GETTING THE RIGHT STI TEST.
Who are you, who do you sleep with and how at risk are you? These are the key questions when it comes to getting the right STI test. From my experience in practice nursing a lot of people are unaware that who you sleep with actually determines what kind of test you will receive. Unfortunately this doesn’t just extend to patients; I have met healthcare workers who either don’t know there are different testing protocols, forget to adhere to them or out of discomfort can’t ask people the relevant questions to perform the correct test. That alone terrifies me and so today’s discussion is all about knowing what the right test is for you so you can be confident in receiving the best care and accurate understanding of your sexual health! In future I will discuss each different STI (including what it is, how you get it and treatment) but today’s topic is purely the basics of getting the right test.
If you’ve ever had a STI test you know it can involve urine samples, various swabs and blood testing. We have so many different tests because STI testing is site-specific; each test is testing for a STI in a specific area. Let’s elaborate:
Urine samples: a urine sample will detect STIs in your genitals, namely chlamydia and gonorrhoea. A urine sample must be performed 1-2 hours after the last time you urinated and it must be the very first part of the urine, known as a ‘first-catch’ sample. Note: this does not mean very first thing in the morning as some healthcare workers still believe, any time of the day is okay!
Throat swabs: a throat swab will check for STIs in your throat, such as chlamydia and gonorrhoea. This test can be mildly uncomfortable but is really brief; a healthcare worker will ask you to open your mouth as wide as possible and stick your tongue out, then briefly trace a sterile cotton swab across your throat.
Rectal swabs: a rectal swab will check for STIs in your rectum/anus, such as chlamydia and gonorrhoea. Nowadays this is generally a self-collected specimen; a healthcare worker will send you to the bathroom to perform this test while doing your urine sample. Place the sterile swab just inside the opening to the anus (a finger-nail’s length or just the length of the cotton tip), remove and then immediately place inside the swab holder.
Blood test: a blood test will check for sexually transmitted blood-borne viruses, such as HIV, Syphilis, Hepatitis B and Hepatitis C (even though Hep C is rarely transmitted sexually it should be included in every STI screen).
Now that you know what each test if for, let’s talk about what you’re going to need based on your sexual partners. In the following categories I have intentionally not utilised terms like heterosexual, gay and lesbian because these are limiting and full of stigma. Some men who have sex with men don’t identify as gay, some people have fluid sexuality; using socially constructed terms might mean people don’t receive every test they need.
Men who have sex with women
If you’re a man who exclusively sleeps with women you’re going to need a urine sample and a blood test. You are most at risk of contracting STIs through your penis due to exposure with a woman’s vagina, anus and/or throat. The men in this category don’t need a throat swab because it’s virtually impossible to contact an STI in the throat from performing oral sex on a woman.
Note: if you share sex toys with your female partners that may come in to contact with your anus or your throat after coming in to contact with a woman’s vagina, anus or throat let your healthcare worker know as you may need additional swabs.
Women who have sex with men
For women who have sex with men your testing will involve a blood test, a urine sample and a throat swab. As with the above category the urine sample will detect chlamydia or gonorrhoea in the vagina and the blood test will screen for sexually transmitted blood-borne viruses. The main difference here is the throat swab. From my professional experience I would argue that around 30-50% of women were unaware that they needed a throat swab. More alarming than this is that it is easily the most overlooked test by healthcare workers; I have added this test to pathology request forms so often it was actually the catalyst for me creating Hot on Health! Performing oral sex on a man generally means the penis glands come into contact with the throat and therefore you’re at risk of contracting gonorrhoea or chlamydia in this area. I encourage you not to refuse the throat swab even if you rarely perform oral sex on men as there is no correlation between the time spent performing oral sex and contraction; it can happen from very brief exposure.
Note: if you are a woman who frequently practices anal sex, or a transgender woman who sleeps with men, it is also recommended to request a rectal swab.
Women who have sex with women
Women who exclusively have sex with other women will need a urine sample and a blood test. As with the first category a throat swab is not required as performing oral sex on a woman does not involve direct exposure between the vagina and the mucous membranes in the throat. Of course if you share sex toys with your female partners that involves any oral and anal penetration you can request a throat swab and a rectal swab as well.
Men who have sex with men
Statistically speaking this category is at the highest risk for contracting STIs and so ensuring you are receiving the right test is very important. Men who have sex with men require a blood test, a urine sample, a throat swab and a rectal swab.
A situation I occasionally encounter at work is men refusing the rectal swab because they identify as a “top”, or rather they are never the receiving partner during anal sex. While theoretically this makes sense, very brief exposure can lead to the contraction of an STI in this area. For example during foreplay any dipping, nudging or rubbing could be enough, and pre-ejaculate fluid also poses a risk. While the test can be mildly uncomfortable it is always better to follow the guideline for testing and have all bases covered.
The idea of “getting tested” is loaded with stigma and often spoken about with a sense of anxiety and dread. The language that we use and the way we talk about getting tested impacts on our desire to do so; if we are able to talk about STI testing in a more positive light then more people would be willing to get tested regularly. It is an incredibly simple process and knowing your sexual health status means you are able to have more-informed, better sex because you remove the anxiety of the unknown.
Who performs the test is also critical. A STI test should involve the healthcare worker taking a sexual health history which involves asking if you sleep with men or women (or both), and if you’ve had any recent events of concern you want to discuss. Depending on why you’re there you may also want to have them perform an exam on you. For these reasons it is important to feel comfortable and confident in this scenario; if you don’t feel that way with your current GP I encourage to you find a healthcare worker who you do feel comfortable with. Ask your friends or check google for any recommendations or you nearest designated sexual health centre. This is your chance to ask any questions about this topic and to remove some of the anxiety from getting tested so make sure the healthcare worker you’re entrusting is the right one.
Sexual heath is only one part of sex. The more you know about it and the more regularly you’re tested will create a sense of empowerment and you can then focus on the fun, intimate and exciting side of sex more fully. Remember the Hot on Health motto: there is no healthcare without self-care. Stay safe and have fun!
References/ Suggested Reading:
ASHA, 2014, ‘Australian STI Management Guidelines For Use in Primary Care’, Australasian Sexual Heath Alliance, viewed 15 June 2016, <http://sti.guidelines.org.au/>.
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 June 2016, <http://www.ashm.org.au/resources/Pages/1976963411.aspx>.