Here’s a statistic that might surprise you: around one in five people in the US have a sexually transmitted infection at any one time. There’s nothing wrong or shameful about that – in this age of modern medicine, many are curable and all are treatable – but if you have one, you at least ought to know about it, right?

That’s one reason why the results of a new analysis – a critical literature review some 32 papers strong from researchers at the University of Tennessee – are so worrying. According to their results, only around one-half of people who have an STI actually mention it to a prospective sexual partner. 

In fact, only about one-half of people think they should even have to say anything.

“STI cases continue to rise annually, yet the STI disclosure literature published across the last two decades has not kept pace,” the authors write. Which is a problem – because, of course, “sexual partners […] face increased susceptibility for contracting the STI(s), if they did not already have the STI(s) and were not the individuals who transmitted it initially.”

Now, perhaps you’re aghast at the one in ten people who are apparently knowingly risking others’ health in order to continue getting their rocks off – and it’s true that in some cases, “it’s just a one-night stand” was deemed reason enough to not come clean. 

But the overall picture is more nuanced than that, the authors found: “many individuals are not receiving sufficient comprehensive sexual health education,” they write. 

And the culprit? Our old friend abstinence-only sex education: “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,” the researchers explain.

That’s right: not only is it bad for your mental health, useless for stopping sex before marriage, and downright counterproductive for reducing teen pregnancies, it turns out abstinence-only sex “education” has rendered many completely ignorant of important sexual health knowledge. For example, the researchers found that many STI-positive people were under the impression that sexual activity was only risky if they were experiencing symptoms: “Many believed, especially in the case of herpes, that being asymptomatic, STI dormancy, and using prophylaxis were enough to completely prevent transmission, and this negated the necessity for them to disclose,” they noted.

But of course, that’s not true. “Although the likelihood of the transmission of herpes is decreased when asymptomatic and using prophylaxis, it is still possible,” cautions the paper. The same is true of chlamydia, gonorrhea, and trichomoniasis, all of which can be spread without the presence of symptoms or even semen, and all of which featured heavily in the responses to various studies in the review (the most common conditions were herpes and HPV, while HIV was excluded from consideration.)

Outside of simply lacking the relevant knowledge, there are other factors at play when it comes to disclosing – or not – an STI-positive status. “For some individuals, it may not be the safest decision to make,” the authors point out; for others, the psychological baggage that comes with a diagnosis is simply too great: “For many, the sexual self is ‘damaged’ upon diagnosis,” they write, “and these deeply meaningful, symbolic processes certainly influence disclosure decision-making.”

So, what’s the solution? According to the researchers, a massive change in sex education is needed. 

“The findings from this review highlight individuals’ gaps in sexual health knowledge,” they write. “This is not surprising, particularly in the United States, as comprehensive sex education remains taboo, rather than the norm.”

That’s not just a job for schools, they add: healthcare providers, especially those who deal directly with people learning their STI-positive status, should be involved too. “The advice that practitioners may give patients will vary depending on the type of STI, which can also inform disclosure-efficacy coaching. This would be an opportunity to provide counseling about how to notify their current partner and deliver treatment, encourage routine testing, and discuss disclosure strategies should future instances arise,” the authors suggest. “Regardless of the type of STI, patients could be referred to more in-depth counseling services, if necessary, to process the diagnosis and develop strategies for disclosure, should they decide to do so.”

And underpinning all of this? Destigmatization – both of having an STI, and of sexual activity itself. 

“Providing individuals with accurate sexual health knowledge, ample opportunities for testing and treatment, and helping them build confidence in their sexual decision-making is paramount,” the researchers conclude.

“Each person interested in pursuing sexual activity with another, regardless of whether they have an STI, should feel empowered to facilitate conversations about their sexual health and wellness with others, including conversations about consent, contraception, preferred sexual behaviors, sexual histories and STI status.”

The review is published in The Journal of Sex Research.