Breaking down the stigma around STIs

“Have you been tested?”

We know it’s not the most comfortable question, but the conversation could make all the difference for your health.

Sexually transmitted infections (STIs) impact young people the hardest, according to the Centers for Disease Control and Prevention (CDC). In 2018, nearly 50 percent of new infections occurred in people ages 15-24.

Matthew Pippenger, PA-C, treats a large number of STI cases at MultiCare Rockwood Clinic in Cheney — the clinic offers on-site student health services for Eastern Washington University.

Pippenger is the clinic’s medical manager. He understands that talking about STIs can be awkward, but says that it shouldn’t be that way with your health care provider.

“It all comes down to being comfortable and acknowledging ‘yes, this exists,’” he says. “We’re here to help, not judge.”

Making STI screening part of your routine health care will also help reduce stigma, says Mary Fairchok, MD, MultiCare’s infection prevention medical director and Mary Bridge Children’s pediatric infectious diseases medical director.

“Health care is health care,” she says. “Just because you’re diagnosed with an STI, it’s not a judgment of your character.”

The key things to remember: Be aware, know how to prevent infection and don’t be afraid to talk about it.

Know the facts about STIs

The most common STIs in the United States are chlamydia, gonorrhea, syphilis/congenital syphilis, herpes, human papillomavirus (HPV) and human immunodeficiency virus (HIV). While the COVID-19 pandemic initially led to a decrease in new STI cases — likely because of social distancing — rates of gonorrhea and syphilis have since surged.

Nationally, 2.5 million cases of chlamydia, gonorrhea and syphilis were reported in 2021. That’s a 25.4 percent increase in gonorrhea and 68.3 percent increase in syphilis since 2017.

STI rates tend to be higher among younger populations due to higher levels of sexual activity, limited access to care or not seeking care, says Dr. Fairchok.

Men who have sex with men and pregnant women are also disproportionately impacted by STIs, according to the CDC. And social determinants of health lead to an unequal burden of STIs in Black, American Indian/Alaska Native and Hispanic communities as well.

There’s even evidence to show the opioid epidemic has had an impact on STI rates, especially in congenital syphilis cases, says Dr. Fairchok.

Whether from not taking proper precautions, fear/shame in seeking care, lack of communication or not knowing the warning signs, Pippenger stresses education for his patients.

“I find that a lot of students don’t understand that STIs can be asymptomatic,” he says.

For example, syphilis sores are typically painless and can be easily overlooked, but that’s also when the infection is most contagious. Chlamydia — the most commonly diagnosed STI — is more often asymptomatic in women than men.

Educate yourself using the STI quick guide below.

Have the conversation

Just as there’s no shame in seeking care, Dr. Fairchok says there should be no shame in talking about STIs.

Awareness, transparency and testing are all part of being a responsible member of the community, she says. The risk factors of each STI vary, but when left untreated, most carry lifelong health impacts. In the most extreme circumstances — such as HIV, which can develop into AIDS — there can even be legal ramifications for those who don’t disclose their status to a partner.

Whether you’re with a new partner or in a long-term monogamous relationship, it’s a conversation that should be had before engaging in sexual activity, and then regularly discussed. The CDC offers tips on how to start the conversation.

“Many relationships start off monogamous and sometimes that changes. I’ve certainly diagnosed STIs in patients who were surprised to find it out,” Dr. Fairchok says. “The second reason: It’s so often that you or a partner may have no symptoms. If you’re not screening or being honest, it’s best to operate from the assumption of ‘Let’s just get tested to begin with.’”

Pippenger adds that just because you may be each other’s only partner now, it’s still important to get tested if you’ve had previous partners. If you have any concerns or questions about your risk, speak with a provider.

Get tested 

The CDC outlines STI testing recommendations for adolescents based on severity, prevalence and cost, as well as gender, sexual activity and risk factors. Recommendations are made regardless of relationship status and don’t change based on gender identity.

• All sexually active women 25 or under (regardless of partner’s gender): Annual screening recommended, especially for gonorrhea and chlamydia
• Women over 25 (regardless of partner’s gender) who have risk factors such as a recent diagnosis, new or multiple sexual partners or interact in a high-prevalence setting: Annual screening recommended, especially for gonorrhea and chlamydia
• Everyone who is pregnant should be screened early in pregnancy
• Men who have sex with women and have risk factors such as a recent diagnosis or interact in a high-prevalence setting: Routine screening recommended
• Men who have sex with men: Annual screening or more frequently as warranted recommended, especially for syphilis, chlamydia, gonorrhea, HIV and hepatitis C (if living with HIV)

Because so many people experience minimal to no symptoms, Pippenger recommends anyone who is sexually active get tested regularly.

Find your nearest testing site online.

The only way to be 100 percent protected from STIs is abstinence, Dr. Fairchok says. But outside of confirmed negative STI results within a monogamous relationship, limiting your number of sexual partners and using condoms or other forms of barrier protection can help lower your risk.

For those whose partner already has a lifelong STI, such as HIV or herpes, there are medications available to reduce risk for both of you.

• For individuals whose partner has HIV or engages in high-risk behaviors for HIV, the pre-exposure prophylaxis (PrEP) medication reduces the risk of contracting HIV from their partner by 99 percent.
• Medications are available to reduce the frequency of herpes outbreaks and risk of spreading to partners.

“It’s much better to do all the preventive health measures you can to keep yourself healthy and protect others,” Dr. Fairchok says. “And always go get yourself checked if you have any symptoms.”