Testing and safer sex

What a standard panel usually covers

A typical sexual health screen tests for HIV, syphilis, chlamydia and gonorrhoea. Hepatitis B and C are often included, particularly on a first visit or where there are specific risk factors.

What it usually does not include, and what people wrongly assume it does:

• Herpes (HSV). Blood testing for herpes is not part of routine screening in most guidelines for people without symptoms, because the results are difficult to interpret and frequently cause more harm than benefit. If you want it, ask specifically and discuss what a result would actually mean.
• HPV. There is no routine HPV test for men. For women it is generally part of cervical screening rather than an STI panel. Vaccination is the main preventive tool and is available to adults in many countries, including some age groups people assume they have aged out of.
• Mycoplasma genitalium and some less common infections, which are usually only tested when there are symptoms.

The thing most people get wrong: sites

A urine test detects infection at one site. Chlamydia and gonorrhoea can be present in the throat or rectum with no symptoms and no positive urine result.

If your activity includes oral or anal contact, ask for site-specific swabs. This is routine at sexual health clinics and frequently omitted by general practices, and it is the single most common gap in people's testing.

Window periods

Testing too early produces a negative result that means nothing. Approximate windows, which vary by test type:

This is why “tested last week” is less informative than it sounds if the exposure was three days before that. Ask when, not just whether.

How often people test

Testing every three to six months is the common practice among sexually active lifestyle participants, with more frequent testing for people with more partners. Many clinics will advise a cadence based on your actual activity if you describe it honestly — and it is worth describing it honestly.

Some couples exchange recent test results before meeting. This is increasingly normal, nobody experienced finds it offensive, and a bad reaction to being asked is itself useful information.

What condoms do and do not cover

Condoms substantially reduce transmission of infections spread through fluids — HIV, chlamydia, gonorrhoea. They reduce but do not eliminate risk for infections spread by skin contact, including herpes, HPV and syphilis, because those can affect areas a condom does not cover.

That is an argument for realistic expectations rather than for abandoning them. Consistent condom use remains the single most effective practical measure available at an event.

Other tools worth knowing about

• PrEP — medication taken to prevent HIV infection, highly effective, and available in many countries to people at ongoing risk. Worth discussing with a clinician if that describes you.
• Vaccination — hepatitis A and B and HPV vaccines are all relevant, and eligibility is broader than many adults assume.
• Doxycycline after exposure — an approach recommended in some guidelines for specific groups to reduce bacterial infections. The evidence base differs between populations, so this is a conversation with a clinician rather than something to self-manage.

If something comes back positive

Most of the common infections are curable with a short course of treatment, and the ones that are not are manageable. The practical obligations are to complete treatment, avoid contact until you are cleared, and tell recent partners.

That last part is uncomfortable and it is not optional. Most clinics offer anonymous partner notification if you would rather not do it yourself, and using that service is far better than not doing it at all.