Sexually Transmitted Infections

Screening and Testing for Sexually Transmitted Infections

Some screenings, such as Pap tests that look for precancerous cervical changes, are offered to almost all women. Other screening tests are recommended only for pregnant women or at‑riskgroups, which usually include sexually active adolescents, people with a history of STIs, people with new or multiple sexual partners, people who use condoms inconsistently, and people who use drugs or do sex work.

You can find specific STI screening guidelines at the following website:

• Centers for Disease Control and Prevention

Individual risk depends not only on behavior but also on the prevalence of disease in your community. In urban communities and communities with high rates of poverty, some populations, especially African Americans and, to a lesser extent, Latinos, may be at greater risk, and broader voluntary screening of individuals without symptoms may be warranted.

The Limits of Screening

Sensitive and specific tests are available for chlamydia, gonorrhea, syphilis, HIV, herpes, trichomoniasis, and chancroid. However, no test is perfect, and even the best tests available occasionally produce false negatives and false positives. Sometimes, tests miss the presence of an STI, if the person exposed is still incubating the infection (for HIV, this is also known as the window period), or if the specimen isn’t collected or processed properly. There also are some STIs for which there is currently no commercially available lab test (e.g., for Mycoplasma genitalium).

Recommended Screening for Pregnant Women

Untreated STIs can reduce your ability to become pregnant and in some instances cause infertility. Because they can increase the likelihood of pregnancy complications and can infect a fetus or infant, early diagnosis is essential.

Pregnant women should be offered screening for HIV, syphilis, hepatitis B, and chlamydia, and possibly gonorrhea. A test for hepatitis C is recommended for women who use or have used injection drugs or received blood products, transfusions, or transplants prior to 1992.

An early prenatal visit is also a good time to check for bacterial vaginosis (BV) and to have a Pap test if it wasn’t done during the previous year or two. Some experts recommend that women who have had a premature delivery in the past be screened and treated for bacterial vaginosis at the first prenatal visit.

Infections first acquired during pregnancy are the most likely to be passed to the baby. Chlamydia, gonorrhea, syphilis, trichomoniasis, and BV can be treated and cured with antibiotics during pregnancy. Viral STIs cannot be cured, but antiviral medication may be appropriate for pregnant women with herpes and definitely is for those with HIV.

You may need more testing later on during your pregnancy if you are at risk of exposure (e.g., if you have new sexual partners). (For specific considerations, see the section below on individuals STIs.)

Where to Go for Care

• Public-health clinics (also called STI or STD clinics). Government-funded sexually transmitted disease clinics provide services, usually regardless of a person’s ability to pay. Clinic staff members are likely to have a lot of expertise in testing, diagnosing, and treating most STIs, and the setting may offer more privacy than your usual provider’s office. To find the nearest walk-in facility, visit hivtest.org. Enter your zip code and it will produce a list of nearby clinics that perform tests for HIV and other STIs, with detailed information about costs and the types of tests offered. You can also call the Centers for Disease Control’s national hotline (1-800-227-8922) for clinics in your area.
  
  
• Family-planning and community clinics. Most family-planning providers (such as Planned Parenthood clinics, local health departments, and other community clinics) also offer affordable and knowledgeable STI counseling, testing, and referral. In the rare cases when they don’t, they’ll know where you can get them. They are also likely to treat you with particular sensitivity around sexrelated issues. Many are low cost and also have sliding-scale fees. To find a clinic near you, go to plannedparenthood.org and enter your zip code.
  
  
• Primary care provider. Go to your regular health-care provider if you’re likely to receive clear, understandable responses to your questions. Family physicians, family nursepractitioners, and physician assistants are trained to test for and treat STIs. However, not all providers have the necessary equipment to do routine STI testing, and they may not know enough about these diseases. Ask whether your treatment follows the most recent CDC treatment guidelines.
   
  
• ER. If you have been forced into sexual activity and you’re afraid you’ve been exposed to a disease, most emergency rooms can give you preventive treatment for STIs, including HIV. Tell the ER staff if you need emergency treatment after being raped or sexually assaulted. Some ERs also have rape kits to collect evidence and can help you file a police report if you wish to make one. (For more information, see “Rape,” p. 700.) Unless you really need emergency care, however, the ER isn’t the best place to go. Since ERs focus on trauma and life-threatening illnesses, the hospital emergency staff won’t be able to give you the time, expertise, and sensitivity you may need to deal with STI issues. Also, test results will likely take longer when performed in the ER.

Excerpted from the 2005 edition of Our Bodies, Ourselves, © 2005, Boston Women's Health Book Collective.