He’s dedicated his life to promoting positive sexual health and spreading the word about STI’s.

The following is a transcript of the conversation between Karl and Dr. David Malebranche.

DR. MALEBRANCHE
That’s one of those STIs that we don’t screen enough for.

KARL
Welcome to “Plus Talk” on “Plus Life”. We’re all about turning positive into a plus today. If I get an STI and I am HIV positive, is it the end of the world? Well, no, I don’t think it is. David Melbranch is here. Good to see you, Doc.

DR. MALEBRANCHE
Good to see you, Karl. How are you?

KARL
It’s not often I get to say you love talking about STIs but I think that’s a fair thing to say ’cause you quite enjoy sexually transmitted infections, don’t you?

DR. MALEBRANCHE
I enjoy sexual health and under the umbrella of sexual health we include STIs, both prevention and treatment. So if that’s how it is, that’s how it is.

KARL
Let’s dive into it. I’m living with HIV, I’m healthy and I’m undetectable. Am I at greater risk for STI as anybody else?

DR. MALEBRANCHE
I think when we talk about people who are living with HIV, people who have HIV, as long as you’re undetectable and your immune system is doing its thing, you’re on your medications, your risk of having complications from STIs will probably be comparable to someone who’s HIV negative. Now if that all goes out the window if you’re not on your medications, your T-cell count is low, your immune system is weak, you can suffer more complications because of that. But it’s really gonna depend on your geography, your sexual networks, the exact behaviors you’re engaging in. So it’s not as simple as saying that just because you’re living with HIV, you’re quote, unquote, “at higher risk for STIs than people who are negative.”

KARL
And those of us living with HIV are seeing our doctors more frequently and hopefully being offered or at least asking for sexual health screenings if we are being quite sexually active at the time.

DR. MALEBRANCHE
Right.

KARL
Are there STIs that I should be more concerned about than others?

DR. MALEBRANCHE
When it comes to STIs, obviously you have the common offenders, the gonorrhea, the chlamydia, the non gonorrhea bacteria that can actually cause urethritis in men, other kinds of cervicitis inflammation of the cervix for women. And so you have other bacteria like ureaplasma, microplasma that can cause similar kinds of discharge in that case. The good news with those things is that they’re treatable with antibiotics and then they’ll go away. You look at something like syphilis and different from gonorrhea and chlamydia, gonorrhea and chlamydia, if you’re engaging in condom use, either with anal, vaginal, oral sex, you can reduce the likelihood of you getting any of those STIs. However, with syphilis, with viruses like herpes and HPV, human papillomavirus, it’s transmitted by skin to skin contact as well. So condoms may protect you to a certain degree but not as much as they’ll confer protection from say gonorrhea, chlamydia or even HIV. And when I think about things that probably we don’t look at and if you look at same gender loving men, LGBTQ communities, HPV is one of those viruses that we may not pay attention to as much. Now for people that are assigned female at birth, people that have vaginas will go and get checkups regularly of their cervix and they’ll get cervical cancer screening. The reason why human papillomavirus is so important and particularly in gay men as well, particularly those who bottom or people who are living with HIV is because human papillomavirus can change the structure of the cells on the inside of the rectum and can be a precursor to anal cancer, anal and rectal cancer. So we actually recommend screening for people who are HIV positive for getting an anal pap smear. It’s not a blanket recommendation, it depends on the state, it depends on the governing body, it depends on the clinic and institution where you may go to how aggressive they are with screening for that. But that’s one of those STIs that we don’t screen enough for. On the flip side, if you’re looking at a virus like herpes, herpes simplex virus, there’s oral and genital. It used to be type one and type two. A lot of people tend to be exposed during herpes in their life, so if you do a blood test to see if you’ve ever been exposed, you’ll see a lot of people who have been exposed in their life. So it may not be the best screening test but for a lot of people what I tell you you should be getting, syphilis, gonorrhea, chlamydia at a baseline, also HIV obviously and then kind of depending on the context and if you feel you’ve been exposed then maybe you can get screening for herpes or if you have a breakout or have symptoms that you’re worried about a herpes. And then HPV, obviously if you’re living with HIV it’s gonna be a little bit more important or you have a history of genital or anal warts.

KARL
I will say I’ve had the HPV, the anal pap smear. Look, it’s not a glamorous procedure but it’s really simple. It’s not painful and it’s done in seconds and it’s a very important thing to do. So if you are someone, it’s seriously worth considering if you’re HIV positive and you should speak to your healthcare provider. Let’s talk about,

DR. MALEBRANCHE
Yeah.

KARL
there’s so many misconceptions and myths around STI because there’s so much stigma still associated much like there is with HIV. What about the thought of if I am exposed to syphilis or gonorrhea or chlamydia, am I at greater risk for HIV?

DR. MALEBRANCHE
The answer is yes and no. It depends on the STI. Certain what we call ulcerative sexually transmitted infections, those that cause ulcers on the skin, so you’re looking at herpes, you’re looking at syphilis, which can cause sometimes an ulcer that’s caused a chancre on the mouth, on the penis, those kind of things that of course when the skin is broken you have easier access into the bloodstream. So HIV is the virus that has to get into the bloodstream to establish an infection, that’s gonna pose a greater risk for that. So it works actually bidirectionally as well. So if you’re living with HIV, you’ll be at more risk for STIs like that. And then if you’re actually just have the STIs and then are engaging in behavior that could get you HIV because of those ulcers that could be on the inside of your anus, your vagina, your mouth, then you’re at higher risk of contracting HIV. So it can work in both sides.

KARL
What are sort of three key things you want everyone, everyone, not just those living with HIV, but everyone to think about when it comes to STI and sort of general sexual health?

DR. MALEBRANCHE
One, I would say have the best sex of your life. Enjoy it. One of the words we don’t use with sex when we talk about sexual health and STIs is pleasure. And I wanna remind people that probably the predominant reason, you see I’m throwing a lot of P’s for alliteration there, a lot of the reasons why people engage in sex is because of pleasure. So enjoy your sex. I also don’t use terms like, number two I guess I would say I don’t use terms like risk. I say that people should know what kinds of things they can be exposed to if they engage in certain behaviors like oral sex versus vaginal sex versus anal sex or versus just skin to skin contact. Know exactly what behaviors can transmit certain STIs and then you judge for yourself what you’re comfortable doing knowing the quote, unquote, “risk” that may be carried with these other things. And then I’d say, I think the third thing I would say is that not all sexually transmitted infections present immediately with symptoms. And that includes HIV. So and that includes actually gonorrhea and chlamydia when it comes to if you have gonorrhea or chlamydia in your throat, you may not have a sore throat. If you have gonorrhea or chlamydia in your rectum, you may not have anal discharge or anal pain or any kind of symptoms back there. So it’s an important, particularly for people who are living with HIV to go and when you get your STI screening, particularly for gonorrhea and chlamydia, don’t just pee in a cup, have them swab your throat, have them swab your ass and make sure they’re checking for all three sites. If you don’t check all three sites, there are research studies that show you can miss up to 70%-80% of gonorrhea and chlamydial infections if you only test the urine for those bacterias.

KARL
And this might be a tricky one. Guideline to how frequently someone living with HIV should consider getting a full sexual health screening.

DR. MALEBRANCHE
Yeah, I think it’s fairly similar to someone who’s not living with HIV, right? It really depends on your behavior. I tend to stay away from making generalizations about what people’s level of sexual activity is. So obviously if you have different sexual partners, some of which you may know really well, some of which you don’t, I would say every three months is reasonable. For some people it’s every six months. There’s no blanket recommendation that will cover everybody on the face of the planet. I think you have to gear it by some of the guidelines which could say every six months to maybe at least once a year you should be checked for HIV and other STIs. But according to your own sexual behavior, it can be less frequent or more frequent than that.

KARL
And there is no shame in asking for a sexual health screening. Don’t be ashamed to do it.

DR. MALEBRANCHE
You shouldn’t have shame. No, now it’s a different thing if the medical provider or clinician that you’re seeing decides they wanna shame you or stigmatize you, but you should walk into those clinicians offices fully armed and confident and don’t feel ashamed at all to ask for the test that you want. KARL
Yeah, well said. And that’s a whole other topic of conversation for another day. Dr. David Melbranch, good to see you my friend. Thank you very much for making the time.

DR. MALEBRANCHE
No worries, Karl. Thanks so much for having me.

KARL
That’s gonna do it for this episode of “Plus Talk”. You want more information, check out the website pluslivemedia.com and you can follow us on social media. We are @PlusLifeMedia. If you’ve got questions for the doctor, ping us, let us know and we’ll have him back soon to answer them. Thanks for watching. Bye-bye.