Getting STD & HIV Testing Before Having Sex. Draft.

Draft



Getting STD & HIV Testing Before Having Sex

One strategy for reducing the risk of getting a sexually transmitted
disease (STD) is for you and a partner to get STD testing (including
testing for HIV) before having sex.

Getting STD & HIV testing is always a good thing, IF the meaning of
the test results, and what they imply regarding risks and risk
reduction, is understood.

Getting STD & HIV testing before having sex also shows concern for
your own health and the health of your partner, and indicates a desire
for openness and communication, which are good things.

However, it is important to understand that getting STD & HIV
testing before having sex might tell you little about the risks of
giving something to or getting something from your partner.
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If testing before sex leads to a false sense of security and sexual
practices that are more risky (for example, not wearing condoms when
you fuck), then it is a BAD thing.
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Before discussing getting tested, it is worth visiting the other
strategy--not getting tested.

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Not getting tested -- a bad strategy
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Many people feel that they do not have to get tested for STDs.

"I know my body. If I had an infection, I would know it."
Unfortunately, this is FALSE.

Many STDs can be present and transmissable without causing any
symptoms.

The majority of people with HIV probably acquired the disease from
partners who thought that they did not have HIV.

Sometimes the symptoms of STDs are slight,
or are not recognized for what they really are.

Often the symptoms go away without treatment
(even though the STD itself does not go away).

Given all of this, getting testing for STDs, even when symptoms are
not present, is an important part of staying healthy, and keeping
partners and the community healthy.

But, as you will see from the following sections, getting testing for
STDs and HIV before having sex tells you less than you might think.

"Knowing yourself" is no guarantee in you or in your partner that
you do not have STDs.

Your ability to detect an STD is actually quite poor.

Urethral infections
gonorrhea and
chlamydia in the throat
or butt,
syphilis,
warts,
molluscum, and
herpes are often not noticed by the people infected,
or are not recognized for what they are.

If you have had unprotected contact with a partner for some days,
weeks, or months, and have not gotten anything from him or her as best
you know, then:

You might already have gotten something from your partner and failed
to recognize it

You might have not gotten something from your partner that he/she
has, but you might get it the next time you have sex.

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Common Fallacies
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Many people who come to a clinic for STD testing expect
(1) to be tested for everything,
(2) that tests are 100% reliable, and
(3) that the test tells them their situation right now.

Unfortunately, none of these are true.

This is not Star Trek.

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Tests do not exist for some STDs
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No tests (in the sense of DNA tests, antibody tests, or cultures)
are available for
anogenital warts,
molluscum,
lice, and
scabies.

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Not all STDs are tested for
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Testing for STDs often does not include one or more of the following
tests:

A urine sediment that can detect evidence of some kind of infection in
the penis

Throat and rectal swabs that detect both gonorrhea and chlamydia

Tests for hepatitis

Tests for endoparasites

No clinic or doctor tests for all STDs.

There are no tests for the human papilloma virus that causes
anogenital warts, and for
molluscum.

If these bumps are present, and the healthcare professional looks for
them, then they might be detected.

But no healthcare provider can see viruses.

There are also no tests for the causes of urethritis other than
gonorrhea and chlamydia when the infections are in the throat or butt.

What tests are done vary.

Not every healthcare setting tests for chlamydia in the throat and
butt, for example, or does a urine sediment.

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Not all sites are tested
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Many clinics and doctors omit tests of the throat and butt for STDs,
or do not offer the tests to everyone who has sexual contact at those
sites.

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Some STDs can only be found by visual examination
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STDs that can only be detected by a visual examination include:

Anogenital warts

Molluscum

Lice

Scabies

For each of these, there are stages of infection that are
undetectable.

Also, the thoroughness of the healthcare provider in performing the
examination plays a central role.

If the healthcare provider omits the visual examination, then the
probability of their finding an STD falls to zero.

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STDs take time to reveal their presence
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In all cases, there is a period of time between when a person is
infected with an STD and the person has symptoms, and until the STD
can be reliably detected by STD tests or visual examination.

This period is often referred to as the window period.

STD tests taken today tell you your situation somewhere between
several weeks and 6 months ago.

For HIV, they tell most people their situation reliably 3 months ago,
and essentially everyone 6 months ago.

For warts, the window period can range up to a year or more, and some
people with the wart virus do not develop visible warts, though they
can still pass the infection to their partners.

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Tests are not 100% sensitive
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No STD tests are 100% sensitive, that is, none detect the STD 100%
of the time.

Amplified DNA tests are in the high 90s, as are a blood test for
syphilis when the person is in the secondary stage and an HIV test 6
months or more after exposure to HIV.

Even these tests are not 100% sensitive because of the possibilities
of errors in collection, labeling, storage, and transport of samples,
as well as of laboratory errors.

Other tests fall dramatically in sensitivity, especially if
infections are recent.

For STDs that can be only be detected visually, the sensitivity of the
test falls to zero percent if no signs of the STD are visible, or if
the healthcare provider does not look.

For STDs for which there is a test beyond visual examination, STD
tests offer a reasonable degree of reliability (perhaps 95 percent)
for the things that are tested for 3 months after the most recent
exposure (counting sexual contact with any partner).

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Results Do Not Equal Your Situation
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There is a difference between knowing the results of a test and
knowing your status.

A test can be negative, but that does not mean that you do not have
the STD.

Negative test results only mean that no evidence of the STD in
question was found.

If your last sexual contact before taking the test was before the
window period for the test, then the result of the test probably
reflects your situation.

But if you have had more recent sexual contact, then the result of the
test tells you less, and maybe nothing, about your current situation.

Rapid tests versus standard ones are no different with respect to
the information they give you about your status.

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Which Partners?
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If you are entering a relationship with a primary partner about whom
you are not concerned STD-wise (because you know him, and he knows his
body, and you are both getting tested), and you are getting tested
because you are concerned about other contacts, you need to understand
that you can also get STDs from your primary partner and, if he/she is
still in the window period, then the chance of detecting the STDs is
reduced.

From the standpoint of STD testing, what determines risk is what you
do with each partner, and what they have done with prior or other
current partners.

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Communication
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Communication in the relationship is probably more important than
testing.

Knowing what infections a person already has, and whether the
relationship is open or closed, is important.

Even when getting tests now, you will often have to rely on the
honesty of your partner to give you the results.

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Best Practices
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Best practices regarding STD & HIV testing for all open
relationships are:

Get tested routinely (for example, every six months) irrespective of
whether you have symptoms, and encourage all of your partners to do
the same.

Get tested if you notice (or a partner notices) any new symptoms that
might indicate STDs
(urethral symptoms, or
new bumps, sores, or
rashes)

Wear condoms when you fuck, inside and outside the
relationship.

Optimally, use them for oral sex.

Best advice for relationships where you want to bet your life on the
monogamy are:

Get tested for STDs (including HIV) at zero months (before having
sex).

This might pick up some infections.

For six months, wear condoms when you fuck.

Optimally, use them for oral sex.

Get tested again for STDs at 6 months.

For another six months, wear condoms when you fuck.

Optimally, use them for oral sex.

The point of this is to make it less likely that warts will be
undetected (though it does not guarantee this).

After this, you can discuss not using condoms when you fuck.
But remember, it is always safer to wear condoms.

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Recommended Tests
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We recommend the following STD screening tests every time you seek
testing, if they are available:

Blood test for syphilis

Urine sediment for white blood cells that are evidence of infection
in the penis

Amplified DNA testing for gonorrhea and chlamydia in the urine

If you have gone down on a male or female partner, DNA testing for
gonorrhea and chlamydia in the throat (amplified or nonamplified)

If there has been any sexual contact with a male or female partner
using your butt, including fingers and toys DNA, testing for gonorrhea
and chlamydia in the butt (amplified or nonamplified)

Visual examinations for STDs:

Lips and
mouth

Genital area in front (between the navel and half way down the
thighs),
including the lower abdomen,
pubic hair,
penis,
urethral meatus,
scrotum, and
groin.

External anal area and
buttocks

Checking lymph nodes in the groin for swelling
or tenderness