Maggie McKay (Host): If you're a member of the LGBTQ+ community, you may have questions about STI and HIV testing. So today, we'll find out more with Dr. Raffaele Bernardo about pride and prevention.

 Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take.

I'm Maggie McKay. Thanks for listening. Today, we have with us Dr. Ralph Bernardo, Medical Director of the LGBTQ+ Services. Thank you so much for being here.

Dr Raffaele Bernardo: Thanks for having me, Maggie. I'm happy to be here.

Host: Let's just start with what are some common sexually transmitted infections or STIs?

Dr Raffaele Bernardo: There are actually several different types of sexually transmitted infections. The most common is the human papillomavirus or HPV. The human papillomavirus is the most common sexually transmitted infection in the United States. And research suggests that about 80% or so of sexually active people will encounter HPV at least once in their lifetime.

Other types of sexually transmitted infections include certain types of bacteria like gonorrhea, chlamydia, and syphilis. We also talk about viruses, including the herpes simplex virus, or HSV, various types of hepatitis, including hepatitis A, hepatitis B, and hepatitis C, and the human immunodeficiency virus, or HIV.

Host: And can anyone get STIs or are younger people more susceptible?

Dr Raffaele Bernardo: Anyone who is sexually active can obviously expose themselves potentially to a sexually transmitted infection. We do sometimes see rates of infections, somewhat higher in younger adults, and this could be for various reasons, including sexual practices, condom use, or even number of partners.

Host: How would I know if I had an STI?

Dr Raffaele Bernardo: This often comes up very commonly in the clinical setting. Believe it or not, many people who have a sexually transmitted infection are asymptomatic. In other words, they actually won't have any symptoms. And the only way to know is to get yourself tested. And I think this highlights the reason why routine testing for sexually transmitted infections as well as HIV is so important. This is important not only for the patient, but for the people that that patient is having sex with.

Host: And what kind of tests would I have to determine if I have an STI?

Dr Raffaele Bernardo: In order for us to determine what types of tests we're going to be sending, it's important for us to have an open conversation. Some of the common types of tests that we do include swabs. We may send a swab from the throat, for example, or we may have a patient self-collect a rectal swab or a vaginal swab. We may also ask for a urine specimen. In addition to these swabs and urine specimens, we may also collect blood samples. The blood samples are particularly important when we screen for infections such as syphilis and HIV.

Host: So, let's say you get your test back and it's positive, what's next?

Dr Raffaele Bernardo: If you are found to have a positive test for a sexually transmitted infection, your healthcare provider will likely offer you treatment. Sometimes treatment can be given in the office or it'll be sent in the form of a prescription to your local pharmacy. Your healthcare provider may also offer expedited partner therapy, or EPT, depending on your state. This is medication that can be given to your partner as well. And this is an option in New Jersey, for example. Depending on the infection and the medication that is used, your healthcare provider might also recommend what we call a test of cure. What a test to cure is, is a repeat test several weeks after treatment to make sure the medication worked and that the infection is cleared.

Host: if you're only having oral sex with your partner, do you need to be worried about STIs? You know, you hear teenagers say that. They're not worried because they're only having oral sex.

Dr Raffaele Bernardo: This is a very common question and a very common misconception. You can actually still expose yourself to certain types of sexually transmitted infections, even from oral sex. For example, the human papilloma virus, herpes simplex virus, chlamydia, gonorrhea, and even syphilis can be transmitted through oral sex. Transmission of these infections are likely lower than penetrative sex, but can still occur. It's also important to know that the risk of HIV transmission through oral sex, according to the CDC, is low.

Host: Dr. Bernardo, what is PrEP and how does it work?

Dr Raffaele Bernardo: I like to consider HIV PrEP or pre-exposure prophylaxis as a group of services that's aimed at empowering an individual to really take control of their sexual health, particularly in terms of HIV prevention. In addition to regular HIV testing and testing for other sexually transmitted infections, we provide options for medication to prevent HIV.

Now, currently, there are three FDA approved medications for PrEP. Two are oral options in the form of a tablet that is taken once daily, and the third is an injectable that's given once a month for the first two months, followed by an injection every other month. Now, here's the great thing. Assuming a patient is adherent to the medication and taking it as prescribed, all three options are around 99% effective at preventing HIV.

The way the oral options and injectable option work is slightly different, however the goal is the same. And that is effectively to prevent the HIV virus from establishing an infection in its target cell in the body.

Host: It's always awkward to talk to your partner about STIs and their HIV status. So, how do you recommend people go about that?

Dr Raffaele Bernardo: It's very common that patients will come to the office and ask me this question. Sometimes these conversations can be very difficult to have with your partner or partners, but I think they are very important to conversations. The first thing to remember is that these conversations are about you, but they're also about the people that you are having sex with. So, it's important to have these conversations not only to keep yourself safe, but also to keep the people you're having sex with safe as well. Occasionally, I'll even have patients bring in their sexual partners to have an open conversation that I can help facilitate. Either way, it's important to be open and honest with your sexual partners.

Host: Dr. Bernardo, how often should I get tested or what's the optimal time to get tested?

Dr Raffaele Bernardo: This is also something that comes up pretty regularly in the office setting. For of my patients, I do recommend at least annual testing for sexually transmitted infections and HIV. Depending on the number of partners that you have, or if you have a new partner, you may want to get tested more frequently.

For some of my patients, I do have them come in every three to six months for testing. It's also important to get tested with any new sexual partner. If you're concerned that you may have been exposed to a sexually transmitted infection, I do recommend getting tested as soon as possible. This may pick up an infection, but it also may serve as a baseline. For some tests, it does take several weeks before they become positive. So, it's important to know what your test results are right after an exposure. We want to know if perhaps you had an infection before that exposure. If that initial test is negative, I often will recommend that patients repeat testing in a few weeks just to make sure.

Host: And what if I'm scared that someone will find out that I got tested? How can I know that I'm safe?

Dr Raffaele Bernardo: The conversations that you have with your healthcare provider and the testing that is performed is between you and your provider. If a test does come back positive, there are reporting requirements through the Department of Health. However, all of this information is kept strictly confidential.

Host: So for a transgender person, how does this affect the care that they'll receive?

Dr Raffaele Bernardo: Identifying as transgender should not affect the care you receive. Individuals should be offered and provided comprehensive, high quality care regardless of their sex, age, gender identity, race, or ethnicity. Unfortunately, Maggie, however, the transgender community continues to remain a marginalized group and they continue to face discrimination in the healthcare setting. And this can range anywhere from insurance barriers, such as. denial of coverage, fear of mistreatment, financial constraints, high rates of psychological distress, and believe it or not, even pressure to conform.

For these and other reasons, many individuals from the community actually avoid seeking healthcare services altogether. And obviously, this has unfortunate downstream effects including less-than-optimal healthcare outcomes. I think this really stresses the importance of why we need to do better as a healthcare community to eliminate these healthcare disparities.

Host: Would it be a good idea if you were transgender to make a phone call before you went somewhere you were thinking of getting tested and seeing if they were transgender-friendly, for lack of a better term?

Dr Raffaele Bernardo: Certainly, one way to get a sense of the type of environment you may walk into is to talk to friends or acquaintances that may have used services in that particular healthcare setting. Because everyone's experience is unique, the only real way to know for sure is to experience it yourself. For obvious reasons, this can cause some stress and discomfort on the side of the patient. And for this reason, I think it is important to try to reach out to friends and acquaintances that again, may have been to that healthcare setting before, or use the internet to your advantage. Go online, see if the healthcare center has a website or has some resources that you can review before making an appointment. A lot of providers also have reviews online, and some of those reviews may be coming from the transgender community. Either way, I think it is important to inform yourself before making an appointment. We really want to make sure that your experience is comfortable, safe, and affirming.

Host: Those are good ideas. So, we talked about the conversation between you and your partner, but what's the best way for me to start a conversation about my sexual health with my healthcare provider? Because that can be awkward too.

Dr Raffaele Bernardo: I agree. Ideally, your healthcare provider should be having this conversation, and should be discussing asexual history when they take other parts of your history, like your past medical history, past surgical history, talking about your allergies. Having a conversation about your sexual health and your sexual history should also be coming up naturally in conversation.

Unfortunately, it very often doesn't, and this could be for one of many different reasons: time constraints, comfort on the side of the patient or provider, education, training. Either way, I think it's important that these conversations come up during the office visit. If the topic doesn't come up naturally or organically during your visit, I think it's important that you as the patient have an open and honest conversation with your healthcare provider. These are important topics that need to be addressed during your visit. You could try starting off with a statement like, "I know this might not be something we normally talk about, but I'd like to discuss my sexual health." You can even try writing down specific questions, or concerns to ensure they get addressed during the appointment.

The other point I'd like to make is that these conversations can also lead to a discussion around other aspects of your sexual health, including vaccinations against certain sexually transmitted infections, like HPV or hepatitis B, as well as a discussion around contraception.

Host: Is there anything else in closing that you'd like to add that we didn't cover?

Dr Raffaele Bernardo: I think we covered a lot today in this podcast, but I would like our listeners to leave with a few points. The first thing I'd like to mention is I think as a healthcare community, we need to normalize conversations around sexual health and HIV testing. It's not until we do that, that we are going to see increased rates of testing. This could potentially have downstream effects both for the patient and for the patient's sexual partners. For the patient, I think it's important for patients to realize that their sexual health is just as important as any other part of their overall health care.

And lastly, if your provider doesn't bring up a conversation around your sexual health, I really would encourage patients to feel comfortable about bringing these conversations to light and having an open and honest conversation with your healthcare provider. These conversations can ultimately then lead to appropriate screening for sexually transmitted infections and HIV as well. and HIV testing is the foundation of HIV treatment and prevention services. After testing, your HIV testing is negative, that may lead to conversations around various forms of HIV pre exposure prophylaxis.

If testing is positive, this can lead to conversations around HIV treatment. Overall, the goal is to normalize and de stigmatize conversations around sexual health, testing for sexually transmitted infections, and testing for HIV.

Host: Such an important topic. Thank you so much for sharing your expertise and for giving us this useful information. We appreciate your time.

Dr Raffaele Bernardo: Maggie, the pleasure was entirely mine. Thank you again for having me.

Host: Absolutely. Again, that's Dr. Ralph Bernardo. For more information about LGBTQ+ medicine at Valley, please visit valleyhealth.com/LGBTQ or call 1-800-VALLEY, that's 1-800-825-5391 to schedule an appointment. And also on today's topic, to be connected with today's guest, you can call 201-612-4735. That's 201-612-4735 or email valleypodcast@valleyhealth. com. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Conversations Like No Other presented by Valley Health System in Ridgewood, New Jersey.