Everyone knows getting frisky can be risky, but as consenting adults, we tend to assume our sexual partners will disclose any relevant diagnoses; however, honesty is seemingly not the best policy for many sexually active individuals.
A new review of international research has determined it is "common" for people with a sexually transmitted infection (STI) not only to keep it hidden, but to feel no obligation to communicate it to their partners before engaging in sexual activity.
Researchers from the University of Tennessee reviewed studies from the US, UK and Australia that analysed STI disclosure - excluding studies on HIV - to explore the reasons for and against telling a sexual partner about an infection.
The researchers say a lack of good-quality sex education and ongoing stigma may be to blame for people staying tight-lipped about STIs, potentially due to feelings of shame or assuming they have taken enough steps to protect their partner - therefore negating the need to inform them.
The research also found that the nature of the relationship between the parties is a key factor in deciding whether to disclose an STI; for example, those in more committed relationships are more likely to tell their partner, whether it be due to a deeper emotional connection or concerns about cheating.
Only around half or fewer individuals felt able to disclose their diagnosis to a partner before sexual engagement, according to the results, which were published in The Journal of Sex on Thursday.
To stop the spread of the infections studied, the team are calling for comprehensive sex education to be provided throughout life - from youth to late adulthood.
"Many individuals lack sufficient comprehensive sex education," the authors state in the paper. "Rather than being taught how to correctly use prophylaxis [preventative methods], identify its limitations, and understand the scope and transmissibility of STIs, youth are only encouraged to be abstinent.
"Individuals diagnosed with STIs may be in vulnerable positions and may face difficult decisions, the outcomes of which can be harmful to their identity and relationships.
"The process of disclosure is complex. Certain contexts, particularly committed relationships, elicit disclosure, whereas others inhibit disclosure. Disclosure is an interpersonal process that involves not just the individual faced with the decision to disclose, but the intended receiver."
Overall, they say their findings "highlight the need for continuous comprehensive sexual health education throughout the life course and an increase in the number of (US) states that offer comprehensive sex education".
Data indicates around one in five people in the US have a STI at any one time, with more than 26 million incidents reported to health services.
Methods recommended by the US Centers for Disease Control and Prevention (CDC) to prevent infections include communicating with partners about sexual histories, such as disclosure of an active STI, as well as using prophylaxis - including the likes of condoms, oral dams and vaccines.
The review, which looked at 32 papers, indicates that fear can prevent many people from revealing their diagnosis.
Other reasons included: believing that condom-use is protection enough; a lack of obligation, such as a one-night-stand situation; and fear of being broken up with. Some even described "passing" as uninfected to avoid having to come clean.
The researchers also found those who chose to disclose their STI typically did so out of love, feelings of moral obligation, or relationship-related reasons, such as greater levels of commitment or the length of time spent together.
Meanwhile, those who chose not to disclose their STI used strategies such as withdrawing from relationships or timing their sexual activity to STI outbreaks.
In the review, herpes and HPV were featured the most, while chlamydia, gonorrhoea and trichomoniasis were also common. The results also revealed the experiences of people on the receiving end of such disclosures were not well-represented in the studies.
"One of the key factors that determines whether an individual will disclose is the intended receiver. How the receiver will react and respond and the relationship with the receiver can be critical influences on the discloser," the authors said.
"As such, it is imperative that we investigate the experiences of receivers to understand the process of STI disclosure more comprehensively. This is so that we may continue to improve sexual health education and care for all."
Existing research on STIs has limitations such as a lack of data on sexual orientation, with the review helping to identify knowledge gaps and areas for future study.
Limitations of this paper included only English-speaking research being reviewed, as well as the limited number of reviewers.
In the future the authors suggest that research should take care to adopt a destigmatising approach.
"Initiating sexual health conversations is everyone's responsibility," they said.
