Scare tactics are one of the staples of teen health and safety education initiatives. Driver’s ed classes with photos of gruesome car wrecks; drug and alcohol abuse programs filled with grim stories about arrests and deaths; and my personal favorite, sex ed programs with slide after slide of genitals covered in festering sores due to an STI. It’s easy to see the thought process behind this: teens have a hard time with risk assessment and considering consequences, so we should counter that by making the consequences HUGE and DRAMATIC and TERRIFYING and thus impossible to ignore.
As won’t surprise anyone who’s been through one of these programs, though, studies have shown again and again that scare tactics aren’t effective. Teens can tell when they are being emotionally manipulated, and they’re much more likely to mistrust the presenter and tune out the message as soon as they start to suspect that dangers are being exaggerated.
In the case of STIs in particular, the scare tactics that are used carry with them some false ideas that have the potential to actually make teen STI risk much worse. The most obvious false idea is that you can tell, just by looking, whether someone has an STI or not. Most STIs are symptom-free. People often go well into adulthood under the impression that if someone “looks clean” there’s no risk of getting an STI from them. Rather than showing the worst-case scenarios of some very advanced infections, we need to be communicating the message, “Infected bodies mostly look just like uninfected ones, so always use protection.”
The second false idea is the one people have a really hard time letting go of. It’s the idea that contracting an STI is a terrible thing. “But wait!” people say. “Of course it’s a bad thing! Are you telling me you go around teaching people that STIs are no big deal and you shouldn’t worry about whether you get one or not?”
Well… kind of, yes. I teach people (mostly college students) that they should be careful and practice safer sex, because getting an infection is always worse than not getting one. I teach them about the potential consequences and complications of untreated STIs. But I would actually prefer that they not worry about contracting an STI, any more than most people worry about catching a cold or the flu when they’re out in public. Most people take sensible precautions against non-sexually-transmitted infections, like washing hands before they eat, without feeling a lot of anxiety or fear around the possibility that they might contract one. I’d love it if people had this attitude about STIs also.
The fear and revulsion that we commonly think of as the healthy and appropriate attitude toward STIs does a lot of harm. It motivates people to create emotional distance between themselves and the possibility of having an infection. There are so many people, teens and adults, who have never been tested for STIs, and would be horrified at the idea of going in for testing, because they’ve internalized the idea that people who have STIs are gross and dirty. They know they’re not gross and dirty, and going for testing would feel too much like admitting the possibility that they might be. So they just avoid it and assume if they have no symptoms, they have no infection.
While it’s more rare, there are also people who will avoid using condoms or other barrier protections for the same reason. In some people’s eyes, using a condom implies that one of the partners might have an infection, which would be insulting. So the fear and revulsion created around STIs actually makes transmission risk much higher.
These are the messages I would like to see taught regarding STIs, to both teens and adults.
– Assume your partner could have an infection at any time, and use protection (until your relationship has reached a level of trust and exclusivity where you both feel comfortable stopping.)
– Assume you could have an infection at any time, and get tested every 3-12 months, depending on your level of sexual activity.
– Don’t freak out about either of those assumptions. It doesn’t mean you or your partner is gross or dirty or slutty, and it doesn’t mean something terrible will happen to you. Just like any sickness, the sensible thing to do is find out if you have it, and get appropriate treatment. No shame or horror required.
“But wait,” some readers might be thinking, “some STIs DO involve pretty terrible consequences. What about that?” Accurate information, rather than nebulous fear, is still the answer. Most STIs are curable, all are treatable, and the most dangerous ones are the easiest to prevent. Cultivating anxiety about STIs doesn’t prevent them; spreading knowledge about risks and prevention strategies does. Adults can then make decisions about their own sexual safety practices, based on accurate information. (I do think that teens, because of their aforementioned difficulties with risk assessment, should be encouraged to use condoms all the time, even if their partner claims never to have had sex before or to be only having sex with them.)
Gonorrhea and chlamydia: These are two different bacterial infections that are usually tested for and treated together. Gonorrhea is sometimes known by the slang term “the clap.” Most people with chlamydia show no symptoms of it, and most women with gonorrhea also show no symptoms. Most men with gonorrhea experience a burning pain with urination, but some may have no symptoms. Gonorrhea and chlamydia are completely curable with a round of antibiotics, although there are some antibiotic-resistant strains of gonorrhea developing. If untreated for a long period of time, gonorrhea or chlamydia may lead to pelvic inflammatory disease, which in turn can cause infertility. They are transmitted through mucous membranes, usually by vaginal or anal intercourse. More rarely, they may be transmitted by oral sex, or by touching one’s eye when the bacteria is on one’s hand. Condom use for intercourse is very effective in preventing the spread of gonorrhea and chlamydia. Washing hands after sex is also a good idea.
Syphilis: Syphilis is a bacterial infection. There is a distinct progression of symptoms: first a flat, painless sore, then a rash which may or may not be itchy and may appear anywhere on the body. Both these symptoms go away on their own, and may not be noticed by the person who has them. After the first couple of months, somebody with a syphilis infection will have no symptoms at all, while the bacteria continue to live in their body. Eventually — usually years later — it may go on to cause severe organ damage and even death. In the early stages of syphilis, it is completely curable with antibiotics. In the later stages, syphilis is much harder to treat, and any damage that has been done can’t be undone. Syphilis is spread through direct contact with syphilis sores in its early stages. If sores are inside the vagina or anus, neither partner may be aware that they are there; condoms are very effective at preventing syphilis from being spread.
Herpes: Herpes is a viral infection that comes in two forms, herpes 1 and herpes 2. Herpes 1 prefers to infect the mouth, herpes 2 prefers to infect the genital area, but either infection can be found in either place. Both versions of the virus work similarly; they lie dormant in nearby nerve clusters, and at times they will come forward and cause an outbreak of painful, itchy sores. Oral herpes outbreaks (usually herpes 1) are commonly known as cold sores; over 50% of adults in America carry an oral herpes infection and thus occasionally get cold sores. Genital herpes functions very similarly, with the sores appearing in the genital area rather than the mouth. Herpes cannot be cured, but there are medications that greatly reduce the risk of having a herpes outbreak. Herpes usually does not have any long-term consequences other than the annoyance and discomfort of outbreaks. It is spread through direct contact with the infected area. Transmission is much more likely during an outbreak, but can happen at any time. Condom use for intercourse is somewhat effective at preventing the spread of genital herpes, as it decreases the area of contact. Other barriers like dental dams are also useful. A person in the middle of a herpes outbreak, whether oral or genital, should consider themselves contagious and avoid contact near the area of the outbreak, until the sores have completely gone away.
HPV: HPV is a virus that most sexually active people contract at some point. There are over a hundred different strains of HPV, which are usually sorted into “low-risk” and “high-risk.” The low-risk strains may cause genital warts, which appear as small bumps, sometimes wart-like and sometimes smaller and less noticeable. These often go away on their own, but they may be treated with topical creams or other treatment. The high-risk strains of HPV are the ones that have the potential to cause cancer. They have no regularly detectable symptoms. Most of the time, the body fights off the HPV infection on its own within a year or two, and the person never knows they had it. If the infection lasts, it causes cell changes in the infected region, which may eventually develop into cancer. Cervical cancer is the most common HPV-related cancer, but it can also cause oral, vaginal, anal, or penile cancers. A pap smear tests for pre-cancerous cell changes on the cervix, which can then be treated to prevent cancer from developing. Because HPV is so common and so rarely has consequences, HPV infection itself is usually not tested for. HPV is spread through skin-to-skin contact; condom use is partially effective at preventing the spread of HPV. The HPV vaccines that are on the market currently guard against the most common strains of HPV, and are most effective if given before a person is exposed to HPV (which means before they become sexually active). While women are the most vulnerable to HPV-related cancers, HPV-related oral cancers are on the rise in men, and so vaccinating boys as well as girls is a good idea.)
HIV: HIV is the virus that causes AIDS. It usually has no symptoms, although a person may experience flu-like symptoms upon first infection. There is no cure for HIV at present, but drug treatment can help keep it at bay. Early detection makes a significant difference in the treatment of HIV. HIV is spread with four and only four bodily fluids: blood, semen, vaginal fluids, and breast milk. If one of these fluids from an infected person enters another person’s bloodstream, the second person may become infected with HIV. HIV transmission during intercourse usually happens because infected semen enters the bloodstream through micro-abrasions in the receptive partner’s anus or vagina (because anal tissue is more sensitive, this is more likely to happen via unprotected anal sex than vaginal.) Condoms are highly effective at preventing HIV transmission; as long as no semen escapes the condom, it is very unlikely that HIV will be transmitted through condom-protected intercourse.
Regular testing, early treatment, and proper use of condoms go a long way toward mitigating any damage that STIs can cause. By discouraging all three of these things, creating fear and disgust around the idea of STIs makes the associated problems worse.