Preventing STIs: Testing Agreements

This is one of the few posts so far to need significant updates. I removed a lot of stuff that reinforced stigma against STIs. Facts are the same, presentation is different. Updated March 29, 2018.

Just going to skim this one, cause I’ll be delving into STI testing in some depth later. But since regular testing is one of the main ways polyam folk tend to protect themselves, it deserves a mention here.

The idea behind using STI testing to preventing getting infected, is that if you never have sex with anyone who has STIs you don’t want to risk getting, you are safe. So if you show a STI test to everyone you have sex with, and everyone you have sex with shows STI tests to you, and you don’t have (unprotected) sex with someone who has an STI test you don’t want to get, you’re both safe right? Maybe.

STI tests are good ways to stop the spread of STIs. And they do provide some protection again getting infected. Over all, if you are going to have multiple sex partners in a non-exclusive relationship, getting regular STI tests is a damn good idea. But, it isn’t perfect. (I should make that the theme of this section – “Preventing STIs: Nothing’s Perfect”) There are no hard and fast numbers on what kind of protection getting tested gives you. This is partly because everyone has different testing practices, and partly because every clinic tests for different STIs. That last is another way of saying that STI tests almost never test for every STI. In fact, I have never heard of any clinic or lab testing for every possible STI outside of the rare research study trying to learn about how prevalent STIs are.

Which is one of the big reasons that STI testing doesn’t provide perfect protection against getting ANY STI. If the tests don’t cover every STI, then you can’t know for sure if you or your partners are STI free. Which means you may well be passing around STIs and not know it.

This is one reason why it’s important to learn about STIs yourself and decide which ones you really want to protect yourself against.

The good news is STIs most people want to protect against, like HIV and Hep B do get tested for pretty much everywhere The other hole in the protection STI protection gives you is dormancy. It takes time for an infection to show up on a test. You have probably heard that HIV can take anywhere from 2 weeks to 6 months to show up in a test. (Semi-good news: sexual transmission almost always shows up within a month, 3 months max. It’s actually the method of transmission that shows up the fastest.) However, the dormancy can still leave you unprotected.

Say you get together with partner X for the first time. Partner X has an STI test they got two weeks ago showing they are STI negative. Partner X hasn’t had sex with anyone since the test. But partner X did have sex with someone a week before getting tested. Partner X may have gotten an infection and it would not have shown up in their STI test. But they can pass it on to you.

In general, STI tests provide more protection when you have fewer partners, and your partners have fewer partners, and etc. If you get involved with someone new every month, and they get involved with someone new every month, the protection testing provides drops significantly. If you get involved with one or two new people a year, and they get involved with one or two new people a year, STI testing gives a fair of protection. However there is a flip side, and a very important one. STI testing isn’t just about protecting yourself. STI testing is also about protecting others. Regular STI testing is the best way to find out about an infection before it gets passed on to someone else. So testing actually provides two layers of protection. It gives you some protection against infections and if you get infected, it gives you a chance to prevent the infection from being passed to anyone else.

What to learn more? See exclusive excerpts from my upcoming book Safer Sex for the Non-Monogamous by joining Jess’ Pack.

This post is part of the Safer Sex Blog Series.

STD/STIs: How often should I get tested?

So far we’ve looked at, why STD/STI tests are important, where you can get them and how much they cost, and what testing involves. The one important question about STD/STI testing we haven’t looked at yet is how often we should get tested. So that’s what were going to do today.

No matter what your relationship status, it’s probably a good idea to get tested at least once a year. Partly because there are some STD/STIs that you can get from kissing a family member or friend or sharing a glass of water. Partly because getting in the habit of being tested is an important part of protecting yourself and your partners.

For any parents who may be reading this, I highly recommend that you make it a routine to take your teenage children to get tested once a year whether or not you are aware of them being sexually active. It is very likely that your children will become sexually active without you being aware of it. It is likely that they will not discuss their sexual practices with you. Making it a yearly routine to get STD testing and telling them: “I am not asking, and you do not need to tell me, but I am going to make sure that if you are active you are safe;” can be an important step in helping your children establish healthy and safer sex practices.

Okay, so that covers the bare minimum, at the very least get tested once a year, just in case. Let’s look past the bare minimum. A fairly standard medical recommendation is that you should get tested about three months after getting involved with a new sexual partner. This recommendation assumes that you and your new partner are exclusive. So if you both get tested once, and you both test negative, then as far as conventional wisdom is concerned there is no reason to get tested again until and unless you get a new sexual partner.

Closed Poly Relationships
This advice can work well for closed poly relationships or poly-fidelitous relationships. If you are not getting new sexual partners, and your partners are not getting new sexual partners, then in theory there is no way for STD/STIs to enter your polycule. If you bring a new partner into your polycule, you can all go out and get tested after three months, and if everyone’s clear just go with the minimal once a year testing.

Okay, I hear you, I hear you, open, closed or sauerkraut, what happened to getting tested before getting involved with a new partner and exchanging test results? Why am I saying get tested after a new partner is involved rather than having a check before hand?

You are right, the standard advice and a lot of poly communities is to exchange STD/STI tests before getting sexually involved. And it’s advice that I repeated earlier in this series when I was going over the basics of safer sex. Yes, it is a good idea to exchange STD/STI testing results with a new partner before becoming sexually active with them. It just may not be enough.

Even if your new partner got their test results back the day you became sexually involved, they could have been infected with an STD/STI that did not show up in the test. HIV is notorious for the fact that tests will not return an accurate result for at least a month after you’ve been infected. There are several other STD/STIs that can take several weeks to show up in testing. So even if you are in a closed relationship, and even if you exchange test results before getting sexually involved, getting tested again after you get sexually involved with a new partner is a good idea.

Open Relationships
If you are in an open relationship, or are in a situation where you and/or your partners are getting involved with new sexual partners on a frequent basis, it is a good idea to get tested regularly once month or once every three months. Even if neither you nor your partners are entering new sexual relationships, if your metamours frequently have new sexual partners or really if anyone in your poly network frequently gets involved in new sexual relationships, you are best off getting tested at least every three months.

Again, it is still a good idea to exchange STD/STI tests before becoming sexually active with the new partner. Also again, exchanging STD/STI tests does not protect you hundred percent from the possibility that to your new partner may have STD/STIs that just didn’t show up in the test. It also (and I hope obviously) does not protect you from the possibility in an open relationship that your partner may get an STD/STI in the future from one of his or her new partners. Which is why regular testing is still important.

Condoms, Fluid Bonding and STD/STI Testing
I want to take a minute to address the idea that if you use condoms you don’t need to worry about getting test. This idea is prevalent enough that a few years ago when I took part in a research study on polyamory, I told the interviewer that my triad had an agreement to get regular STD/STI testing and she automatically assumed we were fluid bonded. The assumption, of course, being that if we were using condoms there would be no reason for us to be tested regularly.

If you’ve been following along in this series on STD/STIs, you may remember the post on barrier methods and the list of specific STD/STIs that condoms do provide some protection from. It’s important to remember though, that condoms do not protect against all STD/STIs and do not provide 100% protection against any STD/STI’s.any STD/STI’s.

Using a barrier method to protect yourself against STD/STIs is a very good idea. Barrier methods are not failproof. They are also not foolproof. If you use barrier methods, it is still a very good idea to get tested regularly.

And that wraps up our section on STD/STI testing. Next week, I’ll start going over the various STD/STI’s: how they infect you, but their symptoms are, long-term medical effects, available treatments and ways to protect yourself against each one.

What Does STD/STI Testing Involve?

Like anything medical, if you’ve never had an STI test before, it can be a bit nervous making. Especially since no one ever bothers to explain anything. STI tests can actually take several forms depending on exactly which STI is being tested for. So if you are being tested for multiple STIs, there may be a couple of different tests.

There are four ways STIs are tested for:

  • Blood testing – includes HIV and Hep, so is part of just about every STI test on the planet
  • Physical Exam – looks for crabs, herpes sores and other obvious signs of STIs
  • Swabs – checks for bacteria such as gonorrhea and chlamydia, and used to test possible herpes sores
  • Urine testing – alternate method for testing for gonorrhea and chlamydia, and a few others.

Every clinic and lab will handle their testing a bit differently, but in general (and depending on what STIs you are being tested for) you can expect something like this:

When you first arrive you fill out any necessary paperwork. The desk may give you a cup to get a urine sample while you wait. When it is your turn, you get called back to see a nurse or med-tech. They’ll have you take off your clothes so they can do a physical exam. They may swab any sores you have or swab the inside of your genitals. After you get your clothes back on they’ll draw blood. Then you head home and you’ll get the results of your tests in a few weeks.

Polyamory and STD/STIs: Getting Tested

 

The two big questions everyone asks are where to get tested and how much will it cost. Unfortunately, there is a common idea that STD/STI testing is horribly expensive. This keeps many people from getting tested, even though there are many inexpensive options for STD/STI testing. Obviously your options depend a bit on where you live, so I’ll try to break it down a bit. However the default here is US info.

Where to get tested? And what does each cost?

The easy answer here is ‘ask your doctor’. If you have health insurance (or live in a place with universal health care – you lucky bastards) you can get ask your doctor about how and where to get tested for STD/STIs.

If going to your doctor is not an option – for reasons of cost or privacy – there are several other options.

Health Clinics

Your local health department has an interest in keeping STD/STIs under control and treated. In the US, municipal health departments offer STD/STI testing either at special once a month clinics or at special offices set up specifically for STD/STI testing (which depends on how many people they expect to need testing and what they can afford). Their tests are either free or at a nominal fee (usually around $10, though I have seen as high as $30).

Outside of the US, I know that Great Britain, Australia and Canada all offer STD/STI testing centers in addition to the ability to get tested by your doctor. I do not know about the rest of the world, but it is (at least theoretically) easy enough to call your local health department and ask or look them up online.

In the US, these clinics rarely cover all STD/STIs, but they will always cover HIV, Hep B, syphilis and these days gonorrhea. They will rarely test for herpes unless you have a sore of some sort – testing for herpes is unreliable at the best of times and is unlikely to be worthwhile unless you have an active outbreak.

Non-Profits

There are also places such as Planned Parenthood where you can get tested (some charge for STD/STI testing, some do not).

Mail Order and Medical Labs

You can also pay out-of-pocket for STD/STI testing. ‘Anonymous’ testing where you send samples by mail order, or you can go down to a local medical lab. The advantage of this is you can get tested for any STD/STI you can afford. However, they will typically charge you over $300 for what you can get for less than $30 from your health department. While it is true that health departments don’t test for all STD/STIs, if you really want to be tested for ‘all’ STD/STIs (I have never seen any lab or for pay program that actually covers all STD/STIs, hell there is no HPV test for men) you are probably best off getting tested by the local clinic for whatever they cover and only paying out-of-pocket for what they don’t cover.

So there you go – finding where to get tested, and affording to pay for it, isn’t nearly as bad as you may have thought.

STD/STI Testing: Introduction

For the past month or so, I’ve covered the various ways poly-folk can reduce their risk of getting infected with STD/STIs. One of those ways which deserves a much closer look is regular STD/STI testing.

Getting tested is fairly standard in the poly community. It’s part of the advice in practically every forum, website and book on polyamory: use protection and get tested. However, STD/STI testing isn’t much talked about. Everyone agrees that getting tested is good, but:

  • What does testing involve?
  • What does it cost?
  • Where can you be tested?
  • What STD/STIs are tested for?
  • How often should you get tested?
  • How often should you ask your partners to get tested?

are questions that rarely come up. So for the next few weeks, I’ll be delving into the nitty gritty of STD/STI testing. Starting with:

What is STD/STI Testing?

The ‘duh’ answer is that STD/STI testing is exactly what it sounds like: medical testing to determine whether or not a person has STD/STIs. And the way we say it makes it sound like there is one straightforward test that you go in and get and when it comes back you know if you have an STD/STI or not.

If only.

‘STD/STI testing’ is really something of a misnomer. There is actually a different test for every STD/STI – well every STD/STI that can be tested for. Some of them have no test in the usual sense. Doctors test for pubic lice with a physical exam, and either they see something or they don’t.

So when you go for an STD/STI test, you are actually going in for a series of tests that may include blood tests, urine tests, cell samples and physical exams. may because it is actually extremely rare for every STD/STI to be tested for. Hep B and HIV are, of course, the big ones. I have never heard of an STD/STI test anytime in the past ten years that didn’t test for Hep B and HIV. Herpes is almost never tested for (and when they do, the tests aren’t very reliable). The only way to know for sure what is being tested for is to ask when you are tested.

Results from an STD/STI test usually take around 2 weeks. A month isn’t unheard of, a week is a pleasant surprise. So don’t go in to get tested expecting to have a print out to show your partners the next day. And speaking of print outs, many STD/STI testing centers don’t give you one. They just call you with your results. By law in the US (and I believe many other countries), you are entitled to a copy of you medical records, so even if they don’t routinely give out printed results it is possible to them, but you may need to jump through some hoops for it.

On a more philosophical level, ‘what’ STD/STI testing is, is the bet way to stop the spread of sexual transmitted infections. Please note, not ‘keep from being infected’ but ‘stop the spread’. When we get tested, we really aren’t doing it for us – if the test comes back positive, we’re already infected. We are doing it for our partners, and their partners, so that if we are infected, we can get treated and take precautions so that our partners (and their partners) don’t get infected. Asking your partners to get tested is for you. Getting tested is for them.

Which leads right into my last thought on ‘what is STD/STI testing’: A damned good way to say ‘I love you.’