STD Tests
Sexually Transmitted Disease Tests
What you can expect during an STD examination and which tests are performed for Sexually Transmitted Diseases may vary from one doctor to the next for a multitude of reasons.
Firstly, there are more than 20 Sexually Transmitted Diseases and testing for all STD's in all patients is cost-prohibitive and just not feasible. Furthermore, some STD's do not have laboratory tests which are capable of detecting them. An example of an STD that does not have a corresponding laboratory test currently available for detection is Human Papilloma Virus in men. Additionally, laboratory detection of certain STD's such as syphilis and HIV may require a time period of 90 to 180 days before laboratory testing is capable of detecting those diseases.
For all of these reasons mentioned above, it is practically impossible for one to be certain regardless of how many laboratory tests are performed that they are 100 percent free of STD's and those organisms that cause them. It is even possible for someone to have never before had sexual intercourse and to still be infected by one of the organisms that causes Sexually Transmitted Disease. An example of this is that many people prior to having had sexual relations may already be infected by the Herpes type 1 virus. This is most likely the result of transmission from adults to children during routine, nonsexual interactions.
The best way to be as certain as is practically possible that one is free of STD's is by consulting with a physician with expertise in Sexually Transmitted Diseases. It is very important that you provide honest answers to questions such as those contained in the Sexually Transmitted Disease Questionnaire provided on this STD Exam website. A qualified physician will use this information to complement a thorough physical examination to determine which STD testing should be performed. By utilizing the information you provide and the their findings on physical examination the qualified physician will recommend certain directed STD tests. It is of utmost importance that you return to that physician for explanation and interpretation of the results of your STD testing. Post testing counseling by that physician should include an explanation of the results, discussion regarding prevention of transmission should any disease be found, administering treatment where needed, discussion of follow up testing and monitoring as needed as well as prevention of contracting additional STD's.
If you choose to be sexually active it is important that a comprehensive physician consultation along with "routine" STD testing be part of your health maintenance program. However, you must understand that if you choose to have sexual relations, even with the most comprehensive testing of your partner and consistent use of condoms, you are still at some risk for contracting a sexually transmitted disease.
Recommendations for which STD tests should be performed is often determined by gender, whether symptoms of STD's are present and the past sexual experience of the patient and their partners.
STD Testing for Men and Women Without Symptoms
STD Testing for Women Without Symptoms
Most physicians concur that all patients, male and female, being evaluated for STD's should be offered HIV testing. Most would also suggest a blood test for hepatitis B.
There is uniform agreement amongst doctors that routine STD testing in women most definitely requires a Pap Test. The Pap test, also called a Pap smear, checks for changes in the cells of a females cervix. The cervix is the lower part of the uterus (womb) that opens into the vagina (birth canal). The Pap test can detect an infection, abnormal (unhealthy) cervical cells, or cervical cancer.
Your doctor can do a Pap test during a pelvic exam. It is a simple and quick test. While you lie on an exam table, the doctor puts an instrument called a speculum into your vagina, opening it to see the cervix. She / He will then use a special stick or brush to take a few cells from inside and around the cervix. The cells are placed on a glass slide or in a special solution and sent to a lab for examination. While usually painless, a Pap test is uncomfortable for some women.
Additionally, many physicians believe that yearly testing for gonorrhea and chlamydia is indicated for many women without symptoms. Their recommendation is based upon the fact that untreated gonorrhea and chlamydia in women can lead to serious health consequences.
STD Testing For Men Without Symptoms
Most physicians concur that all patients, male and female, being evaluated for STD's should be offered HIV testing. Most would also suggest a blood test for hepatitis B.
The Centers for Disease Control and Prevention (CDC) guidelines do not suggest routine STD testing in men that do not have any symptoms, unless their sexual practices include having sex with men.
For men who have sex with men, the CDC suggests annual screening for HIV, syphilis, chlamydia and gonorrhea is recommended.
In addition to these guidelines established by the Center for Disease Control, many physicians recommend that men who are sexually active receive additional yearly STD screening tests such as gonorrhea, chlamydia, and syphilis as these diseases can be present without any symptoms at all.
STD Testing for Men and Women With Symptoms
It is imperative that you see a physician and receive appropriate STD testing if you have any of the following symptoms. When symptoms such as those listed below are present, the appropriate STD testing to be performed can only be determined by consultation with a qualified doctor trained in the diagnosis of sexually transmitted diseases.
genital sores
genital ulcers
genital blisters
genital growths or warts
vaginal or penile discharge
abdominal / pelvic pain
fever
testicular discomfort / pain
joint pains
painful or trouble urinating
any combination of fever, fatigue, swollen glands, decreased appetite, sore throat, diarrhea (symptoms of an acute HIV infection)
STD Test Recommendations By Disease Including Description of How Tests Are Obtained
Gonorrhea and Chlamydia
Since untreated gonococcal infection can lead to serious complications in women, including pelvic inflammatory disease and infertility, many doctors believe testing for gonorrhea yearly should be performed in women without symptoms with one or more of the following risk factors; sexually active women younger than 25 years, inconsistent condom use, a history of multiple partners or a partner with multiple contacts, sexual contact with a partner with culture-proven STD, a history of repeated episodes of STD, sex work or drug use and pregnancy.
Collecting the specimen for Gonorrhea and Chlamydia screening is either done through a urine test or through a swab of the genitalia. The sample is sent to a laboratory to be analyzed. Physicians suggesting these tests be done routinely recognize that approximately 80 percent of women and 50 percent of men diagnosed with chlamydia don't have symptoms at the time of diagnosis.
Because gonorrhea and Chlamydia can also exist in men without causing any symptoms, many men choose to have these tests performed yearly as well. However this is most frequently recommended by doctors for those men without symptoms who are having sexual relations with men.
Syphilis, Hepatitis and HIV
Many physicians include these tests in their routine STD screening. They especially recommend these tests for those with multiple sex partners, IV drug users, pregnant women, commercial sex workers, persons in correctional facilities, men who have sex with men, those who for whatever reason believe they may have been exposed to these diseases, and those that test positive for other STD's since they are at greater risk of other STDs such as syphilis, HIV and hepatitis.
In order to test for syphilis the doctor tests by taking either a blood sample or a swab from a genital sores. The sample is sent to a laboratory for diagnosis. HIV may be tested on a swab specimen from the mouth or by a blood test sent to the laboratory. Hepatitis is also tested on a blood specimen sent to the laboratory.
If syphilis or HIV has just recently been acquired it is possible for the test result to return as negative. If you or your doctor suspects this is the case, retesting at a later date is required.
If an acute HIV infection is suspected (any combination of fever, fatigue, swollen glands, decreased appetite, sore throat, diarrhea) a blood sample for HIV RNA should be sent to the laboratory for detection.
Herpes Simplex
Unfortunately, there are no very accurate screening tests for the herpes virus. Cultures of open sores and blisters if positive are conclusive but negative results do not exclude the existence of herpes infection.
A blood test may also help detect a herpes infection. However results are often inconclusive. False-positive and false-negative results are possible. This means one may be infected with the herpes virus and test negative or one may not be infected with the virus and test positive.
For reasons noted above many physicians do not suggest Herpes testing as part of "routine" STD testing.
HPV
There are greater than 120 related viruses that can cause HPV infection. Some of these viruses cause no symptoms whatsoever while others cause warts and a few may cause cervical cancer. At least 50 percent of sexually active males and females will acquire an HPV infection in their lives.
HPV may be detected in a female during the Pap test if cellular changes consistent with HPV are found. A separate HPV DNA test may be collected with a brushing from the cervical canal at the same time as the Pap test. HPV DNA testing is available for low risk HPV which may cause warts and high risk HPV that may result in cervical cancer.
No laboratory testing is available to detect HPV in men other than surgical biopsy of warts. HPV may be detected by visual examination alone to a great degree of certainty by a physician trained to recognize STD's.
For reasons noted above, in women HPV may be detected during the routine Pap test but a normal test does not exclude the possibility of HPV infection. HPV DNA testing is usually not recommended as part of "routine" STD testing in patients without symptoms.
In men, inspection of the genitalia can help detect warts resulting from HPV but a negative examination does not exclude the possibility of HPV infection.