Safer Solutions: A Valentine’s Day Reminder that STIs CAN Happen to You
People sometimes underestimate their individual risk, thinking, “It won’t happen to me.” Sexually transmitted infections (STI) like syphilis are a good example of this misperception.
This is understandable. Even if we had access to perfect and complete information about our risks, avoiding every potential health risk would be a full-time job (and likely impossible). Instead, whether conscious of it or not, people choose which risks to focus on. Problems arise when “It won’t happen to me” slides closer to “It can’t happen to me.”
This happens most when a specific group or behavior becomes associated with a particular health condition. For example, because HIV affects men who have sex with men and people who inject drugs at higher rates, people outside of these groups frequently assume they are not at risk for HIV.
While it’s true that some communities or demographic groups have greater risk for certain health conditions than others, the reasons for those differing risks are complex and beyond the scope of this discussion. Where people run into trouble is when they assume that because they don’t belong to a higher-risk group, they’re not at risk at all.
One group of people who might underestimate their STI risk is married individuals. Cases like the unimaginably terrible situation where a husband drugged his wife and allowed dozens of men to sexually assault her provide extreme examples of how a person’s perception of their STI risk could be wildly different from their actual risk. Although egregious cases like this are thankfully uncommon, estimates suggest that secret extramarital romances occur in about a quarter of marriages. Despite the uncomfortable implications, marriage does not necessarily eliminate the risk for STIs.
Assumptions about monogamy can also affect health care during pregnancy. For example, congenital syphilis, caused by untreated syphilis infection during pregnancy, can cause severe birth defects and even stillbirth or infant death. Although easily diagnosed by a blood test and cured with an antibiotic, nearly 4,000 cases of congenital syphilis were reported to the Centers for Disease Control and Prevention (CDC) in 2023. Sadly, 279 infants died from congenital syphilis—the highest number since 1992. The CDC recommends syphilis testing during each pregnancy to prevent congenital syphilis; 43 states and Washington, D.C. require screening at the first prenatal visit. However, if a pregnant person is reinfected after completing treatment or gets syphilis after screening, they may not be diagnosed before giving birth—possibly causing an infant to be born with congenital syphilis.
More broadly, a recent study documented poor adherence to CDC and U.S. Preventive Services Task Force STI testing recommendations during pregnancy. In the 12 years of data (including more than 4 million pregnancies), one-third of pregnant individuals who tested positive for chlamydia or gonorrhea never received a follow-up test to confirm successful treatment and rule out reinfection before delivery. Treatment failure or reinfection can leave both the pregnant person and the newborn susceptible to the negative consequences of these STIs.
Even if people acknowledge that they could get an STI, they sometimes misperceive the severity of the consequences. HIV offers a useful example. Because of advances in treatment, HIV is no longer a death sentence, which can make preventing infections feel less urgent. Personal risk perception can change individual prevention behavior, but it can also impact willingness to support policies that help prevent HIV from spreading. In the policy space, stagnant federal funding for prevention, cuts to health departments’ disease intervention workforce and testing programs, and opposition to or skepticism about the benefits of syringe services programs (a proven method for reducing the spread of HIV) suggest that people are less concerned about HIV now than they were in the early decades of the virus.
Although the “It won’t happen to me” mindset seems like an individual-level problem, it can also have policy implications. First, it draws focus away from potential hazards, leading to an “out of sight, out of mind” mentality. Second, focusing on individual risks rather than population risks ignores the collective impact of unfavorable health outcomes on public budgets and public health resources—impacts shouldered by all of us. When it comes to health hazards, the words of Voltaire ring true: “The danger which is least expected soonest comes to us.”
Were you forwarded this email? See past editions and sign up for emails here. We’re Chelsea Boyd (cboyd@rstreet.org) and Jessica Shortall (jshortall@rstreet.org), lead authors of this Safer Solutions newsletter. Please reach out with comments or suggestions for future topics.