Best Practice

RSHE: Some dos and don'ts for teaching STIs

PSHE Pupil wellbeing
How does your school teach STIs as part of effective relationships and sex education? Lucy Emmerson looks at best practice, offers some tips, explains what not to do, and signposts to a range of useful resources and support


The significant physical and mental health benefits for young people receiving relationships and sex education (RSE) are highlighted in a new government report from a 10-year study of young people’s RSE experiences and risk-taking behaviour (DfE, 2021).

The deep-dive report finds that young people who did not receive any RSE in schools were more likely to go on to take more sexual risks (including intercourse before the legal age of consent and unprotected sex) and contract a sexually transmitted infection (STI).

With young people still accounting for around half of all new diagnoses of sexually transmitted infections (STI) in England, what can schools do to ensure they are teaching up-to-date facts and the skills young people need to manage risks and protect their health?


A focus on transmission

Let’s start with what not to do. Showing pictures of the symptoms of STIs on the human body when the STI is advanced, untreated and unsightly is not helpful. This is a scare tactic and is ineffective.

Having a sound understanding of transmission is a much better place to start, and the basic facts can be found in the Department for Education’s online training module on intimate and sexual relationships and sexual health (DfE, 2020), which sets out:

  • Teach that there are different STIs and explain that they can be transmitted through mucous membranes/body fluids (blood, saliva, vaginal mucus, anal mucus).
  • Explain which parts of the body have mucous membrane (mouth, anus, vagina, tip of penis).
  • Ensure pupils understand that transmission of an STI can happen during different types of sexual activity (including oral sex).

Knowing the names and specifics of each and every STI is not the priority. Focus instead on teaching pupils to understand that there is diversity among STIs, with a range of types of organisms (viruses, bacteria, parasites) and therefore some variation in treatment, symptoms, testing and prevention.


A focus on HPV

Some STIs need individual attention, for example Human Papilloma Virus (HPV) stands out because it is transmitted by genital skin to skin contact. HPV is an extremely common STI and is linked to many cases of cervical cancer, as well as being linked to anal, vaginal, penile, vulval, mouth and throat cancers.

All students will be offered the HPV vaccination in year 8, subject to parental consent, and so need to know what it is all about. HPV can also be mentioned in the context of cervical screening, which comes up under health education.


A focus on HIV

HPV should not be confused with HIV – which stands for Human Immunodeficiency Virus. Treatment and prevention of HIV has developed enormously over the last few years. If HIV is detected and a full anti-retroviral treatment regime is followed it is now possible to reduce viral load to an undetectable level. With the virus maintained at an undetectable level it is not possible to pass it on. So “undetectable = untransmissible”, or U=U. Accessing testing for HIV is therefore more important than ever, because early diagnosis and treatment can prevent onward transmission.


A focus on condoms and relationships

Ensuring that knowledge of anatomy is in place is the foundation for explaining STI transmission as well as for equipping young people to assess the risk levels of different sexual activities and how these can be mitigated.

Emphasis on condom-use for safer sex is very important. Brook has a good webpage on how to use a condom (see further information).

However, knowing how to use a condom is only half the picture. It is essential that young people have assertive communication skills and the ability to listen to a partner, so that they can negotiate condom-use and discuss readiness (or otherwise) for sexual activity together.

Studies find that paying attention to gender dynamics and the balance of power in intimate relationships is vital if young women in particular are to be empowered (for example, see East et al, 2011). While male condoms and femidoms don’t provide full protection from STIs they are the only forms of contraception that offer any protection from STIs.


A focus on testing and treatment

It is important for pupils to know that there is testing and treatment available for STIs and how to access this, as well as the fact that not all STIs can be cured.

Signposting to local sexual health services is a requirement in the government RSHE guidance (DfE, 2019). As well as learning about where and how to access services, focus on myth-busting about what STI testing really involves, and emphasise the right that young people have to confidential services.

Postal HIV and STI testing have seen a sharp increase in popularity during 2020, with orders rising by 34 per cent (compared to 2019 numbers) according to the latest Public Health England STI report. However, the availability of free home testing varies from area to area. Young people could be invited to form a working party with school staff to audit the availability and accessibility of local services.


A focus on stigma

Addressing stigma is an important outcome from lessons about STIs. Regular discussion about sexual health helps to normalise it as an area of “health literacy” that is relevant to everyone and is both a right and a responsibility.

Encourage students to engage with the global, socio-economic and even the historical dimensions of STIs in order to explore why and how stigma persists and what they, as individuals, can do about it.

The government’s HIV Action Plan, which was launched in December 2021, aims to end HIV transmissions in England by 2030. The quality of RSE will have a key role to play if this ambition is to be realised.


Further information & resources