IF YOU HAVE A STI
You would not believe how many people I have done STI testing for who, out of fear, are long overdue for screening. It could be their first test or their tenth and there is still always apprehension involved. For people who have never had an STI they fear the worst and for people who have had it before they often rush through the process of treatment in a panicked blur. I will ask patients who regularly get checked what we’re actually testing for and they don’t know.
Sexual health involves far too much stigma which reduces the number of people getting tested. We’re more nervous about a positive chlamydia result than poorly controlled sugar or cholesterol levels. As a doctor I work with often says, “which one is actually going to kill you?” Unfortunately this stigma has negative health impacts. In recent years we have seen an increase in the rates of STIs, from bacterial STIs like Chlamydia to blood-borne viruses like HIV. It’s also essential to reduce this stigma because STIs are generally mild and easily treatable if caught early, but if left untreated can be very harmful. Untreated Chlamydia in women can lead to infertility, syphilis can progress to neuro-syphilis (especially in HIV positive people) and untreated HIV can devastate the immune system.
Getting diagnosed with an STI and receiving treatment is a fairly simple, straight-forward process. Hopefully this video and article combination can shed some light on this process. By reducing the mystery and talking about it blatantly we can decrease the stigma and shame in this area of sexual health.
Here are the 5 steps to being diagnosed with an STI once you’ve gone back for your results.
Step 1: Treatment
If you return for your test results and you have an STI, the first step is always going to be treatment. ‘Treatment’ is a loaded word that sounds intimidating. In a lot of cases it is a very simple process. Treating chlamydia, for instance, simply involves taking two tablets at the time of diagnosis.
Treatment will vary depending on what STI you are diagnosed with; it’s simple for some and long-term or life-long for others. You can research this using the references I’ve provided or discuss this with the person conducting your test so that you know what to expect if you get a positive result.
For bacterial STIs like Chlamydia, Gonorrhoea and Syphilis I always stress that part of this process is no sex for seven days after treatment. This reduces your chance of passing on the infection or being re-infected.
Step 2: Contact Tracing
Getting an STI also involves the responsibility of contact tracing, which means that you need to get in touch with everyone you’ve had any sexual contact with between your last negative test and your current diagnosis. One reason that regular testing is important is that it reduces the window involved in contact tracing so you don’t have to go back years and years. Contact tracing is essential as ideally the primary source of infection will be identified, treated and that chain of infection will be broken.
How you choose to let people know is going to depend on how you know the person and how comfortable you feel. It can be personal, via a phone call, in person, text message, email, etc. - if this is the kind of approach you want to take then your healthcare worker can help you draft some scripts and ideas for messages. This approach is generally best for friends and partners, where a high-level of trust is involved. Of course there are other options, such as anonymous texting services. These websites allow you to enter a person’s phone number, what STI they have been exposed to and send the message anonymously (for an example, take a look at The Drama Down Under - it's designed for men who have sex with men but I recommend it to all my patients regardless of gender and sexuality). Discuss with your healthcare worker the best strategy for you. I personally don’t think this is a conversation that needs to be handled personally all the time; when it comes to sexual health people aren’t amazing at moderating their feelings and this can be hurtful when you’re already feeling vulnerable.
Step 3: Proof of Cure
For some STIs you will need to return once treatment is complete for what is called a Proof of Cure (POC) or Test of Cure (TOC). Put simply this is a repeat test to ensure that treatment worked, your infection has cleared and/or that you haven’t been re-infected. Remember, having an STI makes you more vulnerable to contracting other STIs; for example those with untreated chlamydia or gonorrhoea are more likely to contract HIV. This test is your piece of mind; you know your sexual health status and have all the right information to move forward confidently. It’s also a great chance for your healthcare worker to check in on how your contact tracing has gone and offer any help if needed.
Step 4: Testing Timeframe
Getting an STI makes you statistically more likely to get another STI in the future. Even if your test was negative you are still vulnerable to future infections; everyone is! Rather than be scared of sexual health, embrace how good self-care and regular testing can empower you to know you’re having the best, risk-free sex possible.
For someone who has regular casual partners, a test every two to three months might be appropriate, and for others maybe a six monthly or annual screen. Be sure to be honest with your sexual health history so that your healthcare worker can figure out the best time. What is said will remain confidential but inaccurate information might put you at risk.
Step 5: Talk it out
Most importantly it’s okay to talk about how you’re feeling! Sexual health is rarely spoken about and this is part of the problem. We glorify sex but condemn STIs. Hollywood movies will feature A-list, beautiful celebrities having passionate sex but all we see of sexual health might be an awkward episode of Girls where the protagonist gets HPV. This divide is not only harmful but ignorant; you can’t have sex without sexual health, just like you can’t consider junk food without thinking cardio-vascular health and diabetes.
Your doctor or nurse should be there for you to listen and provide counselling. STIs don’t only affect a certain type of person, they can happen to anyone. If you’re feeling confident enough try to open a dialogue with your friends about STI testing. Remember don’t judge yourself, don’t judge others, always practice safe sex using appropriate precautions and get tested regularly.
I hope this article and the video it accompanies have helped you to think more deeply about sexual health and maybe convinced you to go and get that test you have been putting off. There is no shame in having good sex between consenting adults and similarly there is no shame if this leads to an STI. Would you rather be the kind of proactive person who practices self-care and gets tested regularly so you know that you and your partners are safe, or the irresponsible person who doesn’t? Which is really more shameful?
As always don’t forget, “There is no healthcare without self-care.”
Resources/ Suggested Reading:
ASHA, 2014, ‘Australian STI Management Guidelines For Use in Primary Care’, Australasian Sexual Heath Alliance, viewed 01 December 2016, <http://sti.guidelines.org.au/>.
ABC, 2013, ‘What gets checked in a sexual health check-up?’, Australian Broadcasting Corporation, viewed 01 February 2017, < http://www.abc.net.au/health/features/stories/2013/11/19/3893485.htm>.
ASHM, 2014, ‘HIV, Viral Hepatitis, STIs: A Guide for Primary Care Providers (4th Edition)’, Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, viewed 01 December 2016, <http://www.ashm.org.au/resources/Pages/1976963411.aspx>.
Better Health Channel 2016, ‘Sexually transmissible infections (STIs)’, Better Health Channel, Melbourne, Victoria, viewed 01 February 2017, < https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sexually-transmissible-infections-stis>.
White, G. & Mortensen, A. 2002, ‘Counteracting Stigma in Sexual Health Setting’, Internet Journal of Advanced Practice Nursing, vol. 6, no. 1.
‘Third National Sexually Transmissible Infections Strategy 2014-2017’, Department of Health, Australian Government.
Informal articles on stigma around sexual health:
The STD Project, ‘STD Stigma - The New Scarlet Letter’ - http://www.thestdproject.com/stds-scarlet-letter-std-stigma/
Health Central, ‘The stigma of STDs’ - http://www.healthcentral.com/sexual-health/c/1443/169752/stigma-stds/