We may remember that first uncomfortable conversation about the birds and the bees, but we are less likely to remember talks about sexually transmitted infections (STIs) – because they didn’t usually occur. While we’re becoming more comfortable with conversations about sexuality in general and mental health, we haven’t reached that level of positivity around sex and STIs.
Society generally views sex as a taboo topic, and in doing so, those that contract an STI are seen as having committed an immoral act. People can contract other bacterial or viral infections like a strep throat or ear infection without judgment. Why judge someone with an STI?
Stigmas around STIs may start in adolescence, around religion or politics, family or friends. It can be taught in school or just by whispers, jokes and insinuation, with statements like: “damaged goods” or “the devastating impact of STIs”. This stigmatisation often comes from lack of information or education and is perpetuated by the language we use in speaking about it. Whatever the answer, the important thing is reframing the question for the future – and talking about it.
“At Planned Parenthood, we often see patients coming in with questions like, ‘What is this… Could this be…’ and we respond without judgment,” says Chrissy Cmorick, Senior Director of Education for Planned Parenthood of the Pacific Southwest. “What lead with instead is a conversation stressing the importance of knowing your own body – what’s normal for you – so you can recognize any changes and treat them early. By destigmatizing the conversation, we can destigmatize the treatment.”
What is the impact of STI stigma?
By avoiding discussion of STIs – or not understanding that it is very common and treatable - we impact the health of people of all ages. Silence around the topic and avoiding testing harms both physical, mental and emotional health. Stigma can lead to fear, anxiety and depression, with 36 per cent of people diagnosed with herpes having suicide ideation and 3 percent attempting.
To reduce the stigma and provide a solid platform for education, information and discussion, we need to start talking, factually and with a comprehensive vocabulary. What does this look like?
- Eliminating fear-based education.
- Eliminating negative words like “dirty” and jokes about STIs.
- Creating a positive, safe space for informed conversation and treatment.
- Developing comprehensive sex education that includes STI facts and dispels the myths.
- Recognizing that STIs are common and can impact everyone who is sexually active.
What are we talking about?
Let’s be clear about the facts:
- While nearly half of the 20 million new STIs each year are among those aged 15-24, only 12 per cent were tested for STIs in the last year.
- 15 - 24 year-olds accounted for 75 percent of chlamydia and gonorrhea diagnoses.
- There are two kinds of STIs: bacterial and viral.
- There were 2.5 million cases of bacterial STIs reported in 2019, with an increase of 30 percent of infections reported between 2015 and 2019. The good news? They can be treated with antibiotics.
- Viral STIs, and their treatment, are more variable. There is a vaccine for Hep B and a range of medications for the other STIs, including HIV/AIDS.
What is the most common symptom of an STI?
Often, nothing, which makes diagnosis and treatment more difficult.
If symptoms do occur, they can range from painful urination to an abnormal discharge or bumps, sores or rashes.
So, how can you get an STI – and what can happen if you do?
STIs can be transmitted through bodily fluids, including semen, vaginal fluids, blood and breast milk. They can be passed through anal, vaginal or oral sex with an infected partner, sex without a condom and direct skin-to-skin genital contact.
The side effects of an STI can be serious.
- Gonorrhea and chlamydia can cause pelvic inflammatory disease (PID), which can cause infertility. Lesions from syphilis and herpes can make it easier for HIV to enter the body. And, pregnant women with untreated gonorrhea may have an increased risk of miscarriage.
- Herpes, HIV and syphilis can be transmitted to the infant, which can lead to other health issues.
These are all frightening, but can be prevented. And, all STIs are treatable.
STI prevention starts with education and communication – by tossing out the old norms and eliminating the stigma around STIs.
- Practicing abstinence is one option, as is using barrier protection – a condom – correctly and consistently.
- Using vaccines for Hep B and HPV to prevent infection
- Avoiding sharing needles
- Avoiding sex under the influence of drugs and alcohol
- Testing with each (and every) new sexual partner
Tests for STIs may vary, from taking a swab or urine sample (for chlamydia or gonorrhea) to a visual exam or pap test (for HPV) to a finger prick or blood test (for syphilis, HIV/AIDS or Hep B).
The key is not just testing when there’s a symptom, but testing regularly or for every new sexual partner.
Remember: there may not be any symptoms.
What if I was exposed in spite of taking precautions or I am at risk for contracting HIV?
There are HIV meds for both pre- and post-exposure. PEP, for post-exposure, must be taken within 72 hours after potential exposure and used for 28 days. PrEP is for people who are HIV negative but at higher risk (possibly from an HIV positive partner) for infection. Barrier protection must also be used.
How do I access tests and / or treatment?
First, by taking responsibility for your sexual health – by destigmatizing the conversation around STIs – with yourself and any partners. Knowing your status is step one.
Ask a potential partner whether he/she/they currently have any STIs, other sexual partners, use protection and if and when they were last tested. Know the answers to these questions about your own sexual health.
If either of you need testing, treatment or answers to questions, visit a Planned Parenthood health center or other healthcare provider. Keep the conversation going. There should be no stigma around sexual health.
“The more fear that is attached to STIs the less likely a person is to get tested. It’s actually fast, easy and painless,” says Cmorick. “So let’s remove that barrier for good.”