Show You Care, Protect Yourself, Others from STIs

By V. Hauschild, MPH, Defense Centers for Public Health – Aberdeen

More than 20 years ago, military public health scientists warned that service members had higher rates of certain sexually transmitted diseases, known as STDs, than U.S. civilians. The military’s higher risk of STD was reportedly due to aspects of military life that led to frequent partner turnover, multiple partners, and negative attitudes toward condom use. Despite available resources, stigma and a lack of leadership emphasis led to individuals’ unwillingness to talk to their partners or health care providers.

Today, military health care providers worry that not much has changed.

The Centers for Disease Control and Prevention reports that STDs, now referred to as sexually transmitted infections, or STIs, are an ongoing epidemic experienced by millions of people in the U.S. every year.

This STI epidemic includes about one out of every five service members, who are considered a particular high-risk group.

Military surveillance by the Department of Defense between 2014 and 2022 shows STIs have been steadily increasing among U.S. active duty service members, mirroring the rising rate of STIs in the U.S. population generally.

“Chlamydia, as well as gonorrhea, syphilis, and viral STIs caused by the human papilloma virus, known as HPV, are frequently reported among military personnel,” said U.S. Army Lt. Col. Scott H. Robinson, a preventive medicine doctor working for the Defense Health Agency Public Health directorate.

Chlamydia is the most commonly reported STI in the military. Though sometimes thought of as a women’s disease, the chlamydia bacterial infection is carried by both men and women.

“While chlamydia can cause a burning sensation during urination, like other STIs, it often shows no symptoms at all, so people can have an infection but not know it,” said Robinson.

The military follows the recommendation of the U.S. Preventive Services Task Force for annual screening of chlamydia in asymptomatic young women, said Robinson.

“While chlamydia can affect the health of both men and women, the USPSTF emphasizes concerns about potential serious effects to the health of a pregnant mother or her unborn child, even in asymptomatic cases,” said Robinson.

Robinson explained that since several STIs can have serious effects during pregnancy, the DOD includes screening tests for chlamydia, as well as for gonorrhea, syphilis, and hepatitis B and C, as part of the military’s annual women’s wellness visits for female service members up to 26 years of age.

“Young men are not similarly recommended for annual screening by the USPSTF, so the Department of Defense does not require annual STI screening for men,” he said. “However, DOD encourages all men, as well as women over 26 years of age, to speak to their health care provider about benefits of STI screening when symptoms or exposure risks warrant.”

The biggest concern is that those with a symptomless infection may not know to get tested, and then may unknowingly transmit an infection to other partners.

“The only STI testing that is required for all military service members throughout their military career is HIV testing, which is required every two years,” says Robinson. “However, any service member can be tested for multiple STIs for free–they just need to ask their health care provider. Getting tested, referred to as a ‘confidence check,’ is a good idea for anyone who is sexually active, but the test only detects past exposures.”

The CDC recommends getting tested whenever you have a new partner, and more often if not in an exclusive relationship.

“Knowing a positive test result can, in more ways than one, be half the battle,” said Robinson. “Bacterial infections like chlamydia, gonorrhea, and syphilis are curable with antibiotics. While viral infections like HPV, HIV, and herpes are not, you can take precautions to prevent further spreading of these infections to others.”

Robinson provided additional answers to common questions about STIs:

• What’s the difference between an STD and STI?
A sexually transmitted disease, or STD, develops because of an STI. The term “STD” implies that the infection has led to some symptom of disease. People sometimes use the terms interchangeably, but CDC recommends the term “STI” since the primary goal of public health is to prevent and treat infections before they develop into disease.

• Who is at greatest risk?

Anyone who is sexually active is at risk, but evidence shows those who have unprotected sex, participate in sex or intimate acts with multiple partners, one-night stands, or unknown partners, and men who have sex with other men have higher risk of STIs.

• To avoid unintended pregnancy, I won’t have vaginal sex without a condom. Doesn’t this protect me from STIs, too?

Not necessarily. Condoms are very effective to reduce risk of STIs (as well as un-intended pregnancies). However, they cannot prevent all STIs–neither can abstaining from vaginal intercourse. Remember that STIs pass from one person to another through oral and anal sex as well as vaginal sex.

• If I only have one partner, and neither of us has symptoms, aren’t we safe?

Not necessarily. Individuals may have been infected weeks or months before you met them, and many infected people may never show symptoms. Both you and your partner should get tested. In the meantime, get vaccinated for HPV, and wear condoms.

• If I didn’t get the HPV vaccine when I was a child, is it too late now?

No. HPV vaccine is authorized for up to age 45. HPV is a common STI virus that can lead to certain types of cancers later in life among women and men even decades after exposure. The HPV vaccination can prevent over 90% of cancers caused by HPV. Ideally, children will get fully vaccinated when younger, such as 11–12 years of age. However, per CDC guidelines, if not fully vaccinated as a child, men and women up to 26 years of age should get the HPV vaccine. Even if you are 27–45 years old, you may also benefit from the vaccine—but you should discuss it with your health care provider first.

• What should I know about testing?

One important thing to know is that some tests are site-specific. The commonly used urine test for chlamydia and gonorrhea only checks for the presence of infection within the genitourinary tract, despite the fact that one in seven infected persons have infections of the throat or rectum. It is important to self-advocate and ask your provider for the “triple screen,” and potentially other tests, by fully informing your provider of your sexual practices so they can understand what tests you need.

• Do personnel in the military get the human immunodeficiency virus, HIV?
Some do. Every day, a service member is diagnosed with HIV. Do your part to help end HIV in the military community. Lower your risk by using condoms, getting tested for STIs, and talking to your provider about whether you would benefit from the daily HIV pre-exposure prohylaxis pill (“PrEP”). One of the benefits of military service is your health care is covered, and PrEP to prevent HIV is included.

Service members have access to free resources: condoms, testing and health care.

Robinson reminded everyone:

“If you haven’t in the past, practice safe sex in the future. If you are sexually active or have been–make sure you get tested. Talk to your health care provider about what tests are appropriate and how frequently you should get tested. If you test positive, get any treatment that is appropriate—and talk to your partner(s).”

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