A review of research to-date reveals the complex nature of revealing a diagnosis of a sexually transmitted infection (STI) to a partner ahead of engaging in sexual activity.
With individuals experiencing a variety of feelings and emotions related to the prospect of disclosure, the research shows that only around half or fewer individuals felt able to disclose their diagnosis to a partner before sexual engagement.
Peer-reviewed results, published today in The Journal of Sex Research, also show a similar number of people believed they should have to disclose having a STI to a partner prior to engaging in sexual intercourse.
In order to stop the spread of such infections studied – which excludes HIV – the expert team from the University of Tennessee are calling for comprehensive sex education to be provided throughout life: from youth to late adulthood.
"Many individuals lack sufficient comprehensive sex education," the authors state in the paper.
"Rather than being taught how to correctly use prophylaxis, identify its limitations, and understand the scope and transmissibility of STIs, youth are only encouraged to be abstinent.
"Individuals diagnosed with STIs may be in vulnerable positions and may face difficult decisions, the outcomes of which can be harmful to their identity and relationships.
"The process of disclosure is complex. Certain contexts, particularly committed relationships, elicit disclosure, whereas others inhibit disclosure. Disclosure is an interpersonal process that involves not just the individual faced with the decision to disclose, but the intended receiver."
Overall, they say their findings "highlight the need for continuous comprehensive sexual health education throughout the life course and an increase in the number of (US) states that offer comprehensive sex education".
Around one in five people in the US have a STI at any one time with more than 26 million incidents reported to health services.
Chlamydia, gonorrhoea and syphilis have been at record levels for several years and continue to rise, according to official data.
Methods recommended by the Centers for Disease Control and Prevention to prevent infections include talking to partners about sexual histories such as disclosure of an active STI, as well as using prophylaxis (such as using condoms, oral dams, vaccines
Some public health agencies including in the US recommend disclosure about an active STI.
However, this new review - which looked at 32 papers - shows fear can prevent many people revealing their diagnosis.
Other reasons included: people believing that condom-use is protection enough; a lack of obligation such as a one-night-stand situation; and fear of being broken up with. Some even described 'passing' as uninfected to avoid having to tell.
People who disclosed to their partner did so out of love, feelings of moral obligation, or relationship-related reasons, such as greater levels of commitment, relationship quality, length of time together, and feelings of closeness
Disclosers used a variety of ways to tell people their STI status. Non-disclosers used strategies to pass as uninfected, withdraw from relationships, and using STI outbreaks to time sexual activity.
In the review, herpes and HPV were featured the most, while chlamydia, gonorrhoea and trichomoniasis were also common. The results also revealed that the experiences of people on the receiving end of STI disclosures are not well-represented in such studies.
"One of the key factors that determines whether an individual will disclose is the intended receiver. How the receiver will react and respond and the relationship with the receiver can be critical influences on the discloser," the authors add.
"As such, it is imperative that we investigate the experiences of receivers to understand the process of STI disclosure more comprehensively. This is so that we may continue to improve sexual health education and care for all."
Existing research on STIs has limitations such as a lack of data on sexual orientation. As such, the aim of the review authors was to fill knowledge gaps and identify areas for future study.
Their focus was on the self-disclosure of STIs to current and former partners. Disclosure is the voluntary or involuntary sharing of personal information with another individual such as the fact they have an STI.
This differs from partner notification, which is similar to contact tracing and can involve the use of anonymous messaging services.
Limitations of the paper included only English-speaking research being reviewed, as well as the limited number of reviewers.
Going forwards, the authors suggest that future research should take care to adopt a destigmatizing approach.
"Initiating sexual health conversations is everyone's responsibility," they conclude.
