Why Sexually Transmitted Infections Can’t Shake Their Stigma

I was diagnosed with genital HSV-1 a decade ago, and find some of the comments herein to be depressing, if not outright appalling. My transmission was not unusual- within a monogamous, years-long relationship using barrier protection. My partner had what we thought was a routine cut on his lip- it was oral herpes, which can easily be spread to other areas. You get the idea. Casual sex and promiscuity have no monopoly on STDs, as many of us would be happy to tell you, were you not so eager to shame us. That said, my years of dealing with herpes have taught me with profound clarity that the stigma is far, far worse than the virus itself. One needs only to read some of these comments for a perfect demonstration of this truth.

STIs are caused by germs. It's just a germ, sometimes cureable, sometimes with sad results. The only way to assure that you will be STI free is to have one lifetime sex partner who only has one lifetime sex partner...you. Not always possible. Not always the wise choice. So why would anyone judge? A first experience could result in any STI. Where is the promiscuity on the part of the victim? Why would anyone judge another?

Until the vaccine for HPV, I’m not sure HPV was treated as an STD. I certainly wasn’t aware that cervical cancer was caused by HPV. I was told that all women needed Pap smears to look for cancer, and it was a condition of getting the Pill that I have an annual Pap. Later I was also told that virtually all people are exposed to HPV and it was just a fact of life. Also, where I live, in Canada, my doctor’s office waiting room has a handy chart now of what cancers HPV causes, with photos of each type, divided by sex. Substantial numbers of people get oral cancers from HPV (and more men than women). Also slightly more men get rectal cancer. About the rest of the STDs, as many commentators here have said, they are a big deal! Herpes can affect babies during childbirth. Other diseases can cause infertility. I haven’t been aware that so-called “cisgender white men” aren’t stigmatized for STDs. I thought everyone was! And for many people there is a huge suspicion of men who lead a “player” lifestyle. In my mind, at least, a promiscuous woman is a danger to only herself, but a promiscuous could be a danger to innocent people — especially teenage girls who might be naive. I wouldn’t want a promiscuous man in my home! In the workplace, too, many women are hostile and suspicious of promiscuous men. Men have a responsibility not to offend with their sexuality, nor to misread signs. There is always a suspicion that an unmarried, (widely) dating man is pushy with his sexuality.

This comment section could use so much more empathy. When I was diagnosed with herpes, I thought my entire life was over. I spent over a year convinced that I was unlovable, and I heard joke after joke reinforcing that idea. I had no idea you could get HSV1 genitally, and this comments section has convinced me that the readers of this article don’t know much more about STIs than I did! I’m so lucky now to be with a loving partner and to have supportive friends. Take care of yourselves, inform your partners of your health status, and make sure that the people around you feel worthy of love.

Thirty thousand new HIV infections each year in the US? WOW!!! Remember the 80s, when AIDS scared the daylights out of people? I guess with the new prophylactic and post-infection treatments, those days are over. Yes, it is small percentage of the total population, but it's a risk people shouldn't be taking.

From the CDC website: “CDC does not recommend herpes testing for people without symptoms. This is because diagnosing genital herpes in someone without symptoms has not shown any change in their sexual behavior (e.g., wearing a condom or not having sex) nor has it stopped the virus from spreading. Also, false positive test results (test results that say you have herpes when you do not actually have the virus) are possible. Even if you do not have symptoms, you should talk openly and honestly about your sexual history with your doctor to find out if you should be tested for any STDs, including herpes.” It’s utterly ludicrous that routine screening for all STD’s including herpes isn’t recommended for all sexually active persons. HSV 1&2 can cause genital herpes and oral herpes are commonly known as canker or cold sores. Did you know the chicken pox is a herpes virus? Education and knowledge need to replace stigma and shame. The days of victorianesque values are over.

In 1985, I (straight white, 34-year-old, single male) got a phone call from a recent lover that she had been notified that the man she had been with prior to me (European, bisexual and in search of an easy green-card) had been diagnosed with ARC, known at the time as aids-related complex, and that she was sorry and I should get myself checked out, as she was, herself, doing. because the man was very sick. I remember being in immediate shock, but thanked her for caring enough and being brave enough to let me know. That was on a Friday night; I remember that because I remember spending a very long weekend at the public library reading up on all the latest articles on this new thing called AIDS. During the weekend, at the supermarket checkout line was the ubiquitous magazine rack with a Time magazine announcing AIDS THE GROWING THREAT. From somewhere I found that a blood test had recently been developed to identify certain anti-bodies. On Monday morning at 8 a.m., I was the first person at the County Public Health Office, and I asked to be tested. The reason I am writing this is because of what happened next: The doctor tried to talk me out of taking the test because I wasn’t in the profiled, at-risk group. I insisted, based on what I knew, and basically had to make a scene to get tested! Back then, it took two weeks to receive my results, which came back negative. It wasn’t long after that that the medical community was calling for all concerned people to get tested.

What would have been helpful in this piece would have been definitive, prescriptive info about STI testing. What can be tested for? What can't? How often would be appropriate? How long are latency periods? Etc. Maybe a follow-on piece?

Commenters are pious bunch. Instead of the shaming and blaming, perhaps shift the conversation to a healthcare protocol and healthcare access to catch and treat STIs. Imagine if all primary care physicians, as part of your annual physical tested you without invoking shame. If you heard the words "we're running a lipid panel, a STI panel/tests, and glucose levels" stigma would drop and STIs latent in the population would be caught, and if a treatment were available, treated. Also imagine the world were everybody had health insurance ...

There should be a stigma and shame for conditions caused by reckless and irresponsible behavior. For the same reason there should be stigma and shame for driving drunk. Innocent victims in both cases.

Thank you for your important words. When diagnosing me with HSV 2, the doctor told me, "I'm sure you'll come to forgive yourself." I have never forgotten those words of judgement and spite. No one has ever judged me as harshly as that gynecologist did that morning.

The population least likely to use protection is married people or people in marriage-like relationships especially when they are planning to have children. Another population who commonly does not use protection is people cheating on their spouse. The cheated-upon spouse then ends up with an STI even though they did nothing "wrong". Sometimes they get cancer or die.

"Those words can be thrown at them by their partners, their community, strangers online and even via stigmatizing interactions with health care professionals. The consequence is that many S.T.I.s are on the rise. Between 2013 and 2017 (the last year for data) the number of cases of gonorrhea have increased by 67 percent and syphilis by 76 percent." This doesn't make any sense...unless the author seriously thinks that the stigma went up significantly between 2013 and 2017? Yes, I too recall the great STI purges of 2014 and 2015! The latter half of the 2010s is certainly known for increased stigma towards sex! STI diagnoses are up not because of increased shame but because it is increasingly common for people to be having sex with multiple sexual partners over a short time frame, which is the necessary biological condition for STI transmission.

Some of the comments reflect a notion that all sex is consensual and that all STDs are contracted consensually. How many women have contracted diseases over the course of human history from their husbands and had no idea this could have happened to them until they became symptomatic or their husbands did?

I agree about the stigma. But it is amazing how many men I dated over the many years that I was single, who were generally non committal, but very insistent about preferring to have sex without a condom, claiming they were clean of STD's. Pleasure before principle. And that is how things proliferate.

"Sexual positivity": translation, if it feels good do it. Guess what? So does smoking, shooting heroin, driving 120 miles an hour down the highway. Sorry, but I totally disagree. Yes, sex is being taught wrong. It should explained to be a deep personal connection not this whole "hookup" culture that everyone feels they must participate in or be deemed out of touch. I had my son vaccinated against HPV to protect him! Women are not always the victims here, which is SO politically unacceptable to say. Mistakes, misled, it happens. But let's tell it like it is. Sexual encounters are fraught with danger, from a broken heart to disease. Treat it with respect. Casual sex is a lie.

I was diagnosed with HPV in 1994. I subsequently developed cervical cancer and needed a radical hysterectomy at the age of 33. My OB-GYN at that time told my mother after my surgery (my mother!), that "your daughter is promiscuous". I still feel the shame to this day....

STDs are on the rise because birth control has created a culture of promiscuity especially among young women who think just because they can’t get pregnant that sex doesn’t have consequences. They behave stupidly and take too many risks to appear “ modern” and “ cool. I teach my daughter to respect her body and be incredibly discriminating when it comes to sex. Just because you can doesn’t mean you should!

A big part of the answer should be honest and non-judgemental sex education beginning before children become sexually active. Unfortunately in this country we are not only too squeamish to do what's necessary it's also a sure bet that there will be politicians, media and religious organizations ready to stir up ignorance and prejudice to keep it from happening.

The biggest thing that could be done to reduce STI rates is to give the HPV vaccine to men as well. HPV is the most common STD of all, and yet there is no test for HPV in men (ok, there is one in theory but in reality as a practical matter there isn't), nor are boys typically vaccinated. So you end up with a ridiculous situation where half the population doesn't even know if they might be carrying it, and has no way of finding out even if they do want to know. Even people who have symptoms will never definitively know - and will never know when the virus is gone, if they did have it.

STIs are on the rise because of the lack of age appropriate sex education in our schools. We are not raising our children to be sexually healthy and responsible. In this country boys learn about sex by watching pornography. There is no education on human sexuality. Children need to be socialized properly by their parents or families, churches, and schools. When these three institutions fail to educated children about sex the aftermath of unwanted pregnancy and STIs become the responsibility of the government health care system. There is a direct statistical correlation between abstinence only sex seduction and the dramatic rise of STIs in this country. The result is that women are not educated on proper prenatal care, let alone birth control, and are giving birth to babies with STIs. The care for these children is lifelong and very expensive. Again putting the burden on the government, our tax dollars, to pay for the care of these children. I believe this physician is pointing out that despite the prevalence of sex acts displayed through myriad media platforms, highly educated people, that are able to afford private health care, are unable to comfortably discuss matters of sexual health. They do not have the skill set. It was not taught to them.

Incurable contagious diseases will always have a stigma. That's just reality.

Dr Gunter argues that’s its the stigma of promiscuity thrown at women, people of color and the L.G.B.T.Q. communities that is behind the rise in STI rates. Might I suggest a different cause? Cis-men do not have the same access to sexual health services provided to women under Obamacare (the ACA). In particular, men do not have co-pay free access to well visits or STI testing, while women do. Perhaps if we took men’s sexual health care more seriously, men would get sick in lesser numbers. And, though that should be enough reason, add in that their partners would be less likely to get sick as well. Arguing the rather subjective issue of “stigma” seems silly when we actively discriminate in how we provide healthcare.

The stigma associated with the herpes virus (especially HSV2, or 'genital herpes') is far, far worse than having the 'affliction' itself. Why this remains so is, like Dr. Gunter writes, something of a mystery. It's a skin condition, after all, that may or may not occasionally flare up (something like 80 or 90% of people with the infection are unaware they even have it). If you've dated more than three or four people in your life, you've dated someone with HSV2. It's just not a big deal.

Much of the problem is caused by health professionals themselves. I've heard of doctors refusing to treat suspected cases of STIs without expensive, unnecessary testing. For example, patients that have had sex with someone who has tested positive for an STI should be treated immediately. Instead they're tested to "make sure" and have to wait for treatment. I've also seen people that were treated and tested at the same time. What's the purpose of knowing you were infected after you've already been treated for the infection? And don't even get me started on the number of people that avoid testing due to the invasiveness of public health officials and potential legal ramifications. People in Missouri have been imprisoned because they know they carry HIV. I'd say wise legal advice - and bad health advice - is to never be tested for anything.

I’m disappointed to see lesbians indiscriminately lumped in when using the term LGBTQ. The article stated that LGBTQ persons have elevated risk for STIs. I wrote to the author about this and she wrote back that the risk among young lesbians was comparable to young heterosexuals. That is very different than *elevated*. My guess is that if researchers were to look at lesbians who are exclusively lesbian, we may be very small in number, that they would find risk of infection is lower. This is not to suggest that we should not be safe. Lesbians are often lumped together with other sexual minorities but in fact are different in many and significant ways. I hope that people will be more careful when using this term in the future.

One problem is the media, including this newspaper, and shady information. HIV and AIDS are often treated as interchangeable. They are not. People with HIV are now able to live full lives with few side effects. This isn't a license to go out and be irresponsible, but it's not the nightmare it was just 20 years ago. HIV doesn't mean AIDS any more than HPV means a person with it will develop cervical and/or other cancers. My doctor made the point recently that her HIV patients over the age of 50 who adhere to their medication are healthier than most of her non-HIV patients. Of course, this is never the story that's told by outlets like the New York Times and so the fear, loathing, and self-hatred go on and on...

Sexually Transmitted Disease, not sexually caused disease. It does not penetrate into the reasoning mind. The social mentality of people, the sense of belonging or being rejected, becomes the major concern.

"If it’s all consensual, it’s all good." Fair enough. But you don't have to judge a person's sexual proclivities while explaining in clear and accurate terms about the risks and consequences of the many diseases that are transmitted via unprotected sex, however you define the term. One metaphor that helps drive home the point is this: having sex with someone subjects you to the same S.T.I. risk as having sex with everyone else that person had sex with.

Why wouldn't a woman be upset if she received a diagnosis of a STD? If she gets Herpes and becomes pregnant, she will have to have a C Section if it is active at the time of birth to protect the child. Other infections can cause Pelvic Inflammatory Disease and render her sterile. These diseases are not a minor inconvenience. They can cause life changing issues. Should she be shamed? No. Should she be upset? I think it would be understandable. Should she use protection? Absolutely.

Hook-up culture benefits men. Human beings are not bonobos.

When did the term STDs get replaced with STIs?

Lesbians do not have elevated risk of STIs as stated in the article. Please don’t lump all LGBTQ together. We are different.

Based on what I've read, it seems that condom use in America is down - more popular methods of hormonal birth control for women have made people think condoms are not necessary, especially if their partner "looks clean." (And to be clear, condoms don't protect against contact-based STDs like herpes.) But condoms can go a long way in preventing other STDs, and are quite reliable when used correctly. Condoms are non-hormonal and cause no side effects other than for those with latex allergies. We need to stop telling women and young girls that hormonal birth control is the only option (though it is great as a backup if they are OK with the side effects) and start encouraging men to wear condoms again. If they care about their partner's health and their own, sliding on a condom should be an easy ask...right?

I think a lot of people think of HIV/AIDS when they hear STD. Alas,changing "disease" to "infection" hasn't reduced stigma. Given the plight of early sufferers of HIV--practically a death sentence--hearing of it conjures up an image of sick,dying,youth. That's quite a macabre scene to imagine. What's worse,is that people associate this with the choice of being sexually promiscuous and irresponsible. Like you said,we don't fill out sexual consent forms asking partners of their entire history,first. People like that wouldn't be having a lot of sex.

To be on prep, you are screened for HIV and various other STIs every three months. As long as you are having sex with other people on prep, then your odds of getting an STI are vastly lower. Can anyone support or refute this logic?

Many of the other comments thus far - ironically - embody the same stigma the author is describing. Views that, as a society, we are too sexualized, too overstimulated, and too irresponsible with our bodies. As the author points out, however, most STIs are transmitted unknowingly. Many STIs have latency periods when they are not yet symptomatic, or they never become symptomatic, and it is during these periods that STIs are often transmitted (because treatment is not known to be needed). Even then, common STIs (including syphilis, gonorrhea, chlamydia, and HPV) can be transmitted even when a condom is worn, either through exposure to skin not fully covered by the condom, or through extra-genital routes such as the mouth. I'll also correct another commenter: the HPV vaccine, while not comprehensively protective, does provide resistance to the most common and harmful known strains of HPV in men and women (and protects against 9 strains, not 4). Further, I would argue that our perceived "promiscuity" is really a re-aligning of social norms with our biological reality. We are sexual organisms (in addition to being emotional and intellectual organisms), and we grow across all those aspects of ourselves through, among other things, sexual experiences. Whether one experiences that growth to one's satisfaction through one or a few sexual relationships, or many, makes no difference, so long as in all cases that growth is experienced with mutual respect, consent, and safety.

I heard a demographer once say that the 1918 Spanish flu managed to kill off a lot of people who were already infected with other kinds of diseases while leaving the relatively health people alive. The result of the 1918 pandemic was an overall stronger, healthier, more disease free population. At some point, there will be another pandemic, and a significant percentage of the people with STIs will die. Mother nature has a rather unforgiving way of correcting itself.

In today’s, informative age, it is indeed a shame to catch an STI through carelessness. What would be great is if sex education in schools focused equally on the act of sex and the consequences of it. One reason that STI’s are on the rise is ignorance amongst people on what and how these diseases are spread. The stigma that is associated is natural, it is infectious and can cause scarring of internal reproductive organs leading to infertility. The resistance to antibiotics for many of these STI’s pose bigger problems. As for ‘curing’ an STI, chances are you will still remain vulnerable to others. The HPV vaccine hardly offers complete protection to men or women. It targets the major 4 strains, but there are at least a 150 strains of HPV that we know about. It is entirely plausible, the vaccination will simply cause lesser known species to colonize and cause problems. There are no short cuts to a cure and certainly no known magic bullets. Sex has unfortunately been elevated to strange erotic levels everywhere. It is simply a natural means to procreate ones genes. The fact that it can be pleasurable is more to do with a mental and emotional connect than mere physical contact. Perhaps it would be wonderful if sex were approached with respect for ones body and another’s. Schools can do a lot to portray the positive and educated image of why, when and how sex can be constructive.

In fairness, instead of only attacking the unequal enforcement of traditional views on sex using modern progressive sensibilities (e.g “cis gendered white heterosexual men”) the author should point out that if people actually followed old values on sexuality, STDs would virtually cease to exist. Frankly, it’s also unfair to demonize pre-modern societies that haven’t discovered modern microbiology, much less antimicrobials, for handling STDs in the only real way possible to them, i.e. restrictive sexual norms. I agree with the author that in today’s world we should be more open about STDs to better treat and control them. That said, the author has a clear blind spot in missing the obvious increase in STDs as a result of the increase in promiscuity, an increase the author herself acknowledges: “I don’t need to tell you that we live in an era of easy access to sex.”

Really? STIs come with stigma because it often means that people were making choices to opt not to use condoms before their relationships were monogomous (that transition away from condoms should be accompanied by STI tests)-- or that their expectation of monogamy was violated. I think its a bit of assumption that most people transmit STIs unknowingly. I would be very curious to see the studies that back that up, and what evidence they required to determine that it was always 100% unknowingly or that they just took everyone's word for it.