Total Health Radio

“So…This is Awkward.” How to Talk About STDs

Podcast published: February 25, 2015



Man and woman laughing and hugging

If you were diagnosed with a sexually transmitted disease, would you tell your past partners? If an ex was diagnosed, do you think they would tell you? Talk about a tough conversation. Of the 19 million Americans diagnosed with sexually transmitted diseases each year, fewer than half of their partners have been notified. In this episode of Total Health Radio, we delve into the ins and outs of having that difficult talk. If everyone who had an STD informed their current and past partners – and those partners sought treatment and informed their own past partners – what impact might it have on the health of our nation?

Note: Nothing in this podcast should be viewed as an endorsement of any particular product or service by Kaiser Permanente.

About the Guest
Jessica Ladd is the founder and executive director of Sexual Health Innovations, a non-profit organization dedicated to using technology to improve sexual health and wellbeing. One of its projects is So They Can Know, a website designed to improve sexual health by providing resources that guide and support people in having the difficult conversation about STDs with partners past and present – as well as giving people the ability to anonymously inform their partners of possible STD transmission.

Ladd previously worked in the White House Office of National AIDS Policy and as a public policy associate at The AIDS Institute.  She received her Masters in Public Health at Johns Hopkins and her BA in Public Policy/Human Sexuality at Pomona College.

Episode Host
Joyce Gottesfeld, MD, is an OB/GYN with Kaiser Permanente Colorado, where she’s worked 18 years. She’s a wife, proud mother of three girls, runner and blogger. Read more about Dr. Gottesfeld.

Learn More
Looking for more information about STDs and communicating to a partner or past partner? Check out these links:


Transcript

GOTTESFELD: Welcome to Total Health Radio, I’m Dr. Joyce Gottesfeld. If you were diagnosed with an STD, would you tell your partner? What about your past partners? Of the 19 million Americans diagnosed with a sexually transmitted disease each year, less than half of their partners have been notified. But, if everyone did tell their partners when they were diagnosed with an STD, what impact would it make? Jessica Ladd is the founder of Sexual Health Innovations and So They Can Know. Sotheycanknow.org helps people who have been diagnosed with STDs talk to their partner about it, even anonymously. Hi Jessica, how are you doing today?

JESSICA LADD: I’m doing great. Thank you so much for having me.

GOTTESFELD: What would happen if everyone did tell their partners that they had been diagnosed with a sexually transmitted disease?

LADD: Basically, if that happened we would eradicate Chlamydia and Gonorrhea from this country and eventually HIV, and we would dramatically slow the spread of the other STDs. Because when people tell their partners, and those partners go and get tested and treated and then go tell their own partners, you end up spreading sort of communication and cure back along the lines of disease transmission. So, if you think of a network, sort of a sexual network of everybody being connected to everybody else, disease spreads in these networks and if you can go backwards along this network were disease went before and you make sure that each person who was infected is aware of their status and either get treated or is less likely to spread it someone else, you can really sort of cure the disease from the community in the case of curable STDs like Chlamydia or Gonorrhea and you can really slow how quickly it spreading in the case of something like HIV.

GOTTESFELD: So, you brought up Chlamydia. That’s an excellent example because probably at least half of the women who are infected with Chlamydia don’t even know they have it, so they are asymptomatic and there are probably almost 3 million Chlamydia infections every year in this Country. One in 15 sexually active teen females has Chlamydia and, in my experience with teenagers, they are not ones to have sort of an open, honest communication with their partners or past partners. What is your experience with this?

LADD: Yeah, I think that is very true and I think that is true for both teen men and women. It is common in both populations, though we tend to screen young women more than we screen young men. I think that teenagers and young adults and even not-young adults often feel really awkward about talking to their partners, particularly their past partners. Some of it is sort of a concern about their reputation: whether or not their partner will tell their people, what their partner might think of them. And that is especially true if you are at a time in your life when you are really, you know, really concerned about what people think of you which is often true of teenagers. So, if we can help people to either sort of get over that anxiety and make it easier for them to tell their partners or find some way to get around it almost and anonymously notify their partners where they don’t have to worry about this issue of what they might think of them or the reputation, I think we have a real potential to increase how often people are telling their partners and decrease STD spread.

GOTTESFELD: So, tell us about, So They Can Know, and how it helps foster this conversation.

LADD: Sure. So, we do it in a few different ways. The first is, ideally we would have people tell their partners themselves, either in person or on the phone. And so we give users tips about how to have that conversation. We give them actual scripts about different ways to phrase it and we even have a video that sort of models that conversation, so you can watch two people having a conversation about a Chlamydia diagnosis. The second is that for people who just aren’t willing to have that conversation—it’s not really the wording of the conversation that freaks them out, it is the fact that somebody knows that it was them who notified them—we have an anonymous option on the website and for that we allow users to input their partner’s e-mail addresses and an e-mail is sent to those partners from the website to let them know what they may have been exposed to. Let’s them know basic health information about the STD, like the fact that they probably won’t show symptoms and it connects them back to our website to look for testing locations in their local area so they can get tested and treated. The last piece we try to do is work with providers and with systems of providers to help them have that conversation with their patients about partner notification and about why it is important.

GOTTESFELD: I think it is great. I mean, you can totally envision someone who, for whatever reason, is embarrassed to talk to particularly a past partner. I mean, you don’t want to have to call that person again but, as you say, they got to find out about this so they don’t keep spreading the disease.

LADD: Yep. Yeah, I think that is exactly right. It’s a bit of trying to do your part to make sure this doesn’t happen to someone else as well as a concern about, you know, their health. You know, whether they gave it to you or you gave it to them, they may still be infected and for both men and women they can develop health consequences from these diseases.

GOTTESFELD: How do you try and normalize it or make it at all comfortable or even viable for someone to have this conversation about sex and sexually transmitted diseases with their partner or former partners?

LADD: Yeah, so some of it is we try to give people general tips. Like, sort of what setting they might want to have the conversation with or they should practice first. Tips that they might want to wait until they are not super angry before telling their partners but also making sure that they do it soon after they are diagnosed ‘cause often if people wait for the perfect moment, there will never be a perfect moment. Some of it is so we can give those specific phrases of exactly what to say, so you know, you probably want to tell your partner, for example, that they might not show any symptoms and that just because they don’t have symptoms doesn’t mean they don’t have it. But, there are many different ways to explain that so we try to give people different ways to phrase it so it is more natural for them. Uh, and then we do try to do sort of these videos with the hope that it helps a lot more to see somebody having a conversation and to actually take that in than it is sometimes to read a script or read general advice. Our hope is that particularly if we continue to create more videos that those are really the things that help break down some of the barriers that we have to having those conversations.

GOTTESFELD: Let’s walk through an example here. Let’s say, you know, a gal comes into the office. She finds out she has been diagnosed with Chlamydia and she thinks back and she’s got a boyfriend now but she recently had two other partners. How does that conversation go? She says, “Hi John. This is Jane… I have Chlamydia.” I mean, I don’t think that is exactly how you want to say it, so can you give me an example? I mean, I can’t even imagine how you would open up that conversation.

LADD: So, often what we advise is something like a phone call and if it is a curable STD like Chlamydia, is starting with a little bit of small talk, not a ton. But you know just through the “how are you doing” or, “what are you up to right now?” That’s important also, because if you are calling someone up and they are at work or they are really busy or in a crowded bar or something, you might want to wait and talk to them later. And so it is also assessing whether or not they are in a place to really have this conversation. And, then, once you have sort of laid that ground work, then your brief catch-up, sort of starting it with something like, “There is no good way to say this” or “So, this is really awkward, but.” You know, some sort of intro and then saying I just got to the doctor, just went to the doctor and I got tested and I learned this piece of information. Adding that sort of I just went to the doctor is also helpful because otherwise somebody might be wondering, well, how long have you known, have you been keeping this from me, did you know before we had sex and so if it is the case where you were just diagnosed sort of saying that right up front can help them not have to question that piece of it. And then after that, sort of, after I just went to the doctor and, “I got diagnosed with blank” say Chlamydia, um, then giving them a little bit of information about what it is. So, they might not know that Chlamydia is an STD. They might not know that it is curable. Um, they might not know they can get tested for it and so, giving them that basic information can be really important for their health and it can also reduce how freaked out they are right then.

GOTTESFELD: They also might not know how contagious it is and that they are potentially continuing to spread it and that they got it from someone who may also be still spreading the disease.

LADD: Exactly. So, I think, you know, talking about how you might not have symptoms and how that it is easily spread is important. Sometimes you don’t know whether or not that person gave it to you or you gave it to them and so, sometimes if you think there is a possibility that you gave it to them, acknowledging that, and saying that if it was you, you are sorry can be really helpful for the conversation. Not that you necessarily have anything to be sorry for if you didn’t know it at the time, but that is always helpful for somebody to hear and often makes them a lot more receptive to hearing the rest of what you are telling them. I mean, I think it is important to realize that this conversation is always going to be awkward. There is no perfect way that everybody comes out of this conversation feeling great about themselves. But, that doesn’t mean it’s not necessary and that doesn’t mean there aren’t ways to make the conversation easier and more productive.

GOTTESFELD: So, with Chlamydia and Gonorrhea in some respects it is a little bit easier because they are treatable. But, for example, genital herpes is not a curable disease and it is very common, so that conversation has to be even more difficult.

LADD: Yes. It often is. Um, particularly since things around diseases like genital herpes or HPV can be really complicated. It can be hard to get tested for those STDs so it is hard to know particularly, you know, for HPV for guys whether or not they have it and it’s hard to know how long your infectious for, when you are infectious. So it’s hard to know whether or not you need to tell future partners or how to have that conversation, and so it’s hard to know who gave it to you or who you might have given it to because the diagnostics are so hard. And so, it gets so much more complicated because of all those things. Um, plus the fact that often it is a lot easier to make someone worry less, right, if you can say, “Oh, but you just take one pill and it goes away,” versus something like herpes which sticks around. Generally, when we talk about on our website we also have discussions for each STD and break down sort of, in what circumstances you may or may not want to tell your partners what to think about when you are making those decisions. We do break that down for different types of advice for different STDs, because some of them are relatively simple and some of them are very complicated.

GOTTESFELD: Boy, it’s a complicated situation. Jessica, thank you so much for all of your information today.

LADD: Thank you, too.

 

This show is for educational purposes only. If you have specific health concerns, you are encouraged to address those with your personal doctor. And as always, if you’re having a health emergency, please call 9-1-1 or go to the nearest emergency department.