- A new survey reveals how few young people discuss sexually transmitted infections with their partners.
- Women are more likely to get tested and talk about testing.
- Experts warn that young people are at risk of asymptomatic infections — which could cause serious problems later in life.
Bree was hooking up with a coworker for the first time when she asked, “When was the last time you were tested for STIs?” It’s a standard question for Bree, 18, who gets tested every year, but her partner seemed suddenly flustered. “He said, ‘I’m OK, I don’t think I have any STIs,’ and I said, ‘That’s not the question I asked you,’” Bree recalled. They were on his couch, an hour before they had to head out for a shift at the restaurant where they both worked, and Bree’s partner began to explain that he had never needed to get tested because he always hooked up with “nice girls.” Bree was floored. “I couldn’t believe that he was 20 years old and had been sexually active for a while, but he had never been tested,” she said. “I had to tell him that this wasn’t about him — this is just something that we both have to do for our own safety.”
Her experiences are part of a troubling trend in sexual health — one that could lead to serious long-term health problems for young people with untreated, asymptomatic STIs. A 2016 CDC report shows cases of sexually transmitted infections (STIs) reached an all-time high in the United States and those between the ages of 15 and 24 acquire half of all new STIs. A new Cosmopolitan.com survey reveals that despite this risk, a surprisingly high number of young people don’t talk about STI testing with their sexual partners. And the onus to both talk about testing and get tested falls mainly to women.
The survey of 1,454 respondents between the ages of 18 and 35, recruited from Cosmopolitan.com's and Esquire.com’s social media accounts, found that 47 percent said none of their past partners asked about their STI testing results before having sex. And while 58 percent of women say they’ve been tested in the past year, only 33 percent of men said the same. Men were also three times likelier than women to say they’ve never been tested (33 percent versus 11 percent).
Nearly one-third of survey respondents said they’ve either had an STI or don’t know if they have an STI. The most commonly reported STI was chlamydia (18 percent), followed by HPV (11 percent), genital or oral herpes (5 percent), gonorrhea (4 percent), trichomoniasis (3 percent), and genital warts (2 percent). One percent of respondents said they had pelvic inflammatory disease (PID), scabies, or pubic lice. Women were also twice as likely as men to say they’ve had an STI (36 percent versus 18 percent).
The risks of not getting tested can be devastating. Many STIs can go unnoticed for long periods of time, with no visible symptoms. Left untreated, they can cause serious problems in women, explains Leah Millheiser, ob-gyn and clinical assistant professor of obstetrics and gynecology at Stanford University. “Only 20 percent of women with gonorrhea have symptoms and chlamydia is often a ‘silent’ infection with no symptoms,” she said. “But if they’re left untreated, they can lead to more serious infections that can require hospitalization and cause infertility.”
“It makes me feel like they expect all of the responsibility to fall on me, as the girl."
Jessica, 22, who began getting tested regularly at a local clinic after one of her friends contracted chlamydia, said she’s continually surprised by how many of her male partners don’t ask about testing or carry condoms. “How hard is it to just go buy a box of condoms?” she said. “It makes me feel like they expect all of the responsibility to fall on me, as the girl — I’m supposed to be taking care of their health and my health. ”
Most men (81 percent) know where to get tested — they’re just not doing it at the same rate their female partners are. Women have a built-in opportunity for testing at regular gynecological visits. When asked why they had their most recent STI test, 24 percent of respondents overall said it was because a doctor suggested it at a routine appointment. Doctors are unlikely, however, to suggest a full STI screen for men who have sex with women because CDC guidelinesonly recommend an HIV test for sexually active heterosexual men, according to Hayley Mark, who is the chair of the department of nursing at Towson University and a researcher on STI testing practices. This is because men who have sex with women are less likely to get STIs like gonorrhea and chlamydia, and the health stakes are higher for women, because these infections can lead to infertility. “A lot of STI testing is done at publicly funded facilities and you need to put your resources where you will get the most ‘bang for your buck,’” Mark explained. As a result, men are unlikely to get an STI test at an annual physical unless they believe they were exposed or they ask for it.
Men are also used to their partners initiating a conversation about testing. Although 82 percent of respondents said both partners are responsible for testing, a majority (52 percent) of women say they initiated a conversation about STI testing with their most recent partner, compared to only 27 percent of men.
Gender socialization may help explain this difference, said Hayley Mark. “Because sex and sexuality have such significant implications for women, for example, pregnancy, many women have to become comfortable talking about it,” she said. “Given the implications, women may be more determined to take care of this aspect of their health and their partners.”
The cost of testing isn’t prohibitive for most respondents. Nearly two-thirds (64 percent) of respondents who had been tested for STIs paid nothing for their most recent test, while 15 percent said their test cost $1 to $30, and 20 percent said it cost more than $30. (Information about free or subsidized STI testing is available on the CDC’s website.) Nicole, 25, gets tested for STIs at her annual gynecological appointment and again if she has a new sexual partner. Her insurance policy covers one test per year and each additional test costs about $20 depending on her co-pay, which she views as a worthwhile expense. “I am really, really cautious,” she said. “I’d rather spend the money on the test than something like going out for coffee a couple times a week.”
“If you’re hooking up with a friend ... it doesn’t seem as necessary to have that conversation."
Still, for some, other barriers to testing exist. Ben, 19, doesn’t get tested since he’s on his parents’ insurance and fears they’ll intercept a statement for his tests. He doesn’t always talk to his sexual partners about testing. “If you’re hooking up with a friend and know their sexual history, it doesn’t seem as necessary to have that conversation,” he said, adding that his lack of testing has been OK with his partners, as long as they use protection.
The survey found that women are generally more conscientious than men not just about STI testing, but about safer sex practices: 31 percent of women said they would have sexual intercourse with a partner who couldn’t remember the last time they were tested, compared to 57 percent of men. Similarly, only 30 percent of women but 61 percent of men said they would have oral sex with a partner who could not remember the last time they were tested.
Tyler, 30, said he hasn’t been tested in a few years because he’s been in a monogamous relationship but before that was more comfortable having unprotected oral sex than intercourse with a partner who couldn’t remember the last time they were tested. “It’s just not something I do as often, so once I’ve decided I want to have oral with a woman, I am pretty sure I’d be able to trust her,” he said. (The risk of HIV transmission is lower for oral sex than other forms of sex, according to the CDC, but many STIs, including chlamydia, gonorrhea, and herpes, can be spread through oral sex.)
Women were less likely to distinguish oral sex from intercourse. “All sex has risk,” said Rene, 23. She’s part of a polyamorous community and participates in threesomes, and said it’s common for sexual partners to ask for screenshots of testing results. When partners don’t want to share their testing status, she said, it’s a serious red flag. “If you’re nervous talking about this, maybe you have something to hide.”
Further adding to the risk, a small but significant group — 9 percent of respondents — admitted that they have lied to a sexual partner about the last time they were tested. When asked why they lied, 5 percent of respondents said they didn’t want to delay sex, 3 percent said they couldn’t remember when their last test happened, and 1 percent said they had an STI and didn’t want their partner to know.
These findings highlight the need for young people to get comfortable with routine STI testing and talking with their partners about STIs. But given the burdens women have been tasked with, men especially need to take responsibility for their own sexual health.
“It’s great for women to be empowered about getting tested themselves,” Dr. Millheiser says, “but it means absolutely nothing if your partner isn’t getting tested.”
Credit to Amelia Thomson-DeVeaux and Cosmopolitan Magazing