STD stands for sexually transmitted disease. This term has been used for decades to refer to infections passed through sexual contact. However, in recent years, there has been a push to stop using the term STD. Instead, sexually transmitted infection (STI) is now the preferred terminology when discussing these conditions.
There are several important reasons why the terminology has shifted from STD to STI:
STD sounds stigmatizing
STD has taken on negative connotations over time. The term makes people think of shame, promiscuity, and immoral behavior. It places blame on those who get infected, even though catching an STD is not necessarily anyone’s fault. The stigma surrounding STDs can discourage people from getting tested and treated. Using STI instead helps reduce stigma.
Infection better captures asymptomatic cases
Many STDs do not always cause symptoms, at least initially. However, even asymptomatic people can still transmit infection to others. Infection conveys that a pathogen is present and can spread, whether or not signs are present yet.
It focuses attention on the infectious organism
Speaking of infections underscores that microscopic organisms like bacteria, viruses, and parasites are the cause. It moves the focus away from placing blame solely on the infected individual. There are two people involved in transmission, and either could have initially brought the infectious agent into the interaction.
Understanding diseases as infections shapes prevention strategies
Viewing STDs as potentially asymptomatic infections emphasizes the need for proactive testing, treatment, and partner notification. These public health strategies treat the spread of pathogens in communities as the priority for control efforts.
The terminology change aims to inspire open and accurate discussion
Public health leaders ultimately hope that using STI will make people more comfortable honestly addressing their risks and needs. Accurate terminology is an important part of normalizing sexual health and infectious disease.
When did views of STDs evolve?
Perceptions of sexually transmitted infections have changed substantially over the past century. Here is an overview of how views have shifted over time:
Early 1900s: Social taboo and stigma
At the start of the 20th century, STDs were shrouded in shame and often referred to euphemistically as “social diseases.” Few public health efforts targeted treatment and prevention. Those who caught infections faced judgement rather than care.
Mid 1900s: Medicalization and control
After antibiotics were introduced, infections that had previously been untreatable became viewed as medical problems that could be cured. However, medicalization also extended stigma and reinforced norms around appropriate sexual behavior.
Late 1900s – 2000s: Destigmatization and humanization
Activists began arguing that infectious diseases require public health solutions, not moral judgements. Destigmatization efforts recast STDs as ordinary risks requiring openness, testing, and access to medicine.
2010s – present: Client-centered care
The modern approach focuses on collaborating with patients to meet their goals and preferences. Testing and treatment are framed as tools to take charge of one’s health rather than as ways to police behavior.
What types of infections are commonly transmitted sexually?
Many different bacteria, viruses, and parasites can be passed through sexual contact. Some of the most common sexually transmitted infections are:
– Chlamydia
Caused by the bacterium Chlamydia trachomatis. Often asymptomatic but can lead to fertility issues if left untreated. Curable with antibiotics.
– Gonorrhea
Caused by the bacterium Neisseria gonorrhoeae. May initially be asymptomatic or cause discharge and painful urination. Curable with antibiotics, but rising antibiotic resistance is concerning.
– Syphilis
Caused by the bacterium Treponema pallidum. Marked by progressive stages and a wide range of possible symptoms if not treated early with antibiotics.
– Trichomoniasis
Caused by the protozoan parasite Trichomonas vaginalis. Characterized by discharge and itching in women and sometimes pain or burning during urination in men. Treatable through antibiotics.
– Genital herpes
Caused by herpes simplex virus (HSV). Incurable viral infection leading to recurrent painful genital sores. Antiviral medication can reduce outbreak frequency and severity.
– Human papillomavirus (HPV)
Common viral infection spread through intimate skin contact. Many strains clear naturally, but some lead to genital warts or cervical cell changes that can progress to cancer. Vaccines help prevent infection.
– HIV/AIDS
Caused by human immunodeficiency virus (HIV). Attacks the immune system if untreated with antiretroviral therapy. Greatly raises vulnerability to other infections and cancers.
How common are STIs globally?
The World Health Organization estimates that more than 1 million new curable STIs are acquired every day worldwide. The prevalence of viral STIs is also considerable:
– Chlamydia: 127 million new cases annually
– Gonorrhea: 87 million new cases annually
– Syphilis: 6 million new cases annually
– Trichomoniasis: 143 million new cases annually
– Genital herpes: 417 million people aged 15-49 infected
– HPV: 291 million women infected at any point in time
– HIV: 38 million people living with HIV globally in 2019
STIs disproportionately impact young people, and especially young women. In low and middle income countries, STIs other than HIV are the second greatest cause of healthy life lost in women aged 15-44.
What populations are most affected by STIs in the United States?
| Age | 15-24 years old |
| Gender | Women |
| Sexual orientation | Gay, bisexual and other men who have sex with men |
| Race/ethnicity | African Americans, Hispanic/Latino Americans, Native Americans |
| Income | Poverty |
| Region | Southern United States |
Young people in their teens and 20s account for about half of new STIs, despite being only a quarter of the sexually active population. Bacterial infections like chlamydia, gonorrhea, and syphilis, in particular, disproportionately impact young women.
Structural factors like lack of access to care, mistrust of medical institutions, and higher likelihood of violence also tend to place minority racial and ethnic groups at elevated risk. Economics, culture, and geography all intersect to influence community STI patterns.
How have STI rates changed in the United States recently?
After years of decline, STI rates began climbing steadily around 2015 and have kept rising rapidly since. From 2014-2018:
– Chlamydia increased 19% to 1.7 million cases
– Gonorrhea increased 63% to over 580,000 cases
– Syphilis increased 71% to 35,000 cases
– Congenital syphilis increased 185% to over 1,300 cases
Experts cite falling condom use, stressed public health budgets, and the growth of dating apps as some factors that may contribute to increasing infection rates. Resistance to antibiotics and lack of vaccine for common STIs also pose public health challenges.
How has HIV/AIDS changed from an epidemic to manageable infection?
The course of the HIV/AIDS epidemic has shifted dramatically since emerging in the 1980s:
1980s:
Mysterious illness emerges and devastates gay community. No cause or cure identified. Estimated hundreds of thousands become infected each year.
1990s:
Virus identified and diagnostic test developed. Antiretroviral treatment introduced but only partially effective and expensive. AIDS remains leading killer.
Early 2000s:
Life-extending antiretroviral drug cocktails made treatment more effective. Stigma and discrimination remain major issues.
2010s:
Advocacy makes treatment accessible, preventing AIDS deaths in those diagnosed. Pre-exposure prophylaxis (PrEP) gives high-risk HIV- individuals preventive option. Infection rates decline.
2020s:
Powerful antiretrovirals allow viral suppression, nearly normal lifespans, and prevention of transmission. However, about 1 million Americans living with HIV, many undiagnosed.
While not curable, HIV has gone from a death sentence to a very manageable chronic condition for those with access to modern treatments. However, barriers like costs, stigma, and racism still stand in the way of diagnosis and care for many.
How do STIs increase vulnerability to HIV infection?
STIs compromise the protective barrier the body maintains against infections. This can increase susceptibility to HIV in multiple ways:
– Genital inflammation and lesions
Open sores or inflammation creates more entry points for HIV to access the body during sexual contact.
– High HIV viral load in genital tract
Some STIs increase the concentration of HIV particles in genital secretions, making transmission more likely.
– Immune cells more susceptible to HIV
The cells HIV infects are drawn in higher numbers to the genital region when other STIs are present.
Diagnosing and treating other STIs promptly is an important strategy for HIV prevention. Individuals with an STI have 2 to 5 times higher risk of contracting HIV if exposed.
How do STIs affect pregnant women and newborns?
Because STIs often lack symptoms, many pregnant women are unaware they are infected. Without treatment, STIs can have serious health consequences:
– Mother-to-child transmission: HIV, syphilis, herpes, hepatitis B, chlamydia, and gonorrhea can pass from mother to baby during pregnancy or delivery. This can lead to premature birth, birth defects, developmental delays, or even infant death.
– Poor birth outcomes: STIs may increase risk for miscarriage, low birth weight, or premature rupture of membranes.
– Infertility: Chlamydia and gonorrhea can cause pelvic inflammatory disease, scarring fallopian tubes, and difficulty conceiving in women.
Screening mothers early in pregnancy and treating any infections is crucial. For syphilis and HIV, testing and treatment in the third trimester is also recommended as a final check before delivery.
How has STI testing changed in recent years?
Traditional STI testing required a clinic visit for a physical exam along with collection of samples like discharge, blood, or cells. Now more convenient and private options are increasingly available:
– At-home test kits: Consumers collect their own samples or self-swab at home, then mail to a lab for testing. Available for infections like chlamydia, gonorrhea, HPV, herpes, HIV.
– Self-collection at clinics: Patients self-collect vaginal, penile, throat, or rectal swabs onsite at a clinic rather than undergoing examination. Swabs are tested on premises. More comfortable for patients.
– SMS services and apps: Users order test kits using a website or app, provide a sample at home, and receive results by text or through the platform. Allows testing without visiting clinic.
While innovation has improved convenience, access issues persist around cost coverage. Wider insurance reimbursement for self-tests could help make routine screening more feasible for all.
How has STI education and public health messaging modernized?
Public health communicators have moved toward more sex-positive, shame-free approaches to raise STI awareness:
– Focus on normalizing testing and treatment
Emphasize that infections are common, testing is routine care, and early diagnosis is key.
– Use less stigmatizing language
Say “STI testing” rather than “STD screening.” Avoid terms like “clean” or “dirty.”
– Include diverse relationships and orientations
Expand messages beyond heterosexual couples to reflect LGBTQ needs.
– Portray testing as an empowerment choice
Frame as a self-care action to take charge of one’s health instead of a confession of misbehavior.
– Share real stories
First-person accounts from peers give messages authenticity.
– Promote conversations with partners and providers
Model open communication about sexual history and STI risk to break down taboos.
What controversies exist around sex education?
Sex education programs spark debate around appropriate content for teens:
– Abstinence-only vs. comprehensive sex ed: Should curricula emphasize delaying sexual initiation? Or discuss condoms, contraception, and STI prevention?
– Morality vs. safety framing: Should avoiding pregnancy and infection be the main message? Or promoting healthy relationships and values?
– Opt-in vs opt-out policies: Should parents need to actively enroll teens? Or exclude them from participating?
– Public schools vs. parent-led education: Do public curricula undermine parents’ right to determine messages? Or provide youth with expert knowledge?
Cultural beliefs about teen sexuality fuel political controversies. Evidence suggests comprehensive programs are most effective at promoting healthy behaviors.
How are STIs prevented?
Using protection, getting screened, knowing one’s status, and communicating with partners are key prevention strategies:
– Barrier methods like condoms, dental dams, and gloves
Block pathogens from entering the body during sexual contact. Condoms also protect from STIs during oral, anal, and vaginal sex.
– Vaccines for hepatitis B and HPV
Immunization gives long-term protection against these common viral infections. HPV vaccine protects against cancer-causing strains.
– Routine screening and testing
Detects infections so they can be treated before spreading to partners. Experts recommend yearly chlamydia and gonorrhea tests.
– Honest communication with partners
Discussing sexual histories, protection preferences, and STI status before intimacy allows assessment of risks.
– Prompt treatment if infected
Following prescribed antibiotics or antivirals cures infections and prevents transmission. Ensures partner treatment as well.
– Pre-exposure prophylaxis (PrEP) for HIV
Daily antiviral medication provides over 90% reduction in HIV acquisition for those at high risk, like individuals with HIV+ partners.
Conclusion
STI terminology has evolved to reduce stigma and spur open discussion of common infections. While rising infection rates pose public health challenges, innovation in testing, prevention, and treatment offer new opportunities to lower transmission. Patient-centered care and sex-positive education can promote the normalization of sexual wellness.