Testing, Testing...

If you have read some of the articles here at Scarleteen or looked through the boards, you know that getting yourself screened for Sexually Transmitted Infections (STIs) is essential.

Whether you are with a new partner, or are already in a sexual relationship, getting a full STI -- sexually transmitted infection, sometimes also called STDs -- screening can give you peace of mind and ensure your physical well-being as well as your partners.

Often people ask us if they need to be worried about STIs or STI testing if they haven't ever had sexual contact with another person. The answer is yes, yes, and yes. Sexually Transmitted Infections means that the disease CAN be transmitted sexually not that it can ONLY be transmitted sexually, and when it comes to STIs, both partners' histories are an issue, not just that of one.

Plus, there are some STIs that are often transmitted through non-sexual contact. Oral herpes, otherwise known as cold sores, is one that often runs in families because it is so easy to catch that when one family member gets it, it's very common for other members of the family to catch it from them in completely nonsexual ways. In fact, the majority of people with oral herpes, which can also be passed on genitally, got it as children in a totally nonsexual way.

STIs can affect you for the rest of your life. They can affect your future fertility and your very existence: a couple can be fatal. Several of them cannot be cured. But many of them ARE easily treated, and when treated early, can leave you with no long-term health problems. Using latex (or non-latex alternative) barriers -- condoms, dental dams and/or gloves -- can vastly reduce your risks of most STIs, but that's only one part of safer sex practice: testing is another and is just as important. So, for many reasons, getting tested is important. Have I made my point? OK, read on to learn more.

What exactly does STI testing entail? STI testing includes a few simple tests that can be done in your doctor's office or at a clinic. They may be slightly uncomfortable, but they are not more than that. It's really pretty minor.

The first part is an interview. The clinician or doctor will ask you some questions regarding your exposure to STIs and about your sexual activities and sexual history. This may make you feel uncomfortable. Do not be embarrassed or ashamed believe me, doctors, nurses, and clinicians have heard and seen it all. It is very important that you be honest with your doctor, so they can do their job to get you the care you need. If you have had unsafe sex, accept it and take responsibility for it when you talk to your doctor.

If you are experiencing any health problems or symptoms of any STIs, tell your doctor about them in detail: how long have you been having the problem? How frequently? Has it gotten worse or better since it started? All this information can help them give you a proper diagnosis.

You may not be having any health problems or symptoms of any diseases when you go in for your test. That may mean that you simply don't have any infections or diseases. It can also mean that you simply don't have symptoms that are noticeable. Many STIs have no symptoms, particularly in their early stages. One of the ones that is easiest to miss -- and one of the most common infections -- is Chlamydia, which is called "the silent STI" because many people who have it never know until it's too late, and they have already begun to have serious complications due to inflammation and scarring. That's why it's important to get a full STI screening anyway, even if you don't have any symptoms.

Who's really been tested? Take our poll then take a look at the reality of being tested when it comes to your partners and peers.

Next, the clinician will do a visual examination of your genitals. They will be looking for evidence of sores or lesions. If you have a vulva you will go through the same procedure as you would for a pelvic exam (you might want to read up on that in the Your First Gynecologist Visit article for more details). During the pelvic exam the doctor will take a small sample of cells and fluids called a smear or swab test. It is similar to a PAP smear test, except that in this case, when the technician or doctor looks at the cells through a microscope, they will be looking for signs of the various microorganisms, antibodies, or cell changes related to specific STIs.

What about if you have a penis? If you have a penis, the clinician may do a swab test. This means taking a swab from the inside of your urethra, the tube that runs all the way down the middle of your penis, where urine and semen come out. The clinician gently inserts a thin cotton-tipped swab into the urethra to get a sample of cells. Most of the folks we know who have had this done say that it is slightly painful, but only for a moment or two. On a scale from 1 (nothing) to 10 (being kicked in the crotch), it's usually about a 4. The cells gathered this way will be examined under a microscope, just as cells collected from someone's vulva are.

The clinician may also take a sample of cells from your throat and/or rectum. These are swab tests, too, and are likewise done with a long cotton swab. Having one done in your throat is a lot like getting a throat culture done to test for strep throat in fact, it's the same procedure, only they look for different things in the lab. As for a rectal (butt) examination, the clinician will do a visual examination as well as sampling of cells. Again, it is not terribly uncomfortable, but it can feel kind of vulnerable or embarrassing. It is better if you try to relax, though, since you being relaxed makes it much easier for the clinician, and thus much more comfortable for you.

Depending on the testing the clinician has ordered for you, you may also be asked for a saliva sample, urine sample, blood sample, or any combination of these. Depending on the clinic or doctor you may or may not be given them all. Chances are you will be given a blood test as it is the most common way to test for HIV and syphilis.

Common sexually transmitted diseases and infections and testing procedures

  • Bacterial Vaginosis - Requires a pelvic exam, examination of vaginal fluid, microscopic examination of vaginal tissue (smear test).
  • Chlamydia - Requires the examination of tissue samples (smear test) or urine for a correct diagnosis.
  • Gonorrhea - Requires the microscopic examination of urethral or vaginal discharges and possibly cultures taken from the throat or rectum as well.
  • Hepatitis B Virus (HBV) - Requires a blood test to look for antibodies.
  • Herpes - It can be confused with syphilis, chancroid lesions, and other STDs/STIs. For a correct diagnosis, herpes, it is best to visit your doctor within three days of finding a sore or lesion. When the sores have dried up it is more difficult to make a correct diagnosis. A smear test, a test of cells from the lesion, and/or a blood test may be required.
  • Human Immunodeficiency Virus (HIV) - A blood sample is required as it is tested to detect HIV antibodies. Some clinics use a saliva (cheek swab) test instead. A diagnosis of HIV is not the same thing as a diagnosis of AIDS (Acquired Immune Deficiency Syndrome). A diagnosis of AIDS is based on the presence of one or more of a variety of conditions and infections related to HIV infection.
  • Human Papillomavirus (HPV - also called Genital Warts) - HPV testing is only currently available for people who have a vagina: people who have a penis instead cannot yet be tested for HPV. Requires a microscopic examination of tissue sample and visual examination of warts. A cervical pap smear may reveal precancerous conditions caused by genital HPVs. A special magnifying instrument called a colposcope can detect genital HPVs that cannot be seen with the naked eye during pelvic exams.
  • Molluscum Contagiosum - Requires a microscopic examination of tissue taken from the sore.
  • Pelvic Inflammatory Disease (PID) - Requires a pelvic exam and microscopic examination and/or culture of vaginal and cervical secretions. For further diagnosis and assessment of damage, a laproscopy, a surgical procedure where an optical instrument is inserted through a small cut in the navel to look at the reproductive organs, may be required.
  • Pubic Lice - These can be seen with the naked eye or with a magnifying glass. They look like tiny crabs. They are pale gray but become darker when they are swollen with blood from biting at the skin. Examination by your doctor can be used to confirm the diagnosis and get proper treatment and medication.
  • Scabies - Self diagnosis is possible, but difficult. May require microscopic examination of a skin scraping or biopsy.
  • Syphilis - Requires microscopic examination of fluid from sores, blood tests, and/or examination of spinal fluid.
  • Urinary Tract Infections - Clinicians may diagnose these based solely on symptoms, but they often also use a urine sample and/or a urethral swab test.

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