Sexual Health Screening

What are sexually transmitted diseases?

'Sexually transmitted diseases' (STDs), as the name suggests, are infections caused by microorganisms acquired during sexual activity. Many STDs show no signs and cause no complaints for a long time. However, they can confront you with very serious complications and continue to be transmitted during sexual activity. The causative agents are bacteria, viruses and protozoa. The most common sexually transmitted diseases are:

1. Chlamydia
2. Gonorrhoea (the clap)
3. Mycoplasma genitalium
4. Genital herpes (sores) (herpes simplex virus) (HSV)
5. Genital warts (human papillomavirus) (HPV)
6. Hepatitis B virus (HBV)
7. Hepatitis C virus (HCV)
8. Syphilis
9. Trichomonas
10. ‘Human immunodeficiency’ virus (HIV)
11. Ureaplasma

Everyone who is sexually active is at risk of contracting a sexually transmitted disease. Most of these infections can be transmitted not only through vaginal and anal sex, but also through oral and other forms of sexual activity.  For example, herpes and HPV can be transmitted by skin contact alone. In addition, HIV and HBV are also transmitted by other routes, such as contact with blood and body fluids.

Why is screening important?

Chlamydia, gonorrhoea and certain other infections can occur without symptoms. If diagnosis is delayed, the infection may be transmitted to a partner or cause health problems in some people. Appropriate screening helps detect infection early, plan treatment and assess partners.

Having no symptoms does not mean there is no infection. However, not everyone needs to be tested for every infection at the same intervals. Decisions about which tests are appropriate are based on a combined assessment of age, pregnancy status, previous tests, symptoms, a partner's diagnosis and the type of sexual contact.

Who should seek screening or assessment?

It may be appropriate to discuss testing options with a healthcare professional in the following situations:

1. People experiencing symptoms: Burning when urinating, unusual discharge, genital sores or blisters, groin or testicular pain, pain during intercourse or bleeding after sexual contact. Symptoms require diagnostic assessment rather than routine screening.
2. People whose partner has been diagnosed with an STI or whose partner has symptoms.
3. People with a new partner or multiple partners, those who think their partner may have other partners, or those who do not consistently use condoms during sexual contact.
4. People who have previously had an STI: The risk of reinfection and the need for follow-up may vary depending on the infection.
5. Sexually active women under 25: Annual screening for chlamydia and gonorrhoea is recommended. For women aged 25 and over, screening is considered if there are risk factors such as a new partner or multiple partners, a partner with an STI, or a previous STI.
6. Men who have sex with men: Screening is planned according to the anatomical sites exposed during sexual contact. If risk is ongoing, or in people living with HIV or using PrEP, testing intervals may be shortened to 3–6 months depending on the individual.
7. People who are pregnant or planning a pregnancy: Screening for syphilis, HIV, hepatitis B and hepatitis C is recommended at the initial pregnancy assessment. Chlamydia and gonorrhoea tests may be planned according to age and risk status, while repeat testing during pregnancy may be planned according to ongoing risks.
8. People who have never been tested: HIV testing should also be considered during assessment for sexually transmitted infections. The CDC recommends screening for HIV at least once and offering HIV testing to people seeking STI assessment.

These recommendations are based on general guidelines. Screening intervals and test selection should be determined together with a doctor, based on the person's history and local health recommendations.

The same sample is not used for every infection

1. Blood sample: Blood tests are used to assess infections such as HIV, syphilis and hepatitis B or C. Which tests are needed may vary depending on the person's vaccination and infection history, the timing of exposure and their clinical condition.
2. Urine or genital swab: Molecular tests (NAAT/PCR) may be used for certain infections, such as chlamydia and gonorrhoea. The appropriate sample is selected according to the person's anatomy and the sample types accepted by the test method used. For example, the CDC lists first-catch urine for men and vaginal swabs for women among appropriate samples for urogenital screening. The sample collection instructions for the test kit and laboratory must be followed.
3. Throat or rectal swab: If oral or anal contact has occurred, certain infections may be present at these sites of exposure. Testing only a urine or genital sample may not rule out infection in the throat or rectum. When necessary, separate samples from these sites must be collected and tested.
4. Lesion swab: In conditions involving sores or blisters, such as genital herpes, a sample collected from an active lesion may help with diagnostic assessment. Routine herpes blood testing for everyone without symptoms is not recommended.

For this reason, “a single blood test”, “a single urine test” or “a single PCR panel” does not detect all sexually transmitted infections. In addition, not every test provides protection against every pathogen; when testing is performed immediately after a recent exposure, repeat testing may be needed depending on the infection and the type of test.

The difference between sexual health screening and an STD PCR panel

An STD PCR panel tests for the pathogens included in the panel, within the scope of the method used and the sample types accepted by the laboratory. Sexual health screening may include other tests, such as blood tests, in addition to the PCR panel. Which tests are included depends on the person's circumstances and the contents of the package offered.

The sexual health packages listed on Wellcare’s current check-up page include a multiplex PCR panel for 12 STI pathogens, along with tests for HIV, hepatitis B, hepatitis C and syphilis. The women’s package also includes high-/low-risk HPV genotyping screening covering 35 subtypes. Sample types vary by test; consult the test list for current package contents and sample collection information.

Infections not included in a package should not be considered to have been tested for by that package. HPV screening does not replace cervical cancer screening; screening and follow-up intervals should be determined according to the relevant guidelines.

Before getting tested

Inform the laboratory and your doctor if you have recently taken antibiotics or received any other treatment.

The sample type and timing of sample collection may vary from test to test; follow the sample collection instructions provided to you.

If a potential exposure occurred very recently, ask your doctor which tests can be performed and when, and whether repeat testing is needed.

If an infection is detected, consult a healthcare professional for treatment and partner evaluation.

Sexual health screening is planned individually. Symptoms, exposure history and the sample type appropriate for the anatomical site are assessed together to determine which tests are needed.