Testing, Testing: All About Getting Tested for STIs

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Sam WallWhat does STI testing involve? How do you do it? Where? When? What do you do with your results? We answer all these questions and more to help demystify testing so you can take care of you and yours with less stress and more confidence.

Getting or having a sexually transmitted infection (STI) isn’t the end of the world most of the time for most people. But just like most of us want to avoid getting or passing on a cold, flu, or other infectious illness if we can, most folks want to avoid getting or passing on STIs. If you’ve spent any time around Scarleteen, you’ll know we remind people about STI testing often.

Testing is the only reliable way to know our status in the first place, which lets us and others make our best and most fully informed decisions. STIs can only have the capacity to be no big deal if we can get them treated, learn to manage them, or let extra vulnerable people know we have them: if we don’t get tested to know we have them in the first place, we can’t do any of that. And, of cource, not everyone can access treatment, and some STIs can require extensive and lifelong medications or other management, so the idea STIs are always no big deal is false. Whenever we can, it’s always ideal to avoid them ourselves and to help prevent others from picking them up.

Young people in the age group we serve most — people aged 15 – 24 — have the highest rates of STIs. There are multiple reasons for this. They include crummy or no sex ed, inconsistent, incorrect or no condom use, and misconceptions about STIs — like the belief that if you don’t have visible or otherwise noticeable symptoms, you don’t have an STI — that lead people to think they don’t need to be tested when they really, really do.

Even when folks know they should get tested, they put it off because the process seems intimidating or inaccessible. That’s where this article comes in; we’re going to try and help with that.

When Should I Get Tested?

Do you know you may have been exposed to an STI, like if you found out that a current or past partner (whether the sex you had was protected or not) tested positive for one?
Have you had unprotected sex, or survived an assault in which you know protection was not used?

In either of those cases, you’ll want to call into the clinic, doctor’s office or other testing site (if you’re not sure where to call or go, keep reading), let them know the situation and make an appointment. In the latter case, if you call ASAP, they may also be able to set you up with emergency contraception (EC or MAP) and/or post-exposure prophylaxis (PEP) if needed and wanted. After an exposure, when you should test depends on the STI. Different STIs have different “window periods” (the time it takes before they show up on a test). Some, like chlamydia, only take a week before they’re detectable, while HIV can take three months to do the same. Staff at a testing site can sort out the timing for you: you don’t have to figure that out yourself.

It’s ideal to get tested as a regular practice, not just when you’re worried you might have picked something up. If you’re in a monogamous or closed relationship, it’s best if all partners get at least one new, full round of STI testing 3-6 months into a relationship (if it continues for that long), then keep testing once a year.

If you’re single, poly or otherwise nonexclusive, you’ll want to make sure your testing history is up to date before you’re sexual with any new partners, and ask them to do the same.

In a poly relationship, how often to get tested depends on the structure and dynamics. If no new partners are added, testing once a year or once every six months should be enough. And if you really get stuck on how often you need testing, you can ask your healthcare provider for their advice.

How Do I Get Tested?

There are two primary options for getting tested: at home using a kit or in-person at a testing site. Which type of testing should you use? Here are some basic things to consider.

At-Home Testing

Home STI tests are gaining popularity, in no small part thanks to the COVID-19 pandemic. Too, the strain the pandemic is putting on healthcare providers can mean that clinics have limited availability and capacity for STI testing.

At-home testing can also be helpful for people who don’t have accessible testing where they live or who, for any number of reasons, feel more comfortable testing at home.

The general consensus is that at-home tests have close to the same accuracy as in-person ones, with some caveats.

Certain bacterial STIs, such as chlamydia, syphilis, and gonorrhea, are more likely to be accurately diagnosed through a culture. A culture is where a healthcare provider takes a sample from the area they think is infected and puts it in a special substance to see if the kind of bacteria they think is causing the infection grows. For example, if someone worries they have chlamydia, the healthcare provider looks to see if chlamydia bacteria grow in the culture.  Those bacterial STIs are less likely to be accurate diagnosed by rapid STI tests, which look for specific antibodies and are the kind that come with many STI testing kits.  Nurx does a great job of breaking down the sensitivity levels of different rapid STI tests and what that means in terms of trusting the results.

Another thing to keep in mind is that test accuracy depends on the test being done correctly, which isn’t as easy for untrained folks as home as it is for trained clinicians. If you follow the directions to the letter, you can often achieve the same level of accuracy as a healthcare provider would. But, as with birth control, user error can and sometimes will decrease the effectiveness of a test. That’s probably why some studies have found tests administered by healthcare providers produce slightly more accurate results.

There’s also the issue of cost. Depending on which testing service you use, which tests you buy, and your insurance situation, at-home tests can be pricey. Individual tests often cost around $50, and multi-test kits consistently break the $100 or $200 mark. So if money’s tight, at-home testing kits may not be accessible for you.

If you decide you’d like to try an at-home test, there are a few factors to consider to make sure you’re choosing a reliable one. If you’re in the U.S, you may notice some tests saying they use “FDA approved technology.” That language is misleading, because it doesn’t mean the test itself is approved by the FDA; just that some part of the process or kit is. Look for ones that say “FDA approved test” instead.

If the testing kit service has a website, check to see if they cite their sources when providing information about STIs, testing, and treatment. If you can’t find a single link to a reliable source, I would suggest looking elsewhere for a test. It also helps to look at their FAQ or how-to section to see if it’s robust. Since the accuracy of at-home tests depends on them being done exactly right, you want a service that’s taking steps to help you do just that.  If you use a service that has healthcare providers on call for consultation, you’ll want to be sure that the credentials of those providers are clearly listed somewhere. The same goes for kits that use a lab service; do you they tell you what lab service that is and whether it’s been certified by government health department?  Essentially, you’re looking for services that are forthcoming with information and understand that users have questions or need help, rather than ones that want to get your money, send you a kit, and be done.

In-Person Testing

At the current time, the biggest risk with in-person testing is the potential COVID-19 exposure that comes with simply going outside, let alone unto public transit or a rideshare, or into a clinic. While precautions like masks and social distancing can reduce the risks, the more people you come into contact with, the greater your chances of exposure to the virus. And with cases once again rising in most places, it’s best to avoid going out whenever possible.If you’re more comfortable being tested in-person, or at home tests are not accessible to you or don’t make sense in your situation, there are some basic considerations to help you find the in-person service that works for you.

A benefit of in-person tests is they’re generally less expensive than at home ones. If testing is covered by your insurance, you’ll only have to worry about a co-pay for your visit to a healthcare provider, which is usually between $10 and $30.  If you go to a healthcare provider for the test and don’t have insurance, the tests can run between $50 and $200. If money is tight or non-existent, you still have chances to get tested. Many countries, provinces, states, counties, or cities have programs that offer STI testing at free or reduced costs. If you can’t tell how much getting tested at a certain location costs, you can call or email them to find out what to expect.

The next step is to find a place to get tested.  This can be with a healthcare provider or system you already use, a sexual health clinic, and STI-specific resource like a mobile testing service.  If you’re stuck on where to start, sometimes the simplest way to find testing is search “STI testing” plus “your city/county/state/province”.

You can also use tools like the following to locate testing locations near you:

https://gettested.cdc.gov/
https://www.nhs.uk/service-search/other-services/STI-testing-and-treatment/LocationSearch/736
https://www.actioncanadashr.org/resources/services

One big concern people often express about in-person testing is about privacy, usually around whether parents or guardians can find out they got tested.  While some people may be fine asking the adults in their life for help accessing testing, lots of people would rather it stay private. In many places, if you’re 13 or older you can get tested confidentially (meaning the information isn’t shared with anyone, including your parents).  If you’re over 18, any doctor’s visits or other health information is automatically confidential.

If you’re worried that going to a sexual health clinic might get you in trouble, or you have absolutely no way to arrange a visit to a healthcare provider without your parent or guardian being part of the process, then going through your general healthcare provider might be your best bet. That way you can say you’re going for a general check-up (and make a general check-up appointment), but also ask for STI testing once you are your healthcare provider are alone together.

Using health insurance can also raise privacy concerns if you’re on someone else’s—like a parent’s-plan. Insurance plans send people statements that include what services the insurance was billed for. How an STI test shows up on an insurance statement, or if it shows up at all, depends a lot on laws where you live and the policies of the place you get tested. If you’re worried about it being seen, you can contact the provider you’re planning to see and ask if and how the test will appear on the statement.

One more consideration when getting tested in-person is transportation. If you’re deciding between several locations, factor in what kind of transportation you have access to (a car you can use, public transit, a bike, things like that).  If you have transportation issues, including that you want to keep the testing secret from the people you live with, do you have a way to get to the testing location on your own? Do you have a friend or supportive adult who can help you out? Asking those questions ahead of time can help you avoid setting up an appointment only to discover you have no way to get to it.

How Do I Know Which Tests I Need?

If you know you’ve been exposed to a specific STI, then you can request to be tested for that STI. You’ll also want to ask your clinician, or the customer service if you’re using a home test, if they advise you get tested for other STIs as well.  If you’re visiting a healthcare provider, a member of their staff will gather information on an intake form or in a short interview at the start of your appointment. In order to determine which STI tests you need, they will usually ask about your sexual history. That can include things like which specific sexual activities you’ve engaged in, which methods of protection were used, and how many sexual partners you’ve recently had. They may also ask about other risk factors, like any recreational drug use.

If you’re experiencing any symptoms that you think are related to an STI, you’ll also want to mention those during this discussion. How long have you been having the symptom? How frequently? Has it gotten worse or better since it started? The more information you can provide, the more you can help your healthcare provider work out what tests or exams you need. You don’t have to be the one to figure out what tests you need: that’s something healthcare staff are trained to do for you. So long as you give them all the information they need to do that well, they can do that for you.

If you’re testing from home and don’t know which specific test you need, you can approach your selection one of two ways: you can base it off the listed symptoms associated with each illness (which doesn’t help in cases when an STI is asymptomatic, as they often are) or cover all your bases and order a kit that tests for multiple STIs. Testing services may also have a questionnaire that uses your symptoms or exposure risks to determine what test you need, or may have a helpline you can call for guidance.

What Should I Expect From The Tests?

In many cases, there is more than one way to test for a certain STI. The exact way you test will often depend on whether you opt for an in-person or at-home option. If you test at home, you will either pee into a cup for a urine sample, prick your finger for a blood sample, or take a genital swab. You then send your samples to a pre-determined lab for analysis.

If you get tested in person, the type of test will depend on which STIs are being screened for and what your healthcare provider thinks is the most effective means of diagnosis. Here are the most common current ways of diagnosing STIs and other genital infections.

Bacterial Vaginosis – May involve a pelvic exam and/or examination of vaginal fluid.
Chlamydia – Can be diagnosed by a urine test or by taking a swab of the genitals.
Cytomegalovirus (CMV) – Diagnosed by a blood test, urine test, or biopsy of affected tissue.
Gonorrhea – Diagnosed by a urine test or a swab of the throat, urethra, vagina, or rectum.
Hepatitis B Virus (Hep B) – Requires a blood test to look for antibodies. The blood test can also tell your healthcare provider if the virus is acute or chronic.
Herpes – A healthcare provider will usually diagnose this through a physical and visual examination of the sores. If there are sores present, they’ll take a swab from them to analyze in a lab. If there are no sores and your healthcare provider determines you need a test, they will do a blood test that analyzes your blood for the presence of HSV antibodies (blood proteins that are produced in response to exposure to a substance, in this case, HSV) to detect a past herpes infection.
Human Immunodeficiency Virus (HIV) – Oral fluids collected via cheek swab to detect antibodies are the most common initial method of HIV testing. HIV can also be diagnosed with a blood test that involves either having a tube of blood taken from a vein or having a drop of blood taken from a fingerstick (like when people with diabetes check their blood sugar)
Human Papillomavirus (HPV) – HPV testing is only currently available for people who have a vagina: people who have a penis cannot yet be tested for HPV. It is often tested for during pap smears, or can be done by taking a sample of cells from the cervical canal. A special magnifying instrument called a colposcope can detect genital HPVs that cannot be seen with the naked eye during pelvic exams.
Molluscum Contagiosum – Some healthcare providers may try for a visual diagnosis, but the most accurate results come from a microscopic examination of tissue taken from a sore.
Mycoplasma Genitalium (Mgen)– Diagnosis requires a specific test called a nucleic acid amplification test (NAAT), which looks specifically for the genes found in these bacteria. Doctors who suspect this infection and want to test for it might take a urine sample or a urethral, vaginal, or rectal swab to be sent out for testing.
Pelvic Inflammatory Disease (PID) – There is no single test done for PID. Instead healthcare providers use multiple methods to come up with the diagnosis, including: a pelvic exam and microscopic examination and/or culture of vaginal and cervical secretions, a blood test, or an ultrasound. Your healthcare provider may also decide to perform an endometrial biopsy, where a small amount of the tissue lining the uterus is removed and examined under a microscope. For further diagnosis and assessment of damage a laparoscopy — a surgical procedure where an optical instrument is inserted through a small cut in the navel to look at the reproductive organs — may be required.
Pubic Lice – These can be seen with the naked eye or with a magnifying glass. Examination by your doctor can be used to confirm the diagnosis.
Syphilis – This can be diagnosed via a blood test, which looks for the antibodies that your body generates in response to the syphilis bacteria. If a healthcare provider suspects you have complications in your nervous system from syphilis, they may also test your spinal fluid.
Trichomoniasis – A healthcare provider will perform an examination of the genitals, and may also take a swab from them to examine under a microscope. If you have a penis, a urine test can be used.
Urinary Tract Infections – Clinicians may diagnose these based solely on your symptoms, but they often use a urine sample or urethral swab test to confirm the diagnosis.
Yeast infection: Diagnosis can involve a pelvic exam as well as a sample of vaginal fluid.

How Will I Get My Results?

It generally takes five to ten days to get your results back, though some tests take two or three weeks to generate results. How long it takes depends on what kinds of tests were taken and the specific lab they’re sent to. If you took them in a lab or the lab is close by, they’ll likely come back faster than if the samples have to be shipped farther for analysis. Too, sometimes labs get backed up because lots of tests come in at once, which can cause a delay in getting results to patients. If speed is important to you, some at-home services promise results within one to three days. Results will come in one or more of the following ways: phone/text, online, or in the mail.

If you were tested by a healthcare provider, you will want to talk with them ahead of time about when and how you’ll get your results. Some clinics will only call if you get a positive result, while others will call you either way. If you have an online “portal” that you use to schedule things with your healthcare provider, then there is often a section of that account where you can see your test results.

Many at-home tests offer the option of viewing your results online, as you often have to make an account in order to acquire the test. Some at-home test providers will also call to talk to you about the next steps if you have a positive result, or have a helpline you can call if you have questions about the results you received.

What Do I Do If I Test Positive?

If you test positive for an STI, try not to panic. The stigma around STIs can make it seem as though having one is the end of the world or a sign that you’ve done something wrong, but in reality, they’re no more shameful than catching a cold (which is to say, not shameful at all — we all have bodies, and all bodies get sick sometimes). They’re a possible and common outcome of certain forms of contact with another human, not an indication that you are — or anyone else is — a bad person.

If you were tested in-person and get a positive result, your healthcare provider should run through your treatment options with you and prescribe one (or more) as your next step. If you tested at home, almost all companies have healthcare providers on staff you can call (or who will call you) to discuss your options. Depending on the circumstances, they will either prescribe the treatment themselves or refer you to a local healthcare provider who can. Your next steps also depend on the kind of STI you have. Bacterial STIs like chlamydia or syphilis are curable with antibiotics. Viral STIs like Herpes or HIV cannot be cured, but they can and will need to be managed.

If you get a positive result, it’s also important for everyone’s health and well being to tell any current or recent sexual partners so that they can get tested and care for themselves and best protect any of their other partners, too.  Depending on how comfortable you are with different disclosure options, you can call, text, or tell them face-to-face. If you want to go with that last option and there are people you need to disclose to who are outside your COVID bubble, you need to wear a mask and stay six feet apart. Since that can add an extra layer of difficulty to the conversation, you may find video chatting on something like Zoom is the better option. If you’re not sure where or how to have those conversations, the tips in this piece on disclosing your STI status to a partner can help you out. There are also services that will help you generate a message and send it to a list of contacts, so if you have had multiple partners recently you can contact them all at once.

There you have it! Those are the basic steps of STI testing. Hopefully you now have a better of sense of what to expect, as well as the testing options that are the right fit for you. STI testing doesn’t have to be a huge, scary deal; it can just be another part of looking after your sexual health.

Illustrations by Archie Bongiovanni!

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