Delivering bad news to patients is never easy. When the bad news is a new diagnosis of a sexually transmitted disease (STD) or sexually transmitted infection (STI), patients take it especially hard. But it shouldn’t be this way since STIs and STDs are curable or, at the very least, manageable.
One in two people will contract an STI by the age of 25. However, headlines like “STDs are at an all-time high” continue to stigmatize how prevalent STDs and STIs are in society, and make it more difficult for patients living with them to discuss their experience. In fact, stigma surrounding STDs is so common that it affects how often women and men get routine STD testing as one influential study called Perspectives on Sexual and Reproductive Health found. According to the study, only, “Thirty-seven percent of males and 70 percent of females reporting receiving an STD test in the past year,” and one of the top reasons reported for not receiving testing was, “Fears about negative societal attitudes toward STD infection.”
What we’ve found in my workplace, Carbon Health, is that within the last year, there definitely has been a significant increase in the percentage of appointments for STD testing. This is a result of the CDC’s announcement last August that stated STDs are on the rise. If we look at the data, we can see that appointments booked at Carbon Health for STD testing increased from 60 percent in August 2018 to over 80 percent in September 2018. This number has remained high, as in March 2019, approximately 79 percent of Carbon Health appointments involved STD tests.
Seeing an increase in patients for STD testing is a good sign that more people are taking a proactive approach to their sexual health. Still, this hasn’t resulted in a recent decline of STDs or STIs in general. For example, STIs like HPV are so common, a recent US News article found that 79 million people are living with it in the U.S., “And about 80 percent of sexually active people are infected with HPV at some point in their lives.” Meanwhile, one in two people in the US have oral herpes and one in eight people have genital herpes. The American Sexual Health Association found that regarding genital herpes, “Close to 90 percent—don’t know they have the infection.”
Even though STDs and STIs are pervasive in the U.S., they’re still stigmatized. You can see this in the way STDs or STIs are discussed in popular media. Think of how often, even in 2019, comedians still use people with herpes as the butt of their jokes. Even the language we use to describe STDs and STIs is stigmatizing. Often, when you read about STD or STI prevention, the language is overblown about the “risks,” “the epidemic,” and how many millions of people are “carriers.”
Additionally, another challenge patients face regarding living with an STD is that it is one of the few diseases where a patient does not have complete privacy, since they have to disclose to their partners about their diagnosis. Who wants to think or describe themselves as a ‘carrier of a disease?’ In reality, the vast majority of us will encounter a sexual partner with an STD or an STI, or we’re currently living with an STI/STD ourselves. We need to stop thinking and treating people with STDs or STIs as “infected,” and more as “human.”
Part of treating people with an STD or an STI is recognizing that for many patients, their day-to-day symptoms, when properly managed are not severe. For example, some patients may experience a herpes outbreak as a single blister that goes away within a few days while others may have a larger outbreak that lasts longer. However, when given medication or properly treated, these symptoms are not permanent, and many patients living with herpes can go years without a single outbreak.
Not only is it important to change how we talk about people who have STDs or STIs, it’s important to educate ourselves and our patients about what living with either actually looks like. By encouraging patients to educate themselves on the prevalence of STIs and STDs, they’ll realize that living with one is not a life sentence. From there, physicians can provide patients with tips on how to treat them, and advice on how to discuss STIs and STDs with a sexual partner. The more patients know, the more proactive they can be in regards to maintaining their sexual health.
Questions any physician should be able to answer are: which STIs are still transmittable with condoms, which are not, and which are temporary? How many people have partners with STDs? Knowing these facts greatly reduces the stigma around STDs and helps patients communicate honestly with themselves and future sexual partners about their experiences.
During STD and STI Awareness month, it’s not only a physician’s job to encourage their patients to get routine STD and STI testing. It’s also our job to educate those living with STDs and STIs on how to manage and treat their STDs or STIs, and how to let go of the shame associated with both. We have reached a point in a society where no one living with STDs or STIs should feel like it’s a life sentence.
By Caesar Djavaherian, MD
Dr. Djavaheria is Co-founder and Chief Medical Director at Carbon Health. He previously founded Direct Urgent Care, an urgent care network serving the greater San Francisco Bay Area since 2013. Caesar began his medical career at the New York-Presbyterian Hospital, The University Hospital of Columbia, and Weill Cornell Medicine.
Yeah, I think it’s interesting how STDs are viewed as both rarer and more serious than the reality generally indicates. I do think that’s changing, and I think especially in terms of the culture, that this misperception is in large part due to the outsized role HIV/AIDS has in the general discourse about STDs.