When it comes to sexually transmitted diseases, the terminology can be confusing. Some people use the phrase “STD,” some people insist “STI” is the proper set of initials, and every once in a while you might catch someone using the term “VD.” Over the years, the parlance has changed. What’s the deal?
VD: Venereal Disease
“Venereal disease” has been in use since at least the 1600s (the Oxford English Dictionary cites a 1667 publication referring to a “a lusty robust Souldier dangerously infected with the Venereal Disease”). Around a century ago, Americans flirted with heavily euphemistic expressions, such as “social diseases,” but mostly, “venereal disease” was the terminology of choice for the better part of four centuries — slightly less euphemistic, as “venereal” was derived from Venus, the Roman goddess of love, sex, and fertility. Additionally, since at least the 1920s it was frequently shortened to “VD.” Those of us of a certain age might still remember hushed talk of VD among our grandparents, parents, or peers.
Around the 1930s, public health experts started wondering if referring to VD as a separate category of disease stigmatized these infections and those who carried them, dampening motivation to fight them with the same fervor with which the community battled other infectious diseases like influenza, smallpox, and scarlet fever. In 1936, Nels A. Nelson proposed replacing “venereal disease” with “genito-infectious diseases,” but that never caught on — you haven’t heard of GIDs, right?
STD: Sexually Transmitted Disease
“Sexually transmitted disease” — STD — was introduced in the 1970s. “VD” was still seen as a stigmatizing term; perhaps “STD” would carry less judgment. Plus, not only was “STD” more literal and less euphemistic than the antique moniker “VD,” it also reflected an expanding conception of what sexually transmitted diseases were.
While “VD” usually referred to “classic” diseases like syphilis, gonorrhea, and chancroid, the 1970s and 1980s saw advances in our understanding of what pathogens were transmitted by sexual contact. We discovered chlamydia in the 1970s, and in the 1980s we learned human papillomavirus could cause cervical cancer. Around the same time, genital herpes began to be conceptualized as a sexually transmitted malady, and shortly thereafter, the HIV and AIDS epidemic introduced us to a completely new virus. “STD” was a new term for a growing group of conditions.
STI: Sexually Transmitted Infection
While “STI” was introduced in the 1980s, it wasn’t until the past two decades or so that there has been a concerted shift away from “STD” and toward “STI,” although there’s still no consensus as to which one is better. One idea is that “infection” is even less stigmatizing than “disease,” and perhaps the new terminology will help people feel less ashamed to be tested or to seek treatment. It’s also thought that people might feel more able to prevent an infection than deal with a disease, inspiring them to use condoms and engage in other health-promoting behaviors.
But mostly, “STI” grew out of our new understanding that sexually transmitted pathogens don’t always cause disease — they linger in the body (infection) but don’t necessarily cause symptoms (disease). The Mayo Clinic puts it simply:
Infection, often the first step, occurs when bacteria, viruses or other microbes that cause disease enter your body and begin to multiply. Disease occurs when the cells in your body are damaged — as a result of the infection — and signs and symptoms of an illness appear.
In short: “STI” is more medically accurate, the argument goes. You can be infected with a pathogen like Chlamydia trachomatis — and transmit it to others — without actually exhibiting symptoms of the disease chlamydia. Only about 10 percent of men and 5 to 30 percent of women with chlamydia actually have symptoms — the rest won’t know they have it unless they test positive. However, if people with a “silent” chlamydia infection develop symptoms, such as discharge or a burning sensation during urination, their chlamydia infection is now chlamydia disease.
Raising awareness of the fact that we can unknowingly carry sexually transmitted pathogens and pass them onto others could drive home the importance of getting tested regularly — even when we don’t have symptoms.
STD vs. STI: The Debate Rages On
On the other hand, the fact that sexually transmitted infections can be “silent” could obscure the fact that, untreated, they can still wreak havoc. In the years since “STI” was introduced as a more medically accurate alternative to “STD,” we’ve discovered that so-called “silent” infections can actually be doing serious behind-the-scenes damage. Defenders of the “STD” terminology point to conditions like pelvic inflammatory disease or epididymitis, which are caused by undetected infections and can lead to chronic pain or infertility. Human papillomavirus can cause normal cells to transform into cancerous cells, escaping notice in the absence of cancer screening. HIV infections often don’t cause symptoms until the condition has progressed to AIDS, a process that can take a decade. A “silent” infection can actually have very serious consequences — so perhaps a word like “infection” is not imbued with the necessary heft to convey that seriousness.
What about the idea that “STI” is less stigmatizing than “STD”? There’s some evidence for that idea, although it’s not known if the widespread adoption of “STI” would motivate more people to be tested and seek treatment for symptoms. In this month’s issue of the medical journal Sexually Transmitted Diseases, a couple of researchers found that college students were more likely to react negatively to the idea of STDs than to STIs. Nearly 11 percent described STDs with terms like “gross,” “scary,” or “embarrassing,” compared to nearly 5 percent of respondents describing STIs — a small but interesting difference.
However, the authors of this study conclude that “a shift in language is not enough,” and “more than terminology change is needed to reduce the stigma” of sexually transmitted infections. To make a serious dent in the stigma surrounding these infections, they point to common-sense solutions like evidence-based, comprehensive sexuality education in schools, and good communication between patients and health-care providers. There is a ton of misinformation about sexual health floating around out there, especially in a society in which policies keep us ignorant. Empowering the population with the tools needed to take care of our sexual health will demystify taboo topics like sexually transmitted infections, leading to less fear and shame, freeing people to take care of themselves without fear of judgment.
Language continues to evolve. H. Hunter Handsfield, former president of the International Society for Sexually Transmitted Diseases Research, wonders if someday “STD” will stand for “sexually transmitted disorders.” Cornelius A. Rietmeijer, the director of the STD Control Program at Denver Public Health, wonders if “STI” will someday refer to “sexually transmitted illness.” And the medical linguist Janet Byron Anderson has proposed breaking out of the STD/STI binary by adopting the term “sexually transmissible infectious disease (STID).” Will any of these new phrases catch on, or will they go the way of Nels A. Nelson’s long-forgotten “genito-infectious diseases”?
Currently, Planned Parenthood uses “STD,” consistent with the Centers for Disease Control and Prevention’s usage. You can drop by any Planned Parenthood health center to learn about STDs and how to avoid them, or to be tested and treated for them.
Click here to check out other installments of our monthly STD Awareness series!