Testing for sexually transmitted infections (STIs) can be one of the trickiest topics to navigate in a monogamous relationship. Routine testing is often considered an important health care decision for people who have multiple partners or are in casual relationships, but it is just as important for people in exclusive partnerships. Despite all the societal stigma, it's a routine health screening that all people should be getting regularly, regardless of relationship status.
How Should Monogamous Couples Approach STI Testing?
At the Beginning of a Relationship
The best time to get tested for STIs in a monogamous relationship is as soon as both partners are emotionally (and financially) able to get access to a clinic or test kit. It can often be easier to broach the topic at the beginning of a relationship. Savita Ginde, M.D., M.P.H., vice president of medical affairs at Stride Community Health Center in Denver and former chief medical officer of Planned Parenthood of the Rocky Mountains, believes that "a couple that gets tested sets a healthy foundation for their relationship." She advises early testing, because it allows everyone involved to know each other's health status early on and avoid any feelings or accusations of cheating or dishonesty.
In the Middle of a Relationship
It's never too late to get tested with an exclusive partner. Whether you have been together for a few months or even a few years, getting STI testing is still an important measure to take in a relationship. The conversation may be a bit trickier to navigate the longer you have been with a person, but there are still impactful ways to streamline the conversation.
Beth Oller, M.D., a family medicine physician at Solomon Valley Family Medicine in Stockton, Kansas, recommends approaching this conversation from an educational point of view. She advises stressing the importance of testing for health reasons, to minimize any feelings of distrust a partner may have upon hearing a request to get tested.
Oller recommends starting a conversation about testing with a long-term partner with an opening like this: "I know we've been together a long time, but there are things we could have had from a prior relationship that we don't know about, and to be as safe as possible, we should both get tested."
Why Should Couples Get Routine STI Testing?
STIs Are Extremely Prevalent, and Many People Have Been Exposed to at Least One
STI rates are climbing in America. They are far more common than most people would believe them to be. Ginde estimates that one in two adults will get one in their lifetime. According to the Centers for Disease Control and Prevention, approximately 20 million new STI infections occur each year. Amesh Adalja, M.D., FIDSA, an infectious disease doctor and senior scholar at Johns Hopkins University Center for Health Security in Baltimore, recommends that the couple be open and honest about their sexual histories, because of the high prevalence of STIs and because people should be tested appropriately.
Certain STIs Have Latency Periods
Many STIs do not have immediate effects. For many people, it may take weeks, months, or even years to truly feel and recognize the symptoms of an STI. HIV, syphilis, and hepatitis B are common STIs that can often stay dormant for years after exposure, states Ginde. This can cause a problem for long-term relationships, because if people are not regularly getting tested, they may be unaware of what they have, and they may actually be putting their health and their partner's health at risk for delaying treatment.
Some STIs Can Be Obtained Through Non-Sexual Contact
Certain STIs have multiple transmission methods. They can find their way into our system in a variety of non-sexual ways. STIs such as HIV and hepatitis B can be transmitted via blood-to-blood contact. Other STIs, such as herpes, can be spread via skin-to-skin contact. Ginde notes that many people can get cold sores from relatives as kids that can be spread via oral sex when they are adults. Human papillomavirus (HPV), syphilis, and molluscum contagiosum are other common STIs that can be spread via skin-to-skin contact.
Some STIs Take a While to Be Detected Through Tests
Some STIs have specific window periods after which they show up on tests. A window period is the time between when a virus pops up in the body and when a test can accurately detect it. For example, with HIV tests, certain tests "may be negative soon after infection, because of the limits of detection of the technology coupled to the speed of virus replication and antibody formation," states Adalja. It's entirely possible that an HIV test done just once at the beginning of the relationship may not entirely tell the full story months later into a relationship.
What Should Couples Do If Someone Tests Positive?
If a test denotes someone is positive for an STI, the first step is to not panic! Seriously. The second step is to find an affirmative health care provider who can offer you and your partner the best advice and guidelines on how you all should progress with taking care of your health. Oller recommends going to a family medicine or primary care doctor who can speak to both partners as to the best course of action.
If the STI is one that has a curative treatment, then the affected partners should start a treatment plan as soon as possible to cure their infection and delay or mitigate any harmful health effects. If the STI has a manageable treatment, such as HIV or herpes, then the affected partner should similarly start a treatment plan for their health. If there is a non-affected partner, they should also look into treatment and prevention options they can use to prevent themselves from getting the infection. For example, with HIV, the non-affected partner can look to pre-exposure prophylaxis (PrEP) medication and learn more about sexual safety when their partner becomes HIV undetectable. For herpes, partners should learn how to navigate sexual activities in between and during outbreaks.
Each and every aspect of a relationship should be as healthy as possible. Getting routine STI testing with a partner is an essential way to maintain the sexual health of you and your partner. STI testing can often feel intrusive, and people may at first respond to the idea with distrust, but the truth is that it's just taking care of your health! Monogamous partnerships are not immune to STIs -- and learning to test and, if needed, take care of them with a partner can improve and strengthen relationships.
Going forward with this mentality can lead to a healthier and happier relationship with a monogamous partner.