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STD Scholarship

Scholarship for STD risks and test accuracy is extremely bad. The information on this topic is awful.

One paper on HSV IgG (herpes, many cases of which are called "cold sores") testing stood out to me because it had a good section:
Summary of Test
1. Prepare 1:51 dilutions of Calibrator(s), Controls and samples in the test set Diluent. Mix well.
2. Place 100 μl of the dilutions in the Coated Wells; reserve one well for the reagent blank.
3. Incubate at room temperature for 30 ± 5 minutes.
4. Drain wells thoroughly. Wash wells 4 times with Wash Solution and drain.
5. Place 2 drops (or 100 μl) of Conjugate in wells.
6. Incubate at room temperature for 30 ± 5 minutes.
7. Drain wells thoroughly. Wash wells 4 times with Wash Solution and drain.
8. Place 2 drops (or 100 μl) of Substrate in wells.
9. Incubate at room temperature for 30 ± 5 minutes.
10. Stop the enzyme reaction with 2 drops (or 100 μl) of Stop Reagent.
11. Read absorbance at 405 nm against reagent blank.
It's great to specify details like washing 4 times and the 5 minute error margins on incubation times.

This is much better than most "scientific" papers I've seen which do not give repeatable procedures for doing the experiment with this sort of detail. I think maybe it's because herpes testing is actually repeated a lot (to test many different people), whereas most scientific experiments are only done once or a few times.

No excuses though. All science should meet this sort of standard or higher. (Honestly it's really not that hard or amazing. This shouldn't be unusual.)

But later the paper says something awful:
A negative serological test does not exclude the possibility of past infection. Following primary HSV infection, antibody may fall to undetectable levels and then be boosted by later clinical infection with the same, or heterologous virus type. Such an occurrence may lead to incorrect interpretations of seroconversion and primary infection, or negative antibody status. [my emphasis]
Heterologous is a prestigious word meaning, basically, it's a different strain of the virus.

So they are saying something may later be boosted by infection with the same virus or a different virus. Why would you say it could be either the same or different? And why present that like it's a fancy, complex point requiring sophisticated and hard-to-read language? They are using fancy words like "heterologous" but I think they didn't really think through what they are actually trying to say. The content is confused and confusing.

And the comma after "the same" is incorrect grammar. They're trying to write in a fancy way but are getting the basics wrong. This is written to impress and intimidate people, not to communicate.

The authors are more interested in sounding like smart medical researches than actually communicating effectively.

This reminds me of a Richard Feynman story:
There was a sociologist who had written a paper for us all to read – something he had written ahead of time. I started to read the damn thing, and my eyes were coming out: I couldn’t make head nor tail of it! I figured it was because I hadn’t read any of the books on that list. I have this uneasy feeling of “I’m not adequate,” until finally I said to myself, “I’m gonna stop, and read one sentence slowly, so I can figure out what the hell it means.”

So I stopped – at random – and read the next sentence very carefully. I can’t remember it precisely, but it was very close to this: “The individual member of the social community often receives his information via visual, symbolic channels.” I went back and forth over it, and translated. You know what it means? “People read.”
Another interesting part of the paper was the data that around 70% of adults have herpes (and another roughly 15% test ambiguous, and 15% negative). This is in line with other sources I've seen. The result is that most STD testing skips herpes (unless there's a visible lesion), even though it's a common STD! Many doctors discourage blood tests for herpes. Some clinics or government run healthcare services don't do herpes blood testing at all, or refuse it to most people. People sort of act like herpes is too common to worry about, so just don't make any effort to avoid infection. No doubt this attitude contributes to so many people having herpes. (You may want to consider getting a herpes test. Herpes is contagious some of the time even if you have no visible sores.)

On a related note, many people who "get tested" for STDs don't even pay attention to which STDs they've been tested for. Lots of people are promiscuous without giving much thought to what STDs exist, what tests exist, how good the tests are, how long things take to show up on the tests with what accuracy, etc. (People are also extremely reckless about believing their partners' claims about safety. People lie to their spouses about their sexual activities, so believing someone you're hooking up with – who has to say how safe s/he is to get laid – is pretty foolish.)

Many people also think if they use a condom that is "safe sex" and they don't really have to worry about anything. This is stupid and dangerous. Using condoms doesn't make you immune or take away the value of thinking about what you're doing, researching STDs, etc. (I think one of the reasons STD information is so bad is that no one cares. People don't try to research this stuff in any kind of reasonable way. At most they just find some doctor saying don't worry about something, or assume percentages over 90 are high, and go back to their social life. For example, lots of people seem to think 97% is a high and safe accuracy for an HIV test. I'm not even joking. For fucking HIV, 97% is not something to treat as plenty safe!)

Elliot Temple on November 27, 2015

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