STD screening

The core value of screening for sexually transmitted diseases (hereinafter referred to as STDs) is to "find infection before obvious symptoms appear, block transmission in time, and avoid irreversible physical damage." As long as you have had unprotected sex, multiple sex partners, or a history of sexual partner infection, it is recommended to proactively screen. If you do not have high-risk behaviors, you can also include it as an optional item in routine physical examinations. There is no need to feel ashamed.

Two years ago, when I was rotating in the dermatology clinic, I met a 22-year-old girl. She had been suffering from a dull pain in her lower abdomen for more than half a year. She had been drinking traditional Chinese medicine to treat the pain. Finally, the pain was so severe that it affected her normal work, so she went for a system checkup. The results revealed that she was suffering from chronic Chlamydia trachomatis infection, and her fallopian tubes were severely adhesions on both sides. The probability of subsequent natural conception was less than 10%, and in vitro fertilization was highly likely to be necessary to have a child. She and her boyfriend at the time had been dating for a year, but they both felt that it was not necessary to undergo screening because they were regular partners, and they did not even undergo the first-class physical examination, which caused a big problem.

When it comes to this, some people will definitely refute, "My partner and I have fixed single-sex partners, and we don't mess around. Do I have to do this?" This question actually has different tendencies in the public health field and the clinical frontline: scholars in public health policy making prefer conservative recommendations - as long as adults have had sexual intercourse, regardless of the number of sexual partners, they should have sex at least once a year against the four common types of syphilis, AIDS, chlamydia, and gonorrhea. Screening for the disease should cover all potential infected persons as much as possible to block community transmission; and most of our clinicians who attend outpatient clinics every day will be more pragmatic: if both parties are indeed a single fixed sex partner, have undergone a full set of physical examinations to rule out infection before cohabitation/marriage, and have no sexual contact outside of marriage, then a check-up once every 3-5 years is completely sufficient. There is no need to waste medical resources through excessive screening, and there is no need to add unnecessary psychological burden to oneself.

Another very common misunderstanding is "I don't feel sick at all, so I must be fine." Really not, the data is here: 70% of women and 50% of men do not have any obvious symptoms after being infected with chlamydia. If the hard chancre of the first stage of syphilis grows on the inner wall of the vagina or around the anus, it is not painful or itchy, and you will not even notice it at all. When it develops into the incubation period, you may not feel anything for three to five years. By the time symptoms appear, it has already damaged the nerves and cardiovascular system. Last month, a young man came for a check-up. He had some roseola on his body. He searched Baidu and thought it was syphilis. He was so scared that he couldn't sleep all night. After taking blood tests, he found nothing. It was just a common allergy, which lasted almost two weeks.

The biggest obstacle for many people who resist screening is actually fear of embarrassment, fear of being looked down upon by doctors, and fear of meeting acquaintances. There is really no need to worry about this. HIV and syphilis screenings at centers for disease control and prevention in various places are now free and completely anonymous. You don’t even need to bring your ID card, just leave your mobile phone number after the blood is drawn and wait for the results. If you really don’t want to go offline, you can also buy an at-home test kit from a regular manufacturer, which can be tested by taking a fingertip blood or urine sample. The operation is similar to the previous COVID-19 antigen, with an accuracy rate of over 95% and full privacy. Oh, yes, don’t make blind guesses about Baidu symptoms. It’s really better to spend dozens of dollars to get an accurate test.

Some people ask, "I wear a condom every time, do I still need to be screened?" There is no standard answer to this. Studies have confirmed that correct use of condoms can block more than 90% of sexually transmitted diseases. Many scholars also believe that as long as condoms are worn correctly throughout the process and there are no other high-risk behaviors, there is no need for additional screening. However, we have indeed encountered clinical cases of condoms breaking or contacting the broken skin of the other party and contracting syphilis. Therefore, if you have sex with a non-regular partner, even if you wear a condom, it is recommended to wait until the window period for a check-up. It really doesn’t cost much, and buying peace of mind is better than anything else.

By the way, let me explain the window period in human terms: it is the time period after infection when the body has not produced enough antibodies, or the pathogen load is too low to detect. The current window period of the fourth-generation AIDS test is 2-4 weeks, syphilis is 2-6 weeks, and chlamydial gonorrhea is 1-2 weeks. There is no need to rush to check the next day after high-risk behavior occurs. The test will also be a false negative, which is a waste of money.

I have been in outpatient clinics for so long, and I have seen too many patients who were delayed from getting checked out because they were embarrassed or afraid of being accused of having "a messy private life", and who ended up with infertility or neurological damage. I have also seen many people who are afraid of AIDS and get checked out more than a dozen times a year. Nothing happened but they couldn't control their anxiety. To put it bluntly, STD screening is just an ordinary physical examination. It is no different from checking for Helicobacter pylori or thyroid nodules. In essence, you are responsible for your own body and your partner. There is really nothing to be ashamed of. Don’t panic if you are really tested positive. Most common STDs can be cured with antibiotics if detected early. Even AIDS, you can live to a normal life expectancy by taking antiviral drugs now. Go to the dermatology and venereology department of a regular hospital or the Centers for Disease Control and Prevention. All medical records are confidential and your privacy will never be leaked.