‘I’m a Gynecologist, and These Are the Top Questions Patients Ask Me About STIs’
- Christie Cobb, MD, Arkansas-based gynecologist, intimacy expert, and sexual wellness doctor
Below, gynecologist and sexual-wellness expert Christie Cobb, MD, breaks down what you need to know about STI testing and answers the top questions she gets from patients in her practice about STIs.
Why it's important to get tested for STIs if you have sex
According to preliminary data published last April from the Centers for Disease Control and Prevention (CDC), there were a record 2.5 million reported cases of chlamydia, gonorrhea, and syphilis in 2021—an increase from the 2.4 million reported in 2020. And though these high numbers may reflect, in part, a lack of access to screening and testing during the pandemic, they also build on a concerning trend of rising cases of STIs well before the pandemic.
Because of the widespread prevalence of STIs (and the shame and stigma that work against open disclosure), Dr. Cobb emphasizes the importance of getting tested regularly, so you know where you stand. Even if you don't have symptoms, like burning pee after sex or genital itching or burning, it's still best to get tested.
Regardless of your results, it's also a smart idea to take preventative measures against contracting an STI whenever you have sex. Though no method (beyond abstinence from sex) is a 100-percent guarantee against transmission, consistent use of condoms can significantly reduce your risk. The key word there, though, is consistent. "It's like wearing a seat belt; you just have to wear it every single time [you have sex] like a habit," says Dr. Cobb.
"It's like wearing a seat belt; you just have to wear [protection] every single time [you have sex] like a habit."—Christie Cobb, MD, gynecologist
While the CDC also recommends reducing your number of sexual partners and engaging in mutual monogamy (meaning you and a partner agree to only be sexually active with each other) as a means to limit STI transmission, it's certainly possible for folks in non-monogamous relationship structures and others with multiple sexual partners to enjoy safe sex. It just requires more frequent STI testing and open communication about results.
In particular, Dr. Cobb encourages her patients to "get tested between [sexual] partners, so that if you start a new relationship, you can honestly document that you're negative and then ideally ask your partner to also produce a negative test." It may feel like an awkward topic to discuss, but it's important to communicate your STI status to current and potential partners, so that all people involved can make informed decisions about sex with their health in mind.
How to get tested for STIs
There are plenty of resources for low-cost and even free STI testing. If you have a primary-care doctor or gynecologist, you can plan a visit to get tested (or have testing included as part of a yearly checkup). Dr. Cobb recommends checking with your insurance before your visit to determine which tests are covered under your plan, so you know what to expect in terms of payment. If you'd rather test yourself in the privacy of your home, it's also possible to order discreet, at-home STI test kits from companies like Nurx and TBD Health, which may be partially covered by insurance, too.
If you don't have insurance, you can visit a community health center, like Planned Parenthood, which offers reduced or no-cost STI testing, depending on your financial situation. The CDC also has a dedicated page on its website full of STI information, including an online tool that will identify places near you where you can get tested based on your zip code.
The top 3 questions about STIs that patients ask a gynecologist
1. Do I need to get tested for STIs?
Among the most common questions about STIs that Dr. Cobb gets from patients is just whether they really need to be tested. In fact, she's made it a habit to ask patients herself if they’d like to be tested, so they don’t have to broach the topic first.
The answer is “anyone who has had any intimate contact with any mucus membrane,” she says, “whether through oral, vaginal, or anal contact” should be tested. Given that plenty of different activities can qualify as "sex" for different people, it’s better to err on the safe side, she says: “If you’ve done anything with your body with anyone else and their body that could count as sexual activity, you should probably get tested.” If you’re not having sex, though, you don’t have to get tested for STIs.
2. How often do I need to be tested?
Another common inquiry is when exactly to get tested. If you've recently had unprotected sex or suspect you may have been exposed to an STI, you'll want to wait about three weeks to get tested, given certain viruses and bacteria may not be visible on a test before that window is up. “Usually, the soonest [any infection] is going to show up is three weeks, but I encourage patients who had an unprotected exposure to come back to be tested after three months and six months, too,” says Dr. Cobb. "If all of those tests are negative, you can fully consider yourself negative." (This applies to the most common STIs, such as chlamydia, gonorrhea, hepatitis, HIV, and syphilis.)
In scenarios where you don't have reason to suspect a recent exposure, it's wise to follow the CDC recommendations for STI testing, which vary based on sexual behavior. For example, the CDC recommends that all people between ages 13 to 64 be tested at least once for HIV, and that all sexually active people with vaginas over age 25 be tested for gonorrhea and chlamydia every year if they have "new or multiple sex partners, or a sex partner with an [STI]." In general, though, Dr. Cobb says a good rule of thumb is to get tested before you have a new partner and between partners.
3. Which STIs do I need to be tested for?
Most STI tests cover a variety of common infections that require both blood and urine samples, says Dr. Cobb. Tests for HIV, hepatitis, and syphilis are typically conducted by way of a blood sample, while gonorrhea and chlamydia are assessed with a urine test (or the sample from a pap smear for folks with cervixes). And herpes is most commonly tested with a scrape from an active lesion, she adds.
Because your individual medical or sexual history may also put you at risk for other STIs, it's worth asking your healthcare provider for additional guidance here, too.
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