There are over 50 sexually transmitted infections. Screening includes the most common STIs. STI screening is not automatically done as part of your Pap smear and annual exam, and MUST be requested. You can let the medical assistant or your physician know you would like screening. If you would like to be screened for something that is not included on our standard panel, please ask your doctor.
Our panel includes the following tests:
Sexually transmitted infection screening is recommended in the following circumstances:
No preparation is needed. STI testing can be performed at the time of your annual exam. If you would like testing done at any other time, call and make an appointment.
There are two components to screening. Gonorrhea, chlamydia and human papilloma virus screenings require a cervical swab and is performed by inserting a speculum and placing a q-tip in the cervix, similar to a pap smear. An HPV test is NOT part of the standard panel. If you would like to be screened for HPV, please discuss it with your doctor. A pap smear screens for cervical changes that occur as a result of HPV. If the Pap is normal, HPV status will be checked only if you request it.
The remainder of the STI screen includes blood work. Our standard panel includes tests for syphilis, herpes, HIV, and hepatitis B.
Results are ready within the week. Please provide us with a daytime number to call with results. Let us know if the number you give is confidential so we know if we can leave a voicemail. If you would prefer to call for results, let us know. The following is a brief summary of each STI on our panel and what your results mean:
Gonorrhea
Gonorrhea is caused by a bacterium (Neisseria gonorrhoeae) that is usually contracted during sexual intercourse. The bacterium can be passed on through mucous membranes of the mouth, throat, anus, urethra, and vagina. Ejaculation is not necessary to spread gonorrhea. Contrary to popular belief, gonorrhea cannot be transmitted via inanimate objects such as a toilet seat.
You may be at risk for gonorrhea if you have a new sexual partner or multiple sexual partners, or if you have a previous history of gonorrhea.
Some people with the infection have no symptoms at all, so can often be spread before being detected, but there are several symptoms that indicate a gonorrhea infection such as:
Treatment of gonorrhea involves a one-time antibiotic treatment. This antibiotic may either be injected (ceftriaxone) or taken orally (cefixime).
If diagnosed with gonorrhea, it is important to inform all current or recent sexual partners so that they can also be treated. This is especially important, since people often have gonorrhea without experiencing any symptoms. It is also possible to be reinfected after treatment if your current partner still has the infection. Therefore, sexual contact should be avoided until both partners have been treated and no longer have any symptoms. If you continue to experience symptoms after being treated, please tell your doctor.
Chlamydia
Chlamydia is caused by a bacterium (Chlamydia trachomatis) that is usually contracted during sexual intercourse. The bacterium can be passed on through mucous membranes of the mouth, throat, anus, urethra, and vagina. Ejaculation is not necessary to spread chlamydia. Contrary to popular belief, chlamydia cannot be transmitted via inanimate objects such as a toilet seat.
Some people with the infection have no symptoms at all, so it can often be spread before being detected, but there are several symptoms that indicate a chlamydia infection such as:
Chlamydia is treated with an antibiotic taken orally. If diagnosed with chlamydia, it is important to inform all current or recent sexual partners so that they can also be treated.
Syphilis
Syphilis is caused by a bacterium (Treponema pallidum) and is contagious whenever a sore or a rash is present.
There are four stages of syphilis.
Primary stage: During the earliest stage, a painless open sore called a chancre (pronounced "shanker") develops. Chancres are often found in the genital area, anus, or mouth, but can be found wherever the bacteria entered the body.
Secondary stage: A skin rash occurs during the secondary stage, which usually begins 4 to 10 weeks after the initial infection. Secondary syphilis is highly contagious through direct contact with the mucous membranes.
Latent stage: The latent stage is defined as the year after a person becomes infected. A person in early latent stage may be contagious even though they usually have no symptoms.
Late (tertiary) stage: If syphilis is not detected and treated in the early stages, serious medical problems can occur.
Treatment
Antibiotics cure the infection at any stage. Antibiotic treatment cannot reverse the damage caused by the complications of late-stage syphilis, but it can prevent further complications.
Herpes (Adapted from from UpToDate® - www.uptodate.com)
— Genital herpes is a common sexually transmitted disease that is caused by the herpes simplex virus. It is estimated that at least one in five adults in the United States is infected with the virus, but many people have no symptoms and do not realize that they are infected. Genital herpes is a lifelong condition that cannot be cured. However, the infection can be managed with medication and self-care measures. People who have genital herpes are encouraged to talk to their sexual partner, use condoms, and take other preventive measures to prevent transmission (passing the virus to others). Genital herpes can be spread even when there are no visible ulcers or blisters.
— Genital herpes is caused by infection with the herpes simplex virus (HSV, usually type 2). It can also be caused by herpes simplex virus type 1, which is the most common cause of oral herpes (cold sores on the mouth and lips).
— The symptoms of genital herpes can vary widely, depending upon whether you are having an initial or recurrent episode. However, many people infected with genital herpes never experience symptoms.
Initial episode — For most people, the first herpes outbreak is the most severe, and symptoms tend to be more severe in women than men. The first outbreak usually occurs within a few weeks after infection with the virus. Symptoms tend to resolve within two to three weeks.
The signs of an initial (or primary) episode of genital herpes include multiple blisters in the genital area. For women, the sites most frequently involved include the vagina, vulva, buttocks, anus, and thighs; for men, the penis, scrotum, anus, buttocks and thighs may be affected. Signs and symptoms typically include blisters that become painful ulcers. Blisters on the penis or outer labia may crust over and heal. New lesions may develop for up to 5 to 7 days after the first group appears.
Some individuals also get blisters in non-genital areas such as the mouth and lips. There may also be tender, swollen lymph nodes in the groin, flu-like symptoms, such as joint pain, fever, and headache, and it may be painful to urinate.
A small percentage of people also develop non-genital symptoms, including meningitis (inflammation of the tissue covering the brain and spinal cord) and an inability to urinate (from the effects of the virus on the nervous system). The virus can also cause proctitis (inflammation of the rectum or anus), particularly in men who have sex with men.
Latent stage — After the initial outbreak, the virus travels to a bundle of nerves at the base of the spine, where it remains inactive for a period of time. This is called the latent stage. There are no symptoms during this stage.
Recurrent episodes — Many people experience recurrent episodes of genital herpes, which occur when the virus travels through nerves to the skin's surface, causing an outbreak of ulcers. These recurrent episodes tend to be milder than the initial outbreak, and some recurrences cause no noticeable symptoms at all. When blisters are present, they are usually present for a shorter duration, about 10 days on average.
Ulcers may develop in the same area as those of the first outbreak, or may appear in other areas. It is possible to develop lesions in areas where there was no direct contact; for example, it is possible to have lesions around the anus without having had anal sex.
— Genital herpes recurs frequently in many patients, especially in those with HSV type 2. Over time, recurrences generally become less frequent and less severe.
However, it is also possible to have a recurrence many years after the initial HSV infection was acquired. This type of delayed herpes outbreak can be especially distressing if you never had symptoms during the initial infection, leading you to worry about the sexual activities of your past or present sexual partner(s).
Prodrome — As many as 50 percent of people with a recurrent outbreak experience mild symptoms before ulcers develop. These are called prodromal symptoms, and may include itching, tingling, or pain in the buttocks, legs, or hips. Recurrences tend to become less frequent and less severe after the first year.
Triggers for recurrence — Illness, stress, sunlight, birth control pills, and fatigue can trigger recurrent herpes outbreaks. In women, menstrual periods may trigger an outbreak.
When did I become infected? — The first time a person has noticeable signs or symptoms of herpes may not be the initial episode. For example, it is possible to be infected for the first time, have few or no symptoms, and then have a recurrent outbreak with noticeable symptoms several years later. For this reason, it is often difficult to determine when the initial infection occurred, especially if a person has had more than one sexual partner. Thus, a current sexual partner may not be the source of the infection.
GENITAL HERPES DIAGNOSIS — The diagnosis of genital herpes is based on an individual's medical history, their signs and symptoms, and the results of tests. It is important to distinguish genital herpes from other sexually transmitted diseases, particularly those that also produce genital ulcers, such as syphilis and chancroid.
Several diagnostic tests may also be used to diagnose genital herpes. These tests can usually confirm infection and identify which virus (HSV-1 or HSV-2) is responsible. Tests can also detect asymptomatic shedding in individuals with known infection, although testing is not routinely done for this purpose.
Culture test — A culture test determines if herpes simplex virus is present on the skin and in secretions from the urinary and genital tracts. This is the test most commonly used to diagnose genital herpes.
However, a herpes culture detects the virus in only about 50 percent of individuals with genital ulcers. The culture is more likely to detect the virus when ulcers are new and open, as compared to when they are older and healing. Therefore, it is important to see a healthcare provider within 48 hours of the first symptoms. The test is also more sensitive in individuals experiencing an initial episode of genital herpes than in individuals experiencing a recurrent episode.
Blood test — Blood tests are often used when a person believes he or she may have been exposed to the herpes virus in the past, but has no visible ulcers. A blood test can detect antibodies (proteins that are produced by the body in response to a foreign substance) to HSV type 1 and type 2. Having a positive test for these antibodies indicates that the person was infected with the virus at some time in the past, although it is usually not possible to know when or from whom the virus was transmitted.
The results of antibody testing may be negative early on during the initial episode of infection since antibody formation takes a few weeks. The antibody test remains positive for life.
Blood tests may be helpful for couples if one person has a history of genital herpes and the other does not. It is possible for a person to have HSV antibodies (indicating past infection), even if they have no memory or history of herpes ulcers or blisters.
Determining the type of herpes (1 or 2) can also help to predict the likelihood of future recurrences, given that type 2 recurs more frequently than type 1
GENITAL HERPES TRANSMISSION AND RISK FACTORS
Transmission between sexual partners — The herpes virus is most often transmitted between partners during oral, anal, or vaginal sex. It is possible for a person to develop genital herpes after exposure to a cold sore on an infected person's lip during oral sex; in this case, genital herpes may be due to infection with HSV type 1. Transmission from person to person can occur even if there are no visible ulcers.
There is no risk of becoming infected after exposure to environmental surfaces (door knobs, toilet seats, utensils, bed sheets).
The risk of transmission from an infected male to an uninfected female partner is slightly higher than the risk of transmission from an infected female to an uninfected male partner. The risk of infection is also higher in men or women who receive anal sex.
If both sexual partners have the same type of herpes virus (e.g., type 1 or 2), there is no risk of spreading the virus from one person to another. It is possible for a person with one type of herpes virus to become infected with the other type; for this reason, testing to determine virus type is important for couples.
When am I most likely to spread the virus? — The risk of spreading the infection is much greater when a person has signs or symptoms of active infection. The virus can also be spread as a result of viral shedding, which means that the virus is present in the genital areas but no ulcers are present.
Shedding of HSV type 2 occurs approximately 20 percent of the time (an average of 72 days per year), mostly before, during, or after ulcers are present. Shedding occurs more commonly with HSV type 2 and is most likely during the first 12 months after the infection is acquired.
The virus is shed on 3 percent of days when there are no signs or symptoms of the virus. However, some people with HSV shed virus more frequently than others.
Transmission of HSV may occur within a short time in new sexual relationships. In one study of patients with newly acquired HSV genital infection, the average time from the first sexual encounter to the time a person was infected with HSV was 3.5 months (range 1.5 to 10 months) [1].
One study examined rates of genital herpes transmission in heterosexual couples when only one partner was initially infected [2]. Over one year, the virus was transmitted to the other partner in 10 percent of couples. In 70 percent of cases, infection occurred at a time when there were no symptoms.
Use of condoms and suppressive antiviral medication can decrease the risk of spreading the infection to partners who are not infected, especially during the first year after a person becomes infected
Pregnancy and herpes — Women who have their first outbreak of genital herpes near the time of delivery are at risk of transmitting herpes to their newborn. Women who acquire genital herpes before becoming pregnant are not likely to pass the virus to the baby. However, it is possible for this to happen, particularly if the mother has symptoms of pain or burning, or has active lesions at the time of delivery.
Preventive antiviral therapy with acyclovir is often recommended for women with one or more recurrences during pregnancy. A caesarean delivery is usually recommended in women who experience an outbreak of symptoms at the time of labor.
Since herpes in infants is a very serious condition, women should inform their healthcare provider if they have a history of the infection. Women with no history of genital herpes whose partner has a history of cold sores (generally HSV type 1) or genital herpes (generally HSV type 2) should avoid oral, vaginal, and anal sex during the last trimester of pregnancy. Condoms are recommended during the entire pregnancy. Careful planning during the pregnancy and precautions during pregnancy and at the time of delivery can reduce the likelihood of transmission.
GENITAL HERPES AND HIV — Individuals with genital herpes are at an increased risk of acquiring HIV. During an outbreak, blisters and ulcers make it easier for a partner's genital fluids to enter the body. Therefore, if a person with herpes is exposed to HIV through sexual contact while herpetic lesions are present, HIV can more easily travel through the skin.
GENITAL HERPES TREATMENT — Although there is no cure for genital herpes, the infection can be managed with antiviral drug therapy and self-care measures.
Antiviral medications — Three antiviral medications are used to treat genital herpes: acyclovir (Zovirax®), famciclovir (Famvir®), and valacyclovir (Valtrex®). They are usually taken by mouth (in pill form). Acyclovir (Zovirax®) is the oldest and least expensive antiviral medication. It usually requires more frequent dosing than famciclovir and valacyclovir.
Treatment regimen — The dose and length of treatment depends upon whether the outbreak is the first episode or is a recurrence.
Initial episode — The first episode of genital herpes is generally treated with 7 to 10 days of one antiviral medication, taken by mouth:
Episodic therapy — Episodic therapy may be recommended if you have fewer than six outbreaks each year. Unfortunately, episodic treatment does not reduce the frequency of outbreaks.Treatment is most likely to be effective if it is started within 72 hours of the first symptoms. People with a history of recurrent genital herpes are often advised to keep a supply of antiviral medication in their home.
Episodic treatment of recurrent genital HSV includes one of the following:
Suppressive therapy — Suppressive therapy is low dose antiviral treatment that is taken every day to prevent outbreaks.
Suppressive treatment includes one of the following:
The advantage of suppressive therapy is that it decreases the frequency and duration of recurrences, and can reduce the risk of transmitting HSV to an uninfected sex partner.
Suppressive therapy may be recommended if you have six or more recurrences each year or have a weakened immune system due to the human immunodeficiency virus (HIV), use of immune-suppressing drugs, or other factors.
Suppressive therapy may also be an option if you are in a sexual relationship with a partner who does not have a history of genital herpes or antibodies to HSV-1 or 2 (as determined by blood testing). Taking suppressive therapy can reduce the chances of transmitting the virus by approximately one-half.
It is not clear how long suppressive therapy should continue. Some experts recommend taking a break from treatment periodically (every few years) to determine if suppressive therapy is still needed. If recurrent outbreaks develop, suppressive therapy may be restarted.
No treatment — It is not necessary to treat a recurrent episode of genital herpes. No treatment may be appropriate for some patients, particularly those with infrequent outbreaks and/or minimal symptoms.
Which treatment regimen is right for me? — Many people with recurrent herpes are unsure which treatment regimen (episodic or daily suppression) is right for them. The factors you should consider include how often you have outbreaks, how severe your symptoms are, and the risk of passing the infection to a sexual partner.
Self-care measures — In addition to antiviral medications, local treatments may be used to relieve the pain of a herpes outbreak. Sitting in a few inches of cool water (called a sitz bath) can temporarily decrease pain. This can be done in a bathtub or a specially designed sitz bath, available at most pharmacies without a prescription.
Women who are having trouble urinating may find it helpful to urinate in the sitz bath or at the end of a warm bath. In rare cases, it may be necessary to place a catheter in the bladder if the person is unable to empty on their own. Soaps and bubble baths should be avoided. It is important to keep the genital area clean and dry, and to avoid tight or irritating underwear and clothing.
Acetaminophen (Tylenol®) or ibuprofen (Advil®) may also help relieve the pain of genital ulcers. Over-the-counter creams and ointments are generally not recommended.
GENITAL HERPES PREVENTION — Because all sexually active people are at some risk of acquiring genital herpes, it is important to communicate with a sexual partner before the first sexual encounter. Discussing herpes can be uncomfortable and embarrassing, but it ensures that both partners understand the possibility of transmitting the infection through sexual activity. Regular testing for sexually transmitted diseases is also recommended, especially if one or both partners has other sexual partners.
After being diagnosed with genital herpes, it is still possible to have a safe and healthy sex life; however, it is important to take precautions.
SUMMARY
WHERE TO GET MORE INFORMATION
Hepatitis
Hepatitis is simply inflammation of the liver. A specific type of hepatitis, called hepatitis B, is caused by a virus that is most commonly spread by sharing needles when injecting drugs or by unprotected sexual intercourse. This virus can survive outside of the body for a long period of time, so it can be transmitted by sharing personal items including toothbrushes and razors.
Hepatitis can be confirmed through several hepatitis markers found in blood, which are substances called antigens that are produced by Hepatitis B and antibodies produced by the immune system to control and eliminate the virus. The levels of these markers can differentiate acute from chronic infection.
If you screen positive for hepatitis, you will be referred to a specialist who treats liver disease.
HIV
HIV, or human immunodeficiency virus, weakens the body's immune system, which makes it difficult to fight infections and cancer.
It is possible to have HIV without having any symptoms. Even without symptoms, the illness can be passed on through sexual contact or exposure to contaminated needles.
Without treatment, HIV can cause extreme illness and even death. When the infection is in its most advanced stages, it is called AIDS (acquired immune deficiency syndrome).
It is recommended that you are tested for HIV if:
To test for HIV, a small blood sample is taken. This test is more than 99 percent accurate. A test can be positive, negative, or indeterminate. When a test is positive, it is confirmed with another test. If a false negative result occurs, it is most likely because the test took place before HIV antibodies were made. One can be tested for HIV at any time, but it is suggested to have a repeat test done at 6, 12, and 24 weeks after suspected exposure.
Can you test my male partner?
We will do blood work on your male partner, but are not able to give him an exam or do urethral swabs.
If I test positive, can you treat my partner as well?
It depends. We will let you know on a case-by-case scenario.
What if I don't want results on my chart?
Our charts are confidential. That means no one will see your chart without your written permission. If an insurance company or someone else requests your chart, once you have given your permission to duplicate records, we are obligated, by law, to reproduce the chart in its entirety, including STI screening. If you do not want your results on the chart, a Chicago Board of Health Clinic can test you anonymously.
What if I don't want a positive result reported to the Board of Health?
We are obligated, by law, to report certain test results to the board of health.
What if I don't want the bill for screening to appear on my insurance?
You are welcome to pay out of pocket, and we will not submit the bill to your insurance company.
What if I am covered on my parents' insurance plan but I don't want my parents to know I had STI screening?
You can pay for testing out of pocket and it will not be sent to your insurance company or appear on the bill. You need to tell us this when you check in or out to assure a separate bill is done for testing.
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