Lack of Doctor-Patient Talks Could Be Driving Skyrocketing STD Rates

Coupled with sobering CDC data, a new report indicates women who are sexually active don't always talk to their clinicians honestly about sex and STD risks, and vice versa.

A new report says fewer than one in four young women ask their nurse or doctor for a test and that seven in ten physicians order the test for a sexually active, asymptomatic female patient younger than 25. Shutterstock

Jennifer Ferris gets tested for sexually transmitted infections two or three times a year. “Because I work in sexual health as an advocate, because I have multiple partners, it is the right thing to do,” she told Rewire.News.

Ferris, 40, has had a good experience at the university clinic she goes to in North Carolina—except for one visit last year. She had a new partner and decided to get tested on a day off. She found herself with “a rather older white” attending physician, who asked her why she felt she needed a test. She told him she had multiple partners.

“Medicine says if you have multiple partners you should have an STI check after each partner. Well, me and my doctor decided that would not work for me,” she said. “So what we decided was that I would get tested every two to four months.”

The physician rattled off a series of questions about why Ferris needed the test, all but discouraging her to get tested.

Then he told her the story of a woman who came in and tested positive for gonorrhea. It upset her marriage but later turned out to be a false positive. “Now you don’t want that to happen to you,” he said, adding that if she was using protection and had no discharge, she was OK.

“That’s like the most malinformed thing I’ve ever heard because the whole reason these diseases … proliferate is because they don’t make you have a giant sign on your forehead that says gonorrhea. They can be subtle,” Ferris said.

Ferris tells people to get tested regularly and is stunned by what she faced. “I was nearly turned away. I wasn’t, but it was only because I was a really strong advocate for myself and my health—and because I work in [reproductive health]. I think had I been somebody else, I might have just walked away and not taken a test, which is terrifying,” she said. “The average person would not understand that sexual health testing is a part of their well-being and care. I believe they may not even try to do it again.”

A report from the Centers for Disease Control and Prevention (CDC) indicates that the United States is experiencing “steep, sustained increases” in STIs, with nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis diagnosed in 2017. This is a record high that surpasses the 2016 data by more than 200,000 cases and marks the fourth consecutive year of rate increases.

The CDC recommends at least one HIV test for everyone ages 13 to 64 who visits a doctor, a minimum of yearly chlamydia and gonorrhea testing of all sexually active women under 25 years, and Pap smears for women 21 or older. Men who have sex with men should talk to their health-care providers about general STD/STI screening, it states.

Patients should be asked at every doctor’s visit if they want to get tested for STD/STIs and how they would like to be notified of the results. This is important for male, female, and LGBTQ patients, Dr. Cora Breuner told Rewire.News.

“A full panel is preferred but obviously gonorrhea and chlamydia are essential,” said Breuner who is a pediatrician in Seattle and chair of the American Academy of Pediatrics Committee on Adolescence.

A five-year CDC analysis shows that gonorrhea cases increased 67 percent overall and nearly doubled among men. Chlamydia remains common with more than 1.7 million cases diagnosed in 2017, especially among females ages 15-24.

Breuner said providers can help more people understand and access testing better by asking them key questions like: How are you making sure that you don’t get an STI? Do you understand how essential condoms are? Do you understand that despite the fact that you are on contraception you also need to use condoms?

Expedited Partner Therapy (ECP) should be available everywhere, she said, to make sure that infected patients and their partners are treated immediately. “The more people are aware of their options for screening and treatment the better. The more health-care providers are aware that their patients should be counseled on safe sex and screened and treated for STDs/STIs the healthier their patients will be,” Breuner said.

Coupled with the sobering CDC data, a report from Quest Diagnostics indicates women who are sexually active don’t always talk to their clinicians honestly about sex and STI risks, and vice versa, and that many aren’t being tested as per guidelines.

“We know that people often think of STIs as something that happens ‘to others’ and, frequently, health-care providers have similar beliefs and don’t view their patients as being at risk,” Lynn Barclay, president and CEO of the American Sexual Health Association (ASHA), said in a statement. “Testing is crucial in young women because STIs are very common, often without symptoms, and undetected infections like chlamydia can lead to problems including infertility.”

The report says fewer than one in four young women ask their nurse or doctor for a test and that seven in ten physicians order the test for a sexually active, asymptomatic female patient younger than 25. It found 49 percent of young women claim their nurse or doctor never asked about STI testing and 24 percent of primary care physicians felt very uncomfortable discussing STI risk with female patients.

As a reproductive health advocate, Ferris knows she needs to get tested but given her recent experience, she fears that women who don’t may not get tested. Worse, they may be discouraged from doing so by their doctors. Ferris said she pushed for the test because she believed she needed it, so the doctor eventually sighed and let her. But the entire encounter made her “feel really bad and like a hypochondriac.”

“I am a person who has sex, period. People who have sex, period, sometimes transmit infection, period. There are no caveats needed,” she said.

The ASHA has an initiative, now in its third year, called Yes Means Test, designed to increase awareness of the need for STI testing and help people find free or low-cost services.

The appropriate tests an individual needs is influenced by a number of factors including gender, age, sexual orientation, sexual history and medical history. That’s why it’s so important for health-care providers and patients to have frank, honest discussions around sexual health to pinpoint the testing that might be appropriate along with proper intervals,” said Fred Wyand, director of communications at ASHA.

To ensure better access, all 17 Planned Parenthood clinics in New Jersey offer free STI testing. This started in April as part of National STD Awareness Month. The demand has been so high the program has been extended twice and averages more than 2,000 tests per week—an increase of about 40 percent from the average for the same time period last year.

“Getting tested for HIV and other STDs is a basic part of staying healthy and taking control of your sex life—and it’s easier than ever before,” Triste Brooks, president and CEO of Planned Parenthood of Northern, Central, and Southern New Jersey said in a statement.

New Jersey recorded a 49.7 percent increase in STDs diagnosed between 2009 and 2016, Planned Parenthood says. Statewide data shows that New Jersey’s spike predates the nationwide trend dating back to 2010.

“These numbers make it clear that too many people aren’t getting the health care and education they need in order to keep themselves healthy,” Brooks said. “No matter who you are or where you live, you should have access to regular STD screening and treatment, as well as accurate, nonjudgmental education about STDs and STD prevention.”

There’s still a lack of education and misunderstanding about STIs, all of which are treatable. Many are curable. Safe sex education and STI prevention is a core part of Planned Parenthood’s health-care services. Nationwide last year, its centers provided more than 4.4 million STI tests and treatment, including more than 700,000 HIV tests nationwide. The health-care organization released a series of videos modeling how to talk about STIs with partners.