Q:

If you talk with someone about their sexual history and decide it seems 'safe' (relatively speaking) to have unprotected sex together would you still advise getting tested afterwards? And, if so, what would you advise being screened for? I ask because STI testing can be quite costly.

Also, whether I am doing things like that or not, how often should I be getting tested anyway??? Obviously, it would be ideal to be tested after each new partner, but what is the practical and advisable number if there doesn't seem to be an obvious risk for infection? Every 2? 5? More?

Thank you. I hope this question is not too confusing.

 

A:

There are several realities here, none of which is going to make you happy. Unprotected sex is risky no matter what, unless you and your partner have never had previous sexual contact with another person. STIs are so common now that not using a condom is playing roulette, but the most common STIs (HPV and Herpes) are not prevented by condoms.

No STI testing is 100% guaranteed to detect infection, no matter what you are testing for. So a "clean STI evaluation" is somewhat reassuring but never completely reassuring, no matter how frequently it is done. You are being tested for potential exposure to any STI your partner's former or current partners may have, as well as your partner's partner's partners and so on and so on. You get the picture...

There is no standard recommended time period between STI testing visits. If no change in partners (mutual monogamy), every 4-6 months for a year makes sense, and then if nothing shows up, annually. With a change in partners, a minimum of every 3 months until you are at least a year with nothing showing up.

Make sure you have Hepatitis B immunity on blood testing from previous vaccination. Make sure, if you are female, you have received the series of three HPV (Gardisil) vaccinations.

There is no test for males to detect Human Papilloma Virus, and testing in females does not accurately pick up external (vulvar) HPV. Herpes testing shows history of exposure only, not whether you are actively infected, unless a lesion is tested. Blood tests for Hepatitis B and C, and HIV have a window period where they will be negative before they turn positive, which is why follow up testing is so important. Chlamydia and gonorrhea testing is always a good idea since they are treatable.

You are taking a calculated risk anytime you are sexually active, protection or not. Reduce the risk as much as possible by 1) delaying sexual intimacy in a new relationship, 2) making sure you have the immunity that vaccinations offer, 3) using protection every time from start to finish and 4) knowing your partner's history. You can avoid a great deal of worry and grief caused by infections that can be life long, and that you can end up giving to someone you love.

~The Doc