Which STDs/STIs should I get tested for?

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Which tests for sexually transmitted diseases are useful - and which are not? There is a wide range of tests available on the internet for HIV, syphilis, herpes, HPV, ureaplasma, gonorrhea, chlamydia, mycoplasma and more. You are spoiled for choice. But which test for sexually transmitted infections is really useful and which is better to avoid?

Symptoms and symptom-free testing

First of all, it is important to differentiate: do I have symptoms or not?

Symptoms

If your urethra burns or hurts, if you have a fever or a skin rash, if you notice changes to your genitals or if you have other symptoms, you should consult a doctor. Single-submission tests are not suitable for these cases and there is no time to waste. So go to the doctor you trust.

Without symptoms

Many people want to be tested regularly for sexually transmitted diseases. And that makes sense, because some of them often cause no or hardly any symptoms. These are the diseases we are talking about here. s.a.m health offers tests for HIV, syphilis, chlamydia and gonorrhea. Why we offer these and not others is explained now.

We recommend tests for the following sexually transmitted diseases or STIs:

HIV

Acute HIV infection manifests itself like a flu-like infection and is often misjudged as such. The infection is then usually asymptomatic. HIV damages the immune system over years - until the most serious illnesses occur. Therefore, regular HIV testing is advisable for people at risk during sex.

The earlier the infection is treated, the better. With timely treatment, you then have a normal life expectancy and are no longer sexually infectious thanks to the medication. It is therefore worth taking a test. One test per year is sufficient to ensure that the infection is not discovered too late.

Syphilis

After a few days, an ulcer develops at the site of infection. If the ulcer is located in the vagina, rectum or mouth, it is often not recognized. The rash that appears weeks later disappears by itself.

Afterwards there are long asymptomatic phases of syphilis, during which the bacterium can cause severe organ damage. Regular tests are therefore advisable for people who are at risk. Whether tests are carried out every three, six or 12 months also depends on the number of partners and the risk.

Gonorrhea and chlamydia

These are the most common bacterial sexually transmitted diseases. They cause inflammation at the site of mucosal colonization: in the urethra, vagina/cervix, rectum or throat. The infection may or may not be symptomatic.

The bacteria can colonize the mucous membranes for weeks or months and eventually ascend into the fallopian tubes or abdominal cavity in women and into the epididymis or prostate in men. They can cause more serious illnesses there and may then be the cause of infertility. Young women up to the age of 25 are therefore entitled to be tested for chlamydia once a year. However, this "chlamydia screening" does not work well in practice. Gynaecological practices often do not offer the screening.

It therefore makes sense for sexually active people to be tested for both pathogens: by means of a urine sample and an anal swab.

It is controversial whether a throat swab is necessary. In the throat, the bacteria disappear by themselves after a few weeks and do not cause any damage. The throat may scratch. Only extremely rarely does a clear pharyngitis occur. If the swab is positive, an antibiotic is prescribed.

So you have the side effects of the medication, but hardly any benefit yourself (as the bacteria there are usually harmless). But of course the antibiotic prevents you from infecting sexual partners during oral sex - and they then have the pathogens in their urethra. For this reason, most s.a.m health clients also do the throat test.

A regular STI test for these pathogens is not necessary:

Mycoplasma and ureaplasma

These pathogens are common and rarely cause symptoms. If symptoms occur, treatment is necessary. That much is clear. But this happens so rarely that international professional societies advise against testing symptom-free people. This is because the result would often be positive and treatment would then be necessary.

But unlike with chlamydia and gonorrhea, you often have to resort to an antibiotic that can cause serious and even life-threatening side effects - because the mycoplasmas are often already resistant to the well-tolerated antibiotic. You would therefore be shooting sparrows with cannons and causing more harm than good. In the interests of our clients' health, we therefore do not offer the test.

HPV

There are over 200 subtypes of human papillomaviruses. In most cases, they are not noticeable and disappear on their own after a few months. Some subtypes cause genital warts (which are then visible), others cause cervical cancer, anal carcinomas or penile cancer. For this reason, HPV vaccination has been recommended for young people for several years. Screening for cervical cancer has been around for a long time.

This examination has been changed since 2020: For women up to the age of 35, there is still the annual PAP smear (examination for cell changes); for women aged 35 and over, an HPV smear of the cervix is offered. If the results are negative, women only have to undergo a test every three years. But why don't younger women also get the HPV test? It is assumed that younger women have more sex and HPV would then be detected too often.

HPV cannot be prevented during sex. Condoms only have a relatively low protective effect. Because HPV is too frequently detectable in sexually active people (and does not usually lead to cancer or genital warts), sam health does not offer HPV smear tests. The result would be positive too often. In addition, there is no guarantee that the self-swab at home is nearly as good as the swab in a medical practice (this is the case with chlamydia and gonorrhea). Women should go to the gynecologist's office for a check-up.

If you have many partners, you should consider getting vaccinated against HPV. Some health insurance companies also voluntarily cover the costs for adults. Otherwise, the three required vaccine doses cost around 160 euros each. It is then important to ensure that you receive the 9-dose vaccine. This is because the 2-dose vaccine does not protect against genital warts. The vaccination is well tolerated and provides around 95% protection against genital warts and the corresponding cancers.

Herpes

The first infection with one of the two types of herpes usually causes the familiar painful herpes blisters. Everyone knows them from the cold sores from their youth. The viruses then lie dormant in the nerve ganglia for life. Some people also become sexually infected with herpes. The mucous membranes of the genital organs are then affected. In the case of both cold sores and genital herpes, some people experience a flare-up of the disease at a later stage. This is usually noticeable and should be treated by a doctor if the symptoms are severe.

Rarely can herpes be detected without such symptoms. But this is an incidental finding that does not need to be treated. We therefore do not offer the test, as it would only make the package unnecessarily expensive.

This article was written by Armin Schafberger - doctor and health scientist, and former medical officer of the German AIDS organization.