Stigma: A Central Cause Behind STDs

Authored by: Franklin Gu Art by: Stefanie Chen

One in four college students have a Sexually Transmitted Disease (STD) [1]. If you don’t have one, it could be your friend, your TA, or even that guy you hooked up with on Tinder last night. Additionally, STDs are most commonly spread through sexual contact [2]. Statistics like these perpetuate the growing stigma surrounding STDs in modern society, as discussing them inherently involves uncomfortable topics such as sex and relationships. It certainly doesn't help that diseases like HIV and genital herpes retain permanent infections in the body [3]. 

Alarmingly, the stigmatization of STDs has permeated into the medical field as well. A study in 1997 found that 17% of adolescents reported foregoing STI testing because they did not want their parents to know their results [4]. These rates have not subsided in recent years, as a study conducted by Liddon et al. in 2021 found that up to 25% of sexually active younger adolescents were not truthful with providers when providing their sexual history [5]. This data shows that the stigma behind STDs prompts young adults to purposefully avoid testing despite the associated safety risks.

Adolescents' concerns over confidentiality may have cascading impacts on the state of STDs today. The most recent CDC report findings show that STD cases have doubled since 2004 with more than 2.5 million cases of syphilis, gonorrhea, and chlamydia reported in the United States in 2022 alone [6,7]. This is especially troubling as these diseases can have severe and diverse impacts on health ranging from pelvic inflammatory disease to infertility [8].

Addressing sexual stigma in society requires deep-rooted change. One possible sector of change comes from health curriculums in the education system. Currently, nationwide sexual education programs promote “fear based” learning [9]. A study surveying the materials from 990 Texas school districts revealed that the course content often exaggerated negative consequences of sexual behavior and used misinforming language to shame and guilt students into abstinence from sexual activity [9]. 

For example, Human Papillomavirus (HPV) was targeted to fearmonger students into abstinence. In a hypothetical scenario, a boy says, “marry me, by the way I‘ve got genital warts, you‘ll get it too, and we‘ll both be treated for the rest of our lives in fact you‘ll probably end up with a radical hysterectomy, cervical cancer, and possibly death but marry me” [9]. The video misleadingly highlights symptoms of rare case HPV infections when the majority of HPV infections are asymptomatic or gone within 1-2 years [10]. 

In an attempt to promote abstinence from sex, curriculums like these perpetuate the stigmatization of STDs by emphasizing extreme threats that these diseases can pose, thus misinforming students on their risks. By fostering this attitude towards STDs, schools inadvertently contribute to their stigmatization and the shame that accompanies. This not only hurts people that actually end up contracting STDs sexually, but also increases stigmatization towards congenitally affected individuals who were born with these diseases.

Problematically, misinformation is not limited to Texas schools. Sexual education curriculums are only required in 36 states, with just 26 states requiring the information to be medically accurate [11]. 

STDs are a highly complex issue with a multiplicity of factors affecting their stigmatization. Unlike heart disease, the cold, or the flu, society shies away from talking about them, with many education systems even contributing to spreading their misinformation. Without spending time to search for factual information and talking about what these diseases really are and how they’re spread, many are led to exaggerated beliefs. People fear the shame an STD carries when really they should be treated with reasonable caution, the same as any other disease. These fears feed into a perpetual cycle of stigma and shame that reduces testing and amplifies the spread of STDs.

References:

1. Johnson, A., and Jackson, J.B. (2021). Sexually Transmitted Infections Among College Students. Microbiol Infect Dis., 5(1): 1-4. https://scivisionpub.com/pdfs/sexually-transmitted-infections-among-college-students-1481.pdf

2. Mayo Clinic. (2023). Sexually transmitted diseases (STDs). https://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/symptoms-causes/syc-20351240

3. Gianella, S., Massanella, M., Wertheim, J. O., & Smith, D. M. (2015). The Sordid Affair Between Human Herpesvirus and HIV. The Journal of infectious diseases, 212(6), 845–852. https://doi.org/10.1093/infdis/jiv148

4. Ford, C. A., Millstein, S. G., Halpern-Felsher, B. L., & Irwin, C. E., Jr (1997). Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care. A randomized controlled trial. JAMA, 278(12), 1029–1034. https://pubmed.ncbi.nlm.nih.gov/9307357/

5. Liddon, N., Pampati, S., Steiner, R. J., Hensel, D. J., Tsung-Chieh Fu, Beckmeyer, J., & Herbenick, D. (2021). Truth Be Told: Adolescents' Disclosure of Sexual Activity to Healthcare Providers. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 68(3), 623–625. https://doi.org/10.1016/j.jadohealth.2020.07.005

6. Centers for Disease Control and Prevention. (2024). 2023 CDC data suggest the STI epidemic may be slowing. https://www.cdc.gov/media/releases/2024/p1112-sti-slowing.html

7. Centers for Disease Control and Prevention. (2024). Sexually Transmitted Infections Surveillance, 2023. https://www.cdc.gov/sti-statistics/?CDC_AAref_Val=https://www.cdc.gov/std/statistics/2022/default.htm.

8. CDC Archive. (2024). STDs & Infertility. https://archive.cdc.gov/#/details?url=https://www.cdc.gov/std/infertility/default.htm

9. Wilson, K.L., Wiley, D.C., Rosen, B. (2012). Texas Sexuality Education Instruction: Shame and Fear-Based Methodology. Journal of Health Education Teaching. 3(1):1-10 https://files.eric.ed.gov/fulltext/EJ1085305.pdf

10. Meites, E., Gee, J., Unger, E., & Markowitz, L. (2024.). Chapter 11: Human papillomavirus. Centers for Disease Control and Prevention, Epidemiology and prevention of vaccine-preventable diseases. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-11-human-papillomavirus.html

11. Sex Education and HIV Education. (2024). Guttmacher, State Laws and Policies. https://www.guttmacher.org/state-policy/explore/sex-and-hiv-education