Open the dialogue around sexually transmitted infections (STIs)

February 6, 2019

Physicians should open an important dialogue with patients around this aspect of sexual health.

Sexually transmitted infections (STIs) are the leading preventable cause of infertility, ectopic pregnancy, and urogenital tract cancers in the United States, according to Edward Hook, MD, a professor at the University of Alabama at Birmingham, Ala. 

Yet lingering stigmas around their acquisition often prevents both patients and physicians from discussing them. 

Hook feels physicians can do a better job opening this important line of conversation to engage in and maintain their patients’ sexual health.

“Instead of talking about disease and all the negative implications and misperceptions that go along with it, we should be talking about health,” Hook says. 

Indeed, according to the Centers for Disease Control (CDC), there were 1.7 million cases of chlamydia in the United States in 2017 and more than 500,000 cases of gonorrhea. More than 42 percent of adults test positive for the human papilloma virus (HPV), for which there is a vaccine that can treat people aged 9 to 45 if they’ve never had the virus. 

Screenings and tests for STIs provide valuable knowledge, Hook says, that give physicians the opportunity to intervene on the patient’s health. 

He points out that in unvaccinated populations, over 80 percent of sexually active Americans will have an HPV infection, which is linked to reproductive tract cancers. 

“It’s much easier to vaccinate than to deal with the problems as they come up.”

Bust STI myths

Additionally, he says, physicians need to work to bust the many misperceptions that abound in relation to STIs. "There is a misconception that most STIs were symptomatic, not asymptomatic, and that testing is only warranted for people who have multiple sexual partners,” Hook says. 

He makes it clear that monogamy is not a guarantee to avoid infection. “The vast majority of women who get the most common STI, chlamydia, are monogamous and have only had one sex partner in the preceding year,” Hook says.

Most STIs are transmitted by people who are unaware they are affected, he explains, because STIs don’t always present with noticeable symptoms.

Deepen the physician-patient relationship

While patients might experience a moment’s discomfort in discussing their sexual activity, Hook says, “It’s our responsibility as healthcare providers to open the door to patients, to provide opportunities to allow them to ask and answer questions.” 

His goal, he says, is to “promote and empower our patients to be more comfortable and willing to talk about [sexual health].”

Making such dialogue a routine part of our history is good for patient care, Hook says.

For physicians still feeling awkward about these conversations, Hook recommends using the word “infection” over “disease” and framing the conversation in terms of data gathering in order to recommend important screening and testing for health maintenance.

Moreover data shows that patients feel like their physicians know them better if they’ve taken a sexual history.

For physicians who feel challenged to fit an entire sexual history into a brief patient evaluation he recommends breaking it down to two simple questions:  

  • Are you sexually active, or have you been in the past year?

  • If so, how many sexual partners have you had?

Those questions enable a physician to determine if a patient should get any STI screenings or follow-up care. 

“STIs are transmissible by people in some of their most private and personal interactions. So we are not just protecting them, but their partners and other people.”

Be sensitive but not squeamish

It’s important to convey openness and a lack of judgment to the patient, he says, no matter what the physician’s personal values or beliefs. 

When patients have expressed fear of being judged to him around this line of conversation, he makes clear that this is just another aspect of their health, and nothing to feel ashamed about discussing.

“We have to take care of our patients’ entire health,” Hook says.