[Question #5551] Stopping the stigma and miss-information.

22 months ago
First thank you for this site and service. I think it will help with the stigma and in dispelling the myths. Id like to note that comedians, tv script writers and screenwriters often make jokes about Herpes that they would not make about HIV/AIDS or Syphilis or any of the other STIs.   I am in support of and consider the HPV vaccine a great primary prevention aide - but believe that sometimes fear instead of sensible information is used to sell vaccines. With that being said. I really would appreciate you looking at a very short clip of an  "educational video" that rebukes a certain group of the population for spreading STDs.  I think it's misleading and  uses fear via grotesque pictures. But what is most concerning to me is-  I'm not certain the pictures used are accurate.  If they are-I think they should be put into perspective. The video has been viewed over 3million times and endorsed by legislators, religious leaders and other non health care professionals. This again, is a cropped clip from the video. 

https://ytcropper.com/cropped/4g5d086e922b4a8
1. Are the pictures accurate?  If they are how common is it to get them near the mouth and on the lips?    Can HPV ,genital warts, or HSV  be transmitted by fomites? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome to the forum and thanks for your unusual question, and for your kind comments about this forum.

The link shows a very curtailed video, a repeated loop about 6-7 seconds in duration, with two photos, one showing apparent oral warts and the other showing skin lesions of secondary syphilis around someone's mouth. The second photos is very familiar to me and most STD experts, I believe originating from CDC but now pretty much in the public domain; it has been shown thousands (millions?) of times on various websites, publications, etc. To my recollection, I have not previously seen the first image of oral warts, but I imagine that the creator of the video also found it on a publicly available site.

The syphilis photo is not atypical at all. Oral warts are uncommon, so showing that particular image may be misleading if not accompanied by other, more typical warts, genital or otherwise. So I have not seen enough video to comment on how biased the entire presentation might be. HSV is not transmitted by fomites, and HPV probably not -- or at least so rarely that exposure to HPV on fomites or otherwise in the environment should not be a concern.

I agree with your general comments about "educational" materials, on the web and elsewhere, often being biased and stigmatizing. That said, for the most part this is not controllable:  as you likely know, anyone can post pretty much whatever they want on innumerable online sites. What we can and should expect, however, is that public and professional agencies and organizations (CDC, state and metropolitan health departments, academic agencies, and so on) do their best to present information in unbiased, non-stigmatizing form. I believe most such resources do this quite well. The main online resources on STDs and HIV to which this forum's moderators refer our own patients and forum users are CDC (www.cdc.gov/std, www.cdc.gov/hiv), the American Sexual Health Association (the sponsor of this forum, www.ashasexualhealth.org), and Terri Warren's own website that emphasizes genital herpes (https://westoverheights.com). There are many other accurate, non-biased, non-stigmatizing resources. We generally advise not using websites run by commercial enterprises and sites run by and for people with certain conditions (e.g., herpes or HPV) if not professionally moderated. Some such sites are good, but it's hit or miss and viewer discretion is advised!

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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22 months ago
I agree with this statement "...public and professional agencies and organizations (CDC, state and metropolitan health departments, academic agencies, and so on) do their best to present information in unbiased, non-stigmatizing form. I believe most such resources do this quite well. The main online resources on STDs and HIV to which this forum's moderators refer our own patients and forum users are CDC (www.cdc.gov/std, www.cdc.gov/hiv), the American Sexual Health Association (the sponsor of this forum, www.ashasexualhealth.org), and Terri Warren's own website that emphasizes genital herpes (https://westoverheights.com)."

My concern is that many individuals dont know to go to these sites and a video viewed 3 million times and supported by non experts could do more damage than good. I also agree we can not go about policing the internet for  dis- information -I don't do that.  Everyone has the right to post anything that fits their opinion.  However, If we are sent things that seem misinformed we should check them- one of the reasons stigma persists is that no one does the checking and no one redirects indiv. to proper sources.  I thought one way to "check" is to ask an expert.  I don't consider it unusual just thinking a bit more globally.   What impact might this video have on anyone viewing it- whether they have the issues described or not?  This is a public video and it's views can be verified.
Thank you for confirming the veracity of the photos and offering a bit more perspective on it. I will also further check out those sites.    And I understand you cannot comment on the video as a whole. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
I agree with your concern that many people are not sophisticated in their online searching methods or standards, whether about STDs or anything else. And certainly it is true that checking with an expert is a good way to resolve uncertainties when initial information is not credible, potentially stigmatizing, etc.

I also should clarify my comment about the syphilis photo. Such prominent skin lesion on the face are uncommon, so this could be considered an atypical illustration. And perhaps some would consider use of an obviously African American visage to be prejudicial. Of course syphilis occurs in all races and ethnicities, but in the US, the large majority of syphilis patients are caucasian (reflecting the demographics of men who have sex with men, who are more often white than black).
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