Ask Amy #5: “When should I start getting STI tests?”

It’s been a while, but it’s time for another reader question! Don’t forget you can submit your own questions to me to be answered – anonymously – via Twitter or email.

A red condom and some pills. For a post about STI testing.Today’s lovely reader asks:

I have a possibly-stupid question about sexual health testing: I’m quite new to having any kind of sex, and have never had PIV sex. What point should you start getting tested? I obviously want to practice safer sex, but should I get tested now or does it not matter so much until I start having penetrative sex?

We had a bit of back-and-forth discussion and then they followed up with a second question:

To complicate things a bit, I’ve also learned that I have vaginismus. I’m planning to go to the GP about this, but it made me realise that I have zero idea what would happen when getting a tested for STIs! I assume this would involves things going into my vagina?

First: on when to test

My view is that anyone who is having any kind of sex with other people should be getting tested regularly, whether that sex is penetrative or not.

Different activities carry different transmission rates: broadly speaking, anal is riskier than vaginal, which is riskier than oral, which is riskier than hand sex or toy sharing. However, any sexual activity with another person does carry a level of transmission risk, including – for HSV or herpes – any skin-to-skin contact.

Please don’t take this as intended to scare you, dear reader – forewarned is forearmed.  Knowing the facts means you can take steps to look after your own and your partners’ health.

What barriers and safer sex methods you use is entirely up to you. Personally, I use condoms for PIV and shared toys (unless they’re pure silicone and without a motor, which can be boil-sterilised) and have hardly ever bothered with barriers for oral or hand sex. I’ve always been fine. Your level of acceptable risk may be different, and that’s completely fine. A good rule of thumb is to let the most risk-averse person set the level of precautions (e.g. “I don’t insist on barriers for oral but I’ll happily use one if a partner wants to”). And of course, whatever protective methods you ultimately decide to use or not use, it’s vital that this goes hand-in-hand with an open and honest conversation about testing practices and sexual history with your partner(s).

For more info on how to have this conversation, check out Reid Mihalko’s ‘Safer Sex Elevator Speech’.

Finally, this bears saying over and over again: Most STIs aren’t that scary, and the majority can be cured with a simple course of antibiotics if they’re caught early. A huge percentage of the population (between 50 and 90% depending on who you ask) is carrying the HSV virus, and the majority will never have an outbreak and may never know they’re carrying it. Even HIV, which many regard as the worst of the worst, is completely manageable these days and those diagnosed can live a full and normal life.

Knowing your status is your first and best weapon in protecting yourself, so please start getting tested as soon as you start having sex with other people.

Now, on to the second question: what actually happens when you go for a test?

It slightly depends on the clinic.

I’ve been going for STI testing regularly since 2009. Back then there tended to be a full, clothes-off-feet-up-in-stirrups examination by a nurse. But that hasn’t been the case for years. And as someone who has moved around a lot, I’ve been to quite a few different clinics.

Every clinic I’ve been to in the last 6+ years has asked for either a urine sample or a self-swab, the latter being more common. This is a tiny tiny thing that you put in your vagina for a few seconds, swirl around and then pop into a sterile container and give to the clinic nurse. You do this in private, either behind a curtain in the consulting room or in the bathroom. (If you’re having anal or oral sex, they should do rectal and throat swabs too, though I sometimes have to prompt for this). They’ll also do a blood test, which is the most reliable way to screen for blood-borne infections such as syphilis and HIV.

The most important bit is to speak to the nurse/practitioner on the day about any concerns you have, including your vaginismus. The swab things are really tiny (much much smaller than even the smallest tampon), but if anything going into your vagina is a no-go for you, they should offer you another option such as a urine test. STI testing shouldn’t have to be painful or uncomfortable.

At some point during the test, they’ll ask you some questions about your sexual history, especially your most recent partners. Some of the questions might seem weird or irrelevant, but it’s important to answer them honestly. A good healthcare practitioner shouldn’t make you feel judged for whatever you tell them, and if they do, you’re within your rights to gently push back or even ask to see somebody else.

After that, you usually wait two weeks for your results. Some clinics will text you to tell you everything is okay, and others operate on a “no news is good news” policy. If there are any issues, they will call you and ask you to come in to discuss the issue and your treatment options.

And that’s it! Go forth, lovely reader, and have lots of responsible safer sex.

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