Why Extreme Syphilis Symptoms Are Showing Up Now
Syphilis Is At Its Highest Levels Since The 1950s. Here's How Experts Are Trying To Fix That.
It was spring 2023, and Dr. Irene Stafford had been called to the ER for what should have been a routine delivery.
But Stafford, a maternal-fetal medicine physician at the University of Texas Health Sciences Center in Houston, quickly realized something was wrong: She couldn't find a heartbeat. The unborn baby boy had already died in the womb.
Soon after, the mother's syphilis test — given to all women before delivery — came back positive. The infection had been silently passed from mother to son.
It's a death, Stafford said, that could've been prevented with early detection and a shot of penicillin.
Syphilis, a sexually transmitted infection, was nearly eliminated in the U.S. At the beginning of the 21st century but has made a dramatic comeback. In 2022, the Centers for Disease Control and Prevention reported more than 200,000 syphilis cases — the highest counts since 1950. Congenital syphilis has similarly increased tenfold over the past decade, the CDC says, even though 90% of cases are fully preventable.
Syphilis in the U.S.More than 200,000 cases were reported in 2022, the most since 1950.
The return of syphilis is the result, experts say, of poorly funded prevention programs over the past two decades and difficulties in diagnosis; syphilis is referred to as the "great imitator" because its symptoms can vary so widely. Most people don't show symptoms or know they're infected, and even if they do visit the doctor's office, there's no guarantee they'll be properly diagnosed.
Stafford said her patient didn't have the resources to seek prenatal care, and no doctor or public health worker had ever told her that she should get tested for syphilis. So, when the patient noticed a small rash on her belly, she didn't think too much about it, Stafford added.
"There's a lot of people who are seen in private practice, hospital ERs, or walk-in centers, and those clinicians are not necessarily thinking of syphilis, they're not necessarily getting a sexual history," said Dr. Kenneth Mayer, an infectious disease physician and medical research director of the Fenway Institute in Boston. With a generation of doctors who saw few, if any, syphilis cases during their training, Mayer said that "the issue is tests not being done in the first place."
The all-encompassing nature of the Covid pandemic added fuel to this fire, as public health departments redirected STI resources toward fighting the coronavirus.
"The solutions for controlling syphilis are relatively straightforward. We're not talking about high tech approaches or a novel therapeutic," said Dr. Dave Chokshi, chair of the Common Health Coalition and a former New York City Commissioner of Health. "It simply revolves around closing gaps in testing and treatment."
As syphilis cases surge, doctors and public health officials are starting to develop innovative and sometimes unconventional strategies to screen people for syphilis and curb the spread of the disease.
Most often, that comes down to figuring out how to get people tested, a task that's far easier said than done.
Spreading the word about syphilisGiven these challenges, some public health departments have launched eye-popping awareness campaigns, trying to raise the alarm among both the public and health care providers.
A few years ago, Donna Fox, the HIV and STI manager at the Toledo-Lucas County Health Department in Ohio, noticed that about one-fifth of syphilis cases in the area were among people who reported paying for sex.
So, trying to be proactive — and a bit provocative — Fox and her team ran billboards across the county in 2022 saying, "Paying for Sex? Get Tested!"
"We had to go bold, and we had to get to the point," she said. The pushback was inevitable — "you might have to say something to your 10-year-old who can read," Fox conceded — but the impact was measurable. From 2021 through 2022, the number of syphilis appointments scheduled via the county health department jumped by almost 50%, and syphilis cases dropped by 12%, she said.
Of course, syphilis doesn't just spread among sex workers, so last year, Fox's team broadened the campaign, keeping the same look and feel but instead saying "Syphilis is Serious" with "Spreading Locally!" overlaid over the side.
Other billboard campaigns across the country have featured giant bloodshot, infected eyes with the blurry words "Eye Syphilis is Serious" and a black silhouette of a pregnant woman with a red belly saying "Syphilis Can Be Fatal to Your Baby." While these billboards are factually true, Mayer describes how this kind of fear-based campaign, or "loss frame," draws lots of attention but may not be particularly effective at motivating behavioral changes for STIs.
"We're not telling anybody not to have sex," Fox said. "We're telling people to have safe sex," and to get tested afterward.
The sex positivity message isn't just for the public. The Toledo-Lucas health department also launched an educational campaign for clinicians, reminding them to take a sexual history of all patients — since the county saw syphilis in people ages 15 to 72 last year — and to order a blood test if they suspect an STI, since the standard "pee in a cup" test can't detect syphilis.
"Many physicians haven't seen syphilis, and they've got a million things to know," Fox said. "If we don't talk to the physicians, we're not going to get the testing we need done."
Stafford, the maternal-fetal medicine doctor in Houston, has taken a more hands-on approach. Texas mandates syphilis testing for pregnant women at three points — during their first prenatal visit, around the 28-week mark and before delivery — but in reality, these tests are often missed. So, last year, Stafford launched an alert in UTHealth's electronic medical records, prompting providers to test their pregnant patients for syphilis at each of the prescribed times. The simple tweak helped increase screening rates from 2% to 47% at all three timepoints, while decreasing congenital syphilis cases by half.
Chokshi sees this as another good example of the public health and health care systems working hand-in-hand, with the former "setting the parameters of what standard of care should look like" and hospitals making it a reality.
Make syphilis testing convenientBeyond greater awareness, access to testing and treatment needs to be quick, easy and convenient, Chokshi said.
Indian Country has led the way on this, partly by necessity: American Indian and Alaska Natives have the highest syphilis rates of any racial or ethnic group, almost seven times higher than white people.
As such, tribes across the U.S. Have turned to incentives, giving people $10 gift cards if they come in for STI testing or treatment, said Jessica Leston, founder of the Raven Collective, an Indigenous public health organization.
"We're just helping people pay for gas and child care and get food on their table," Leston said. At Cass Lake Indian Hospital's pharmacy in rural Minnesota, the strategy increased STI testing tenfold, according to one study, with over 70% of the patients who got a test not having a primary care provider.
In 2023, a coalition of tribal communities partnered with Johns Hopkins School of Medicine to ramp up a program called I Want the Kit, which sends at-home STI test kits in the mail. The tests come in unmarked envelopes with instructions on how to collect a sample and send back the test. Results come back in a week or two, and patients are linked to health care resources if the test comes back positive.
Even with these programs, syphilis testing can be overshadowed by more immediate concerns.
In California, for example, half of pregnant women with syphilis reported methamphetamine use, and a quarter were homeless. In the state's rural Shasta County, near the Oregon border, almost 100% of pregnant woman with syphilis similarly have a substance use disorder and 90% are unhoused, said Trojan Carvajal, a supervising public health nurse in the county's STI unit.
In April 2023, Shasta County launched the CommUNITY Mobile Care Clinic, an RV retrofitted with a reception area and two exam rooms, bringing STI tests and treatments to the county's most vulnerable — from homeless camps to pop-ups with the local LBGTQ community center. Importantly, there's no STI branding on the mobile clinic itself, allowing people to feel more comfortable walking in to get tested.
Last year, one-third of all syphilis tests performed by Shasta County were done through the mobile clinic, according to Jai Winchell, a community education specialist with the county's public health department. These people would likely have never sought syphilis services otherwise, Winchell said, but with this mobile clinic crisscrossing the county and arriving at their doorsteps, they can get tested and treated in just 30 minutes.
Piggybacking syphilis servicesShasta County's mobile clinic also offers other services, including test strips for deadly drugs like fentanyl and xylazine, naloxone to reverse overdoses and referrals to addiction counselors, as well as water, snacks and dental kits, Winchell said. The idea is to address overlapping concerns together, while also attracting those who wouldn't have considered STI testing, if not for the package deal.
This approach also helps build trust, said Dr. Arlene Seña, an infectious diseases physician at the University of North Carolina Chapel Hill, showing how mobile clinic staff are invested in you as a person with various needs, rather than a singular problem to be solved. "It might be more costly, but it's also much, much more effective and helpful to the community," Seña said.
Syphilis services can also be integrated with general health care services. In March, Stafford launched a rapid testing program at two Houston hospitals aimed at all pregnant women admitted to the emergency department. The program, called Preg-Out, was set up on an opt-out basis, so everyone got tested unless they refused. It took about 15 minutes, and women were offered prenatal care regardless of the result.
"We noticed that pregnant patients, especially those that end up having a child with congenital syphilis, often frequent the ED and don't get tested," Stafford said. In the three-month pilot, Stafford said testing rates for pregnant women increased twelvefold, with about 35% of their partners wanting to get tested as well.
Other hospitals have implemented opt-out screening programs for all patients, including Grady Memorial Hospital in Atlanta in one of their urgent care centers and the University of Chicago in their emergency department. Not every hospital has the resources to test everyone, Seña said, so she believes prioritizing pregnant patients, as done in Houston, can be a high-impact first step.
"You can't just rely on public health departments to do the brunt of the work for STI recognition and prevention," she said. "You have to go hand in hand with other providers in the community."
The future aheadThe U.S. Got syphilis rates down before, but that was in the 1990s, when HIV was ravaging through America.
"What changed behavior then was lethal, hard-to-treat disease," said Mayer, from Fenway Health. "Now, you have a generation of people who may be less informed," leading to lower rates of condom use and STI screening rates.
However, it's also a time of innovation. In June, the CDC recommended doxycycline post-exposure prophylaxis for high-risk groups — essentially, a morning after pill for STIs. If taken within 72 hours of condomless sex, so-called DoxyPEP reduces syphilis rates by over 70%, and Fenway Health, where half of patients are LGBTQ, has already begun ramping up distribution, Mayer said. Meanwhile, other researchers like Seña have been working on developing a syphilis vaccine, but that's probably several years down the line.
"Our task right now is to arrest the growth in cases," said Chokshi, from the Common Health Coalition, and he's optimistic that these innovative awareness, testing and treatment campaigns can do that. But permanently bending the syphilis curve will require scaling these efforts nationally and promoting greater coordination between health care and public health.
"There's no reason that the endgame can't be, once again, trying to eliminate syphilis — this historic scourge that is completely preventable and treatable," Chokshi said.
This article first appeared on NBCNews.Com. Read more from NBC News here:
The Best At-home STD Tests Of 2024
These kits make it easy to be informed at home. (MyLab Box, CVS, Everlywell)
Did you know you can check the status of your sexual health without going to your doctor's office or local clinic? Here's how: with at-home tests for sexually transmitted diseases (STD) or sexually transmitted infections (STI). There are multiple benefits to using an at-home STI test, like minimizing anxiety about your status if you have to wait weeks for an appointment with your healthcare provider, finding out potentially positive test results in the comfort of your own home, or having to worry about health insurance coverage and test prices.
Quick Overview
Being concerned about exposure to an STD or STI is more common in the United States than you might think. Currently, the United States is facing record-high numbers of STDs and STIs, with gonorrhea and syphilis especially on the rise, according to the Centers for Disease Control and Prevention. What's even more alarming is the recent study showing there were more than 3,700 babies born with syphilis in 2022, which was over 10 times the number reported in 2012. Furthermore, in 2022, there were 231 stillbirths and 51 infant deaths due to syphilis infection during pregnancy.
Dr Alyssa Dweck, Chief Medical Officer at Bonafide Health, tells us that while the younger generation is disproportionately affected by STD and STI infections, she's noted a rise in sexually transmitted infections in perimenopausal adults and seniors engaging with new partners due to divorce or being widowed. "Many in this demographic don't necessarily think to use condoms, since contraception may no longer be needed, thus the STI rate increases," she explains. Regardless of age, If you're sexually active it's important to proactively test for common STDs and STIs at least once a year, especially if you have multiple sexual partners.
If you're uncomfortable discussing your sexual health with your doctor or a stranger at a health clinic, fully at-home or hybrid at-home tests that screen for various STDs and STIs are a reliable and fast alternative, "access and affordability are benefits of at-home testing," says Dweck.
There's a surprisingly large range of in-lab and at-home tests available that can be purchased both in-store and online. To find the best STD tests and STI tests available for over-the-counter purchase — including tests for herpes and syphilis — our team consulted with multiple doctors and testing experts about what to look for in a good test and rated each based on elements such as if the lab used to process the test is ISO/IEC/CLIA-accredited, test accuracy, ease of use, if medical providers were available for consultation, user experience and cost. Every person has different needs, so we made sure to include a range of tests to cover various diseases, infections, needs and budgets.
Best overall at-home STD testEverlywell
Test collection method: Blood, swab (women-only), urine (men-only)Time until results: 2-5 daysFree shipping: Yes
Everlywell, a trusted name in home testing offering a multitude of tests and prescription services, tops our list of at-home STD tests due to offering male- and female-specific tests that you conduct entirely from the privacy of your home, no trip to the doctor or lab needed. This STD test kit checks for the six top sexually transmitted diseases and infections, such as chlamydia, gonorrhea, hepatitis C (HCV), human immunodeficiency virus (HIV), syphilis and trichomoniasis. The testing process is simple: Take a finger prick and vaginal swab (for women) or finger prick and urine sample (for men). Once the samples are ready, drop your specimens in the mail using the included prepaid shipping box. Within a few days, you'll get results via an app or the website. What especially stands out is that if you test positive for an STD or STI, an Everlywell healthcare provider will reach out to go over what everything means, as well as treatment options and prescribe medication if necessary. If you need your test results ASAP, you can opt for express shipping for an extra charge ($30).
While this test is pricy (which is standard for a test that offers a complete STD and STI panel), you can save 15% by signing up for a semi-annual subscription. All packaging involved is plain and discreet, so you don't have to stress about nosy neighbors or roommates. Insurance coverage depends on your plan, but the tests are FSA- and HSA-approved.
ProsSTDCheck.Com
Test collection method: Blood, urineTime until results: 1-2 daysFree shipping: N/A
STDCheck's test detects a whopping 10 STDs and STIs: chlamydia, gonorrhea, syphilis, HIV, early HIV, hepatitis A, hepatitis B, hepatitis C, and herpes I and II. The only caveat to this test (but also why it screens for so many STDs and STIs and the results are returned so quickly) is that a trip to an affiliated local lab is necessary to provide your test samples.
When you purchase the test online, you'll immediately get an access code to schedule an appointment at one of its 4,800 affiliated nationwide labs of your choosing - you may even find you can schedule your appointment with the lab the same day and have your results back within 12 to 48 hours.
Another major stand-out feature of STDCheck is that you can add the HIV RNA Early Detection test to your order, which is an FDA-approved test that detects early HIV infection within 9 to 11 days after potential HIV exposure. STDCheck.Com also offers a range of tests for individual STIs, should you prefer to test for only one or two conditions.
ProsCVS
Test collection method: UrineTime until results: 1-3 days from the date the lab receives the sampleFree shipping: Yes
CVS brand STI test kit tops our list for best budget-friendly at-home test because it covers the top three common STIs for under $100: chlamydia, gonorrhea and trichomoniasis. The test is conducted fully at home and requires a simple urine sample you drop in the mail and ship to the lab (prepaid postage included). A high-complexity CLIA-certified laboratory will process the specimen and then send the report to an independent physician licensed to practice in your state who will review and approve the findings. The final report will be sent to you via a secure online portal in about 1-3 days after lab receipt of your test. Unlike the aforementioned test kits that have a provider available for consultation, you will need to visit your medical provider should you test positive to discuss the best treatment plan.
One reviewer said, "I found this test kit to be extremely user-friendly. The step-by-step instructions were easy to follow, and the entire testing process was efficient."
ProsQuest
Test collection method: Blood, urineTime until results: 3-5 business daysFree shipping: Yes
If the name or logo for Quest is familiar, then it's likely because you have a Quest lab close to you, after all, there are thousands of Quest labs located throughout the US due to many major hospitals and physician offices that use its services. While the major STD and STI panels offered through the Quest website are hybrid tests that require you to buy online and then visit a lab in-person to provide a specimen, there are plenty of at-home tests available that are conducted fully in the privacy of your home.
Quest offers two in-lab STD panel options: A basic STD screening panel ($139) that covers four conditions: Chlamydia, gonorrhea, syphilis, and HIV 1 and 2. There's also the Expanded Screening Panel test ($269) that covers 7 of the most common STDs and STIs: Chlamydia, gonorrhea, hepatitis B, hepatitis C, trichomoniasis, syphilis, HIV-1 and HIV-2. Once you choose a test, you'll make the purchase online, schedule with the lab and then head over to provide your blood and urine samples. The test kit's purchase also includes the option to consult a physician if you happen to test positive, although it will cost you an additional $6.
In addition to the STD panel tests mentioned above, there are a total of nine STD and STI testing kit options available through the Quest Laboratories website, should you want to zero in on a specific disease or infection or a combination of conditions. At-home and in-lab tests offered by Quest range in condition and price from $45 for the fully at-home HIV 1 and 2 test kit to 19 tests for women's health including a urinary tract infection test (UTI) ($39) and 15 men's health tests, including a test to show health risks based on your genetics.
ProsMyLab Box
Test collection method: Blood, urineTime until results: 2-5 daysFree shipping: Yes
The MyLab Box Love Box is a fully at-home STD test kit specially designed to be inclusive for all couple combinations: male and female, male and male or female and female. In addition to being for couples, the kit costs $378 (with 15% off your first purchase if you join the mailing list ), making it about two-thirds the cost of purchasing two separate complete panel tests at a competitor. Each test screens for the top eight sexually transmitted diseases and infections: chlamydia, gonorrhea, hepatitis C, HIV (I and II), herpes simplex 2, syphilis and trichomoniasis.
To take the test, you and your partner will first do a finger-prick blood test, then a cavity swab (female) and/or urine sample (male), then drop the samples in the pre-paid box and ship to the lab. A certified CAP and CLIA high-complexity testing lab will then process the specimens. Within 3-5 days after lab receipt, you'll receive your results electronically, and you can rest assured HIPAA web security protocols are enacted to protect your data. If one or both of you test positive, you can consult with a doctor in your state via phone consultation about the next steps and be prescribed treatments if needed. If the tests are negative, you still have the option to consult with a certified STI counselor. The tests are FSA and HSA eligible.
ProsNurx
Test collection method: Blood, swab, urineTime until results: Within daysFree shipping: Yes
Nurx has a range of STI kits that are covered by most insurance carriers, including the Full Control Kit which checks for five STIs: HIV, chlamydia, gonorrhea, syphilis and hepatitis C. There's also a Basics Covered at-home STI Home Test Kit that screens for the four top STIs: HIV, chlamydia, gonorrhea, syphilis. The Healthy V STI Home Test Kit screens for HIV, chlamydia, gonorrhea, syphilis and trichomoniasis. While there is an easy-to-use app, you can still order via the Nurx website, regardless of method, you'll start by answering a few questions about your personal and sexual health to find the best test for your needs; All at-home tests are conducted fully at home then shipped to Nurx affiliated lab.
Nurx is also a great option for those wanting to move to telehealth for sexual and overall wellness needs, including having the option to get prescriptions for birth control, acne control, emergency contraception and even hair loss products, with all medications delivered straight to your home. There's a $15 sign-up fee, but the fee includes access to a year of unlimited messaging with a provider.
One reviewer raved that the process was "EASY AND CONFIDENTIAL," adding that they "Loved this experience. I hate going to doctors, especially around sexual health. The fact that everything can be done without having an in person or video/phone call is AWESOME!"
ProsLetsGetChecked
Test collection method: Blood, urineTime until results: 2-5 daysFree shipping: Yes
LetsGetChecked is all about making you feel informed from beginning to end. There's a detailed video walk-through on what's in your test kit, how to collect your samples, mistakes to avoid during sample collection, how to ship your samples, and what to expect after the lab receives your samples; there's even a walk-through on how to use the company's super easy-to-use app.
The test screens for five major STIs: chlamydia, gonorrhea, HIV, syphilis and trichomoniasis. If you test positive, a nurse will reach out with information on what to do next, including helping you set up a virtual consultation (for an additional $39) that will include a consultation with a doctor and a prescription for medication if needed.
"If you have anxiety about going to the doctor and requesting an STD screening, this is a really good alternative," said a user. "Also, I was able to use my HSA to pay."
ProsIf you are being proactive about regular testing after being with a new partner, it may be best to choose a test kit that screens for a wide range of conditions. If you've had a known exposure to a particular STD or STI, you could choose a test that screens for that particular condition or a combination of conditions.
Testing methods
Methods for at-home testing generally include instructions for self-collection at home via a blood sample, urine or internal swab, which is then shipped to a lab to be tested. If home collection for whichever type of sample is not something you're comfortable with, then choosing a hybrid test that allows you to visit a lab to have your specimen collected may be the better option.
BudgetAs you can see from our list, there is a wide range of pricing options for test kits ranging from $45 for screens for one or two conditions to upwards of $300 for panels for 10+ conditions. In some cases, your insurance may cover the test, if not, HSA and FSA are generally accepted with most all at-home and in-lab tests. Figuring out in advance how much you want to spend can help you choose the right test, whether that be a full panel or a screen for the condition you suspect you may have.
Follow-up careSome tests include counseling from a healthcare provider, while others do not — and Leslie says that's definitely worth considering. "There are issues of follow-up and high anxiety when a test is positive and no healthcare professional is available," he says. You know yourself better than anyone: If you feel like you would be OK waiting to connect with your doctor or someone at your local health care department if you test positive, there's no need to look for a test with a provider connection. But if you know you'd want to talk to a professional immediately about a positive result, a test kit that includes a health care provider consultation may be the best option.
How we chose the best at-home STI/STD testsTo find the best at-home tests, we spoke to multiple doctors for their input on what to look for in an at-home or in-lab STD and STI kits, as well as different types to consider. From there, we researched more than 25 at-home test kits and rated each on elements including sensitivity, ease of use, whether follow-up care is included and good and bad user reviews.
At-home STD test FAQs What's the difference between an at-home test and a hybrid at-home test?At-home tests are conducted in the privacy of your home, with all specimens for the test collected by you, and then mailed to an affiliated lab in a prepaid envelope or box included with the test. "I'm an advocate of home tests, and I'm a big advocate of home collection," adds John A. Nelson, director of the AIDS Education & Training Center National Coordinating Resource Center at the Rutgers School of Nursing. Home collection test kits are easy to use, allow for a level of discretion and privacy you can't get in a medical setting, offer the ability to avoid awkward conversations with your doctor or a stranger at a clinic and provide accurate results relatively quickly, he explains.
Conversely, if you need an STD or STI panel and prefer to skip a trip to your doctor or health clinic but are uncomfortable drawing your blood or taking the samples needed for the test on your own, you may prefer the hybrid at-home test approach which, just like an at-home test, allows you to purchase the test online and get your results electronically, but when it comes to collecting the specimens, you'll go directly to the lab to have your samples taken — usually about a 5-10 minute process. Dr Kevin Huffman, Doctor of Osteopathic Medicine, tells us a benefit to taking the hybrid at-home test approach is that "proficient experts conduct in-lab testing, which provides a more extensive and precise evaluation."
What's the difference between an STI and an STD?It's important to point out that even though the terms STI and STD are often used interchangeably, there is a difference: STIs are infections that have not yet developed into diseases, such as bacterial infections, viruses and parasites. Fun fact (or not): There are more than 30 different bacteria, viruses and parasites that can be transmitted sexually, yet no single test screens for all of them.
Also, different STIs are detected in different ways, regardless of the test you choose: Some diseases or infections are detected through urine, while others are best detected via blood or cavity swabs. Whichever test you choose will guide you on the best collection method — and state upfront what you can expect.
How do at-home STI tests work?There's variety with these tests and the way they work ultimately depends on the individual test. "Some require an oral or genital swab; others require urine or blood samples, which will then go to a lab," women's health expert Jennifer Wider, MD, co-host of the Open Wider podcast, tells Yahoo Life. It's important to read the manufacturer's information carefully in advance to make sure you're comfortable with the testing procedure.
How do I know whether I have an STI?The only way to know for sure if you have an STI is to get tested. Some sexually transmitted infections don't have symptoms, so you can be positive without knowing, Wider points out. That puts you at risk for health complications such as fertility issues and also increases the likelihood you'll spread the infection.
Are at-home STI and STD tests reliable?Every test kit has its own sensitivity — meaning, how likely it is to detect an infection. "Many are quite reliable, especially if collected properly and then brought to a lab as quickly as possible," Wider says. Dr Leslie agrees, adding, "The test kits work when done correctly and reach populations that are at risk and might not seek traditional medical help for suspected STDs."
Where can I get a free STI and STD test?Local health departments and sexual health clinics such as Planned Parenthood usually offer free or very low-cost sexual health tests. If you prefer to try a local clinic, visit your local health department's website to see what's offered; you may even be able to schedule an appointment for testing on the site.
Our expertsDr Alyssa Dweck, Chief Medical Officer at Bonafide Health
Dr Kevin Huffman, Doctor of Osteopathic Medicine
Dr Stephen W. Leslie, associate professor, Creighton University School of Medicine
Dr Jennifer Wider, women's health expert and co-host of the Open Wider podcast
John A. Nelson, STI screening researcher and director of the AIDS Education and Training Center at the Rutgers School of Nursing
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My Teen Just Came Home With A Shocking Test Result. I'm Not Sure What To Do Next.
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Dear Care and Feeding,
My 16-year-old son's recent physical showed that he had a treatable STI. I revisited my age-14 sex safety talk with him in more detail, including explicit information about sharing test results.I tried to make it a conversation, but he just sat there silently blushing until it was over, and wouldn't talk about how he caught it.
I'm worried enough that I scheduled a 6-month screening for him against his protests, and created a safe sex box in our bathroom cabinet that I'll periodically restock. I also told him he could get tested any time, no questions asked. But should I be asking more questions? I'm trying so hard not to overreact that I might be underreacting.
I assumed that he'd start having sex when he started dating, but he doesn't have a girlfriend (or boyfriend) yet that I know about, and I don't know how to walk the line between privacy and safety here. This could be a stupid teenage thing, but I worry it could also be a sign of abuse. I've never been a helicopter mom, but we live in the suburbs, so I have to drive him everywhere and thought I generally knew what he was up to. My husband died six years ago, and I need another parenting perspective—I don't want to violate my son's privacy by bringing this up with other parent friends. I had hoped his pediatrician could give me some advice, but he just recommended we move my son out of pediatrics and had no parenting tips. What should I be doing here?
—Under or Overreacting?
Dear Reacting,
I'm not surprised that your son wasn't an active participant in the conversation you tried to have with him—that's not necessarily an indictment of you, or your relationship, or the things you were saying. He's 16, and probably embarrassed, and perhaps also dealing with some shock following the diagnosis (I really wouldn't underestimate that part, especially if the news was delivered awkwardly by a doctor he's known his whole life!). I know you have a lot of important information to convey, but you don't want to overload him with too much at once and then have none of it sink in. He may be more willing to hear from or talk with you about all this once he's had some time to process. So keep trying, and trying—this should be an ongoing dialogue.
I think you've already done several good things: You didn't shame or punish your son. You got him medical treatment. You offered him practical information and support. You tried to educate him about how he can be responsible with and for his own health, as well as the health of any sexual partners. You didn't contribute to the stigma around STIs or screening. If you'd totally freaked out, or grounded him, or gone on and on about your own confusion or fear or disappointment, how likely do you think it is that he would ever talk to you about this again? You need him to be able to communicate with you when it's really important. And he may not have consciously clocked it yet, but it sounds like you've done your best to show him that you are a safe person for him to talk to next time.
I hear what you're saying about privacy, but asking basic where/when/who questions isn't "helicopter parenting." I think knowing what your kid is up to, knowing that they will tell you if they need help, helps build your trust in them—which can lead to them being allowed more privileges, not fewer. And if one is a safe parent to tell (I realize not every parent is), I also think it is reasonable to want to know if one's 16-year-old is dating anyone, seriously thinking about becoming sexually active, or already having sex. Ideally, you want whatever information you need in order to feel assured that they're being responsible and have the tools they need to be safe.
I would tell your son that you'll always try to respect his privacy as much as possible, but while he is still a minor living at home, there will sometimes be conversations you need to have in order to help him stay safe and healthy. You definitely want him to come to you in the future, for example, if he's experiencing any STI symptoms—as you would want him to come talk to you about any other medical issues. You want him to understand what respectful communication and/or a healthy relationship looks like, whether or not sex is involved. You want him to know that any sexual contact needs to be consensual, something all parties want—which could be a way to start talking about whether anyone has done something he didn't like or didn't want. I know that's a horrible thing to think about, but you're already wondering, and the importance of respect, autonomy, and consent on all sides is a crucial part of this conversation. You want him to have all the information and tools he needs to be as safe as possible, and keep his sexual partner(s) as safe as possible. And you want him to know who he can go to if he ever needs help or treatment or feels unsafe.
Your son's situation is very common. All the same, I know it was a shock, and now you're understandably concerned about his health and your ability to communicate with him about it. I do think it's alright to look for more advice or support if you need it. If there's a close friend you really trust to keep this to themselves (maybe someone who lives elsewhere and isn't in touch with anyone from your community, if that makes you feel better), it's ok for you to talk to them if you need a sounding board. Or, if you really don't want to do that, consider talking with your doctor or someone else who is bound to confidentiality and might be able to offer more practical advice. And I absolutely agree that your son probably needs a different doctor—someone he can talk with (in private) whenever he needs, who also won't shy away from having the important sexual health discussions that many of us, regardless of age, really don't want to have with our parents.
—Nicole
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