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STI screening - do it!

A combination of friends, acquaintances, metamours, and patients making choices that disappoint or scare me have tipped me into making a PSA about STI screening, and about sexual health/wellness more generally.

When was the last time you were screened for sexually transmitted infections (STIs)? Do you know what tests that screening included? How about your partner(s)? How you would tell your partner(s) if you tested positive for something?

I hear a lot of patients tell me that they don't need to be tested because they are in a monogamous relationship. Monogamy does dramatically decrease your risk, but, monogamy fails. If monogamy is what you and your partner have agreed to, I hope yours doesn't fail; I also hope you hedge your bets and get periodic testing anyway. GSS data indicates that about 18% of married people have ever had sex outside their marriage, and 10% of married people have done so at least once within the last year. Let's be generous and assume that even half of those people have negotiated some form of consensual non-monogamy...that leaves a lot that didn't.

I also hear a lot of people say that they don't need to be tested because they always practice safer sex. Safer sex fails -- because barriers are imperfect, but mostly because people aren't actually doing a good job of practicing safer sex.

GSS data says that 77% of people didn't use a condom the last time they had vaginal/anal/oral sex involving a penis. Sadly, they don't collect data about other barrier use. A good portion of those people are probably in (or think that they're in) monogamous/fluid-bonded relationships. But, a lot aren't.

What do you mean when you say safer sex? Do you use barriers for penile-vaginal sex? for cunnilingus? fellatio? penile-anal sex? analingus? manual sex? Do you use barriers on your toys or sterilize your toys between partners? Do you do it every time?

Unfortunately, even if you do use barriers for every sex act, every person, every time...the barriers themselves offer incomplete protection and they can also fail. Barriers reduce transmission of HSV (herpes) and HPV (genital warts, increased risk of genital cancers) by about 70%. Barriers theoretically offer 98%+ efficacy in preventing transmission of fluid-bourne infections like HIV, gonorrhea, and chlamydia -- however a few studies have found actual real-world protection to be more like 85%-90%. Maybe that's because people weren't actually always using barriers, or weren't using them correctly. Maybe they just aren't that effective. We don't know. The real bummer is that even being a safer-sex superhero won't protect you from contracting syphilis -- it's very contagious in its primary and secondary stages.

What to test and when to test.
If you're sexually active, it is a good idea to be tested at least annually for HIV, gonorrhea, chlamydia, and syphilis. Pap smears and HPV typing (if you have a cervix) following the current ACOG guidelines is also indicated.

Depending on your risk factors, you may want more frequent screening and/or more comprehensive screening. Other tests to consider include HSV, hepatitis B, hepatitis C, and oral and/or rectal swabs for gonorrhea and chlamydia.

Where to get tested.
If you have health insurance your primary care provider or OB/Gyn should be able to provide all of these tests. If they can't, fire them, and be sure to tell them why you're finding a new provider. You can even ask them to call me and I'll explain it to them. :)

No insurance? Your local health department, Planned Parenthood, or LGBTQ health services clinic should be able to see you for a flat fee, sliding scale, or possibly even for free.

Further reading in the links below. I just got done with a long and painful second college degree -- therefore I have not included any citations here, hah! However, if you'd like a reference for anything, just ask.

Information about emergency contraception. I recommend that anyone who is relying on a single method of contraception have it on hand in case of condom failure, forgotten pills, IUD expulsion, unexpected pharmacy closing, etc.

Great site about safer sex and STI risks for the nonmonogamous. This link is just to the intro page, the whole thing is worth reading.

Article explaining why barriers don't protect against HSV and HPV very well.

Safer-sex how-tos

Great option for free STI testing in DC:


( 10 comments — Leave a comment )
Jul. 14th, 2011 02:08 pm (UTC)

You have given me extra inspiration for my testing next month. And thank you for compiling all the useful links.

Jul. 14th, 2011 04:09 pm (UTC)
Good for you! I hope you have no hassles or trouble getting appropriate screening and that all results are normal and negative. :)
Jul. 15th, 2011 04:10 am (UTC)
Thanks for the reminder. I'll stop procrastinating on setting up my appointment. I appreciate the info on what to ask about as well.
Jul. 20th, 2011 05:12 pm (UTC)
I would like to link to this, can you give expanded forms of the abbreviations you use like GSS which I am unfamiliar with? Thanks!
Nov. 1st, 2011 02:27 pm (UTC)
Oops, never saw this reply until now -- guess it must have happened during one of the periodic comment notification outages.

Anyhow, yes, you are very welcome to link to this! :)

GSS stands for General Social Survey. The GSS is a huge sociological survey of the US that well-loved by both professional and armchair researchers because its data set is available to the public and they have some basic data analysis tools built right into their site. http://www3.norc.org/GSS+Website/

Please correct me if I'm wrong, but I think the only other missing abbreviation expansion is ACOG. ACOG is the American College of Obstetricians and Gynecologists. It is the professional organisation for OB-Gyn providers, as well as the organization that issues guidance on things like timing of pap smears and management of common OB-Gyn conditions.
Jul. 26th, 2011 03:05 am (UTC)
Thanks! OK to link to this next time I do a linketies post?
Nov. 1st, 2011 02:27 pm (UTC)
Just finally saw this comment now -- but, absolutely!
Aug. 31st, 2011 01:24 am (UTC)
Hey, if you get a chance could you take a look at this post of mine and add any insight you have into the Mirena question?

Nov. 1st, 2011 02:28 pm (UTC)
Just saw this comment too -- would be happy to, but it is coming up as protected/no access. Maybe on a filter I'm not in? In any case, I'm up for being added to whatever filter it is if input would still be helpful.
Nov. 14th, 2011 03:39 am (UTC)
Oops, sorry! I just locked down a bunch of stuff because my partner's ex is about to become aware of my existence and I'm trying to smooth the path a bit. It was a question about IUDs and fisting -- there's no actual research on the topic I can find, but anecdotally I'm hearing it's fine. Any feedback from your side of the women's health world?
( 10 comments — Leave a comment )


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