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If you get in a car, you might crash. If you eat food, you might get food poisoning. And if you're having sex, you are risking an STI. “I don’t tell people you can avoid STIs,” says Ina Park, M.D., associate professor of Family and Community Medicine at UC San Francisco and medical consultant for the Division of STD Prevention at the CDC. “We’re all going to get an STI someday, or at least get exposed to one.”
Park literally wrote the book on STIs, and she’s perfectly clear: Sexually transmitted infections are more common than we like to acknowledge. You may not be able to avoid them entirely, but you can reduce your chances of getting them, and plan to catch them immediately. “We might as well empower ourselves to take charge of our sexual health,” she says.
As social distancing restrictions relax, experts are bracing for a new onslaught of STI cases. The summer of 2021 has been referred to as the start of the new Roaring Twenties, the Whoring Twenties, and Shot Girl Summer. But it’s just as likely to be the great summer of STIs. Why? Every year for the past six years of available data, the CDC reported that cases of chlamydia, gonorrhea, and syphilis reached an all-time high. Basically, it’s an STIs world, and we’re just exchanging fluids in it.
Why, God? What have we done to deserve this?
Why have STI rates climbed every year for the past half a decade? In September 2020, Gail Bolan, M.D., then director of the Division of STD Prevention at the CDC, summed up the factors: “Poverty, unstable housing, drug use, stigma, lack of medical insurance or steady medical care; discrimination or mistrust of health systems; decreased condom use among vulnerable groups including young people and gay men; and cuts to STD prevention programs and services at the state and local level.”
In other words, until we create better systems for public health, people will be sick.
To be clear, STIs are rampant among educated people who are have ample resources too. Lisa Wade, a professor studying sociology and gender at Tulane University, has been conducting hundreds of in-depth interviews with current students about their lives during the pandemic. In each interview, she asks: Given the yearlong lesson in infectiousness that is the pandemic, have you changed the way you think about sexually transmitted infections? “Most of them screw up their faces like I’ve asked them something very strange,” she says. “They’re just like, ‘No.’”
Wade says she couldn’t square the fact that undergraduates are getting tested up to three times a week for COVID, but aren’t necessarily making the leap to STI testing. One interviewee put it into perspective: “If you say, ‘Have you gotten tested for COVID?’ and [the other person] says yes, that’s all good,” the student told her. “If you ask when they’ve last been tested for STIs, it implies that they’ve done something they shouldn’t have done.”
Having an STI does not mean you are dirty, have too much sex, or are deserving of shame. Many of them are quickly curable. But if you have an STI for a long time without knowing it, you can get seriously sick. Jessica Shepherd, an ob-gyn in Texas, warns that “some STIs left untreated can lead to serious health consequences, such as infertility in women, pelvic pain, and abnormal bleeding.”
The school systems that preached abstinence instead of teaching these facts did us a huge disservice. Now we’re paying for it, when we should just be enjoying sex.
STIs are so stigmatized that it’s easier to pretend that they never happen to “normal” people. I write a lot about sex and dating, which means that almost every day I hear smart people say some of the dumbest shit I have ever heard about STIs. “Oh, he seems really nice, so I don’t think he would have an STI.” “We’ve gone on three dates, so we don’t have to use condoms.” “I trust her, so I’m not worried.”
We don’t want to accept the basic facts about STIs—that they are common, often silent, and morally neutral—because we’re busy trying to distance ourselves from the kind of people who have sex that has consequences. But all sex has potential consequences. We’d be safer if we accepted that.
Didn’t STI rates go down during the pandemic?
You might assume that STI cases have gone down during the pandemic. Most people have at least curbed their socializing, even if social distancing hasn’t been embraced across the board.
But a couple of major factors of pandemic living spell public health catastrophe: One is that many people have avoided routine checkups, including the kind of doctor visit where you would get a quick STI screening. Even if you were willing to risk it, testing was less available—a survey by the National Coalition of STD Directors found that, during the pandemic, 60% of clinics had reduced capacity to treat STIs. Many clinics shuttered. And, Park points out, in the second half of 2020, there was actually a shortage of STI testing materials, since items like swabs were being used for COVID testing. Even though early 2020 statistics show that STI case numbers have gone down, experts think that just doesn’t reflect the reality.
And STI numbers may get worse. As social distancing restrictions lift, people will likely have more sex partners. And after more than a year spent avoiding human contact, some may have a sense that surviving a disaster means that we’re invincible. “They’re going to feel a sense of freedom,” says Park, “and a sense of ‘I deserve to have condomless sex because I’ve held out for so long.’”
But that just isn't how science works—the COVID vaccine saves lives, but it doesn't cover syphilis.
Yeah, but I won’t get an STI, because I’m careful
Oh, I know. You have sex only with people you trust! “Most STIs are asymptomatic,” says Park. “Most of the time people don’t even know that they have something when they pass it on to you.” This is something I would like to print on business cards and pass to people when I hear nonsense about STIs. It’s not a matter of knowing or trusting your partner.
Fewer people are using condoms than you may think. “Some students say, ‘Oh, I always use a condom,’ and others almost never,” says Wade. “Often it’s the woman who wants to use them and then men will make it weird, and then women don’t ask because they don’t want men to push back.”
But you're smart! You use condoms. And that’s hugely important. But remember, while condoms protect from some STIs, they don't protect against all of them. They also don’t protect at all from STIs passed during oral sex (unless you use a barrier for oral sex, which is rare). “A lot of people think of oral sex as safer sex, but we know that oral sex can also transmit gonorrhea, chlamydia, and syphilis,” says Park.
So what am I supposed to do if want to bang?
“Living in fear of catching an STI is no way to conduct your sex life,” says Park. “Because it’s futile.” Instead, you should follow best practices. Ideally, she says, you should have one partner at a time, use barriers (like condoms) and get tested between partners. “Having concurrent partners is one of the easiest ways to spread both STIs and HIV,” she says.
In the context of modern dating, that’s not always realistic. So the next best thing is always using barriers and getting tested regularly. That way, you reduce your risk of contracting an infection, and you make sure that you discover an infection if you do get one. “I have patients who change partners really rapidly and have a lot of concurrent relationships, and they test every two months,” says Park. Getting an STI test is quick and easy—much easier than dealing with the long-term health effects if it later turns out you’ve had a silent STI for months or years.
How bad is it if I do get a common STI?
For the more common STIs—syphilis, gonorrhea, or chlamydia—“the prognosis is fantastic if you can catch it early,” says Park. “We have really effective antibiotic treatment, some of which can be given with one dose and then cured. The thing is, for folks who have a silent infection, especially women, it can climb up into the fallopian tubes and into the uterus and can cause scarring or can cause pelvic inflammatory disease, and repeated infections increases the risks of all those complications.”
It may feel scary to think that you could get an incurable STI, like herpes, HPV, or HIV. But that’s all the more reason to get educated. Want to protect yourself from the most serious strains of HPV, which can cause multiple forms of cancer? There’s a vax for that—and this time you don’t even have to wait inside for a year. Anyone from the ages of 9 to 45 is eligible for that vaccine.
And more than ever before, herpes, or HSV, doesn’t have to change your life. Park points out that, counterintuitively, having sex with a person who knows they have HSV and is taking suppressant medication could actually be safer than having sex with a random person. “The people that know their status and are taking their meds and are doing what they can to reduce transmission are less likely to transmit than the person who’s just running around who has no idea of their status,” she says.
Most of us think of STIs as this dark, lurking presence, like a seedy alleyway that smart people know to avoid. But that’s not what STIs are—they are everywhere, on every kind of person, and they’re no more dirty than any other kind of infection. If you get regular testing for STIs, you can quickly find out about infections and get treated. It’s just as empowering as buying a vibrator or taking a leap and asking someone out (though, why not do all three?).
This summer, just remember: There is nothing—nothing—sexier than a clean STI panel.
Jenny Singer is a staff writer for Glamour. You can follow her on Twitter.
