Only half of people report or think they should report STDs before sexual intercourse

A review of research to date reveals the complex nature of disclosing a sexually transmitted infection (STI) diagnosis to a partner before the onset of sexual activity.

Research shows that many people experience a range of feelings and emotions around the prospect of disclosing their diagnosis, yet only about half or fewer people feel able to tell their partner about their diagnosis before engaging in sexual activity.

The findings, published in The Journal of Sex Research, also show that a similar number of people believe they should disclose STIs to their partner before having sex.

To prevent the spread of such infections (excluding HIV), an expert group from the University of Tennessee calls for comprehensive sex education throughout life, from adolescence through late adulthood.

"Many people do not have adequate, comprehensive sexuality education," the authors note. "Instead of being taught how to use prevention methods correctly, recognize their limitations, and understand the scope and modes of transmission of STIs, young people are simply advised to abstain from sexual contact. Individuals diagnosed with STIs may be in vulnerable situations and face difficult decisions that may have harmful outcomes for themselves and their relationships.

The process of disclosure is complex. Certain contexts, particularly in stable relationships, facilitate disclosure, while others inhibit it. Disclosure is an interpersonal process that involves not only the person who has chosen to disclose, but also the intended recipient of the information."

About one in five people in the United States has an STI at any given time, with more than 26 million cases reported to health care providers.

According to the Centers for Disease Control and Prevention (CDC), methods to prevent infections include discussing sexual history with partners, disclosing active STIs, and using prevention tools (e.g., condoms, barrier napkins, vaccines).

Some public health agencies, including those in the United States, recommend disclosure of active STIs.

But a new review that looked at 32 articles shows that fear may stop many people from disclosing their diagnosis.

Other reasons include the belief that condom use is sufficiently protective; the lack of commitment, as with one-night stands; and fear of rejection. Some even described "masquerading" as uninfected to avoid being discovered.

People who disclosed their status to their partner did so out of love, a sense of moral obligation, or for relationship-related reasons such as high levels of commitment, relationship quality, length of time together, and feelings of closeness.

Disclosers used a variety of methods to communicate their STI status. Non-disclosers used strategies to appear uninfected, avoid relationships, or use STI outbreaks to plan sexual activity.

The most commonly mentioned infections in the review were herpes and HPV, but chlamydia, gonorrhoea and trichomoniasis were also considered. The results also showed that people's experiences of receiving STI information are underrepresented in such studies.

"One of the key factors that determines whether a person will disclose information is the intended recipient. How the recipient reacts and their relationship with the discloser can significantly influence the disclosure decision," the authors add.

"Therefore, it is necessary to explore recipient experiences to more fully understand the STI disclosure process. This will allow us to continue to improve sexuality education and health care for all."

Existing research on STIs has limitations, such as a lack of data on sexual orientation. Therefore, the authors of the review aimed to fill gaps in knowledge and identify areas for future research.

Their focus was on self-disclosure of STIs to current and former partners. Disclosure is the voluntary or forced sharing of personal information with another person, such as disclosing that you have an STI.

This is different from partner notification, which is similar to contact tracing and may involve the use of anonymous messaging services.

Limitations of the article included the inclusion of only English-language studies and the limited number of reviewers.

For the future, the authors suggest that further research should approach the topic with a destigmatizing approach.

"Initiating conversations about sexual health is everyone's responsibility," they conclude.