STD or STI? Making a Difference with Sexual Health Education
By Laura Perkins, MLS, and Suzanne Schrag, BA | April 14, 2021
Health Literacy Editor and Product Manager/Editor, ETR
Sexual health educators all over the world agree: we want people to be healthy so they can live their best lives. Period.
Sexual health educators are passionate. They are also pragmatic. They want people to understand how to protect themselves, take care of themselves, and feel good about themselves.
Years ago, some educators decided one way to address the stigma around STDs (sexually transmitted diseases) would be to refer to them as STIs (sexually transmitted infections). The word “disease” suggests a medical problem with clear signs and symptoms, but many common sexually transmitted viruses, bacteria, and parasites cause few or no symptoms.
Patient Education Materials
Over the years, ETR stayed consistently with STD, especially in our patient education materials. This was the term that was easiest for most people to understand, particularly teens, young adults and low-literacy readers. It was also the term used by the CDC and many other leading health organizations.
ETR conducted regular surveys on the terminology issue to make sure our materials worked for the educators using them in the field. In 2020, for the first time in decades, our survey indicated a shift. More than half of the respondents stated a clear preference for using “STI” with their clients.
In order to address the needs of sexual health educators everywhere, ETR now offers updated and accessible information about STDs/STIs with two titles: STD Facts and STI Facts. Many well-informed experts make absolutely no distinction between STI and STD. Others feel the distinctions are real and important. However you choose to educate about STIs/STDs, both STD Facts and STI Facts give you a great foundation to start the conversation.
STD/STI Education Enters a New Era
The CDC estimates that about 20% of the US population—about one in five people—had an STI on any given day in 2018. Half of the new STIs were among youth ages 15–24. The COVID-19 pandemic has made it more challenging to address STI prevention and treatment, straining our public health infrastructure and creating more barriers to obtaining adequate care.
Despite the challenges, however, we are hopeful! On December 18, 2020, the U.S. Department of Health and Human Services (HHS) released the nation’s first-ever plan of its kind for STIs: the Sexually Transmitted Infections National Strategic Plan for the United States: 2021–2025.
With this roadmap for education and care, a vision with goals, objectives, and strategies, together we can enhance and expand STD/STI programs at the local, state, tribal, and national levels.
Sexual Health Educators: In Their Own Words
Rebecca Shemesh, PhD, CHES
"My preference at this time is STD because of its ubiquity. I previously worked at Planned Parenthood and we attempted to convert to STI to no avail. I was also recently facilitating a training at another Planned Parenthood and asked them if STI has caught on. Most of them were saying they use both interchangeably because STD is still so common. I also think that until CDC changes, it's best to stick with what people understand as far as written language is concerned. I'm certainly a proponent of using both interchangeably in verbal language. Eventually STI will catch on, as it is a more accurate description and likely less stigmatizing."
Kyra Huete, MSW, MPH, Children’s Social Worker
"I’m a children’s social worker, so when talking to kiddos I think STD comes across as a more familiar term. But I would let them know that STI is another term used to refer to the infectious stage of STDs, and that can be used as a teaching tool. In other words, information is power!"
Gina Lepore, MEd, Trainer and Sexual and Reproductive Health Specialist at ETR
"I use STI fairly consistently when I teach and train. Infection conveys the message that these viruses and bacteria are transmitted from one person to another, whereas disease distances us from the concept of transmission. I feel this distinction creates more awareness of the vulnerability we all share, decreases the tendency to distance ourselves from those with an infection, and increases empathy and personal responsibility. When students with whom I work ask for clarification between the terms I have found that it takes about one minute to explain why I use STI and briefly describe the shift in terminology, without judgment, and then move on with the main content of my lesson.
"Ultimately, how we teach about STIs is more important than the acronyms we use. Consistent, accurate, inclusive, non-stigmatizing, and comprehensive education about STIs will help us achieve the goal of improving communication, testing, and prevention strategies. A more balanced approach to STIs would allow us to talk about them like we talk about the common cold, flu viruses, and minor skin infections. The prevalent, often negative messaging about some viral STIs, herpes and HPV in particular, in the media, pop culture, and in educational and medical settings, has created unnecessary alarm about two STIs that are generally quite manageable. I highly recommend Ella Dawson’s Ted Talk on this topic."
Annika Shore, MPH, Director of Education at Planned Parenthood of the Great Northwest and the Hawaiian Islands
"After all this time, I still use STD and STI interchangeably. I find that funders in the sex education field often require one term over the other, so sometimes that dictates formal use of a particular term. I still prioritize my learners’ understanding and use either term depending on which one my learners use.
"That said, I use them interchangeably when I am using one as an umbrella term. When discussing or describing individuals or characteristics of particular infections, I use the term “infection” because it is more accurate and less stigmatizing."
Mia Barrett, MEd, Project Director at dfusion
"I prefer the term STI because it is more medically accurate. Because STD is a more commonly used acronym by the general population, I always make sure to state that the terms are used interchangeably but give my reasons for using the term STI, one of which is the feelings that may come with the word disease. This then gives me the opportunity to talk about stigma around STIs.
"I try to be very intentional about my word choice in the classroom, and this is an opportunity to clearly model being deliberate in the words one uses. My hope is that this encourages folks to think about the words they use and what impact they may have. So, while using STI instead of STD may lend to some initial confusion, using STI helps set the tone for the lesson and promotes continued use of the more accurate term."
Lindsey Hoskins, Health Education Director of Family Tree Clinic and author of Principles of Pleasure: Working with the Good Stuff as Sex Therapists and Educators
"I think it is important to be accurate, and I trust people to be able to learn the term STI, so that is the word I choose when writing on the board or on a worksheet. I will define it so no one is confused, and specify that not all infections result in disease. Then I move forward using the two terms somewhat interchangeably in speech, associating the terms freely with each other and getting people used to hearing them both. The audience always seems fine with this approach."
Laura Perkins (she/her/hers) is a health literacy editor for ETR, incorporating plain language principles in public health education materials. She can be reached at laura.perkins@etr.org.
Suzanne Schrag (she/her/hers) is a co-developer and the series editor of HealthSmart, ETR’s K–12 comprehensive health education program. She can be reached at suzanne.schrag@etr.org.
