How Worried Should I Be About STIs?

The mere mention of sexually transmitted infections, or STIs, can generate significant anxiety, and conversations around sexual health are often shrouded in stigma and shame. The truth is, STIs affect individuals of all walks of life, regardless of age, gender, or sexual orientation, and they needn’t be a source of shame for anyone.

For someone with anxiety, both worrying that you might have an STI and the prospect of getting tested to find out can be agonizing.

Engaging in responsible safer sex practices not only promotes personal health but also contributes to a broader culture of well-being and awareness. As we work towards living the transparent, honest, and informed lives that constitute a cultural shift towards true consent, STI testing emerges as a pivotal component, bridging the gap between individual wellbeing and a collective commitment to a healthier and more aware society.

Safer Sex Practices

Anyone, regardless of age, socio-economic status, the type of sex they’re having, or who they’re having sex with can get an STI. There is no 100% prevention method, which is why we say, “safer sex practices” instead of “safe sex practices.”

However, there are many things that you can do to reduce your risk.

For example, we know that consistent and correct use of latex condoms reduces the risk of sexually transmitted disease (STD) and human immunodeficiency virus (HIV) transmission.

Consistent use means using a condom every time you have sex; STI transmission can occur from a single sex act. Correct use of a condom entails using it through the entire sex act without slippage, breakage, or leakage.

Non-latex condoms are somewhat more prone to breakage, so if no participating sex partner has a latex allergy it’s probably best to stick with latex. Keep in mind that oil-based lubricants can weaken latex condoms (and some kinds of non-latex condoms as well), so water-based or silicone-based lubricants are safer.

It’s also recommended to use barrier protection for all kinds of sex acts, even though people rarely use condoms or dental dams for oral sex. This is because, while the risk of transmitting HIV through oral sex is extremely low, many other STIs are highly transmissible through oral sex.

STIs Happen

The CDC reports that around 1 in 5 people in the United States have an STI. Some STIs are even more prevalent. For example, the Human Papillomavirus (HPV) is so common that 85% of people—or nearly every sexually active person who hasn’t been vaccinated—will contract HPV at some point in their life.

This is all to say, contracting a sexually transmitted infection is something that happens to many people. If it happens to you, it has absolutely no bearing whatsoever on your character. It doesn’t mean you’re “dirty,” irresponsible, that you’ve failed in your attempts at safer sex practices, or that life as you once lived it is over.

Once we remove the stigma and normalize frank conversations about sexual health, getting tested for STIs stops being scary and starts being attractive because, ultimately, it’s a way of caring for others and for yourself.

Self-respect and empathy are sexy.

Getting tested is a foundation of safer sex practices.

Ok, so, we’ve established consensus: STI testing is sexy! But, what now?

How do I even begin? What do I get tested for, where, and how often? What do I expect?

We got you!

How often should I get tested?

You should always get tested immediately if you have symptoms that might possibly be an STI. For example, the appearance of sores, unusual discharge, flu-like symptoms, and burning or pain when you pee or have sex would all be reasons to book an appointment. However, the absence of symptoms doesn’t mean absence of STIs, so don’t rely on symptoms as your sole indicator of when to get tested.

As a bare minimum, you should get tested once a year, even if you’re in a monogamous relationship.

When you find yourself in-between sex partners, that’s a time to get tested.

If you have multiple sex partners, you should get tested every 8-12 weeks, and if you’re involved in sex work, you should be tested even more regularly. Performers working within the adult industry testing program FSC-PASS are required to get tested every 14 days.

As long as you have these minimum bases covered, the sky’s the limit. Do your thing--- get tested as often as you want!

What should I get tested for?

Generally, if you walk in and say, “test me for everything,” you’ll get screened for: Chlamydia, Gonorrhea, Syphilis, Trichomonas, HIV, and Hepatitis C. In other words, “everything” doesn’t literally mean everything.

For example, it’s not common practice to test for herpes (HSV) if you’re asymptomatic, and the CDC only recommends testing for HPV for people with a cervix who are 30 and up, and even then, only every couple of years.

Your provider may offer population-specific recommendations, like these published by the CDC, but ultimately the decision about what to get tested for is yours alone.

Options for STI Testing

These days, there are more options than ever for seeking out STI testing.

Sexual health clinics are a great resource, especially if you don’t have health insurance. They generally offer sliding scale options for payment if you’re not covered. Massachusetts has many excellent clinics, like Tapestry in Western Mass and Health Imperatives on Nantucket.

If you’re not really feeling the face-to-face interaction, there are several mail order testing services available. Check out:

• Everlywell
• Nurx
• My Lab Box
• iDNA (I Do Need Answers)

You can also, of course, always go through your primary care provider if you have one.

STI Testing Methods

STI screening can include urinalysis, blood drawing (either a finger prick or a blood sample taken from your arm), and site-specific swabs.

The testing method will depend on:

• The STI: for example, Hep C and HIV are always blood tests.
• How you have sex: for example, if you receive unprotected anal sex a rectal swab might be indicated for certain tests.

If you have symptoms, a provider will examine you and might make recommendations for additional non-STI testing. This could include screening for a UTI, yeast infection, bacterial vaginosis, or cytolytic vaginosis.

Understanding STI Testing Windows

The amount of time it takes after intercourse for a new infection to be detectable varies widely depending on the STI and the testing method.

STI incubation periods can range from a week to twelve weeks. Chlamydia and Gonorrhea, for example, have shorter incubation periods than Syphilis, Hepatitis and HIV.

For this reason, it’s important to keep relevant timelines in mind relating to sex acts and sex partners, and to discuss the particulars the test(s) you’re getting with the person conducting the screening.

This is also a crucial conversation to have with new partners, in order to understand the accuracy of their testing practices. For example, if someone got tested several days after a sexual relationship ended, and received negative and non-reactive results, it may be that the window of time between possible exposure and screening was not long enough to detect possible STIs. 

Under-appreciating incubation periods is the number one whoopsie-daisy we see in our practice, and understandably, the calendar math gets a little complicated if you're juggling sex with multiple partners and their multiple partners.  Do your best to keep track, and try to hold some grace and compassion for yourself and the other people in your sex bubble.

Understanding Clinic Notification Practices

Different agencies and providers have different practices about how test results will be shared, and getting clarity on this process can help mitigate anxiety while you wait.

Ask questions about how soon the results will be available, and how results will be shared with you. Sometimes these answers depend on whether the tests are negative/non-reactive or positive/reactive.

For example:

• Some clinics may publish all test results on their patient portal that you can view as soon as the results are back.
• Some clinics require that results are reviewed by the provider that conducted the screening before being released, which could lead to a small delay.
• Other clinics require that positive/reactive test results are communicated by phone call, rather than patient portal.

We've had patients call us in a panic because they called the clinic to ask for an update on their results, and they were told "our Nurse Practitioner is going to have to call you back."  Understandably, they assumed this meant their results were positive, when it turned out, at that clinic, the Nurse Practitioner who ordered the tests had to review them all before they were allowed to be shared with the patient, regardless of what the results were.  Knowing this practice ahead of time could have meant skipping a good hour-long meltdown.

It's also helpful to factor in how long results will take. For example, if your test is Thursday afternoon, you might not see results until Monday afternoon.  We love a Tuesday or Wednesday appointment whenever possible!

Worrying while you wait

The Pomegranate Institute specializes in treating worriers! It’s normal to worry, even if your likelihood of having an STI is low.

Make a game plan for how to spend the time while you wait:

• Run down the clock: schedule little projects, errands, or activities to help pass the time.
• Make plans to connect with loved ones to keep your thoughts occupied.
• Remind yourself that this feeling of intense worry is not permanent; you will eventually have a definitive answer.

Be on the lookout for thought distortions and practice your CBT exercises to evaluate thoughts for accuracy and helpfulness.

For example, the automatic thought: “I’m going to test positive and my life will be over!” is a really stressful distortion. Remind yourself that most STIs are curable, and all are treatable.

Testing, Testing, 1, 2, 3: Talking to Partners about Getting Tested

We need to normalize talking to prospective partners about their STI testing practices.

Ask detailed questions about how often they get tested, what they get tested for, and what their safer sex practices are.  We've found that people will colloquially say they "always" use barrier methods with their partners, when in reality, what they mean is they use barrier methods when they have penetrative sex, but not when giving or receiving oral sex.   

We're big fans of asking to see recent test results, and not feeling guilty.  Try saying: “I get tested every twelve weeks and I like to share my test results with new partners; are you open to sharing your results with me?”

Remember to use verbiage like “my most recent test results were negative and non-reactive” rather than “I’m clean,” to avoid the implication that people who have experienced positive STI results or currently have an STI are “dirty.”

If you Test Positive and Need to Notify Past Partners

Say you do, in fact, test positive. What now? A positive diagnosis can feel overwhelming but luckily there are many resources to help.

First off, the place where you receive your testing will have recommendations about notifying past partners and how far back into your sexual history to extend.

Folks who have experienced a history of domestic violence in their current or past partnerships may have concerns about how disclosure may impact their safety.

There are anonymous notification systems that can send generic messages to past partners via phone or email, such as:

• STDcheck.com
• TellYourPartner.org

Keep in mind that some testing clinics may have a requirement to report positive results to the department of public health.

For circumstances where you do feel safe informing a current or past partner about your positive status, but you’re unsure of what to say, try: “Hey there’s no easy way to say this but I just tested positive for chlamydia. I’m not sure when I was infected, but you should get tested, and I would really appreciate it if you kept me posted on the results.”

Try not to frame positive test results as a “whodunit.” You aren’t realistically going to discover who transmitted the infection to you, and it’s much more likely that it was transmitted without the person knowing they had it.

Lastly, ask if the clinic has Expedited Partners Therapy, a process where partners of the index patient (the person who just tested positive) can get treatment without:

• having to wait to be seen, and
• wait for test results.

Making a Plan

You may be worrying while you wait because you're a worrier, but your worry might also be an indication that something about your own safer sex practices need to change.  Each time you get tested is an opportunity to reflect and decide if you want to change your plan moving forward.

For example, if you find yourself especially worried about your risk for HIV, now may be a good time to discuss PrEP with your healthcare provider.

Or maybe the screening process highlighted that you don’t have as much information as you thought you did about what safer sex practices your partner is following with their other partners-- now is an opportunity to revisit this conversation!

Conclusion

Prioritizing regular and transparent STI testing practices is not just about fostering a safer culture around physical intimacy, but also about dismantling the stigma associated with positive results.

Testing is an important part of safer sex, but it doesn’t make you “unsafe” if you test positive.

Remember, STIs are bacteria and viruses that spread from person to person during sex-- they aren’t a judgement on your character or your worth as person or a partner.

If you’d like talk more about this, schedule a free consult at The Pomegranate Institute.