Guest: Jill Grimes, MD; Host: Christopher Springmann
Christopher Springmann: Be smart, be well. Four words of great health and medical advice, especially when it comes to your sexual wellness and avoiding STDs, Sexually Transmitted Diseases. I’m Christopher Springmann and this is your Life, Love and Health. And sexual health literacy and wellness is the goal of our next guest, physician Jill Grimes, author of Seductive Delusions: How Everyday People Catch STDs, the old fashioned way. And Dr. Grimes is featured in a BeSmartBeWell.com video on STDs. Dr. Grimes, thank you so much for joining us today on this special edition of Life, Love and Health.
Jill Grimes, MD: Thanks so much for having me, Chris.
CS: Dr. Grimes, the Be Smart, Be Well video certainly gets to the point, as does your book about how sexual wellness is determined in great part by candid and honest conversations with your provider and one’s potential sexual partners. Is this the message of the video?
JG: Absolutely. There’s multiple messages in the video, but perhaps the most important is that these diseases are really common and people need to not be afraid to discuss it with their providers. We’re trying to take some of the mystery out of that.
CS: Well, you not only take the mystery out of it, but you also demystify the conversational process, and I believe give people a great deal of confidence in terms of speaking with their own physicians about these issues. Now Molly, the patient who is featured, says, “I was sort of a good girl. I never anticipated contracting an STD. That was the furthest thing from my mind.” And then she says, “I have genital herpes, which I contracted when I was 23 years old. My symptoms were an incredible burning sensation, especially when I urinated. So I went immediately to see the doctor.” Well, Dr. Grimes, is that an unusual experience?
JG: No, not at all. In fact, the vast majority of people we diagnose with STDs are completely shocked that it has happened to them. Often they’ve come in with symptoms like Molly had, with burning when they urinate and they don’t even expect that to be a sexually transmitted disease. They think that they’re in there for a bladder infection. And this is true for men and for women.
CS: You have said that we, as the public, as consumers, have this misperception that STDs belong to a fringe of society, but the reality is we treat everyone. It crosses racial barriers, educational barriers, or certainly economic differences. Tell me about that.
JG: Absolutely. A lot of people falsely believe that STDs are segmented off in prostitutes or anybody except their own group. And the reality is that we treat doctors, lawyers, accountants, cheerleaders. You know, you name it, whatever your definition of success is, I promise you, there’s people in that category that have STDs. With one in five Americans over the age of 14 having genital herpes, that hits all of us.
CS: In the STD video as part of the Be Smart, Be Well series, you say, “When I counsel my patients about how to be sexually responsible, the first thing of course is for them to have a basic knowledge of diseases. If you’ve had a new sexual partner, well, then it’s time to be tested. And this is true whether or not you practice safe sex using a condom, because some diseases, such as herpes are spread outside of condoms.” I would suspect that many of your patients have said to you, and I’m just guessing here, “Gosh, you know, we used a condom. We were very, very careful. We washed our hands, all this. And I still got sick. What happened, Doctor?”
JG: Well, exactly. And the thing is two-fold. One, condoms aren’t fool-proof. Until we have developed a condom that looks like boxer shorts, we’re not going to be able to completely protect against those diseases that are spread in the boxer short region but outside the area covered by a condom. And that includes HPV, which is the Human Papillomavirus that causes genital warts and cervical cancer, and herpes and syphilis. All of those diseases can be spread just by direct skin-to-skin contact.
CS: Our guest is Dr. Jill Grimes, a board certified family practice physician and author of Seductive Delusions: How Everyday People Catch STDs. Dr. Grimes also participated in a BeSmartBeWell.com video on STDs. Well, there are many people who believe that their intimate activity really doesn’t constitute sex, which could be part of the problem. For example, anal intercourse, oral sex, or perhaps digital intimacy. Is that the right term?
JG: Well, sex being if you stopped there is pretty safe. But the problem is, we now realize, that shouldn’t come as a shock to any of us, that if there’s more sexting and more intimacy digitally, that subsequently leads to more risky sexual behaviors in person, which in turn leads to more STDs. But, yes, I think oral sex in particular is probably the biggest source of transmission of STDs that people don’t have any idea that that is risky.
CS: Because it seems very innocent and very often people will participate in that because it’s not, as we suggested before, real sex, at least in their perception.
JG: Right. A lot of people practice abstinence, but part of their abstinence is that oral sex and anal sex are okay because that falls outside of the traditional realm of what can get you pregnant.
CS: Your book Seductive Delusions: How Everyday People Catch STDs is primarily directed to teenagers and young adults. In fact, it’s even been adopted by a school district in Texas. However, people who engage in sexual activity do grow up, and I have a story in front of me about older people and HIV, including individuals in their sixties, seventies and eighties. It’s probably pretty hard for a lot of teenagers to believe that people that age have sex. But with the advent of Viagra, for example, which enables men who are previously thought to be impotent to have sex, many of those men engage in sex with prostitutes and then bring home, well, they bring home an STD and often, we don’t have exact statistics on this, but very often they bring home HIV.
JG: Well, and not only HIV, and I’d like to add that it doesn’t need to be a prostitute. Your example there is feeding into that same myth that we all have. But the reality is we have over a million people living with HIV disease here in the United States, and up to 90 percent of them—Or excuse me. We have a million people that are diagnosed with HIV living in the United States, and we believe that there is a great number of people in addition to that who don’t have any idea that they have HIV disease.
CS: Well, also older people may lack awareness of the risk factors for getting HIV.
CS: And very little HIV prevention education is targeted at older people. We see that here in San Francisco. It’s primarily targeted to a younger community. And besides, the stigma of having HIV/AIDS may be worse for older people. This can result in their hiding their infection from family and friends.
JG: Exactly. People are very concerned. I was actually speaking with several HIV doctors last week who were telling me that their patients were so concerned about that stigma that when they needed a work excuse to go back to work after they had been out for an illness, they asked that it be written on different letterhead than the clinic, because the clinic was a known HIV clinic.
CS: Oh, no. So they’re afraid of perhaps, well, not only being stigmatized, but potentially unemployed too. Even though that’s against the law, of course, but, well, strange things happen.
JG: Right. But they are very concerned, and they don’t want anyone to know that they are HIV positive, even though they are, other than that HIV positivity, they are really leading very productive and overall healthy lives on the new antiviral therapy.
CS: I would like to suggest that folks check out that video that you did with the Be Smart, Be Well folks at BeSmartBeWell.com. Because the last comment by patient Molly regarding her herpes is very educational. She said, “The shift from being so devastated originally about my diagnosis of herpes to the happiness I now feel about my life developed slowly over time. As I became more educated, I was able to educate others. My advice to people who are living with herpes, or in this case probably any STD, would be to realize that although the word incurable is used with this disease, it is definitely manageable.” Dr. Jill Grimes, thank you so much for joining us today on Life, Love and Health. It’s just been a pleasure.
JG: Thank you so much for having me.
CS: I’m Christopher Springmann and you’re listening to Radio MD.