STD Questions To Review at Your Next Appointment

Most people think they know the gist of STD testing: After you are sexually active, you show up and get tested, right? However, it’s a bit more complex to know if you have been tested at the right time and for the right disease. So, here are a few tips for you to guide your discussion with your gyno regarding STD testing:

1. Have I been exposed?
2. What is the incubation time of what I was exposed to?
3. How accurate is the test I am taking?
4. Am I immune?
5. Should I take a post-coital prevention?

These are questions that many patients aren’t even aware need to be answered. So, why do they need to be asked in the first place?

1. I had sex without a condom. Just how likely is it that I have been exposed? This may seem like a simple question, but exposed to what? Just an STD? Unfortunately, things aren’t that simple, since there are many STDs that one can be exposed to, such as HPV, Herpes, HIV, Syphilis, Chlamydia (CT), and Gonorrhea (GC).
   • 80% of sexually active people have an HPV infection at some point in their lifetime, so yes, you most likely have been exposed.
   • HSV infection is even more common, and 90% of people with genital herpes don’t even know they have the infection!
   • HIV is more rare and in clusters in certain cities and populations, fortunately, much less likely to be exposed.
   • Syphilis rates are rising and it’s very contagious. 30%-60% of those exposed to syphilis will contract the disease.
   • (CT) is also very common, 1 in every 20 sexually active women has CT.
   • (GC) you can get even if no ejaculation occurred. Around 20% of women exposed to the disease will contract it, however, this number rises to around 60%-80% after 4 or more exposures. So message here: condom consistency is critical!
2. How soon can I test for anyHSV STD infection I may have been exposed to? Incubation time is the period between acquiring an infection and having the condition to become apparent. Know the STD incubation time so it can be determined when you might have contracted the disease, and plan your gyno visit accordingly.
   • HPV’s incubation time is from 2 weeks to 8 months, with the most common symptom of genital warts appearing at around 2-3 months, but abnormal pap smear incubation can be a lot longer.
   • HSV’ incubation time is relatively quick, as symptoms begin to appear between 2-12 days after being infected. However, there are people who actually had the condition before, and first symptoms are actually not your first infection.
   • HIV’s incubation time varies with age, but the average period for adults is estimated to be around 10 years!
   • Syphilis’ incubation time can range from 10-90 days, so get a check up, and then be vigilant, in a few months, check up on your check up.
   • CT’ s from exposure to development of symptoms is typically around 1-3 weeks.
   • GC’s incubation time is around 1-14 days.
3. How accurate is STD testing? Very, but not perfect.
   • The newest for HPV , can identify 95%-100% of risk of advanced cervical disease, but they have eliminated HPV testing for the types that cause warts.
   • The most accurate blood tests for HSV detect IgG antibodies, of which these tests prove to be close to 100% accurate. However, these tests cannot determine whether the site of infection is oral or genital, nor when you actually acquired the disease. Cultures are positive as soon as there is viral shedding, but that varies a lot!
   • The test for HIV can be done via blood sample or oral swab and require a few week window period for an accurate result. The test accuracy is 99.68% for blood.
   • Testing for syphilis is a two-step identification and confirmation process on blood, but very accurate once completed. There is also a possibility of false positives with syphilis testing within the initial 90 days of exposure. There is also a possibility that those who have had syphilis in the past have lingering antibodies in their bloodstream, which can also produce false positives.
   • For CT tests, the most common way to get a false negative would be to test too early after having unprotected sex. The most accurate tests are given after 2 weeks.
   • For GC, it is similar to chlamydia, where inaccurate tests are given too early and it is best to show up at least a week 7 days in order to obtain the most accurate results. Don’t dawdle too long, if either gonorrhea or chlamydia track up into your uterus, you can develop PID and risk permanent scaring.
4. I already had an STD, I figure I immune. Is this true? There is some truth to this, with some infections, but some are just too wily to give you immunity.
   • There is a vaccine for most types of serious HPV, and yes, if you have contracted one, you won’t get that one again. But there are many types you probably haven’t developed immunity to.
   • Currently, there is no effective vaccine for all herpesviruses. For humans, there are 8 different herpes viruses and there is only an effective vaccine for one HSV cousin, (chickenpox). There is a possibility of there being some degree of immunity in some people, however, use protection and do not assume you and he share the same virus!
   • The percent of people with this resistance to HIV is under 1%.
   • There is no natural immunity to syphilis and past infections do not offer any protection to patients for future cases.
   • There is no immunity to CT, you can get re-infected over and over!
   • Similarly to chlamydia, there is no immunity with and just because you contract it once, doesn’t mean you can’t get it again, what’s worse, the gonorrhea bacteria has proven to be resistant to antibiotics.
5. I am a planner. What if our condom breaks. Should I immediately go for treatment? In many cases, yes, but with so many conditions and so many treatment options available to you and it is important that you first discuss all options. Here are a few tips.
   • Get vaccinated for before exposure not after HPV exposure, there is no treatment for the virus itself.
   • For HSV , there is a specific antiviral therapy that can decrease the severity of initial genital herpes infection and recurrences once infected, but taking the medicine cannot prevent you from getting the infection.
   • There is medication that can suppress the HIV virus and keep the immune system working to prevent illnesses. It is important for you to know your own status so that you can begin your treatment plan. It is also important for your sexual partners to be aware of your status.
   • The best way to prevent syphilis (and most STDs) is to practice safe sex, but rapid post-coital treatment might work. Again: it is important for your partner(s) to also be tested and/or treated.
   • There is antibiotic treatment for both GC and CT once exposed, however, these infections can still be transmitted to a sexual partner during the antibiotic treatment, so it is important to abstain from having sexual intercourse until you have completed a 7-day course, or you will recontract the disease you just passed on!

So, we know these are not the only questions you have, so, do come in to discuss the rest! WHP