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question about getting tested (young woman)
I'm a 28-year-old woman in NYC and I'm sexually active. I was in a fairly long monogamous relationship where we had unprotected sex, and since my breakup many months ago I've been dating quite a bit. The vast majority of the time, we've used condoms. But there have been moments when I've been particularly hot and heavy with someone and they've penetrated me unprotected. After a bit they've withdrawn and used protection, but the contact was certainly there. I also engage in unprotected oral sex (giving and receiving).
I plan to get tested as soon as possible, and seeing how I'm not sensing a life partner in the near future, I would like to get tested as often as I should. But there are many, many tests out there - I'm a graduate student, so my funds are limited. I've never had any symptoms, but I know that many STDs can be asymptomatic in women. So my question is this: which tests would you suggest I get while I'm asymptomatic, and how often?
Follow-up question: I know that I can contract STDs by giving unprotected oral sex to a man, but I'm not clear on how risky this is. So, how risky is this?
I plan to get tested as soon as possible, and seeing how I'm not sensing a life partner in the near future, I would like to get tested as often as I should. But there are many, many tests out there - I'm a graduate student, so my funds are limited. I've never had any symptoms, but I know that many STDs can be asymptomatic in women. So my question is this: which tests would you suggest I get while I'm asymptomatic, and how often?
Follow-up question: I know that I can contract STDs by giving unprotected oral sex to a man, but I'm not clear on how risky this is. So, how risky is this?
Doc HHH,
So you are the fellow who wrote that fantastic book. <g>
Thanks from many of us who you helped in the clinic.
Annie, feeling mighty humble
So you are the fellow who wrote that fantastic book. <g>
Thanks from many of us who you helped in the clinic.
Annie, feeling mighty humble
One interesting comment made by the doc was to avoid partners who may be at high risk. The catch to this comment is getting to the truth regarding the individuals' behavior. Having spent years interviewing people who have been exposed to diseases or have caught them, I will assure you that many don't tell their partners the truth. And not too many people know what to look for even in "good light". Err on the side of caution regarding protection and your own behavior.
It might be in your best interest to visit your local health department STD clinic and ask for some of the statistics on diseases in your area if you engage in unprotected sex in any form. Most departments have a pictoral literature available to help you learn about signs and symptoms.
Getting vaccinated for Hepatitis B is a great suggestion. Depending on your other practices, you may also want to consider asking the health department about their recommendations for Hepatitis A in your case. Be honest with the nurse or physician you speak with as you will get the best advice to help you stay safer.
An aside about "high risk"...
I remember a practice which was in the habit of treating syphillis by presumptive diagnosis versus blood testing because they didn't have to report just giving penicillin, but would have to report a positive lab test. They didn't feel the contact investigations done by the health department was in the best interest of their "conservative" patients. It may have ruffled a few feathers, but the outbreak that it caused affected a lot of people who supposedly were low risk and monogamous did more than ruffle feathers, it put many truly innocent people at risk for a preventable disease, including newborns.
I worked in this county that once had the distinction of having the highest rate of syphillis in the county. Risk is an interesting subject.
Former STD Clinician
Communicable Disease/Epi nurse
It might be in your best interest to visit your local health department STD clinic and ask for some of the statistics on diseases in your area if you engage in unprotected sex in any form. Most departments have a pictoral literature available to help you learn about signs and symptoms.
Getting vaccinated for Hepatitis B is a great suggestion. Depending on your other practices, you may also want to consider asking the health department about their recommendations for Hepatitis A in your case. Be honest with the nurse or physician you speak with as you will get the best advice to help you stay safer.
An aside about "high risk"...
I remember a practice which was in the habit of treating syphillis by presumptive diagnosis versus blood testing because they didn't have to report just giving penicillin, but would have to report a positive lab test. They didn't feel the contact investigations done by the health department was in the best interest of their "conservative" patients. It may have ruffled a few feathers, but the outbreak that it caused affected a lot of people who supposedly were low risk and monogamous did more than ruffle feathers, it put many truly innocent people at risk for a preventable disease, including newborns.
I worked in this county that once had the distinction of having the highest rate of syphillis in the county. Risk is an interesting subject.
Former STD Clinician
Communicable Disease/Epi nurse
MEDICAL PROFESSIONAL
I don't disagree, Annieouse; it's often a **** shoot, people give misinformation intentionally or unintentionally.
On the other hand, some people have unprotected sex with 20 new partners a year without ever getting an STD, whereas others have 3 new partners in 2 years and get gonorrhea or chlamydia each time. The difference probably is in how and where people select partners.
Sexually active persons can dramatically modify their risk by thoughtful partner selection, even before they ask him/her the lifestyle questions: No sleeping with someone the same night you meet and usually not the first date; someone introduced by a friend is safer than someone you meet at a party or bar; careful about obvious drug users (it isn't always obvious, but often it is); avoid the campus hunk who you know has overnighted at 4 separate sorority houses in the past month; don't pay or exchange drugs for sex; and so on.
That's the sort of thing I mean by general advice to be careful about partner selection. Nothing perfect, but it helps.
HHH, MD
On the other hand, some people have unprotected sex with 20 new partners a year without ever getting an STD, whereas others have 3 new partners in 2 years and get gonorrhea or chlamydia each time. The difference probably is in how and where people select partners.
Sexually active persons can dramatically modify their risk by thoughtful partner selection, even before they ask him/her the lifestyle questions: No sleeping with someone the same night you meet and usually not the first date; someone introduced by a friend is safer than someone you meet at a party or bar; careful about obvious drug users (it isn't always obvious, but often it is); avoid the campus hunk who you know has overnighted at 4 separate sorority houses in the past month; don't pay or exchange drugs for sex; and so on.
That's the sort of thing I mean by general advice to be careful about partner selection. Nothing perfect, but it helps.
HHH, MD
MEDICAL PROFESSIONAL
Great questions--which undoubtedly apply to many (most?) sexually active single persons.
Chlamydia: Test for sure at least once a year. If "quite a bit" means you have a new or different partner as often as once a month, or if you have fewer partners who likely are seeing other women, then I would suggest testing every 3-6 months if you're having unprotected vaginal sex, but once a year remains OK if you can be consistent about the condoms. Make sure your provider orders one of the newer, more accurate tests. The technical term is nucleic acid amplification test (NAAT); the available brands are Aptima (GenProbe company), Amplicor (Roche), and ProbeTec (Becton Dickinson, or BD). They can be done on urine or a self-collected vaginal swab, so you don't need a pelvic exam each time. Don't let your provider do the older, non-amplified probe test (Pace II, also by GenProbe), which misses up to 30% of infections.
HIV, syphilis, gonorrhea: You're undoubtedly at much lower risk for these than chlamydia; once a year is plenty. However, most common chlamydia NAAT tests also test automatically for gonorrhea, so you might end up being tested more often anyway.
Pelvic exam with pap smear: Once a year. Make sure this includes tests for trichomonas and bacterial vaginosis (BV).
Herpes: This is controversial. Some experts recommend a blood test for herpes simplex virus type 2 (HSV-2) in persons as sexually active as you; others advise doing it only if there is a particular suspiction of infection, such as symptoms or sex with a person know to have herpes. My inclination is to do it once, but not necessarily even once a year thereafter. If you choose herpes testing, make sure the proper test is done. The only ones that give accurate results are the HerpeSelect HSV-2 test (Focus Technologies) and the Biokit HSV-2 test (Biokit USA).
Of course, you might need additional testing in certain circumstances: of course if you develop symptoms, such as increased vaginal discharge, odor, painful urination, or if a partner tells you afterward that he has an infection.
Please get vaccinated against hepatitis B, if you haven't been.
Finally, your follow-up question: The risk of STD by performing fellatio is quite low. Gonorrhea is possible, but chlamydia doesn't infect the throat. HPV theoretically is possible, but oral warts or HPV infection are extremely rare. Herpes is possible but uncommon. HIV also is a theoretical risk, but low even when a guy is infected; anyway, your main HIV protection is to avoid partners to are at high risk--bisexual guys, injection drug users. One of the good things about oral exposure is that if lighting is sufficient, you can get a pretty good look for abnormal discharge and skin lesions of the penis.
Good luck-- HHH, MD
Chlamydia: Test for sure at least once a year. If "quite a bit" means you have a new or different partner as often as once a month, or if you have fewer partners who likely are seeing other women, then I would suggest testing every 3-6 months if you're having unprotected vaginal sex, but once a year remains OK if you can be consistent about the condoms. Make sure your provider orders one of the newer, more accurate tests. The technical term is nucleic acid amplification test (NAAT); the available brands are Aptima (GenProbe company), Amplicor (Roche), and ProbeTec (Becton Dickinson, or BD). They can be done on urine or a self-collected vaginal swab, so you don't need a pelvic exam each time. Don't let your provider do the older, non-amplified probe test (Pace II, also by GenProbe), which misses up to 30% of infections.
HIV, syphilis, gonorrhea: You're undoubtedly at much lower risk for these than chlamydia; once a year is plenty. However, most common chlamydia NAAT tests also test automatically for gonorrhea, so you might end up being tested more often anyway.
Pelvic exam with pap smear: Once a year. Make sure this includes tests for trichomonas and bacterial vaginosis (BV).
Herpes: This is controversial. Some experts recommend a blood test for herpes simplex virus type 2 (HSV-2) in persons as sexually active as you; others advise doing it only if there is a particular suspiction of infection, such as symptoms or sex with a person know to have herpes. My inclination is to do it once, but not necessarily even once a year thereafter. If you choose herpes testing, make sure the proper test is done. The only ones that give accurate results are the HerpeSelect HSV-2 test (Focus Technologies) and the Biokit HSV-2 test (Biokit USA).
Of course, you might need additional testing in certain circumstances: of course if you develop symptoms, such as increased vaginal discharge, odor, painful urination, or if a partner tells you afterward that he has an infection.
Please get vaccinated against hepatitis B, if you haven't been.
Finally, your follow-up question: The risk of STD by performing fellatio is quite low. Gonorrhea is possible, but chlamydia doesn't infect the throat. HPV theoretically is possible, but oral warts or HPV infection are extremely rare. Herpes is possible but uncommon. HIV also is a theoretical risk, but low even when a guy is infected; anyway, your main HIV protection is to avoid partners to are at high risk--bisexual guys, injection drug users. One of the good things about oral exposure is that if lighting is sufficient, you can get a pretty good look for abnormal discharge and skin lesions of the penis.
Good luck-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
