Introduction
Beginning with a Bang
Sometimes life’s unhappy accidents inadvertently lead to happy consequences. Strange Bedfellows represents the silver lining in a dark cloud that descended on my family in January 2015, when my husband and I experienced a parent’s worst nightmare. As we walked out of our house on our way to a birthday party one afternoon, my seven-year-old son, Nate, released my hand and bolted across the street, only to be struck by an oncoming car.
I recall seeing his legs splayed underneath the vehicle and hearing his screams echoing down the street. I, on the other hand, did not utter a sound. This was no longer my son lying on the street—this was a trauma victim who required attention. I ran over to him, silently reviewing the algorithm that was ingrained in me from years of medical training: Is the patient’s airway clear, are they breathing, do they have a pulse? While Nate’s head was bleeding and his leg clearly deformed, his screams afforded an odd sense of relief: he was breathing, conscious, and coherent while expressing his pain.
Nate and I were transported by ambulance to UCSF Benioff Children’s Hospital in Oakland, where he was admitted to the pediatric intensive care unit (ICU) to await surgery on his broken femur the next morning. Nate had also sustained a skull fracture, so as a precaution, the ICU nurses checked on his neurologic status every two hours. They needn’t have bothered. I kept vigil at his bedside the whole night, too wired by guilt to fall asleep.
The next morning, before 7:00 a.m., four members of the neurosurgery team came by on their rounds. The attending neurosurgeon started questioning Nate to assess his mental status: his name, his age, his grade in school. Then the surgeon glanced over at me. “Mom, I understand that you’re a physician?”
Before I could speak, Nate interjected, “Yes, she is.” Then out of nowhere, he added, “Hey, have you ever had herpes? Ask my mom—she knows all about it.” I shook my head and closed my eyes, lowering my forehead into my hand. The team erupted in peals of laughter. The surgeon raised his eyebrows and looked at me. “Well, seems like he’s clear neurologically.”
Nate’s accident happened to coincide with his realization a few weeks earlier of what I did for a living. Not just that I was a physician but one who happened to specialize in sexually transmitted infections (STIs). He had never talked about my job with others before this hospitalization, but he soon grasped that mentioning it would get a rise out of anyone. And he was going to milk it for as many laughs as he could.
During the hospital stay, Nate proceeded to chat with the ICU nurse about HIV, the orthopedic surgeon about syphilis, and to my chagrin, with the hospital chaplain about chlamydia. I would discover later that this behavior is a common phenomenon among the children of my colleagues. My boss’s daughter wrote her college admissions essay about syphilis conversations over Shabbat dinner, while her son told his friends’ parents that “my mom works in the sex industry.” She’s the chief of the Division of STD Prevention at the Centers for Disease Control and Prevention (CDC), but I suppose that’s close enough.
As I watched my son’s antics from his bedside, seeds of thought started to germinate in my mind. At the time of his accident in 2015, I had been working in the field of public health and STI research for eight years since completing my residency. STIs such as syphilis, gonorrhea, and chlamydia had been on the rise since 2000. Infections such as human papillomavirus (HPV) were so common, nearly every sexually active person would be infected at some point during their lives.
But even with the ubiquity of STIs, I knew that most people (even health care providers) simply don’t feel comfortable discussing them. For most of us, having sex is much easier than talking about sex, especially its least pleasant consequences. Yet my son and colleagues’ children had no problem talking about sex and STIs. They had become comfortable with the topic before they were old enough to realize that it was an uncomfortable subject for others.
During hours of downtime at the hospital with my son, I began to wonder if there was something I could do to make people more at ease discussing STIs. I knew I couldn’t be overly ambitious. Some people have a hard-enough time discussing STIs with their sexual partners; I couldn’t just expect them to bring up the topic with their mail carrier or local barista. Still, if I could spark a larger dialogue among the public about the topic, perhaps it would begin to reduce the stigma behind these ubiquitous infections.
By the time my son was discharged from the hospital four days later, I had a plan: I would write a book that would weave together storytelling, science, and humor to tell the little-known backstories behind various STIs. I dreamed that people would become so entertained by these tales that the ick factor around STIs might gradually be replaced with a bit of wonder and fascination.
Had the accident not happened, I would have done the sensible thing and waited until my kids left for college to write a book. I would not have started the process with one newly invalid kid and another still in diapers. Still, there is nothing like a little trauma to provide one with a foreshortened sense of the future. The accident, in addition to an earlier brush with death that I’d had during childbirth, made me wonder whether bad karma from a past life had caught up with me. I decided I’d better get writing before lightning could strike again.
I soon realized that tackling STI-related stigma would not be easy. The shroud of shame surrounding STIs is as old as the infections themselves. To many, STIs are considered to be “God’s judgment for the sexually immoral and adulterous” (Hebrews 13:4) or punishment for fornication. And if STIs were a punishment, then by default, those afflicted with them should feel guilty. Never mind that STIs can afflict anyone, even someone who’s only had sex within the confines of marriage.
Despite the stigma, I knew there were fascinating backstories behind my favorite sexually transmitted bugs that might capture people’s interest. STIs have represented the interplay between sex and society as far back as the 1500s, when links between prostitution and disease outbreaks were first established. During the 1800s, prominent artists from Beethoven to Van Gogh suffered neurologic effects of syphilis that influenced their personalities and iconic works. More recently, STIs have played key but hidden roles in everything from World War II to the growth of the internet to The Bachelor.
STIs are also destined to remain part of our future. In 2019, the number of STIs reported by the CDC hit historic highs and are continuing to climb. The threat of multidrug resistance looms large for bacteria such as gonorrhea and Mycoplasma genitalium. There are viruses such as Ebola or Zika that we only recently discovered as STIs, which can linger in the semen for weeks or even months. Who knows what’s next? We can’t predict when another STI might emerge, but be assured—something is coming, and we’d better be ready when it does.
Strange Bedfellows is my attempt to explore the role of STIs in our past, present, and future. It is a journey that goes from the microscopic clashing of two human microbiomes during sex to the big picture of sexual networks, appreciating the influence that just a few players have over the sexual health of the many. We’ll meander through the twists and turns of real people’s sex lives and debunk common wisdom about STIs. You’ll meet my dear colleagues, a scrappy bunch of scientists and public health workers who have chosen to devote their lives to this field. Then I’ve thrown in the details of my own journey: the tale of a studious Korean girl who ended up spending her days between other people’s legs for a living. This book is a peek into my weird and wonderful world, and I hope you will love it here as much as I do.
Will shedding light on these hidden yet influential genital creatures help us defeat STI-related stigma? I don’t know, but we must start somewhere. We’ve managed to defeat stigma surrounding previously taboo subjects such as cancer, creating discourse and shifting public sentiment toward support rather than shame. We need a similar sea change around STIs to have any hope of curbing the current epidemic.
Fortunately, reading about STIs presents no risk of actually catching one. However, I suggest you read the rest of this book with your clothes on. Otherwise, I make no guarantees.
Author’s Note on Terminology: What’s in a Name?
“What’s in a Name?” was the title of an editorial written by my colleague Hunter Handsfield in the journal Sexually Transmitted Diseases in 2015, which raised an important question: What term should we use to refer to the dozens of sexually transmitted bacteria, viruses, and parasites?
In the United States, the term venereal disease, or VD, was in vogue before the 1970s. It was a term that implied that venery, or immoral behavior, was involved in disease transmission. The 1970s ushered in the era of sexually transmitted diseases (STDs), a term felt to be less stigmatizing than VD. We were happy with STDs for a while. But in the 1990s, there was growing recognition that some sexually transmitted bugs were silent infections that resolved spontaneously, meaning they didn’t cause disease (e.g., HPV). Thus, the term sexually transmitted infection, or STI, came onto the scene.
Today, there still isn’t consensus about which terminology should be used. While VD has fallen by the wayside, both STD and STI are still in use. Whether they’re called STDs or STIs, you probably don’t want either of them inside your pants. But if using STI helps reduce stigma, then I’m all for it. In fact, if something better eventually comes along, I’m prepared to throw STI to the curb in favor of another term.
All three of these terms are used throughout this book, because I wanted to preserve the language used by the people I interviewed or the names of organizations or programs, and reflect whatever term was in use at the time these stories take place. The subtitle of the book uses STD, as I felt that term would be most recognizable to both younger readers, generation Xers, and baby boomers. But I use STI as much as I can throughout the book, because that is where I think we are headed eventually.
Then we have sex work versus prostitution. We know that prostitution refers to sex work that involves exchange of sex for money. But sex workers can also be erotic massage therapists, exotic dancers, cam girls/guys, phone sex workers, and porn actors. I recognize that sex work is a more positive and more inclusive term for the diverse activities that go on in the industry. But when historical interviews or research refers to work with prostitutes, I’ve kept that language as it was originally referred to.
Words matter, particularly when it comes to topics as charged as sex and STIs. As I wrote the stories throughout this book, my aim was to maximize scientific accuracy, minimize stigma, plus educate and entertain along the way. I hope that I’ve achieved my goal.
1
Killing the Scarlet H
Stigma and Scandal in the World of Genital Herpes
Pray It Away
The woman sitting across from vaccine researcher Nick Van Wagoner at the University of Alabama–Birmingham was willing to do anything for a cure. She had been diagnosed with genital herpes in her midtwenties, and she had not had sex since her diagnosis. That was more than twenty years earlier.
A cure wasn’t possible, Van Wagoner explained gently. Perhaps she could enroll in his clinical trial of a therapeutic vaccine; eventually, it could lead to a therapy that might lessen her symptoms. And such a vaccine might reduce the chances that she would transmit herpes simplex virus (HSV) to her future sex partners. Van Wagoner nodded as he said this, conveying the tacit message that yes, she would have sex again someday.
If she agreed to participate in the trial, she would be injected with the active vaccine or the placebo; Van Wagoner wouldn’t know which she had received. She understood—she was ready to enroll. After she signed the consent form and left, Van Wagoner found himself thinking about her for days afterward. He knew for most people, herpes was not debilitating. Other than occasional genital discomfort, there were no lasting physical consequences of the infection. Over time, outbreaks were milder and became more of a nuisance than anything else; sometimes they stopped altogether. However, Van Wagoner could never predict people’s psychological responses. They could range from a shrug of acceptance to the dramatic response of the woman in his office, for whom the shame of the diagnosis had upended her life.
More than a decade later, Van Wagoner still has vivid memories of that first patient he enrolled in a herpes vaccine trial. After working with hundreds of patients, he would come to realize that while the woman’s reaction to her diagnosis was unusual, it was not unique. Abstaining from sex was the way some patients initially coped with the diagnosis. It didn’t do anything to the course of the infection, but it prevented one from having to disclose their HSV status and risk the sting of rejection. For a time, one could live their life as if the diagnosis hadn’t happened. But living in denial and avoiding sex was likely to fail eventually. Van Wagoner should know. He had tried to live that way himself for years.
Van Wagoner was born and raised in Utah, the youngest in a devout Mormon family. He first realized that he was attracted to other boys at the age of four. Even at that early age, he understood that it wasn’t okay. “I quickly learned that such attractions were not only unwelcome but considered by God second only to murder in spiritual condemnation.”
In the fifth grade, Van Wagoner first learned that HIV/AIDS was killing gay men, and his initial thought was, That’s what is going to happen to me. Family friends’ reactions toward the epidemic didn’t help matters. “Either go to hell now or later,” they remarked. Van Wagoner knew his fate was set. God would punish him for his attraction to men by giving him HIV, and he would die.
Terrified, Van Wagoner spent much of his teens begging God to change him. He tried to “pray away the gay.” He kept up appearances by dating Mormon girls. One benefit of dating within his faith: he wasn’t pressured to have sex. Then on his twenty-second birthday, his parents took him out to dinner. Afterward, they sat him down.
“Nick, we know you’re gay.”
While the shock of being outed by one’s parents might cause other people to curse, Van Wagoner’s inner Mormon held steadfast.
“Well, holy cow, how did you know?”
Copyright © 2021 by Ina Park