Emma McGowan, certified sex educator and writer, addresses how often you should be getting tested in this week's Sex IDK column.
Q: How often should you get tested?
Here’s my wish for 2019: That every sexually active person get tested for STIs at least once. I know, I know — testing isn’t super fun. But just as it’s important to get your blood pressure and cholesterol levels checked periodically, so too is it important to make sure your genitals and reproductive organs are healthy. So let’s all make “get tested” a New Year’s goal this year.
And if you’re thinking, “But I don’t have any symptoms!” I’m sorry to be a Debbie Downer, but many STIs and STDs don’t show symptoms. Or, they have such mild symptoms that you don’t even notice. For example, I found out that I had HPV when I was 19 because of one tiny bump on my inner labia. If that bump had shown up anywhere that pubes grow, I would probably just have assumed it was an ingrown hair and wouldn’t have gotten it tested.
Other STIs that often show little-to-no symptoms are chlamydia, gonorrhea, herpes, and trichomoniasis (trich). But the thing is, you can pass them on even without symptoms. And some of them — including chlamydia and gonorrhea, which are two of the most common STIs for people under 25 — can cause infertility in women and other people with uteruses if they’re not treated. Yikes!
But before we go into the CDC's recommendations for testing, I want to talk a little bit about STI stigma. So many people freak out when they get diagnosed with an STI. They start questioning their life choices or they assume their partner is cheating or they dig themselves into a shame spiral or they call me with 10 million questions that their doctor should have answered.
Is that reaction fine? Sure. Feel your feelings. But is that reaction proportionate to the damage the STI will do to their bodies? Almost never. That’s because we’re all steeped in deep shame about sex, even if we don’t realize it. And so when people get an STI diagnosis, they view it as a moral judgment on their character. After all, if they weren’t doing that dirty, disgusting, immoral sex thing, they never would have gotten a terrible disease in the first place.
That’s the perception, anyway. Here’s the reality. Most STIs are no big deal. Just like we humans sometimes give each other colds and flus and even skin infections, we sometimes give each other sexually transmitted infections. The only difference between a viral infection that affects your genitals and a viral infection that affects your sinuses is one carries a massive load of stigma, while the other doesn’t. You don’t feel ashamed when you catch a cold, right? So, if you don’t have an issue with sex, why feel ashamed when you catch HPV?
Of course, I always have to add the caveat that just because most sexually transmitted infections are no big deal, doesn’t mean all are. Some people — especially those with already compromised immune symptoms — show significantly more symptoms than others. We all saw those photos of weeping sores and wart-encrusted genitals in sex ed class or on Google. Those are real people. That does happen. But it doesn’t happen to the majority of people or even to most. Remember: Most STIs are curable and all are treatable.
So with all of that in mind, here’s how often you should get tested, according to the Center for Disease Control (CDC).
How Often Should Women Get Tested?
The CDC recommends that women under 25 get tested for chlamydia and gonorrhea every year. They also recommend that women over 25 who have new or multiple sex partners or a sexual partner who’s tested positive for an STI get tested yearly as well.
The difference in recommendation based on age is because half of all people will have an STI by age 25 and half of all new STI infections every year happen in people under the age of 25. But despite that fact, only 12 percent of people in that age group get tested every year.
And while the CDC doesn’t recommend it, I also recommend that women in long-term relationship get tested every few years. That’s because, unfortunately, many people do cheat. And while obviously none of us want to think that our partner would cheat, isn’t it better to quietly take control of your own sexual health than blindly assume you don’t have an infection?
Finally, pregnant women should be tested for syphilis, HIV, and hepatitis B. And pregnant women who are having sex with multiple partners throughout their pregnancy — or whose partners are having sex with multiple partners — should also be screened for chlamydia and gonorrhea periodically through the pregnancy.
How Often Should Gay, Bisexual, And Pansexual Men Get Tested?
The CDC recommends that gay, bisexual, and pansexual men (or, in their words, “men who have sex with men”) get tested at least once a year for syphilis, chlamydia, and gonorrhea. They also recommend that these men get tested more frequently — meaning every three to six months — if they have multiple or anonymous partners. Same goes for HIV testing — the CDC says that these men “may benefit” from HIV testing every three to six months, but should be tested at least once a year.
Why is it recommended that men who have sex with men get tested more frequently? Mainly because many STI rates — including syphilis and HIV — present at higher rates in those men. That’s because of a range of factors, including the fact that this group is less likely to use condoms and that anal sex presents a higher risk of tearing (and therefore of infection) than other sex acts. Also, homophobia, stigma, and discrimination can sometimes keep men who have sex with men from getting tested and treated. Bottom line? If you’re a part of this group, get tested more frequently.
As for straight guys, there’s actually no CDC recommendation for testing. Surprised? Me too. But it turns out that’s not an oversight. The CDC doesn’t recommend regular testing for straight men because there’s no evidence that regular screening of straight men would reduce the infection rates; the consequences of infection aren’t as high as they are for women; infection rates aren’t as high as they are in men who have sex with men; and funding is limited. Because MSM are at a higher risk of infection and women have more severe consequences with infection, the CDC chooses to direct their limited funding toward those two groups.
How Often Should Everyone Get Tested?
Finally, the CDC recommends that everyone get tested for HIV at least once in their life. People should get tested more frequently if they have any of the factors we went over already, or if they have “unsafe sex” or share injection drug equipment.
And if you have symptoms? Get tested. Even if you think it might be a yeast infection or it could be an ingrown hair, it’s worth knowing so that you can take appropriate steps for treatment. Remember: All STIs are treatable and many are curable. Time to make that appointment.
Note about language: These are the CDC's recommendations. Unfortunately, the CDC doesn't have recommendations for trans or non-binary or gender nonconforming people yet. It's recommend that people who don't fall within the gender binary follow the recommendations for the genitals they have, while taking into account other risk factors. (For example, it's recommended that a person who has multiple sex partners get tested at least once per year or as often as every three to six months, regardless of their gender or genitalia.)
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