April is STD Awareness month. This article is one in a series published by RH Reality Check in partnership with the National Coalition of STD Directors, focused on aspects of STD prevention, treatment and funding and the public health implications of neglecting STDs.
Got STD testing?
That’s right. Many people think about getting tested for Sexually Transmitted Diseases (STDs) like Madison Avenue made us think about buying milk: Just get it. When it comes to milk, that approach is fine. Milk is milk, regardless of who’s buying. Not so for STD testing. That’s because recommendations from the Centers for Disease Control and Prevention (CDC) regarding STD testing depend on the person getting tested, the gender of his or her sex partners, and the types of sex he or she is having with those partners. One size doesn’t fit all.
That distinction is critically important for men who have sex with men (MSM), among whom STDs (including HIV) exact a disproportionate toll and for whom CDC’s recommendations for STD screening are substantially different from its recommendations for women and men who have sex only with women. In my experience as a physician specializing in STDs, it’s rare that my MSM patients know which STDs they ought to be screened for, and how often. And studies show that MSM don’t get screened often enough for diseases like syphilis, gonorrhea, and HIV.
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This lack of knowledge would be less of an issue if clinicians did a better job of safeguarding the sexual health of their MSM patients. But clinicians often don’t know the sexual orientation of their MSM patients – and even if they do, they often fall short of CDC recommendations in advising their MSM patients about their sexual health. The following recommendations are meant to help MSM patients get screened appropriately for STDs, including HIV:
First, know which tests you need, and how often.
Get the following STD tests every three to six months, if you’re sexually active, regardless of how often you use condoms during sex and even if you’re having no symptoms (since many STDs, including HIV, can cause no symptoms):
- A test for HIV, if your last test was negative or you’ve never been tested.
- A blood test for syphilis.
- A test of your urethra for gonorrhea and chlamydia, if you’ve had insertive anal sex or received oral sex in the past year (or since your last test). The urethra is the tube that takes urine through the penis. In the past, testing meant inserting a swab into the urethra. These days, fortunately, all it takes is a urine sample. The best tests for gonorrhea and chlamydia are called NAATs, pronounced like “gnats” and short for “nucleic acid amplification tests.” Ask for them.
- A test of your rectum for gonorrhea and chlamydia, if you’ve had receptive anal sex in the past year (or since your last test). This is done with a (painless!) swab that’s inserted into your rectum. It should be tested with NAATs.
- A test of your throat for gonorrhea, if you’ve given oral sex in the past year (or since your last test). This is also done with a swab. This can be a bit uncomfortable if you’ve got a strong gag reflex, since the swab hits the back of your throat. But it’s not too bad, and it only lasts a second or two. Then it’s tested with NAATs. (Note that CDC doesn’t specifically recommend chlamydia tests of the throat, but in practice most NAATs test for chlamydia and gonorrhea at the same time.)
You should also discuss with your doctor whether blood tests for hepatitis B, hepatitis C, and herpes simplex virus type 2 are right for you.
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Second, know where to go.
Ask your doctor if he or she can do the tests above. If your doctor can’t, or if you don’t have a doctor, search for clinics that offer STD and HIV testing at findstdtest.org and hivtest.org, respectively. If you’re looking for a gay-friendly doctor, check out the Gay and Lesbian Medical Association’s directory.
Third, remember to get tested every 3–6 months.
Set reminders on your calendar. Or make a pact with a friend to get tested together at regular intervals, and remind each other. Or get reminded electronically. In San Diego County, where I work, we have a service, called “We All Test” (www.WeAllTest.com), that sends free email and/or a text message reminders to get tested for STDs every 3 or 6 months.
A handy sheet summarizing these tips is available for download here (although information on where to get tested is aimed at MSM in San Diego). Armed with this information, MSM asking the question “Got STD testing?” can make sure the answer they get is appropriate to keep them, and their partners, safe from STDs and HIV.