Even if you had a sex ed class in high school, odds are the section on STIs was nothing more than a slideshow packed with close-up images of people’s genitalia and a strong message to just never have sex. Or maybe you were lucky and had a great sex ed program and consider yourself an STI expert! Either way, you can almost certainly stand to know more about STIs and STI testing.
To pick up where your sex ed class left off, three gynecologists answered seven questions you might be too scared to ask out loud — but really shouldn’t be.
“How often should you get tested if you’re single and having sex with multiple partners?”
In a perfect world, you should be tested before any sort of sexual activity with a new partner. And any new partners should be tested too. Leah Millheiser, an ob-gyn and director of the Female Sexual Medicine Program at Stanford University, said she sees a lot of female patients in her practice who get tested before their partners do, find out they don’t have any STIs, and then never ask partners to be tested. A Cosmoplitan.com survey of 1,454 Millennials supports this — 47 percent of respondents said none of their past partners ever asked about STI test results before having sex. And making things even riskier for women, men are three times likelier than woman to say they’ve never been tested at all.
Of course, the rule of thumb if you’re single is to always, always, always use a condom (and plenty of lube, while you’re at it), and be honest with partners and yourself about your screening history. If you feel it’s time for a test, get a test. Don’t be shy about asking any and all of your partners when they were last tested either.
“Does one test cover all STIs out there?”
There’s actually no such thing as a blanket “STI test.” What is a thing are tests that doctors use to screen for individual STIs. Chlamydia and gonorrhea can each be tested through a urine sample, a vaginal swab, or swab inside the penis, while a blood sample is needed to test for HIV and hepatitis. According to Jenn Conti, an ob-gyn, “a full STI screening includes both blood and urine tests and checks for HIV, syphilis, hepatitis B and C, chlamydia, and gonorrhea.” But if you ever think you’ve been exposed to something not on that list — like herpes or crabs — you can talk to your doctor about testing for those individually at any time.
“Are STI tests always accurate?”
No medical test is 100 percent accurate 100 percent of the time. Dr. Millheiser said it also depends on what type of test the lab is using and which STI you’re testing for.
For example, herpes blood tests are often said to deliver false results. According to the CDC, false negatives are common shortly after contracting genital herpes, and false positives are common especially among people who have a low value of herpes antibodies. So the current guideline for herpes testing is to avoid routine screening, and primarily test if or when someone is displaying symptoms.
“The most effective test [for herpes] is to actually do a swab on a lesion as soon as you see it,” she said. “A blood test tells you if you have antibodies for herpes 1 or 2, but that doesn’t necessarily mean you have genital herpes.”
The testing method can also play a role in result accuracy. Chlamydia and gonorrhea can both be tested with a urine sample, for instance, but Dr. Millheiser said an actual cervical swab and full cervical exam will deliver the best, most accurate result. You can (and should) talk about all of the testing methods available with your physician. And as always, see a doctor sooner rather than later if you have any symptoms — like discharge, itching, or bumps — that could be indicative of an STI.
“Where can I go for affordable testing for men and women who do not have health insurance and can’t afford expensive lab testing?”
Both Colleen Krajewski — an ob-gyn and medical adviser to Bedsider, an educational site from the National Campaign to Prevent Teen and Unwanted Pregnancy — and Dr. Millheiser recommend Planned Parenthood, which is very much open to all genders, not just women. Dr. Millheiser also mentioned going to a free health clinic in your city. If you live in a rural area, check to see if your county has a local health department — most will offer free or low-price STI testing. The CDC also has a resource for finding free STI testing near you.
“Why do gynecologists not test for things like herpes and HIV unless you request testing? These seem so serious and yet they’re not on the annual testing list.”
This question is a bit complicated to answer. The only things on an “annual testing list” for women under 25 are gonorrhea and chlamydia, again because they’re the most at-risk for those two STIs due to the nature of their cervical cells at that age. HPV screening is done alongside a Pap smear, so every three to five years for women under 65. HIV is screened every one to five years for people who are at an increased risk for contracting it, or at your request otherwise. And as mentioned before, herpes is only screened for upon request or when someone’s displaying symptoms. Dr. Millheiser said routine blood testing for herpes just causes patients “undue anxiety” because the antibodies for HSV are common, even among people who’ve never had a lesion.
All that said, what you should be routinely screened for should be determined by you and your doctor. “Doctors will tailor all the tests to each specific patient based on preexisting conditions and prior diagnoses,” Dr. Millheiser said. As with any medical procedures, you should never be afraid to ask your doctor which tests they’re ordering, and feel free to ask questions about those tests and request others if you feel they’re necessary.
“Is it necessary to get an STI test if you haven’t changed partners since your last test?”
It’s up to you. “I don’t recommend it but then I think patients are better at assessing their own risk than I am in terms of how much they suspect something else going on,” Dr. Krajewski said. In other words, if you suspect your partner isn’t being totally monogamous or is perhaps lying to you, talk to your doctor about being tested.
Or let’s say you haven’t had sex with anyone new but are worried you may have contracted something from your most recent partner even though you don’t have any symptoms. STIs have incubation periods and the incubation period for each one is different. Dr. Millheiser recommends seeing your doctor right away if you think you may have come into contact with an STI and they can help you work out a testing plan. Dr. Millheiser gave the example of herpes. “If somebody has been exposed to herpes and had an infection but didn’t show up to my office until a week after the lesion showed up, the test may come back negative if it’s already scabbed and healed over,” Dr. Millheiser said. Herpes is a particularly good example because, again, it’s known for delivering false results — so if a lesion pops up even though you haven’t had any new partners, you should see your doctor and discuss testing.
The rule of thumb is to make an appointment with your doctor for testing the moment you suspect you’ve come into contact with an STI or think you’re having STI symptoms, even if you haven’t changed partners in a while. Your doctor will work out a plan for retesting from there.
“How do you tell your partner you have an STI?”
If you’re looking for specifics on how to get the conversation started, Dr. Krajewski offers thoughtful advice here. The most important thing, though, is to just be honest with each of your partners — the best way to avoid spreading STIs is regular testing, vigilant condom usage, and full disclosure. There’s nothing shameful about having an STI and any partner who makes you feel otherwise is almost certainly not worth your time.
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