What Happens When You Go for an STI Test

Yesterday I went for my quarterly sexual health check-up. This is an important part of my life as a non-monogamous person and it’s now a really normal, routine, “no-big-deal” thing. But that wasn’t always the case! When I went for my first STI check-up at age 19, I was shaking like the proverbial leaf and had no idea what to expect.

Several medical sample tubes, for a post on STI testing

So let’s answer some common questions, shall we? Please bear in mind that my experiences are entirely based in the UK, so if you live in a different country your experience may vary somewhat.

Where do I even go for a test?

There are sexual health clinics or “GUM” (genito-urinary medicine) clinics at most major hospitals and at some smaller practices too. Just Google “sexual health test + [your town]”.

Some clinics have “walk in” times where you just turn up and wait to be seen. Bear in mind these tend to be VERY busy – I arrived 15 minutes before the clinic time officially started for my test, and still waited about an hour. Get there early, bring a book, and don’t expect to be seen in five minutes. Alternatively, some clinics have bookable appointments, where you ring up and book like any other medical appointment. Again, these services are very busy and in-demand so you might need to wait a couple of weeks to be seen. If you have symptoms, explain this at the clinic or on the phone and you may be seen sooner.

Do I have to pay?

Nope! In the UK, all sexual health services including testing and contraception are free of charge. Praise the NHS.

If I’m under 16, will they tell my parents?

No! As long as you’re over 13, you’re entitled to the same medical confidentiality as anyone. If your provider feels that there is a serious risk to your safety going on, such as sexual abuse, they may need to tell someone in order to keep you safe, but according to NHS guidelines “the risk would need to be serious and this would usually be discussed with you first”.

Also, if you’re under 18, get off my blog. This is not the space for you. Get yourself to Scarleteen.

Do I have to answer questions about my sex life?

Your provider will ask questions about your sexual practices so they can make sure they’re giving you all the tests and advice you need. You don’t HAVE to answer anything you don’t want to, of course, but it’s important to be as honest and thorough as you possibly can to make sure you get the best care. Everything you say is in strict confidence. Questions may include:

  • When was your most recent sexual encounter?
  • What is the sex of that partner? (They may assume opposite binary sex unless you tell them otherwise. It’s bad practice but heteronormativity is strong).
  • Is that partner your regular/only partner?
  • Have you ever injected drugs or knowingly had sex with someone who injects drugs?
  • Do you have reason to believe you might have come into contact with HIV?
  • Have you been raped or sexually assaulted? (If you indicate yes, they’ll ask if you need any support or resources).
  • Have you ever paid for, or been paid for, sex?
  • Have you had sex with someone born outside of the UK?
  • When was your last sexual health screening?
  • Are you pregnant or do you think you might be pregnant?

Once you’ve gone through these preliminary questions, it’s time for your test.

How is a test carried out?

There are slight variations depending on the clinic but here’s how it normally goes:

For folks with a vulva, you’ll swab the inside of your vagina and possibly provide a urine sample.

For folks with a penis, you’ll provide a urine sample and may also swab just inside your urethra.

If you engage in receptive anal sex, you will swab just inside your anus.

If you engage in oral sex, the health care provider will swab the back of your throat.

Unfortunately, anal and oral swabs are not always offered as a matter of course. You may need to prompt your provider for these. I strongly advise you do so, as infections can grow in these areas of the body without being present in the genitals.

The provider will then do a blood test to check for blood-borne STIs such as HIV, Syphilis and Hepatitis. (You can get a vaccination against Hepatitis B and if you haven’t had the vaccine, I recommend you ask your provider for it. This is most commonly offered to men who have sex with men, or women who have sex with bisexual men, but I really believe everyone should get it if possible).

You do the vaginal and rectal swabs yourself in private, either behind a curtain in the consulting room or in the bathroom. Your provider will give clear instructions on correct insertion of the swabs. There is not usually a need for a genital examination unless you have any symptoms such as genital warts, a rash or pain.

Does the test hurt?

Not really. Throat, anal and vaginal swabs aren’t exactly comfortable but shouldn’t be painful either, and they only take a couple of seconds. Some men do find the urethral swab slightly painful but, again, you only need to go very slightly inside and it only takes a few seconds.

Some people (hi, I’m one of them) find blood tests make them feel a bit sick and lightheaded. If this is you, tell your provider and they’ll let you lie down and should check on you at every stage. The actual test feels like a brief quick scratch, nothing more.

Will my provider judge me for the things I tell them?

They really shouldn’t. I’ve been getting STI tests regularly for 10 years and only a couple of times encountered a judgemental provider. And yes, I always tell them I’m a polyamorous swinger and exactly how many partners I’ve had since my last test.

Your provider’s job is to help ensure your health and safety, not to judge you. If you feel that they are overly judgemental or they make inappropriate comments about the things you tell them, you should report this to the hospital or practice.

Again: this is really rare. Most sexual health professionals are absolutely lovely. Comments I’ve had on explaining my lifestyle range from “sounds like you have lots of fun!” to “it’s great to see you’re being responsible and taking care of everyone’s sexual health”.

Even the judgy comments were hardly “you’re a filthy slut and you’re going to hell”. They were more along the lines of, “you need to be aware that you’re at high risk for STIs and unwanted pregnancy” (“no I’m not, because I take precautions and know the facts”, I did not say but wanted to).

How and when will I get my results?

Many clinics operate a “no news is good news” policy, meaning that if you don’t hear from them within two weeks you can assume everything is fine. But they should also give you a card or phone number with details on how to check your results if you want to be sure. I always recommend you phone, as it is rare but possible for a clinic to lose your samples. This happened to my partner once, and they didn’t call to let him know he needed to be re-screened until after the two week window had passed.

Other clinics may text or email you (usually something simple like “your tests or all fine”) or, less commonly, ring you to let you know you’re in the clear.

What if I do have something?

If you do have an infection, they will ring you to let you know. Then you’ll make an appointment to go back to the clinic and make a plan for treatment. For most of the common STIs, such as gonorrhea and chlamydia, treatment is a simple course of antibiotics.

For more serious STIs it’s more complicated (if you have HIV, for example, you’ll be on medication for the rest of your life – but you can still live a totally normal, long and fulfilling life). STIs are not a death sentence. They are not a source of shame. They’re things that humans sometimes contract in the course of doing normal human activities like having sex – and it’s much better to know so that you can get the most effective treatment quickly.

Bear in mind that HSV (herpes) and HPV (human papillomavirus) are EXTREMELY common – most of us are carrying one, the other or both and may never even know it! – and are not picked up on standard screenings unless you have symptoms such as warts. HPV can also be picked up on cervical screenings, so if you have a vagina make sure you go for your smear tests.

But STI testing is just for sluts!

Nope! Everyone, and I mean everyone, should be getting tests. Stigma like this, that people who go for tests are inherently slutty (and that being slutty is bad) contribute to the misinformation and fear-mongering that are already far too ubiquitous in our culture.

How often should I get a screening? 

That really depends.

My partner and I go every three months because we are non-monogamous and quite promiscuous. Three months is also about the longest incubation period for any of the known STIs, so this schedule means that if we do contract something we are unlikely to have it for long without finding out.

If you’re a swinger, polyamorous or have a lot of casual sex, I really recommend the three-monthly schedule. At an absolute, absolute minimum, please try to go every six months.

Even if you’re in a monogamous relationship, it’s wise to test every now and then if there’s ANY possibility that either of you has had sex outside of your relationship at any point. Unfortunately, cheating is rife and many people have caught STIs this way and not known they had them for months or years.

Whatever your relationship style, I recommend a test before every new sexual partner where possible.

Anything else I need to know?

Many clinics offer free condoms and, less commonly, dams (for oral sex on vulvas). Don’t be afraid to ask for supplies or take them if they’re offered to you. Using barriers is the best way to protect yourself and your partners from STIs.

When did you last get tested? If it’s been a while, go and book one in!

Five Meaningful Things To Do for World AIDS Day

December 1st is World AIDS Day. The AIDS epidemic, at its height in the 1980s and early 1990s, is still in many ways ongoing and has claimed over 35 million lives in the last ~40 years. Check out this fact sheet to learn more.

A red ribbon for a post on World AIDS Day

From the World AIDS Day website:

[World AIDS Day is] an opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV, and to commemorate those who have died from an AIDS-related illness. Founded in 1988, World AIDS Day was the first ever global health day.

Many of us, especially LGBTQ+ people, feel helpless in the face of something this huge. It scares the shit out of lots of us – and it should. AIDS was and is one of the most destructive pandemics in human history. But there is hope, too. UNAIDS have a hugely ambitious treatment plan which, if it works, will see 90% of HIV-positive people knowing their status, 90% of these on antiretroviral therapy, and 90% of these with a viral load declared “undetectable” – all by 2020.

So today I wanted to share some small but meaningful things you can do to make a difference this World AIDS Day.

1. Donate if you can

Donate to a charity that’s doing important work in the areas of HIV and AIDS. I suggest amfAR who are pioneering research into a cure, Terrence Higgins Trust who campaign and provide services connected to HIV and sexual health, or the National AIDs Trust who fight for change and champion the rights of people living with HIV/AIDS.

2. Get a test and know your status

When was your last full sexual health screening? Go book one in now! If you’re sexually active, you really should be getting a test every six months at a minimum – and more often if you have multiple partners, practice unprotected sex, or regularly have anal sex. I’m fairly slutty and I have a full screening every 3 months. Knowing your status is the best way to protect yourself and your partners.

3. Smash the stigma and share factual information

See people talking shit about people with HIV, AIDS or STIs? Tired of false information? Engage in some stigma-smashing by challenging them to rethink their views and sharing some facts. People living with HIV are not dirty, sluts, immoral or stupid. HIV cannot be transmitted except via infected blood or sexual fluids (or to infants via breast milk). It cannot be passed on through kissing, skin-to-skin contact, sharing food or drinks, water fountains, toilet seats, mosquitoes, saliva, sweat, or modern blood transfusions. This handy guide is useful to share.

4. Stock up on sexual health supplies

As many people as possible practicing safer sex is one of our greatest weapons against HIV/AIDS. Make sure you’re well-stocked with condoms, dams and gloves, as appropriate to the types of sex you have. If you can’t afford to buy supplies, ask your doctor or sexual health provider where you can access them for free. Remember to check your condoms and dams before using to make sure they’re still in date!

Pro tip: Gay bars/clubs and sexuality-focused events often give out safer sex supplies as freebies. If you go to any of these, don’t be scared to claim some for yourself! I used to go out to gay bars so often I don’t think I paid for condoms until I was 24.

5. Wear your red ribbon

The red ribbon is the internationally-recognised symbol of HIV/AIDS awareness and advocacy. Here’s a useful list of where to get them in the UK. If you can afford to, you can also buy a brooch version and support NAT’s work.

What are you doing to support World AIDS Day and show solidarity with people affected by HIV all over the world?

Image from Pixabay. Contains an affiliate link.

I Had My First Smear Test and…. It Was a Complete Non-Event

I am in my late twenties. In my country, people with cervixes are offered cervical smear tests (often called “Pap Tests” in the USA) every three years from the time they turn 25. These tests detect abnormal cells on the cervix and act as an early screening for cervical cancer or warning signs thereof. Until this week, I’d never had one, despite being several years overdue.

Two medical swabs face down on a surface. For a post on cervical smear tests.

The reasons for this are varied, but there are two main ones. The first is practical: I moved house a lot prior to moving in with Mr CK (11 times in 9 years by my count) and as such had to register with a lot of different doctors in different cities. I’m not sure one of the letters inviting me to book in for a smear even found its way to me until I was at least 27. The second reason is that I was scared. I had a horrible experience when I got my IUD put in about 3 years ago – pain that rendered me entirely unable to function for three days and very much struggling for over two weeks. Therefore, understandably, the idea of anything going near my cervix elicited a strong and visceral NOPE reaction from me. So I just kept putting it off.

What eventually pushed me into going for one was a person in my extended poly/swing network having something flag up on their screening. I realised that by not knowing my status, I am not only putting myself at risk (and there is some history of cancer striking young in my family) but also putting my lovers at risk. And I couldn’t do that. I made the appointment.

On the morning of, I asked Twitter how much pain I should expect. Answers ranged from “none” to “maybe a bit but it’s over quickly” to “you probably wanna book the day off work”. (It was a little late for that, of course). I popped a couple of ibuprofen, just to be sure. Had I not been driving, I might have gone straight for the codeine, which my doctor gave me for the severe pain when my IUD acts up.

So what happened?

I went in and the lovely nurse introduced herself and asked if I was happy to have a student nurse present for the test. I said I’d rather not as it was my first time, and they were both fine about that. She asked about my STI testing history. I said we test every three months and had in fact been the week before. She asked if I knew about HPV, and I said yes.

I went behind the curtain, took my knickers and jeans off, and got comfortable on the bed thing. (I’ve never understood the point of a privacy curtain when they’re literally about to look at your insides, but there you go). The nurse explained that she would open my vagina with a speculum and do a quick swab of my cervix. She said I might feel some pressure, but it shouldn’t hurt.

Having one’s vagina opened with a plastic speculum is never comfortable. (Unless you’re into that sort of thing. Which I actually am when it’s with a sexual partner in a roleplay scenario. But dear god, fun medical play is a MILLION MILES from an actual medical exam). I winced a bit but remembered to breathe. I braced myself for severe pain.

“There you go, we’re done”. And the nurse was removing the speculum from my vagina and taking off her gloves.

“What, that’s it?” I could hardly believe it.

“Yep!”

Wow, I thought. That really was nothing.

The whole thing took less than five minutes. I felt no pain and only the mildest discomfort. A tiny price to pay indeed for knowing my status, protecting myself and my sexual partners, and possibly avoiding cervical cancer in the future.

So why am I telling you this non-story?

Honestly, I was fully expecting to have to tell you a horror story involving immense pain, shitty judgemental clinic staff, an unplanned day off work or all three. But none of this happened.

So instead I thought I’d share this story in the hopes that, if you’re afraid of getting your cervical smear, this will put you at ease. The staff should be kind and understanding. You shouldn’t feel any pain – even if your cervix is extremely sensitive and grumpy, as mine is.

Please – if you have a cervix, get your test. It takes five minutes, it doesn’t hurt, and it’s a tiny thing that could potentially save your life. Just go. I’m now kicking myself that I didn’t go three years ago!

If this post was helpful to you, please consider buying me a coffee to say thanks!

Image from Pixabay.

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.

Again, please submit your questions to me for an anonymous answer on the blog. Patreon supporters get priority!