STI Testing Recommendations Don’t Even Exist for Straight Men—Why?
I always figured that the men I date received the same advice from their doctors that I did about testing, but I recently learned that's not necessarily the case. While researching a story on STIs, I came across the CDC's guidelines for STD testing. All sexually active women are advised to get tested for chlamydia and gonorrhea once a year if they're under 25 or if they're over 25 and not in a monogamous relationship. Men who have sex with men are also advised to get screened for those infections (plus syphilis and HIV) anywhere from one to four times a year. But there are zero recommendations specifically for straight men, other than to say that "anyone who has unsafe sex or shares injection drug equipment should get tested for HIV at least once a year."
Sorry, but I'm confused. If women are considered at high risk for chlamydia and gonorrhea—which is what this screening recommendation implies—surely a significant number of them are getting it from heterosexual men. In fact, says Peter Leone, MD, an infectious disease specialist at the University of North Carolina, "for the majority of the population of women, their biggest risk is their male partner." So if that's the case, why should women bear the full burden of getting tested?
"For the majority of the population of women, their biggest STI risk is their male partner." —Peter Leone, MD
When I posed this question to the CDC, a spokesperson first told me that the guidelines are suggestions, and not hard-and-fast rules. If a doctor thinks their straight, male patient is at risk for STIs—if he has unprotected sex with multiple partners, perhaps, or if he's showing symptoms of an STI—he should, of course, be tested.
But this lack of clear screening guidelines seems problematic. For one thing, many STIs, including chlamydia and gonorrhea, usually don't present with symptoms in men. So even if a guy is infected, he may not realize it—and if he doesn't think anything's wrong, he probably won't proactively visit the doctor. While women tend to visit their OB/GYNs consistently for birth control and pap smears—a time at which many doctors perform routine STD screenings—the same can't always be said for men. "Most men in their teens and 20s [the ages at which STD risk is highest among heterosexual men and women] don’t have a primary care provider or go in for any regular visits," Dr. Leone points out. "As a result, they aren’t being screened for asymptomatic infections, which is what you want to do to reduce the overall prevalence of these infections."
The CDC also says that there isn't enough evidence to show that recommending widespread screening of straight men will have enough of a public health benefit to justify the cost. That's a fair point: Funding for STI prevention programs has dropped by about 40 percent in the past 15 years, and there aren't enough resources available to cover the costs of universal screenings for everyone. The Affordable Care Act currently offers free STD screenings and counseling for populations considered at high risk, but some of these benefits—like chlamydia and gonorrhea screening—are not available to men.
"A lot of the funding for STI screening has to do with making sure women can get pregnant and not transmit infections to their babies," explains Dr. Leone. While untreated STIs can cause infertility and other complications in women, the same isn't true in men. "If your metric is reproduction and reducing fetal complications and mortality, it’s hard to show those dollar benefits by men," says Dr. Leone. "So the idea is you screen women because you’re closer to the outcome you’re trying to prevent."
I don't think it's too much to ask for male partners to take it upon themselves to be screened regularly—both to protect themselves and the women they supposedly care about, for whom the consequences can be pretty damn dire.
However, Dr. Leone thinks we're missing an opportunity to reverse the current STI trends by taking this approach. Men on average have 6.1 opposite-sex sexual partners throughout their lives (while women have 4.2 opposite-sex sexual partners), per the National Center for Health Statistics. And 21 percent of men have had 15 or more opposite-sex sexual partners, compared to just 10 percent of women. "You could argue that if you did screen [straight] men, you could drive down the rates a lot faster in women and reduce the consequences even more," Dr. Leone says, adding that it's short-sighted to talk about it as if it's an issue that only impacts women. Hear, hear—especially since the approach seems to prioritize women's ability to have children over anything else.
Experts also argue that if a woman tests positive for an STD, there are expedited partner therapy programs in place that allow her partner to be treated at the same time, without visiting a doctor. Two birds, one stone. But again, there's an expectation for the woman to do all of the heavy lifting in this scenario—and honestly, don't we do enough of that when it comes to sex? I don't think it's too much to ask for male partners to take it upon themselves to be screened regularly—both to protect themselves and the women they supposedly care about, for whom the consequences can be pretty damn dire.
"Women have been more accommodating when it comes to getting screened, because the culture for them is different in terms of going in and getting reproductive health services," Dr. Leone says. "We’ve got to get the men on board to understand that they’re half of the equation." This is a big job, obviously, and there's no simple path forward. But now that I know that men in general probably aren't getting tested as routinely as I am—although there is currently no nationwide screening data available to confirm this—I'm definitely going to start having more frank discussions with my partners about this topic. The way I see it, the health of my lady parts is totally worth a few minutes of awkwardness.
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