STD testing: What's right for you?

If you're having sex, especially with more than one partner, you may have questions about your risks of getting sexually transmitted diseases (STDs). These are infections spread mainly by contact with genitals or bodily fluids. Bacteria, viruses or parasites cause STDs, also called sexually transmitted infections (STIs) or venereal diseases.

When should I be tested?

Everyone at risk of an STD needs to be tested. These infections can cause serious health concerns. You can have an STD without knowing it because sexually transmitted diseases often have no symptoms. Many experts use the term sexually transmitted infections (STIs) because that means there's an infection even without symptoms of disease.

What types of STD testing do you need? And how often should you be screened? The answers depend on your age, your sex life and other risk factors.

Don't expect to get STD testing every time you have a pelvic exam or Pap test. If you think that you need testing, talk with your healthcare professional about what tests you might have. Your healthcare team can work with you to decide if STD testing is right for you.

Chlamydia and gonorrhea

Some groups of people may be at higher than average risk of getting chlamydia or gonorrhea. Healthcare professionals may suggest getting tested for these STIs every year or even more often for:

• Sexually active people assigned female at birth who are younger than 25.
• Transgender people with a cervix who are younger than 25.
• People assigned female at birth who are older than 25 and who have a higher risk of infection. Having a new sex partner or having more than one partner raises the risk.
• Transgender people with a cervix who are older than 25 and who have a higher risk of infection.
• People assigned male at birth who have sex with others assigned male at birth.
• People with HIV.
• People who have been forced to have sex against their will.

You may be screened for chlamydia and gonorrhea with a urine test or a swab of the throat or anus. The sample then goes to a lab for study. Swab tests are particularly important for transgender women and for people assigned male at birth who have sex with other people assigned male at birth because urine testing may miss an infection.

HIV, syphilis and hepatitis

HIV testing may be recommended at least once as part of a routine medical checkup for people between the ages of 13 and 64. Younger teens or older adults should be tested if they have a high risk of an STI. If you have a high risk of infection, your healthcare professional may suggest HIV testing yearly or more often depending on your risks.

Hepatitis B screening may be recommended for people at higher than average risk. This includes all pregnant people, people who have close contact with someone with a hepatitis B infection and people with symptoms of the infection.

The American College of Obstetricians and Gynecologists suggests screening all pregnant people for syphilis at the first prenatal visit, in the third trimester and at delivery.

Talk with your healthcare professional about testing for HIV, syphilis or hepatitis if you:

• Have symptoms of infection.
• Have had an STI.
• Have more than one sexual partner or have a partner who has had more than one since your last test.
• Inject yourself with drugs through a vein.
• Have been in jail or prison.
• Were assigned male at birth and are having sex with others who were assigned male at birth.
• Are pregnant or plan to become pregnant.
• Have been forced to have sex against your will.

Your healthcare professional tests you for syphilis by taking either a blood sample or a swab from a genital sore you have. The sample then goes to a lab for study. Your healthcare professional also takes a blood sample to test for HIV and hepatitis.

Genital herpes

Healthcare professionals suggest testing people for genital herpes only if they have symptoms or other risk factors or have sex with people who have genital herpes. But most people with herpes never have symptoms. And they can still spread herpes to others.

Your healthcare professional may send a tissue sample or culture of blisters or early ulcers, if you have them, to a lab. But a negative test doesn't always mean you don't have herpes, especially if you have symptoms.

A blood test also may show if you had a past herpes infection, but you can't always trust the results. Some blood tests can help show which of the two main types of herpes you have. But there's no cure for either type.

HPV

Some types of human papillomavirus (HPV) can cause cancer, and other types of HPV can cause genital warts. Many people who have sex get HPV at some time in their lives but don't have symptoms. Most of the time, HPV goes away on its own.

For people assigned female at birth, HPV screening involves:

• Cervical Pap test. This test uses a swab to check the cervix for changed cells. Experts suggest that people assigned female at birth ages 21 to 65 have a Pap test every three years.
• HPV test. Experts suggest that people assigned female at birth ages 21 to 65 have an HPV test alone or an HPV test with a Pap test every five years if earlier test results have been within the standard range. People who are at high risk of cervical cancer or those who have Pap or HPV test results that cause concern may need testing more often.

People assigned male at birth may get HPV testing if they have symptoms, such as genital warts. A healthcare professional removes a sample of the wart and sends it to a lab.

An anal test that's like the Pap test also may be suggested for people at high risk of developing anal cancer. Sometimes called an anal Pap test or anal cytology test, it may be suggested for:

• People who've been diagnosed with precancerous conditions of the vulva or vulvar cancer.
• People who've had a solid organ transplant and are HIV positive, starting 10 years after the transplant.
• People assigned female at birth, starting at age 45 if they are HIV positive.
• People assigned male at birth who have sex with people assigned female at birth, starting at age 45 for those who are HIV positive.
• People assigned male at birth who have sex with people assigned male at birth, starting at age 35 for those who are HIV positive and age 45 for those who are HIV negative.
• Transgender women, starting at age 35 if they are HIV positive and age 45 if they are HIV negative.

At-home STI testing

At-home test kits for certain STIs, such as HIV, chlamydia, gonorrhea and syphilis, have become more common. For home STI testing, you collect a urine sample, a swab from your mouth or genitals, or a blood sample and then send it to a lab. Some newer tests process samples and give results through a software app.

Home testing lets you collect the sample without the need for a pelvic exam or office visit. If you test positive for an STI on a home test, contact your healthcare professional or a public health clinic to confirm the test results. If you test negative but have symptoms or know you have been exposed to an STI, contact your healthcare professional or public health clinic for more testing.

Positive test results

If you test positive for an STI, make an appointment to have more testing. Then get treatment from your healthcare professional if needed. And tell your sex partners. They also need to be tested and treated because you can pass some infections back and forth.

Having a positive STI test may make you feel shame, anger or fear. Know you did the right thing by getting tested. After testing, you can tell your partners, get treated and help keep others from getting the infection. Talk with your healthcare professional about your concerns.