STI screening information for students: 3/07
If a student without symptoms comes in for STI screening at Vaden, these are the questions that are considered. Note that these are general guidelines, not rules. Couples might consider seeing the same clinician to be sure they get the same information.
Note that positive tests for gonorrhea, chlamydia, syphilis, hepatitis B, and (since 4/06) HIV all must by law be reported to the county health department.
Considerations
- How many sexual partners have you had in your lifetime?
- Have you previously had an STI?
- Have you had the Hepatitis B vaccine? (currently Hepatitis B, and HPV [since 6/06] are the only vaccine-preventable STIs)
- What sexual behaviors have you engaged in, both protected and unprotected?
- Any other risky circumstances – tattoos from unreliable sources, transfusions prior to 1992, drug use using needles?
Those who are statistically at particular risk are those who have had multiple sexual partners, have a history of STIs, have sex for money, use drugs (esp. by injection), or are homosexual (males) or bisexual. Partners of the aforementioned are also at risk.
Blood tests: HIV, Hepatitis B, Syphilis
Routinely, blood tests are performed testing for HIV, Hepatitis B (unless already immune), and Syphilis. Blood tests may not become positive up to three months after the exposure.
Hepatitis B is transmitted the same ways as HIV, is probably 100 times as contagious, and is vaccine-preventable – the vaccine is now given to infants in the US, since 1991. Hepatitis B is endemic – very frequent - in parts of Southeast Asia and Sub-Sahara Africa – it is possible to be infected at the time of birth from an infected mother. Most people with chronic Hepatitis B have no symptoms, but they are infected and are contagious.
Incidentally, when you donate blood, the sample is tested for HIV as well as for Hepatitis B and C. If you are concerned that you may have been infected with these viruses, you should not donate blood; however, if you have already donated, you have been tested for these infections.
Urine testing is done for Gonorrhea and Chlamydia. In
women testing for these two organisms may also be done from the cervix during
a pelvic exam; this method is a little more sensitive than urine testing
in women. Testing is particularly advised for women under 25 with
2 or more partners in the last year, if they do not always use barrier contraceptives.
Men who have sex with men (MSM) should also be tested for
gonorrhea of the throat, and if they have had unprotected receptive anal
intercourse, with rectal cultures for gonorrhea and Chlamydia as well.
Tests which are controversial
Herpes Simplex Virus (HSV), Types 1 & 2
If you have had cold sores (fever blisters) around the mouth (not canker sores, inside the mouth), you have herpes 1. Up to 80% of adults in the US (about 33% of Stanford students) are infected with HSV I, the type that usually causes cold sores around the mouth. However, over 50% of genital herpes is caused by the HSV I virus as well, because of oro-genital sexual contact. The blood test does not tell the location of the herpes, only the type.
20-25% of adults in the US - (about 10% of Stanford students), higher in
some ethnic groups– are infected with the HSV II virus, which
is almost always genital.
Moreover, in both of these groups, most of the individuals
who have positive tests have no history of having had any kind
of a typical herpes sore, but they are infected and they are
potentially contagious. Although you are more contagious
when you have a sore, you are still potentially contagious at other times;
most herpes which is newly acquired is passed on by a person with no symptoms.
Ongoing preventive use of anti-herpes drugs, such as acyclovir, may decrease the shedding of the virus and the contagion in those with frequent outbreaks, but not to zero.
Two circumstances are medically important with respect to herpes:
- If a pregnant woman with HSV transmits the virus to her baby at the time of delivery, the baby may suffer serious consequences.
- If you have herpes, especially with a sore, and you have unprotected sex with a person definitely infected with HIV, you have a significantly increased risk of getting HIV from this encounter.
Otherwise, herpes is generally a nuisance phenomenon, although it is never great experience to have genital herpes, or even more, to give someone else genital herpes.
Consequently, you need to think hard as to whether it would be helpful for you to know if you are infected and are potentially contagious for herpes of either type. Keep in mind that herpes, while an STI and often extremely uncomfortable, does not have any severe complications, with the above two exceptions.
Testing may be especially relevant in couples who are discordant, meaning that one of them is infected and the other is not. If both are infected or if neither one is, herpes becomes a non-issue for that relationship.
Tests not usually performed
Human Papilloma Virus (HPV)
There multiple strains of HPV, some of which are linked to genital warts and some of which are linked to various types of cancer, especially cervical cancer. No blood test is currently available. A Pap test is the best screening test in asymptomatic women, and there is a test now which can pick up the presence of the dangerous types of HPV present in the cervix; this test may be done if the Pap is abnormal.
Be aware that since 6/06 a vaccine (Gardasil) has been available to prevent four of the most prevalent types of HPV, including two of the most common causes of cervical cancer and two of the most common causes of genital warts. Currently the vaccine is recommended for both females and males between the ages of 9 -26, regardless of previous exposure, and it may be given to some older women in some circumstances.
Hepatitis C
You are at risk for Hepatitis C if you have ever used drugs by injection, even if only once, even if a long time ago. You may also be at risk if you are a frequent sexual partner, using no protection, of someone who has used drugs in this way. Most people with Hepatitis C have no symptoms.