Why is testing of asymptomatic STIs not routine?

Dear Frustrated,

Understandably, you are eager to protect and maintain your sexual health. Your discovery that the most common symptom of a sexually transmitted infection (STI) is no symptom at all has prompted you to think about what should be standard STI testing protocol.

From a individual's point of view, it seems to make logical sense to be tested for every STI. Presumably negative results from these tests offer assurance to individuals, and to their partner(s), that they take responsibility for their health and have "proof" that they have no STIs. This confirmation might be seen as a seal of approval, when presenting themselves to their new partner(s) as a no or low risk source of STIs. ("Whew! I've been tested and I'm fine.")

After consulting with three health care providers, however, you learned that none of these sites routinely test for STIs unless the person has a symptom or a reason. You might wonder…how can sexual health care be of high quality if it doesn't include a complete STI screening? Why is a full work-up not the standard practice? For one thing, while people infected with STIs are often asymptomatic, most asymptomatic people are not infected with STIs. The other major consideration is that there is no single test for STIs, but rather individual tests for each different STI and some tests are not considered as reliable if there are no symptopms.

Medically, learning one's actual risk for STIs is the real key to determining whether testing is necessary, as well as what kinds of tests need to be requested. To get this information, a health care provider first learns about a person's sexual health status from their past and current health history, in writing and in a conversation. It's also good to be tested according to a person's history of risk. High quality health care doesn't involve testing everyone for every STI when they don't have symptoms (these are indications of not being at risk). For example, the number of recent partners is a better gauge of the need for comprehensive STI screening than simply having a new sexual partner, especially when safer sex techniques are used correctly and consistently. Simply put, using safer sex techniques consistently and correctly reduces risk for STIs, making testing less necessary.

To help the health care provider get a complete and accurate a picture of a person's sexual health, answer a provider's questions fully. If the individual has more info to offer than is being asked for, it's helpful to bring up the subject(s) that needs filling in, even if it feels uncomfortable or embarrassing. It's valid to expect the health care provider to be sensitive and open to addressing any questions or concerns. Health care providers are bound by law to maintain confidentiality, so you don't have to worry about private information being shared.

Following the discussion with the health care provider concerning risk factors and symptoms, if any, a person may be experiencing, they will have a physical examination that identifies whether any signs suggestive of an underlying STI are present. Based on the health history, any symptoms a person may describe, and noticeable evidence observed from the exam, the provider makes judgments about further testing. Specific screening test(s) may be ordered to rule out or confirm any suspected diagnosis. This comprehensive practice of gathering health information individualizes the testing process so that it is appropriately unique to each person and only the necessary tests, if any, are performed.  It's also good to note that some of the tests are rather expensive and testing everyone would not be very cost effective since the majority would not have the STI.

Routinely screening for asymptomatic STIs raises more questions and concerns, and could actually work against what many people seek: assurance of their sexual health status to themselves and their partner(s). This assurance can be misleading, as the tests are very good, though none of these is 100 percent accurate. If you still have questions or concerns, perhaps a conversation with your health care provider, one you trust and whose judgment you value, may offer you the peace of mind and the reassurance you seek.

Sex with another person can be intimate, fun, sensual, exciting, and satisfying... And sex also comes with risks. Using sound judgment and practicing safer sex can help bring pleasure and piece of mind.