It's another week and another brand new episode here on the Granny Penny Podcast.I'm your host, Ruby Lynn.Don't forget to like and subscribe so you'll get notified when we have brand new episodes.
If you'd like to follow me, your host, Ruby Lynn, you can find me at rubylynn.bio.This week's guest I reached out to and invited him back on the show because I wanted to get some clarification and information regarding something I read on Twitter.
Because you know, sometimes you can't always believe everything you read in social media.So I wanted to find out what the newest testing protocols and prevention are for STIs in the adult industry and beyond.
So help me welcome back to the show, Jamie Bell NP, who is the Medical Director for PASS Certified, and the Medical Director for the LA LGBTQ Sexual Health Center.
Jamie, I'm so excited to be face-to-face through the screen again with you this week, and your short notice when I contacted you to be on the show.I appreciate it.
Oh, I'm so excited to be back with you, Ruby.Thank you for having me.
Yeah, I thought it was due time to kind of have an update about what's happening in the STI world among talent and testing and all that good stuff because gosh, I think it's been over a year since you were on.
And so how are things?How are things at the, we'll do a check in, the LGBTQ Center of LA, and how are you?
Yeah, I'm doing great, thanks.Yeah, things are going really well at the center.And yeah, since we talked last, I think there are some, you know, new developments on the STI prevention front.So that'll be exciting to talk about.
Things are going really well with PASS.Folks are working on the PASS certification program now for studios to be involved in PASS certification.
As you know, being a member of our medical advisory panel, which we're so honored to have you, we are working on
you know, looking at the current testing panel and maybe where we can make some tweaks and adjustments, you know, in what is the best interest for performer health, but also financial, you know, issues as well.
Right, right.Yeah.I'll be excited for updates with that. Well, it sounds like everything's going good.I kind of want to just really dive in and kind of tell you why I contacted you.So, I don't know, it was about a week ago, I think, or so.
I saw a post on Twitter, which kind of made me stop and think for a minute.
And someone had asked a performer, someone who's not in the industry, probably a fan, had seen some Twitter posts about them having some really crazy wild times and interactions and sex and this kind of thing.
And kind of questioned them about, you know, are, how do they approach being safe?Are they being safe?You know, that kind of thing.
And they responded with some of the medications that they're taking.And for me, I just wanted to make sure and also being a past health advisory board member that we get the right information out there.Yes.And I myself have questions.
So what the performer said was, uh, I, you know, don't worry about me.I'm on PrEP doxy, doxy pep.
Uh, I've had all my HPV vaccines as a teenager.I'm on birth control and I'm taking, is it Val?Cycle Val cycling, cyclovir, Valtrex.
Yeah.Preventative probably for herpes outbreaks.
Right.And so, For me, I'm like, I know that doesn't prevent any herpes outbreaks.I thought, okay, who better to call?I'm going to call the expert.
You know, PrEP has been around a while now.I know a lot of performers are on it.
And that is the HIV medication, which has great statistics, correct?
Yeah, yeah.It's an HIV prevention medication.It's over 99% effective at preventing HIV. Um, yeah, generally, yeah, generally really well tolerated.
I know you and I both remember the days that were, you know, we didn't have these, these, uh, interventions that we do today.So, so yeah, PrEP is amazing.Um, as you said, a lot of folks in the industry are, um, looking to be on PrEP.
Um, yeah, so that, that takes care of the HIV, uh, HIV prevention part.And then
Let's talk about Doxypep, because that has me really curious.I don't know a lot about it, but let's talk about all the new stuff in that.
Yeah, so it definitely is the hot topic now, just through social media, word of mouth.We at the LGBT Center in LA are prescribing it really on a daily basis to folks.
So Doxypep came into use kind of late 2022, early 2023 at the San Francisco Department of Public Health.They're always kind of the early adopters of what's cutting edge in sexual health.We here in LA have been doing it for well over a year now.
But like I said, it's really picked up with the interest recently.
So studies were done with doxycycline, which is an antibiotic in the class of tetracyclines, where a person takes two tablets or 200 milligrams total dose of doxycycline within 72 hours of unprotected sex.
Studies showed about an 88, 89% reduction in chlamydia and syphilis.So really good. didn't fare quite so well for gonorrhea.It's about 55% reduction, so it does help.
And ideally, taking it within 24 hours after the encounter is probably even better, or just right after.But this study showed the efficacy out to 72 hours.
And there were a few studies done, you know, relatively good size studies.Side effect wise, I mean, doxycycline for some people can cause some GI or stomach upset, you know, nausea or diarrhea.
In general, most people tolerate it really well, and taking it with some food can minimize those side effects.Doxycycline has a long history of long-term use for dermatological issues.People stay on it for weeks or months at a time for their skin.
It's been used for decades for malaria prevention, Lyme disease prevention.So we have a long history.
There are long-term studies, you know, showing the safety and monitoring for drug resistance based on those other, you know, conditions that it's been used for. That being said, resistance is a big concern.
That was my question.You unanswered my next question.
I mean, it's a big concern among folks who come in and ask for it.And then I think, you know, what I'm seeing on social media.And for those of us who are prescribers, it is a concern, too.You know, we want to be good stewards of antibiotics.
So far, you know, study participants are still being monitored.There haven't been any reports of antibiotic resistance.And then we have to remember, this is really taken as an as-needed basis.It's not really meant to be taken every day.
you know, the recommendat do it as frequently as a period.Wow.Yeah.But I t least most of my patients when they feel like they m Um, but definitely that's the impact of antibiotics I was just going to ask t Yeah.
So, you know, takin bacteria, you know, that's if folks are sensitive to for people with vaginas, y also be a concern.
So I necessarily for everyone.People who are really sensitive or really have significant concerns, it may not be right for them.
But we want to get that information out so people can make informed, educated choices if they feel like this is something they would like to have in their arsenal of risk reduction.
Right.Yeah.So you, you like answered some of those questions.I was like, you know, uh, it's just like the penicillin, you know, it was over prescribed.And then we started to see some super bugs and that kind of thing.
And so that was really my question is whether it was a per incident medication or something like prep that you take every day.
Yeah.And that's a, that's a great point, Ruby, because there was a study done, uh, for doxy prep. where folks were taking one tablet daily.We don't really advocate for that.CDC does not advocate for that.The health departments don't.
Just because, again, you're taking a daily antibiotic long term versus as needed.And so, you know, you minimize side effects, you minimize potential, you know, long term issues with resistance.
Gotcha.Well, and then so. If we don't live in a hub, if we don't live in a hub, is our primary care doctor the best person to actually talk to about that?Because I feel like they are going to say absolutely not.
Yes.Unless you have a primary care provider who is really well versed in sexual health, they may be reluctant to prescribe this or just unfamiliar with the data or how to prescribe it.
The other aspect of that, which I think is really important, and this is a lot of inquiries that I get from cisgendered female talent, trans men, because we don't have study data to show the efficacy in those folks.
There was a study in Kenya looking at doxypep in cisgendered women, They were not able to conclude the efficacy, not because it didn't work, but the study, they had a difficult time with adherence from the participants.
So they basically just didn't have sufficient data to say this works.
Now, an encouraging piece to this is earlier this year, a small study was published looking, it wasn't DoxyPep, but it was looking at the concentration of doxycycline after a 200 milligram dose in rectal, vaginal, and urethral tissue.
And within a few hours after that single dose, the levels were all equal across the board.So that's encouraging to say that this in all probability is going to work for people with vaginas.
We at the LGBT Center do prescribe it for cis women and trans men. Um, you know, I do a shared decision making approach with the patient.You know, here's what we know.Here's what we don't know.Here are the pros.Here are the cons.
Um, ultimately, if you want a prescription for doxy pep, I'm going to write it for you.And, you know, we have that conversation together. So I think especially for cisgender women or trans men, it's going to be more difficult at this point.
CDC does say that, you know, it's not absolutely forbidden to do this, but it should be a conversation about, you know, the data available. I will say anyone pregnant or planning to get pregnant, absolutely no doxycycline.
If a person is taking the medication Accutane for acne, no doxycycline.There can be a serious drug interaction there.Otherwise, it is really safe. Sometimes folks get a little photosensitivity, sunsensitivity.
So depending how frequently it's taken, that could be a concern.If people are having like laser hair removal or light-based cosmetic treatments, absolutely let the person know who's doing those treatments because it can cause sensitivity there.
Okay, yeah.And and then part of that tweet too, was with the bow, I can never say that Val, just say Valtrex.
Yeah, that doesn't I mean, I know the answer to this, but I want to you know, I want folks watching to know but it does.It does not prevent that transmission.Correct.
It reduces the risk, yeah.We can't say that it would 100% prevent it, but it does reduce the risk of transmission to partners.
And whether that's oral herpes, genital herpes, taking daily suppressive therapy with either acyclovir or valacyclovir can greatly reduce the risk of transmission to partners. As well as, you know, just the frequency of outbreaks.
But like, you're absolutely right.It doesn't guarantee that a person won't get an outbreak or that they are 100% protecting their partners.But it does help.
And then I see it too as if I was the one taking it, it doesn't mean that I won't get it.So say I do not have that diagnosis, but by taking that medication isn't going to protect me from getting it, correct?
Yeah, we really don't have good data on that to say that that is the case, that taking basically like herpes prep kind of is what we're talking about.
At this point, we don't really have good data to say that. Do I hear stories of people being creative with doses?Sure.And I know there are studies going on at UCLA, is one of the locations of a herpes vaccine.
So those are things that are in trials and development now, but no, as far as doing it kind of as a pre-exposure, yeah, we don't know if that would even work.
Well, and then my question too, I know you and I could go down these rabbit holes with medical stuff, but taking the Doxypep, is there any study about the help of not getting Mgen, which is so prevalent, or came to the forefront at the beginning of last year?
and that kind of thing.Is there any data on that?
To my knowledge, there are no, well, there are no data.And to my knowledge, there aren't studies.I actually told our research department at the LGBT Center, this would be an amazing study to do.You know, what is the impact on MGen?
That could be a game changer for folks in the industry.We just don't know at this time. especially since doxycycline, or I'm sorry, MGen is a little trickier, and now you have to use a two-step regimen.
Doxycycline may or may not have a significant impact on that, but I would love to see studies done.Yeah.
And what are the two prevalent antibiotics for treating MGen?
The preferred regimen is seven days of doxycycline, twice a day.MGen used to be effectively treated with doxycycline by itself, but over the years resistance has happened.
And so it's doxycycline followed by a week of moxifloxacin, which is once a day. dosing.So it's a two-week course of treatment, and some people don't tolerate it really well.
There are alternatives if there are drug allergies, so we have other options as well.
Well, it is interesting that the doxycycline is part of that.So maybe at some point there could be some correlation.Wouldn't that be amazing?
That would be amazing, yes.Yeah.
So yeah, there needs to be a study.I don't even know how you do that, but.
Yeah, I put the bug in in the year of our research department, and I'm like, especially being in Los Angeles, where, you know, the hub of the industry, you know, and I'm sure a lot of folks would be interested in participating in something like that.
So more to come, hopefully, on that.
Nice, nice.And then I want to address the last part of that tweet just because I, you know, at my age, they didn't have HPV vaccines when you and I were young.So talk to me a little bit about that.I mean, does it, is it really the vaccine?
Like you will not get that ever?Or is it like, I don't know, chicken pox?Like you get the vaccine, but you still might get it.I don't know.
Yeah, so, well, when HPV vaccines first came out, they protected against the four most common strains of HPV that could either lead to genital, anal warts, or like precancerous cell changes.
Over the years, a newer vaccine was developed, Gardasil 9, so now protects against the nine most common strains. of three, it is highly e those strains.Um, and a account for, you know, hi And, um, the efficacy again is high, 90% for those strains.
Um, there are no recommendations for boosters.So once a folks, a person has received that series, that's they're good for life. So I highly advocate for men, women, trans men, trans women, anyone in the industry.
HPV vaccines are so important for sexual health, especially in terms of the cancer prevention aspect.
Well, can you get that series of three as an adult?I thought it had to be as a teenager.
Yeah, so initially, it was FDA approved ages 9 through 26.And then a few years back, the age was extended to 45.
Oh, well, I'm still out of that range.
We won't tell anyone.Yeah, no, I had it a while back.But yeah, I think it's an important for sexual health.Yeah, population, but especiall industry.
And what is the that series?Yeah.So a pe vaccine and can get the s
Um And then the t six months from, yeah.So fine.You know, I have so two years ago.Do I need we pick up wherever you l
Um, yeah, and generally, you know, in those series after the second dose, you know, the protection is very high, you know, just like with any vaccine, those boosters really give you the longevity.
So, yeah, so I do recommend, you know, if they haven't started, you know, to start and finish up if they didn't complete it.
Gotcha.Well, that is brand new info to me.I had no idea they extended it to adults.
Been a while since I've worked in a clinic with immunizations.
Well, I'm really excited that you were able to kind of clear that up.Do you have anything else you want to add?Is there any other new stuff coming out?
Well, I think if we can go back to DoxyPep for a minute here, because I do want to be clear that, you know, I've had folks on social media say like, you know, you're advocating irresponsible antibiotic use.Right.Absolutely not.
Like I said, this doesn't mean it's for everyone.We just want to get this information out there. And by no means do I think folks in the adult industry should be popping to doxycycline after every scene.
We have those rigorous past testing standards for a reason, right?But I think there are some situations where it may be a good idea to have a prescription for doxypep on hand.
I mean, we know that it's common for talent to do work outside of the tested talent pool. And, you know, and I hear folks say, well, I use condoms with partners, whether it's for work outside of tested folks.
But we know oral sex can transmit chlamydia, gonorrhea, and syphilis very easily.So maybe this would be an appropriate time to doxypept to help reduce that risk.
Also, let's say if you work with someone today who is at the end of their 14-day testing window, they get tested the next day or two and they pop for chlamydia, let you know, if you're within that 72-hour window period, taking 2-doxycycline can reduce your risk of chlamydia by 89%, which that could prevent a week or 10 days of lost work.
Right. So, you know, I think those are maybe situations where having it on hand might be useful for talent.But again, not after every scene or... Yeah.
Right.And, you know, just because you're in the adult industry doesn't mean that you're not doing some, you know, you're not dating, you know.Sure.
Personal life, absolutely.Yeah.
Meeting people.I'll tell you what, I tell you who needs doxy pep is all my single girlfriends who go out to the bar and drag me.
Yeah, who are not past tested every 14 days.
I mean, I'm always like, you guys are way more risky than I am.Are you kidding?I wouldn't touch I wouldn't.
Yeah, absolutely.Absolutely.
Yeah, I agree with you that I think it's like an insurance policy.Yeah, you have it and you may never need it.
But yeah, yeah.And I do.Yeah, I feel like I've been writing more of those prescriptions lately.Just I want to have it in case you know the situation.And because it is time sensitive, it has to be dosed within that 72 hours.
Like you mentioned, you know, How accessible is this for everyone?If you're trying to search for somewhere that's going to write this prescription for you in that short time frame, why not just have it on hand?It's generic, it's cheap.
If it expires, it's not a big loss and we give you a new prescription. Um, so yeah, those are just things to think about for for people that may feel like, you know, I'd like to have this available.If I love that.
I love that.I mean, I personally looked into prep with my doctor because she was she knows what I do.But I am not a high volume scene shooter, you know, so I kind of I'm approved for it.I just haven't.I haven't decided to get it and take it.But
you know, I love that they, even in my small area, there was no question.I felt very fortunate.It was like, if you want it, we're going to prescribe it.And so that made me super happy.
Yeah, that makes me happy to hear those. stories too, because for each one of those, I hear ones that, you know, it's not so supportive.There are ways to get Doxypep online now.
There are platforms that, like especially some of these online prep platforms I've seen lately, they're advertising Doxypep as well.
Again, I'm not sure, you know, how liberal they're going to be with prescribing it outside of, you know, the cisgendered men who have sex with men, you know, recommendations that we had from the studies.
But I also have heard a trans man who his provider prescribed it, no questions asked.That's nice.That I'm a sex worker, I want it.Okay.Yeah.That's awesome.
What's the typical prescription then?I mean, is it like 20 pills or how, you know?
Yeah, typically I do 30 pills.So 15 doses, um, you know, for some of my, uh, sexual athlete patients that are not in the industry, um, get refills, you know, so they always have access. to having their DoxyPep.
Then again, we can adjust that based on a person's need.We just, you know, we want to make sure folks have current STI tests when we prescribe it.We don't want to undertreat an asymptomatic STD with DoxyPep.So we are very, you know,
strict about making sure STI testing before we pr for the most part that's of an issue because of th
Right.If you're not in the industry, is it like every 90 days, the same as it is for PrEP?
Yeah.We want every three months.Yeah.And, you know, I, again, with the efficacy being lower for gonorrhea, I mean, I do have patients who end up getting gonorrhea and they do DoxyPep.
So, you know, that's around 50-50, but definitely I would say just anecdotally with syphilis, I've seen a drop.I don't know how much of that is just the natural, you know, ups and downs of the epidemiology of syphilis.
But, you know, I think time will tell how much of that is attributed to doxepath.
Right, right. Gosh, the technology and the medications available.
Yeah.I mean, now for PrEP, we have an injection that's every two months, HIV prevention.
That's awesome.I could do that.I don't want to take a pill every day.
Next year, we're going to have a six-month injection for HIV prevention.So yeah, technology just keeps advancing.Medical science keeps advancing, which is
You know, it's great for everyone, but I think it's so exciting for folks working in the adult industry and doing sex work that we now have these tools to help keep people safe and healthy.
Yeah, absolutely.Gosh, I learned so much already.I love it.Yeah.Is there any other new studies or meds that you've heard of or anything or coming out?
Nothing else comes to mind at the moment.We, you know, and I think that's to like through PASS, you know, we will ensure that we keep people really informed of any new developments on the sexual health front.
So, you know, folks follow PASS, they can count on, you know, getting the most current information from us.
Right, right.Yeah. the amount of good information that comes out.I mentioned all my single girlfriends before, they haven't even heard of some of this stuff.
I hope as time goes on that these different avenues, preventions, or even like MGen, they're- Yeah. my clinic didn't even know what the heck, you know, when you ask about it, or they're like, you're due for your annual HIV test.
I'm like, well, I've had that about eight times here.Yeah, no, they don't even test for some of the things that we do.
Sure.Yeah.Yeah, I think in general, like the LGBTQ health centers tend to be a little more cutting edge on some sexual health issues.
But, you know, we're of the mindset if someone comes in and asks for PrEP, they're going to get PrEP, just like if they ask for birth control, they're going to get it.You know, we have a discussion again.
Here are the risk benefits and that whole thing.And if they feel it's right for them, We're going to prescribe it.I don't care who their sexual partners are.That's why we have these options now to keep people healthy.
Yeah.If I was more of a volume scene shooter, I would definitely do it.Who knows?When I move to LA someday.
Wow, so interesting.I am really appreciative that you were able to clarify that because, you know, like I said, I'd read it and no judgment or shade to that person whatsoever.
I'm so excited they are taking all these steps, but yet I was like, I want to verify.
Yeah, and to give them credit for putting it out there because it sparks discussion.And I know people take a lot of, you know, a lot of heat online when they do that from people, but then it sparks discussions like we're having and educate folks.
So yeah, kudos to them for being open and transparent.
Yeah, that was awesome.Very awesome. And also, I was like, sometimes those wild things are staged a little, you know, like the general public doesn't know that.
Yeah, right, right.Yeah, absolutely.
Great.Awesome.Well, and so PASS, is there anything brand new?I mean, I know, but anything that you can talk about or studies that they're looking at?
Yeah, it's really lately really been just this emphasis on trying to get, you know, studios and labs, certification, um, you know, keeping keeping the community informed.Yeah, and just,
continuing with our medical advisory panel to kind of look at ongoing, because that's really a first for PASS to have this sort of panel where we have infectious disease specialists, we have laboratory scientists, we have talent like yourself who have backgrounds in public health or science backgrounds,
We're always looking for more talent who have that background as well.So if anybody has that interest, you have a science, a health background at all, please reach out to me because it's so important for us to have talent representation.
on these panels.We're all volunteers.You know, the physicians and the scientists that are on the panel, everybody's volunteering because they want, you know, they're passionate about keeping the community safe.
So that's so exciting that we have that and it will continue to evolve.
That's awesome.Yeah.I'm very proud to be a member of that.And I get so excited in the meetings because it's like, I love STIs.What are we talking about?
Yeah.Yeah.I mean, I don't think they'll mind me saying, you know, we have Haley Rose on the panel. We have, yeah, Ken Fields, you know, who have backgrounds in sexual health education, biology, your public health.
So, but the more representation we can get for folks, you know, yeah, again, please let me know.
Awesome.Awesome.Wow, you answered all my questions and more.
Thank you so much for coming on and chatting about that.And I'm always excited to use my platform to put out information.It's not always just entertainment.
No, and I think that's so needed, and we really appreciate you for doing that.And no, it's my pleasure to be here.And yeah, folks can always reach out to me on social media if they have questions or need help seeking care, anything like that.
Okay, awesome.Why don't you shout out your Twitter or how you want them to contact you?
Sure, on Twitter or X, I'm JamieNP, J-A-M-E-Y-N-P, for Nurse Practitioner.On Instagram, it's also JamieNP, but Jamie underscore NP.
Yeah, so, and I'm always happy to try to help link people to folks, or link folks to the care that they're trying to get.And if I can't help them, I try to connect them to someone who can, so.
Yeah, you are such a blessing to this industry and your community.Oh my gosh.
I'm very honored to be able to do this work.It really, yeah, it means so much to me that folks, you know, trust me and reach out to me.And yeah, it's my honor.Absolutely.
Awesome.Well, thank you again.And I think I'm just going to have you on once a year, whether you like it or not.
Absolutely.Anytime.Anytime.Thank you so much.
Sign in
