Why you need STI checks

For heterosexuals up to 29 years, an annual chlamydia test is recommended. Photo / 123RF

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. But, armed with a little information to counter all the misinformation out there, an STI check can be a really positive step towards keeping yourself healthy.

There are a range of different reasons for getting tested for a sexually transmissible infection (STI).

You can have an STI test any time if you just want to look after yourself and your partner/s, but you should have one at the following times:

• If you have symptoms or just feel something is not right
• If you think you may have an STI - perhaps a contact has been told they have an STI
• If you have had unprotected sex, perhaps a condom broke
• If you just want a routine sexual health check
• If you and a new partner are beginning a sexual relationship
• If you are pregnant

Many people, particularly women, with an STI have no symptoms so they, their partners or contacts may have no idea they have an STI unless they have a check.

STI symptoms take many forms. You might have 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. Or you may have no symptoms at all.

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 for in New Zealand include one or more of the following: chlamydia, gonorrhoea, syphilis, hepatitis B and HIV (human immunodeficiency virus). In some populations, the testing might also include hepatitis C, trichomoniasis or other vaginal conditions which may or may not be related to STIs.

Here's what your doctor or nurse might ask you to help them decide which STI tests you might need:

• your age and gender
• 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
• whether you have travelled to high STI risk countries and may have been exposed to an STI while there.

To give a fuller picture of STI risk, you could be asked whether you have ever paid or been paid for sex, been in prison, are using needles, or had tattoos or piercings done overseas or at home.

Although potentially daunting, most people believe that their doctor or nurse is the right person with whom to discuss their sexual health. A doctor 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 in many cases 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 if she doesn't have any symptoms. Women who have symptoms will still need to have a vaginal examination.

Chlamydia is the most commonly diagnosed STI in New Zealand. Chlamydia and gonorrhoea tests can be done on a urine sample from a man and a woman may be able to take her own swab if she hasn't got symptoms and doesn't need a cervical smear test. Urine samples are less accurate for women.

If there is a concern about anal sex transmission, you can collect your own swab from your rectum. Men who have sex with men and who are 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). These tests take a while to show up so you may need to delay having the blood test.

Trichomoniasis is also called trike. In women, it is tested for by taking a vaginal swab. Testing in men is unreliable.

Bacterial vaginosis (BV) and candidiasis (thrush) are caused when there is an imbalance in the usual bugs found in a woman's vagina. They only need treating when you have symptoms or are pregnant. You may be able to take a vaginal swab yourself but the doctor or nurse will want to examine you if you have symptoms.

If you need an examination, the doctor or nurse should explain the procedure beforehand. They should also tell you 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 sexually active heterosexuals up to 25 years old, an annual chlamydia test alone should be considered. However it is important not to wait until the year is up if you think you may have caught an STI. 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.
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 and the nurse or doctor will talk with you about safer sex options such as always using condoms to reduce the risk of another infection. The nurse or doctor will also talk with you about contacting your partner or partners and recommending that they too have an STI check and treatment. It is important that you don't reinfect each other so you should not have any sexual intercourse during the treatment time and for one week afterwards. For some STIs, including the most common - chlamydia - you will be asked to have another test three to six months after treatment. This is to make sure that you have not become reinfected.

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.

Melissa Kang is a Senior Lecturer, Department of General Practice at University of Sydney. She does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation.

Family Planning National Medical Advisor Dr Christine Roke also assisted with this article. More information on STI testing and treatment in New Zealand can be found at www.familyplanning.org.nz

Read the original article.