Sexually transmitted disease (STD) prevention is HIV prevention, but the inverse doesn't necessarily hold true, and we must clear up any lingering confusion about that.
Condoms still work. Serosorting is applicable. Injectables and microbicides are being researched and developed. Treatment as prevention is phenomenal (say it with me, "U=U"). And, pre-exposure prophylaxis (PrEP) is an amazing tool for preventing HIV transmission. We have many tools; however, one strategy in the arena of STD/HIV prevention needs to be bolstered a bit: three-site STD testing.
Three-site STD testing, also known as extragenital testing, entails appropriate screening of the throat, penis, and rectum. Simply put, wherever you sex it is where you should test it. This applies to oral and anal sex. You know better than anyone else what kind of sex you're having, and some doctors may not ask specific questions about it. This could be a helpful guide:
Related: How to Make Your Next Sexual Health Check Less, Erm ... Awkward
- If your penis has been in someone's butt, throat, or vagina, then you should pee in a cup.
- If someone's penis has been in your vagina, you should pee in a cup.
- If another person's penis has been in your mouth, then you should get your throat swabbed.
- If someone's penis has been in your butt, then you should get your butt swabbed.
Three-site STD testing should be a routine part of your sexual health care. Considering that most STDs do not have obvious symptoms, a test every three to six months is recommended (every three months if on PrEP). Providers should perform a thorough sexual history, including discussion of the 5Ps: partners, prevention of pregnancy, protection, practices, and past history of STDs. Of course, this needs to be done in an affirming, sex-positive, non-judgmental manner. It's understandable and well known that many people may feel uncomfortable talking with their doctors about their sex lives.
Three-site STD testing is especially important for gay, bisexual, and other men who have sex with men (MSM) -- regardless of HIV status or whether on PrEP. Three-site testing is not limited to MSM, though. Women and transgender and gender non-conforming folks, and frankly, anyone having oral and/or penetrative sex (anal and/or vaginal) should consider getting screened.
Our sexual health conversations would benefit from going beyond the disease narrative. Sexual health includes both HIV and STDs, along with consent, pleasure, kink, and many more facets.
The U.S. Centers for Disease Control and Prevention has reported the third consecutive year of record-high rates for all STDs, including gonorrhea, chlamydia, and syphilis. We need an urgency rooted in sex-positivity and not slut-shaming stigma. So, without the judgement, you should ask yourself the following:
When was your most recent STD test? Did you pee in a cup? Was there a throat and/or rectal swab? Did you also have blood drawn for HIV and/or syphilis testing?
Yes, that's right. Collecting urine is insufficient alone. If you used your mouth or anus during sex, an oral and/or anal swab is called for. Depending solely on urine results, active infections go undetected in the butt and throat. In fact, for gay and bisexual men, more 70 percent of gonorrhea and more than 85 percent of chlaymdia go undetected if three-site testing isn't used. Many clinics will allow you perform your own throat and butt swab with a kit you take into the bathroom, if you're uncomfortable with your provider doing it. And urine tests and throat/butt swabs don't count for syphilis testing -- you need to have your blood drawn. With rates of syphilis rising nationally, especially for gay and bisexual men, you should be getting regular syphilis screenings, as well.
Three-site STD testing isn't going the "extra mile"; this is the basic standard of care, and it's what you should expect from your provider. This is what health equity looks like.
Routine STD testing can be a wise strategy in addressing rising STD rates and could possibly stem emerging concerns, such as antibiotic-resistant gonorrhea or meningitis.
And make no mistake: STD prevention is HIV prevention. STDs are far too often parceled off from HIV conversations. Addressing HIV prevention within a holistic sexual health framework has the potential to reduce these record-high STD rates. Providers miss a vital opportunity when they don't broach the topic of PrEP upon informing people of a positive STD result. Absent undetectable HIV status and condoms, what caused a person to contract rectal gonorrhea could lead to contracting HIV. By taking these steps, we can mobilize more people to become engaged in PrEP.
If we return to the premise that STD prevention is HIV prevention, a positive chlamydia, gonorrhea, or syphilis test could be the most ideal launchpad into PrEP recruitment. According to research, one in 15 MSM diagnosed with rectal gonorrhea or chlamydia and one in 20 with infectious syphilis acquired HIV within one year of their STD diagnosis.
A renewed push for three-site STD testing should be in full effect. Community can demand that this service happens at its local STD clinics, and you can even ask your own doctor during your next visit. With concentrated efforts, we could turn the tide in rising STD rates and be deliberate in ensuring that the sexual health needs of everyone, especially our most disproportionately affected communities, are being met.