STI Reality Check: Swine Flu Is Worse Than Chlamydia!

A guy once told me he’d rather get hit by a car than get oral herpes. Thinking rationally, that makes absolutely no sense. A car hit can kill you or permanently injure you, affecting dramatically your quality of life. Oral herpes–the virus that causes cold sores on the lips–is something that over 60% of the U.S. population has. Aside from being annoying, itchy, and a bit painful for a few days when you have an outbreak, oral herpes really doesn’t affect your life that much. But when it comes to STIs, we’re not thinking rationally. Our fears, instilled in us by systematic and pervasive sex negative culture, overpowers our rationality.

We live in a world that stigmatize sexually transmitted infections (STI) far beyond the severity of the physical health consequences they lead to. Sure, they are unpleasant and inconvenient, and some can have serious long-term effects, but so do many other communicable diseases. Yet no one seems to think that you’re dirty or disgusting or irresponsible or risky if you have or you transmit to someone, say, tuberculosis or the flu. But mention something that’s sexually transmitted, and those labels will get slapped on you in no time.

A study just published in the International Journal of Sexual health provides a striking example of how completely disproportionate the stigma we attach to STIs is in relation to the severity of their actual outcomes. A group of 400 online volunteers (average age = 30) were asked to imagine one of two scenarios. Scenario one: Sarah is going to a party and she noticed some symptoms but disregarded them as another urinary tract infection. She had unprotected sex with a guy and it turned out she had Chlamydia that also got transmitted to him. He had to go to the doctor and take a week of antibiotics. Scenario two: Sarah felt kind of under the weather before going to the party. She dismissed her symptoms as allergies, had unprotected sex with a guy and ended up giving him swine flu (H1N1). He got so sick that he died from it.

How selfish, how dumb, and how risky is Sarah, participants were asked. Guess what? Sarah was rated as more selfish, more risky, and dumber when she transmitted chlamydia to her partner even when it explicitly stated he had to go and get one week of antibiotics than when she gave swine flu to her partner and he died from swine flu.

Please note that in both cases Sarah didn’t realize she had these diseases (thought from the symptoms she had were due to a noncommunicable issue), and the infection got transmitted while she engaged in the exact same risky activity – unprotected sex with someone she didn’t know well. Yet something that led to another person’s death was perceived as less problematic than something that led to a week of Z-pack.

We also just fear that STIs are so much more prevalent and easy to catch than they actually are. In a second experiment reported in this study, about 600 volunteers were asked how many people out of a thousand are going to die: a) in a car crash while driving from Chicago to Detroit (a 300-mile drive) versus b) from AIDS after having unprotected sex one time with someone who was a non-intravenous drug user? thought the risk of dying from AIDS after a single unprotected sexual encounter was much higher than the risk of dying in a car crash on a 300 mile drive (from Chicago to Detroit). In reality, it’s the other way around. This is why we need real sex education and not shaming.

People estimated that an average of 4 people out of 1000 would die in a car crash compared to 17 people out of 1000 would die of AIDS. That’s a huge difference. In reality, far less than 1 in a 1000 would die in either case – so people wildly overestimated the risk of both events. But people in particular overestimated dying of AIDS. In reality, the numbers are reversed: You’re about 20 times more likely to die in a car crash on a 300-mile drive (about 1 in 500,000) than you are to die of AIDS after having unprotected sex once (about 1 in 10 million).

How is that possible? Well, consider these numbers. First, only about 1 in 300 people in the US have HIV. Next, HIV is actually pretty difficult to transmit: about 1 in 1000 will get HIV when having vaginal sex with someone who is HIV positive (anal sex is more risky, about 1 in 300). Finally, current anti-retroviral medications treat HIV+ people to prevent AIDS, making it relatively unlikely that you would die of AIDS even if you are HIV+. Running into someone who’s HIV+, then actually getting the virus, then actually getting sick enough to die from the virus is just really really unlikely.

Our ideas of risks are incredibly inflated. Our ideas of STI risk even more so. Again, it comes down to social stigma and irrational fears.

Please don’t get me wrong: STIs are no fun and you should take as many precautions as you feel are necessary to protect yourself from them. Just like you would protect yourself against the flu or any other communicable diseases. But I think we could all collectively benefit from chilling out about STIs and how scary they are. Demonizing these infections and falsely scaring people into prevention–by inflating risks or making people feel guilty and dirty for having an STI–is counterproductive: It makes it more difficult for people to get tested and have honest conversations about these things.