Transitive STD testing and testing for oral transmission, oh my!

September 17, 2011 5:42 AM

I had unprotected sex and performed cunnilingus. I'm uninsured. I'm asymptomatic. Where and what type of STD testing should I look for? Also, if I test clean then what is the chance that that she too is/was clean? The primary question is where can I get a general panel of STD testing cheaply (or free) given that I am currently uninsured because I'm (hopefully temporarily) unemployed. Barring other options, how much should I expect to spend at my general doctor for the proper tests? Is that worth it given my situation below?

Also, given that in addition to sex I performed cunnilingus with no protection what other STD hazards have I potentially exposed myself to and how do I bring this up with my doctor or whoever does the testing? Do I need specific tests?

Finally, how conclusive would my being clean be to establish that my exclusive sexual partner is also clean?

Quick background, I've never been that sexually active in the past. Even so, in the last about 5 years with no activity I've had a few of the "oh might as well do the STD blood work" during some of my physicals just because, why not? I've always been clean.

Fast forward to about 3 months ago, I was traveling abroad and had the above mentioned sex with (and only with) the woman who is now my girlfriend. I have had no real symptoms* but I worry. She will be visiting the US soon and I'm concerned about how to broach the topic of mutual STD testing since... it seems a little like closing the barn door after the horse has left. Plus it could be a touchy subject, cultural differences and all, she may not understand if I demand she get tested out of the blue. (don't get me wrong, mutual testing is my ideal scenario, barring cost and confusion factors)

So I'm thinking maybe if I get tested and am clean it would imply that she too is clean? Does it work like that? For the record we had unprotected sex+ about 6 times ending around a month ago. I expect we will have unprotected sex+ again when she visits.

Thanks Hive Mind.

*I am a hypochondriac so I've "noticed things" but they are minor and have more reasonable explanations... like I'm thinking about it too much. At any rate, nothing to indicate a specific test or concern.

posted by anonymous to health & fitness (10 answers total)

An important concept here is the "window period", the amount of time between the moment of infection and the time when testing can detect the disease. In particular, most STIs have window periods of under three months, but in rare cases HIV and Hepatitis B/C can take as long as six months to be detectable.
posted by Johnny Assay at 5:54 AM on September 17, 2011

If you are in the US, Planned Parenthood offers low-cost STD tests for uninsured individuals.
posted by pupstocks at 5:58 AM on September 17, 2011 [3 favorites]

You can usually get STD testing for free at your local health department or for a nominal cost at Planned Parenthood.

You don't need to ask for anything in particular, if you describe your unsafe behavior to the clinician, they will help to determine which tests you need to get. Some things which you might contract orally, like syphilis, are tested for with a blood test, and some things, like chlamydia, are tested for by culture. In the former case, one test will cover any possible route of infection, in the latter, you would need a swab of your throat. Some places do not test for chlamydia this way.

You can certainly be asymptomatic and still have an STD. So can your partner. It sounds like you have a psychological peace of mind issue that you would like to solve unilaterally, but I would submit that this would be difficult to do. In the first place, there is no guarantee that you would contract whatever STD she might have just because you slept together half a dozen times. HIV, for example, is relatively (RELATIVELY) difficult for a man to contract through unprotected vaginal sex, so frequency of sexual contact is part of the equation for transmission. You might have gotten lucky the first six times, but the eighth you won't be so lucky. In addition, viral load, or the amount of virus in your partner's body, appears to greatly influence transmission rates for HIV, and it's possible for a host of different reasons to have the viral load fluctuate. It might have been low before and high now. In the second place, while you know what your sexual activity has been since you last slept with her, you do not know what hers has been. She may have been STD-free when you first met her, and have an STD now. You can't know.

In general, it's not a great idea to sleep with people that you do not know to be STD free without using a barrier method of protection. This is especially true if you have a psychological predisposition toward worrying about the consequences after the fact.
posted by OmieWise at 6:07 AM on September 17, 2011 [3 favorites]

Yes, Planned Parenthood is the best option for you. You may be eligible for their insurance which will cover all of your sexual-health-related costs. And you should get tested now and in 6 months. (Actually, they recommend testing every 6 months.)

As for as your gf... have "the talk" with her. It doesn't need to be a blame talk, just a discussion. A lot of U.S. women get tested regularly and are comfortably talking about this with their partners if it comes up. It's better to be safe. I don't know what other countries are like with STD testing, but I'd bet it's a topic they are comfortable talking about.

And yes, why are you having unprotected sex if you haven't had the STD talk? Even if she's on birth control, you should use a barrier method both for protection against STDs and a backup method to prevent pregnancy (NO method except for abstinence is 100% effective).
posted by DoubleLune at 6:11 AM on September 17, 2011

Planned Parenthood has a neat little online tool where you answer a series of questions to get some suggestions about what testing you might want to do. (If that link doesn't work, it's in their STD section, under "check".)

So I think you have two issues: One, you had unprotected sex with someone you aren't 100% sure about their sexual history, right? So you will want to get some basic STD testing done, probably HIV plus the usual suspects; as others have said, any Planned Parenthood, health department, or even your regular doctor can hook you up, no problem.

Two, there's the question of what do you do when your girlfriend shows up. First and most important: your getting clean test results tells you nothing about her sexual health status right now. She could have had an STD that you were lucky to not catch, she could have had sex with some other guy last week, who knows. Part of being an adult is having these kinds of uncomfortable conversations. I think your options are pretty much:

a) Wearing condoms (yes, they suck big time, but STDs and unplanned pregnancies suck a lot more).

b) Sucking it up and asking her to get tested; you can represent this as a funny American quirk, maybe, if that helps the conversation along. But even if she got tested on her first day here it might take a while to get results back, and you aren't going to be 100% sure on HIV unless there is retesting a few months later, so you are still back to condoms or living dangerously for while anyway.

c) Doing nothing and continuing to live dangerously. This is the easy option, but I think you are now seeing the downsides to this approach.

Having been there, done that, I know how hard it is to have these conversations in another language, or with someone from a very different cultural context. It's easy to have miscommunications and hurt feelings, but it's still a necessary part of modern adulthood, and way better than worrying. Good luck!
posted by Forktine at 6:39 AM on September 17, 2011

Can you tell through a mod where this woman is from? It might help with suggestions of how to brush the issue.
posted by Iteki at 8:19 AM on September 17, 2011

Get tested, ask her to get tested. Its not a big deal. If you can have sex with someone this conversation shouldn't be a big deal. Particularly if this person is a girlfriend, she should understand.

(Being tested isn't a big deal, and its good to have a clean bill of health...or if you do have something, it can be taken care of or managed. Either way think of it as a big win on both of your parts.)
posted by handbanana at 8:47 AM on September 17, 2011

Just fyi, and not to derail, using the term "clean" to describe someone who is STD-Free places huge judgement on people who do have STDs.

Just go get tested and stop bean plating about it.
posted by These Birds of a Feather at 9:23 AM on September 17, 2011 [5 favorites]

"Hey, if we're going to keep having unprotected sex, do you want to talk about splitting the cost for birth control? Are you ok with the pill? Oh yeah, over here when we start having sex regularly, it's kind of a thing that we both get tested. If there *is* anything, it can usually be cleared up with a round of antibiotics and clearing it up sooner rather than later is usually better. Want to go get checked out together?"
posted by porpoise at 10:45 PM on September 17, 2011

If Planned Parenthood is not an option for you for whatever reason, your local city or county health department may have a clinic that does low- or no- cost STD testing. For example, here in Portland, OR we have this. If you can tell us through a sockpuppet or through a moderator where you are located, someone may know of a local resource for you.
posted by dersins at 9:15 AM on September 20, 2011