STD Testing - The Comprehensive Way
If you are sexually active and non-exclusive (which is becoming the default dating mode throughout most of the western world), you should be getting frequent STD tests. End of story.
Unfortunately, in the United States at least, when you ask your doctor/health provider for an STD test (on your insurance), many are programmed to save money by signing you up to the basic package where they might only test for a couple of STDs, and omit all the rest which can be tested for. Kaiser Permanente is notorious for being stingy on this, but so are most health providers - some even come across as judgmental. Most American's don't get tested enough, and even the ones that do are often getting shortchanged on test... so it is little wonder STDs are rife and 50% of American's catch their first STD before age 25. Don't be a sucker. Know your options. I wrote this guide with the help of friends, to help you get your doctor to test you more thoroughly!
Asking your Doctor for the Full Package
Lots of modern doctors allow you to send emails, and maybe you find talking about STD tests, a little awkward to begin with (heaven forbid your doctor asks about your sex life), so just copy and paste this into an email.... Or print if necessary.
With this letter you should get full permission to come into the lab for the full package whenever you want. Which means on dates you'll always be able to impress your potential lovers with a recent test.
I'm currently sexually active and dating and I want to be very responsible in protecting others, so I want an "at call" comprehend STD test, including:
> HIV, both versions. (inc. blood)
> HSV (herpes), both version 1 and 2. (inc. blood)
> Syphilis. (blood)
> Hepatitis A/B/C. (blood)
> Ghonorrhea (urine and oral > anal not necessary)
> Chlamydia (urine and oral > anal not necessary)
PS: As for immunity/vaccinations:
> HPV - I can skip this because I am vaccinated*
A few things to note:
- Note the words "at call", means you should be permitted to come into the lab anytime. This is fantastic, because if you have to email or even visit your doctor to ask for STD tests every few months... well that's just annoying!
- Where I say "anal not necessary"... if you are a receiver of anal sex (gay men and many women), you should replace the word "not" with "also".
- Down the bottom you might want to list immunity/vaccinations as something you can skip. In the US, younger people (born after 2000) are usually HPV vaccinated.. older than that and your doctors basically assume you already have it (yes, it's that common). Fortunately the body usually clears it in a few years, and only in rare cases does it turn into cancer. read about HPV.
- Your doctor may talk you out of HSV-1. Why? There are two kinds of herpes virus: HSV-1, which is usually not an STD and occurs on the lip (cold-sores), and HSV-2, which usually causes genital herpes (1 in 6 Americans), which is essentially an STD in the genital area. Both viruses can be transmitted by saliva, body secretions or oral sex. HSV-1 "the kissing disease", is very common and you've maybe seen someone with cold sores on their lips, but the fact is 50% of Americans have HSV-1 and most won't have symptoms, so they can spread it, but they have no idea they have it. If you kiss people, you can assume you probably have it - it's so frequent doctors often suggest the test isn't necessary. It's up to you, but the more sexually awakened camp like to know this and educate others. read more about HSV.
- Keep in mind the above list doesn't include all STDs, not even close. You can find a more completely list of STDs on beforeplay.org or Wikipedia - the thing is not all STDs can be readily tested for, and some are rare, so you have to be reasonable to get tested for all the "main types" of STDs and if you do have a good doctor you can have a good conversation about this. If you doctor is at all judgmental (versus constructive)... and some are... just change doctors and leave them feedback.
How Frequently Should You Be Tested
We live in a world of online dating and we're finally breaking the barriers of shame around being sexually active. Oh sure, COVID-19 has slowed things down, but people are still dating, and (hopefully) still having good sex.
And yes, even during coronavirus lockdown, you should still be getting STD tests. If you are non-exclusive and going on one date a week (which is many, many Americans), then every 4 months is pretty good. With new partners you should always have a Safe Sex conversation which includes the date of your last test and wether you've had any unprotected sex since that test. Also, know that condoms fall off or break way more often than you think, so it's good to have high integrity about this also. For this reason, every 4 months keeps you in good standing - it shows you are a responsible adult. If you date less, then you might only do every 6 months, but even people who are exclusive should know that lots of STDs surface later... and not every partner is completely faithful (sadly), so doing it once a year can be great peace of mind. Condoms or not, STDs can spread and show up later. With most decent medical insurance, STD tests cost nothing, so why not!
Be Careful of Someone Who Just Says "I'm Clean"
When you look at the frequency of STDs in Americans, you quickly realize that people who say "I'm clean", often mean they think they are clean, but there's a good chance that:
- They have been tested a long time in the past (or they just *think* they are clean.
- They may have had multiple partners, some of them completely unprotected, since this last test.
- They have only been tested for the default STD tests (gonaroea/chlamydia/HIV), so they odds are they have at least one STD they don't know about (HPV, HSV-1 or HSV-2).
For this reason I have developed the CHIP Safe Sex Conversation, which help you make sure you ask for details! Don't be afraid to ask for someone's STD tests - the smart thing to do is to save a copy to a private Google Drive folder so you can quickly show them to a potential partner on your phone. Nothing is worse than waking up after a night of sex and then realizing you don't know your partners history, so you could have just contracted something.
I grew up in Australia, and our sex education was pretty good, but still not at the level it should be. I didn't really become sexually active until 24, but it wasn't till I moved to the US in 2010 that I realized that the default mode of dating is "non-exclusive" and that I should be tested regularly. I work at Google in the San Francisco Bay Area and I have Kaiser Permanente since the beginning. Keiser is good at some things, but very stingy at STD tests, and when I asked my doctor for testing in the South Bay, each time he would almost look at me like "really"! Maybe he thought as a software engineer in an area with fewer women than men, surely I wasn't getting any "action". I don't think he was too judgmental, but he'd ask me if I was gay each time (not since last time you asked buddy!) and then approve my lab test, but ONLY for the basic test.
Unfortunately, I didn't have friends until later who pointed out that when I ask for STD test, I need to use just the right wording to get the full complement of tests. Before when I told any girls "I'm clean, I was tested recently", I should have almost been saying "I'm tested with the bare minimum, so I'm kind of only confirmed 50% clean - cool with that?!". Oh, and keep in mind that most StDs don't show up immediately and there are many STDs they never test for, so "clean" is very much a relative word.
I changed doctors to on in San Francisco itself (where I guess people are generally having more sex) using the template above and my new doctor immediately approved it. I also insisted on the HSV-1 test. I came back negative for everything but HSV-1, and at first I though... Oh crap, I have an STD!... But then I realized HSV-1 is crazy common, and I'm glad I asked for it. I've never had an outbreak of cold sores, so I'm very low risk, but I write this here because I feel like for integrity you need to say these things. As you get older you realize the person who says they have HPV or HSV is less of a risk than the guy or girl who has never been tested for the full complement of STDs, and thus probably has these and possibly more. SF is quite unique in that there are many people here with the level of integrity where they do admit to having other parters, and having comprehensive test results on hand.
I hope my little vulnerability here inspires you. I once also had chlamydia, from a girlfriend who I was exclusive with. I've never cheated on anyone, but unless it showed up very late for her, it's likely she cheated on me, so I do encourage people who think, "yes, but I'm exclusive" to consider testing anyway. Nothing hurts worse than a partner who has put your health at risk. Fortunately chlamydia is very quick to cure, and that scare is the reason I rushed out to pay big money (Keiser refused) to get immunized for HPV (a set of 3 shots over ~9 months) and I had already received Hep B immunity (also a set of 3 shots over several months).
By talking about my experiences with friends, I hear more and more stories of qualified doctors who have judgmental language and frankly not well versed on STDs. Maybe they are republicans, or maybe they are jealous that they never explored their sexuality much... I have no idea why so many doctors suck at this topic, but it makes you appreciate finding a doctors who is well versed with information and practical advice, make you feel seen and will actually approve you for tests without putting up barriers for you.
Once you start following the guidelines of frequent testing and high integrity.... Well actually you end up with better, more connected and (honestly) more fun. Women appreciate it. Men appreciate it. Everyone appreciates it... so it may feel awkward at first to ask your doctor for the full complement of STD test, and awkward the first time you ask a partner to see their STD test, and/or encourage them to read this article ahead of intercourse, but the peace of mind feels incredible.
For more information, I highly recommend beforeplay.org as the best resource I've found on birth control, STDs and everything sex using understandable English!
Be responsible out there people! :)
- The CHIP Safe Sex Conversation - How to have a mature consent conversation now that you've done your testing!
- COVID-19 Testing SF - Tips on getting COVID-19 tested, since modern times COVID-19 just as scary as STDs... especially for anyone spending time with parents or other family members in the high risk bracket.