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Sex, White Lies and the 12% Club: How to Have the STD Talk

by Gretchen Brown
May 7, 2019 | Health

Betsy gets tested for sexually transmitted diseases after every new sexual partner.

But she still finds it hard to ask the men she dates if they do the same.

“I haven’t gotten the courage to figure out how to ask before,” said Betsy, 25. “And I’m always using other protection.”

She says getting tested isn’t a big deal — it’s fully covered by her insurance. It’s something she’s been more proactive about in recent years.

That’s in part because she finally has an OB-GYN she loves. And, in part, because she feels less indestructible than she did in her early 20s.

According to the Centers for Disease Control and Prevention, about 20 million people are diagnosed with an STD (also called sexually transmitted infections, or STIs) each year.

Illustration of gay couple looking at each other. STD Talk pbs rewire
Being able to have uncomfortable but honest conversations with a new partner can make the experience better for everybody.

Half of those are young adults ages 15 to 24.

But one recent survey even showed that only 12 percent of the sexually active young people in that age group had ever been tested.

That statistic doesn’t surprise Heather Corinna, founder and director of sex education website Scarleteen.

Corinna said there’s still a stigma around STDs — connected to a broader stigma around sex, and false ideas of who can contract STDs.

That’s enough to keep people away from being tested, especially when many STDs don’t show symptoms.

“People who get STIs are usually people who have either had sex or have contracted an STI through sexual assault,” Corinna said. “But the very tenacious and popular scripts that people have around sex shaming and STI ignorance are all there, that only people who are immoral get diseases; that only people who have sex with everybody, not the “right” people, the wholesome people; that people don’t get them the first time.”

Not always accessible

There are other things that keep people from getting tested. Sometimes, the barrier is physical.

While your primary doctor can usually do the testing for you, there’s a shortage of medical care in rural areas, which can make getting an appointment — and getting to it — challenging.

And because getting tested is still stigmatized, privacy concerns can also keep young people away, especially in rural communities where the physician might be a family friend, Corinna said. They might not know whether their physician honors privacy and worry about their parents finding out.

Free and low-cost testing options do exist, especially in metropolitan areas. The American Sexual Health Association offers a clinic finder to help you figure out where you can get tested.

If you’re unsure what to say to your doctor in the first place, Corinna recommends asking your health care provider for a full STD panel. The provider will probably ask you more questions about your sexual behaviors to figure out what you should specifically be tested for.

Testing might involve a blood draw, a urine sample, or both. You can even order an STD test kit online.

The Affordable Care Act made it so most insurance providers have to cover STD screening. But if you don’t have insurance, going through a primary doctor could be expensive.

Elise, 22, has insurance; it costs her about $60 out of pocket every time she gets tested.

Without insurance, her last bill would have been nearly $600 to test for just HIV, chlamydia and syphilis.

Elise is dating casually, so she gets tested every few months. She also makes sure to ask potential partners, before things heat up, if they’ve been tested recently.

She often meets people on dating apps. She’ll frequently ask if they’ve been tested before they even meet for the first time.

“If they say yes, I ask if they’re having sex with other people; this can obviously be an awkward question,” Elise said. “I phrase it like ‘I know it isn’t my business and it’s okay if you are, but are you having sex with other people?' If the answer to that is yes, then my next step is to just have them use a condom.”

Protection makes a difference

Elise said many men she dates presume they don’t need to wear a condom. There is some evidence of “condom fatigue” among young adults, as condom use has declined over the past 10 years.

That’s despite the fact that, as Corinna says, STD risk is extremely low when you combine regular testing with a barrier like a condom or a dental dam.

“It’s this idea that if we ask someone if they’ve been tested, or we ask someone to use a condom, that what we’re saying is we don't trust them,” Corinna said. “Of course, that doesn’t make sense here. Trust doesn’t prevent those things.”

As a young adult in the 1980s, Corinna said negotiating condom use wasn’t that hard, because they felt entitled to it.

They want other young women to do the same — just pass over the condom instead of asking like it’s a big favor, for instance, they said.

You can still contract an STD through oral sex, but condom use for oral sex among 15-24 year olds is rare (only about 8 percent in the age group report using one). Dental dam use is comparatively low.

One of Betsy’s female friends was recently asked by a male partner to use a condom for oral sex. It was the first time she’d ever been asked, and among their friend group, most had never even considered it before.

“We thought it was pretty funny initially,” Betsy said. “Poor guy became a little bit of an inside joke for us, but honestly he’s probably the safe one.”

Open the conversation

Sydney is 25, and also makes a point to get tested frequently — usually about three weeks after each new sexual partner.

It’s the first question she asks new partners, too. “When’s the last time you were tested?” The second question is then, “Have you had sex with anyone new since then?”

If they haven’t been tested recently, some things are off-limits.

“I tell them we can’t do anything mouth-to-genital or genital-to-genital until they’re tested,” she said. “Everyone has been cool because they’d been tested recently, except one guy. He was really pushy and insisted he was clean (and) would go that week. I just held off and eventually he gave up. Then tried to tell me that Tuesday he’d gotten tested and was all good. Only HIV results come back so quickly. So I did not see him again.”

Josh, 24, also makes sure to have a direct conversation with each new partner. He typically leads with his own experience.

"Sex, for me at least, is only exciting and pleasurable when I know that both me and my partner are being safe and are comfortable," he said. "Because I have been with quite a few different partners I feel like it is absolutely necessary to have that conversation."

He's currently in a long-term relationship. They talked about it on the second date, before they ended up back at his place. It felt natural.

Corinna said that making it a conversation like this can make it easier to get an honest answer from a new partner. It’s also the only way to get all the information, because “have you been tested, yes or no?” doesn’t tell you anything about your safety.

You might feel like bringing it up at all will ruin the mood. But Corinna said that being able to have uncomfortable but honest conversations with a new partner can make the experience better for everybody.

Because when you're more communicative from the get-go, you'll likely feel more comfortable communicating about what feels good and what doesn't.

“It is harder to talk to someone about what you really like and don’t like and what you want and don’t want,” they said. “And one of the pieces of advice I’ll tell young people is that if you can do that, then things like negotiating birth control get 100 times easier.”

Don’t stop talking about it

That's been Lain's experience. They are 31 and are queer and polyamorous.

"It’s important for me to have a conversation about what feels good with my partners. I’m non-binary and have dysphoria sometimes worse than other times, so I like for my partners to know what feels validating for me," they said. "So if we’re talking about what is pleasurable, it’s an easy way to slide in use of protection and if there is any concern for STI currently."

They're not incredibly concerned about STDs. That's because, so far, they have only had sex with people assigned female at birth, and STD transmission rates between people of that sex can be lower — in some cases — than other populations.

However, STD transmission is still possible, especially HPV. Lain gets tested about once a year. In addition, because a bacterial infection called bacterial vaginosis, or BV, might be passed between folks assigned female at birth, Lain is upfront about any infection and uses latex gloves in those instances, combined with frequent hand washing.

Corinna said testing should be an ongoing conversation, especially if the relationship is not monogamous.

And just because you’re the one asking your partner about testing, doesn’t mean you’re off the hook for getting tested yourself.

Scott, 25, has had three sexual partners throughout his life. He's never been tested, mostly because they've all been friends who turned into longterm partners.

But they've told him they've been tested, and he's always trusted that.

"I've never been one for one night stands," he said. "But with partners I generally go over my history with them and I am open to any questions they have."

It’s an easy mistake to make, Corinna said — but you also have to do your part.

Gretchen Brown
Gretchen Brown is an editor for Rewire. She’s into public media, music and really good coffee. Email her at [email protected], or follow her on Twitter @gretch_brown.
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