STD vs. STI: Is There a Difference? And Why Does It Matter?
Identities give meaning to our personal existence. Some are assigned to us based on our outward appearances and involvement, and others we ascribe to ourselves, like our sexual identities. After being diagnosed with herpes simplex virus type 2 (HSV-2), I found classifying my virus to be an unexpected roadblock to navigating my sexuality.
Between dealing with the stereotypes associated with having herpes and trying to understand the biological basis of the virus, I didn’t know where my personal identity fit into the puzzle, if at all. In my research, I found articles that labeled herpes as a “sexually transmitted disease” (STD), while others favored the term “sexually transmitted infection” (STI). Even government health agencies like the National Institutes of Health (NIH) use the terms interchangeably, often without explanation for doing so. With such ambiguity, it’s hard to discern fact from fiction.
Why does it matter?
To understand whether there are any fundamental differences between STDs and STIs, it's helpful to deconstruct the meaning of each term. “Sexually transmitted” is universally understood to mean “contracted through sexual contact.” While some consider sexual contact strictly genital-to-genital intercourse, sexual contact can encompass a broader range of actions that includes more innocent touch, such as a kiss or caress. “The terms ‘infection’ and ‘disease’ are not synonymous,” according to the NIH. Not knowing the difference can cause blurred lines, even among reputable websites and medical practitioners.
Here’s how the NIH defines these terms:
Pathogen: A pathogen is a microorganism that can cause disease. There are five major types of pathogens: bacteria, viruses, fungi, protozoa, and helminths.
Infection: An infection takes place when a pathogen establishes itself in a host (e.g., a human).
Disease: A disease is when a body’s ability to perform normal functions is interrupted or changed, usually presenting with certain signs and symptoms.
So what does this mean?
When I first noticed the ambiguity of the terms STD and STI, I thought STI was simply a more politically correct way of referring to those who were infected. However, I’ve since learned it is more a matter of accuracy. The American Sexual Health Association credits the public health field for creating the trend of using STI over STD, but prefaces that not all sources reflect this transition. The above definitions reveal a key scientific reasoning for the recent shift in word choice. A pathogen enters its host, in this case, the human body. The conditions in the host body may or may not result in the pathogen’s growth, or infection. If a function is impaired and results in signs and symptoms that are not caused by personal injury, a disease will develop.
In my case, the pathogen, HSV-2, entered my body through sexual contact. The pathogen established itself in my body as an infection and presented itself as a primary genital herpes outbreak, but it has not resulted in a continued disease. An infection is a step in acquiring a disease, but it does not equate to having one.
So does this make herpes a disease?
Herpes is a virus, which is a type of pathogen. With the definitions above in consideration, I believe it is more accurate to say that I have an STI, not an STD, because I have not developed a continued disease based on my infection. Like me, many people with herpes experience only occasional outbreaks, or even no symptoms at all.
A similar example would be human papillomavirus (HPV), which is the most common STI in the U.S. Some types of HPV have been linked to various types of cancer, but cancer doesn’t always develop. If an HPV positive person does develop cancer, “sexually transmitted disease” would be a clinically appropriate definition.
Carving out space for my identity
In analyzing my own identity, I favor using the terms STI, “HSV-2 positive,” or simply “herpes positive.” Over the past two years, my use of terminology in self-description has evolved beyond my personal identity into my identity as a researcher and writer. At first, there was a period of learning to associate myself with the words “herpes” and “STD.” As I slowly found room for myself in those definitions, my curiosity about the virus led to increased knowledge and comfort when discussing them. This comfort grew into an eventual confidence that allows me to hold my current preference for more specific terminology.
Creating your own identity
Although it is easy to make assumptions based on someone’s public appearance and personal statements, it is difficult, if not impossible, to know how someone defines themselves unless they tell you. Despite the factual differences between the terms “infection” and “disease,” they are often used interchangeably in blogs, forums, and even well-known resources. In conducting your own research, a basic understanding of these terms may help you navigate which words feel better when associated with your personal identity and sexuality.