Only half of people report or believe they should disclose that they have an STD before having sex.

A review of research to date reveals the complex nature of disclosing a sexually transmitted infection (STI) diagnosis to a partner before engaging in sexual activity.

Research shows that many people experience a range of feelings and emotions associated with the prospect of disclosing their diagnosis. However, only about half or fewer people feel able to tell their partner about their diagnosis before engaging in sexual activity.

The results, published in The Journal of Sex Research also show that a similar number of people believe they should disclose an STI to a partner before engaging in sexual activity.

To prevent the spread of such infections (excluding HIV), an expert group from the University of Tennessee calls for the provision of comprehensive sexuality education throughout the lifespan, from adolescence to late adulthood.

"Many people do not have sufficient comprehensive sexuality education," the article's authors note. “Instead of being taught how to properly use prevention options, identify their limitations, and understand the scope and transmission of STIs, youth are simply told to abstain from sexual intercourse. Individuals diagnosed with STIs may find themselves in a vulnerable position and face difficult decisions, the consequences of which may be harmful to their personality and relationships.

The disclosure process is complex. Certain contexts, especially in stable relationships, promote disclosure, while others discourage it. Disclosure is an interpersonal process that affects not only the person making the decision to disclose, but also the intended recipient of the information."

Approximately one in five people in the United States has an STI at any given time, with more than 26 million cases reported to public health services.

According to the Centers for Disease Control and Prevention (CDC), infection prevention practices include discussing sexual history with partners, disclosing active STIs, and using preventive measures (eg, condoms, face shields, vaccines).

Some public health agencies, including those in the United States, recommend disclosure of active STIs.

However, a new review that examined 32 articles finds that fear may prevent many people from disclosing their diagnosis.

Other reasons include the belief that condom use is sufficiently protective; lack of obligations, as in the case of one-time relationships; and fear of being rejected. Some even described "disguising" themselves as uninfected to avoid detection.

People who disclosed their status to a partner did so out of love, a sense of moral obligation, or for relationship-related reasons such as high levels of commitment, relationship quality, length of time together, and feelings of closeness.

Disclosers used a variety of methods to report their STI status. Nondisclosers used strategies to appear uninfected, avoid relationships, or use STI outbreaks to plan sexual activity.

The review most often mentioned herpes and HPV, and also considered chlamydia, gonorrhea and trichomoniasis. The results also showed that the experiences of people receiving information about STIs are underrepresented in such studies.

"One of the key factors that determines whether a person will disclose information is the intended recipient. How the recipient reacts and his relationship with the discloser can significantly influence the decision to disclose," the authors add.

"There is therefore a need to explore the experiences of recipients to more fully understand the process of STI disclosure. This will allow us to continue to improve sexuality education and health care for all."

Existing research on STIs has limitations, such as lack of data on sexual orientation. Therefore, the aim of the review authors was to fill gaps in knowledge and identify areas for future research.

Their focus was on self-disclosure of STIs to current and former partners. Disclosure is the voluntary or forced sharing of personal information with another person, such as disclosing an STI.

This is different from partner notification, which is similar to contact tracing and may involve the use of anonymous messaging services.

Limitations of the article included consideration of only English-language studies, as well as a limited number of reviewers.

For the future, the authors suggest that future research approach the topic with a destigmatizing approach.

“Initiating conversations about sexual health is everyone's responsibility,” they conclude.