Why You Should Get Tested for STIs Annually—Even if You’re in a Monogamous Relationship

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When you don't have any symptoms, getting tested for a sexually transmitted infection might not be near the top of your list of things to talk to your doctor about at your annual check-up, especially if you're in a monogamous relationship. But it should be, says Kerry-Ann Kelly, MD, MPH, a board-certified OB/GYN in California.

With rates of the most common bacterial STIs—syphilis, gonorrhea, and chlamydia—increasing rapidly among Americans, testing is becoming ever more essential to your health. One out of every two sexually active people will get an STI by the age of 25, and 2.5 million cases were reported in 2021, according to the latest U.S. Centers for Disease Control and Prevention statistics. Syphilis rates rose 32 percent, while gonorrhea and chlamydia rates each went up by four percent between 2020 and 2021—and those numbers are likely even higher because of undiagnosed infections due to fewer people getting screened during the COVID pandemic.

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Yet a 2018 report by Quest Diagnostics found that only 56 percent of sexually active women in a large survey had ever been screened for an STI. Others assumed they weren't at risk, or figured it wasn't important because they didn't have symptoms, or were simply uncomfortable talking to their doctors about it.

Dr. Kelly says anyone who’s sexually active should be tested for STIs every year, or in some cases more often. That’s because although STIs can cause symptoms like pain when urinating or unusual discharge, it’s not uncommon for someone with an STI to have no symptoms at all. That’s especially true for chlamydia, which is found most often through routine screenings.

It's not uncommon for someone with an STI to have no symptoms at all.

“The best way to find out if you have an STI is to test,” Dr. Kelly says.“The body is so amazing and strong it can sometimes mask symptoms, or people can ignore the signs if the infection is not aggressive. That’s why universal testing is my recommendation.”

And that recommendation goes no matter how long you’ve been in a monogamous relationship. “Monogamy is a fluid concept in our culture and society. What it might mean to one person, it doesn’t always mean to their partner,” she says. “If you’re monogamous, you can’t be certain your partner is. I see people in long-term monogamous relationships have positive STI test results all the time. That’s why I encourage every single woman to get tested yearly, and her partner as well.”

If you do have multiple sexual partners or are in a high-risk group, Dr. Kelly says you might want to get tested more than once a year. For instance, gay and bisexual men are disproportionately affected by STIs and should undergo routine testing every three months. STIs are also underreported among Black people and Native Americans, according to the CDC, although it’s most likely due to lack of access to health care (not sexual practices).

If the potential cost of screenings is holding you back, don't let it: There are free testing sites across the country.

The complications of untreated UTIs: infertility and pain

Let's look at the costs/benefits here: Getting tested might be a bit of a hassle, and require you to pee in a cup or get some blood taken. But catching an STI early can have a major impact on your life.

Untreated STIs, particularly gonorrhea and chlamydia, are one of the most common causes of infertility, something that many couples who are having trouble conceiving may not realize, says Dr. Kelly. Untreated chlamydia or gonorrhea are the main causes of pelvic inflammatory disease, which can cause scarring of the fallopian tubes. This can make it harder for an egg to get to the fallopian tube, and eventually to the uterus. Sperm never even get the chance to fertilize it.

“If the fallopian tubes are blocked, then you can’t get pregnant through natural means,” says Dr. Kelly. “STIs are one way to become infertile and screening for them should be at the top of the list” if you’re having trouble conceiving.

Along with infertility, untreated STIs can cause long-term pelvic pain in women, testicular pain in men, and, if left untreated long enough, turn into sepsis if the infection spreads throughout the body.

Fortunately, when caught early, most STIs are easily treated with antibiotics. Routine screenings mean infections can be taken care of before they lead to complications. And while condoms can help prevent STIs, they aren’t foolproof and can break or fail, says Dr. Kelly.

While you shouldn’t be afraid to ask your healthcare provider for STI testing, at-home testing kits offer reliable results for those who aren’t comfortable talking to their providers, or are told they don’t need testing. “Even if your physician says testing’s not necessary, you need to do it,” she says. The risks of skipping that annual test just aren't worth it—for you or your partner.

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