Six Myths About STBBIs and Testing

This article is a presentation of Émissaire.

If we could believe everything we saw in movies and on TV, sexually transmitted and blood-borne infections (STBBIs) would always present with symptoms and would only happen to “irresponsible” or “naïve” people. Cold sores, burning pee, questionable discharge… Symptoms that almost always signal infidelity, in committed relationships, or dishonesty, in the case of casual sex. But are these representations realistic?

This article is dedicated to deconstructing six myths about STBBIs and testing, many of which are unfortunately perpetuated by the media, in everyday conversations, and on social media.

1. “I don’t need to get tested, because I don’t have any symptoms”

If you ever had sex education in high school, chances are you were shown pictures of genitalia demonstrating symptoms of different STBBIs. Although it’s important to talk about symptoms, showing these kinds of images can give the false impression that STBBIs always or almost always show symptoms. However, in many cases, STBBIs don’t show any symptoms.

For example, in a U.S. study, 45% and 77% of participants who tested positive for gonorrhea and chlamydia, respectively, had no symptoms (Farley et al., 2003). A person can therefore unknowingly contract and transmit an STBBI.

For this reason, instead of asking your partner “Do you have an STBBI?”, it’s best to ask three specific questions:

  • “When were you last tested?”
  • “What were your results?”
  • “Have you had any sexual partners since then?”

Some STBBIs, including chlamydia, gonorrhea, syphilis, human immunodeficiency virus (HIV) and some strains of human papillomavirus (HPV) can lead to health or fertility complications when left untreated. So, even when there are no symptoms, it’s still important to get tested in order to treat the infection as soon as possible.

2. “I ALWAYS use a condom, so it’s impossible for me to have an STBBI”

Barrier methods, such as condoms and dental dams are, hands down, the most effective in preventing STBBI transmission. That said, it’s important to remember that these methods are not foolproof, especially if used incorrectly (feel free to check the packaging for instructions).

STBBIs can also be transmitted during sexual activities other than vaginal or anal penetration, such as during sexual touching and oral sex—activities that many people don’t consider to be risky. For example, there is a risk of bacterial STBBI transmission (chlamydia, gonorrhea, etc.) when mucous membranes come into contact with infected bodily fluids. These membranes include the mouth and throat, the underside of the foreskin and the areas it covers (the head of the penis and clitoris and the area underneath them), the labia minora and vestibule (the area around the vaginal entrance), the anus, nostrils, and the eyes.

Also, some viral STBBIs such as HPV and herpes can be found on parts of the body that are not covered by condoms and dental dams, and can therefore be transmitted through skin-to-skin contact.

3. “Clinics routinely screen for all STBBIs”

The only STBBIs that are routinely screened for are chlamydia and gonorrhea, via a urine sample or a sample taken with a cotton swab. Other STBBIs, such as HIV, hepatitis C, and syphilis, which are screened for using a blood sample, are not screened by default in most cases.

During your appointment, your healthcare provider will ask you questions about your partner(s) and your sexual practices to better determine what other tests should be carried out. If no risk factors are identified, they will test you for the STBBIs that you specify, whether for chlamydia, gonorrhea, hepatitis, syphilis, or HIV. At some screening clinics, such as Prelib, these questions are asked online before your appointment to make the screening process smoother and more efficient.

Some relatively common STBBIs are usually only tested for when an individual is symptomatic.

For instance, with herpes, screening is not recommended for several reasons:

  1. it’s very common, especially type 1, so chances are you already have it (World Health Organization, 2022);
  2. it doesn’t lead to health or fertility complications;
  3. tests cost money and the stress that a positive test result can induce outweighs the public health benefits of screening;
  4. a positive result, especially for type 1, doesn’t allow healthcare providers to pinpoint the site of infection (on the mouth? On the genitals?)
  5. the rate of false positive results (i.e. a test coming back positive when the person is not actually infected) is relatively high in low-risk populations (up to 29% for type 2; Scoular, 2002), which would lead many people to worry over nothing.

As for HPV, it is only detected in people with a cervix, following the detection of abnormal cervical cells in a Pap test, which are almost always caused by HPV.

4. “Only people who have (or have had) a lot of partners are at risk of contracting an STBBI”

Several studies have documented this belief (Balfe et al., 2010; Nack, 2000; Shepherd & Harwood, 2017), and according to our survey on STBBIs and testing, 16% of people believe that a person can contract an STBBI because they have “too many” partners. This is consistent with the belief that a person can contract an STBBI because they’re “immoral” or “irresponsible” (Balfe et al., 2010; Fortenberry et al., 2002; Shepherd & Gerend, 2014). According to our survey findings, 16% of people endorse this belief.

However, the rest of our data paints a more nuanced picture. In our sample, as many people in consensual non-monogamous relationships as those in monogamous relationships reported having tested positive in their lifetime. To our knowledge, the only published scientific study that compared these two groups has produced the same results (Lehmiller, 2015).

This suggests that it’s less a matter of the number of sexual partners than of safer sex practices, such as the use of condoms or dental dams. However, keep in mind that no sexual behaviour is 100% safe. The only “behaviour” with zero risk of contracting STBBIs is total abstinence from sexual contact, injection drug use, and from getting tattoos.

You can also take a look at our article on STBBI testing in the context of monogamous relationships.

C’est important de garder en tête qu’aucun comportement sexuel est 100 % safe. Les SEULS comportements avec zéro risque de contraction d’ITSS sont l’abstinence totale de contacts sexuels et de consommation de drogues injectables ainsi que choisir de ne pas avoir de tatouages.

5. “People who contract STBBIs are dirty and unhygienic”

While many people are aware of this belief (Fortenberry et al., 2002; Kinghorn, 2001; Scoular et al., 2001), most of those who participated in our survey don’t endorse it. Only 1.9% of participants reported agreement with the idea that a person can contract an STBBI because they’re dirty and unhygienic. Those who had never been tested were more likely to endorse this belief (4.5%) than those who had been tested (1.6%).

But let’s get one thing straight: STBBIs are caused by bacteria, viruses, or parasites, not dirtiness or lack of hygiene. A squeaky clean person may have an STBBI and, conversely, a person who seriously needs to take a bath may not. It’s not by bathing regularly that we can prevent the contraction of STBBIs or that we can “wash them off.”

We commonly hear the expressions “clean” and “not clean” to refer to people free from or infected by STBBIs, respectively. Though the people who use these expressions don’t necessarily have bad intentions or prejudices towards others who have or have had STBBIs, these expressions still perpetuate the myth that people who have them are dirty and unhygienic, in addition to contributing to the stigmatization of STBBIs and of people who have tested positive for one.

It would therefore be better to completely drop these expressions when talking about STBBIs and instead talk about:

  • status (positive or negative);
  • having or not having an STBBI; or
  • living with or without an STBBI.

6. “STBBIs only affect the most marginalized people in society”

STBBIs are often seen as mostly or only affecting the most marginalized people in society, such as the incarcerated, IV drug users, sex workers, and people with mental health difficulties (Balfe et al., 2010; Kinghorn, 2001; Scoular et al., 2001).

According to our survey on STBBIs and testing, 11% of participants reported the belief that a person can contract an STBBI because they work in the sex industry, and 2% associated STBBIs with mental health problems.

However, as the woman quoted above notes, no one is invincible. A person can contract an STBBI regardless of age, mental health status, ethnicity, gender, sexual orientation, number of partners, or occupation. Receiving a positive test result doesn’t determine anyone’s worth.

In part, the misguided confidence that one cannot be at risk stems from stigma towards STBBIs, the people who have contracted them, and what many believe to be the “type” of person who contracts them. As human beings, we generally tend to distance ourselves mentally from these people, that is, we perceive ourselves as fundamentally different from these stigmatized groups. If we see ourselves as “good people,” we become less likely to see STBBIs as something that could potentially affect us.

  • Balfe, M., Brugha, R., O’Connell, E., McGee, H., O’Donovan, D. et Vaughan, D. (2010). Why don’t young women go for Chlamydia testing? A qualitative study employing Goffman’s stigma framework. Health, risk & society, 12(2), 131-148. https://doi.org/10.1080/13698571003632437

    Cuffe, K. M., Newton-Levinson, A., Gift, T. L., McFarlane, M. et Leichliter, J. S. (2016). Sexually transmitted infection testing among adolescents and young adults in the United States. Journal of Adolescent Health, 58(5), 512-519. https://doi.org/10.1016/j.jadohealth.2016.01.002 

    Deblonde, J., De Koker, P., Hamers, F. F., Fontaine, J., Luchters, S., & Temmerman, M. (2010). Barriers to HIV testing in Europe: a systematic review. European Journal of Public Health, 20(4), 422-432. https://doi.org/10.1093/eurpub/ckp231

    Farley, T. A., Cohen, D. A. et Elkins, W. (2003). Asymptomatic sexually transmitted diseases: the case for screening. Preventive medicine, 36(4), 502-509. https://doi.org/10.1016/S0091-7435(02)00058-0

    Fortenberry, J. D., McFarlane, M., Bleakley, A., Bull, S., Fishbein, M., Grimley, D. M., … et Stoner, B. P. (2002). Relationships of stigma and shame to gonorrhea and HIV screening. American Journal of Public Health, 92(3), 378-381. https://doi.org/10.2105/AJPH.92.3.378

    Heijman, T., Zuure, F., Stolte, I., & Davidovich, U. (2017). Motives and barriers to safer sex and regular STI testing among MSM soon after HIV diagnosis. BMC Infectious Diseases, 17(1), 1-11. https://doi.org/10.1186/s12879-017-2277-0

    Kinghorn, G. R. (2001). Passion, stigma, and STI. Sexually Transmitted Infections, 77(5), 370-375. http://dx.doi.org/10.1136/sti.77.5.370

    Lehmiller, J. J. (2015). A comparison of sexual health history and practices among monogamous and consensually nonmonogamous sexual partners. The Journal of Sexual Medicine, 12(10), 2022-2028. https://doi.org/10.1111/jsm.12987

    McDonagh, L. K., Saunders, J. M., Cassell, J., Curtis, T., Bastaki, H., Hartney, T., & Rait, G. (2018). Application of the COM-B model to barriers and facilitators to chlamydia testing in general practice for young people and primary care practitioners: a systematic review. Implementation Science, 13(1), 1-19. https://doi.org/10.1186/s13012-018-0821-y

    Nack, A. (2000). Damaged goods: women managing the stigma of STDs. Deviant Behavior, 21(2), 95-121. https://doi.org/10.1080/016396200266298

    Organisation mondiale de la santé. (1 mai, 2020). Herpès (virus de l’herpès)https://www.who.int/fr/news-room/fact-sheets/detail/herpes-simplex-virus 

    Scoular, A., Duncan, B. et Hart, G. (2001). “That sort of place… where filthy men go…”: a qualitative study of women’s perceptions of genitourinary medicine services. Sexually Transmitted Infections, 77(5), 340-343. http://dx.doi.org/10.1136/sti.77.5.340

    Scoular, A. (2002). Using the evidence base on genital herpes: optimising the use of diagnostic tests and information provision. Sexually Transmitted Infections, 78(3), 160-165. http://dx.doi.org/10.1136/sti.78.3.160

    Shepherd, L. et Harwood, H. (2017). The role of STI-related attitudes on screening attendance in young adults. Psychology, Health & Medicine, 22(6), 753-758. https://doi.org/10.1080/13548506.2016.1234715

    Shepherd, M. A., & Gerend, M. A. (2014). The blame game: cervical cancer, knowledge of its link to human papillomavirus and stigma. Psychology & Health, 29(1), 94-109. https://doi.org/10.1080/08870446.2013.834057