Asthma, Yeast Infections, & STIs: Let’s think about Sexually Transmitted Infections in a new way

By Leslie Massicotte, Teens Climb High Assistant

Let’s start with a story.

Meet Tory, a 20-year-old college student who is on their third date with super nice, super hot Kyle. On their previous dates, it’s been clear that they’re both really into each other and the physical desire is strong. And this date is no different--except that they’re both ready to take things to the next level.

Their dinner date progresses into going to Kyle’s apartment nearby and things start to get hot and heavy. It’s clear that they’re moving towards having sex but Tory begins to feel nervous and hesitant. Tory was recently diagnosed with Type-1 genital herpes and isn’t quite sure how to proceed, having gotten very little guidance from their doctor about how to deal with this new status while dating. Tory really wants to have sex but wonders, Should I tell Kyle? Will Kyle still want to have sex? Will Kyle think I’m “dirty” or “gross”? Since I don’t currently have a breakout and lots of the world has herpes, maybe it’s ok for me not to say anything?

Now this story can end in two ways. The first ending is that Tory could not say anything and proceed to have sex, too afraid and ashamed of their status to share with their crush. Probably this reality is all too common because of a nasty little thing called stigma.

Stigma is that feeling of disgrace or shame that is perpetuated by our negative attitudes and perceptions of sexually transmitted infections (STIs) and those who have them.

Stigma has been shown to be a main reason why people don’t get tested and don’t tell their partners about their STI status. This stigma makes it hard to admit to ourselves, let alone our partners, that STIs could or do affect us.

But in reality, one in two people in the US will contract an STI before the age of 25. Think about that: a young person is about as likely to get an STI as they are to play a high school sport.

So if STIs are so common, why does stigma continue to exist?

Miseducation has a lot to do with it.

Going back to our story, Tory’s experience with Type-1 herpes (or HSV-1) is not uncommon. Globally, it is estimated that 3.7 billion people under the age of 50 have Type-1 herpes. That’s 67% of the world’s population. In the US, about 1 in 8 people has genital herpes. Next time you’re in a group of 8 or more people, consider that statistic (in a nonjudgmental, curious sort of way, I’d hope!).

Type 1 herpes (HSV-1) is often acquired in childhood but can be passed any time during someone’s life, from simple actions like skin-to-skin contact or giving a child a peck on the cheek. Despite the ease of spreading it, herpes testing is often not included when you go in for routine STI tests, so many people don’t even know that they have it. The Centers for Disease Control and Prevention (CDC) actually doesn’t recommend that people get tested for herpes unless the person is showing symptoms--and most people with herpes are asymptomatic.

So, lots of people already have herpes, most people don’t know it, and testing isn’t recommended unless you’re already showing symptoms--yet herpes is still classified and stigmatized just like any other STI. While it’s true that you can pass herpes through sexual intercourse, why does it still come with the same stigma? What if we viewed herpes the same way that we view folks who have asthma, for example? Some people have it, they can’t do anything about it, it’s not exactly fun, but with treatment, it’s completely manageable and nothing to be ashamed of.

This stigma extends to chlamydia and gonorrhea as well, two of the most common STIs for young people. In 2019, a study showed that North Carolina ranked 6th in the country for STI rates, particularly for high chlamydia and gonorrhea rates. In other words, a lot of us have had or do have chlamydia or gonorrhea, too.

Before you start freaking out, treatment for chlamydia and gonorrhea is easy and often free, and with treatment, folks can completely get rid of the chlamydia or gonorrhea bacteria. Therefore, for the many people who do get tested and can access medication, treatment of either chlamydia or gonorrhea is a part of their life, much like a yeast infection--they’re not fun, they’re pretty embarrassing, but you just follow the treatment and it’s gone. A key difference is stigma.

HIV stigma is perhaps even more intense.

Studies have shown that nearly 1 in 5 adults and 1 in 3 adolescents reported fearing people living with HIV, and this stigma prevents people from accessing treatment and follow-up care.

Yet, with regularly taken antiretroviral treatments, a person with HIV can actually become what is called undetectable. This means that the number of HIV viruses in the body decreases so drastically that the person won’t test as HIV+ and they can’t pass HIV on to anyone else. Well managed HIV, then, could be likened to well managed diabetes--serious if left untreated, but a part of life and nothing to be ashamed of.

Likening common STIs to other health conditions is by no means meant to disregard the specifics of STIs or the unique experiences of folks dealing with these STIs. STIs can spread between people, unlike many of the other conditions I mentioned, and can have pretty serious consequences if left untreated. This refarming exercise is instead meant to encourage us to rethink our attitudes about STIs and question why we still view them in ways that stigmatize and hamper both prevention and acceptance. When we embrace STIs as being a common part of our lives that can be prevented, treated, and talked about, we make strides towards reducing STI rates and keeping us all healthier.

If we revisit our story from the beginning, alternative to not sharing with their partner, Tory could fight the stigma and decide to talk about their herpes status with their partner. In the heat of the moment, Tory could ask to slow down, stop, and talk it out. Kyle could fight the stigma and be receptive and nonjudgmental. Even more preemptively, Tory and Kyle could normalize having this conversation early in a relationship and discuss STI testing and concerns before things get hot and heavy. Not being afraid to say, “Hey, I’d like to talk about a few things before things progress any further” and ensuring that you both know the facts and can make informed decisions helps us all stay healthy and happy.

I encourage you to review your own thoughts on STIs, see if and how you potentially perpetuate stigma, and work towards normalizing STI prevention and treatment as a part of all of our lives.

If you or someone you know needs STI information or testing, call the health department or your local clinic to make an appointment!