How Sexually Transmitted Infections Are Portrayed In Cinema

Movies are made to entertain, sometimes at the expense of realism. When it comes to STIs, this can lead to exaggerated symptoms designed to shock or amuse the audience. For example, in Easy A (2010) a comedy about a teenage girl named Olive who gets caught in a web of rumors after lying about losing her virginity, there’s a scene where another teenager, Micah, writhes in agony at the hospital. He is ultimately diagnosed with chlamydia after a supposed encounter with Olive. Similarly, in Off Limits (1988), a character with gonorrhea experiences such severe pain that he feels like his penis “is about to fall off”. Although these scenes play into the comedy of Easy A and the drama of Off Limits, they are far from accurate to most patient’s experience.

In reality, many STIs, particularly chlamydia and gonorrhea, are often asymptomatic. One study estimated that a staggering 45% of gonorrhea and 77% of all chlamydial infections go completely unnoticed. Movies with exaggerated symptoms can create a dangerous misconception that STIs always present obvious symptoms, potentially discouraging individuals from seeking out the routine STI testing recommended for those with high-risk sexual behaviors.

This misconception is problematic because untreated STIs can lead to serious complications. In women, chlamydia can cause pelvic inflammatory disease (PID), which can increase the risk of ectopic pregnancy and infertility. In men, it can lead to epididymitis. Untreated gonorrhea can spread to the bloodstream and joints, causing serious health problems. Additionally, asymptomatic individuals can still transmit these infections to others.

2. Sexually transmitted infections are rarely shown and highly stigmatized in classic cinema

How many classic (i.e., prior the decade that introduced the mullet and Rick Astely to the world) movies can you think of that feature STIs as a plot point? We would wager you could count them on one hand, if that. While the HIV epidemic of the 1980s sparked a rise in STI-related films, earlier movies rarely utilized the dramatic potential of the infections. This scarcity is largely due to a pervasive stigma, not just in the United States but in the film industry as a whole. 

From 1930 to 1968, the Motion Picture Production Code, or Hays Code, strictly regulated film content to ensure that it did not “lower the moral standards of those who see it”. According to the code, “the sympathy of the audience should never be thrown to the side of crime, wrongdoing, evil or sin”. Such principles are subject to contemporary ideals of morality, including restrictions on “the use of liquor in American life” or “excessive and lustful kissing”. The code stated that STIs, then referred to as “venereal diseases” were “not subjects for motion pictures”.

The exclusion of STIs from film reflects the era’s prevailing attitudes: those who contracted STIs were seen as immoral and unfit for sympathetic portrayal. A fascinating example of this censorship is the production of Dr. Ehlrich’s Magic Bullet (1940).

The film centers on Dr. Paul Ehrlich, the real-life, Nobel-Prize winning scientist who discovered arsphenamine in 1908, the first effective treatment for syphilis. The subject matter was controversial, not only because Warner Bros. was wary of marketing a film about a Jewish scientist during World War II, but also because the plot was intrinsically linked to a “venereal disease”. We imagine the initial reaction of the Motion Picture Association (MPA) to be something like the above photo.  After extensive negotiations, the MPA allowed the script to explicitly mention syphilis. However, scenes depicting the treatment of patients with syphilis were prohibited to avoid engendering audience sympathy for those who had contracted the infections. This precedent, set during Hollywood’s formative years, significantly delayed the inclusion of STIs in popular movies.

Although society has progressed significantly since the days of the Hays Code, some of the stigmatizing ideas that conflate morality with health persist among patients and healthcare providers alike. Addressing these misconceptions is crucial in promoting a more accurate and compassionate understanding of STIs.

3. Sexually transmitted infection transmission in film is often far easier than in reality

While we recognize the dramatic potential of STI transmission in storytelling, movies often portray it as far easier and more sensational than it is in reality, perpetuating misinformation and harmful myths.

For example, in The Dictator (2012), a political satire, Sascha Baron-Cohen’s character General Admiral Haffaz Aladeen proclaims “you now have herpes” after having vaginal intercourse with Megan Fox, who plays herself. This scene, played for laughs, reinforces the common misconception about herpes simplex virus (HSV) transmission. Although the virus can be present in genital fluid, transmission is most likely through skin-to-skin contact during outbreaks of blisters or sores. It raises the question of how many viewers, contributing to the film’s 180 million dollar box office revenue, understand this distinction. 

Another example is Kids (1995), a drama depicting the rapid spread of human immunodeficiency virus (HIV) among a group of teenagers engaging in unprotected sex. Made during a time when HIV was much worse than it is today, the film seems to impart a conservative message towards its hedonistic main characters. However, unprotected sex does not always result in HIV transmission; the risk varies depending on the type of sexual activity, the viral load of the infected person, and the presence of other STIs. While emphasizing safe sex is important, such portrayals can also contribute to unnecessary fear and stigmatization of those diagnosed with STIs. The transmission of STIs is overall much more nuanced than these films suggest.

A particularly egregious example is the portrayal of HIV transmission in The Brothers Grimsby (2016). In this comedy, Daniel Radcliffe is declared to have AIDS after being sprayed with the blood of an African boy living with HIV. Later, Radcliffe’s blood splatter infects a nearby Donald Trump when it enters his mouth. This absurd and inaccurate depiction is problematic. Transmission of HIV through incidental contact with blood is exceedingly rare, with no documented cases among healthcare workers from such exposure. Post-exposure prophylaxis (PEP) is estimated to further reduce the already low risk by 80%. The film’s humor recalls the panic of the 1980s when people feared using a toilet after someone with HIV.

Have you ever seen a movie where an STI spreads with dramatic ease? While these scenes may create tension or humor, they are far from accurate and can fuel fear and stigma.

4. Syphilis is often portrayed as a historical disease when statistics shown it is on the rise

Syphilis is one of the lesser-discussed STIs in popular culture, usually relegated to films set in a pre-antibiotic era. Historical dramas like Vincent & Theo (1990) or Capone (2020) showcase the devastating effects of untreated neurosyphilis, portraying it as a disease of the past. This perception extends into the medical field, where a quick search of PubMed will reveal numerous research papers referring to syphilis as a historical disease. While these titles are likely intended to be eye-catching, they reflect the idea that the public seems to view syphilis as an “old” disease, out of step with the reality of rising syphilis rates in various populations today.

This lack of awareness can have serious consequences, leading both patients and healthcare providers to underestimate the threat of Treponema pallidum infection. This can result in missed diagnoses and an increase in complications. This issue is particularly critical in pregnancy, where undiagnosed syphilis can be spread to the neonate, causing severe outcomes like cerebral palsy, hydrocephalus, hearing loss, and musculoskeletal deformities.

The portrayal of syphilis as a historical illness also skews perception of treatment options. Movies like Florence Foster Jenkins (2016) and The Libertine (2004) depict syphilis treatment with toxic metals like arsenic and mercury. While these portrayals are historically accurate, they do not present modern medicine, where effective treatments like penicillin can cure syphilis. However, this also means that the illness does not have the deadly complications it once had. This is perhaps why modern-day syphilis is not portrayed as much in popular media.

Interestingly, the use of metals in medicine is not entirely outdated. Silver is still used in wound care and catheters, copper surfaces help prevent infections in hospitals, and the antibiotic arsenal even contains a metallophore–antibiotic conjugate, cefiderocol, to fight resistant bacteria. These examples show that while treatments have advanced significantly, the historical context of syphilis treatment still offers valuable lessons for contemporary medicine. 

Closing Thoughts

At the end of this article you are probably wondering if all STI portrayals in movies grind our gears. This is not the case! While comedies such as Forgetting Sarah Marshall (2008) and Barb and Star Go to Vista Del Mar (2021) respectively feature HSV and human papillomavirus (HPV) as punchlines, they also impart accurate statements regarding transmission and prevalence. There are many films about HIV that make efforts to combat stigma around the virus. Early films portraying HIV like Parting Glances (1988) and Longtime Companion (1990) aimed to showcase a realistic and well-rounded depiction of LGBTQ+ people affected by the virus. Bohemian Rhapsody (2018) and Dallas Buyers Club (2012) are set in a harrowing pre-antiretroviral era of HIV treatment but showcase characters that are accepted by their peers and continue to live a fulfilling life after diagnosis.

As a whole, we love many of the movies mentioned in this article (though we could do without The Brothers Grimsby), but a deeper analysis of how they depict STIs reveal some interesting trends that may reflect and even influence public perceptions. As healthcare providers, it is crucial for us to be aware of these misconceptions to better understand what our patients might already believe about STIs to fine-tune our counseling efforts. All this, of course, in between our hundredth rewatch of Easy A.

What movies have you seen that “grind your gears” as an ID specialist?

REFERENCES & READINGS

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ABOUT THE AUTHORS

Michael Deaney, Pharm.D., AAHIVP

Dr. Deaney is finishing his second-year infectious diseases pharmacy residency at Denver Health Medical Center, a 500-bed community teaching hospital and safety net institution.

He received his Doctor of Pharmacy from the University of South Carolina College of Pharmacy in Columbia, South Carolina. His interest areas include antimicrobial stewardship, HIV, sexually transmitted infections, antibiotic allergies, and antimicrobial resistance.

Kinsey McClure Johannemann, Pharm.D., BCPS, AAHIVP

Dr. Johannemann graduated with her Pharm.D. from the University of South Carolina in 2022. She completed a PGY1 Pharmacy Residency at Moses Cone Hospital in Greensboro, NC and is completing her PGY2 in Infectious Diseases at Huntsville Hospital in Huntsville, AL.

Dr. Johannemann serves as a resident member on the ACCP Infectious Diseases PRN Executive Committee and is also a member of the Alabama Infectious Diseases Society (ALIDS) and SIDP. After residency, she will return to South Carolina as an Infectious Diseases Clinical Pharmacist at Piedmont Medical Center in Rock Hill, SC.

Dr. Johannemann’s professional interests include diagnostic stewardship, teaching and precepting, the human microbiome, and HIV and STIs.

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