Sexuality is a means of pleasure, fulfilment and intimate connection with other humans. But it can also be a source of anguish. So it’s perhaps no surprise that of all the areas in health care, the “STI check” is one of the most fraught.
An STI check is one or more tests performed on a person who has no symptoms but is potentially at risk of having one or more sexually transmitted infections.
If you have symptoms – such as vaginal or urethral discharge; lower abdominal, pelvic, testicular or genital pain or itch; lumps, warts or ulcers in the genital area; unusual vaginal bleeding; painful urination; or anal symptoms if you have had anal sex – then the context changes to being a diagnostic assessment.
STI checks for asymptomatic people fall into the realm of “opportunistic health screening” – think blood pressure checks for hypertension, blood sugar tests for diabetes and other scenarios where you’re offered a test but have no symptoms. However, the STI check is not one-size-fits-all, nor does a “full STI check” actually test for all possible STIs.
So, which STIs are relevant to your own personal STI check? These are determined by your sexual history, what is known about the patterns of STIs in different populations, as well as the technical reliability of the tests.
The STIs tested include one or more of the following: chlamydia, gonorrhoea, syphilis, hepatitis B and HIV (human immunodeficiency virus). In some populations, it might also include hepatitis C, trichomoniasis or bacterial vaginosis.
Here’s what your doctor or nurse might ask you to help guide the STI check:
- your age and gender
- whether you are Aboriginal or Torres Strait Islander, or a recent migrant (if so, from where), or travelled recently
- your recent sexual encounters, including the number of partners you have had in the past three months
- the gender of your sexual partners ever (male, female, both)
- the nature of your sexual practices (vaginal intercourse, anal intercourse, oral sex)
- whether and how often you have used condoms
- whether you’ve had an STI check before and when
- whether you’ve ever been diagnosed with an STI.
To give a fuller picture of STI risk, you could be asked whether you have ever paid or been paid for sex, been in gaol, injected substances, or had tattoos or piercings done overseas or at home.
Although potentially daunting, most people believe that their GP is the right person with whom to discuss their sexual health. A GP or nurse who makes you feel comfortable is likely to be one who explains confidentiality, asks questions sensitively and gives you clear explanations of what the STI check will involve. They will also explain that choosing whether to answer questions is up to you.
When it comes to the tests, the good news is that technology has done away with the once-uncomfortable, or downright painful, swab up into the urethra of men, or the need for a woman to have a speculum inserted into her vagina.
Chlamydia and gonorrhoea tests can be done on urine samples in men and women or self-collected vaginal swabs in women. If there is a concern about anal sex transmission, you can collect your own swab from your rectum. Gay men having unprotected oral sex are advised to allow the doctor or nurse to collect a throat swab.
Syphilis, hepatitis B and HIV are tested for on blood samples, as is hepatitis C (this is an infection mainly passed on through sharing needles).
Trichomoniasis mainly affects Aboriginal and Torres Strait Islander women living in remote and regional Australia and can be tested for on a urine sample or vaginal swab.
Bacterial vaginosis (BV) is not strictly an STI but is much more prevalent in women who have sex with women. BV is diagnosed via a vaginal swab, usually collected by the doctor or nurse.
If you need an examination, it should be explained beforehand that you can request a chaperone in the room (such as a nurse present while the doctor examines you). A curtain and sheet for privacy are standard.
The recommended frequency of STI checks also varies. In heterosexuals up to 29 years, an annual chlamydia test alone is recommended. In men who have sex with men who have additional risk factors (such as any unprotected anal sex, ten or more partners in six months) testing every three months is recommended. Some people want an STI check when they embark on a new relationship and can request one.
It might be helpful to know that two of the most common STIs are not included in the STI check: human papillomavirus (HPV) and herpes simplex virus (HSV). This is related to the reliability of the tests and the way in which these infections spread in populations, making routine test unhelpful. If you have particular concerns about these infections, because of a known contact for example, it’s best to discuss this specifically with your doctor.
Follow-up is an important part of the STI check. Discussing the most reliable way of contacting you is part of pre-STI check counselling. You might opt for an SMS, or prefer a return appointment to go through everything.
If you do have a positive test, appropriate treatment will be recommended, supportive counselling provided, and notifying sexual partners will be discussed. Depending on the STI, you will be asked to try to contact sexual partners from the past two to 12 months. Your doctor, or a public health unit, can help and it can be done anonymously.
For some STIs, including the most common – chlamydia – you will be asked to re-test some time after treatment to make sure it has cleared and you are not reinfected. Many STIs are notified to central health surveillance units, an important part of managing communicable diseases.
STI checks are a way of being proactive and preventive when it comes to health. If sex and health are an important part of your life, then try to think of the STI check as something that will contribute to your enjoyment of both.