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What is an STI test and when should you have a screening?

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While we might all think, ‘I’m safe, it’ll never happen to me’, recent reports show that STI diagnoses in England are on the rise, with those aged 15 to 24 seeing a 26% increase in diagnoses between 2021 and 2022 alone.

In fact, gonorrhoea and syphilis diagnoses in England have recently hit record levels. In 2022, gonorrhoea cases rose to 82,592, the highest number since records began in 1918, while cases of syphilis increased to 8,692, the largest annual number since 1948.

And that’s just two of a whole raft of sexually transmitted infections. This spike in cases means you definitely know someone who has or has had an STI, and your risk of contracting one is significantly higher than it used to be. But luckily, STIs are preventable, treatable, and easy to test for. You just need to know what to do.

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According to a 2023 women’s health report by Flo, one in four British women don’t understand how you catch an STI, while 7% of 18 to 24 year olds are looking to porn for sexual health information. In a new report, the Women and Equalities Committee has suggested that inadequate sex education in schools and the government’s underfunding of sexual health services are to blame.

“Sexual health services are at breaking point,” committee chair and MP Caroline Nokes said in the report. “They are underfunded and, in many cases, unable to provide the services their local area needs. The 2022 data is a red flag, and should encourage everyone to do better.”

Despite the government making it compulsory for all secondary schools in England to offer Relationships and Sex Education (RSE) from September 2020, Nokes concluded there’s “compelling evidence” that lessons are insufficient, including in relation to contraception and STIs. “Nearly half of children say education in this area is so poor that they rely on finding information for themselves online,” she wrote. “This exposes children to an unacceptable risk of harm.”

In light of mainstream social media sites’ persistent censorship of sexual content, including valuable sex education, when children and young people do seek advice on the internet, they’re often faced with swathes of disinformation (as per a recent survey, 42% of teens turn to TikTok for sex ed).

“With anyone having access to platforms such as TikTok and Instagram, anyone is able to post their own information around sex and transmitted diseases,” explains Hope Flynn, head of content of iPlaySafe sexual health testing. “There are so many restrictions on social media platforms that prevent qualified sex educators from reaching those who need the information. Yet so much dangerous misinformation is being passed around.”

So, to cut through the noise, here’s all the expert-guided facts you need to know about testing for STIs, signs, symptoms, and when to get tested.

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”Many people assume that sexually transmitted infections are only spread through certain sexual behaviours like having multiple partners, but that isn’t true,” says iPlaySafe’s chief information officer Bianca Dunne. “Most STIs are spread through sexual contact with an infected person, but some infections are transmitted in ways you may not expect.”

You might think if you give someone a blow job but don’t have P-in-V sex, there’s no chance of you picking up an infection. But STIs can be passed from person to person through oral, anal, and vaginal sex, and even kissing. In fact, you can catch the virus that causes genital warts (also known as the herpes simplex virus) without having sex at all – all it takes is skin-on-skin contact.

“It’s a common misconception that penetrative sex is the only way STIs can be transmitted,” adds Samantha Marshall of sex toy company Smile Makers. “‘Going all the way’ is how society has defined partnered sex, and if it’s not vaginal or anal, it doesn’t count. This narrative is so wrong, and not to mention confusing for many queer experiences. Sex is much more than intercourse, and STIs know it. If you’re having outercourse – think oral sex, fingering, using toys, scissoring – there’s a risk of STIs.”

Do I need to get tested if I use contraception?

If you’re using a barrier method of contraception, you’re much safer and are doing the best job you can to protect yourself from STIs. However, not all contraceptives are barrier methods and even barrier methods like condoms, latex underwear, and dental dams aren’t 100% effective all the time.

Also, Dr Karan Rajan, host of The Referral podcast, whose TikTok videos are a great source of factual information on health and wellbeing, points out that “contraception is not just the job of one person, but both”.

“There is also a huge reluctance to wear condoms,” says Marshall. “Condoms are literally the bare minimum; a search on TikTok shows you the frustrations so many people with vulvas have with carrying the weight of contraception, while their partners don’t even think about protection. We need to change the experience of [condoms] only being accessible in paper bags from sexual health clinics or the hurried dash down the toothpaste aisle.”

But look, not everyone uses condoms (although you can find latex-free if you happen to be allergic). If you use another form of contraception, just be aware that taking the pill, using spermicide, or having a contraceptive injection or coil won’t protect you from an infection. This means it’s a good idea to have a conversation about your sexual health status with the person you’re sleeping with and disclose anything you might both need to know if you’re not planning on using a barrier.

But, even if you are using a barrier, you should still be getting tested regularly. “Be proactive rather than reactive when it comes to your sexual health,” advises Dunne. “Regular STI testing can prevent transmission of infections. Get tested for STIs every six months, or more often if you have multiple partners. This can help you identify any infections early on, which can make treatment more effective and prevent the spread of the infection to others.”

If you’re not using contraception or if you’re hooking up with a few different people, getting tested more often than every six months can’t hurt. But it’s worth bearing in mind that STIs do take a while to show up in your system, so a test every week isn’t going to tell you much.

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When to test for an STI

“A lot of miseducation around STIs and STDs has always existed especially on social media as people are unaware of things such as the testing windows,” explains Flynn. “A lot of young adults think they can have sex and test the next day, however you need to wait at least two weeks for things such as chlamydia and six months for HIV to show up on sexual health screening. This is why regular and proactive testing is necessary.”

“A key thing definitely worth knowing – and not many do – is the difference between incubation period and window period of STIs,” says Dunne. “This is the time between when a person is infected with the sexually transmitted infection and when they begin to experience symptoms. The incubation period can vary depending on specific infections. Some STIs may not cause any symptoms at all, so a person may be infected and not know it.

“For example, someone could have sex with an HIV positive person on a Friday, do a test on the Monday, and the test wouldn’t pick it up because it’s too soon to be detected on a test,” continues Dunne. “It’s also worth noting the ‘window period’ is different to an STI incubation period, but the two are often confused. Window periods are the time between when a person is infected and when the infection can be detected by a diagnostic test. This depends on the STI and the type of test used.”

“The window period for HIV, for example, can be as long as three months after infection, meaning your test results may come back negative despite you being infected,” she adds. “This is something you need to be aware of if you believe you have been in contact with an HIV positive person – make sure you re-test. Most other infections will show up on diagnostic tests within a few weeks.”

The general rule of thumb that sexual health practitioners will advise is to wait three weeks after the sex that you think might have caused an infection, then do a test. Obviously this can be difficult and anxiety-inducing in the case of a broken condom, if someone stealths you (which is assault, FYI), or if you experience a sexual assault. You can inform the clinic immediately and make the appointment at a time advised by a professional. This can be a comprehensive test at a sexual health clinic, or at at-home finger prick and swab test, depending on what’s recommended.

What is an STI test?

There are a few different types of sexual health screening. STI tests generally test three bodily fluids – discharge, blood, and urine. Yes, that means you’re going to have to pee in the cup. Take aim!

If you’re visiting a clinic, the test will consist of you filling out a form with some questions about your sexual behaviour and your personal details. Then you’ll have a chat with a sexual health professional who you can voice your concerns to. Sometimes if you’re just having a routine check-up it can be more challenging to be seen face-to-face, so if you have a concern, make this clear when you’re booking your appointment.

After the initial chat, you’ll be asked to provide a urine sample (which means heading to the bathroom to pee in the cup), a sample of the bacteria that’s in your discharge (which means using a little swab like a cotton bud to swipe some fluid from inside the vagina or the tip of the penis), and a blood sample. The blood sample is the only part of the test that can be a little uncomfortable – no one really likes having a blood test, but it’s over quickly.

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These samples will then be sent to a lab to be tested for sexually transmitted infections. You might also need to have a physical examination, which obviously you can refuse if you’re uncomfortable, but it will help with getting to the root of any problems quicker and will confirm whether you’re looking healthy down there. A sexual health professional may invite a chaperone into the room to ensure you’re safe while the nurse or doctor looks at your skin and examines your vagina or penis. They might press on your pelvis to check for any pain and ask you a few questions about any other symptoms.

Then you have your at-home test. These tests generally check for the ‘big six’, which includes chlamydia, gonorrhoea, HIV (I, II, P24 antigen), syphilis, hepatitis B, and hepatitis C. There are quite a few other infections and bugs that are classed at STIs – things like mycoplasma, ureaplasma, and trichomoniasis – but unfortunately, due to funding cuts and a long history of women’s health being understudied and underserved, we aren’t taught much about these infections and their risks in our sex ed classes, and we aren’t encouraged, nor offered, to test for them.

If you want to be tested for a full panel, you might have to buy a full at-home test online, rather than sending off for a free one from the NHS. Or you’ll have to ask to be tested for the works in your clinic.

How to get an STI test

If you want an STI test, call up your local clinic or find its website to book online. You’ll have to select which option you feel you need and probably fill out a form, so be clear. You can speak to a human if you need to by calling the clinic directly and booking on the phone. Some clinics offer walk-in appointments, but these can be hard to come by so call early in the morning to secure one if you can.

Or if you don’t have any symptoms and only want to test for a limited number of STIs as a routine test, order a home kit from your local NHS sexual health provider. Symptoms can vary and some infections have no symptoms, so don’t assume that you don’t need to test if you aren’t showing any signs of an STI, especially if you’re not using protection or sleeping with multiple partners.

“Knowing the symptoms of common STIs can also help you identify an infection in the early stages and seek treatment,” advises Dunne. “Some common symptoms of STIs include pain or burning during urination, unusual discharge from the genitals, and sores or bumps on the genitals or mouth. If you experience any of these symptoms, you should get tested and seek treatment right away.”

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If you are experiencing symptoms, be sure to tell the person booking your appointment, or select the right option when booking online so you can go straight to the right part of the clinic when you arrive, and can receive the best care.

“If you do test positive for an STI, don’t worry – it isn’t the end of the world (or your sex life!),” says Dunne. “The most important thing is to stop having sex so that you don’t infect anyone else, and get medication to treat your infection quickly.”

Marshall agrees. “We need to stop perpetuating the stigma around STIs,” she says. “They’re not a joke; they’re a reality for so many of us, and we need to stop the shame. This shame can result in people not getting tested, or not disclosing their positive results to a partner. For those dating, don’t accept partners who rely on third-party testing. It blows my mind how many people say they’re good because their last partner had a check-up and their results were fine. Nope. Open up the conversation so the education can flow, and explain why they also need to be tested.”

“It’s not something to be ashamed of,” concludes Dr Rajan. “Because of the excessive amount of stigma, people are less likely to come forward and get treated and tested, which contributes to the issue of rising STD levels. Be safe, be sensible, and get tested regularly. If you have a positive test, let your partner or previous partner know. It’s a normal part of life sometimes.”

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