Two years ago, the journal published a commentary by one of us,1 followed by a reply from the other,2 about the pros and cons of the terms “sexually transmitted disease” (STD) or “sexually transmitted infection” (STI). Favoring “STD” are historical patterns of use and that subclinical infections often have serious consequences and thus are no less “disease” than symptomatic ones. “STI” is supported by the possibility that the term may be less stigmatizing for infected patients and persons at risk, and that it may foster an emphasis on primary prevention (avoiding infection), arguably a higher priority than secondary prevention (ameliorating disease).
In a direct and gratifying response to our commentaries, Lederer and Laing3 undertook a study that surveyed young persons about their perceptions of the 2 terms, the results of which are published in this issue. They enrolled 419 undergraduate university students taking health-related courses and randomly assigned them to online surveys that were identical except for exclusive use of “STD” or “STI.” No statistically significant differences were found in several understandings and characterizations of the 2 terms, such as risks for acquisition, perceived severity, types of people at risk, symptoms, and treatability. However, 10.6% of those in the STD group but only 4.8% of the STI group expressed overtly negative emotional reactions, using such terms as “gross,” “scary,” or “embarrassing” (P = 0.024). These responses imply more stigma associated with “STD” than “STI.” Still, only a 6% difference suggests that enhanced stigma from “disease” is quantitatively small. In addition, 17.6% of the STD group but only 12.0% of the STI subjects described these conditions as “severe.” Although the difference was not quite significant (P = 0.112), this trend might imply greater motivation to avoid STDs than STIs. Another study several years ago (of which Handsfield1 was unaware in his commentary) surveyed 302 women’s clinic attendees and female university students about their perceptions of “STD” versus “STI.”4 Several modest differences were found in perceptions about curability and symptomatology associated with the 2 terms, but not in measures of stigma.
Where do we go from here? Probably nowhere fast. Lederer and Laing’s results imply a slight preference for “STI” as less stigmatizing,1 and Handsfield agrees with Rietmeijer that there is value in using terminology that may underscore the importance of primary over secondary prevention. That said, we are skeptical that many prevention programs or health care providers have significantly altered their prevention strategies or clinical procedures because they use either term. “STD” and “STI” both are firmly established in daily usage and in the names of various academic and public health programs, supportive organizations, and scholarly journals. We also endorse Royer and Cerf’s conclusion that the differences in perception by some persons at risk imply that educational materials and prevention recommendations should consider defining and perhaps using both terms4 to assure that they understand that the differences between them are largely semantic and should not influence the clinical or prevention services they need or that we offer. The American Sexual Health Association offers a fine example of a user-friendly explanation of the terms for persons at risk and the public.5 Rietmeijer2 observed that this minor controversy may be limited to English speakers; the terms in other languages do not seem to have generated similar debate.
As we recommended in our previous commentaries, those who prefer either “STI” or “STD” should use it in comfort, pending more conclusive data on our patients’ perceptions of stigma. Enough said?
1. Handsfield HH. Sexually transmitted diseases, infections, and disorders: what’s in a name? Sex Transm Dis 2015; 42:169.
2. Rietmeijer CA. You say STD…. Sex Transm Dis 2015; 42:469.
3. Lederer AM, Laing EE. What’s in a name? Perceptions of the terms sexually transmitted disease and sexually transmitted infection among late adolescents. Sex Transm Dis 2017. [ this issue].
4. Royer HR, Cerf C. Young women’s beliefs about the terms sexually transmitted disease and sexually transmitted infection. J Obstet Gynecol Neonatal Nurs 2009; 38:686–692.
5. American Sexual Health Association. STD or STI: What’s the difference? http://www.ashasexualhealth.org/stdsstis/