STI/STD Awareness: Debunking Myths and Increasing Patient Education
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Did you know that sexually transmitted illnesses and diseases are at an all-time high for the sixth consecutive year? Nurses are in a unique position to debunk the stigma and myths about these infections. This might help prevent reinfection and improve their patient's health.
The healthcare community is also moving away from calling these health conditions sexually transmitted diseases (STDs). Instead, they are moving toward using sexually transmitted infections (STIs).
On this page, we cover some of the more common myths and stigmas about STIs. Learn how to improve STI awareness and ways nurses can debunk stigmas and myths that interfere with patient care.
Addressing Stigmas Around STIs and STDs
Dr. Gary Schoolnik is an attending physician in internal medicine and infectious diseases at Stanford University Hospital. He says that STIs are unlike other infections since "there are stigmas relating to STIs that are centered on judgment from others around the misperception that only 'bad' or 'dirty' people get STIs, and women typically bear the brunt of that stigma."
Yet, as Schoolnik notes, it only takes one sexual contact to get an STI, and roughly 50% of Americans will have one STI or more throughout their life.
There are over 35 different infectious organisms that can be transmitted sexually. This has a direct effect on reproductive and sexual health. According to one study, while people of any gender can be infected, of the two genders for which data were collected, women experience STIs more frequently and have more serious complications than men.
Tresa Wallace is a nurse practitioner with many years of experience in women's health. In her experience, women tend not to get tested for fear of the unknown.
"Some assume that an STI diagnosis means they can't have sex or be in a relationship again," she says. "There's also a lot of internalized shame around STIs because they've become so stigmatized in our culture."
Roughly 50% of Americans will have one STI or more throughout their life.
Stigmatization is a barrier to healthcare. It impacts public awareness and training in healthcare workers. Schoolnik also points out that cultural or religious taboos can reinforce these stigmas.
"Many people tend to think that they could never get an STI, and therefore are 'better than' those who have had an STI, when nothing could be further from the truth," he says.
In part, Wallace believes the stigma surrounding STIs stems from sexual education in schools that frame infections as something only people having unprotected sex with many partners can get.
This stigma is most often placed on women since society sees women as "dirty" for having sex with several partners but doesn't use the same standards for men. People of any other gender than those in the binary are generally disregarded.
Many fears and anxiety about STIs are complicated by patients' lack of understanding of how an STI could affect their dating and sex life. However, Schoolnik reminds patients that "people living with STIs lead full and rewarding lives, and that includes dating, relationships, marriage, and yes, even sex."
He stresses the importance of connecting with a community of people living with STIs considered chronic, lifelong, or uncurable, such as HIV or herpes. Nurses can help introduce patients to these local support groups.
Stigmas and Shame Interfere With Patients Seeking Care
People are sometimes so fearful of what an STI diagnosis may mean that they delay getting tested. Schoolnik finds this is particularly true as it relates to seeing a primary healthcare provider.
Instead, patients may go to a clinic for testing. They may also decide to use another name so their primary care provider (PCP) isn't notified, resulting in long-term health consequences.
"People who find themselves in this situation may consider an STI clinic or other sex-positive healthcare environments that can provide testing, education, and treatment in a judgment-free environment," Schoolnik says.
The Centers for Disease Control and Prevention (CDC) recommends people who are sexually active have annual screenings. The recommendations for sexually active people include:
- Anyone ages 13-64 to be tested at least once for HIV
- People with vaginas who have new or many partners to be tested for gonorrhea and chlamydia
- Pregnant people to be tested for syphilis, HIV, and hepatitis B and C early in the pregnancy; if sexually active with many partners, test also for chlamydia and gonorrhea
- Any sexually active people with penises who have sex with others who have penises to be tested for syphilis, chlamydia, gonorrhea, and HIV
Annual screenings are important since you can have an STI with hardly noticeable or no symptoms. Sexually active patients may want an annual screening even if they believe they are in a sexually monogamous relationship, since their partner may not be monogamous, or any of the partners could have a latent or asymptomatic infection.
Additionally, while condoms and other barriers reduce the risk of getting an STI, they aren't 100% effective.
When an STI is undiagnosed and untreated, it can lead to more people getting infected. Many infections may also trigger infertility, chronic pain, pelvic inflammatory disease, and cancer.
Shame Plays a Role in Diagnosis and Treatment
The stigmas and shame surrounding the diagnosis and treatment of STIs can impact patient care and future health conditions. Although science recognizes shame as a powerful force, it has not been well researched or recognized in the context of health-related behaviors.
Shame leads to avoidance behaviors, which in turn can lead to secondary health conditions. While nurses and doctors have been working to reduce the effect of stigmas against STIs in the healthcare system, societal stigmas continue to affect diagnosis and treatment.
"To avoid the shame of asking friends or seeking help, often individuals turn to Google or social media platforms to get information about their condition," Wallace says. "This, in turn, can lead to misinformation, misdiagnosis, and worsening symptoms or complications."
Additionally, Wallace points out that many Black or African American patients mistrust the healthcare system. This stems from many factors, including ongoing and historic examples of racism, like the exploitation perpetrated on the community during the Tuskegee Syphilis Study.
"This kind of exploitation eroded trust with healthcare providers and is one of the reasons these misgivings still persist today," Wallace says.
Any conversation about sex, especially STIs, will trigger generations of programming that trauma, family, and culture influence. Social norms have also shaped the way that society views and treats STIs, including healthcare professionals.
"Unfortunately, some PCPs even judge patients who request testing for STIs negatively," Schoolnik notes.
Conscious Language Helps Reduce Stigmas
Language plays a role in the development and perpetuation of stigmas around STIs. Despite being among the most common infections, STIs are among the most stigmatized.
Even people who have a "sex-positive" attitude may contribute to the stigma by referring to a negative test as a "clean" test — and people who have negative results as being “clean.” This may seem like a harmless comment until you realize the opposite of "clean" is "dirty."
Shifting language away from terms that stigmatize those with STIs and moving away from calling infections sexually transmitted "diseases" are good first steps to creating a safe environment for patients.
Stigmas about STIs and the resulting shame can influence people's behaviors and slow down STI awareness and prevention strategies that depend on open, honest communication.
Nurse's Role in Debunking Stigmas and Raising Awareness
Schoolnik believes that nurses play a unique and critical role in reducing stigmas within the healthcare system "by treating it as just another infection, like a cold or flu, and addressing it in a welcoming and open way."
Nurses are typically the first healthcare provider patients have meaningful interactions with in many healthcare settings. So, nurses can help set the foundation for an open and caring environment. Patients who have a high level of comfort with nurses will likely ask more questions. This offers an opportunity for education that can help reduce fear and encourage regular testing.
Fear of the unknown is one of the driving forces behind anxiety and procrastination, which can interfere with patients seeking early testing and treatment. This is why education and information are powerful ways of addressing fear and encouraging patients to routinely get tested.
"The primary benefit of increasing patient education around STIs is to give people the information they need to keep themselves healthy, in a stigma-free way," Schoolnik says.
Left untreated, some STIs can have long-term consequences. Ectopic pregnancy, pelvic inflammatory disease, and infertility can result from untreated chlamydia or trichomonas infections. Since most STIs have no or very few symptoms, regular testing is critical.
Schoolnik notes the results of one study published in the Journal of Pediatric and Adolescent Gynecology. The data showed that women who received education had significantly lower reinfection rates at the patient's one-year follow-up appointment compared to the control group.
Importance of Increasing Patient Education and STI Awareness
Nurses play an essential role in STI awareness and education. Information and education can help patients make healthier choices, and education about STIs is no exception.
Education and information also help debunk myths about STIs and can reduce stigma.
1. Patient Education Can Take Many Forms
Some patients prefer reading information or may be too embarrassed to talk about STIs. Nurses must be comfortable having conversations about STIs with their patients. Otherwise, nurses could contribute to a patient's embarrassment and the potential risk of not being tested and treated.
2. Nurses Should Encourage Regular Testing
Healthcare practitioners should speak with every patient who is sexually active about having annual screening for STIs. The stigma of STIs may lead patients to remain silent or uncooperative. This can result in untreated STIs and long-term consequences.
3. Nurses Can Destigmatize STIs on a Community Level
Nurses can also participate in community efforts to destigmatize STIs and encourage the community to seek annual screening. Nurses are also commonly approached by friends and family with healthcare questions. This is another opportunity to pass information and education that can help reduce the stigma and encourage annual screening.
The stigma around STIs can cause shame and embarrassment, which leads to silence. Unfortunately, when patients don't know they have an STI, they can pass it to others, especially their sexual partners.
Education, information, and STI awareness can help reduce the growth of the problem, increase the number of people treated, and improve patient outcomes.
STI/STD Frequently Asked Questions
What's the difference between an STI and STD?
The abbreviations stand for "sexually transmitted infection" and the "sexually transmitted disease." Although they usually refer to the effects on a person that come from the same sexually transmitted organisms, not all infections lead to disease, and not all disease starts with infection.
Additionally, there appears to be a great stigma around "STD," so many in the healthcare community are using STI to denote infection with a sexually transmitted organism.
When should I get tested for an STI?
The CDC recommends anyone sexually active should be screened annually.
Additionally, everyone ages 13-64 years old should be tested at least once for HIV. All pregnant people should be tested early in their pregnancy and again if they are sexually active with many partners.
What are common STIs?
While there are over 35 different sexually transmitted organisms, the most commonly diagnosed STIs include chlamydia, gonorrhea, herpes, genital warts, human papillomavirus, pubic lice, syphilis, HIV, and trichomoniasis.
How do I prevent STIs?
Using condoms every time you have vaginal, anal, or oral sex can also reduce the risk of getting an infection, especially with new partners. Having conversations with your partners before you have sex is essential.
Be sure to talk with your partners about safe sex, STIs, and regular testing before engaging in sex.
Meet our Contributors
Tresa Wallace, NP
Tresa Wallace is a nurse practitioner at The Pill Club. Wallace started her nursing career working in oncology and went on to spend 12 years as a labor and delivery (L&D) nurse. Following her time in L&D, Wallace worked as a nurse practitioner in various capacities, including at a private practice OB/GYN, a community mental health clinic, Planned Parenthood, and most recently, the OB/GYN department at Louisiana State University. Wallace earned her bachelor's in nursing from Loyola University in New Orleans and master's in nursing from Frontier Nursing University.
Dr. Gary Schoolnik
Dr. Gary Schoolnik is chief medical officer of Visby Medical. He is also professor of medicine (emeritus) at Stanford Medical School, attending physician in internal medicine and infectious diseases at Stanford University Hospital, and associate director of Stanford's Institute for Immunology, Transplantation and Infection. Schoolnik received his medical degree and infectious diseases subspecialty training at the University of Washington in Seattle and served as chief resident at Harvard's Massachusetts General Hospital in Boston. His academic research focuses on the molecular, genetic, and genomic aspects of infectious agents and on the development of new drugs, vaccines, and diagnostics.
Page last reviewed: March 22, 2022
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