It is difficult to know how many people are avoiding testing for STDs despite having a sexually transmitted disease. A 1998 study by the Kaiser Family Foundation found that the incidence of disease was 15.3 million in 1996, though there is great uncertainty due to under-reporting. 32 For a potentially embarrassing disease such as an STD, seeking treatment requires trust in both the provider and the health care system for confidentiality. Greater trust should lead to more testing and greater levels of treatment. Earlier treatment for curable STDs can mean a decrease in morbidity and the costs associated with complications. These include expensive fertility problems, fetal blindness, ectopic pregnancies, and other reproductive complications. 33 In addition, there could be greater overall savings if earlier treatment translates into reduced spread of infections.