort of the basic five things.
Speaker 2:But what I'd say is a lot of people will do those tests at home and still have symptoms and they'll think, ok, well, I've ticked that box, it's not an STI, and then they'll move. Ok, well, I've ticked that box, it's not an STI, and then they'll move on to, usually through Dr Google. You know they'll be working out what they have and often get it very wrong. So what I'd say is make sure you know you access the care that you need if needs be. So if you've no symptoms and you do your STI screen, that's fine.
Speaker 2:But if you have a chronic discharge, burning, itching, discomfort, don't just stop there, you know, seek us out and come and find us, because there's lots of things that aren't tested for in those test kits. So they'll test for the basic five, but there's other infections that we can maybe test for, or it can be something that's not an STD but that we deal with. So we deal with things like chronic candida, huge issue for a lot of women, and because there's so many treatments available now in pharmacies where you can just walk in and get your canis and pessary, your clotrimazole or your clotrimazole cream, you know there's people who just keep on testing or, sorry, treating themselves in the community, not realizing that there might be something more sinister going on. That's so important isn't it yeah?
Speaker 2:So because of the nature of what we do, people think, god, it's really embarrassing. I can't go to my GP. He's known me since I was a toddler. It's really embarrassing. I know everyone in that practice, or you know, I don't want to show anyone my bits down there. You know the overwhelming response when people come in to us is, oh my God, you're actually normal and it's actually nice and we can have a chat. And they go away thinking why didn't I do this sooner? I've been going around with this for years and years and years, self-treating or just going into the GP and saying, oh look, I've got that thing down there. Would you mind giving me a bit more Diflucan and I'll take the tablet.
Speaker 1:That just happens and we say in the pharmacy as well Diflucan tablet after Diflucan tablet, and then you can become azole resistant, absolutely.
Speaker 2:So after about 20 to 30 treatments you know you have a high chance of getting azole resistance and it won't work then. So we have to look options, you know, and and so we can test for resistance in those cases. A lot of people so this is a really important thing about the chronic candida, so a lot of women with chronic candida have actually it's an underlying issue with their skin in the area.
Speaker 1:That's the cause we just say actually sorry, just to qualify, the chronic candida is otherwise known as locally thrush. Isn't that right? Yeah, so thrush, I always yeah. I always say yeah so thrush.
Speaker 2:I always yeah, I always say candid. I remember once when I was a junior doctor, a trainer of mine saying I wrote thrush on a file and he's like thrush is a bird, you know, like I give it out to you. So now I'm always like so careful not to use the word thrush, but, yes, thrush for the general public. So I had. There was a really brilliant talk one time I was at a couple of years ago by this mycologist from London called Dr Rena Richardson and her specialty is fungi and she did this amazing talk and she said she did this clinic in London for women with chronic candida and all her colleagues called it her itchy, fanny clinic. She's absolutely brilliant. And she said she didn't call it that. What she called it was her angry skin clinic.
Speaker 2:Because what a lot of people don't realise is you know you can keep just treating the thrush and giving them Diflucan, diflucan, diflucan until they get a result resistance and then you know you're on to other things or you can look at the reason why they're getting it. So that's kind of where we come in, like we'll sit down with the patient and go through lots of questions and try to work out what is it? Is it even chronic candida? Because you will find thrush or candida in about 25% of women's vaginas, that doesn't necessarily mean that all their symptoms are related to that. Just because a swab comes back showing that there is thrush there doesn't mean that this is all thrush and that's another common mistake.
Speaker 1:And can candida in the vagina just be there and not cause any symptoms?
Speaker 2:either. Oh, it is, it's there in 25% of women. If you just swab them, they have candida. And actually the species of candida you get is the same as your mother and grandmother. It's passed down generation to generation, really, so it's the same genus, yeah, so you're born with your particular and you can't eradicate it. It's impossible to eradicate. So you know, people say, oh, I've got another swab and there are some thrush there. But we look at the symptoms and we look at why they get the chronic candida and often it starts with angry skin and it can be a reaction to the skin having a dermatitis. Nowadays the vulva is so exposed because a lot of people do a lot of grooming in that area, which can have a knock-on impact on the vagina's discharge and an imbalance in the normal microbiome of the vagina.
Speaker 1:So are you for bringing back the bush Aisling?
Speaker 2:I have said that several times in clinic to women when they sort of protest, I said oh, bring back the bush.
Speaker 1:I think we need a national program to bring back the bush. I'll be the face of it, OK.
Speaker 2:You can be the face. I don't know if it's a face we need, though no bush. So nowadays we have these very bare vulvas. I've seen it.
Speaker 2:In my 17 years of doing this specialty I've seen the evolution in females and males in the genital area and the knock-on impact, and we now get lots of girls coming in with chronic discharge, with candida, with BV. They're two sides of the same coin. They're just an alteration in the microbiome of the vagina and they just keep treating it but not actually getting to the root cause of it. So when they do hair removal it leaves a very exposed skin down there. And now, as we wear, you know, leggings and do lots of workouts and do spin classes and then have sex with our partners who maybe have also shaved, so there's this constant grating effect or stubble effect on the skin down their sanitary pads. When they looked under the microscope at the skin after being in contact with sanitary pads, they could see like a cheese grater effect, because if you look at the sanitary pads, the top of them, it's nearly like a cheese grater.
Speaker 2:That cloth and you know, I've had girls who are allergic to moon cups, for example like moon cups are brilliant for loads of people, but some people are allergic to it. So there's all sorts of things that can trigger down there. People using FemFresh, you know those sort of feminine hygiene products that are packaged in lovely bright pink and you know telling you your vagina should smell like a raspberry, and all of this sort of stuff. So there's a lot of grooming that goes on in that area, which is actually counterproductive and causes discharge and causes issues that we didn't have 17, 18 years ago. Wow, yeah, so yeah. And then, with the skin being exposed down there, you're more vulnerable to infections. So you know you're more vulnerable to getting genital herpes warts.
Speaker 1:Because the hair has kind of acted as a barrier.
Speaker 2:Yeah, so the hair has many functions. So it acts as a barrier and it creates a level of moisture and warmth that it's, you know, creates a particular ecosystem in that area. So I always say to girls well, you know, it's like deforestation If you cut down the rainforest in Brazil, you wouldn't expect all the little animals underneath to be the same. And then if you spread it with a load of chemicals and perfumes, you wouldn't expect that everything living beneath that would be in the same, because the environment, the ecosystem, has completely changed. So you know, obviously nowadays most people, or a lot of people, want to groom and that's fine.
Speaker 2:But I think what they need to be conscious of is then they need to replace what they've removed to add a skin barrier. So we're very much. I mean I think I should be sponsored by Ovel and what's my anointment? I literally, and it's cheap as chips, but it is amazing for the skin down there For most people. That person will say it's cheap as chips, but it is amazing for the skin down there for most people. I thought that person will say that it's a bit irritating, but it's amazing for adding an extra barrier on the skin, because we're taking away the hair and you're exposing the skin and just that it's.
Speaker 2:It's under a fiver and they can put a tiny bit on every day, and adding that barrier down there really makes all the difference, does it?
Speaker 1:help with? Um, you know dry dryness down there really makes all the difference. Does it help with, you know dryness down there as well? Yeah, yeah. Okay so if someone's experiencing I suppose that you know genital urinary syndrome, menopause, where their vulva might be going a bit dry due to lack of estrogen, that can be used as like a moisturizer A moisturizer lubricant. Yeah.
Speaker 2:So it's multi, multi purpose and the mind of women that have come out into me and go oh my god, that changed everything for me, just replacing, because you know, we look after the skin in our face so much and the poor vulva, you know, gets a bit a bar of soap in the shower which is really harsh, and it's taking away the skin barrier and taking away the oily layer that should be there. And then we've done the hair removal and it's just really battered at this stage and not being and and when you say lubricant, can you use it when you're having sex as a?
Speaker 2:lubricant you can, as long as you're not using condoms with it, because it can erode the condoms and disrupt their integrity. So you need. If you're having condomless sex, it can be used.
Speaker 1:Okay, because then there's so many expensive lubes in the market that you know.
Speaker 2:There are and look people have to find you know people. Sometimes some people react better to silicone based, water based. It's more oily, yeah, so it really depends finding the right one.
Speaker 2:The main thing is just not to have friction, because with chronic candida and BV it often comes from that irritation, and sex in itself is an irritant because of friction. So you'll find people say I'm fine, and then I have sex, and then you know it's provoking again and sometimes it's that cycle where you're associating sex with discomfort and then you're not actually sort of ready to have sex and then it's a vicious circle so it's more abrasive and then you know and you get thrush afterwards and it keeps going round and round in circles. So there's many factors that can cause chronic candida and there's many ways to treat it. But the wrong thing to do is just to keep sort of going in and getting.
Speaker 1:Getting your canistin. Getting your canistin Like yeah.
Speaker 2:I see girls who have that azole resistance and then we maybe have to go with nistatin. But another thing that actually I don't I haven't seen in any pharmacies I don't know, maybe you'll know as a pharmacist, but I often direct them to an online website is boric acid. Do you ever?
Speaker 1:Oh yeah, but we need to buy it in. You know, you have to buy it in a little tub, yeah, and I suppose it's like how much would they use off it? And I suppose it's like how much would they use off it? And if the pharmacist has to make it up, that has to be written on a prescription so you wouldn't see people getting that.
Speaker 2:Yeah, I've found a website that you can buy it in capsules, so that's actually really successful, for a cell-resistant candidate is using boric acid. Pessaries never eat it because it could kill you, so it's always into the vagina and we have great success with that in some women. So they put 600 milligrams into the vagina every night for two weeks and it's a great treatment. That's recommended in the guidelines for chronic cancer.
Speaker 1:But someone would have to go to a doctor and get prescribed, that wouldn't they? No, you can buy it online.
Speaker 2:There's a particular website I think it's something like iHerb where you can buy a box for €30 of 30 boric acid vaginal pessaries and use them. Now we have them in our clinic in St James's, in the guide clinic, where I can prescribe and the pharmacy there will dispense. But if we're out of stock or anything, I'd say, look, you can actually buy them online. This is a way of getting them.
Speaker 1:Okay, that's really interesting and that is for Candida treatment, Okay it actually works for BV2.
Speaker 2:And yeah, so it's a good sort of treatment option for women who are, you know, running out of options for treatment that have had lots of. But the first thing is to work out why it's happening you know, you know to to sort of go back to basic principles of why am I getting chronic candida?
Speaker 1:OK, so they clear the skin, you sort their skin out, or their angry skin, in a number of ways. You use the barrier, moisturiser, et cetera. And then what else can they do?
Speaker 2:Yes, you have to look at other things. Sometimes it's not even chronic candidate. It's lichen sclerosis or it's psoriasis or eczema, you know. Or they've got a latex allergy and it's every time they have sex with a condom that they're getting thrush after that because they're having an allergic reaction. So there's multiple different. I've had women who are allergic to their husband's semen. You know that whenever there's an ejaculation inside that they'll get this burning, itching, swelling afterwards. So there's lots of different factors, but it's important to sit down with someone to sort of tease through what's happening.
Speaker 1:And there's not many people we can't fix you know you did mention itching and sclerosis there and I just want to kind of just for a little minute because it's a very difficult disease to have. Or is it a disease or a skin issue? It's not a disease, because it's not a thing.
Speaker 2:Yeah, it's a skin issue.
Speaker 1:Yeah, so it's not an infection of sorts.
Speaker 2:It's not an infection, so it's a skin issue.
Speaker 1:But you know, I've heard of women leaving it so late that you know almost their clitoris is gone with it or their vagina is nearly closing with it. So can we say the symptoms, please, and just encourage ladies if they do have these symptoms they have to get referred. Yeah.
Speaker 2:So and who to refer to? So that's the question. So again, this is something that we do do as Genetic Urinary Medicine physicians, but a lot of people don't know where. You know what we do and sometimes go. I'm not going to an STI clinic, you know, and that's the thing. That's the thing or they'd be mortified, they'd be referred. I know some people have the specialty clinic on a Friday morning in St James's where we see people who've been referred in by their GP for more chronic issues or more issues that are just need a bit more of a specialist. You know they don't want to be seeing a more junior doctor, they want to see the consultant and so sometimes, because this affects older people generally they'll be sitting there and suddenly realize they're in an STI clinic and they come in and be like, oh my God, I didn't know this was the sort of clinic.
Speaker 2:I was in and absolutely. But then as we talk and sort out the problem, like, well, now, if I'd have known sooner I would have been here, because you know and they realise we're all nice and it's, you know, we're very easy to talk to. Generally it's the sort of specialty that attracts people who are open-minded and, you know, liberal and can easily chat to people about their sex laws. So, you know, because we're not embarrassed, they're not embarrassed. It's that sort of rapport, as I said, flora you missed your calling.
Speaker 1:I love my calling if I had been a doctor, I definitely would have been a gum doctor let me just put that on the line because people say, oh, you would have been a menopause specialist. No, I just love talking about the taboo areas too much.
Speaker 2:I think you would have a menopause special. I'm like no, I just love. I love talking about the taboo areas too much. Yeah, I think you would if I could absolutely see you in our clinic having the crack we have such crack with our patients.
Speaker 1:Yeah, do you know, it's really light hearted generally and isn't it important to make light of those kind of topics, because then it puts patients at ease.
Speaker 2:Oh, at ease, yeah because they come in and research, you look at, you know we're all here because someone had sex you know yeah exactly you know. Don't think you're unique, because you had sex, don't think you're something special exactly in here.
Speaker 2:So yeah, back to lichen sclerosis. So it affects generally. It affects older people, it can affect men and women. I have seen people younger in their 20s, 30s with it and we don't know why it happens, but the theory is that there's definitely association with urine leakage.
Speaker 2:It tends to happen in women who have a little bit after having babies, have a little bit of urinary incontinence and the urine is sitting chronically on the skin. They're sitting in damp pads or damp underpants and you get this figure eight it's called around the perianal area and up around the vulva, and over time that chronic inflammation leads to things like loss of architecture, architecture telangiectasia, which are little red bruise type sort of looks, purpura, but what the patient would notice first of all would be itch and burning. That's the most common thing and that's why I say if you've got chronic candida, to always especially if you're slightly older to get someone to look at the vulva just to inspect the skin, because I've seen so many women that by the time they get to me they've had years and years and years of thrush treatment when actually what it was was lichen sclerosis because gps pick it up bashing them.
Speaker 2:Oh yeah, look, there's a lot of brilliant gps out there, amazing gps. They're so run off their feet, I know they're so run off their feet.
Speaker 2:I mean I I don't know how gps are doing it these days because you know they end up with eight, ten, twelve minute consultations and they have to get someone you know, speak to them, work out what it is and, you know, get them undressed up in the bed, inspect, write their note, prescribe. I don't know how they do it. We're so lucky in my specialty because we have the luxury of time and we have the luxury of being able to see someone back. So if I saw you on a Friday morning and I was worried about you, I'll say try this. And you don't always get it right first time. We don't always go straight to biopsy because, you know, often it's a clinical diagnosis and we'll say do you know what? I think you've got this. Take this, use this cream, a potent steroid, for a couple of weeks. We'll see. Once you're in, you're looked after very well and there's a big team that you're really well looked after and I think most people that attend our clinics would say that they've been really well looked after.
Speaker 2:So the main symptom will be itching and burning and then over time it can change, the architecture can change so they can get loss of like the definition of furosalabia in a woman or on a man. It often happens in men with post-maturation dribbling. So as they get a bit older they'll have a little bit of dribbling and the urine, a little dribble, will come out after the finished peeing and it will stick under the foreskin. So we don't see it, and this again goes with the urine theory. We don't see it in men who've been circumcised, because if they dribble it sort of just rolls away, whereas if they have a foreskin it'll capture it and it'll sort of sit like a little well of water along the coronal sulcus and over time that will gradually absorb. So rather than having the definition of the glands and then the shaft of the penis, there'll be like a melted candle effect where it'll sort of start to melt in and you'll lose that actual definition. Oh God, yeah.
Speaker 1:And then the foreskin, I've learned something today. Now, I didn't know men could get it, oh goodness, yeah. So I thought it was because I mainly talk about vaginas to people, so that's why I.
Speaker 2:No, absolutely. Men get it too, and they're even worse at coming to see the doctor.
Speaker 2:It's often they'll come in for a different reason and when you're examining them that you'll point it out and go. You know, have you noticed this tight white banding or that the foreskin's getting very tight and hard to retract and there's gradual loss of architecture? You want to get it sooner rather than later, before there's sort of permanent structural damage. You know, often they may well, they may often have to get circumcision, which OK, yeah, but still, even before the circumcision, the glands could have been affected.
Speaker 2:Yeah, yeah, they'll have like these white patches, red patches. But a lot of it we can reverse with steroids over time. But with the loss of architecture you won't reverse that.
Speaker 1:And do the steroids though, the potent steroids that you're talking about? They cause skin thinning in and of themselves, and with lichen sclerosis, they often have to maintain the steroid use. So how do we counterbalance all that?
Speaker 2:Yeah, so the potent steroid is fine to put on damaged skin. Okay, so if you're putting it on good skin then it will thin the skin, but if you're putting it on actual damaged skin it shouldn't thin the skin. And it's a tiny amount and we wean them down off it. So we go from you know twice a day to maybe once a day, to once or twice a week, and then we reduce down to a less potent steroid over time and we monitor them. So we'll monitor every three months and then to once a year, once we're happy with their progress, and we'll refer them on to surgeons if needed to. They need operations to help with, um, you know, any tightening or anything like that.
Speaker 1:You can refer them on to gynae or urology so it would be a lot easier for someone to refer to you with lichen sclerosis than refer to a dermatologist now there's some well, dermatologists do do it, some do, but it's very specific.
Speaker 2:So there's a lot of dermatologists don't do it, yeah yeah, and some gynecologists do it. So it's just about the GP knowing who to send to. I know there's I think it's Ife, lally and Vincent's does it, so there's some dermatologists are absolutely happy to do it. So everyone's got their little special interest areas and there's some would just be like absolutely not, I don't.
Speaker 2:I don't do this, I'll refer you on. So it depends. It's really about your GP being good with a little black book of knowing who does what. Yeah, so it's yeah, ok.
Speaker 1:Right. So you did mention with the candida and BV, so can we, can you tell everyone what BV is and how people can treat it, because it's often something that's bandied around and people don't know what to do with it.
Speaker 2:Yeah, so bacterial vaginosis is not an STI. It's something that, like thrush, a lot of women will get at some point in their lives it can lead to. The symptoms would be something like a malodorous, itchy, uncomfortable, more profuse, slightly off color. Sometimes it can be white, sometimes green, yellow colored discharge Is it fishy smelling.
Speaker 2:Yeah, can be fishy, fishy smelling and it's important. You could have BV, but it could be with an STI, so it could have been triggered by also getting an STI. So always do an STI test if you have any change in discharge or any abnormal bleeding and so, yeah, so it's important to not just go in and buy your. You can buy, you know, a BV test in the pharmacy and people might do that and go, oh, it's BV, that's what it is now in the pharmacy, and people might do that and go, oh, it's bv, that's what it is. And then and then do their treatment. Some over-the-counter treatments like relaxagel that people can put into the vagina every night for seven nights, um is an option, and what do they have in them that helps with the bv?
Speaker 1:I don't know I think there's a lactic acid in them and I think there's like a probiotic or something. Yeah, it's a ph balancing, so I don't know the exact ingredients, but it balances the pH.
Speaker 2:So with BV, what they have is a very high pH, so they'll get an overgrowth of anaerobic bacteria in the vagina. So the vagina is a very finely tuned, finely balanced ecosystem where you'll have your aerobic bacteria, your anaerobic bacteria, your yeast, all living in harmony and then this is why we don't stick soap up there, girls. Don't, oh goodness, no, douching nothing, you don't need to wash your vagina.
Speaker 1:It's a self cleaning oven. It is.
Speaker 2:You see, you're halfway to being a gum consultant already. Laura, don't go near it. And a little bit of water in the groin, and you're grand, you're good to go.
Speaker 1:Anyone trying to sell you fanny smelling stuff is just yeah, they've no morals now this is half my consultation done.
Speaker 2:Now you just hit repeat and you say that again, again, again, every day. Um, so yeah, that is so. So it's just this imbalance it's, and again we like to try and work out why. We don't often get to the bottom of it. But a lot of it is in young girls that do a lot of the feminine hygiene. They're like being hygienic and they're washing a lot. So you know we treat it with usually flagell or metronidazole for five days, or you can use clindamycin into the vagina for seven nights and they're prescription only.
Speaker 1:bacteria, they're prescription only.
Speaker 2:Antibacterial. Sorry, yeah, but if you're getting, it's okay to get BV a few times. People just get them like UTIs and Candida. This is part and parcel of being a woman. But if you keep getting it again and again, ideally you need to come in and talk to one of us to sort of try and work out what it is, why you're getting this, and always do an STI screening, because it could be that that's triggering something and do probiotics help?
Speaker 1:You know? The way there's some probiotics that make it to the vagina or something like that. Do they actually help with keeping the balance right there?
Speaker 2:I don't think there's any evidence of that. You know there's no harm in it, but I don't know if there's any strong evidence that it works. No harm in it, but I don't know if there's any strong evidence that it works.
Speaker 1:Okay, great, now we want to get into the meaty stuff. So the sexually transmitted infections, yeah. So let's start with your biggest bugbear, or the reason that women come to you so embarrassed and just yeah, go herpes.
Speaker 2:Yeah so herpes, it's my life's mission to try and de-stigmatize it. I see women's lives. I say women, like obviously herpes affects men but mostly it affects women. So most people diagnosed in Ireland it's a really 70 to 30 percent women to men. So it mostly affects women and I'd say the women that actually end up coming to me in clinic it's about 100 to 1 women versus men. It's, you know, it's predominantly.
Speaker 1:And is it just because it affects women? More Men carry it, but women get more symptoms?
Speaker 2:Yeah, because it likes the mucosal surfaces and because the nature of the vulva there just is more mucosal surface, women tend to get more symptomatic. So the first thing about herpes is to know your type. Ok, so this is, this is the biggest misconception about herpes is that herpes on the genitals is genital herpes and that equals herpes type 2. Ok, the large majority of genital herpes we see is herpes type 1. Ok, and that's just cold, sore bars, ok, what we nearly all have. So whenever I see a young woman who comes in to me under the age 25, ok, and you can nearly diagnose them as they're walking in the door because they're in such agony. They can hardly walk, they can hardly sit down. They look like they've been crying for days.
Speaker 1:Oh, my God, it's horrific.
Speaker 2:And so they come in and it's a really traumatic diagnosis for them and you say, look, it looks like genital herpes. But nearly all of those young women, ok, are herpes type 1. And what happened was they got HSV-1 finally. And I say, look, it doesn't feel like it right now, but it's a good thing, ok, it's a good thing that you got this, because now you're normal, now you're like most of your friends. Most of your friends have herpes 1. So most people in Ireland have herpes 1 by the time they're age five and they get it from being kissed by their mommies, daddies, aunties, uncles when they're little children.
Speaker 2:Okay, when you're born you generally will have antibodies given from your mom to you in utero passive immunity for about 18 months and then after that you get every infection going. So that's why you know you send your kids to pressure. He's getting their temperature rashes, all of this, and you may or may not notice, but your kid will probably at some point get a little mark on their lip and it's a cold sore. And most people don't even know that. They grow up and you say, have you ever had a cold sore? And they say absolutely not. But if you actually check their antibodies. They have antibodies to HSV-1. Ok, so if you're in a class of children, about 80% of them will have HSV-1 antibodies. Okay, okay, and they're going around absolutely hunky-dory, fine, not even knowing about it. There'll be maybe one of those children who gets cold sores and everyone will be like, oh, don't share a bottle with them they've got cold sore, not knowing they already have it anyway, you know.
Speaker 2:So there's all of this stigma.
Speaker 2:It's just the way it presents in some people isn't that right In some people, a small minority, will get recurrent cold sores, okay, um, and then you'll have the child who never got the cold sore and they weren't kissed enough. Okay, and I say, blame your mom and dad. But basically they get to adulthood and even though they're out in the disco snogging away, they, they've just never picked it up. Ok, they've got to. And then they reach sexual debut and they have a sexual encounter with a partner who gives them oral sex, ok, and that partner probably doesn't have a big cold sore, but they're shedding and sort of things align. Where they're shedding the herpes type one and the person has no antibodies and they suddenly get it.
Speaker 2:And it's not like when you get it as a child, because when you get these things like chickenpox as an adult is much worse than as a child. So when you get this infection as an adult on the genitals, it's horrific, it's really bad, it's really painful and it covers the whole vulva in ulcers and you can hardly sit down, hardly pee, ok, so this is what we call a primary herpes attack. Ok, and that is usually seen in women and usually around the age sort of 18, 19, 20, up to 25. Ok, and if those women are not seen and diagnosed properly and given the right information, they then heal and go off and I've seen the detrimental effects 20 years later.
Speaker 2:I saw a woman recently who basically didn't go on to have relationships children all of that because she thought she had this horrific infection that she could give to any partner. So let me just explain that most, most people, so that I actually feel like crying. Yeah, it's awful. Like every day I see at least one girl a day who their lives have been absolutely ruined by this and have been taught because they've been given so much misinformation. Because often say in medical school, herpes is like the bottom of some slide once in one year and it's moved on and it's just herpes. That's that really bad genital infection that everyone makes fun about in you know, south park or one of you know those things and there's a lot of sort of social jokes about it, when actually it's just this really common virus that we nearly all have.
Speaker 2:They find it in prehistoric man, so it's been around since caveman times we've lived through you know millennia with it and it hasn't caused the stigma and shame that it does today because of society.
Speaker 2:now, but let me get back to the herpes one on the genitals. So basically, what I say to the girls is look, it's actually a good thing that you got this, because it doesn't feel like it now. This will last for two weeks, ok, for a fortnight you're going to have this and it will gradually go. We'll give you some antivirals for a few days days, but it's going to run its course and your body's going to build up antibodies. Okay, and you'll not everyone does, but most people build up antibodies and then it often doesn't recur after that. Okay, it might a couple of times in the first year while your antibodies are still building, but generally speaking, you'll be like all those people who get it here who have no idea they have have it here. It doesn't bother them, ok.
Speaker 1:And Aisling is touching her lips there, just in case. Oh yeah, she's touching the lips on her face, ok, which means when you have it here, so OK.
Speaker 2:So mostly you have it on their mouth and they don't wake up every day going, oh my God, I've got it. You know, oh my god, I've got herpes. I've got herpes. You don't wake up thinking about it. I'm sure I have it on my lips. I've never tested my antibodies, but I know once every couple of years I'll get a little tingle on my lips. It never breaks out into a cold sore, but I'm sure I have it.
Speaker 1:So you don't have to have a big, dirty, cold sore to actually have it, and that's really important.
Speaker 2:Most people with herpes have no symptoms of it. So the large majority of people with herpes one and two have absolutely no idea they have it. The poor people who are so distressed by it are the ones who know they have it when they make up the minority, ok. So the girls. I say to them look, this is a once in a lifetime experience getting your primary herpes outbreaks because you've no antibodies. Any recurrence will not be like this because at that point you have antibodies built up. Ok.
Speaker 2:And their biggest concern? So when it comes to herpes, the biggest concern that people have is not how they're feeling, not how you know the pain and the discomfort for the large majority. Their biggest concern is giving it to someone else OK. When in fact they can't give it to someone else, okay. When in fact they can't give it to someone else because most people they're going to be with have it already, okay. And I say to girls well, look out of all your mates. Say you've got 10 mates, eight of them will have this already. You know, are they going around worrying about giving oral sex to partners? No, do they? You know well. And I said I've yet to see someone turn down, you know because, someone you know, because they already have HSV1 the large majority.
Speaker 2:It's very hard to get through life and not and not pick it up, okay, so that's just. It's just really important to know what type you have. And then the other thing I say is often, if it's not explained right, they think absolutely everything that happens down there is related to herpes. And I love girls coming in, going. I'm on suppression, I am plagued Every month. I get an outbreak and it's not. It's actually what they get is these little paper cuts, I call them around the interoitus. That is actually candida. So candida presents like that and it happens every month just before their period. Because of hormone fluctuations, you're more vulnerable to getting candida at that point and it comes out like little tears and that's not herpes. And I'll say that's not herpes. And they'll be thinking for every month that they're getting a herpes outbreak and they're absolutely not.
Speaker 1:And they're afraid then that if they do get the outbreak, that they'll transmit it to your partner or who probably has it already.
Speaker 2:So once you have it on your lips, on your face, you have antibodies and you can't get it in two locations, okay, so you only get it in one place or the other.
Speaker 2:So the large amount of people out there already have been inoculated under the age of five are immune to getting it on their genitals.
Speaker 2:This is herpes one I'm talking about, which makes up the majority of the herpes diagnosis in Ireland. And I say you know, you're now just normal, you're like all the other people that you've been hanging out with and kissing and dating and all of that. And the good thing about it is is now you'll have antibodies to pass on to your baby, because up until now, if you had a pregnancy and had a baby, your baby would have been born without antibodies. So this is Mother Nature's way of ensuring that you have antibodies to pass on to your baby, because what you don't want is a newborn baby being exposed to herpes, because that can be really dangerous. So what you want is to pass on the antibodies so that when you know granny comes to give the baby a kiss, that it's not being exposed without antibodies, without protection, and up until the point of you getting HSV1 on the genitals, you were potentially being you know, not having antibodies to pass to your baby.
Speaker 1:Okay, and can I ask you then? So they get it once? And you say that's normally the once in a lifetime. Well, that first one, the awful one, is the once in a lifetime. Just like cold sores can come and go during times of stress, or if you're exposing yourself to the sun or whatever not that anyone, that's, was there all the time. Oh, it depends on what you're into, but, um, can they get repeat infections?
Speaker 2:or can it flare up again, or recurring infection.
Speaker 1:But it's never as bad. Is that it never usually as bad, and?
Speaker 2:over time it gets less and less and less. So we don't often see people as they get older in life, coming in with as I said, we've had this since prehistoric times we don't have people in their 40s, 50s, 60s, 70s. You do have some, but not as many as you would. So it wanes over time the amount of recurrences. Now you will get the odd person and they'll come into us with recurrences that we need to put on suppression, so Valtrex or Valacyclovir or something like that. Suppression where they take one tablet every day to prevent passing it on to a partner, to prevent recurrences for themselves. So there's and I'll do a clinic. I do a clinic in the Coombe Hospital for pregnant women. So if you have genital herpes, it's recommended that from week 36 of pregnancy until birth that you take the suppressive therapy to ensure that there's no herpes present at the time of birth. So I'll do a clinic for women where we provide them with the suppressive therapy for the last part of their pregnancy.
Speaker 1:And will they only? Would you only know that if the woman discloses that she had genital herpes or herpes type 1, before or 2,.
Speaker 2:Yes, genital herpes can be herpes 1 or 2. It's a specific question. They ask at booking. The midwives ask at booking in the Coombe Hospital. I'm not sure about the other hospitals, but they're very good in that hospital and they'll ask it. It's part of the you know have you ever had? And then they'll be redirected into seeing myself to go on suppressive therapy.
Speaker 1:OK, and if someone has an active herpes outbreak when they're giving birth, obviously that's taking you. Look at that, take that very seriously.
Speaker 2:We do yeah, yeah, and sometimes it will indicate needing a C-section OK yeah, ok, ok, yeah, but there's options for everyone. We do yeah, and sometimes it will indicate needing a C-section okay, okay, sometimes there's options for everyone and it's really important that you just go and get seen to girls, like it's so important.
Speaker 1:Just talk, you know, come and talk to us, we're not we're not horrible people, we're you know we're very approachable.
Speaker 2:So yeah, look, and we deal with and like all things go and humans are humans and we all do mad and crazy things. There's nothing that can shock me. There's nothing that can shock me either. There's nothing I haven't heard. I mean, yeah, you'll get it in your confessions, you know, like so that it's so important that women know that and men know that too.
Speaker 1:We love men.
Speaker 2:So herpes type 2 then Herpes type 2 tends to be in older patients. So by older, older I mean over 25. You do get it in under 25s, but just it's just epidemiologically who people at that age are having sex with. They tend to keep within their own cohorts, but slightly older tends to be more HSV too. Obviously you can get one and two in both we never actually said.
Speaker 1:Hsv stands for herpes simplex virus, different to hpv, which will come on different people do mix them up but they're totally different so, yeah, hsv um two, uh, look it's clinically.
Speaker 2:you can't tell the difference really. Like I'll be able to have a good educated guess if I see, say, a young 20 year old girl with really bad herpes tends to nearly always be HSV1. Whereas if it's a kind of slightly older person with a few lesions it tends to be more HSV2. The reason for that is because the older person generally already has HSV1 and that attenuates their response in that there's some cross immunity to that, so you don't get the big huge reaction that you tend to get with HSV1. So HSV2, the only difference really in the two is well, two things You're more likely to get recurrences with HSV2 and the issue of you could potentially pass it on to partners because it's less prevalent. Okay, so because HSV2 is less out there in the community, whereas I can sort of say to people with HSV1, look, most people have it already and it's kind of one of those things that you're more normal to have it than not have it. So why are you worrying about passing it on? Because nearly everyone you're with has it anyway.
Speaker 1:You know HSV2 is less common, and it's only in the genitals. You don't get that on your lips, yeah it tends to be only in the genitals.
Speaker 2:So we've ways of attenuating their issues with HSV2 sort of well. Initially we do what's called episodic treatment, which is you kind of try to recognise the symptoms. Some people get an indication that they're going to have an outbreak, like a tingling or a pain or an itch, and then they take antivirals twice a day for a few days and that stops it being a bad outbreak. The hardest, I think, for people with herpes is just being on the dating scene and meeting someone and disclosing to their partner. So sometimes we'll help them with that, you know. And sometimes people will come in with a partner and for education it's.
Speaker 2:I always say to the girls it's like I see so many women come in and worried about it. I do have men, males, who come in and they're worried about it, obviously, but the ratio is about 10 to 1. So there's a lot and what those women are worried about is the men, ok. So they come in really stressed about passing it on to a partner that doesn't even exist yet. So these are usually single women and they're worried about ever meeting someone and, you know, telling that person and I said like this guy doesn't even exist in your life.
Speaker 2:Sometimes it can be a really good screener of who really loves you or not, you know in that I've had patients come back and then go OK, you know, it's worked out really well. I told him, to be honest, girls tend to be now, this is a bit of a generalisation but tend to be more worried about it than boys are. So often I don't mind generalising my knowledge. Often I say to the girl look you're just gorgeous. You know this guy, look you're just gorgeous.
Speaker 1:You know this guy?
Speaker 2:if you're, they're just delighted to be having sex at the gorgeous moment you know, and they'll take that hit of potentially maybe getting a virus that's common enough that for most people is absolutely asymptomatic and at worst, will cause three days of a little blemish on their genitals you know, and a lot of people will be asymptomatic if they have it.
Speaker 1:Is that right? Most people and at worst will cause three days of a little blemish on their genitals. You know, you've got to put it in perspective. And a lot of people will be asymptomatic if they have it. Is that right?
Speaker 2:Most people are asymptomatic, especially men are asymptomatic if they have it. So they get in such a tailspin about this and it's just really important to put it in perspective. Like I say, if we had to explain this to an alien that landed, you know, there's no other disease that I know of that causes so much, causes so little health issues like real health issues, that causes so much distress. You know, there's just such a disparity between the actual disease in itself that for most people it's asymptomatic, but the level of stress and worry it causes it's really, really disproportionate. I don't, I can't think of anything else in health that causes that level of disparity between what the disease actually means and it's all just because it's all in here, it's all. It's all about the psychosomatic element of it and the social element of it and the stress and worry about meeting a partner and, generally speaking, most people like not to minimize it.
Speaker 2:Like you know, there are people who have a bad time with herpes, but the large majority, the large majority don't okay, they've absolutely no symptoms. It doesn't cause them a bit of bother. The biggest issue is worrying about giving it to someone else and often when they have the chat with the guy or the guy with the girl, but usually it's the girl with the guy. They're not that bothered, you know they're not that bothered. You say, look, there's a tiny chance. But we can really mitigate it by making sure I take antivirals, don't have sex whenever I have symptoms, use a condom. All of that can really mitigate and I've seen people who has a decreased immune system and suddenly they'll get symptoms and they've been together for 50 years and the other partner doesn't have it. We do their antibodies and they, you know they don't have it.
Speaker 2:So it's not that trans, you know it's transversal, but it's not a guarantee.
Speaker 1:And with either HSV1 or 2 roughly on average, how many outbreaks would someone have a year if they do have the virus With one? With one it's none.
Speaker 2:Okay, you know it's hard to say an average. The average is close to zero, okay. So, the average is most people is they don't have any outbreaks. Okay, the biggest worry is just the knowledge that they carry. You know, and that's why we don't screen for it, because you know you leave everyone freaking out.
Speaker 1:You leave everything freaking out.
Speaker 2:You know, first do no harm. So you don't want to give people the stigma and shame that they shouldn't have, because this is something that's very common and causes very little harm to people, you know. It causes very little symptoms in the majority of people.
Speaker 1:Okay, and then HSV2, how many outbreaks did they have, or how many you know recurrent infections might they have in a year? Or does it just happen, Is it?
Speaker 2:really sporadic. So it is such a like the large majority none. Okay, so most people with herpes one anti have absolutely no idea they have it. So you know, nine out of ten have no idea they have it. And sometimes the only way they find out is because someone they slept with phones them up and says I just got herpes, you must have it. And they say absolutely not, I've never had it. And then they come in to us and we do an antibody test and they do have it, and that can turn their world upside down a bit, you know. So it's sometimes better not knowing. Sometimes.
Speaker 1:But can you transmit it without it being an active infection?
Speaker 2:Oh, absolutely Most transmit it without active infection.
Speaker 1:OK.
Speaker 2:Most people that get herpes, the person they're with had no idea they have it. They have no symptoms of it, never did have, so it's like a lottery out there anyway, then, isn't it? It's a total lottery. I just think it would be so much easier if everyone was just given herpes 1 and 2. Because then no?
Speaker 1:one has any like. It would just alleviate all of the issues around it.
Speaker 2:Because the main worry about it is passing it on. So if everyone has it already, it would take away all the stress yes, absolutely, Okay.
Speaker 1:Well, look, I'm glad that we sorted that out.
Speaker 2:I'm just looking back at my notes to make sure that I want there's other things that we need to talk about, but I just want to. Okay, so we talk about the HPV now. Hpv, human papillomavirus yeah, yeah, yeah. Again, super common virus. We nearly all can assume we'll get it if you're sexually active at some point in your life, so about 90% of people will get it Of one form or another. There's over 150 different types and this is the thing Loads of types of HPV and people have become so aware now of HPV.
Speaker 2:Ever since we started screening for it with the cervical check programme so since I think it was 2020, it's been introduced as the initial screening when you do your pap smear. So what they'll do is they'll look for a range of the carcinogenic types, so main ones are 16 and 18, 33, 45 and a handful of others that will cause, can potentially cause, abnormal cervical cytology, leading on over many, many years in a small percentage, to cervical cancer. Okay, that takes a long time, generally speaking, and that for the large majority, they don't progress, so people get in an awful tailspin again getting a positive pap smear for HPV and pre-2020, we weren't even screening for HPV. So it's brilliant now that we have it, but it does cause a lot of angst and worry and questions now about STIs and all of that.
Speaker 1:I know and I've had women message me saying you know, my last smear was clear of HPV. This smear is positive. Does that mean my partner's had an affair? It doesn't.
Speaker 2:It doesn't. It could mean OK, you can't say either way, but certainly it can lie dormant, mean Okay, you can't say either way, but certainly it can lie dormant. There's been studies showing that that it can lie dormant and it just wasn't picked up before. But also it could be that their last smear was pre-2020, when they weren't screening for HPV. Or it could be that your partner had it all along and you've just acquired it now. Or it could have been that it was in a little reservoir at a very low level that has only flourished now because it's raised up to a higher level to be detected. So sometimes it'll be either dormant at a low viral load and then it's not detected, or it's missed on the brush and then it's picked up subsequently, or the partner could be having an affair.
Speaker 2:I see a lot of clinics talking to a lot of people having affairs. So you know they're all possibilities. But you wouldn't be standing up in a court of law with, you know, hands in the Bible saying this man had an affair based on that, or a woman, yeah. So you know, okay, no, fair enough.
Speaker 1:So can we just talk a little bit about the vaccine then that we give to our children to help prevent Really important vaccine? It really is, and to help prevent Really important vaccine? It really is and it's groundbreaking, but apparently there is. What is the goal? Is it to eradicate? Is it to eradicate cervical cancer by 2040, or something I don't know it could be 30 or 40. I'm not sure.
Speaker 2:I'm actually not entirely sure and in Australia and New Zealand there's streams ahead. Yeah, they really are.
Speaker 1:So let's just explain it to people why we give our children the vaccine, why we give it to them at the age that we do, and the importance of it.
Speaker 2:Yeah, so it is a very safe vaccine. There's been very targeted campaigns in the past and probably still ongoing, and the history and origins of those campaigns are interesting to look into. It originated, I think, in sort of Bible Belt America, but it's just because there's a sexual element to this. You know people think of HPV and it's like whenever you know you're talking about contraception that it encourages people to nearly have unprotected sex and so on and so forth. But there's been very coordinated campaigns of misinformation saying it can cause X, y and Z and there's been no evidence of that. And it's a very safe vaccine which I'll be signing all of my three children up to.
Speaker 1:I've given my first to it, not me personally. They've had it and my third fellow will have it and mine. Are all boys as well, and it's important that the boys and the girls are all treated.
Speaker 2:And Aisling's going to go through the reasons for this now. Yeah, so it's just you want to get it before a sexual debut.
Speaker 1:So you know Sexual debut means the first time someone becomes in any way sex.
Speaker 2:Yeah, because it's skin to skin contact, because you know it's a ubiquitous virus, as I said at the start, we nearly all have it, you're nearly all going to be exposed to it and it's a lottery as to whether or not your child goes on to develop pre-cancer or cancer cells from it. And HPV is linked to head and neck cancers, anal cancers, penile cancers. So we do give it to gay men as well, up until the age of 45, you know, who have not been vaccinated as children, because they're more predisposed to HPV infections and leading on to anal cancer. So it's been proven to help decrease that risk. So it's just, I think it's brilliant.
Speaker 2:You know, I always sort of look at Daffodil Day and you know people donating money and go, you know, to cancer research. Isn't it amazing we now have an anti-cancer vaccine like? That's just, it's unreal, isn't it? It's it, you know, it's a brilliant, a brilliant invention and the studies so far have been showing, you know, the the falling right off a cliff, the cervical cancer diagnoses and deaths. We look to australia because they were the first that's where it was invented and their way ahead in the vaccination of young men and women. So we get all our data coming from there showing this is really, really working. And the vaccine they give now Des as well, covers the ones that cause warts. So HPV causes genital warts as well and they're just the ugly, benign cousin of the cancer causing one. And they threw that into the vaccine, sort of as an add on to reduce genital warts A little upsell, a little upsell Might as well get rid of the ugly warts too.
Speaker 2:The ugly warts too, but like people get really upset about genital warts. But you know they're not the same as the type that causes the abnormal cells and the cancer. They're the type 6 and type 11. And they're just the sort of ugly cousin, but it's a benign one. The one that's more deadly is the invisible types that affect the cervix. So yeah, the vaccine very safe, very effective should be for boys and girls because we want to eradicate this virus. And it works. We give it all the time in clinic and I've never had anyone have any bad reactions ever to it. I'm sure you'll get, you know, people out there who will say they've had a reaction to it or have had a reaction to it. But by and large there's absolutely no evidence that it's not safe and generally.
Speaker 1:Generally, we're giving it to our kids when they're in first year in school. Um, it's two shots.
Speaker 2:I think it's two shots, yeah, and then and like, I'll see young women and men, but women because it was women who were vaccinated first, who come into me now with genital warts in their early 20s and they're so upset and they'll just be like, oh, my parents didn't consent, they were, you know, and and it's not their parents fault there was a big misinformation campaign. There was horrific facebook videos. All of this was going around. It was a real, you know, coordinated attack on on um, on vaccines, as you know, you still get, but um, you know, and their parents didn't consent, not because you know, just because they felt I don't want to do harm to my child. And you totally understand that.
Speaker 2:If you're being fed this information and now they've got genital warts and it's so upsetting for the young women and I thank God, you know whatever about the warts. Imagine now, like you know, and they're not going home often and telling their mom thanks a million, mom, you know, I, I know I've got genital warts. Now you should assign that, you know. But I just think, god, what if you know? That person then is at risk of going on. You know they could be at risk of getting HPV that causes cervical cancer and whatever about the warts. Imagine being by the bedside of your child whenever they have abnormal smears or cervical cancer and you're like thinking, goodness, I had an anti-cancer vaccine free to me and I didn't give it, so I just think it's yeah, it's an important revolutionary anti-cancer vaccine.
Speaker 1:I'm not entirely sure about the catch up programs and all that that are going on currently, but there was, there were catch up programs for children that missed out on their first, on the first doses, and things like that. And then, as you said, with gay men they can get it up to the age of 45 because it can still, even if they do have the virus, can't the vaccine still help to prevent the disease?
Speaker 2:it's. Yeah, the studies weren't hard to look at that, but there's thought behind that. But it's not just that. It's more that you could have been exposed to. But it's nine different strains that it's protecting against. There might be some cross protection against other strains. So it's shown to be cost effective up to the age of 45. And if you go to buy it, it's very expensive. It is very expensive.
Speaker 1:I remember, before it came in under the national programme, I remember a couple of parents in the pharmacy coming in and spending Now program. I remember I remember a couple of parents in the pharmacy coming in and spending now this was, I'm telling you, about 20 years ago about 500 euro for their daughters oh yeah, no, that's the cost of it yeah, very expensive.
Speaker 2:Um, so yeah, it's, it's yeah, and, and if you have an abnormal, it's recommended by NIAC but it hasn't been introduced into policy by the HSC to fund it that women with abnormal smears now should be getting it. I think it's from CIN 1 or 2 and above. It's been shown to be helpful in sort of a parallel treatment and adjunct.
Speaker 1:Okay so that might be coming in the future. Might be coming, hopefully. Yeah, the genital warts that you talked about there do they recur often or do people like? How do they treat it?
Speaker 2:And we know that the issues with supply of the Aldara and all the wort condyline, aldara, wort condyline impossible to get out of pharmacies at the moment. So with the type 6 and 11, gentle warts again important to get properly sometimes I'll see people who've been told they've warts and it's not warts, it's vestibular papillae. So it's just normal anatomy at the entrance of the introitus and someone sort of you know has made a Troy comment in a clinic and said, oh, I think you've got genital warts. And here's this. And I've seen people who've gone through lots of painful treatments and they never had warts. Oh, my goodness. So it's important, if you're questioning it, just to get a second opinion opinion. But look, a lot of GPs are out there, well used to dealing with warts, um, so with warts there's lots of different treatments, but um, the home treatment's hard to get your hands on nowadays and that's very frustrating. So it means often the main treatment we'll do is cryotherapy. It's where we freeze them. Um, so it's just ablative therapy because they don't really go away with themselves, do they not really? No, not really, um, and so you have, you get the virus and then usually you. So again there's a misconception, misinformation online about how you'll have the virus forever for life and generally speaking, you don't. So usually you get infected, um, usually it's within um six to twelve months of a new partner, generally speaking not always, but generally speaking and often the partner doesn't have warts. So there's all of this confusion. Right, it's gone. I don't know. They think I'm having an affair. You know, I don't know what's happening. So, again, like the herpes, a lot of people carry it and have no idea they have it. So the large majority of people with HPV have no idea they have it.
Speaker 2:Only about 10% will develop warts and that's to do with your own immune system. So if you develop warts, there's usually around a six month growth phase when more and more could pop up. So you could start treating them quite early. And it's a bit like guacamole. Another one will pop up. So you have to keep treating them. So you have to manage patients' expectations. Sometimes they'll come into you with two and you'll treat them and then about two months later they'll come back and go. I only had two and I came to you and now I've got six. You know you made it worse. So you have to try and explain that we've no treatment that gets rid of the virus.
Speaker 2:The virus eventually clears itself with your immune system. What we can do is treat the warts, but the virus is often plugged into your DNA and causing the warts to grow up in that area. So it's basically programmed in the skin cell to say grow a wart, okay, and we can ablate away the wart, cryo the way the wart. You know there's different ways to skin a cat, so to speak, and the virus will still live there in your skin. So although you're wart free, you'll still have the virus and at any point it could reactivate. Generally speaking, if you're going to get recurrences, for the large majority it's within the first six months. So if 10, 12 months passed, you're less likely to get recurrences and usually, on average, to clear the virus in two to three years.
Speaker 1:So OK, it's a bit like, a bit like a baroque on your foot.
Speaker 2:Yeah, HPV as well.
Speaker 1:They just go away themselves. I know that you're under time and I don't want to keep you late, but we've only a few minutes left and I wanted to ask you a little bit about HIV. I know we could have a podcast in and of itself about HIV in the clinic, but I wanted you to talk about the fact that it's a chronic disease management now really with HIV. But it's still very important for people to test, test, test if they have had unprotected sex and then maybe, if we have time a little bit, perhaps see. But I also wanted to ask you how you got into gum itself.
Speaker 2:So I don't know if we'll cover all that in 10, 15 minutes, but let's try HIV first anyway. Hiv first. So HIV has changed so much even since I started in this area. It's gone like if you think back. So HIV has changed so much even since I started in this area. It's gone like, if you think back to the 1980s, when it was first discovered, to now, you know, when they didn't have a cure to. You know, taking 20 pills a day, to now where it's one pill a day and a normal life expectancy and, generally speaking, now a lot of our HIV patients will probably have a better life expectancy than the general population because they're getting seen every six months by a specialist, they're getting a full MOT, everything's looked after. You know they get really well looked after.
Speaker 1:It is because I've spoken to a few people that would have said that to me before that they actually generally can, because they're being looked after so well. They've got really healthy, really healthy.
Speaker 2:Everything's so well looked after. You know their blood pressure, everything's checked. They have access to other specialties if needed. So thankfully it's come a long way. The main message I guess about HIV now is most people who have HIV diagnosed go on their treatment, usually one pill a day and you cannot get HIV from them. Okay, so they're really.
Speaker 2:I said to often to the gay guys I say look, you know, the safest person in the club to have sex with is the person who's got the HIV diagnosis, because they'll come in sometimes for post-exposure prophylaxis, really anxious because they'll be in a relationship or with a partner and then the partner eventually maybe discloses they have HIV and it can again sort of really upset some people and they'll come in and go look, I've been having sex with this person. They just disclosed to me that they've got HIV and now I'm really worried I've got HIV and I'll say well, look, that's actually that person. I can be very certain if they've been telling you that that most people are on their antivirals the large majority it's very rare to find someone who isn't and that their viral load's undetectable and it's impossible for them to pass on HIV. So they're the safest person If you have sex with a random person, a one night stand, no condom that's when you should be worried. You know, not with the person who actually has HIV and on treatment, because that's the one person you're guaranteed not to get it from.
Speaker 2:So it's a totally manageable chronic illness. You still don't want to get it, obviously, and a lot of our gay men now will be on PrEP, pre-exposure prophylaxis that's been a great invention in the last few years, where they'll take a tablet and it's kind of like being on the oral contraceptive pill, um, to not get pregnant. This is to not get HIV. So it's antivirals that you take before sex, um, and sort of. You can take it continuously every day just to prevent getting HIV or you can take it in the, you know if you're planning on having.
Speaker 2:Yeah, you can take it sort of weekend, yeah you can take it two pills sort of, before going out and then pill the day after, pill the day after. Ok, so it's an amazing revolution in health care and in my lifetime, because I remember when it first, you know in the 1980s, I remember, I remember.
Speaker 1:Freddie Mercury dying. I remember that and it just being so you know.
Speaker 2:I remember being thrown out of like the living room and I remember that and it just being so, you know, terrible. I remember being thrown out of like the living room, granny and my mom. There was a spotlight program coming on TV about this new killer infection and they were like, okay, this is coming on at nine o'clock and we sort of what is this? You know what is this?
Speaker 1:The picture interest, then the picture interest.
Speaker 2:It was like there's something taboo here. You know what is this really interesting thing that's been on and um. You know I remember things like don't share toothbrushes, don't share like, and all of this information on, on, on, on this program, um, and it's gone from that to where we're at now. Now still huge ignorance and stigma around it, huge amounts, because most people are still stuck in that. It's because you know it's not in their lives, not thinking about it every day, it's not part of their world. But you can guarantee nearly everyone listening has a friend or colleague or someone in their family with HIV. It's something that you know it's in your community.
Speaker 1:Okay, chlamydia and gonorrhea I'm. You know some of the news flashes that come out in the last few months is it's on the rise or there's. You know, there's a section in the Midlands where loads of people have it. They're all riding in the Midlands not using protection. So can you just, can we just talk a little bit about that? Yeah, there's been.
Speaker 2:I mean it's year on year rise there's been. I think it's something like a 30% rise from 2022 to 2023 of STIs in general in Ireland. So from 2022 to 2023 of STIs in general in Ireland. So that is a big rise in itself. Some of that is down to better testing, but not all of it. So some of it's down to the now access to care and home testing kits and 100,000 kits going out, but still the majority of STIs are not diagnosed through those home testing kits. So the majority are still diagnosed in STI clinics and with GPs, so it only accounts for a small amount.
Speaker 2:We don't fully understand why there's a rise. There's lots of different factors feeding into it. You know there's pornification, there's the advent of PrEP, you know more condomless sex, young people taking more risks, more hookup culture all of that drink drugs. You know there's a lot of factors that have caused an increase in STIs. The biggest worry is in the young girls. So the biggest increase is the 15 to 24 year old cohort. We break that down into 15 to 19 first. So in 15 to 19 first. So in 15 to 19 year old girls, there's been 175 percent rise in gonorrhea from 2022 to 2023. So that's a big jump 175 percent um, 150 percent overall if you break it from 15 to 25 um.
Speaker 2:And we haven't seen the same rise in in young men and it's worrying because girls bear the brunt of the consequences of STIs. So you know it's not nice to get an STI, whether you're a boy or a girl. But for girls there's much more sinister complications in that it can affect their fertility. It can lead to ectopic pregnancies, pelvic inflammatory disease, chronic pelvic pain. So it's just something that they're doing, a study at the moment, which we'll have the results later on in the year, looking at trying to assess why this isn't potentially is there maybe a reservoir of gonorrhea in the pharynx? So a lot of people don't realize you can get chlamydia gonorrhea in the throat and pass it on through oral sex. So we'll have young women and I think I feel a lot of it is from access now to pornography and that the expectations in that cohort, with just 24-7 access on their phones and now the expectation of how to perform, of what to be doing it's all a very different landscape.
Speaker 1:It's all. It's all this deep throat, anal, everything, yeah, and stuff that we we never would have even thought about, and it's a huge pressurized environment for these young women and men, um, and I think that's probably a huge part of what's happening.
Speaker 2:It's hard to say that, it's hard to study and it's hard to, you know, to get concrete evidence. But just in talking to young women, I feel like that's something that's just a big issue, because they're operating in a landscape that is streets ahead of where their sex education's at. So you know, it's not, it hasn't caught up to what's real life and what they're being educated on. Totally, you know they're, you know.
Speaker 1:They're poles apart, aren't? They Poles apart, yeah, and then you know, I noticed in the pharmacy, you know, condom sales dropped considerably.
Speaker 2:Yeah.
Speaker 1:Condoms packs of condoms were going off, like they were going off on the shelf to bin them.
Speaker 2:They're going to date.
Speaker 1:I'm like what yeah so people aren't using them.
Speaker 2:You see where they're getting their education. Now is TikTok Porn sites Okay right, sorry, I was like TikTok. But with sex, you know they don't use condoms like. So the normalization of condoms is totally gone.
Speaker 2:So condom is an artifact as far as young people and they're like what? That's something historic that you know. They just do not see that. Now. It's not talked about in schools, it's not, um, you know, it's not there where they're viewing. That's how they're learning about sex, is watching pornography a lot of the time and there's just no condoms like it's a totally.
Speaker 2:They're like what's kind of like shoot, that's not used so that I think that's a huge part to play in the culture and it's just, you know, it's not. It's not something they see.
Speaker 1:And can both chlamydia and gonorrhea lead to fertility issues in women when they get older? And the thing about it is as well, as they don't they like what is it something like 70% of them are asymptomatic.
Speaker 2:Oh yeah, especially in women. In men they tend to get more symptoms because they can see it coming out of the urethra. The urethra doesn't normally have a discharge so they can see it, whereas in the vagina there's usually discharge. So abnormality, you know an abnormal discharge, a little bit of pain and discomfort in the pelvis, but often it's silent.
Speaker 1:So it's really important that the girls especially get tested regularly yeah, so if you're have, if, if I don't know if any young people listen to my podcast, but if you're a mommy or a daddy of a youngster. The conversation has to be you have to assume that they are having sex. Ok, I think that that's where you need to you have to assume that they're probably having sex, no matter what they say to you having that constant conversation about the importance of testing in between partners, Ideally first just using condoms.
Speaker 2:Oh yeah, well I'm sorry, Laura, go back a bit. Yes, of course Not having multiple partners. Of course, use condoms. Of course not a multiple partner. And all that kind of education is so important Education abstinence. It's not.
Speaker 1:OK, yeah, and I suppose because we live in kind of this fast paced world, this hook up culture too, where so you know, I feel like an owl when saying this, but it was a big deal to have sex with someone when I was young, yeah, and I think it's okay to still say things like that I think it's, you know.
Speaker 2:We're in a very permissive society. Now it's okay to say you know, take the pressure off. Young people say it's okay to not have sex. It's okay to have it if you want to, but don't feel under pressure. Don't feel under pressure to have lots of partners just because you, you know. And sometimes it's about doing that as a first step and then, if you are, use condoms and get tested regularly.
Speaker 1:And also the porn thing, I think is important for both boys and girls, because you know we're saying that girls feel like they have to reform, but boys do too, because they see the porn as well and they think, and they don't know what they're doing half the time either. So I think it's just about having the conversations with our children, and it's having the conversations, not this big sit down chat. It's like you're in the car and you're talking about it.
Speaker 2:You're making a cheese sandwich you just bring it up casually every so often. Then it's like it's not a big build up of yeah, you sort of let them know the door's open.
Speaker 1:You're cool about it I had a little question yesterday from one of mine so is is sex always? Always when the penis goes into the vagina or is there other is other things, sex that's a good question.
Speaker 2:Yeah, it's a good question. I was like it's a good question.
Speaker 1:I was like well, it's all mixed in, there's all new words and terminology, but when you're sharing your body with someone.
Speaker 2:It's general. I mean that's lovely because it shows you have that lovely, open relationship with your son and he feels. You know a lot of boys, a lot of parents don't have that relationship.
Speaker 2:So it's really nice that you have that. Yeah, we do a lot of that kind of chatting. Goodness, it's 11, 56, okay, why did you get into gum? Why did I get into gum I?
Speaker 2:So I, as a student, I remember being inspired by, um, this amazing professor Fiona McKay, who's now semi-retired, and I just thought there wasn't many women consultants and I just thought she was class. Okay, she was just fab, she had it all going on. Um, she still has it all going on, but you know, she was just fab, she had it all going on. She still has it all going on, but you know, she was just had a really lovely rapport with the patients. There was a mutual respect. She was able to go in, you know, diagnose something, sort them out and on top of that all she was glamorous and she just was cool and I was like I want to be her, she's fab, she's fab and I just loved it.
Speaker 2:There's a quick fix. You know about it. Like I'm just one of those people and it speaks to my personality that I like to sort problems. I like that someone can come in, sit down in front of me and within you know 10 minutes of them talking, I can generally go. I know what your problem is and I examine them and test them and I can, for the large majority, say I know what it is and I can fix that and we can have the problem done and dusted within 15 minutes and there's such a sense of reward from doing that and you'll often get patients going. Oh my God, I wish you know, I knew about you sooner or could find you sooner, and I've been struggling with this because of the nature of what it is.
Speaker 2:It's really secretive and a lot of people will sit at home for months, sometimes years, worried about something and self-diagnosing with Dr, google and all of that now and they get into this absolute angst ridden sort of but not a tummy situation where they can't, you know, even think about it anymore and they're up all night and then eventually they'll make their way in and they'll get to you and you go oh sure, it's this you know, and that's easy, we can fix that and it's just. I love that about that specialty you know about gum. There's there's not many things that you can sort of say I can diagnose and fix most things. And then there is the HIV side of it where it's really interesting chronic illness that you can now keep people alive normal life expectancy. It's evolved in my lifetime. There's interesting sort of scientific elements to it, so it just had both and there's no on-call with it. There's no emergency STIs. Let's be honest. I bloody well should have done that. It's like a brilliant job.
Speaker 2:There's no phone call at two in the morning. My husband is an emergency medicine consultant so one of us needed to be stable, so you don't get a call at two in the morning saying this person's got gonorrhea generally. But it's a really, really rewarding specialty.
Speaker 1:I say you see the relief in someone's face when they just see that you're willing. You're not judging them for being there and, as you said at the very start, we're all here because we've had sex. We're mammals and the reason why we're on this earth is because and we have the crack like.
Speaker 2:Honestly, there's not many patients go away without a bit of a giggle and a laugh about it.
Speaker 2:You know, we're able to and it's a great, you know sort of icebreaker where you know you can introduce a bit of lightheartedness about it and people are like, okay, oh, my goodness, I was. So I don't know why I was so worked up coming in. I was so stressed about coming in here. Lovely specialty, yeah, where can people find you? So I work across four different sites, mostly St James's Hospital, so that's my public service job. I'm a consultant in the guide clinic there and people can book online self-book through our Q on guideclinicie or they can get referred by their GP in if there's a particular chronic illness, because then we screen it and go right, that person needs to see Aisling next Friday. You know, so often GPs will refer and they can refer on HealthLink Privately. I've got a private clinic called Himaris Health, so it's just himarishealthie or sticlinicdublinie.
Speaker 1:I'll say it all at the start. I need to double check. Don't worry, we'll tag it and everything anyway.
Speaker 2:Himera's Health anyway is the main one, and people can book in online. Generally speaking, there isn't too long wait to be seen, because we can't do waiting lists with STI people, do we not?
Speaker 2:want to wait six weeks and then, yeah. So pregnant patients I do a clinic in the Coombe Hospital, so if they are attending the Coombe you have to be a patient there for your pregnancy and you've got genital warts, syphilis, herpes, hiv and a few other things, I'll see you there. And then I also do a clinic, a HSE clinic for sex workers, so where we'll do screening for sex workers or victims of trafficking that will be come in and see us. Where we do contraception, we'll do smear tests, sti screening, there's social worker counselling services and all of that.
Speaker 1:Okay, we'll have to get you back to talk about that. Anyway, aisling, what advice would you give young people today?
Speaker 2:I mean so much but I'll focus on the one thing that I see so much health anxiety just in the job that I'm in and I know now with AI coming fast down the track and Dr Google, I see so many patients who have self-diagnosed, who've sat online and I think now with AI it's going to be an even bigger threat and nothing ever replaces coming in and just having a chat. You just need that human element because Dr Google often gets it wrong with STIs. You know I'll have people coming in telling me they've got HIV or telling me they've got syphilis or trichomonas vaginalis. They'll come in with all of these things going. I've worked it out, I've got this and it's honestly, it's about 99% of the time wrong and often they'll have worst case scenario. They'll fixate on and it causes so much anxiety and nothing just ever replaces talking to another human and I think that's going to be a bigger and bigger and bigger threat to our young people now because humans are going to gradually get replaced and you know medicine will not be immune to that but I don't think it'll ever replace the empathy and compassion and the humor and the chat and all of that that can alleviate so much more, because a huge amount of what we do it's it's there's a psychosomatic element to it and it's reading people's body language yeah
Speaker 2:and and working out the reason they have these symptoms is because x, y and z happened that maybe they aren't forthcoming with initially, but then they gradually work out. It'd be OK to tell her that I went and slept with a prostitute you know on a golf trip or whatever you know, and they'll gradually sort of go OK, I can trust her and tell do that OK. So it's really important to just come and talk to someone if it's a health issue, a doctor or a nurse or whoever, if you're worried about something, ok. And then what is the meaning of life for me personally, because everyone will have a different meaning to their lives? Um, and for me it is, I guess, twofold.
Speaker 2:So there's in the day or in the moment of the here and now, and that's to be a good person and to to make a difference in people's lives and to get fulfillment and purpose. And I, I do think most days I'm driving home from work, going. God, I made a difference to at least one, at least one person today, and they've gone home and are a happier person because of our interaction. And you'll get that in your job. It's just important to have that purpose and satisfaction and to bring joy and happiness, and you'll get it in all sorts of jobs, you know, be it your computer programmer or firefighter or whatever it is. I think it's just so important to have that. And then I guess your legacy and for me it'll be my children, you know to have decent, decent humans at the end, to raise them, to propagate the you know and to to have, um, I have just good human beings going forth after long after I'm gone, because you, you know, I heard this awful fact that you know, within two generations, most of us are dead and gone, forgotten about you know, your great great grandchildren do not know you or remember you, and very few humans on this planet will ever be remembered.
Speaker 2:There's a handful who will be remembered in 500 years time. So it's just for here and now to pass on. You know your genes and make good, decent humans to keep it going.
Speaker 1:That's lovely Aisling. Thank you so much for joining me. It's been an absolute pleasure.