A Guide to Having the STI Talk for the Cripplingly Anxious

In order of least terrifying to most, here's my list of situations that sound less scary than having a mature conversation about sexually transmitted infection (STI) status with a new romantic interest:

• Fighting a shark
• Fighting a bear
• Having a mature conversation about STI status with a shark or a bear

Importantly, one thing that doesn't make the list is contracting an STI—though just barely.

Particularly in a new relationship, conversations about STI status can seem unromantic and unsexy at best and accusatorial and harrowing at worst.

"Bringing up our STI status feels like such a daunting prospect because we're not given practical and relevant examples of how to have that conversation," said Jenelle Marie Pierce, C.S.E., executive director of the STI Project in Asheville, North Carolina. "And that's just the thing, it's a conversation. People often feel like a disclosure conversation is an admonition of guilt or shame, that you are having to admit to something bad about yourself, and instead, it should be framed as a reciprocal discussion among all parties involved."

However, Pierce and other sexual health experts stressed that it's critical to have the discussion before engaging in any kind of sexual activity with anyone—be they the love of your life or a one-night stand—because it protects both of you from the health consequences of an untreated STI.

With rates of reported cases of chlamydia, gonorrhea and syphilis higher than they've ever been in American history, anxiety—even crippling anxiety—over conversations about sexual history can hardly be considered a compelling excuse to avoid them. But if you are filled with dread by the idea of discussing STI status with a prospective sexual partner, we have some advice.

Get tested regularly

Considering how the most common symptom of an STI is no symptoms at all, and how many STIs may go undetected in premature testing, the only way to determine whether you have an STI is to be tested regularly. Experts recommend getting tested every few months and before having unprotected sex with a new partner. Deb Laino, who holds a doctorate in human sexuality and is a board-certified clinical sexologist in Delaware, said it's a good idea to get tested so you can have the conversation as soon as you begin entertaining the idea of sex, even if that's before the relationship is clearly defined.

Have a conversation before things get hot and heavy

STI test results in hand, when do you bring up your status with a prospective sexual partner?

"The only hard-and-fast rule is that you want to share your status before engaging in activities; that ensures that fully informed consent occurs," Pierce said. "Make sure you're having the conversation clothed and sober. This ensures there is no coercion and full consent can be given, giving you and your partner the physical and emotional space to consider what you'd like to do together and how you'd like to reduce risk.⁠"

In terms of conversation setting, Pierce suggested any environment that feels safe for you: the kitchen table, a quiet park, your living room or somewhere private and not sexually charged.

If the idea of looking your partner in the eye and asking them to get tested makes you squirm, you don't need to have the talk in person.

"Even though many folks believe face to face is the only way, any method is fine," Pierce said. "If you feel uncomfortable or unsafe having the discussion face to face, feel free to call, text or send an email instead. Technology might allow a partner to pause and consider before responding, without you or them being worried about an initial reaction or facial expressions.⁠"

Remain calm (or try your best)

"Try to approach the conversation from a calm and confident place, but if you get emotional, cut yourself some slack," Pierce advised. "It's not easy to talk about your STI status or your sexual health as a whole because we are not shown practical examples of what that might look or sound like, and you probably aren't going to ace the conversation right from the start.⁠"

To get the ball rolling, Laino recommended starting the conversation by saying, "Taking care of my sexual health is important to me. Is there anything I should know about your sexual history?" Or maybe: "Before we have sex, we should talk about our STI status. I'll go first. My last STI test was [date] and I'm [positive/negative] for [STI]. What about you?"

Be prepared for all possible reactions

"All people should respond positively, because it indicates that you are a conscientious person who cares about your health and others' health," Pierce said. "However, that's not always the case, because it's not the norm right now, so people can be afraid of what they don't understand."

What if your biggest fears materialize and your partner responds angrily, defensively or accusatorily? A prickly response tells you a lot about a person, Laino said. People who refuse to talk about transmissible sexual infections are indicating they don't care about your health.

"Ask yourself, is this really a person you want to be with?" she urged.

Sex doesn't have to be awkward, and talking about the ins and outs of your sexual health shouldn't be, either.

If your anxiety is keeping you from acting on this important conversation, perhaps a conversation with a mental health professional will help. A lot of people don't have a therapist they see regularly, so taking that first step isn't always easy. Video visits have become a viable option for most people, and more physicians and therapists have added them as a service. Giddy telehealth makes it easy to get connected to qualified healthcare professionals who can help with a variety of conditions.