Sexually transmitted infections (STIs, also known as sexually transmitted diseases, or STDs) are extremely common, with more than 20 million new cases per year in the United States. Would it be obvious if you caught an STI? Do they all cause immediate physical symptoms? No, typically they do not. In fact, the majority of STIs are completely silent, causing no symptoms at all for months to years after the initial infection. The only way for someone to tell if they have an STI is to get tested. Testing specifics may vary depending upon symptoms (or lack thereof), gender and provider preference. Clarify which tests will need to be performed, rather than asking for full STI testing. There is no screening test, for example, for HPV in males.
HIV, syphilis, herpes simplex virus (HSV) and hepatitis B and C infections are all detected by blood tests. A lab technician will draw blood from your arm using a small needle and syringe, a process that takes only a couple of minutes and involves minimal discomfort.
Chlamydia, gonorrhea and trichomonas infections may be detected by urine samples, although this is not always the preferred method.
Clinicians use cotton-tipped applicators to directly swab inside the tip of the penis or inside the cervix, especially if the patient is complaining of any type of discharge from those areas. Additionally, swab testing may be used for the throat and anus for patients who engage in oral or anal sex. Swab tests may be used for chlamydia, gonorrhea, trichomoniasis and herpes.
Self-obtained vaginal swabs have been shown to be comparably effective as clinician-obtained swabs to detect gonorrhea, chlamydia and trichomoniasis. This self-obtained method may be used for home testing (in which you mail your swab to a lab) or in health care settings to facilitate access to STI testing when a pelvic exam is not planned.
Physical exams are not always part of STI testing, but when included, clinicians first visually inspect the genital area, looking for any evidence of pubic lice in the pubic hair as well as any sores, bumps, blisters or discharge that might suggest other infections. They examine the groin area to detect any enlarged lymph nodes. Pelvic exams for women may include a speculum exam, in which the provider can inspect the vagina and cervix, as well as perform swab testing.
If the patient has receptive anal intercourse, the exam may include inspection and swab testing of the anal area.
Likewise, if the patient performs oral sex, the mouth and throat area may be inspected and swab tested.
Who Should Get Tested for STIs?
Anyone sexually active who has genital or urinary symptoms (such as burning, pain, blisters or discharge) should be evaluated immediately for STIs. Screening guidelines for people who are sexually active but have no specific concerns vary between different medical organizations, but all generally recommend a minimum of annual STI testing for people who have had new partners since the previous year.
If you are sexually active and have never been tested, it’s time. Not knowing does not change whether or not you have disease, and many STIs can be treated or cured, while untreated STIs can progressively and silently cause damage to your body.
Which STI Tests Are Recommended?
HIV testing is recommended once for everyone between the ages of 13 and 64 years and should be repeated annually for those who are sexually active with a new partner since their last test.
Gonorrhea and chlamydia tests are especially important for sexually active women of childbearing age because these infections can cause chronic pain and infertility if they are not diagnosed and treated, but are easily curable if detected early. Men who have sex with men (MSM) should be tested for gonorrhea and chlamydia at all sites of contact (oral, anal, penile) at least annually if they have new partners.
Syphilis testing is recommended for all pregnant women at their first prenatal visit. Men who have sex with men should be tested annually for syphilis.
For herpes simplex virus type 1 and type 2, blood tests should be considered in all patients asking for STI evaluation, per 2015 CDC screening guidelines.