Melanie Cole, MS (Host): Thank you for tuning in to Back to Health, the podcast that brings you up to the minute information on the latest trends and breakthroughs in health, wellness, and medical care. Today's special episode is part of our Women's Health Wednesday series, which features in depth conversations with Weill Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insights that will help you make the most informed and best healthcare choices for you.

I'm Melanie Cole. And today, on this Women's Health Wednesday, we're discussing HIV seroconcordant and serodiscordant relationships for women in the context of HIV status and we're talking about STIs in general. Joining me is Dr. Lona Prasad. She's an Assistant Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medicine. Dr. Prasad, thank you so much for joining us today. I'd like you to start by telling us a little bit about the prevalence of STIs in general in the adult population. Are they on the rise? Are we seeing more of them in people that are finding themselves newly single? The most common that you're seeing, just kind of give us a brief overview. overview

Dr Lona Prasad: Sure. Thanks, Melanie, for having me today. It's a pleasure to be here. So, STI rates are definitely on the rise in the United States with a notable increase in cases of syphilis, gonorrhea and chlamydia, and rates are highest in the under 25 age group. However, there's definitely been a rise in infections in the older population, and this is particularly those over 65.

Those newly single may risk and not necessarily take precautions, such as condom use and STI testing, before having sex, let's say, with a new partner. Because of the age, there's a lack of concern about pregnancy, which also diminishes condom use. And now, we have drugs to treat erectile dysfunction in men and hormone replacement therapy is available for women, which also helps the older population remain sexually active. There are also a larger number of older adults who live together in assisted living facilities, and it may have been many years since they received sexual health education. Also, in older relationships, there are people who are having new partners because the spouse died or they divorced. In terms of the question you asked me about my practice, I would say I most commonly see human papillomavirus, which is HPV, also genital herpes, chlamydia gonorrhea and trichomoniasis cases.

Melanie Cole, MS: Wow. You know, we don't hear enough about the things that we need to do to prevent these and stop the spread. And we're going to talk about that today. What are some of the more serious consequences beyond the immediate impact of the STI itself? There are things that affect the quality of a person's life really and can affect the quality of their sex life and relationships and all of it. Speak to that a little bit.

Dr Lona Prasad: A lot of the STIs are treatable. Things like infections such as herpes, gonorrhea and syphilis, these can increase the risk of HIV acquisition. HPV infection can cause cervical and other types of cancers. And hepatitis B, when it's not treated, can result in death mostly from cirrhosis and hepatocellular carcinoma. Gonorrhea and chlamydia are major causes of pelvic inflammatory disease and infertility in women.

Melanie Cole, MS: Now, let's talk about screening because we're learning more and more, Dr. Prasad. I mean, obviously now, we're giving our kids Gardasil to hopefully ward off HPV and then even following that, cervical cancer and testicular cancer. We're learning so much more about the vaccines and preventing these in the first place.

But then there's also screening. And I know that I got screened for HPV. And at my age, you know, the cervical cancer screening comes every couple of years. It's not every year the way it used to be with the Pap smear. So, tell us a little bit about screening and HIV screening as well. What are we looking at? What's going on today?

Dr Lona Prasad: As far as screening goes, according to the US Centers for Disease Control and Prevention, the recommendation is that everyone between the ages of 13 and 75 should get tested for HIV at least once. However, we need to take into consideration that there are certain risk factors that a person should be considered in terms of they should be tested more frequently. For example, if they have had anal or vaginal sex, let's say, with someone positive for HIV; maybe had more than one sex partner since the last HIV test; perhaps the person has shared needles, syringes or other drug injection equipment, or exchanged sex for drugs or money; if a person has been diagnosed with or treated for another STI; and certainly, if someone has sex with someone who's done any of the above that I've just mentioned, or with someone whose sexual history is not known, then this population should get tested for HIV once a year.

As for the other STIs that you discussed, it's recommended that women, when they're younger than 25 years of age, have routine screening for genital chlamydia and gonorrhea annually, and be tested for HIV and hepatitis C virus at least once. If the woman is at increased risk, as I mentioned risk factors before, she should additionally be screened for syphilis, trichomoniasis and hepatitis B. Now, the group of women who are older, say, than 25 should be screened at least once for HIV and hepatitis C. Those, again, in the increased risk group should also be screened for chlamydia, gonorrhea, syphilis, trichomoniasis and hepatitis B.

Melanie Cole, MS: These are great discussions to have with your obstetrician-gynecologist because you are the ones that help we women really get through all of the things that we go through over our life course. I say it in the intro, but I really mean it because it is exactly what we from teenagers until post-menopause are looking at, and especially if we are sexually active. Now, I'd like you, Dr. Prasad, to explain what it means for a relationship to be seroconcordant in the context of HIV. Explain those two words that I said in my intro, serodiscordant and seroconcordant. What do these words mean?

Dr Lona Prasad: If you break down the word, let's say seroconcordant, the word sero means blood. Concordant means matched. So in the context of HIV, this means that either both sexual partners are HIV-negative or both are HIV positive. Now, discordant, on the other hand, means mismatched or different. So, in the context of HIV, again, this means in a relationship, one of the partners is positive and the other is testing negative.

Melanie Cole, MS: Well, thank you for that. That does help us to understand. So now, as we continue along this line, what are some of the key considerations for women in serodiscordant relationships when it comes to HIV prevention and management? So, I'd like you to speak about safe sex practices, because that's what's really going to make the situation dealable, right?

Dr Lona Prasad: safe sex is key. It's important to be aware of the viral load in the infected partner. So when the HIV load is stably suppressed and low, and that's defined as less than 200 copies per milliliter, the transmission to the HIV-negative partner has really not been reported.

Now, this is usually achieved after 6 months of the infected partner starting their antiretroviral therapy. condom use, of course, is always a good way to reduce the risk of transmission. If there is ever any question about viral load or adherence to antiretroviral viral medication by the partner with HIV, there is a medication available called HIV PrEP, which PrEP is short for pre-exposure prophylaxis. And this is available in oral and injectable form and has been proven to reduce the risk of HIV transmission by probably greater than 99%.

Melanie Cole, MS: Yeah, PrEP's really an advancement, isn't it? It's incredible. Now, I'm just wondering if women are in a same-sex relationship that's serodiscordant. Are there any different recommendations?

Dr Lona Prasad: So, first of all, there is no risk of HIV spread with kissing, as it isn't transmitted through saliva. However, HIV is passed on through blood, semen and vaginal fluid, and also anal mucus. So, one would need to be cautious, let's say, when performing oral sex on her or their HIV-infected partner, as the infection could be spread via the blood stream if the HIV-negative partner has cuts or open wounds in or around the mouth. Again, though, if the viral load is low, this risk is extremely minimal. But, you know, all partners should be tested regularly for all STIs, even in same-sex relationships.

Melanie Cole, MS: What an important episode that we're doing here today. Dr. Prasad, I'd like you to summarize. I know it's a lot to ask to summarize what we've just discussed the importance of regular HIV and STI testing, the importance of these recommendations for serodiscordant relationships, whether they be same sex or heterosexual. It really is an important bit of information for all of us to know. So, I'd like you to summarize it all for us now.

Dr Lona Prasad: Well I will say that, importantly, HIV-positive people and their partners should get STI testing for genital chlamydia, gonorrhea, trichomoniasis, and syphilis at least annually. Now regardless of being serodiscordant on either side, if one experiences genital or anal discharge or rashes, then it's important that partners get tested at that time. If an individual has multiple partners, he, she or they should be tested every three to six months. Remember, gonorrhea, chlamydia, trichomoniasis and syphilis can all be treated. And all of these are actually risk for HIV acquisition. So, it could prevent, let's say, a partner who is in a serodiscordant relationship and they're the HIV-negative person from actually getting HIV.

Also importantly, being in a long-term mutually monogamous relationship and condom use will reduce the risk of getting other STIs. And, you know, there are vaccinations out there, as you mentioned before, to protect against human papillomavirus and hepatitis B, and these should really be discussed with your gynecologist.

Melanie Cole, MS: Thank you so much, Dr. Prasad, for joining us today and sharing your incredible expertise on this topic. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. We're so glad that you joined us for Women's Health Wednesday. We hope you'll tune in and become part of a community and a fast-growing audience of women looking for knowledge, insight and real answers to hard questions about their bodies and our health.

Please download, subscribe, rate, and review Back to Health on Apple Podcasts, Spotify, and Google Podcasts. For more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. So much great information there as well. I'm Melanie Cole. Thanks so much for tuning in today.

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