Ovia’s Chief Medical Officer on STI testing, stigma, and how to start the conversation 

An interview with Dr. Leslie Saltzman during STI Awareness Week.

Let’s start with the basics, how often should someone be STI tested? Can you tell us a little more about what exactly to expect?

The guidelines are that everyone who is under 25 and sexually active should be tested at least once a year for gonorrhea and chlamydia. Many STIs can be asymptomatic (particularly in women), so it’s important to make testing part of your annual care. Every annual preventive visit should include a conversation about STIs. Certain people may be at higher risk and require more frequent screening. 

Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STI should also be tested for gonorrhea and chlamydia every year.

All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.

Everyone who is pregnant should be tested for syphilis, HIV, hepatitis B, and hepatitis C starting early in pregnancy. Those at risk for infection should also be tested for chlamydia and gonorrhea starting early in pregnancy. Repeat testing may be needed in some cases.

Are there other options for testing besides at a primary care visit?

Yes. Urgent care is an option, as are retail health clinics, community clinics and OB/GYN providers. Home tests are also available.

Can you tell us more about specific STIs and how they’re tested for?

Gonorrhea and chlamydia are tested with a urine sample, a cervical sample, or a swab. 

HIV, hepatitis, and syphilis can be tested for with blood tests. 

We’ll test for herpes (HSV1 and HSV2) with a swab of the lesion if you have symptoms. 

What are your recommended best safe sex practices with a new sexual partner?

It’s great if both people can discuss STI testing before they forgo using barrier methods like condoms. This way you know where you’re starting out. 

And what if someone doesn’t feel comfortable having those conversations with a new or more casual partner?

These can be hard conversations, especially early on in a relationship. 

To start off, everyone can empower themselves and at least get testing for themselves. These conversations can certainly sometimes put pressure on relationships about the future of the relationship or expectations around monogamy. If you’re not there yet, that’s a good reason to continue using other methods to protect yourself. Then when you both feel comfortable you can test again. 

What are some common symptoms of STIs to pay attention to? 

Women and people with uteruses will typically experience symptoms like pain with urination, vaginal discharge, and painful bumps or sores. 

Gonorrhea can also infect the throat, this can be asymptomatic or cause a sore throat. 

HIV can look like an acute illness with viral symptoms — think swollen lymph nodes and a fever. These symptoms are often missed because they can be mistaken for another type of virus. 

Can you get an STI from oral sex?

Yes. We commonly see gonorrhea which can present as a very painful sore throat. The good thing is that providers are more informed and educated about this symptom as a potential sign of an STI, so they should be taking a swab and testing. 

Herpes (HSV) is often spread during oral sex as well.

Which STIs are treatable vs. curable?

Gonorrhea, chlamydia, trichomonas, and syphilis are all curable. We give medication and we may recommend a test for cure. HIV, as we know, is a chronic infection, which is treatable and we have great therapies and treatments, but it requires lifelong treatment and monitoring. 

An initial outbreak of HSV is treated with a high dose of an antiviral treatment, which shortens the amount of time a person is symptomatic, and most likely the time they’re infectious as well. And then depending on how often a person has outbreaks, we may recommend that they go on suppressive therapy, which is a daily antiviral medication. This can be a lifelong medication.

After a number of years of being on antiviral medication, most people have very low rates of outbreaks. I say that because when people are told that they have HSV, it can be very upsetting. They might be worried about navigating conversations with sexual partners given some stigma that’s still lingering around HSV. People also worry that they might pass it on if they’re pregnant. But we have great medication that is safe and generally has minimal side effects, so most people can go back to living a normal life. We do recommend that they tell new sexual partners. 

Any tips for how to have these conversations with a partner?

HSV is transmitted through skin contact. And we know that there can be transmission of HSV even when a person doesn’t have an outbreak or an outbreak that’s visible to them. This is particularly true right before they have an outbreak, when there can be a high level of virus. And condoms don’t protect anyone 100%. 

These conversations can be hard with a new casual partner before you have any sexual contact. You might say, “I just wanted to let you know that I tested positive for HSV [X] years ago. I’m on suppressive therapy, which reduces the risk, but I just wanted to let you know.” 

Because it’s such a common virus, many people are in this situation, so hopefully the conversation is met with kindness and appreciation that you disclosed it.

HIV can be a more challenging conversation, but it’s similar in many ways. This is a conversation to have earlier rather than later. In relationships with two people who have discordant HIV infection, the partner who is not HIV positive often chooses to go on PrEP therapy to prevent their chance of being infected. Also, here condoms are very effective, because HIV is not transmitted through the skin. 

There is a lot less stigma than there used to be, but these conversations can be hard.

How long should someone be on suppressive therapy before it kicks in?

Those who are HIV positive need to wait until they’re controlled before having sexual contact. Their HIV specialist or internist will help them manage their treatment plan. 

And for other STIs, how should we think about testing timelines? 

If you were sexually active with a new partner recently, your current testing might not reflect your status. It’s good to get tested when you haven’t been with anyone else for 6 weeks, so waiting until you’re 6 weeks or so into a relationship can make sense. This is because it can take 6 weeks for the body to mount an antibody response to the virus so that it can be detected in blood work. 

Certain STIs have recommendations for follow up — in those cases, we recommend that people get tested for cure to make sure they’re fully treated. If both partners are positive for an STI, both should be treated at the same time and there should be no sexual contact during treatment to prevent transmission back and forth.

Any tips if you don’t feel comfortable talking to your provider about sexual health?

There are on-demand tests that you can use, which can be a great option. You can also email or message your provider to ask for certain tests/labs if you don’t feel you can ask in person. We like to minimize barriers for testing for important health issues.

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