A Gentleman’s Guide to STI Testing

Okay guys, bring it in — we need to talk.

When was the last time you were tested for sexually transmitted infections?

If you’re anything like the men I recently polled on Twitter, there’s a good chance the answer is “never.”

Let me put this bluntly: That’s wack as hell. I knew, anecdotally, that straight men tend not to get screened nearly as often as women and queer men, but I had no idea things were this dire.

Of course, a Twitter poll isn’t representative of any real population. But if you want something more sophisticated, a recent CDC study found that 53.8 percent of men between the ages of 15 and 44 had never once been tested for HIV. And a smaller study by the fertility app Kindara found that 44 percent of the men in its 500-person sample had never been tested for any STIs at all.

Anecdotally, one sexual health provider I know here in New York tells me that she frequently sees young men who have never been tested, including some who’ve had sex with 10 to 20 partners in the last year alone. She describes it as a result of men relying on other people’s bodies and health behaviors — i.e., their sexual partner — to do the work for them. Aside from being pretty rude, it’s a reflection of a broader sexual culture that puts the onus on women to prevent all of the unintended consequences of sex, which involves the financial costs of birth control falling disproportionately on women, too.

Needless to say, it’s downright irresponsible as well. Not knowing your sexual health status presents risks not to you and your partners. This is especially true given that some infections, such as chlamydia and gonorrhea, are asymptomatic in men, but can have ugly repercussions for women — infertility to name just one.

That said, I don’t want to put this all on straight guys. Current CDC recommendations don’t actually mention heterosexual men at all, except to say that everyone from 13 to 64 should be tested for HIV at least once in their lives. Plus, plenty of men aren’t offered STI testing. In fact, in the CDC study I mentioned earlier, the second most common reason for never testing for HIV is never having been offered a test. (Thankfully that’s changing, as more and more medical practices are moving to routine voluntary screenings, at least for HIV.) On the flip side, women are consistently examined at the OB/GYN, where doctors test for STIs even when symptoms aren’t present.

It’s still no excuse, though. So if you’re starting to feel a little guilty or if you’re one of those guys who’s never been tested for STIs, here’s how to change all of that…

Chlamydia, Gonorrhea and Hepatitis

Chlamydia is a bacterial infection that’s one of the most common STIs — almost 3 million Americans get it annually. It’s spread through sexual fluids and typically infects the genital region. Usually symptomless, chlamydia can nonetheless cause health problems down the line if untreated.

Gonorrhea often goes hand-in-hand with chlamydia, which is why they’re typically tested for together. It, too, can often be present without clear symptoms. But dicks are more likely to show the signs — e.g., discharge, pain while urinating and swollen testicles.

Both of these infections are detected the same way — through urine. For chlamydia, your throat or butt might be swabbed as well. A medical professional will normally help out with the throat swab. You’re on your own for the butt, though, which usually involves inserting a narrow. swab into your rectum. This is only necessary if you’ve had unprotected, receptive anal sex. Trust me, it’s not as bad as it sounds.

There aren’t vaccines for chlamydia or gonorrhea, though they can both be cured via antibiotics.

Herpes, Syphilis and Hepatitis

Herpes is a viral infection that’s pretty common — more than half of Americans have oral herpes, often from childhood, and one in six has the genital variety. Unlike many STIs, herpes is spread through contact rather than sexual fluids. There’s no cure for herpes, which is one reason why it carries so much stigma. There are, however, effective meds (e.g., Valtrex) that can prevent outbreaks and reduce risks of transmission.

Syphilis may have something of a reputation as an old-timey STI, but in recent years, it’s come back in a major way. Between 2014 and 2015, rates of infection increased all across the U.S., with men continuing to experience the highest rates. It’s a bacterial infection that can be cured, but early detection is important as it can cause brain damage if left untreated.

“Hepatitis” just means inflammation of the liver (don’t say I never taught you anything), but that inflammation is caused by one of several viruses. In the U.S., only Hepatitis A, B and C are common. Hep A can be sexually transmitted, though it’s often acquired through infected food or drink. Hep B is highly transmissible through sexual fluids, while Hep C is usually only transmitted via blood. Hep A doesn’t cause long-term liver damage, and most people recover from it with lifelong immunity. There are vaccines for both Hep A and Hep B. And while Hep C was historically incurable, thankfully that’s beginning to change.

For each, testing is done by a blood draw, typically from the inner elbow.

HPV

Human papillomavirus (HPV) is common, frequently harmless and generally resolves on its own. Most sex havers get it at some point. But it can have devastating consequences — for instance, some types of HPV cause genital warts. Some also cause cancer, typically cervical, but sometimes also in the vulva, penis, anus, mouth and throat. HPV is spread from skin-to-skin contact, and there’s no cure.

Unfortunately, there’s no approved test for HPV in men — or more specifically, people without cervixes. Check with your doctor if you find unusual discolorations or sores on your dick, even if they don’t hurt. There’s a vaccine available too, but if you’re over 26, you’ll probably have to pay out of pocket for it. Similarly, there’s no way of quantifying exactly how much protection it’ll get you, due to the lack of tests available. Still, it’s something to consider.

HIV

Even though heterosexuals constituted 24 percent of HIV diagnoses in 2016, plenty of straight people continue to think they don’t need to be tested for HIV.

Don’t be stupid, okay?

You do have some options when it comes to testing: home kits where you send the results to a lab; home testing where you check the results yourself; and lab tests generated by medical professionals. There are pros and cons to each, though all things considered, the professional route is the more confidential, reliable and affordable one.

Historically, HIV testing was more complex than other STI screens, because detectable antibodies — what the previously most common tests looked for — don’t show up during the “window period” after exposure (window period = up to three months). So-called “fourth generation” tests, though, look for both antigens and antibodies, meaning they can detect HIV positivity earlier after exposure. The tests that can detect HIV the quickest after infection look for actual viral load, but they’re relatively expensive.

It’s important to note that in 2018, testing positive for HIV doesn’t mean you have, or will progress to, AIDS. It also doesn’t mean your life, sexual or otherwise, is over. The social politics of pos status are too complex to get into here, but you should know that sophisticated management regimens can reduce viral loads to what’s known as “undetectable” levels, allowing you to live a long, healthy life with zero risk of transmission to partners.

The Bottom Line

Despite the lack of official directives by health organizations on straight men getting tested, there’s no good reason not to get tested for STIs on a regular basis — even if it’s just once a year. If money’s a concern, know that there are places you can go — like Planned Parenthood — that offer low or no-cost confidential testing for the most common infections.

I should also add that I don’t mean to minimize the stigma attached to asking for tests, or the fact that you may have to convince your doctor to screen you. But pushing through the discomfort is worth it to become a more responsible sexual citizen. Because remember: Being aware of your sexual health isn’t just about you, it’s about your partners as well.