#125 Avoiding and Managing Sexually Transmitted Diseases with Jenelle Marie Pierce

[Angel Donovan]: Jenelle, thank you so much for coming on the show.

[Jenelle Marie Pierce]: Thank you for having me. It's my pleasure.

[Angel Donovan]: So, I wanted to quickly dive into your background. You've headed up this project, the STD project. How did you get started with that? Why did you choose to get into that and how long have you been doing it for?

[Jenelle Marie Pierce]: That's a good question. Well, my traditional education is not in sexual health and public health. I have a BBA and a NBA in honor's professional accountancy. So, I was a successful accountant. I was an auditor before deciding to become a sexual health STD-specific advocate and I started the STD project based on personal experience.

I'm also a college professor. I teach at a community college locally. So, education has always been big in peripheral but at the time, like I said I was in the corporate world and I just felt like there was something else that I needed to be doing that I wanted to. Ultimately, I wanted to help people. I was at place in my professional and personal life that I felt really secure in who I was, who I'd become and all the work that I put into the person that I saw myself becoming and I realized that reconciling how I believed.

I have an STI. When I was 16 years old, I was diagnosed with genital herpes and it was a traumatic experience for me and I always had a really hard time reconciling how I felt about myself as opposed what the stigma associated with all STIs told me I should feel about myself. That I was now dirty and damaged goods and this bad person that nobody would ever want and I had more value and nobody would want to date me. Like all this plethora of negative connotations associated with people who have contracted STIs and that was opposed to how I really felt about myself. What kind of person I thought myself to be and what I thought I brought to the table in a relationship and all of that?

At this point, I was 29 years old when I launched the STD project and that's been almost five years. In April, it will be five years, our five-year anniversary. At the time I thought, "You know, I want to help people to not have to." It took me years and years to overcome that stigma and to tell myself that what I was hearing externally on late-night comedy and television and even from my peers and all of the jokes that are told that that did not gel with what the reality was for me. The actual experience was of living with a STI and what that meant for my dating life and all of that. That those two things didn't pair up. So, I wanted to help other people walk through that process and overcome that stigma a lot faster than it took me and a lot less painstakingly, hopefully.

The idea behind the STD project was to provide a platform that was both resources. Like what you find on line a lot of times is all of that clinical factual information which is really helpful and necessary but then, I wanted to delve into that gray area that you don't see a lot of. Like what do you think about yourself now going forward and how do you reconcile the two things, that stigma and all those negative connotations with who you really are? How are you going to date going forward? Does that mean that you can still have a healthy sex life and can you still have a fun wonderful thorough and awesome healthy sex life or are you now going to have to be celibate for the rest of your life? Which of course, is not true.

So, I wanted to help people kind of navigate that that you don't see as often. We provide both on the STD project. We're kind of like a catch-all where we have that clinical factual information but then, we also talk about the personal experiences. People come into the website and share their interview anonymously, their personal experience anonymously because, everyone's perspective is unique. We welcome everybody's point of view and anyone from any walk of life kind of deal. Then, we encourage people to do their own research, to not stop at the STD project but, we link to a lot of amazing resources.

I sit on the board of the National Coalition for Sexual Health and we work with a lot of those folks too and a lot of those organizations and we really encourage people to empower themselves via education and awareness to if we don't love what we're saying, then find another resource that helps support your narrative and is accurate, of course. As long as your narrative is accurate but, we really want to just empower people to walk forward and move past that initial shock and stigma and to have the information and tools so that they can move past their diagnosis.

[Angel Donovan]: Great, that's quite a while, 16 years old to 29 and I'm guessing that that wasn't an easy journey at some point. How did you think your contracted your STD at such a young age? Was it literally like the first time you had sex or something?

[Jenelle Marie Pierce]: Well at the time, I was already sexually active and I'd had more than one partner. I don't know from whom I contracted it. I was too petrified of trying to approach anyone and asking whether or not they had been tested or whether or not they'd been diagnosed and whether or not they knew they had an STI. So, I don't actually know who I contracted it from which is fairly irrelevant at this point. Everybody always wants to know the origin and they want to have answers and they want to be able to point a finger and things like that but, it takes two to engage in sexual and partnered sexual activity, right?

So, I was also responsible and I knew there was risks. I was totally ignorant of how relevant the risk was to me. I thought like, "Oh, I'm not sleeping with anybody who has an infection and everybody I'm sleeping with is 'clean'," which is a word that we don't use and I can explain that later but, in my 16-year-old-teenage mind, I was thinking that was a risk that I didn't have to worry about. I was on birth control at the time. So I thought like, "I'm being..., " I had gone to Planned Parenthood and I thought I was being responsible.

[Angel Donovan]: You're being sensible.

[Jenelle Marie Pierce]: Yeah, exactly. I thought no issues or whatever so, it was a complete shock but at that time, I was sexually active and had been engaging in partner sexual activities. So, I'm guessing it's from penetrative sex. Although, it could have been from oral sex too, I just don't know at this point.

[Angel Donovan]: Yeah, that's one of the confusions I want to get into later to help people understand that because, I think thereÕs a lot of myths and a lot of misunderstandings.

[Jenelle Marie Pierce]: 100%.

[Angel Donovan]: Yeah, I know if you Google. I just find it terrible that you can't get proper information out of the sites, the clinical sites, anything out there. I feel it's just kind of funny because, there's a lot of money and campaigns that go into it and stuff and I still feel like it's just a big mess out there.

[Jenelle Marie Pierce]: Totally.

[Angel Donovan]: This is why we're talking to you to help clarify some of this stuff. It's also like, since then... because, one of the things you started talking about is you can have relationships, you can have a fruitful sex life afterwards. It'd be helpful if you just kind of relate your story afterwards. Like, have you had a fully developed life or are there kind of like things that you have to manage or anything? What are the big differences or are there any from you compared to other people?

[Jenelle Marie Pierce]: Yeah, my sex life has not really changed. I mean, in a lot of ways, it ultimately shouldn't have to. What ends up happening a lot of times when people get diagnosed is now they're having to have a conversation that they didn't have prior to their diagnosis which I would counter with, "We should be all be having these sexual health conversations with our partners. We just aren't," and I'm practical about that. I think that's kind of where some of the campaigns that you see, all this money is being put into awareness and testing, encouraging testing and encouraging condom usage and stuff like that but, I don't think we're talking to people on a peer-to-peer level, on a practical level what really is happening in and outside of the bedroom.

These conversations just don't go down. It's actually irregular for you to have a conversation about sexual health and people get really weirded out when you start talking about condoms and safer sex and stuff like that because they're like, "Well, why? Are you sleeping around with a lot of people?" They make these assumptions like because you're cognizant of it and you're being mindful and practical and considering other people's health and your own, then all of a sudden that might be a red flag which is should be the other way around. It should be if we're not having those conversations, that should be your red flag.

So for me, I've never had a partner not want to have a sex with me because I have an STI and that's everyone's experience mind you. So, I have to at least be transparent about that and acknowledge that some people do have rejections as a result. They might tell somebody who's close to them that they have an STI and then, the person chooses not to engage in activities with them. They're just not willing to take the risk at that time and that's acceptable and that's understandable and we all have that right to say that, "I'm not ready to consider that risk at this time."

For me, I have not a single partner and I like to say that I'm an equal-opportunity dater. I've dated every different kind of person from your preppy people to your red-neck country folks. I mean, I don't know. It's a stereotype and things like that but I mean, I've really dated all different kinds of men in particular and it's never stopped a relationship from happening. Actually, even so far they've said, "Really? That's all you have to tell me?" Like, I've sat them down and said like, "I have a conversation or I want to talk to you about something." They said, "Oh geez, I thought you were going to tell me that you were pregnant or I thought you going to say something worse than that," or the response has been, "Well, this doesn't change who you are, does it?" I'm like, "No, it has nothing to do with who I am and my personality. It just something that we have to consider." For the most part, yeah it has not changed a single thing in terms of my sex and my relationships or dating or anything like.

I will that it certainly is a risk I have to consider and so, I have genital herpes. That's forever and for life and I do get active outbreaks. Not everybody with genital herpes gets outbreaks. Some people are asymptomatic, which means that they don't actually have the physical signs or symptoms but, they can still transmit the infection to somebody and those people could still get physical signs or symptoms. It's just based on how your immune system handles the infection. For me, I actually do get outbreaks.

When I have outbreaks, I don't engage in sexual activities with a partner and I do take other preventative measures to reduce the risks of transmission and things like that. That's been discussions that I've had with people that I probably wouldn't have had that detailed a discussion with but, should have I suppose. So yeah, there's been a little bit more of conversation in that realm but other than that, it hasn't limited sexual activity. It hasn't limited relationships and for me, it's been kind of a nonissue.

[Angel Donovan]: Great to hear. I know people who have contracted STDs or STIs and it's interesting on the herpes thing that sometimes, it's asymptomatic. We've spoken to people before about this, notably an ex-porn actor who was talking about STD testing in the industry. He was talking about the asymptomatic aspects that have a lot of people thinking they don't have it when they actually do have it.

I have friends that have never had symptoms and then, they've had an outbreak many years after actually an infection would have occurred. It's because, they get a damaged immune system sometimes like, they've been traveling abroad or something. They get an infection or something like that and then, they get it and then they start thinking, "Who have a slept with recently?" Then, they remember, "Oh, wait a minute. It was more likely like 10 years ago down the road because, I've been super careful lately." It is a little bit tricky like that how you contract these things. You can't actually jump to conclusions because, they don't necessarily always have the symptoms straight away.

We've been throwing some terms around so, I wanted to clear those up. STD and STI, what is the difference if any between those two things?

[Jenelle Marie Pierce]: That's a really good question. At the STD project, we use them interchangeably. We named the STD project the STD project because, that term is the most widely known. It's the most common thrown around term. So, any layman out there or whatever, you know your friends or your family and things are going to understand that term and they can recognize it. So, we wanted to make sure that we're reaching out to not only those folks who are in the sexual health or have a college education and somehow taped into public health and have heard those terms before but, we want to make sure that this information is accessible.

That said, technology STI is the most medically accurate term. When we're talking about medical jargon, STI is sexually transmitted infection and STD is sexually transmitted disease. An infection means that you don't necessarily have to have signs or symptoms. You just are infected with the bacteria, parasite or virus. Those are the three different kinds of STIs that there are but, parasitic, viral and bacterial. So, you can have the infection without noticing any signs or symptoms or having any kind of disease present. That's what the difference is between the disease.

The disease means that you actually have noticeable signs and symptoms whereas, an infection means you're just infected and you don't have signs or symptoms at all but, with both STI and STD, even if you're infected, you can still transmit the infection to other folks. They, like I said with the herpes example, with having an outbreak, even if you have the infection and you don't have signs or symptoms, you may transmit it to someone else and they wind up with signs or symptoms. Then, they would have an STD.

So, all STD are preceded by an STI. The infection is the first step and then, some people end up having signs or symptoms but, the most common symptom of all STDs or STIs is no symptom at all. Most people never know that they actually have an STI or STD and sometimes, depending on the infection, your body will clear it on its own. Other times, you need to have it treated or you have it for life. It just depends on what infection we're talking about.

Also in terms of the sexual health community, STI is a little friendlier we think and that's kind of why you hear STI a little more commonly now because, an infection sounds a little more friendlier, a little less worrisome than a disease. Disease sounds like big doom and gloom and, "Oh no, " and people worry about death and all sort of really bit ramifications which, there are big ramifications for both STIs and STDs but, we use them interchangeably. You could say both and you would be fine saying both but, if you're being 100% medically accurate, all STDs are proceeded by an STI. You have the infection first and then, disease if you have signs or symptoms.

[Angel Donovan]: Right and not everyone has an STD?

[Jenelle Marie Pierce]: Yes. Ú

[Angel Donovan]: That has an STI?

[Jenelle Marie Pierce]: Correct.

[Angel Donovan]: What are the most common STIs that people should be aware of?

[Jenelle Marie Pierce]: I think probably the number one that comes to my mind is HPV. The numbers state that, if you think about it. Okay so, HPV is the human papilloma virus. There are two main kinds of HPV. There's low-risk and high-risk. Low-risk results in genital warts and then, high-risk are the kinds that can cause cervical cancer, penial cancer or throat cancer. The statistics that 80% of all people by the age of 50 will have contracted HPV at some point in their lives.

So, 80% of all people by the age of 50 will have contracted HPV at some point. Now, HPV tends to clear on its own within about six months to two years for most people, both low-risk and high-risk strains. So, it's fairly rare to contract HPV and then have it progress into cancer if you have a high-risk strain and it's also fairly rare to have a low-risk strain have genital warts happen for more than two years, unless you're immunocompromised, unless you have an immune system deficiency as a result of maybe the HIV virus, hepatitis or some other reason that your immune system might be compromised. Then sometimes, you end up having HPV for longer and your body has a harder time clearing it on its own.

Most people clear it on its own. Most people never know that they have it. Men can't even be test for HPV. The only to be diagnosed with HPV as a male is if you have the low-risk strain and you're having physical symptoms which would be genital warts. Otherwise, you never know that you have it. You could be transmitting to other people and then, somebody could end up and it could develop into cancer but, that's fairly rare.

In HPV, so many people which is... I should put out this number because, so many people will say when you're talking about missing things. Like, "Oh, I've never had an STI. No, it's not an issue for me, blah, blah, blah." When it's like actually, 80% of all people will have HPV at some point. They may have cleared it on their own and never even known they had it but, I put that number out there because, that's one infection out of all of the infections. According to the World Health Organization, there are 30 plus STIs out there and when we're talking about one, we're only talking one when we were talking about HPV and 80% of all people will contract HPV at some point.

The reason I kind of put out these numbers is not to freak everybody out and make everybody worried about like, "Oh my gosh. I need to go hide in a rubber bubble or something." It's that they're so common. It's really a very common thing but, we just don't talk about it. So, everybody has no idea what the real risk is and then when you talk about it and say, it's all of a sudden like this big like, "Ew, it's really gross. Oh my gosh," and you just get a lot of people freaking out as soon as you bring up STIs and STDs. So yeah, HPV is I think one of the most common.

When you're talking about bacterial infections, there's trich, chlamydia, gonorrhea. Chlamydia's really common. Those ones are treatable and curable. Pubic lice is really common. Herpes is quite common as well. HSB1.

[Angel Donovan]: Wait, wait, wait. Pubic lice sounds really scary. What is that?

[Jenelle Marie Pierce]: Pubic lice is basically the same thing as head lice, just tiny little bugs that bite you.

[Angel Donovan]: Okay.

[Jenelle Marie Pierce]: Yeah, and live in your...

[Angel Donovan]: Are they insects or something?

[Jenelle Marie Pierce]: Yeah, they're little bugs.

[Angel Donovan]: Okay.

[Jenelle Marie Pierce]: They're tiny little parasites. So, that's a parasitic STI. They live off of your... they eat your blood and it is really gross. Thinking of bugs in general. Even though I talk about how STIs are so common and I understand that they're still gross. Nobody wants an infection and when you talk about little bugs living in your pubic in general.

[Angel Donovan]: So, what's the one called the clap?

[Jenelle Marie Pierce]: Yeah, the clap is gonorrhea.

[Angel Donovan]: Okay, and then was a term for the lice which was something else.

[Jenelle Marie Pierce]: Crabs.

[Angel Donovan]: Just because, I know there's jargon. Yeah, crabs. There you go. I want to make sure people make the connections here. Is there any other jargon which is thrown around?

[Jenelle Marie Pierce]: Let's see, the hiv would HIV. The herp, I don't know. Kind of those are just shortened for herpes. Crabs, what I am thinking of?

[Angel Donovan]: Yeah.

[Jenelle Marie Pierce]: Trich, which is...

[Angel Donovan]: I don't remember which rock band it was but apparently, their whole bus had the crabs at one point.

[Jenelle Marie Pierce]: At where?

[Angel Donovan]: Like I was watching a... they had crabs on the bus. You know, they go around touring in these buses.

[Jenelle Marie Pierce]: Oh.

[Angel Donovan]: I can't remember. It was one of the hard rock. It wasn't Metallica but, it was a similar band to that. There's a documentary. I'm not the one spreading gossip but you know, apparently at one point, everyone basically had it. The whole band, they spread it throughout. So, the girls, the drummers, everyone, the driver, everyone had it. It was disgusting apparently.

[Jenelle Marie Pierce]: Oh yeah.

[Angel Donovan]: So, like I know that... just on that one, like I know everyone... like it's very common for people to shave these days or wax. Does that prevent it or make it more...?

[Jenelle Marie Pierce]: It's certainly going to reduce. Now, it's interesting because, if you're shaving genital hair, it might reduce what they're going to hang on to and live in. So, they would be a little noticeable because, there wouldn't be as much hair for them to hide in and there really wouldn't be anything there for them... because, the pubic lice kind of like hangs on to the little hair shafts and like crawls through your genitals and you know, bites you and that causes bumps and itches and whatever. So, it's just like lice just in a different location, like head lice or whatever that you see on children.

Sometimes, people spread pubic lice with like beards and oral sex and stuff like that and vice versa. You do see but, it's kind of fairly rare case because, people notice it right away when it's on their face but, you see sometimes, somebody coming in with it in their beard or something like that but, that pubic lice is treatable. That totally goes away and that...

[Angel Donovan]: It just sounds like that one's just tricky to know if you have it.

[Jenelle Marie Pierce]: Well, no. That one, you pretty much know right away because, it itches and it bothers you. That's pretty much a STD right out of the gate because, you're going to have signs and symptoms. You're going to have little red bumps that are itchy and you may notice the actual... the lice are teeny tiny. You may notice them or the teeny tiny eggs that accompany them and that kind of thing but, the interesting part about shaving though, I will have to say is that yes. That may reduce your risk of pubic lice a little bit because, you're kind of minimizing the home in which they would hang out in however, shaving can put at an increase risk of bacterial infections and/or skin-to-skin transmitted infections.

So like, HPV and herpes and molluscum contagiosm. Molluscum is another skin-to-skin transmitted infection that causes little itchy bumps. Those things, if you are reducing... you're increasing the friction and you're reducing the barrier by taking the hair away and so then, you're providing a little bit more risk for some of those other infections. Bacterial infections, if you're shaving and you have these tiny cuts and tears, that also produces an entry point for infection that might now have been there if you weren't shaving.

So, I don't know. I mean, it's six to one, half a dozen of the other I suppose if you're trying to reduce risk of infection. I wouldn't say that shaving and/or not shaving is really the way to go. There are other probably more effective ways. There are other much more effective ways to reduce risk of infection. Shaving is not one of them. I'd just say, shaving is your preference and just know that there are risks associated with shaving and not shaving.

[Angel Donovan]: Is it the same deal with waxing?

[Jenelle Marie Pierce]: Yes, waxing would be the same, Mmm-hmm.

[Angel Donovan]: Okay.

[Jenelle Marie Pierce]: Yep.

[Angel Donovan]: Alright, good to know. Okay, a little detour there. In terms of kind of prevalence right now, like the ones most common, I guess HPV is the most common by the sounds of it. What comes next after that if we kind of go down the list?

[Jenelle Marie Pierce]: I would say then... let me see. I have it pulled up actually because, I thought that we might be talking about this.

[Angel Donovan]: Okay.

[Jenelle Marie Pierce]: Trich is super common. That's a bacterial. Trich and HPV are two of the most common. So, trich is a bacterial infection that's curable.

[Angel Donovan]: Wait, is that the full name for it? Trich or is trich a...?

[Jenelle Marie Pierce]: Trichomoniasis.

[Angel Donovan]: Okay.

[Jenelle Marie Pierce]: So, the trich is the shortened. T-R-I-C-H or trichomonis depending on how it's spelled. It's the trichomois bacteria but, the actual infection is called trichomoniasis.

[Angel Donovan]: Okay.

[Jenelle Marie Pierce]: Some of the treatments that they give treat multiple things. So, they'll treat both chlamydia, gonorrhea and trich and mycoplasma. Mycoplasma is another bacteria but in terms of commonality, I would say trich and HPV are up there. Chlamydia and pubic lice are up there. Probably then, scabies and herpes comes next. Scabies is another bug that lives under the skin.

[Angel Donovan]: Oh.

[Jenelle Marie Pierce]: Both the bug itself and the eggs that it lays in your skin bother the skin and cause itching and they make little trails on your skin. It's almost like tiny little scratches that become red and inflamed and usually that takes a little while for somebody to notice until they're really bothered by it and they're noticing the signs and symptoms. Again, that's curable. You just put a cream on and it goes away. Kids get scabies as well.

Some of these infections, interestingly enough too go in both directions. Like sometimes, they're not always STIs. Sometimes, they're transmitted from families and from children especially in like day care settings and things like that. So scabies is common. Molluscum is common in children.

[Angel Donovan]: This is just through touch or something?

[Jenelle Marie Pierce]: Yes, skin-to-skin transmission.

[Angel Donovan]: Right.

[Jenelle Marie Pierce]: The three different ways you can transmit infections; two I guess I should say. It's either through, it would either be from skin-to-skin transmission or from fluids and some infections are transmitted just from genital fluids, like salvia and things and other infections required a blood transmission and then, you've got your skin-to-skin. So, either genital fluids and salvia or blood transmission or skin-to-skin transmission.

[Angel Donovan]: Okay, that provides quite different prevention strategies or understanding of what your risk with which activity. So, I think that be useful to talk about because, I think this is a really big area of confusion. Just define just kind of the scope of risk for each of those areas. The ones that can just be passed through blood. How would you get that?

[Jenelle Marie Pierce]: Blood transmission are going to be the ones that are not as easy to contract because, there would have to be an exchange. So, that's going to be things like hepatitis C, HIV, syphilis, I think that's it on my list of ones that I can think of. Zika can be blood transmitted, yeah. Some of the bigger ones that have some long-term big implications but, you're able to live with them because of the great treatment that's out there, hepatitis C is now curable. They're saying HIV too depending on... some of this is depending on your access to these treatments and cures but, they're all certainly livable with the right kind of medication and management but, those ones are blood transmission.

Then, things like unprotected, so without a barrier, without lube, penetrative sex would be your way of contracting those infections. That would anal or vagina. Anal, if you were talking about non-protected. If we're not talking about barriers at all, anal's going to be a little riskier only because the anus is not self-lubricating. So, there's a little higher risk for natural cuts and tears when you're engaging in anal sex. There's just going to be a little bit more likelihood of small tiny cuts and tears. That provides an entry point for those infections.

[Angel Donovan]: Right, are we talking about microscopic tears?

[Jenelle Marie Pierce]: Microscopic cuts and tears is all it takes. So, you wouldn't necessarily feel it or know it. It doesn't necessarily have to be painful or you don't have to see bleeding happening for there to be an entry that microscopic which also happens with vaginal penetrative sex too. It's very common for tiny little microscopic cuts and tears but, the vagina is resilient. It heals really quickly. It's self-lubricates often times. So often times, you don't even notice that that's occurring. You wouldn't necessarily think like, "Oh, there was this giant cut where infection came in." It doesn't have to be that way. You don't have to notice that's it's even occurring.

Anal sex would be the highest risk. Unprotected anal sex specifically would be the highest risk because, it is not self-lubricating. Then, penetrative vaginal sex would be next on the list of risk for blood transmitted infections and really all infections if it's unprotected. If we're going down the list of what's the most risky activity to the least risky activity, unprotected anal sex would be first. Unprotected vaginal penetrative sex would next. Unprotected oral sex would be next and then, touching and kissing and things like that would come farther down the line. So, there is still some risk even with things like touching and kissing because, I mentioned that stuff is skin-to-skin transmitted. There are infections that if you're just naked together and you're not actually having any penetration or even any oral sex and there's no mouths or anything engaging, there are still risks of scabies and pubic lice and molluscum and herpes and even HPV. There's actually a quite a bit of risk when it's skin-to-skin transmission.

[Angel Donovan]: Okay, is that just kind of like rubbing against each other?

[Jenelle Marie Pierce]: Yeah.

[Angel Donovan]: In the areas? So, grinding for instance something like that?

[Jenelle Marie Pierce]: Yep and you have to come in contact. Now that being said, depending on the infection first of all, you have to come in contact with an area that's infected. So just because, I have herpes genitally, if you touch my arm and you're even rubbing my arm very vigorously, you're not going to contract herpes because, that's not where the infection's located, right?

[Angel Donovan]: Okay.

[Jenelle Marie Pierce]: That's important to clarify. It seems silly right but, it's like when I talk about all of this, the epidemiology of these infections and even surface level and it's like it gets confusing. You're like, "Oh my gosh, she's just talk about 20 different infections at three or four different ways to contract them, different kinds of sexual activities. It makes you want to go hide in a rubber bubble."

[Angel Donovan]: Yeah.

[Jenelle Marie Pierce]: But that's not the point. The point is to know that there are relevant risks basically, with all partnered sexual activities. It's just understanding what the risks are and knowing that STIs are super, super common. The majority of people contract one or multiple at some point and times in their lives. Nobody talks about it so, you wouldn't know but, it's not the end of the world. Knowing that, consider your risk. Consider the risks you're willing to accept because, there's a reward too. A healthy, happy sex life is amazing and really good for you and your body and all of the chemicals and things that are involved and that are positive about that. For every risk, there's an equal and opposite reward and vice versa. So, understand that and then, move forward. I just want to kind of put that PSA out there. Even though we're talking about these details, I hate to and certainly not intending to freak everybody out anymore than we're already freaked out about STIs, right?

[Angel Donovan]: So, which ones... there's two scenarios I think would be helpful to have more clarification because, I think there's confusion around them.

[Jenelle Marie Pierce]: Sure.

[Angel Donovan]: The first one is oral sex. I think people really don't know what's happening with oral sex, what they can be exposed, what they can't. There's also some stuff they can read about that. Then when they are protected, where they're wearing a condom, what are they still exposed to in terms of risks because, I think a lot of people just awesome that, "You know, I've got my condom. I can do anything I want as long as I have my condom on."

[Jenelle Marie Pierce]: Right. Excuse me. My allergies are bothering me. I'm trying not to sniffle on the podcast, okay? So, great questions and the thing is condoms will reduce a lot of the risks. They're really a great way. They're the only way to reduce both your chances of STIs and unplanned pregnancy together. I guess that's if we're talking about male and female partnered activities. That's your only way to reduce both of those potential risks and condoms greatly, very significantly reduce the risk of infection from blood-born pathogens. That would be your hepatitis C and HIV and syphilis as well as... syphilis can be transmitted via blood and the actual contact with the sores themselves, the fluids coming from the sores but often times, you don't see that as readily. That being said, condoms are great for that.

They do not though however... they will reduce the risk but, they do not entirely eliminate the risk. Actually, nothing entirely eliminates the risk unless you're being abstinent and that's the only safe sex. That's why we call it safer sex nowadays instead of safe sex because, there's no such thing as safe sex. There's safer but, they don't reduce hugely anyways, not nearly as much as the bacterial infections and the fluid-born pathogens. They don't reduce the skin-to-skin transmission risk. So if somebody has a genital wart or a herpes outbreak or molluscum on their inner thigh or something and you're still coming into contact with that because, the condom won't cover that area, you're still at risk of infection there.

Actually though, some of that stuff just depends on the infection we're talking about. People are really paranoid about herpes but, you can tough a herpes outbreak, not that this is what somebody wants to do. Just hypothetically, you can actually come in contact with it and if it doesn't have an entry point into the system, if it's not touching on a genital area where there are mucus membranes or it's not touching on an open sore or whatever. Like, I've put cream on my outbreaks and wash my hands and I don't have herpes all over my hands.

[Angel Donovan]: Right, right. Your fingers, things like, it shouldn't be a problem.

[Jenelle Marie Pierce]: It's not such a big deal there. Yeah, I mean they're just kind of being cognizant of washing your hands afterwards. If you're fingering somebody and you're worried about maybe you came into contact with something that you didn't touch or see or that you didn't feel. Yeah, condoms reduce your risk but, they don't take it away entirely. It certainly is a great way in which to mitigate that risk and to make it little bit less worry some but, you still want to have a conversation. If you really are super concerned about STIs then, you want to have a conversation about, "How often have you been tested or how many partners are you having protected or unprotected sex with." That might be relevant or maybe to you, donning a condom is enough in order to reduce your risk and then, you're willing to accept whatever else comes as a result and that's okay too. That's understandable and acceptable.

When we're talking about oral sex, a lot of people think that, "Oh well, I'm not having penis in vagina sex. So, I'm not really having sex. This is my safe way of reducing my chances of infection and pregnancy and stuff." Yes, oral sex will reduce your chance of pregnancy. You're not going to get pregnant that way however, there still is a fairly significant risk of infection from STIS, herpes being one of them. So, people who get cold sore which is most often or I should say, commonly cold sores on the mouth are HSB1 but, those can be transmitted to the genitals. If I have a cold sore on my mouth and I go down on a partner, I can give them HSB1 genitally. It's actually the most common form of genital infection in the UK right now of herpes.

[Angel Donovan]: People are being busy with oral here.

[Jenelle Marie Pierce]: Yes, which good for you guys! Across the pond, you guys get down. I'm on board. Good for you but, I think that there's this misconception that, "Oh, okay. Well, we'll just do this and then, we'll be safe," and then, people are getting shocked when all of a sudden, they have HSB1 genitally. It's more common right now in UK than HSB2 genitally. There are more new cases...

[Angel Donovan]: Interesting.

[Jenelle Marie Pierce]: ... of HSB1 genitally. We're seeing that way more and more too in the US here. So, it's like people don't realize that they're of the same strain of virus. They're in the same family. They're all the herpes family and they're very little differences. Herpes can be on any part of your body. It just so happens to live orally and genitally because of mucus membranes. We have mucus membranes in our mouth and our ears, in our nose, in the vagnina, it's all mucus membranes. The vuvla I should say and internal and the vagina has mucus membranes and inside the urethra is mucus membranes.

What mucus membranes are, it's a porous material intended to trap unwanted pathogens and it's intended to trap it. Then, your immune supposed to attack it and get rid of it before it enters your system. However, because it can't combat these STIs, it's porous and it traps the infection and the infection goes right in. So, any are that you expose a mucus to an infection, that's your entry point. Any place that has that, that's where you can get infected basically. That's why you see HSV, herpes. You see herpes in the mouth and in the genitals most often because, that's where those mucus membranes are housed. I don't know if that got too technical?

[Angel Donovan]: No, no this is great information. This is the kind of clarity that's needed. So, thank you very much for that.

[Jenelle Marie Pierce]: Okay, good.

[Angel Donovan]: You mentioned syphilis in the sores. I can't remember. What I remember is that Mosa Dong [phonetically] got it and went crazy because, I lived in China for a bit. In terms of what it actually looks like, you said sores. It is similar to herpes or something? They get outbreaks and then, they go away again and then, they can come back?

[Jenelle Marie Pierce]: Yep, they can and syphilis is on the rise right now in the US. I want to say I heard that it was on the down swing in the UK. Syphilis is but then overall, STI rates are high, are going up. So, syphilis has gone down in the UK, up in the US but, yes. It is sores. The sores are quite a bit different. I would say that herpes yeah. Often times people will get a sore or two and then, they go away and then, the infection lies dormant for a while until it moves into a different stages. There's stage one, two and three of syphilis.

[Angel Donovan]: Yeah.

[Jenelle Marie Pierce]: The stage that you're talking about where people go crazy is stage three and one of the gangster in... Al Capone or something, I want to say is rumored to have died from syphilis too. Yeah, I'd have to clarify that but anyway, that's rumor. I guess it's irrelevant but, yes. Syphilis, it's transmitted both via blood as well as if you came into contact with the actual sore themselves. So, not just any genital fluid. You'd kind of have to come into contact with the fluid in the sore to transmit it. So, it's not super easily transmitted but, it is on the rise. I think just because, people just aren't... they don't feel like it's a concern for them. I just think, every time I talk to somebody.

I just had an argument with somebody in Staples the other day of all place. I have the weirdest conversations when I tell people what I do for a living and people want to talk to me about it every where I go. I was literally in Staples, trying to get a wireless router and the guy was telling me his story and he said he was clean for all things and he had been tested for everything. I told him, "You can't actually be tested for everything." "Oh yeah," I mean he argued with me about it. I'm like, "No, you don't understand. Let me break it down for you." That to me shows how pervasive the lack of knowledge is, the stigma about STIs are. It just speaks volumes to how much work needs to be done and how we're falling short in terms of education.

[Angel Donovan]: Yeah, it's a combination of misinformation and fear, right?

[Jenelle Marie Pierce]: Yes.

[Angel Donovan]: We like to avoid things. Everyone's scared of STDs. No one like them, right?

[Jenelle Marie Pierce]: Totally.

[Angel Donovan]: Especially, given the media attention and the way it's portrayed. So, anything that we're kind of scared and where there's tons of misinformation. Like I said, if you Google it, it's really hard to get a yes or no answer or any clear information. So, it just spreads confusion and then, I think people run with the most common stories that are past between friends or something. I don't know what the base source of information.

[Jenelle Marie Pierce]: 100%. It's weird because when you think of it, we don't seem to be afraid of like the cold and the flu. Nobody wants to gets sick. Nobody wants to have the cold or the flu but, nobody goes like, "Okay, which door handle did I touch that had the infection? Which bathroom did I forget to wash my hands long enough in?" We don't trace it back and try and find a culprit. We don't freak out. We don't hide in a corner. I mean, we don't feel like our life is over. Again, nobody wants additional infections or any kind of malady whatsoever but, I think it's because we're so afraid to talk about sex.

I mean, that's the interesting part is not only do people want to talk to me about STIs, when I tell them that run an STI website, they want to talk to me about anal. They want to talk to me about the kink that they were interested in and that they thought about and that they were like, "How do I talk to my partner?" Stuff that's really out of my realm of expertise but, it's obvious that people just need this resource and this outlet because, it's like everybody feels this way and I just want to tell people.

I have like some 800 or 900 friends or something on Facebook now and I literally do not know anybody anymore who has not had an experience with an STI. I mean, I've had people come out of the woodwork from high school. I graduated 16, 17 years ago now and I've had people reach out and it's always the same. They send me a message and they say, "Hey Jenelle, long time no see. I see the work that you're doing. I think it's great. I'd love to meet up with you for a beer sometime."

[Angel Donovan]: Yeah.

[Jenelle Marie Pierce]: I'm like, "Okay, sure." So, I meet up with them for a beer and then, they pour their hearts out and tell the story. It's always the same thing and I try to not to make assumptions about what to expect or anticipate. Like, maybe they just really do want to hang out. No, they want to tell me about some sort of experience, some STI, they're sex lives. I'm like, "Geez, we all feel this way. Everybody I know feels this way. Everybody has a story and wants to talk about it," but society has made us feel so guilty and so shameful. It's shame. They've made us feel so bad about our sex lives that anything that happens as a result of it is bad and doom and gloom. Then, it also inhibits us from finding that information and using our resources and our knowledge and stuff and asking questions. I know, I could. Obviously, this is my soap box.

[Angel Donovan]: Yeah, I'm being better at prevention and management if we had this information. So, it's super counterproductive.

[Jenelle Marie Pierce]: Super, exactly.

[Angel Donovan]: You just mentioned that STDs on the rise, I believe? Could you give us a bit of a trend? Has this been going on for the last 10 years? Is it specific STIs or what?

[Jenelle Marie Pierce]: This is what's interesting about that to me. The number of reported cases is on the rise. It's higher and that is a trend and that's been going up for the last few years however, like all statistics, there are more questions that we need to ask about this because, this is reported cases. So like, the reported cases annually according to the CDC, and this is in the US, are about 20 million new reported cases every year. At any one point and time though when you delve into these numbers, there's about 55 to 65 people who have an STI. So, there's 20 million new reported cases every year but, at any point in time, if we were to survey the general population, there's about 55 to 65 million living with an STI, whether short-term or long-term.

What that means is now, cases first of all, get reported to the CDC. Not all STIs get tested and/or treated and/nor noticed. So, we talked about earlier how the most common symptom is no symptom at all. Most people have no idea that they have an infection whatsoever. You would have to go and get tested at a place that does reporting and you'd have to have an actual physical test done. You couldn't get diagnosed visually and then, that would get reported if it was a non-physical, non-visual diagnosis. If it was an actual test that went to a lab and then, it got reported to the CDC, that's where that 20 million is coming from and that's where they're talking about there's been an increase.

Now, that could mean there's just been an increase in people getting tested. Are more people getting test? I would say probably not but, there is an increase in population naturally. Every year, population increases. So, there's going to be more infection. Unless we're really doing a good job at limiting and reducing the number of infections but, what I'm thinking is, we don't know if more people are getting tested. If there are just more centers and more accurate reporting going on. We don't know if it's just a population increase. We don't really know. The media will have you believe that, "Oh my gosh! Everybody is now infected with STIs.! Run for the hills! It's the STI apocalypse going on," but it's not that severe I don't think.

I certainly think that the number hasn't decreased which is interesting. With all the people working and there is a lot of work in sexual healthy and advocacy and awareness and stuff going on and there's more there even was five years ago when the STD project launched. So, it's obviously not making a huge impact but, when we think about testing, if you think about going to your local clinic, if you think about going to your doctor's office, it doesn't matter where you go. There's only about four to six at max... well four to six often, when you say, "I want to get a full panel. I want to get tested for everything. Test me for all of the things you can test me for," usually people only get tested for four to six infections.

Remember earlier, I said that there are over 30 plus infections according to the World Health Organization that are STIs. So if you're only getting test for four to six, there's all sorts of STIs out there that aren't getting tested, diagnosed and documented. The number is actually probably higher. Even the CDC's number, when they say 20 million and that number is on the rise, even in small print it says, "This number is likely much, much higher. These are only the reported cases," kind of thing. I don't necessarily think so. It doesn't crazy alarm me because, one it's a statistic and you have to look at the nuances and the details behind that. I'm curious if more people are getting test or are they just documenting more cases and what about all these undocumented cases?

[Angel Donovan]: Are more tests being done? Is there a wider range of tests? I find the whole testing area a bit of a mess also. I don't know about you. I've traveled a lot and I try to do it pretty regularly, every six months or so. I've done it many different countries.

[Jenelle Marie Pierce]: Sure.

[Angel Donovan]: ItÕs a bit of a nightmare every time I do it. HIV is normally relatively straightforward because, that one's such a big deal but, when it comes to all the other ones, like getting consistent types of test, getting the same types of infections tested for, I'm still trying to figure it out quite honestly. I just want to go. I'm London at the moment. I want to go and get a full stack of tests. I want to get a really comprehensive one and I don't think the NHS is going to help me with that. I went a few years ago to the NHS and it was really hard just to get the information out of them what I was getting tested for.

The NHS is the government health body here where you go to STD clinics here. I wasn't happy with those. I was like, "I need to find some proper full panel of tests if I want to really know what's going on. This isn't going to do." I haven't been through government testing in the US. I go privately, trying to figure out my panels and stuff in the US. So, I don't know what the situation is with the government ones there which are typically more accessible. I don't know how it is in the US but, in UK, I think most people are going to the government clinics because, they're accessible, they're free and all of this. Is that the same situation in the US or more people doing private?

[Jenelle Marie Pierce]: No, I mean most folks are going to go to your local health department or to a Planned Parenthood. Your NHS is similar to our Planned Parenthood, although even though, NHS for you guys is government funded and Planned Parenthood is private but, they operate similarly. They do similar stuff. Yeah, it's because it's low cost and/or free but, with that of course for the health department with that is you only get like four to six tests done. Like you said, you don't always get the same type of test done. Sometimes, they're updating and changing the type of tests they're doing all the time. That said, you're not getting necessarily... you can't get tested for everything under the sun anyways and you may not even be getting tested for as many things as you could be if you purchased a private test but, the private test are certainly not cheap.

We link to a couple of sites that we worked with and that I always specifically go through the testing process myself before we ever recommend anything on the STD project and there's one STD check of an STD test express that we work with. They have like ten different kinds of tests that you can do which is one of the highest number. I mean, that's the highest panel if you want to get the full panel but, it's $150 to $200 to get it done. Not everybody has that lying around, especially when you don't feel like it's a big risk and that's a huge concern. Not everybody will want to spend that kind of money.

You're right. It's not consistent across the board. It's certainly not consistent country to country. The UK tests for mycoplasma whereas the US doesn't. Mycoplasma is a bacterial infection that's fairly quite common and it's on the rise and the UK readily tests for it often times in their panels but, we don't test for it over here. The stuff that treats chlamydia and gonorrhea and trich will treat mycoplasma too. So, we're treating someone we think, " Oh well, it just kind of wraps up all in there," but if they didn't test positive for one of those infections and we're not treating them, they may still have mycoplasma and we're not doing anything about it.

Some of that's just kind of health standards across the board are not consistent. It's understandable too because, not all of the tests are consistent. There can be false positives and false negatives depending on which tests we're talking about. Like you said, HIV, you can get pretty commonly in those quick rapid tests and that across has been a lot of work done in the HIV realm. Still more work needs to be of course, always. When Charlie Sheen came out as HIV positive, it reminded me how much work needs to be done in terms of stigma and education and prevention but even so, I think that there's been a lot of really positive work done in that direction, specifically for that infection but the rest, it's like it's a crap shoot. You don't really know what you're going to get tested for. Most people just think, "Give me a full panel." They don't even ask what they've been tested for.

[Angel Donovan]: They just trust that it's all the same and it's going to be good. Basically, the medical testing, the labs aren't there yet. The technology's not really there. It's not super accurate, super sensitive all the time. It varies per test. So, you can get variations of more sensitive and less sensitive and yes, it's a mine field.

So, you recommended one panel for the US there that you worked with STD Express. How do you recommend people go about testing and when? If you have a like a testing strategy or I don't know which makes sense. If you get into a new relationship or when other good times? It's probably like an economical strategy. So, just depending on the lifestyle, say someone's going to be a constant dating strategy and someone who is just getting into a relationship. What are the different scenarios and different testing you'd recommend?

[Jenelle Marie Pierce]: Sure, I don't think STD Test Express operates in the UK but, your equivalent would be Better to Know is another private testing provider out there. They are out there but, like I said again, that's coming out of your pocket. Some of them, STD Test Express accepts insurance and some of them are starting to but again, it depends on what your insurance will pay too.

That said, if you're trying to be as sexually healthy and responsible as possible, on the one end of spectrum of being uber sexually responsible and healthy and really aware, you would be getting tested before and after each new partner. So, if you're having multiple partners and maybe multiple partners per week, you're getting tested probably four to six weeks. The reason why we say before and after each new partner and/or every four to six weeks, which that's a lot right but, it just depends on what your lifestyle is and what risk you're willing to accept but, that's because there's an incubation period and window period in terms of testing.

So, incubation period is how long it takes for you from the time you got infected to the time for you to notice signs or symptoms. The window period is the time you got infected to the time that your infection is recognizable on a test. Every test is different depending on what they're testing for whether they're testing for the actual infection or a reaction from the infection or whatever. So, to try and encompass this window period so that the test is accurate and is depicting an accurate result, then every four to six week. If you're sexually active and you have multiple partners and you might be changing out partners on a regular basis, I would say every four to six weeks. Again, then if you're doing something like that, you could go to your local health department and do the test that they offer for free.

I would say, my thought process is, here's the deal. Yes, there's all this risk. There's all of these infections you could potentially expose yourself to and anytime you're engaging in partnered sexual activity, there's some sort of risk. Instead of getting really freaked out or being too paranoid about like, "Okay, which tests are they doing? What kind of tests are they doing this time and did they test me for the same thing as they did last time?Ó I would say, kind of like you were saying that you did, every six months or so. Maybe every three to six months, you go in, get tested as often as possible. You also make a cognizant decision to choose whether or not you'd like to use barriers regularly. Maybe you always use barriers if you're doing penetrative sex. Maybe you always use barriers for both oral and penetrative sex or maybe you also incorporate lube. Lube also reduces your risk. It reduces your risk of friction and that reduces the risk of the tiny cuts and tears. So, that's also a safer sex approach.

Maybe you decide to incorporate a couple of these and then at the end of the day, you say, "You know what? I'm going to accept the rest of that risk. I'm being as responsible as I can within my budget, within the lifestyle choices that I'm making. I'm deciding what's going to be good for me and then, I'm going to choose what risk I'm willing to accept and go from there." I think that that's the most practical way of viewing that. It is important to know what you're getting tested for and I would still ask that and maybe write it down or just keep it in your mind of what you're being regularly tested for.

[Angel Donovan]: Or just keep the records, the reports so you can refer back. If something happens later, you can figure things out but, if you don't know what you were tested for last year and if you ever do come up with something, that might be useful information.

[Jenelle Marie Pierce]: That's true, yeah. If you do want to pinpoint and sometimes the thing is, is because they stay dormant and because you may have had a false negative, you may never know exactly who it came it from or what time period it came from. I would say that that's probably the least important aspect of when someone gets diagnosed. That's usually the number place they go. Like, "Who gave it to me and why? They didn't tell me," and all of this. I understand that train of thought. It's just not productive. It's not productive to moving forward and being responsible and getting on with your life, basically.

[Angel Donovan]: Cool, so if you're getting into a relationship scenario, is it worth maybe getting a fuller panel? Assuming that it's going to be a monogamous relationship for a while, it's worth investing a bit more money, getting it done properly.

[Jenelle Marie Pierce]: Yeah, I would say so. I mean, why not do that as a date night? You know, go out and then, have a beer afterwards. Like, "Cheers to us and our sexual health." You can make it kind of a fun thing. You can make it kind of... I mean, some of that stuff is awkward no matter what you do a little bit because, you're not used to doing it but, why not do that together and make a commitment and be on board, commitment specifically. I'm not saying you have to be monogamous but, a commitment to your sexual health and to being responsible and to caring about one another's health. Saying like, "Hey, I care about you and me and I want us to feel good about our choices. So, let's go do this and then, we can celebrate afterwards and have a pint or whatever." I'd like see more people do that. It doesn't happen. I mean, it just doesn't but, I would love to see the tide change a little bit.

[Angel Donovan]: Yeah, I think it's that the people aren't used to the conversations yet. They're quite shy of the conversations. I agree with you. It can be a bonding experience.

[Jenelle Marie Pierce]: Right.

[Angel Donovan]: Going through that together but, it has to be brought up in the right way. It's easy to offend people and it depends on the type of person you're talking to as well. If they're already on board and they're already responsible, then they'll be like, "Yeah, yeah sure. Let's go."

[Jenelle Marie Pierce]: Totally.

[Angel Donovan]: "It sounds like a great idea. I've never been with my boyfriend before. Finally, I get to go and do it together." It depends on the person you're talking and where they're coming from. If they're concerned about you're accusing them or something. You have to be very careful about that. Like, "I'm not accusing of anything here but, I'm just somebody who's really responsible about my health. It's something I do routinely. I think we should talk about this since, we're hanging out and we're doing this.

[Jenelle Marie Pierce]: Right, exactly.

[Angel Donovan]: Yeah, thanks for that testing information because, it is a little bit of a minefield there. So, I'm sure that's cleared up a bunch of stuff for people. Now, kind of moving on a bit.

One thing I wanted to just go on because, I guess we didn't pinpoint it was like you did mention kisses and getting stuff. I don't want people to be thinking, "What am I going to get from kissing?" What can we get from just kissing?

[Jenelle Marie Pierce]: Well, you can contract herpes, the oral kind. Like I said, the oral kind can be transmitted to the genitals later and vice versa. Kissing is probably the least concern I would say that people are going to have, especially when there are no open cuts and tears in the mouths. There's no sore or anything like that. Really, herpes is going to be about that.

Mono, mononucleosis. Mono is common in teenagers and in high school and things like that. Mono is just a virus that eventually your body, as long as you're not immunocompromised again, your body will clear up on it's own. It takes a couple of weeks and it makes you feel sick like the cold or the flu. Yes, mono is one of the risks in kissing.

Cytomegalovirus is another virus. CMV, you see it in babies and young children too. It can be passed from mother to child but, it is very uncommon. CMV is uncommon. Mono's common but, clears up on its own. Really the biggest concern for kissing or making out with somebody would be herpes, would be HSV1 and/or somebody had HSV2 orally which is possible too. HPV, I guess should say HPV potentially if somebody already has HPV orally is a risk but, it's not as common as HPV genitally.

[Angel Donovan]: Right, right. Okay, cool. Actually another thing, just on the herpes on the mouth, on the cold sores or mouth herpes, if you Google that it says like 98% of people have it. I'm sure what to believe. Have you got any solid information on that?

[Jenelle Marie Pierce]: On the number off the top of my head, I want to say it's 80% of people have it but actually, I'd have to clarify that. So, don't take that from...

[Angel Donovan]: Right and then, they don't necessarily ever get a cold sore?

[Jenelle Marie Pierce]: Yeah, totally. Right, not everybody even who has it orally gets cold sores. They just carry the infection. Their body is fighting off the virus or the actual physical signs and symptoms. Yeah, that's the same for both oral and genital herpes. The majority of people are asymptomatic. They don't have any outbreaks. So, they don't know that they carry the virus.

[Angel Donovan]: Excellent, thank you. What are the implication of say... we've kind of dealt with prevention quite a bit here but, if you have already got one or you catch one, how does it impact your life? If someone just discovers that they have one of these, what's the first line of advice?

[Jenelle Marie Pierce]: I'd like to say, "Don't freak out, " but they're going to. I mean, that's just what's going to happen because, that is what happens right now. My first line of advice is to educate yourself, to do your research and to find out just the factual information about the infection itself and how to manage it. Then also, what helped me and I really encourage others to do is researching the stigma and the origin of stigma and why that prevails, where it comes from because, what the implications of an STI, the hardest part of being diagnosed with a STI is not the infection itself. It never is. Often times, there are no signs or symptoms or it goes away or it's manageable or treatable.

Whatever it is, it's not the actual infection and the physical ramifications. It's the social stigma associated with it. You just feel awful, like you're damaged goods and you're tarnished and you're dirty and trashy and all of these things that you immediately embody and think this is all you and it's not. It's not actual relevant and has no bearing on your character and what kind of person you are whatsoever. Everybody, all walks of life, people from every angle and every corner contract infections.

So, understanding though that stigma. Why it prevails and understanding where it originates and why it continues, I think helps you to not take it so personally. It helps you to understand, "Okay, I get where this is coming," because I've heard everything. I've heard every slur, every name that you could call somebody with a STI. I've heard every rude comment and at this point, it's kind of a non-issue. It doesn't bother me. It's a non-plus because, I realize that it's just a reflection of their lack of information. It's a reflection of what they don't know and don't understand about how common STIs are, how little they really have an impact on your health and your sex life and your dating and all of that.

Yeah, to me, I know better than to take it personally but, I didn't for the longest time because, I really just felt like, "Well, if that's what everybody's saying, it must be true about me." I think that education is what it takes in order to empower yourself and to move forward with that. To know better than to just listen to the malarkey that's going on.

[Angel Donovan]: Right and of course, your site's a good place to get started. We'll put all of those links in the show notes.

[Jenelle Marie Pierce]: Cool.

[Angel Donovan]: That would probably be the first place to go...

[Jenelle Marie Pierce]: Yeah.

[Angel Donovan]: ... to start getting your education.

[Jenelle Marie Pierce]: And don't stop there. Find additional resources and empower, educate yourself that way. We certainly are not the end-all be-all, that's for sure.

[Angel Donovan]: The other tricky thing I think for people is communicating about it. You mentioned a little about how you tackled it a little bit earlier but, do you have some specific advice. I'm guessing you should communicate up front but, I think for listeners, it really helps when you've got some concrete examples and stuff on how to bring this up, how to talk about it. Maybe things not to say when you're talking to a partner. When to bring it up? Is it on the first date? Is it while you're Tindering them or you know, at what point do you bring this up and have this conversation?

[Jenelle Marie Pierce]: That's a good question. There is two schools of thought when it comes to disclosing to a new partner. You can either tell them right up front, right out the gate. You can lay all your cards on the table and say, "Here it is," before you ever even like on Tinder or on your Match profile. You could do that if you want and the idea behind that is that at that point, you won't have developed a relationship and attachment to the person. So if they choose not engage in a relationship with you or pursue you, it won't break your heart. That's the kind of idea behind that.

Of course you always want to tell people before putting them at risk. So before engaging in any partnered activities, you have to disclose to your partner. That said, I've never told anybody right from the very first start because, to me nobody tells everything, every personal detail and secret and every little nuance about them on the first date. That would be weird. That would be like verbal vomit of, "Here, let me tell you all the things like I have a halitosis and I have stinky feet or my mother never stops calling and I have a brother in jail. I don't even know anything. I have a problem with money and really bad credit." I mean, people just don't go on and on about all of these things that may not really be relevant to the relationship but, that may change someone's initial opinion of you. We don't share all of those things all at once.

To me, that's one of the areas. If we're not having sex or engaging in sexual activities, I don't necessarily need to tell you right out the gate. That's been my approach because, I wanted to establish some trust before disclosing this very personal information about myself to someone but, I understand the putting it all out there, right out the gate. I'm the spokesperson for Positive Singles which is a dating site for people with STIs and the intent behind that is like if you're petrified of having to tell a new partner then, this a great way to get your feet wet again and get back into the dating realm because, at least they'll already know about your infection. I mean sure, there should be still other sexual health conversations but, at least that part of the conversation is done.

That said, if you are having to tell someone or whatever way you're going about it, when you first have to. Like, how to tell a partner, that's one of the number one questions we get asked on the STD Project is how am I going to have this conversation with someone? I would say, you asked about don'ts. I would strongly urge if you can help, I didn't always do this though because, I was super emotional about it initially but, I urge to not be uber emotional, to not bawl like a baby and freak out. That's going to be hard if you're very shy or still very new and you're super emotional about it but, I feel like that kind of rubs off and it portrays a doom and gloom. "Oh my gosh. If I'm freaking, then you probably should freak out too."

It's more like a matter-of-fact practical approach. It's what I like to encourage. A finding a time that is a safe space for that person. A time and place that's safe and quiet and is not a public place so if they do have a reaction that's adverse then, they don't feel like they're on the spot and that they can't actual be genuine because, they're in this public location. There shouldn't be a bunch of other people around and things like that and distractions so that they can't think it through.

Often times, for me that's worked out in their home. Like, I'd go and pop over to their house and say like, "Hey, I want to quick to talk to you about something." I'd show up, sit them down, let them know like, "Okay, so I want to talk to you about sexual health and I need to let you know that I have genital herpes. I was diagnosed when I was 16," and I share a little bit of my story. You can share as little or as much as you want. Then, I also follow that up with some additional, just some quick factual information about how common it is and what the real risk is if we were to choose to engage in partnered activities. Then, I encourage them to do their own research too. Like, "There's a lot of resources on line. This is a really good website to go to," and I might spout off a site that I like the best. Then, I try and leave.

I make it clear that I want to know that this choice is up to them and how they feel about it and I'm happy to answer any questions but, I would respect their decision in either direction. If they just felt like we couldn't move forward in the relationship at this point, that would be cool. I understand or if they needed some time, I wanted to give them some time to kind of think about. It's as short and sweet as possible, like a 10-, 15-minute conversation, provide some information and then, give them some space to think about it, to do some research and then, go forward. Then, come back and follow through with any questions if they have any. Simple, kind of to the point, open, understanding and empathetic for whatever decision they make and then, see what happens.

At the end of the day, no matter what though, for the folks who are doing this, whether you tell them up front, right from the start, whether you tell them after you've had a couple of dates and before you think you're going start doing some sexual stuff with them, no matter how you're doing it, don't take it personal. Their choice is not personal. It's really a reflection of what they know and where they're at and what risk they're willing to accept and somebody else will move forward. I'm a good example. I've literally never had anybody say I don't want to be in a relationship with you as a result and so many people who come to my site say the same thing. There have been people who've told me stories how they were rejected as a result and that may happen but, it's not personal. It's not a reflection of who you are, your value or anything like that.

[Angel Donovan]: You can feel good about yourself. You can live with integrity. Otherwise, you're going to feel guilty about it and this goes for guys and girls. It's exactly the same as your situation. I know guys who have STDs and they haven't come across situation where they're being rejected. I think one of them one time was not really harshly rejected or anything. It was just kind of a turn down. "Oh, sorry." As you say, it depends on the people you're talking to and everyone's different and has their different risk assessment and so on. So, it's nothing to be afraid of.

I was thinking about your emotional point. That's great instruction you gave, by the way. The point about not being emotional about it. I think it's probably important for them to have spoken about it before whether it's with friends, ex-girlfriends or maybe posting. You have an anonymous posting of STD experiences. Basically, getting it out there. Not waiting until it matters to make this the first time you're going to... like say you meet the girl of your dreams. You've got to tell her, "You know, I've got an STD and it's this type," and everything's on the line for you. You don't want that to happen. You want to be able to just feel comfortable of talking about it because, you've done it many times before. I think it's a really good idea just to get comfortable about talking and being more open about it.

I was at conference a few months ago. It was nothing to do with dating or anything and there was a young guy talking through his dating problems. The girl next to me, one of the girls I've been hanging out with, she just said, "You know, I have herpes. It's not a big deal. I had it on my mouth. I gave a blow job to my boyfriend. He got it and then, he gave it back to me. It's no big deal." She was really open with it. That's happened to me a few times in the last year. So, I think people are getting more mature and open about it. It's someone I'd only known for a few days at the conference. It wasn't like we had a big trust relationship or anything. So, I think there are people getting more mature about this.

You see other communities like the polyamory community and I think, also to an extent, the kink. They're a little bit more responsible about it. They're also obviously taking more risks so, they kind of have to be but, I think they tend to have more conversation about it and there's more communication about it also.

[Jenelle Marie Pierce]: Yeah and I would even counter that. I actually feel like those communities that you mentioned, they're taking fewer risks in that they're communicating. Part of a healthy polyamorous and a part of a healthy BDSM relationship requires extensive communication upfront and during and all throughout that relationship. That said, it's inherent in being less risky is communicating what you're willing to accept, what you're expecting in terms of safer sex, what you would like out of a partner and how you feel about that. All of that to me I think is part of being sexually responsible.

At the STD Project, we like to talk about sexual responsible instead of sexual health because, I think a lot of times, people assume that sexual health mean without infection. You can be sexually healthy and responsible and have a STI. Those things aren't mutually exclusive and to me, sexual responsibility is understanding what those risk and like you said, deciding what your risk assessment is and what you need to do in order reduce whatever risk you're concerned about and then, going forward with that.

I love hearing that that somebody was just chatting about it kind of like everyday conversation. It should be every day conversation or at least within our close circles. Like not everybody talks about their sex lives with random strangers and that's fine but, at least within your friends or close family members, your sister or something. Whatever it is, I just think we should be having these conversations a little more often to make it feel less of a freak out, less of this is the end of the world kind of thing because, it really isn't.

I always say, nobody wants an infection, a cold or flu of any kind of any sort of issue but, our bodies are resilient but, they're not infallible. This is a product of human life. This is a human experience, infections are. Not necessarily that every human has to have an STI but, there are risks in everything we do. When I go down the road and drive to work, I get in my car, I put on my seatbelt, I was my blinker, I look behind me before I change lanes. I do things to help reduce risk.

[Angel Donovan]: You don't look at your phone.

[Jenelle Marie Pierce]: I don't look at my phone.

[Angel Donovan]: Too much.

[Jenelle Marie Pierce]: Too much, very often right. I don't Snapchat while I'm driving at least. Yeah, I do things intentionally to reduce the risks but, I don't stop getting in my car and going to because, I want that paycheck and I want to go to work. So, the reward is worth it. I just take other considerations and I take other risk-reduction approaches. That's the same thing I think about this sexual responsibility is. You do whatever you feel is necessary in order to reduce your risk and don't settle for anything less. Then at the end of the day though, if you do contract something, it's not this, "Who gave it to me and it's all your fault." "No, I mean you understood your risk. You were being responsible. You're being thoughtful about it and you chose to engage in those activities too. So, move forward and let's roll along together." That's my soap box again.

[Angel Donovan]: That was great. Great, thank you. Someone just opened my door as well. So, that distracted me. Are there any common misunderstanding about STIs that we haven't discussed or popularized myths, Basically, are there any big things you think we haven't covered?

[Jenelle Marie Pierce]: No, I feel like we touched on so many. That really is the one I wanted to talk about was the testing, that you don't get tested for everything. So, when we happened to end up naturally talking about that one, that was one I put on my list. So, that would be my biggest thing, to know. I would say if somebody says, "I've been test for everything. I'm clean." If they use the word "clean", there's no such thing. Like cleanliness and hygiene has nothing to do with STI transmission anymore and really, it has very little to do with the overall infection in a first world country anyways nowadays. That's fairly irrelevant and it speaks volumes to someone's lack of information about the subject. That to me would be a yellow flag. If somebody says, "I've been tested for everything," then again, that's another yellow flag. She can't be tested for everything. That speaks and shows their knowledge.

I would follow that through. It doesn't mean, don't engage because, the majority of people are going to say that quite honestly because, the majority of people have very little information about this but, I would that that then tells you to have an additional conversation. To think a little bit through that and maybe decide to open up that conversation and build some intimacy there with that knowledge. That would probably be my last addition.

[Angel Donovan]: Thank you. One point I just thought of I wanted to bring up. I've been doing protected oral and penetrative sex pretty much since I was 17 or 18, a very long time. Oral a bit later because, I didn't understand the implications. I think it was about 10 years or something I've been doing the oral. What I noticed is for the oral in particular, I'd get some push back from the girls. They'd be like, "Are you kidding?" I've had all sorts of comments when I say, "No, wait. I've got to put my condom on first before oral sex." Their eyes go big and they feel like they're being accused of something because, there's probably no other guys that's asked them to do that. So, I just wanted to bring up the point that you kind of get this negative social pressure in some situations. Where some of things we've spoken about today where there's myths and it's not so common and stuff, you can pretty much expect that you're going to hear some kind of remark or something because, the other person's not used to it. You might have to introduce it beforehand or softly or just be ready to like receive some kind of comment like that and then, explain it and just get on with it. They're fine afterwards but, I think it's a little bit of a shock to some people.

[Jenelle Marie Pierce]: It definitely is and I mean, if we're trying to change, it doesn't happen in a vacuum. In that sense, we have to understand that that's just not the norm but, the norm has resulted in such a plethora of STIs.

[Angel Donovan]: Right, so that's maybe not the best.

[Jenelle Marie Pierce]: It's not necessarily positive, right. Exactly so, if we want to change that and if we want to change the conversation, we're going to have to ruffle a little feathers and take people aback but eventually, the more we do that, the more that the opposite will be true. That will happen. It just takes some of our bold people being willing to have those conversations at first and having a thoughtful of approaching if somebody takes offense to it. That is certainly not offensive or it's intended to be. We're just trying to be responsible and the thing is, is it's not only like you're worried about your health. You're worried about their health too because that barrier for the two of you.

[Angel Donovan]: Absolutely.

[Jenelle Marie Pierce]: Right? You could have an infection that they don't want in their mouth and vice versa. So, it's not just you're worried about contracting genital herpes from their oral cold sores. I mean, it could go both ways and I think sometimes, that's what people don't realize is that it's mutual. It's a mutual health issue.

[Angel Donovan]: That's definitely the frame you have to bring it up under. You don't want to be like, "Hey, I'm protecting myself from you." That's not going to work. That's going to cause a problem, some kind of problem, definitely and it's going to stop any sex happening, I'm sure.

[Jenelle Marie Pierce]: Right, right. Exactly.

[Angel Donovan]: What are the best ways for people to connect with you to learn more about you and your work.

[Jenelle Marie Pierce]: Online is always best. I'm on all the social medias. Yes, definitely, through the website. I have a contact form there but, I'm on Instagram and Facebook, Pinterest and Snapchat, all of the things.

[Angel Donovan]: Excellent.

[Jenelle Marie Pierce]: Yeah so, hit me up, reach out. Yep, I'm always happy to chat and message with folks.

[Angel Donovan]: Alright great. So, we'll put the links as usual in the show notes for that and it's probably STD Project on searches as well, I guess?

[Jenelle Marie Pierce]: Yeah, The STD Project, yeah.

[Angel Donovan]: Who beside yourself would you recommend for high quality advice or knowledge in this area? Anything to do with dating, sex and relationships. Obviously, your specialty is STDs, if you know other people who's got great information in this area?

[Jenelle Marie Pierce]: In the US, the American Sexual Health Association is great. The National Collation for Sexual Health, the CDC for all of your clinical, real factual information and statistics. Planned Parenthood is phenomenal. NHS is really good too. They do a whole lot of helpful videos and just information and things about testing and stuff like that. If we're talking about the UK, those would be the first that I can think of that come to mind. The Center for Sexual Health and Pleasure, CSPH, I want to say is their great for all sorts of other kinds of not just like sexual health and STIs and unplanned pregnancies but, just orientation and communicating with partners and all of that. Yeah, those are the ones that come to mind anyways.

[Angel Donovan]: Great, thank you. What would be your top three recommendations to guys to improve their dating life as fast as possible?

[Jenelle Marie Pierce]: Oh, that's a really good question. Communication, I would say don't be afraid to communicate and talk about the things because, I know as well as they do that they have feelings, concerns and there's a lot of this stigma about men not caring and not having emotional needs and that's just inaccurate and not true and it's not my experience with any of the men I've ever been with. The more that I work with sexual health educators and things, the more I learn that it's just a feeling, a barrier feeling that they can't communicate about their needs and desires. I think that that helps build trust and intimacy. So, don't be afraid to communicate your wants and concerns.

Consent goes in both directions, right? So, we talk a lot about sexual violence and things like that in women but, it's important too for the man to communicate what they would like and what they are interested and then, at any point and time, you can revoke that consent. You can decide that it's not going to work for you and that's okay. So, communication I think would be number. Three more or two more? I don't know. I think that's one, two and three. Can I make that one, two and three?

[Angel Donovan]: Yeah, sure. Different types of communication.

[Jenelle Marie Pierce]: Communication.

[Angel Donovan]: That works. That just reemphasizes how important it is. Well Jenelle, thank you so much for your time today. It's been a really comprehensive look at it. It's the first time we've really done it with the STDs and STIs which is amazing but, I've been looking for someone to talk about it for quite a while actually and I struggled a bit. So, I'm glad to have found you and the information was the great. So, thanks very much.

[Jenelle Marie Pierce]: It's my pleasure. Anytime, any follow up or anything, I'd be happy to participate. So yeah, thanks for having me.

[Angel Donovan]: Great, thank you.