One size doesn’t fit all: A life-saving guide to STD and HIV testing for gay guys

Editor’s note: Dr. Katz is a physician and public-health practitioner in San Diego specializing in sexually transmitted disease (STD). He is president of the California STD Controllers Association, adjunct associate professor in the Graduate School of Public Health at San Diego State University, and voluntary assistant clinical professor in the Division of Dermatology at the University of California San Diego. The views expressed in this article do not necessarily reflect those of organizations with which he is affiliated.

“I just got my full battery of STD tests,” my friend Dave recently told me.

My friends know that I’m a physician specializing in sexually transmitted diseases (STDs). So they sometimes ask me STD-related questions or, like Dave (not his real name), tell me they’ve been tested recently.

“Great!” I said to Dave, who’s gay. “What’d you get tested for?”

Pause.

“Um,” he said.

Longer pause.

Then: “Not sure. But they took some blood, and I peed in a cup.”

Unfortunately, that means that Dave, like many gay men, probably didn’t get the “full battery” of tests that he really needs. That’s too bad.

The need for testing

Let’s be clear: Sex is important, and it should be fun. But there can be consequences sometimes, including STDs and HIV. Fortunately, many of those diseases are curable, and all of them – including HIV – are treatable. Unfortunately, the gay community is hit especially hard by STDs and HIV. Check out the following facts:

• Gay and bisexual men in the U.S. are about 45 times more likely to get HIV or syphilis than straight men.

• Rates of HIV and syphilis (and possibly gonorrhea) among gay and bisexual men in the U.S. are increasing.

• In a study of 21 U.S. cities in 2008, 19% of gay and bisexual men were HIV-positive – and 44% of those guys didn’t know it.

• Gay and bisexual men account for 53% of all new HIV infections in the U.S. each year, and 48% of people living with HIV.

You can reduce your risk of STDs, including HIV, by using condoms, limiting the number of sex partners you have, and talking with your partners about STDs and HIV, including disclosing your STD and HIV status.

But if you’re having sex, there’s no way to eliminate risk entirely. That’s why getting tested regularly is so important.

STD tests -- and what they mean

As in Dave’s case, I often hear friends – and patients – report being tested for “everything.” But there’s really no such thing as “one size fits all” when it comes to STD tests.

According to Centers for Disease Control and Prevention (CDC) guidelines, the STD tests a person needs, and how often to get them, depend on numerous factors. What kind of sex are you having? What is the gender(s) of your sex partner(s)? How many partners do you have? Where in the U.S. do you live? Which STDs, if any, have you had in the past, or (like HIV or genital herpes) do you currently have? Do you have any signs or symptoms of an STD?

That’s why your doctor needs to know a lot about the sex you have. That means your doctor should ask – and, if you’re comfortable, you should tell – about having sex with guys. If that doesn’t happen, you probably won’t get the tests you need.

How can you make sure that you get everything you need? The three steps outlined below -- summarized in a downloadable sheet -- should help you get the STD and HIV tests you need, when you need them.

First, know which tests you should get, and how often to get them.

Dave had his blood and urine tested. But for what? Blood and urine can be tested for lots of things, not just STDs. And, for many gay men, blood and urine aren’t the only things that need to be tested.

If you have sex with guys, you should regularly get tested for STDs, according to CDC recommendations. That applies regardless of how often you use condoms during sex. It also applies whether or not you feel or see anything wrong with your body, since many STDs, including HIV, can cause no symptoms at all, at least initially. (If you are having STD symptoms, however, get checked as soon as possible.) And many of the tests you need are different from the ones recommended for straight men and women.

You should get the following STD tests every three to six months

• A test for HIV, if your last test was negative or you’ve never been tested.

• A blood test for syphilis.

• A test of your urethra for gonorrhea and chlamydia, if you’ve topped or gotten a blow job in the past year (or since your last test). The urethra is the tube that takes urine through the penis. In the past, testing meant inserting a swab into the urethra. These days, fortunately, all it takes is a urine sample. The best tests for gonorrhea and chlamydia are called NAATs, pronounced like “gnats” and short for “nucleic acid amplification tests.” Ask for them.

• A test of your rectum (butt) for gonorrhea and chlamydia, if you’ve bottomed in the past year (or since your last test). This is done with a (painless!) swab that’s inserted into your butt. It should be tested with NAATs.

• A test of your throat for gonorrhea, if you’ve given a blow job in the past year (or since your last test). This is also done with a swab. This can be a bit uncomfortable if you’ve got a strong gag reflex, since the swab hits the back of your throat. But it’s not too bad, and it only lasts a second or two. Then it’s tested with NAATs. (Note that CDC doesn’t specifically recommend chlamydia tests of the throat, but in practice most NAATs test for chlamydia and gonorrhea at the same time.)

There are also a few other tests to know about, as follows:

• Blood test for hepatitis B. You should get tested, typically just once in your life. But you might be protected already. In 1991, babies born in the U.S. began being routinely vaccinated against hepatitis B, and beginning in 1999 students entering seventh grade in California were required to have been vaccinated against hepatitis B (except those exempted for personal beliefs or religious reasons). If you don’t have hepatitis B infection and haven’t yet been vaccinated, you should get the three-shot hepatitis B vaccine series. (On that note, although you don’t need to get tested for hepatitis A if you don’t have symptoms, you should get the two-shot hepatitis A vaccine series, which has been recommended for all children in California since 1999, if you haven’t yet had it. A three-shot series that includes both hepatitis A and B vaccines is available.)

• Blood test for hepatitis C. You should get tested if you currently use injection drugs or used them in the past, if you’re HIV-positive, or if you engage in rough sex (like fisting) or sex with multiple partners. Discuss with your doctor how often, if at all, you should get tested. There is no vaccine for hepatitis C.

• Blood test for herpes simplex virus (HSV) type 2. That’s the type that usually causes genital herpes. CDC doesn’t necessarily recommend this test, but your doctor might consider doing it if your last test was negative and you haven’t been tested recently.

• Anal Pap smear for anal cancer screening. CDC also does not recommend this test, which has not been shown to be effective in preventing deaths or other bad outcomes from anal cancer. Moreover, screening can lead to other more invasive procedures. For those reasons, I recommend against this test for my patients.

Know where to go

Many doctors can give you all the STD and HIV tests you need. But some doctors can’t, because they’re not aware of CDC recommendations, because their patients aren’t comfortable coming out to them, or because they work with labs that can’t do some tests.

If that’s the case with you – or if you don’t have a doctor or health insurance– there are other options in San Diego County, as follows:

• The County has four STD clinics, where anyone age 12 or older can get a physical examination, STD testing and treatment, HIV counseling and testing, and hepatitis vaccines for a $15 fee (waived for those who can’t afford it). The main clinic, at 3851 Rosecrans St., is open Monday through Friday. Other clinics, in Oceanside, Mid-City and Chula Vista, are each open one or two days each week. All clinics operate on a walk-in basis. The County also offers free anonymous HIV testing at 3851 Rosecrans St. and at The Center in Hillcrest. More information on locations and hours is HERE.

• The Gay Men’s Health Clinic in North Park, run by Family Health Centers of San Diego, offers STD and HIV testing on Tuesday and Thursday evenings.

• UCSD offers HIV testing through the “Early Test” research study.

Other places that offer STD and HIV tests are listed at findstdtest.org or hivtest.org.

Third, remember to get tested every three to six months.

It can be hard to keep track of when you’re due for your next round of tests. To help yourself remember, sign up for the “We All Test” service to get free e-mail and/or text message reminders to get tested for STDs every three or six months. Then print out downloadable sheet and take it with you when you next visit the doctor to know what questions to ask.

So that’s what you need to know. Seem daunting? At first, it might be. But once you start routinely getting the tests you need, when you need them, then it becomes, well, routine. And when we all test regularly, we help keep ourselves, our partners, and our community as healthy as possible.

Have fun, be safe, and stay healthy!

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