April is STD Awareness Month.*

Emily Jamea, Ph.D., is a sex therapist, author and podcast host. You can find her here each month to share her latest thoughts about sex.

At any given time, one in five Americans has a sexually transmitted infection (STI). That means there’s a good chance that at least one person in line with you for morning coffee has been there.

Even though STIs are very common, having one still carries a lot of shame and stigma. Unfortunately that stigma is partially what contributes to the spread. People are scared to disclose they have an STI because they’re afraid of being judged.

That was the case for my client, Alyssa. I’d been working with her for about six months. She had gotten a divorce the year before and had started therapy to get help navigating the dating world, which had changed significantly in the 20 years she’d been married. She’d experienced a few ups and downs while dating, but was mostly having a grand ole time sewing her wild oats. She’d married and had children very young and had no sexual experience prior to her husband.

She usually came to therapy with a big grin on her face and a hot story to tell, but I could tell something was different the moment she stepped in my office that April morning. Her eyes were wide, and she looked pale. She’d seemed smitten over a guy named Darren she’d gone out with for a few weeks, so my first assumption was that he’d ghosted her or she’d found out he was married.

“What’s going on?” I asked.

“I’m mortified,” she started. “Look.” She handed me a slip of paper. It was lab results from a recent blood test.

CHLAMYDIA TEST RESULTS…….POSITIVE (Detected)

There was a note from her doctor at the bottom indicating that medication had been called into her pharmacy and advising her to notify any recent partners, since the onset of symptoms can be delayed from the time of exposure, and to refrain from sexual activity for a full seven days after taking her medication.

“Okay, take a deep breath,” I told her. “You’ve got this.”

“No, I don’t!” she protested. “I finally met a guy I actually like. There’s no way he’s going to stay with me now. I’ve exposed him to chlamydia!”

“It could have been him that gave it to you. We don’t know yet,” I told her.

“I doubt it,” she said. “We’ve been using condoms. I must have contracted it from that guy I went out with a month ago. The one I got carried away with at the bar. Maybe I just shouldn’t tell Darren. I could avoid seeing him for a few days and then just tell him I’m on my period. He may get suspicious because my period just ended, but whatever. I can’t tell him this.”

“Let’s talk through it a little bit more before you make a decision,” I suggested. Part of my job as a therapist is to help clients make their own decisions by helping them process their feelings about possible outcomes. I always avoid giving direct advice. “What are the pros and cons of telling him versus keeping it in?”

Alyssa was a smart, compassionate woman. I didn’t have to tell her what she already knew.

“I know I’m going to have to tell him. It’s not fair to him to keep this a secret. Even though we’ve been using condoms, he could have been exposed. I also need to reach out to that guy from the bar and to ‘banker boy.’ (She’d taken to nicknaming her dates). This is awful.”

I reminded her how common STIs are and that, fortunately, the one she had was easily treatable. Others, like herpes, hepatitis B and HIV stick around.

“So, what do I say?” she asked. “How do I break the news to these guys?”

“Well,” I told her, “You have a few options with the guys who were one-night stands. If you’re able, you could reach out to them anonymously. Simply let them know that they were a sexual partner of yours within the past two months. Let them know you tested positive for chlamydia and advise them to get tested and notify any other partners they’ve had. In addition to practicing safer sex, the best way to control STIs is by controlling the spread. That means notifying partners so they can get tested and treated. You could, of course, also reach out without concealing your identity.”

“That actually sounds pretty easy when you say it like that,” she began to breathe a sigh of relief, but stopped. “But what about Darren?” “Maybe I could tell him anonymously too,” she mused.

“And if you did,” I began, “what would that feel like?”

“Honestly … it would feel like a lie … especially if I can’t have sex with him for a while. Plus, there’s the chance I’ve exposed him. If he ends up catching it and finds out I knew I had it and didn’t tell him, he’d definitely break up with me. I mean, I would break up with someone if they did that to me.”

“I wonder if you could use it as an opportunity to build intimacy. Being open and having the courage to be vulnerable is what strengthens relationships. What if you say something like this, ‘Darren, I know we’ve only known each other for a short period of time, but I’ve really enjoyed getting to know you. I want us to be honest with each other, which is why I need to share something. I recently learned I have chlamydia. Because of the timeline of my symptoms, I think I most likely contracted it from the person I went out with before you. As you know, I’m relatively new to dating and have to admit I got carried away one night. Fortunately, chlamydia is treatable, but you should get tested even though we’ve been using condoms. I hope that instead of judging me for contracting an STI, you’ll appreciate the fact that I was honest with you despite this being incredibly difficult for me to share.”

“I think I can do that,” she said.

“Let me know how it goes and report back.”

She returned to therapy a couple of weeks later, smiling like the Alyssa from before. “How did it go?” I asked.

“Better than expected! He was such a gentleman about it. He actually said the same thing happened to him after his divorce. He said he makes it a point to get tested before having sex with new partners, so he feels confident he didn’t give it to me, and he’ll get tested to make sure he’s in the clear. It led to a great discussion about sexual exclusivity while we’re getting to know each other.”

“I’m so happy to hear that!” I said.

It can be challenging to tell a partner you have an STI, but many people find that they’re pleasantly surprised by their partners’ reactions. Plenty of couples go on to have meaningful relationships and satisfying sex even when one person in the relationship has an STI that can’t be fully cured. And if you do feel embarrassed, just remember that the person standing in line behind you at Starbucks has probably been there too.

*STDs are sexually transmitted diseases, whereas STIs are sexually transmitted infections. Some STIs can lead to STDs but they don’t always progress to that stage.

Resources
American Sexual Health Association
The STI Project: Breaking the Stigma