Notes from the TN Dept of Health: Health Literacy Month and STIs

The following information was written by and is provided in partnership with the Tennessee Department of Health:

October is Health Literacy Month, and it could not come at a better time. We have been bombarded with health information because of the pandemic, and wading through it all can be difficult. Health literacy is the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions (source). 

Most of us experience greater health literacy in some instances and less in others. Those of us living with a chronic health condition find ourselves becoming expert in that condition and the resources around it. On the flip side, some parts of our health are less familiar to us. Sexual health usually falls on the less familiar side. 

Sexually transmitted infections (STIs) are a topic where health literacy is often low. While one in two sexually active people will get an STI by their 25th birthday, the common experience of having STIs has not been enough to build expertise and comfort with this facet of our health. 

There are as many reasons to change this as there are different types of STIs. All STIs are treatable, and most infections can be cured with oral or injectable antibiotics. For infections like HIV and genital herpes, early and consistent treatment can make a huge impact on how the disease affects a person’s life. Most STIs infect us without symptoms, so routine testing is the only way we have to know when treatment is needed. 

Nationally and in Tennessee, rates for almost every STI are rising. But not all STI testing is created equal, and research demonstrates that requesting the right type of STI testing is increasingly important. 

According to the Centers for Disease Control, 15–24 year olds make up a fourth of the nation’s population, but account for half of all new STIs (source). STI rates in Tennessee are also on the rise. From 2018 to 2019 all STI rates increased: Chlamydia by 8%, Gonorrhea by 9%, Syphilis (all stages) by 29% (source: Patient Reporting Investigation Surveillance Manager (PRISM), 2018–2019). Tennessee surpassed U.S. rates for both gonorrhea and chlamydia in 2018-2019 (source). 

Even with these rising STI rates, the numbers are still under-estimates because when people present to get STI testing, they are often not getting the most complete testing available. Testing for STIs like Gonorrhea and Chlamydia is recommended at all sites of exposure, including the throat and rectum, and oral and anal testing is referred to as extragenital testing. Those presenting for STI testing usually receive standard testing, which is done by collecting a urine and/or vaginal swab and for some STIs a blood sample; but standard testing only identifies penile and vaginal infections in some STIs, and does not identify extragenital infections. Standard testing is often focused on the least invasive and most comfortable option for the patient, and is what is routinely offered in health department clinics.  

When it comes to STIs, a little bit of additional discomfort during testing is worth it. Nationally, traditional urine testing for gonorrhea and chlamydia miss 70%–88% of infections that are found using extragenital testing with men who have sex with other men (source). In 2019, a Tennessee Department of Health study identified that standard testing alone would have missed up to 46% of infections in males, and 18% of infections in females (Source: Patient Tracking Billing Management Information System [PTBMIS], 2019).

STI tests now include a lot of new options, and one key characteristic of STI screening that can significantly impact its accuracy is the type of sample used to run the test. Unless you specifically request something different as the patient, you are likely to be provided with standard testing for STIs. 

In 2019, a Tennessee Department of Health study found that when extragenital testing was offered to all patients, testing increased significantly. Among males, rates of rectal testing increased by 200%, and oral testing increased by 78%; among females, oral testing increased 122%, and rectal testing increased 316% compared to 2018 testing data (Source: PTBMIS,2019). This suggests that patients and health care providers are not always talking about oral and anal sex. If health care providers use patient reporting alone, oral and rectal testing may not be completed or offered, even if warranted.  This is why it is so important to not only talk to your health care provider about all of your sexual practices, but also to request extragenital testing.

Extragenital testing is not new, but health literacy and personal advocacy are required to get access to it. Healthy literacy includes knowing that this type of testing is more accurate and where you can go to get it. In Tennessee, local health departments that provide STI testing have oral and rectal testing available. Personal advocacy involves asking for the version of the test during the appointment that fits your needs and answering the detailed questions about sex asked by a medical provider that will lead to knowledgeable, personalized care. Medical providers often assume that patients will be more comfortable giving a urine sample than they will be using an anal swab, so personal advocacy includes speaking up to let your provider know that you want to get more comfortable taking oral and rectal tests. 

Annual testing is recommended for all adults for all STIs, so every year you have a chance to use your increased health literacy and personal advocacy skills to get more effective testing. Asking for STI testing that includes oral and rectal swabs will not increase the cost you are asked to pay, and health departments all over Tennessee offer STI testing at little to no cost. HIV testing on its own is free, and the cost range for full STI testing is usually between $10–$20 in metro areas and is either free or calculated using a sliding scale based on income at regional Health Departments. When making an appointment, the clinic can provide information on cost. You will not be turned away due to an inability to pay the day of services.  Many clinics have same day or next day appointments and some clinics allow for same-day walk-ins. 

Here are some helpful steps to take as you get ready to get STI testing:

  1. Identify your testing location and learn more about STI testing there. Click here for a list of health departments in Tennessee to quickly find one close to you. Once you’ve identified the place, go on their website or call to learn more about their scheduling procedures, what forms of identification you need to bring, and what your STI testing (and potential treatment) will cost.
  2. If you are coming to a health department clinic after being tested at another location, bring your information with you. Bring any lab results and information from your last clinic appointment with you to your health department visit to save time and ensure you are getting the correct tests and treatment options. 
  3. Be ready to answer questions about your sexual history. Be prepared for the questions they will ask you, and bring questions of your own. Write down 2 – 4 questions you have so that when you are face-to-face with your provider, you don’t forget what to ask. 
  4. Write down any requests that are important to you. This includes requesting extragenital testing for STIs. It can also include requesting a walkthrough of the exam before you start. 
  5. Learn more about STIs before you go. Doing your own research can both increase your knowledge and help you feel confident and comfortable during the process. The Centers for Disease Control and Prevention’s STI resource page is a great place to start. 
  6. Choose a change to make in the next year. STI testing is annual, and it can be a great time to make a new resolution to improve your sexual health. Learn more about how to get free condoms, start on Pre-Exposure Prophylaxis (PrEP), and other ways you can improve your health on Tennessee Department of Health’s HIV Prevention page.

STIs are common, but STI testing is widely available in Tennessee. Start planning today, and don’t let discomfort or a lack of information stop you from getting the best testing and care possible. 

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