On Campus Podcast – STIs on College Campuses

Darren Gaddis: From CITI Program, I’m Darren Gaddis, and this is On Campus. Today, I spoke with Philip Chan, an Associate Professor in the Department of Medicine and School of Public Health at Brown University and an Infectious Disease Physician. As a reminder, this podcast is for educational and entertainment purposes only. It is not intended to provide legal advice or guidance. You should consult with your organization’s attorneys if you have questions or concerns about relevant laws and regulations discussed in this podcast. Additionally, the views expressed in this podcast are solely those of the guest and do not represent the views of their employer. This podcast provides general information and a discussion about medicine, health, and related subjects. This podcast is not intended to provide medical advice. Please be sure to contact your physician if you have questions about your healthcare. Hi, Phil. Thank you for joining me today.

Philip Chan: Thank you so much for having me.

Darren Gaddis: To get us started today, what is your educational and professional background?

Philip Chan: Yeah. I am a Infectious Disease Physician. I’m on faculty here at Brown University. I also work for our state health department on all things related to infectious diseases and public health.

Darren Gaddis: Our conversation today is going to be about STIs. What exactly is an STI and how does that differ from an STD?

Philip Chan: STI, sexually transmitted infection, is any number of infections that are predominantly sexually transmitted. There’s not a clear distinction always between the term STI, STI, so sexually transmitted disease versus sexually transmitted infection. It tends to refer to the fact that an STD, when you have a disease, tends to present with symptoms, signs and symptoms of something, versus an infection where a lot of people can be asymptomatic. In general, the field and just the terminology has generally gravitated towards STI because many of these STIs can actually be asymptomatic, versus STD, which generally refers to people having some sort of symptoms.

Darren Gaddis: With this information in mind, are some STIs particularly more prevalent on college campuses? If so, why could this potentially be?

Philip Chan: Yeah. When we talk about STIs, things that come to mind, HIV, syphilis, gonorrhea, chlamydia, these are all the infections that are commonly reported to the health department. There’s other STIs that are incredibly common. Things like HPV, human papillomavirus, SV, human simplex virus, which can cause genital warts, so these STIs are incredibly common. Of course, they’re very common among younger populations that are sexually active. We do see a pretty significant peak in a lot of these in younger folks, and especially people in college campuses, and especially as people are exploring their sexuality sometimes for the first time. Those are the reasons why we’re seeing them.

Darren Gaddis: Is it true that certain STIs are being reported currently at higher rates and some of those are even potentially becoming resistant to traditional treatment methods?

Philip Chan: We are seeing some STIs at really high rates. The good news on, for example, with HIV, we’ve seen declining HIV rates here in the U.S. over the last decade, which is a tribute to the efforts of many people, including things like HIV pre-exposure prophylaxis, a pill a day to prevent HIV, but some of these other STIs, some of these bacterial STIs have been unfortunately increasing over the last 10 to 20 years. These are STIs like syphilis, like gonorrhea and chlamydia, and some of these are really at all-time highs that have really becoming increasing over the last couple decades. One of them specifically, gonorrhea, this is something you may occasionally see in the news as a super STI. It’s one of those STI infections that there is a significant concern that it’s becoming resistant to common and traditional treatment antibiotics.

Darren Gaddis: What are some ways to prevent STIs on college campuses?

Philip Chan: There’s many ways to prevent STIs and not one approach is right for all people. I think that’s important for people to keep in mind. The first step is just to really understand your risk. I think one thing I hear from young folks is that a lot of people who even get an STI never thought that they were at risk of an STI. For me, one of the important things is just to be educated about it, is just to learn about your risk, to talk to a health professional, a provider, about your sexual activity, to be honest about it, find someone you trust, and just to talk it through and discuss and have an open discussion about things that you can do to prevent STIs. I think really the first step is just to think about it, and to talk about it, and to get tested routinely.

Even if you do nothing else, just being tested routinely, because some of these STIs do go on to have pretty significant side effects long-term. Just being tested routinely in a discussion with your healthcare provider is really good step. Of course, there’s a number of other things. Things like condoms, very effective. For HIV, there’s PrEP or pre-exposure prophylaxis. There’s even a newer thing out there for some other STIs called STI post-exposure prophylaxis, where you can take potentially an antibiotic after having sex, which prevents some of the bacterial STIs. There’s also some more conservative options like being abstinent, frankly, or being monogamous, or just even talking to your partners and making sure they get tested before you have sex with them or enter a relationship. Lots of different things you can do. Again, not one approach it right for everyone, but important to think about and talk it through.

Darren Gaddis: You just mentioned pre-exposure prophylaxis or PrEP. What exactly is PrEP?

Philip Chan: PrEP is a pill a day which can prevent HIV infection. You can also take it intermittently, also prevents HIV infection. There’s a couple medications out there now, both pills actually, and now there’s even a shot out there that people can get once every two months. But for folks that may be at higher risk of HIV, and in many places in the U.S., that includes gay and bisexual men, especially younger gay and bisexual men, if you are a gentleman that’s having sex with other guys, you should at least know about PrEP. It’s worth having a discussion, again, with the health professional about whether or not it may be right for you.

Darren Gaddis: I think you might’ve mentioned this earlier, but what could potentially happen if an STI is left untreated?

Philip Chan: Various things. I will say that for a lot of STIs untreated, that a lot of people may have no complications, but there’s a number of people that may have significant complications depending on what STI you have. For example, for HIV, which is not curable at this time, but untreated HIV will lead to age and immunocompromised state. People can die from being immunocompromised and having opportunistic infections, and getting sick from all these things that your immune system normally otherwise fights off. That’s the most severe potential complication. But a lot of these other STIs, things like gonorrhea and chlamydia, especially for people that may have repeated unknown infections, it can cause infertility. It can cause pelvic inflammatory disease. It can cause chronic pain. Things like syphilis untreated can cause some pretty significant things with your hearts, and occasionally, with your brain. Some of these things can be pretty nasty, which at the very least, it’s important to routinely test to see if you have one of them so that you can get treated. Again, I encourage people to discuss what testing may be right for them with a health professional.

Darren Gaddis: What is the best approach for an individual to figure out if they might have an STI?

Philip Chan: For different STIs require different testing approaches. Sometimes it’s providing a sample of your urine, sometimes it’s a blood draw. We’re also doing things like throat swabs and rectal swabs for people that may have anal sex to test for some of these STIs. This is why it’s really important to really find a healthcare provider that you trust and just to talk it through about what testing may be right for you as well.

Darren Gaddis: From your perspective, how might we combat the stigma of STIs amongst college populations?

Philip Chan: I think, unfortunately, the data shows that STIs are common in younger populations in general. Of course, that includes people on college campuses. I think the first step is just to just talk about it and have an open discussion. Our goal for all of us in public health is really to reduce STIs in general, reduce STIs on college campuses, reduce stigma. I think really the first step of that is just having open conversations and acknowledging that, first off, there are STIs among people and certainly college campuses, and then looking at options to prevent. At the end of the day, as I mentioned, I think just having that conversation and just promoting things like routine testing is a step in the right direction.

Darren Gaddis: What else should we know about STIs on college campuses?

Philip Chan: I think just, again, that people should really just understand the risk, that if you are sexually active on a college campus with other people, then you are going to have some risk of STIs. That doesn’t mean that you may be at high risk, especially of course if you’re in a monogamous partnership, but certainly if you’re having more than one partner or you are not in a monogamous relationship, and even if you’re having oral sex, which I think is sometimes overlooked as not having sex, but even if you’re having oral sex, is that there is going to be a risk for STIs. Again, just encouraging people to find that trusted healthcare provider, someone in the field that they can have open and honest discussions with to talk about their risk and what approaches to prevent STIs may be right for them.

Darren Gaddis: Phil, thank you again for joining me today.

Philip Chan: Thank you so much for having me.

Darren Gaddis: Thank you for listening to today’s episode. Be sure to follow, like and subscribe to On Campus with CITI Program to stay in the know. If you enjoyed this podcast, you may also be interested in other podcasts from CITI Program, including on research and On Tech Ethics. Please visit CITI Program’s website to learn more about all of our offerings at citiprogram.org. I invite you to review our content offerings regularly as we are continually adding new courses, subscriptions, and webinars that may be of interest to you, like CITI Program’s What You Need to Know About Sexually Transmitted Infections course. All of our content is available to you anytime through organizational and individual subscriptions.

As this season of On Campus wraps up, I have some exciting news to share about the future of On Campus with CITI Program. While I won’t be your host for the next season in the new year, I’d like to introduce you to our new host, Edward Butch. Edward Butch is the Assistant Director of Content and Education at CITI Program. Before I say my final goodbye, I want to say you all the listeners have made this a truly exceptional experience and I’m thankful for your support. With that, it’s time to say goodbye for now, and On Campus with CITI Program will be back in the new year with a new season.