STD screening

As long as you have had unprotected sex with a non-regular sexual partner, your sexual partner has a clear history of STD infection, or you have suspected symptoms such as genital ulceration/abnormal discharge/unexplained rash, you should go to the dermatology and venereology department of a regular hospital or the CDC for targeted screening as soon as possible. You need to bear it hard; even if you have a fixed single sex partner, it is recommended to do routine STD screening at least every 2-3 years. Monitoring data from the Chinese Center for Disease Control and Prevention in 2023 shows that the cure rate of common STDs detected early is close to 100%, which is much higher than the prognostic effect of seeking medical treatment after symptoms appear.

Last week, I met a young girl who had just graduated from the clinic. She came in with her face covered and was speechless for a long time. Finally, she confessed that she did not take any protective measures when she met her online date. Afterward, she always felt a little itchy in her private parts and was embarrassed to come to the hospital. I searched a lot on the Internet and became more and more scared. It took me three months to come. The result was that she was positive for HPV16 and had chlamydia infection. In fact, chlamydia infection can be cured by taking doxycycline for a week in the early stage. Now there are low-grade lesions on the cervix, and I have to follow up for more than half a year, which is a pity.

Oh, by the way, many people ask me, do I still need to check every time I wear a condom? Of course, they are not foolproof. The protection rate of condoms against STDs such as HIV and syphilis that are transmitted through body fluids can reach more than 95%. However, for HPV and genital herpes that can be transmitted through skin and mucous membrane contact, the protection rate is only about 60%. Therefore, even if you wear a condom every time, if your sexual partner is not fixed, it is still recommended to check regularly and don't be careless.

As for the frequency of screening, there is actually no completely unified standard in the industry. Experts in the public health field prefer "wide coverage" and recommend that all people aged 18-45 who have had sexual intercourse undergo routine STD screening once a year. After all, sexual concepts are now open, and many people, even if they are regular partners, may not know each other's past history. There is no harm in checking more than once; but most of our clinical front-line doctors will be more pragmatic. If it is indeed the first time for both parties to have sexual partners, and there have been no other high-risk behaviors since being together, and there is no discomfort, in fact, checking once every two or three years is enough, and there is no need to waste money on excessive medical treatment. Of course, if you are a group of people who have a higher risk of infection, such as men who have sex with men, we will still recommend screening every 3-6 months, so don’t leave anything to chance.

Many people are afraid of being scammed for the first time, so they go to private institutions or physical examination centers to choose a "complete STD package" that costs thousands of dollars. It is really unnecessary. Last time I met a young man who spent more than RMB 6,000 to check for perianal gonococcus, oral mycoplasma, and even the antibody quantification of genital herpes. After asking for a long time, he had never even tried oral sex or anal sex. These tests were completely useless. Formal screening will first ask you about your sexual behavior and whether you have high-risk contacts, and then prescribe the corresponding items. Regular vaginal/urethral secretion tests for gonococcus and chlamydia (now basically use nucleic acid amplification tests, which are more than three times more sensitive than previous smears, and are rarely missed), plus HPV typing, syphilis antibodies, and HIV fourth-generation tests. These items add up to only three to four hundred yuan, which is enough to cover more than 90% of common infection risks.

There are a lot of STD self-test papers sold online now, and people ask a lot about them. Scholars who support self-testing believe that it provides good privacy, and many people who are too embarrassed to go to the hospital are willing to use it, which can improve the coverage of screening. However, there are also voices of opposition. After all, it is difficult for ordinary people to meet the standards for sampling. For example, testing for chlamydia requires cervical or urethral secretions, which is very difficult. Many people only take leucorrhea or urine samples at home, and the false negative rate can be as high as 30%. There are also HIV self-test strips, and the false positive rate is not low if they are not used properly. I have met several people who came to the hospital crying when they self-tested positive, but the final reexamination was negative, and they spent several days in vain. So my suggestion is that if you are really embarrassed to go to the hospital, you can buy a regular brand of test strips and test first. But as long as it is positive, regardless of whether you have symptoms or not, you must go to the hospital or the disease control center for confirmation. Don’t scare yourself, and don’t take it seriously.

In fact, after working in the STD department for so many years, the most common thing I say is that screening itself has no moral attributes. Don’t think that checking for STDs is a “private life mess”. It’s just like checking for C13 if you are afraid of Helicobacter pylori after eating takeaway. It is a healthy choice that is responsible for yourself and others. If you really have high-risk behaviors, don’t delay. Don’t check a bunch of symptoms and check them out. Go to a regular hospital to draw two tubes of blood and take a secretion. The results will be available in two or three days. You can rest assured that everything is fine. If something goes wrong, it won’t cost much to treat it early. It’s a hundred times better than just imagining things at home.