Testing, Testing...

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

Whether you're 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 concerned about STIs or STI testing if they haven't ever had sex with another person. The answer is yes. Sexually Transmitted Infections means that the disease is most often transmitted sexually, not that it can ONLY be transmitted sexually. When it comes to STIs, both partners' histories are an issue, not just that of one: it doesn't matter if you've never been sexual with someone else if someone you're being sexual with now has. Too, people mean different things when they say "had sex," and some only mean intercourse when they say that, but STIs can be transmitted by more kinds of sex than just intercourse.

Plus, there are some STIs that are transmitted through non-sexual contact. Oral herpes -- which some people call cold sores, because those are the most common symptom -- is one that often runs in families because it is so easy to catch that when one family member has it, it's very common for other members of the family to get 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.

Most STIs are treatable and curable, so long as they're diagnosed in time and treated.  Some aren't curable, but can be managed.  People can get or have STIs and be okay, just like people can get or have other kinds of illness and be okay.

But like some other kinds of illness, STIs can potentially affect you for the rest of your life. They can affect your future fertility, your quality of life and your very existence: a couple can be fatal. Several cannot be cured. So, ideally, it's best to do what we can to both prevent STI transmission, like with barrier use, and take care of it when it happens, with treatment. Testing is ultimately the most important part of safer sex of all because it's necessary for both prevention and treatment.

For many reasons, getting tested is important. Have I made my point? Okay, let's read on to learn more.

What exactly does STI testing entail? STI testing includes a few simple tests that can be done in a private healthcare provider'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. Unless they only get this information through the intake forms you filled out, 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. Don't be embarrassed or ashamed: believe me, doctors, nurses, and clinicians have heard and seen it all. It is also 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 unprotected or otherwise unsafe sex, just accept it and acknowledge it when you talk to your doctor.

If you are experiencing any health problems or possible 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 infgetions or diseases when you go in for your test, by the way. That may mean that you simply don't have any. It can also mean that you, like most people with most STIs most of the time, simply don't have symptoms that are noticeable. Many STIs show 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 regularly, even if you don't have any symptoms.

Next, the clinician will do a visual examination of your genitals. They will be looking for evidence of sores or lesions as well as for unusual discharges or smells.

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.

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 through. When they do this, 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, similar to how people who have experience pap smears usually describe those. 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.

Whatever your body parts, 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.

If -- as it should -- your screening includes an HIV test, it will probably be done with a cheek swab: a bunch of cells gently scraped from the inside of the mouth and used to rapidly screen for HIV. If that test is positive, iffy or a clinician feels a need for this for other reasons, a blood test may be done as well or instead. Depending on the testing the clinician has ordered for you, you may also be or have been 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.

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.
  • Cytomegalovirus (CMV) - Diagnosied via a blood test, urine test, or chest x-ray.
  • 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) - Oral fluids collected via cheek swab are used to detect antibodies are the most common primary method of HIV testing. Blood testing is another way, and can be used to follow up an oral test. 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) - 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, but is not itself an HPV test. 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.
  • Syphilis - Requires microscopic examination of fluid from sores, blood tests, and/or examination of spinal fluid.
  • Trichomoniasis - Requires microscopic examination of genital discharge and a genital exam.
  • 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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