Being tested for sexually transmitted infections (STIs) can help keep you and your partners healthy and stop STIs in their tracks.
Sexually transmitted infections, or STIs, are an unwelcome intrusion into our sex lives, which can have serious health consequences if they aren’t diagnosed and treated appropriately.
If not treated some bacterial infections, such as chlamydia and gonorrhoea, can leave you infertile or with chronic pelvic pain. Other viral infections, such as herpes and HIV, are with you for life once you have them. In the case of HIV, a daily regimen of medication is required to keep the infection in check.
STIs are passed from one person to the next during sexual intercourse, and other activities where close physical contact occurs. Bacteria, viruses or parasites can all cause STIs, and in many cases, infection will not lead to any tell-tale symptoms.
Regular STI check-ups can be essential for diagnosing STIs in people who would otherwise be unaware of an infection. So, when should you head to the doctor for an STI check-up? And what does one involve?
Who’s at risk?
Australia’s STI landscape is changing. While notifications for chlamydia, gonorrhoea and HIV have been steadily increasing over recent years, the prevalence of other STIs, such as genital warts, is declining thanks to the introduction of a vaccination program targeting the wart-causing human papilloma virus (HPV).
In general, you are at greater risk of contracting an STI the more partners that you have, particularly if those sexual encounters are unprotected.
But some groups are at higher risk of infection, these include young people, men who have sex with other men, travellers, Aboriginal and Torres Strait Islander people, and injecting drug users.
Chlamydia is the most common sexually transmitted bacterial infection in Australia.
- More than 82,000 cases were diagnosed in 2012, the majority in young people aged 15-29 years.
- Estimates suggest around 1 in 20 young Australians are infected
- Up to 90 per cent of these infections have no symptoms.
Guidelines for Australian general practitioners recommend testing young people, aged 15-29 years for chlamydia once every 12 months.
Heterosexual men and women are no longer routinely tested for gonorrhoea.
Your doctor may also suggest you consider a HPV vaccine if you haven’t already been vaccinated through the school vaccination program, which began in 2007 for girls and 2013 for boys.
Women should have Pap smears every two years to detect changes to cervical cells that may result from HPV infection.
Men who have sex with men (MSM)
Gay and bisexual men are at increased risk of contracting a wide range of STIs, including HIV, gonorrhoea and syphilis.
In 2012, MSM accounted for 88 per cent of newly acquired HIV infections.
Guidelines recommend MSM be tested annually for:
- hepatitis A and B if not immunised,
- hepatitis C if HIV positive or using intravenous drugs.
More frequent testing – once every three to six months – is recommended for men who have unprotected anal sex, have had more than 10 partners in the past six months, participate in group sex, or use recreational drugs during sex.
Aboriginal and Torres Strait Islander people
Rates of diagnosis for chlamydia, gonorrhoea and syphilis are higher for people who identify as being of Aboriginal or Torres Strait Islander status. Hepatitis B is also more common in Indigenous Australians. Remote Indigenous communities are at higher risk than communities living close to urban or regional hubs.
Young Indigenous Australians may be tested for:
- hepatitis B.
In some communities, tests for syphilis or trichomonas might also be appropriate.
People often take greater risks, such as engaging in unprotected sex or visiting sex workers, when they are on holiday.
This can place them and their partners at risk of contracting STIs. A 2008 study in Western Australia found that over 85 per cent of heterosexual men and 56 per cent of heterosexual women newly diagnosed with HIV acquired the infection overseas.
Returning from overseas travel is a good time to visit your doctor for an STI check-up.
Injecting drug users
Blood-borne viral infections, such as HIV and hepatitis B and C, can be transmitted from person to person via shared needles.
Injecting drug users are also at increased risk of STIs including chlamydia, gonorrhoea and syphilis.
What happens during an STI check-up?
Just as the risk of contracting an STI varies from person to person, a sexual health check-up will also vary from one person to the next.
If you request an STI check-up, because you have had unprotected sex or you wish to get a clean bill of health before commencing a new sexual relationship, your doctor may request a more thorough STI screen. Under these circumstances your doctor may also request more information on your sexual history than if they were simply offering a routine test.
Each STI requires a specific sample to be taken for laboratory analysis. In many cases, a single sample will be tested for multiple infections at once. The following is a list of samples that your doctor might require:
- Urine: to identify chlamydia and gonorrhoea.
- Vaginal or cervical swab (women): can be used to grow (or ‘culture’) infectious organisms such as gonorrhoea and trichomonas in the laboratory. A pap smear is often performed at the same time.
- Anal, urethral or throat swab (men): Swabs from specific sites help to ensure that chlamydia and gonorrhoea infections do not go undetected. MSM will commonly be tested at all sites, whereas heterosexual men are usually only required to provide a urine sample.
- Blood: is used to detect the presence of antibodies, proteins made by the body in response to a specific infection. Antibody tests are used to diagnose HIV, hepatitis A, B and C, and syphilis. Most infections have a window period between when exposure to the infection occurs and when it can first be detected through laboratory tests. This window period can last up to 12 weeks for HIV and syphilis, and retesting once this window period has elapsed is the only way to ensure that a new infection is detected.
Test results are usually available a few days after samples are collected; however, rapid HIV tests that can provide on-the-spot results are being adopted by some services as a preliminary screening tool for people at high risk of infection.
What if you have symptoms?
Having an STI check-up when you don’t have symptoms is a responsible way of stopping the spread of STIs and protecting yourself against complications from undetected infections.
But the most important time to have your sexual health checked is if you have any of the following symptoms:
- Lumps and bumps: These can be due to normal anatomical variations, but if new lumps and bumps arise on or near the genitals, they could be genital warts (caused by a wart-causing HPV type) or a viral infection called Molluscum contagiosum.
- Ulcers: Blisters, sores and split skin is usually due to genital herpes, which can be diagnosed by taking a swab of the lesion. Syphilis causes distinctive lesions that will be confirmed by blood test.
- Discharge in men: Infection of the urethra – the tube that enables men to urinate and ejaculate – can result in inflammation and discharge. Discharge can be indicative of chlamydia or gonorrhoea; however, many infections are asymptomatic.
- Discharge in women: Vaginal discharge can indicate infection with chlamydia, gonorrhoea or trichomonas. But other conditions, such as bacterial vaginosis and vaginal thrush (which is not an STI), can also cause vaginal discharge.
- Pelvic pain: Chlamydia, gonorrhoea and Mycoplasma genitalium can pass through the cervix to infect the uterus and fallopian tubes – the upper genital tract – in women. These infections, known collectively as pelvic inflammatory disease (PID), can be severe, causing acute pain, fever and scarring that can result in infertility.
Additional information and factsheets on STIs can be found at the Melbourne Sexual Health Centre website: http://mshc.org.au/STIsInformation/tabid/219/Default.aspx.
If you have been diagnosed with an STI, it is important that you not only get properly treated, but that you also inform your current and previous sexual partners so that they too can be tested and treated.
Different STIs have different notification periods, according to the Australasian Contact Tracing Manual.
Guidelines for some of the most common STIs in Australia are:
- Chlamydia: inform all partners from the past 6 months
- Gonorrhoea: inform all partners from the past 2 months
- HIV: inform all known sexual and needle-sharing partners since last negative test or start of unprotected sex or needle sharing
- Syphilis: inform partners up to the past 12 months, depending on stage of infection
- Genital herpes: partner notification is not recommended for infection with HSV1 or HSV2
- Genital warts: partner notification is not recommended
The following sites provide resources to assist you with informing your sexual partners that you have had an STI diagnosis, including methods for anonymous partner notification: