'The C Word with Catharine Redden'

The Maths of Sex (GUEST CHAT) (PART ONE)

• Catharine Redden • Episode 19

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0:00 | 53:20

Part 1 of a two-part conversation with Associate Professor Simon Graham about sexual health, stigma, statistics, testing, HPV, bacterial vaginosis, public health, relationships, and the gloriously awkward reality of being a human with a body.

This isn’t a morality lecture wrapped in a lab coat. It’s an honest, funny, occasionally chaotic conversation about how sexual health actually works in real life, and why shame is often the least useful public health strategy imaginable.

Part 2 will be released shortly in the main feed.

Disclaimer
This episode is general information and conversation only. Catharine Redden and Associate Professor Simon Graham are not medical doctors, and this podcast is not a substitute for personal medical advice.

Bacterial Vaginosis (BV)
Common symptoms of BV can include unusual vaginal discharge, a fishy odour, irritation, or burning when urinating. Many people have no symptoms at all.
Source: healthdirect Australia

Getting Tested in Australia
Public sexual health/STI clinics in Australia are free and confidential. You do not need a Medicare card to attend most public clinics.

• SHINE SA (South Australia)
• Melbourne Sexual Health Centre (Victoria)
• NSW Sexual Health Infolink
• Queensland Health Sexual Health Clinics
• WA Sexual Health Helpline & Clinics
• Clinic 60 (Tasmania)
• Northern Territory Centre for Disease Control Sexual Health Services
• Canberra Sexual Health Centre (ACT)


🎙️👀 What worked? What dragged? What made you mutter “Jesus Christ, Catharine”? Tell me.

Content Note
This podcast gets into bodies, panic attacks, trauma, sexism, mental health, and the occasional emotional sinkhole. Please look after yourself only listen when you feel safe to engage with potentially triggering material. 
Also, I swear.

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1800RESPECT 1800 737 732
Emergency 000

Outside Australia, local crisis services are available.

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Credits
Recorded on the lands of the Ramindjeri and Ngarrindjeri peoples.
Sovereignty never ceded.

Recorded & edited at Ridley Farm Studio by Luke Ridley
https://ridleyfarmstudio.com.au...

SPEAKER_00

Hello and welcome to your brand new episode of The C-Word with Catherine Redden. This is part one of a two-parter. And before we jump into this conversation with Associate Professor Simon Graham, I just want to quickly add something important. And look, it doesn't need to be super quick, team, because I've just checked into a new house did and I'm looking after a really lovely ex-camp dog called Lawrence, but he's also really committed to barking. And I think this is take number eight. So if you hear some crunching, that's Lawrence eating his raw hide. He's calm. I've got his favourite TV show on. So hopefully we've got a couple of minutes to record the intro. During the conversation today, Simon talks about sexual health testing and how often people should get tested. After the chat, Simon and I both realised we wanted to make something really clear. The advice around testing is not around your sexuality, it's around the number of sexual partners you have. And so, broadly speaking, if you're having sex with about one new partner a month, yearly testing is generally recommended. If you have more sexual partners than that, huzzah. And the guidelines suggest getting tested more often. If you are unsure of what's right for you, you can talk to your GP or your local sexual health clinic. They deal with this stuff every day and they're very normal about it. And they can give you advice specific to you and your situation. And it won't be weird and it won't be anything like your year nine sex ed class, you know, where you had to put the condom on the banana and you're thinking, what is going on? Anyway, Simon's going to just jump in quickly now with some up-to-date information around testing, and then we'll get into the conversation. Enjoy.

SPEAKER_03

Hi everyone. Uh, this is Simon Graham speaking. So I just wanted to make a more factual point about the number of different sexual partners that we Catherine and I spoke about on the podcast you were about to listen to. So in it, I was specifically talking about the men who come to an STI clinic to get tested. Uh, and I just wanted to make a very factual point that what I wasn't talking about was lifetime partners for the general population who do not go into the STI clinic. So just to make uh it clear, for heterosexual men, their lifetime number of partners is about 14 women, and the mean, or the average, is about eight women. And for gay men, their lifetime number of partners is about eighty, and the mean is about thirty-two. So I just wanted to the the overall message is still the same that men who have sex with men or gay men have higher numbers of sexual partners over their life and within the last year compared to straight men and the number of women they've had sex with in their life and over the last 12 months. I hope you enjoy the episode.

SPEAKER_01

Today I'm joined by Associate Professor Simon Graham. Simon is an associate professor at the Poche Centre for Indigenous Health at the University of Sydney. He completed his PhD in 2014, where he led a sexually transmitted infection trial that significantly increased testing and identified a large number of asymptomatic chlamydia cases among young people in New South Wales, which listens is a really big deal. Since then, he's worked internationally across New York, London, Vancouver, Berlin, and Bangkok, bringing a global perspective to sexual health and public health. On top of all of that, and perhaps a much better qualification, Simon is also a friend of mine. We met in the mid-90s at Flinders University Hall as two slightly terrified freshers, and we built a very strong friendship mostly around dancing Britney Spears and figuring out who we were. I'm especially grateful that he's here today because after I asked him to come on the pod, I Googled him and I realized Simon is significantly more accomplished than I ever gave him credit for. So we are very lucky to have the benefit of his expertise. Welcome, Simon. Where do we find you today?

SPEAKER_03

Uh I'm in Sydney today.

SPEAKER_01

That doesn't sound anywhere near as glamorous as Vancouver or Bangkok or anywhere like that. Today I want to talk about what sexual health actually looks like in real life, not just in theory. So we're going to get straight into it and I'm going to ask Simon, why does sexual health matter?

SPEAKER_03

Uh well, overall, sexual health, everybody, I suppose, thinks starts thinking about sex or becomes sexually active in their mid to late teens. And it can have significant impacts on people's lives, especially young people who are just navigating through their teenage adolescent years. And I suppose, especially for those in their teenage years who are not so confident about their sexual health or confident about their bodies at that point, having clear uh information and accurate information so they can make choices that benefit them is quite important at that age. Especially, I suppose, for young girls who are having conversations about contraception at that age. And also around navigating uh, I suppose young people on both sides uh navigating the interaction between girls and boys and people can become quite problematic because uh whether we like it or not, porn does play a role, or seeing porn or watching porn does give people ideas to make it.

SPEAKER_01

So, do you mean so I've got two questions. When when you say impact, do you mean like it it adversely affects their physical health and their mental health if they get infected with a sexually transmitted disease?

SPEAKER_03

There's often panic uh as a and also they obviously they can Google where to get tested. I think it it really is, I suppose if they do have symptoms, which to be honest, doesn't occur in most cases. Because I suppose if we go back a step and talk about, say, the most common STI in Australia and in the Western world actually is uh chlamydia. And so we know that around 80% of chlamydia infections don't have any symptoms. So it actually means the individual uh has no reason to go and get a test.

SPEAKER_01

So do we know how many young people are affected by chlamydia?

SPEAKER_03

Yeah, so it's a nice steady increase. It's like watching a plane take off from an airport. That nice smooth graph has been, uh I suppose, uh that plane has been taking off for years. So it's it's the same graph for decades. And actually the only tink in that graph is COVID-19 when people were not able to meet.

SPEAKER_01

So do we know is it 20% of young people? And I know it's a big, like it's a broad, and I know I'm I know that it's a lot more nuanced than that, but are there any figures around 20% of young people under 18?

SPEAKER_03

I suppose in Australia there's around 80,000 new cases per year.

SPEAKER_01

Holy whole right. And when you say asymptomatic, is it asymptomatic until like how can you tell you've got it and like what a it's asymptomatic until it gets bad? I'm a newbie, Simon. I I have no idea about this stuff.

SPEAKER_03

So if you leave, if you don't get tests and you don't know yet how it, and let's just say you're a young woman or you're a woman, we know that chlamydia can lead to a pelvic inflammatory disease. And it usually takes depends on the individual, but on average it will take about 12 months to get there. And at 12 months, uh, the younger woman or the woman will definitely know that there's a problem. So she'll have chronic pelvic pain, she'll have some of them, some women will have discharge. And so at that point, she will know that there's a problem, and she'll go to the clinic. And the important thing in terms of the, I suppose the GP or the general practitioner at that point is that the treatment for chlamydia is different from the treatment for pelvic inflammatory disease.

SPEAKER_01

Right. And so if you treat it when you're asymptomatic, can you not get like the pelvic inflammatory disease?

SPEAKER_03

Yeah, so and the treatment the the thing that I suppose frustrates scientists and medical doctors about chlamydia is that it's a very simple treatment. It's one of the most commonly used antibiotics to cure chlamydia. And it's usually at the moment, we it used to be azispromycin, but now it's doxycycline. So it's usually two tablets a day, morning and night, over seven days in its dead.

SPEAKER_01

And does that stop it coming back again, or can you get it again?

SPEAKER_03

So you're while you're on the treatment, I suppose while you're on the seven-day treatment, you won't get it again. But as soon as you, you know, day eight, nine, ten, if you come in contact with someone who has chlamydia, or you go back and have sex with the person who first gave chlamydia to you, then you're going to get chlamydia again.

SPEAKER_01

Right. And I just want to walk back to something you said about porn. Talk to me more about that.

SPEAKER_03

I suppose uh when we do surveys of young people and we talk about sexual health or we talk about sex, um, porn always comes up. It always comes up, and I suppose whether parents like it or not, um, especially young men will be watching porn. And of course, if they're uh I suppose in a perfect world, porn has people with beautiful bodies. There's this role-playing or whatever that's going on in porn or not. And I think some young men may get ideas about actual sex from porn, and that some of those ideas can be uh not so great for young girls, is probably what I'm trying to say.

SPEAKER_01

I'm gonna say the porn that I've watched, there's not a whole lot of condoms.

SPEAKER_03

And the the the interesting thing around um porn is that sometimes it it it it follows trends, and so it obviously it's a business. So, you know, in the 80s, the men may have had like hairy chests and beards and mustaches and mohawks and whatever. Um, whereas now uh well I suppose in the 90s and early 2000s it was waxed bodies, shady waxed bodies and skinny, really thin people. So yeah, so allegedly so it's a business. So you know it follows a trend if there's a demand.

SPEAKER_01

And I'm just thinking too now when we watch sport, there's a lot of gambling ads, but there are also in those gambling ads it says something along the lines of gambling's not great for you, if you have a problem, call this number. I've yet to watch a porn video that says, Do you know what? This is not like real life. Maybe you should get tested. It doesn't seem to be that regular. I could be wrong. If anyone from the porn industry wants to be on the show, very happy to interview you. Um, but there's not that hey, porn is not real life. This is the consequences of not protecting yourself. I think leads us into how often should people realistically be getting tested?

SPEAKER_03

So national guidelines in Australia recommend once a year for uh straight people. Yeah and so there's a very when we look at the statistics around STIs, we know that most of the people that will test positive will be between the ages of 15 and 29 years, and so they're the core group for chlamydia, especially, uh, should be tested. And so it's for straight people, it's every once a year is the best way to put it. Right. For other groups, especially I suppose gay men, and sometimes they say LGBT, but they're I would say they're they're talking about gay men, it's recommendations are every three months.

SPEAKER_02

Yeah.

SPEAKER_03

And the reason for that is that gay men have higher numbers of different sexual partners. So, and I suppose we could, if we just remove straight men, gay men, straight women, trans women, all that sort of stuff, this is based on the number of sexual partners that an individual has. So you could be a straight person, and if you have the same number of sexual partners as a gay man, you should be tested every three months.

SPEAKER_01

And is there a number?

SPEAKER_03

Is it like we I suppose we we we don't really make a public the numbers, but I'll just give you an idea. So when people go into, and we should probably talk about this, is when someone goes into the sexual help clinics in Australia, and there's multiple sexual help clinics in every uh city uh in Australia that are free, and when those when someone comes into the clinic, there's a little 10 questions that the nurse or doctor will ask. And one of those questions, it's it's who do you have sex with men or women or both? And one of those questions is how in the last three months, how many different sexual partners have you had? I should be careful with this, but on average, a straight male will say three in the past three months, in the past three months, yeah. Some of them will say one, some of them will say two, and some of them will say five. Yeah. On average, it's around three, and that's why it's once a year. Uh so if a gay man, and not all gay men, but we're talking about not all gay men, we're not accused. We're talking about averages, no judgment here.

SPEAKER_01

We're judgment free. There is no judge. We care about people's health, that is it.

SPEAKER_03

On average, if if a gay man is the one that's coming to the clinic and they get asked in the last three months, how many different men have you had sex with? On average, the number's about 15. And so if you add up 15 every three months, the number is getting up. And so the more different sexual partners you have, the more likely you are to become exposed to something like Plumity or Ogonary. And that's all it is. It's just maths, it's just pure maths, it's not about, oh no, you've had sex with 15, really? It's not about that.

SPEAKER_01

Finally, finally, maths becomes important.

SPEAKER_03

Yeah, so well, you know, maybe it's jealousy. They're 15 in the last three months, of course.

SPEAKER_01

Um, it sounds like if you have one different sexual partner every month, so if you have sex with a different person once a month, then get tested once a year. And if it's more than that for any person, think about going more frequently, which might look like once every three months.

SPEAKER_03

It's really hard because personally I would love a benchmark number to say, okay, if you've had sex with five people this month or more, that's every three months.

SPEAKER_01

And like a buzzer goes off, bing, a little angel appears and takes you to the clinic. Now let's talk about the clinics and where they are and how much they cost, and also what it's like getting tested.

SPEAKER_03

So in every urban city in Australia, there is usually uh in Sydney, there is one, two, there's five in Sydney, for example. So um, and if people listening to this are in Sydney, there's one at War Prince Alfred Hospital in Newtown.

SPEAKER_01

I have at least nine listeners in Sydney. Hello to them all. Hi.

SPEAKER_03

There's one at Martin Place at the Sydney Hospital, there's one down in Salgar at St. George, there's one at Parramatta, and there's uh one at Civil Annas. And so they are free. So all the sexual health clinics are free. And the important thing to remember about these clinics is that they only do sexual health testing. You can't go in there for a coffin cold, you can't come in there for a chlamydia test and then say, by the way, I have a sprained wrist. Do you offer anything else?

SPEAKER_01

You can't say you can't say, look, I've got a headache and I don't want to have sex. Uh, what can you give? What can you give me for that?

SPEAKER_03

Apart from a divorce. And so the I suppose um the the one I know that's not in an urban city is in Cairns in northern Queensland.

SPEAKER_01

What I'll do is I can put a link in the show notes, and I love saying that, in the show notes too. I'm sure there's a website. I'll put a link in the show notes that people can click on and find their nearest one. And there's something else that I know about getting tested and cost that I think is amazing, and that is you do not need a Medicare card.

SPEAKER_03

No, you don't. So, in other words, um, international students can um ring up a sexual health clinic. And I actually should go through that process. So you can ring the clinic, and then you usually you'll speak to a nurse, or you will leave a message and they'll ring you back. And they'll use the first question is do you have any symptoms? And if the answer is yes, they usually say come in today.

SPEAKER_01

Immediately get yourself in an Uber, get there immediately.

SPEAKER_03

Oh, I can make an appointment on Wednesday this week or next week, and they'll uh usually make the appointment for you to come in in New South Wales, in where Sydney is, for those not in Australia.

SPEAKER_01

Also, overseas listeners who are jealous of how free getting tested for an STI is in Australia, you should absolutely try and come to our country and live here. What they should say that as the way to get people to move here.

SPEAKER_03

So for international students who don't have a Medicare car, and even for Australian citizens, usually at the STI clinic, if it's your first visit, they will say, Do you have a Medicare card? And if you say no, that's fine. You'll still get seen, you'll the testing is free, and the treatment is free.

SPEAKER_01

And so you get the same service, whether you've got a Medicare card or not.

SPEAKER_03

And so when you go in, when you have your appointment and you go in, usually the nurse or doctor will come and see you, and then they'll ask you those 10 questions. And so you answer the questions, and then they will usually give you a little container that'll have a urine cup and swabs. And so usually you will go into the bathroom, you'll give a urine sample into the little cup, and then you'll swab, it's usually a throat swab. And if you've had anal sex, there will be an anal swab. And if you're a woman, of course, there's a pajamas, and then you'll come back to the clinic and the doctor will draw blood, and that usually is for testing for HIV simplist therapy.

SPEAKER_01

You know, it occurs to me, because before this, I talked to you about this, I really didn't have much of an idea of how important looking after your sexual health is. And you can tell how many people it affects by the fact that these clinics are free and you don't need a Medicare card. Because going to your usual doctor, you have to either have a Medicare card, pay a gap. If you don't have a Medicare card, pay the full price. And so if we think about just that, that means STIs are affecting a lot of people in Australia.

SPEAKER_03

Yeah. So if we think about the 80,000 that were diagnosed, and we take into account the fact that 80% of plometer infections don't have any symptoms, and meaning people have no reason to go to the clinic, then we are own diagnosing probably thousands of plometer infections this year.

SPEAKER_01

I want to grab my teenage nieces and nephews by the hand and drag them to an STI clinic.

SPEAKER_03

I suppose the important thing, um, especially there is a bit of a difference between the where the sexual health clinics are in the different states. So in New South Wales, if you go into the clinic, any of the clinics here in Sydney, they usually prioritize priority populations. So these are Aboriginal Terrestral Islander people, sex workers, people who inject drugs, people who are LGBTQ, and young people and immigrant populations. And so those people who belong to those groups, when they make the phone call, that usually that question gets asked. And they will, especially if they have symptoms, they'll be told to come in.

SPEAKER_01

Why are those groups why is the rate of infection? This is a big question, but is it about education? Is it about Cultural stuff.

SPEAKER_03

I think it is a whole range. Yeah, that's another podcast. I think there's a whole range of social problems that are driving STIs in those priority populations. And you know, and they range from racism to poverty to you know transphobia to uh a whole range of things are impacting those populations. I think the important thing, I suppose, for those people who don't have a Medicare card, is that those clinics do have a lot of information that has been translated into different languages. And so they're able to provide those to those populations so they can read them in their first language. And the important thing is that in most of those clinics, the treatment is there, especially if someone tests positive for gonorrhea or syphilis, they need a needle. A gonorrhea is a needle of ceftraxone, and syphilis is a needle of penicillin. And so that that will be delivered. I think most of the time the treatment for chlamydia will be given to the patient. But I know I've heard from some young people that the they have received a script from the doctor and they have to go down to the chemist to get the doxycyclum. And at that point, they might have to pay the $6 for the Yes.

SPEAKER_01

But I think the big the eye-opening thing for me is that to get a diagnosis or a whatever outcome, I don't have the words, but like that's free.

SPEAKER_03

It's free, and it's the the one thing I suppose some young people complain about with that clinic is that they do the tests and you say if you've got no symptoms and you just come in for a screen. You do the tests and you walk, walk out of the clinic, and the nurse or doctor will say to you, if you don't hear from us, it's all negative. And I think that that little sentence makes some young people quite nervous because they're like, I just need to know that it's all negative, and I would prefer it if you ran.

SPEAKER_02

Yeah.

SPEAKER_03

But that's the policy of the clinic where they say, if you haven't heard from me in two days, you can just assume it's all negative.

SPEAKER_01

And that sounds like a money-saving thing to me.

SPEAKER_03

It's it is, and I know that the and the reason why I'm talking about the Sydney Clinic and those priority populations is that it's different down in uh Victoria, where Melbourne uh is the capital. And in those, because they receive money from the Victorian government as well. And one of the conditions of the Victorian government is that they cannot just see priority populations, they must follow in the clinic to everybody. And so the reason why I'm saying that is the lineups outside the Melbourne Sexual Health Clinic are incredible.

SPEAKER_02

Oh, really?

SPEAKER_03

It's actually located very conveniently across the road from Melbourne University. And so I bet there's a coffee cart. And you know, a lot of people, I suppose young people especially, uh, they don't want to be seen lining up on a street outside the sexual health clinic. Now, just exactly what it is.

SPEAKER_01

Now, just on that, you were telling me about a country that's has a totally different way of testing.

SPEAKER_03

Yeah, so the UK has had, I would say, over 10 years now, they have home testing kits for its population. And they have been sort of an incredible way for people to get tested where they don't need to come to the clinic. And I suppose a critic's eye of the UK, having lived in London, and just to give you an idea, if you do live in London, you can only go to a GP that's in your postcode or your suburb.

SPEAKER_01

You can't do GPS, like for anything. So if I want to go to the doctor, they have to be in my postcode.

SPEAKER_03

Yeah, and they're really funny about it. And so I got sick in London when I lived there during the winter, and I rang up the GP clinic that I had registered with, and she said, Yes, I can make an appointment for you in three months' time. And so I said, Don't worry about it, I'll just sit here and I'll be dead by then. So that's the context of the UK in terms of trying to get into the GP. And because of that, they set up a what I think is quite innovative, and that is a home testing kit system. So they have a system where there's a website and and they've expanded since then. At the time, it was uh uh one website you can go to, you can order a home testing kit, and all you don't need a name, all you need is a mobile number, so the results can be texted to you, and you need a home address for that box to be sent to. And so it was a beautiful system of the STI clinic, British Post, and the laboratory. And so the STI clinic would send out a box, the home testing kit. The box would turn up to whatever address address you gave it. It could be your workplace, your home address, wherever you had gave the address. Your side piece's address. Exactly. And um, you do the test, all the swabs in the urine uh jar comes in the box, and also a fingerprint test for HIV and SIFOS. And you do it at home. Um, it has very clear instructions and it gives you uh to tape up the box again, and it has the return address on the box. So you don't need to write the address, you don't need to do anything. All you need to do is tape up the box again and you place it into any British post box on any street in the UK, and it gets sent for free. There's no postage costs. And within two to three days, you get a text on your phone with all the STIs that were tested and all the results for each of them. And it means that you've never had to step foot into the clinic, and it's a great way for people who don't have symptoms to not go to the clinic, and it also saves the clinic.

SPEAKER_01

To not line up outside Melbourne University if you're trying to get concert tickets.

SPEAKER_03

Exactly. And so the STI clinics in the UK mostly, not always, but mostly see people with symptoms, or they've got a phone call for one of their sexual partners to say, hey, I've got chlamydia, you better go and get tested.

SPEAKER_01

What were the findings?

SPEAKER_03

It's extremely popular, especially for people who don't have symptoms. And it's really popular for people who maybe don't want to be seen walking into a sexual health clinic, especially say men who are having sex with men but wouldn't identify as gay. Yes.

SPEAKER_01

But it also helps certainly straight presenting married men. Hello, I know you're listening. Hi.

SPEAKER_03

It also helps populations where maybe English isn't their first language and they feel more comfortable not going into a clinic like that, and they want to do the test at home, so it suits them as well.

SPEAKER_01

People like me who don't like going outside. And I just presume that early detection saves the government money. I care about people's health, but the government cares about not spending everybody's money.

SPEAKER_03

Yeah. I suppose there's been some research articles more recently about oh, why are we getting people who don't have symptoms to get tested every three months? But the thing is, the clinics are free. And if someone is having quite a high number of different sexual partners, then they have every right to get tested for STRs as much as they want.

SPEAKER_01

And so exactly. Look, it's good for the person, but it also saves them ending up in hospital. I know that's a bit dramatic, but it saves them having to get. I imagine the treatment for the pelvic inflammatory disease is long and expensive. And that doesn't just mean for the person, it might mean for the government. Um, and so getting tested early and easily, surely it's win-win-win-win-win.

SPEAKER_03

It is a win, and especially for young people who are making up 80% of the positives.

SPEAKER_01

And when we say positives, we mean testing positive for an STA.

SPEAKER_03

And you know, we know that young people are more likely to have different sexual partners because they're they're young and they're experimenting, and and that's fine. And I suppose it highlights good luck to them, I say.

SPEAKER_01

Good luck to them.

SPEAKER_03

I suppose it highlights, you know, the older you get, the less partners you have. Unfortunately.

SPEAKER_01

And so I mean, speak for yourself, Associate Professor Simon Graham. Speak for yourself.

SPEAKER_03

I suppose like we the different STIs have different, um, and this is gonna sound a bit technical, but the different STIs have different epidemiology, and so that all that means is for example, chlamydia is everywhere. It doesn't matter where you are, it's everywhere.

SPEAKER_01

So it's like the pigeon, yes.

SPEAKER_03

And however, say if we take syphilis, for example, syphilis is an incredibly old disease. Actually, I think is it King Edward or something died of syphilis in 1450 or whatever?

SPEAKER_01

They all died of syphilis.

SPEAKER_03

Um, but syphilis is mostly found in two groups. One is gay men in urban cities in Australia, and average normal and terrestrial islander people in remote areas of Australia.

SPEAKER_01

Oh, that's interesting.

SPEAKER_03

And so there are these two key groups where we are literally just absolutely pumping out the health promotion messages and testing messages, and because the consequences of syphilis are extremely serious.

SPEAKER_01

What are they? Talk to me. Well, I mean death.

SPEAKER_03

Well, syphilis is actually, from a laboratory perspective, extremely difficult to diagnose. It's not like chlamydia and gonorrhea. You test positive or negative, full stop. Syphilis has you get a blood test. If you've ever had syphilis in your past, you will always test positive for the first test, right? So it stays with you. The second test, if you test positive for the first one, they usually then go on and test it for the second test. That usually shows a reaction. But if it doesn't show a reaction, it means, oh, you used the you had syphilis in the past when you got treated. So you don't have infectious syphilis right now. And usually after that, they usually then go on and do a third test. If the two first ones are positive, they then do this third one, which is actually called a TTA score. So it's a a number. And the reason why it gets really complex is because you need multiple syphilis tests and multiple TTA scores and a sexual health history. And usually, if you are positive and you have infectious syphilis, that score will triple every month. It will go up. And at that point, the doctor or the specialist will say, Okay, this is a new syphilis infection. But it also I should make it really clear that you could have had syphilis in the past and got treated, and you couldn't, if your Teter score is going up now, that means you have a new and syphilis infection. It gets difficult.

SPEAKER_01

So this is quite uh we're getting a little technical, but no, but I do think because because one consequence of having syphilis is death, and when you're young, you don't often give a shit about that kind of about testing and all that kind of stuff. But I think it's important to say death's not a great outcome. And so being a self-advocate for your health is really sexy. If you can go to the gym every day and get into an ice bath and whatever it is, you can go and get tested four or five times.

SPEAKER_03

The issue with uh syphilis, it has three stages as well. So there's primary syphilis, secondary syphilis, and tertiary syphilis, and usually, okay, this is going to be a little educational. So primary syphilis, usually within the first say week or two, a little a lump will appear on the exact site where syphilis entered your body. So it can be in your mouth, it could be on your anus, it could be on your penis, it could be anywhere, right?

SPEAKER_01

It doesn't hurt, it's just it's like a pin, it's like a map marker.

SPEAKER_03

And so people who have infectious syphilis at that stage look at it and go, Oh, that's new, that's different. And the the the thing is, it doesn't hurt, it doesn't sting or ache or anything.

SPEAKER_01

I have a dumb question. Can can women get syphilis?

SPEAKER_03

Yes.

SPEAKER_01

Okay, good.

SPEAKER_03

And so at that point, you should probably know you should go into the STI clinic or C G P, whatever it is, and you'll get an injection of um penicill. And but if you don't treat syphilis and you do have infectious syphilis, it actually impacts your central nervous system and can cause meningitis and long-term untreated syphilis. The person ends up with neurological problems and they sort of, in an easy way to put it, they go crazy. And so it has really, really serious mental health neurological impacts. And especially for a pregnant, if a pregnant woman gives birth and she has syphilis, she then can give her baby congenital syphilis, which has the ability to kill the baby. And so it becomes a really serious, and that's why in Australia and a lot of countries, we have the perinal testing every, I think it's every trimester, there's a screening of a whole bunch of uh conditions, and one of them is always STIs.

SPEAKER_01

And I think to bring it back to getting tested once a year is so important if you're sexually active.

SPEAKER_03

Yeah. And I suppose, you know, we one of the more, I suppose, interesting developments over the last, I'd probably say 12 months is um around bacterial vaginosis.

SPEAKER_01

Oh, I'm glad you brought that up because that's on my miss. No, no, and because bacterial vaginosis is really common, right? Isn't it 30% of women or something?

SPEAKER_03

Like it's Yeah, it's very common.

SPEAKER_01

Talk about the symptoms. What are the symptoms of vaguterium?

SPEAKER_03

Bacterial vaginosis.

SPEAKER_01

B V. We're just gonna call it BV. B V.

SPEAKER_03

It is quite common, and and I don't want to drag them in, but this is a conversation about it.

SPEAKER_01

Oh no, we can drag them. Straight white men are dragged on this pod quite. Love you all, quite honestly.

SPEAKER_03

The background of of this is the STI clinicians and researchers have always rejected that BV is a STI. We've always rejected it. And said, no, no, no, no. It's just the woman, it's just a different buildup of flora in the vagina.

SPEAKER_01

So what we've done, so just to I want to be clear about this because it's fascinating. So basically, what we've done is said that BV has been caused by something the woman did or didn't do, had nothing to do with sex. Nothing to do with the male partner, nothing to do with the male partner.

SPEAKER_03

And over the last, I suppose, 10 years, researchers in BV have sat there and thought, oh, I actually really do think the male does play a role. But everyone rejects this idea that the male could be playing a role in this. And I need to prove it. And finally, last year, well, actually, finally two years ago, because they had to run the trial. A group of researchers and clinicians in Melbourne did a randomized control trial of B V. And I suppose for the listeners, this is going to be an imperfect environment, which research always has to start with. So they recruited couples, and the couples had to be monogamous.

SPEAKER_01

And I know a few people that would count out.

SPEAKER_03

So the trial enrolled women who had reoccurring BV. And within seven days of the woman having a new case, uh new case of BV, they had to recruit the male sex partner in. And they had to have been their sex partner, I think, in the last three, the only sex partner of theirs in the last three months. So a lot of these couples were either married or in long-term relationships. And the male had to come into the trial within seven days of the woman being uh diagnosed with BV. And the other thing, and we can maybe actually we can get to it, but the the male needed uh not needed, but the men were uncircumcised. Right. And so, and that there's a history of this where the female sex partners of men who are circumcised have far less incidence of BV than compared to women who have a male sex partner who is uncircumcised.

SPEAKER_02

Yeah.

SPEAKER_03

If you're a woman out there with uh a male sex partner who's uncircumcised, maybe and you keep having BV, maybe you should have a conversation with him at getting through.

SPEAKER_01

I mean, I'm kind of just gonna leave it there because I didn't wanna. I mean, I have thoughts on that, right? But BV too, like when I read that article you sent me, I think that women may confuse a UTI with BV as well, because it's got similar symptoms from what I read.

SPEAKER_03

And I think with the with this trial, the reason why it will change clinical guidelines now, especially in Australia, is that only 35, I should probably talk about the intervention. The intervention was there was around 70 couples in the intervention and around 70 couples in the uh control group. The intervention is the woman receives the usual standard antibiotic, oral antibiotic tablet, plus her male sex partner receives the antibiotic as well, plus he receives a cream that he has to place onto his foreskin every morning and every nine for seven days. In the control group, or it's only the the woman received the standard clinical guidelines care. So only she got the all antibody, he got nothing, right? So he had the two groups, and the outcome that they were watching was reoccurrence, BV coming back after treatment. And they ended up finding that within the control group, where only the female got the treatment, 63% of them got BV again, and only 35% of the women in the treatment group got BB again.

SPEAKER_01

Didn't they stop the trial because it just became so obvious?

SPEAKER_03

Yeah, they stopped it early.

SPEAKER_01

Because it just became so obvious that the male was contributing to the woman getting BV.

SPEAKER_03

Yeah, and so now because of this trial, there's a lot of conversations around should we change clinical guidelines now? And the other question is should we accept that BB is an STI?

SPEAKER_01

I didn't even know what it was until you brought it up. And it affects is it 30% of women? Like it's really high.

SPEAKER_03

It's quite high, it's quite common.

SPEAKER_01

And so it sounds really painful too. Like it's and I've forgotten, do you know what the symptoms are?

SPEAKER_03

No.

SPEAKER_01

Okay, I don't either, but I'll put them in the show notes. But we will correct that. But it sounded to me like painful urination and all this other kind of stuff. And I do remember too, you sent me to like some like when people in the study talked to the researcher. What's that called? Like yeah, like and and one woman, it was causing us so much stress. She was anxious about this BV all the time.

SPEAKER_03

Yeah. I have heard an interview with the lead researcher down in Melbourne about this trial, and she said in this interview that a lot of the women that were in the trial were at breaking point. Yes, getting BB again and again and again and again. And they were relieved. I suppose it it's a little unfair for the women in the control group because they didn't get the intervention. But now that the trial's over, of course they're coming in to get that cream for their male partners.

SPEAKER_01

It's just, I don't think we can understate what an important bit of research that is, you know, like because if you're you're at your breaking point and you think that it's what you're doing or not doing, and you can't do anything to stop getting this BV, and then all of a sudden there's a cure. Well, a remedy for it. That's an amazing breakthrough.

SPEAKER_03

That the reoccurrence still happened in some of the treatment group, but it it's significantly reduced, and it's significant enough for us to really reconsider treatment guidelines for this, especially for the women. Um, I suppose the other major thing, which actually is the complete opposite to the bacterial vaginosis trial, is the gonorrhea vaccine trial. And this is going to be a negative failure.

SPEAKER_01

But for that's okay, we talk about negative stuff here. We talk about it all.

SPEAKER_03

But for about, I would say six years, something like that, there's been hints that there's a possibility that menumia croc or B vaccine could reduce the incidence of gonorrhea infection.

unknown

Right.

SPEAKER_03

And this comes from surveillance, or it comes from these trials where these young people usually School age kids receive the meningococcal B vaccine. And it's really important that we stress B, because there's the meningiacoccal A, C, X, and Y, I think it is, vaccine. So we're not talking about that vaccine, we're talking about B. And there was the suggestion, or someone noticed that over a long period of time that those kids who received that vaccine and then became adults and sexually active had a lower rate of gonorrhea. And they thought, oh, okay, is there something happening amongst this cohort of young people who got vaccinated or meningo cross or beef? And so they finally did some uh randomized control trials of this. And in the meantime, they started making suggestions that, oh, if you're getting gonorrhea, or if you've had gonorrhea in the past and you've had it a second time or whatever, perhaps you could consider the meningococcal B vaccine, which you can get uh from your GP. Two doses, I think it's four months apart, to reduce your chances of uh gonorrhea infection. And I should probably go back a step here. Meningecoccal B and gonorrhea belong to the same family of bacteria. Nesseria meningococcal and Nisseria gonorrhea. So they're cousins. Think of them as cousins.

SPEAKER_01

Lovely, gorgeous, beautiful cousins that ruin your life.

SPEAKER_03

And so they finally did this trial and it failed. So having or receiving the meningococcal B vaccine did not have any impact in reducing your chances of getting gonorrhea. Just a coincidence. And but it comes from that the idea of this that the bacteria come from the same family is the same idea that we have used more recently with smallpox vaccine and mpots disease. Or it used to be called monkey pox, but we don't really use that word anymore. So now they use the smallpox vaccine to reduce people's chances of MPOX because MPOX and smallpox come from the same family. Right. But cousins.

SPEAKER_01

But that one has We've all got those cousins.

SPEAKER_03

And yeah, and I I think there's been a lot of supposed awareness of vaccines has significantly increased since COVID-19. And there's this idea that oh, if you get vaccine, you're at zero chance of getting a disease or getting that disease. And I think during COVID, people suddenly realize, oh, it's not really zero. It's just, you know, the COVID-19 vaccine overwhelmingly reduced your chances of being hospitalized with COVID or dying from the smallpox vaccine, it does not 100% protect you from impulse, but it significantly reduces the severity of the disease if you do get MPOX. And that's the key to this whole thing.

SPEAKER_01

There's another vaccine I want to touch on as well before we go, and that's HPV. You tell me what HPV stands for, because I can't say the middle word.

SPEAKER_03

It's the human papillomavirus.

SPEAKER_01

And what is that?

SPEAKER_03

It's a virus which can lead to cervical cancer.

SPEAKER_01

And I think I'm right in saying that Australia has been at the forefront of stamping this little sucker out.

SPEAKER_03

Yeah, we have a school vaccination program in Australia, which has been implemented for a number of years now. And those people who first entered the vaccine program are now young adults. And so obviously they're sexually active. And the HPV vaccine has demonstrated to reduce your chances of developing certain cancer as an example. And in the beginning, Australia rolled, it's 12 and 13-year-olds that receive it at school. And it's rolled out first uh with young girls only. And then a few years later, it was rolled, we oh not we, Australia decided to also vaccinate young boys who are 12 and 13 years old. And the reason for that was that there were some small proportion of young girls' parents did not consent to their daughters being vaccinated. And so they thought, okay, what if they grow up and become adults and if they have sex with a young man who was vaccinated, it can potentially indirectly reduce the chances of that young girl being exposed.

SPEAKER_01

I actually, sorry to interrupt you, but I really love this because those boys getting vaccinated are protecting girls. I don't know. I just think it's a lovely thing. There is a percentage of the population who won't consent to having their girls vaccinated. And you know, when we were at school, Simon, I remember, sorry to just be anecdotal here and not very academic, but we didn't even need parental consent. Like you, I just got the rubella vaccination. Mum and dad didn't sign a form, just went to school and got it.

SPEAKER_03

I should probably add to this that it also can cause genital warts.

SPEAKER_01

And um the vaccine can. It actually causes let's be clear, it's not the vaccine that causes genital warts, Catherine. That's incorrect.

SPEAKER_03

I should probably go back a step. HPV can cause several cats: anal cancer, cervical cancer, throat cancer, vulgar cancer, penis cancer, a whole bunch of stuff. And also can cause genital warts, which can be.

SPEAKER_01

I'm sorry, Pete, penis can't. I've never heard of penis cancer. Is that really a thing? Simon, are you making that up? That's really a thing.

SPEAKER_03

And because of genital warts and anal cancer, the the vaccine is rolled out amongst gay men as well. That's probably quite important to point out that that it's right.

SPEAKER_01

So that's so they're not just doing it for the good of girls not getting cervical cancer. Got it. Cervical cancer. I never know how to say that.

SPEAKER_03

So it's it's been shown to have significant reductions in general rewards. And so it is a valuable tool uh in reducing risk.