Stopping the Rise of STIs

In 2019, there were 2.5 million reported cases of chlamydia, gonorrhea and syphilis, breaking the previous record high for the sixth year. These infections have a staggering cost of as much as $16 billion annually. There are many reasons for increases in sexually transmitted infections (STIs); however, they can be boiled down to three challenges: stigma, access and education.

Stigma is a factor that continues to impact STI rates. In many communities, a positive STI result invokes deep feelings of shame and guilt. Getting an STI can exacerbate any internal belief that sex is immoral and acquiring a STI is punishment.

Facets of the medical community are complicit in perpetuating these beliefs. Questions commonly asked in sexual health clinics such as, “How many partners have you had?,” insidiously add to the subtext that one gets STIs from being promiscuous. While having unprotected sex with multiple partners certainly increases the risk of getting an STI, it only takes one encounter to acquire an infection. Asking where, when and with whom someone last had sex often leads to unease as well. These questions can exacerbate discomfort, embarrassment and reluctance to return for further testing and treatment.

Access to testing is the second challenge. Although COVID-19 lockdowns decreased interaction with people outside of one’s household and, in general, people had less sex during the pandemic, this does not mean they were abstinent. In fact, online dating services experienced huge growth during COVID-19. The pandemic also largely shut down in-person primary care, limiting people’s ability to get tested for STIs. Many people also delayed preventative care during the pandemic. Against this landscape, STI testing decreased as well.

Even without COVID-19 hampering STI testing, access can be a challenge. One study found that 35 percent of counties have no STI testing clinic, and 34 states had less than one clinic per 100,000 population. Rural areas were especially underserved. Additionally, concerns about lack of confidentiality and cost are barriers to accessing STI testing.

Reducing stigma and increasing access are needed to improve testing rates, but education is important for prevention. Unfortunately, many sexual education programs are abstinence-only, which are ineffective and typically result in people feeling reluctant to get tested proactively when symptoms are present. A great majority of adults will have sex with several partners in their lifetimes, so sustaining an abstinence or monogamy-only approach exacerbates shame, embarrassment and mistrust of medical professionals.

Instead of upholding a pro-abstinence moral argument, educators and health providers could reduce STI rates by normalizing several evidence-based harm-reduction approaches to preventing and reducing STIs.

Condoms, when used exactly as intended, prevent fluids from being exchanged between partners. This allows people to enjoy sexual intimacy while significantly reducing the likelihood of acquiring an STI. Pre-Exposure Prophylaxis (PrEP) implementation in communities with high STI rates is also a harm-reduction strategy. PrEP reduces risk of HIV transmission to nearly zero. Taking PrEP also includes a regimen of best practices, including STI testing every 90 days.

The first reform that must be implemented to address rising STI rates is to make STI testing more accessible. Opening more clinics and expanding hours is one way to achieve this. Additionally, exploring pharmacy partnerships where testing and treatment can be accessed in one visit, and using telehealth in combination with self-testing can also expand access. Other ways to decrease STI rates include talking more openly about sexual health, implementing comprehensive sexuality education and improving provider education. All of these actions will decrease stigma and increase knowledge—vital steps in STI prevention.

One thing COVID-19 showed us is that people desire human connection. People have a right to learn and understand the myriad options that allow them to enjoy sexual intimacy and connection while reducing risk of STIs. But if there is silence among educators and providers and a reluctance to implement evidence-based data and prevention strategies, people at high risk will continue to obtain and spread STIs. After all, we are all in a position to help end the silence about STIs, reduce stigma, increase knowledge, and enhance health and pleasure for all.

Image credit: RHSupplies