Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

 

RTIs, STIs, STDs, or even the old “VD”—do these terms mean the same thing, or does each refer to something a little different? In health care, science, and communication, we need to be on the same page, so to speak, in defining what it is we are talking about.

At most Contraceptive Technology conferences, I’m asked to differentiate among the terms reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases. Each of us has our own distinct preferences, some with a fervent advocacy. In our book Contraceptive Technology, we use the term “reproductive tract infections,” in part because we tackle the realm of issues related to women’s reproductive health.[1]

The field of sexually transmitted diseases is currently reevaluating its own semantics. A colleague, Hunter Handsfield, has recently described the history and current thinking on the topic.[2] The new editor of the journal Sexually Transmitted Diseases, Bill Miller, has requested readers to offer their own opinions about what they think their field should be called.[3] So the time is right for those of us in the reproductive health field to consider what we want to label the infections we see in our sexual and reproductive health clinics each day.

My own personal odyssey reflects the history of the changing terminology. When I moved in 1981 from the family planning to the sexually transmitted infection side of the Centers for Disease Control, the group I joined was still named the Venereal Disease Control Division. The two main VD we were concerned about were gonorrhea and syphilis. Together with the national family planning program, our VD group had initiated a highly successful gonorrhea control program in the 1970s. We produced key national treatment guidelines on both syphilis and gonorrhea. But by the 1980s, the field had expanded to include chlamydia, herpes, and the emerging human papilloma virus. Even worse, the term VD had become pejorative, symbolic of the inadequate clinical care sometimes offered to persons with these infections in public health facilities. So CDC changed the name of our group to the Division of Sexually Transmitted Diseases, and included the range of new infections in our 1982 STD treatment guidelines. We embraced chlamydia control programs, discussed ways to prevent herpes infections, and even tried to attack HPV as we had other sexually transmitted infections, with vinegar washes and lasers. This last approach failed miserably.

Although this STD nomenclature seemed broad enough to include most new possibilities identified as being transmitted sexually, a move began to rename the field with a more precise term—sexually transmitted infections. The debate between “diseases” and “infections” has raged for the last 3 decades. The traditionalists argue that we are primarily concerned about the consequences of the infections (pelvic inflammatory disease, infertility, general cancer, chronic ulcers, etc.), thus the term “diseases” is more appropriate. The purists argue that the organism—specific etiology takes precedence, and that the term “diseases” is itself pejorative, thus “infections” should predominate. Lines in the sand have been drawn. To further complicate things, as mentioned above, some of us have employed a distinctly different semantic, namely reproductive tract infections. 

So what are we to do right now? My own personal view is that “a rose by any other name is still a rose.” Namely, all of these terms are basically synonymous. Use them interchangeably, whatever best suits your preference and/or your clinical situation. We have no evidence about which one is preferable to our clients, but if any of you have the inclination to conduct a survey, we’d love to hear what your clients prefer.

Meanwhile, if you would like to let the editor of STD know your opinion, please submit any comments to the following link: http://www.stdpreventiononline.org/index.php/blog/view.993. Do you prefer any of the three terms over the other? Does it really matter? Dr. Handsfield has even suggested the field may evolve to use the term “disorders” rather than either diseases or infections. This would allow incorporation of the microbiome hypothesis of some of the syndromes such as bacterial vaginosis and even pelvic inflammatory disease. Note that this would still retain the “D” of STD, always preferable.

Stay tuned for any follow up, since I am sure that regardless of what people may feel, or journals may be renamed, or organizations may develop, the terminology will continue to be debated.

—Willard Cates, Jr., Distinguished Scientist and President Emeritus, FHI 360, Durham North Carolina