Why don’t people talk to their sexual partners about sexually transmitted diseases? Stigma plays a big role

Worldwide, people between the ages of 15 and 49 become infected with over a million curable sexually transmitted infections (STIs) every day. These include chlamydia, gonorrhea and syphilis.

In Australia, it is estimated that one in six people will be diagnosed with an STI in their lifetime – and the numbers are rising.

Very few common infections are as stigmatized as STIs, making them a particularly complex public health problem. Stigma induces shame and fear in people diagnosed with an STI, which can lead them to delay testing or treatment.

Stigma can also make it difficult for people to tell their sexual partners about an STI diagnosis. A recent study found that only about half of respondents told their partner about an STI before sex or believed they should.

Why don’t people disclose an STI and why do they?

The study, published this month in the Journal of Sex Research, was a systematic review, meaning the researchers analyzed the results of several studies. They looked at 32 papers in total, most from the United States, some from the United Kingdom and Australia. The study included a range of sexually transmitted diseases, but did not include HIV.

When researchers summarized the results of these studies, they found that only half or fewer of the respondents told their partner about a sexually transmitted disease before sex or believed they should tell their partner this information.

The most common reasons for not telling a sexual partner about an STI include fear of the partner’s reaction and fear of rejection by the partner.

Some people felt they did not need to tell their partners or considered it a private matter – especially if they had casual sex. Younger people under the age of 24 were less likely to tell their sexual partners about an STI than older people.

Others believed there was no risk of transmission because they did not have symptoms or felt they had taken adequate precautions to protect their sexual partner from transmitting an STI.

When used correctly, condoms are one of the most effective ways to protect against sexually transmitted diseases, including chlamydia and gonorrhea. However, they do not necessarily protect against sexually transmitted diseases such as herpes, genital warts or syphilis, which can be transmitted through skin-to-skin contact. Dental dams can also be used during oral sex to prevent sexually transmitted diseases.

Keeping STIs secret from sexual partners – especially if effective protection was not used – can cause problems. It can lead to a person who may have been exposed to or transmitted an STI not getting tested and treated, which can then pass the STI on to others.

The study also found that after being diagnosed with an STI, some people stop sexual activity altogether or choose not to enter into a new sexual relationship to avoid having to tell their partner about their STI status.

Those who tell their partner often said they value honesty in their relationship or see disclosing their STI as a moral obligation. Others disclose their STI status to protect their partner’s health and ensure they avoid long-term problems, such as infertility, that can result from untreated infections. Some people tell their partner for emotional support.

Independent research has shown that not telling a sexual partner about an STI can lead to increased anxiety and reduced sexual satisfaction in the affected person.

Simplifying disclosure of sexually transmitted diseases

Talking about an STI diagnosis can be awkward and uncomfortable, but there are resources to help people talk to their partners about STIs or help them disclose an STI diagnosis.

These include confidential services that allow people to send anonymous text messages or emails to their sexual partners to inform them that they may have been exposed to an STI.

These can be helpful for people who feel unable to talk to a previous sexual partner about their diagnosis, for example because they had only casual contact with their last sexual partner.

However, most people who report an STI prefer to talk directly to their sexual partner, especially if they are in a committed relationship.

Combating stigma is key

Sexually transmitted diseases are usually covered in sex education classes at school for young people, but caution must be taken. Teaching that only focuses on the risks, dangers and ‘gross’ aspects of sex puts young people off and can reinforce the stigma surrounding sexually transmitted diseases. This can make young people less likely to get tested for sexually transmitted diseases or to disclose an infection.

Modern approaches to comprehensive sexuality education emphasize the importance of supporting young people in having safe, respectful and enjoyable sexual relationships.

Education should also include non-blaming information that demystifies young people and makes them aware that sexually transmitted diseases are common, that testing is easy and that most sexually transmitted diseases are easily treatable.

But sexually transmitted diseases are not just a problem for young people. We cannot assume that someone is automatically aware of their sexual health as an adult.

Investing in campaigns that normalise STI screening, such as the fantastic Drama Downunder campaign, which uses striking and humorous imagery to raise awareness of STI prevention and testing for gay, bisexual, queer and trans men, can support people to access sexual health services and start conversations about STIs.

The Australian Government recently launched Beforeplay, a national advertising campaign to promote STD awareness and testing uptake among adults. The success of this campaign will depend on its ability to normalise open communication about sexual health and STDs among the wider population.

The high level of stigma and shame associated with sexually transmitted diseases makes them a unique and complex public health problem. To reduce sexually transmitted diseases, we must combat this stigma and shame.