STIs in Indie Romance
We started thinking more seriously about the representation (or lack thereof) of folks with STIs in romance novels after Editor Maria read After the Shut Up Ring by Cate C. Wells in June of 2024. It really started to feel like a gaping hole in the fabric of romance when we talked and thought more about how important it is for ALL different kinds of people to see themselves reflected in romance novels. If only the villains in romance novels contracted STIs, how must it feel to read romance if you are one of the 50+% of American adults who have (or will) contract an STI? Probably not great.
So we asked Cate C. Wells to write a piece for our August newsletter about STIs in romance, and here’s what she shared with us.
STIs in Romance
by Cate C. Wells
What one thing do over half of your readers have in common?
According to the Centers for Disease Control, twelve percent of people in the US aged 14-49 have genital herpes, and over half of Americans will contract a sexually transmitted infection of some kind in their lives. According to the World Health Organization, the numbers worldwide are similar.
In other words, for every ten people who read your book, at least one has genital herpes.
What is the one thing that over half your readers have in common?
Experience with an STI.
However, by and large, STIs do not exist in romance. When they do, they are a punchline, a boogeyman, or an inconvenient reality that is dispensed with quickly by a character sharing negative test results.
How many romances have you read where a character remarks that the cheater or playboy is going to get an STI? Here, STIs are portrayed as a punishment for sin. The implication is that STIs are disgusting and deserved, a bad end for a bad person. The reality is that STIs—like all infectious diseases—are simply a part of the human experience.
How many stories have you read where the possibility of an STI serves to raise the stakes for a character who has been betrayed? Here, STIs are a crime against the innocent. (I, myself, am rather guilty of this take in my novel After the Shut Up Ring.)
How many novels have you read where characters disclose that they have been tested and are “clean” before intimacy?
I was surprised to learn while researching After the Shut Up Ring that most standard STI screening does not test for herpes. The U. S. Preventative Services Task Force found that the risk simply outweighed the benefit for asymptomatic people. The risk? The mental health cost of dealing with the stigma and the prevalence of false positives. For asymptomatic folks, the stigma caused much more damage than the infection.
We have characters in romance declaring themselves “clean” based on screenings that most likely did not test for one of the most common STIs. And what does this suggest about those who test positive if those who don’t are “clean?” That people with STIs are dirty? We are feeding into the stigma.
And then, if you are an alien or paranormal romance fan like me, how many books have you read where the author makes a point that STIs do not exist in the fictional world?
It occurred to me while writing After the Shut Up Ring that this escapist world we’ve created without STIs is very similar to the fictional world I discovered when I fell in love with romance in the 1990s. Back then, there were no fat or LGBTQIA main characters, very little disability or chronic illness, and very little diversity in terms of race, ethnicity, and religion, at least not in the popular titles that made their way onto the shelves of my local library.
As a young fat woman, I absorbed the message without interrogation—love was not for me. I was not main character material. My happy ever after was certainly not assured.
Is that the message romance is sending to young folks with STIs? That love is not for them?
Romance has come so far since the Fabio days, but we have further to go, especially when it comes to STIs.
A good start is to audit our backlist for stigmatizing references to STIs. Luckily, as indies, we can correct any missteps very easily.
When it makes sense in the story, we’d do well to normalize STIs. Representation matters. In my opinion, content warnings and sensitivity readers are also a must. I was able to tap a local sex therapist and licensed social worker to sensitivity read.
While writing After the Shut Up Ring, I had dozens of conversations about STIs with readers, authors, and friends. Every single time, after an initial hesitance where we spoke in generalities, there would be a disclosure—either the person I was speaking to or a close friend or relative had an experience with an STI. Every. Single. Time.
Over half of our readers will experience an STI in their lifetime. With our pens, we can fight the stigma and shout from the rooftops that love is for everyone. Happy ever after is always on the table. I think we should do it. I think that’s what we’re here for.
After this great piece by Cate, we continued talking about STIs in romance, because it’s one of our soapboxes now. We started chatting with one of our favorite bookstagrammers Jillian (@onlyonebookshelf), who happens to also be a herpesvirologist, and she was making connections between purity culture and STI representation in the larger culture and in romance in particular. So we invited her to be a guest contributor to our newsletter as well, and she definitely delivered.
“The Talk™” as read by a Herpesvirologist
By Dr. Jillian Carmichael
You know the drill. It’s the middle of that romance novel you’ve been reading and it’s finally getting steamy. Things are heating up. Clothes are coming off. Desire is burning. What happens next? If it’s an open door romance, typically one of three outcomes occurs. First, the characters proceed straight to intimacy with no discussion of pregnancy prevention and/or safer sex practices. Alternatively, barrier protection is used without any real discussion of pregnancy or sexually transmitted infections (STIs). Finally, in my favorite outcome, the characters have some type of discussion regarding pregnancy prevention (if applicable) and STI status before things progress. For simplicity, let’s call this final option “The Talk™”.
I love The Talk™. For brevity, I will skip the contraception part and address my favorite topic—STIs and safer sex practices. I come by my appreciation of STIs naturally. During grad school, I studied Herpes Simplex Virus Type 1 (HSV-1), which is the causative agent behind cold sores and some cases of genital herpes. I literally wrote my PhD dissertation on herpes. At the same time, I was also deconstructing from the conservative evangelical faith in which I was raised and shedding the harmful tenets instilled by purity culture. The more I learned about herpes and other STIs, the more I realized the extent to which purity culture teachings were not only shame-inducing, but often scientifically inaccurate. And it is because of this experience and my expertise that I scrutinize The Talk™.
The Talk™ has evolved over the years. I’ve found that romances published in 2024 are more likely to include on-page discussion of STI status than romances published 10, 20, or 30 years ago. It is also genre dependent. In my opinion, science fiction fantasy (SFF) romance gets a pass on the STI portion of The Talk™ because suspension of reality is part of the appeal. Historical romance provides a unique viewpoint because unless it’s set in a post WWII era when penicillin was first used to cure syphilis, there were no effective treatments for STIs. Some historical romance authors address this by having their characters use barrier protection like french letters or by being extra selective with their paramours. But seeing as many STIs can be spread asymptomatically and there were no diagnostic tests prior to the 20th century, I still have to suspend my belief in reality at times. It’s amusing how many of our favorite fictional rakes are magically free of STIs when they lived in an era where they (almost certainly) would have been infected with syphilis.
Contemporary romance is the genre where The Talk™ can mirror real life. The most common version of The Talk™ I’ve encountered is the main characters disclosing that they have recently been tested for STIs and are “clean”, “negative”, or “clear” of infection. I have two things to say about this. First, good on these fictional characters for getting tested. This is a great way for romance authors to normalize STI testing. Second, I would ask that romance authors avoid using the word “clean” when discussing STI status as this word implies that having an STI makes you dirty. This is reminiscent of using the problematic term “clean romance” to describe a romance that has on-page intimacy, as it evokes a purity culture ideal (the notion that sex = dirty). Thankfully, I have noticed more authors avoiding the term “clean” when writing The Talk™. This makes romance more inclusive.
However, in all my romance reading, I had never encountered a main character with an STI until last month. Before I get into the details, I first must mention that of the more than 30 identified STIs, only two cause lifelong, incurable infections. The first is Human Immunodeficiency Virus (HIV) which causes AIDS. While incurable, scientific research and the development of antiviral drugs now allows HIV+ patients to live full and normal lives if they can access medical care. Side note: I’ve read multiple Achillean romances (M/M) where the characters discuss being on PrEP, a pre-exposure prophylaxis antiviral cocktail that prevents the user from being infected with HIV, even if they are exposed. I smile everytime I see PrEP mentioned in The Talk™ and would love to see it included in more than just M/M pairings. But I digress. The second incurable STI is genital herpes, which is caused by infection with either HSV type 1 or HSV type 2. While HSV-2 is canonically associated with genital herpes and HSV-1 with oral herpes, HSV-1 also causes genital herpes and can be transmitted during oral sex. For this reason, never kiss someone or perform oral sex if you have a cold sore or are recovering from one. And while there are antivirals that can reduce the severity and frequency of herpes outbreaks, there is no cure or FDA approved vaccine for herpes. It remains one of the most stigmatized STIs for this reason.
You can imagine my delight when I discovered that Cate C. Wells wrote a romance with genital herpes representation. [mild spoilers ahead] In After The Shut Up Ring, we learn that Angie, the heroine, has genital herpes and is HSV-2 positive. She has lived with the diagnosis and sporadic outbreaks for years after acquiring the infection from a cheating ex-boyfriend. Her HSV-2 status is a source of great shame for Angie and much of the book focuses on her character growth and recovery from trauma. Thankfully, her love interest responds in a positive, if slightly weird way when she discloses her HSV status during The Talk™. It was apparent that Cate C. Wells took great care when writing about this topic and she did her homework–of the many HSV-2 facts included, only one was inaccurate (pregnant people are not generally screened for HSV-2 if they have no symptoms, as Angie was when she was diagnosed). When authors write about STIs and STI testing, it makes a difference when they do the research to get their facts right.
As a herpesvirologist, reading After The Shut Up Ring was a treat because I got to see my favorite virus represented. However as a romance enthusiast, reading this book meant even more. For the first time, I saw a heroine with an incurable STI being presented as a whole human being who is worthy of love, hot sex, and a happily ever after. Herpes was not the butt of the joke. Angie was treated with dignity by the hero of her love story. I cannot convey how important this behavior is for destigmatizing genital herpes. It is my hope that more romance authors will write characters who have herpes. Ideally, it would be fantastic if this STI status did not cause the main character to be crippled with shame because herpes doesn’t make a person dirty (most adults are HSV-1 positive, FYI). After all, I read romance because I believe that every person is deserving of love. Thank you, Cate, for taking the groundbreaking step and centering a heroine with genital herpes in this love story.
Resources for further reading:
Strange Bedfellows by Dr. Ina Park (my favorite STI book) https://www.goodreads.com/book/show/51182566-strange-bedfellows
The STI National Strategic Plan for the US: https://www.hhs.gov/sites/default/files/sti-progress-report-2021-2023.pdf
HSV addendum to the STI National Strategic Plan: https://www.hhs.gov/about/news/2024/11/07/hhs-releases-sexually-transmitted-infections-stis-progress-report-herpes-simplex-virus-addendum.html
STI fact sheet: https://www.paho.org/en/topics/sexually-transmitted-infections#highlights
Beyond Shame by Matthias Roberts (a book about healing from sexual shame from purity culture): https://www.goodreads.com/book/show/52364717-beyond-shame
