Our Bodies, Ourselves (62 page)

It is crucial that we take care of ourselves and work to change the systems that make self-care so difficult. Too often, public support is lacking for the tools we need: comprehensive health insurance and health care, drug treatment programs, adequate housing, healthy and affordable food options, and child care. We all have a right to enjoy sex without risking our health, to advocate for ourselves and one another, and to get the medical care we need.

Some screenings, such as Pap tests that look for precancerous cervical changes, are offered to almost all women. Other screening tests are recommended only for pregnant women or at-risk
groups, which usually include sexually active adolescents, people with a history of STIs, people with new or multiple sexual partners, people who use condoms inconsistently, and people who use drugs or do sex work.

You can find specific STI screening guidelines at the following websites:

• Centers for Disease Control and Prevention: cdc.gov/std/treatment

• The California STD/HIV Prevention Training Center: stdhivtraining.org/resource.php? id=15

Individual risk depends not only on behavior but also on the prevalence of disease in your community. In urban communities and communities with high rates of poverty, some populations, especially African Americans and, to a lesser extent, Latinos, may be at greater risk, and broader voluntary screening of individuals without symptoms may be warranted.

Sensitive and specific tests are available for chlamydia, gonorrhea, syphilis, HIV, herpes, trichomoniasis, and chancroid. However, no test is perfect, and even the best tests available occasionally produce false negatives and false positives. Sometimes, tests miss the presence of an STI, if the person exposed is still incubating the infection (for HIV, this is also known as the window period), or if the specimen isn't collected or processed properly. There also are some STIs for which there is currently no commercially available lab test (e.g., for
Mycoplasma genitalium
).

Untreated STIs can reduce your ability to become pregnant and in some instances cause infertility. Because they can increase the likelihood of pregnancy complications and can infect a fetus or infant, early diagnosis is essential.

Pregnant women should be offered screening for HIV, syphilis, hepatitis B, and chlamydia, and possibly gonorrhea. A test for hepatitis C is recommended for women who use or have used injection drugs or received blood products, transfusions, or transplants prior to 1992.
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An early prenatal visit is also a good time to check for bacterial vaginosis (BV) and to have a Pap test if it wasn't done during the previous year or two. Some experts recommend that women who have had a premature delivery in the past be screened and treated for bacterial vaginosis at the first prenatal visit.

Infections first acquired during pregnancy are the most likely to be passed to the baby. Chlamydia, gonorrhea, syphilis, trichomoniasis, and BV can be treated and cured with antibiotics during pregnancy. Viral STIs cannot be cured, but antiviral medication may be appropriate for pregnant women with herpes and definitely is for those with HIV.

You may need more testing later on during your pregnancy if you are at risk of exposure (e.g., if you have new sexual partners). (For specific considerations, see the section below on individuals STIs.)

•
Public-health clinics (also called STI or STD clinics).
Government-funded sexually transmitted disease clinics provide services, usually regardless of a person's ability to pay. Clinic staff members are likely to have a lot of expertise in testing, diagnosing, and treating most STIs, and the setting may offer more privacy than your usual provider's office.

To find the nearest walk-in facility, visit hivtest.org. Enter your zip code and it will produce a list of nearby clinics that perform tests for HIV and other STIs, with detailed
information about costs and the types of tests offered. You can also call the Centers for Disease Control's national hotline (1-800-227-8922) for clinics in your area.

•
Family-planning and community clinics.
Most family-planning providers (such as Planned Parenthood clinics, local health departments, and other community clinics) also offer affordable and knowledgeable STI counseling, testing, and referral. In the rare cases when they don't, they'll know where you can get them. They are also likely to treat you with particular sensitivity around sex-related issues. Many are low cost and also have sliding-scale fees. To find a clinic near you, go to plannedparenthood.org and enter your zip code.

•
Primary care provider.
Go to your regular health-care provider if you're likely to receive clear, understandable responses to your questions. Family physicians, family nurse-practitioners, and physician assistants are trained to test for and treat STIs.

However, not all providers have the necessary equipment to do routine STI testing, and they may not know enough about these diseases. Ask whether your treatment follows the most recent CDC treatment guidelines.

•
ER.
If you have been forced into sexual activity and you're afraid you've been exposed to a disease, most emergency rooms can give you preventive treatment for STIs, including HIV. Tell the ER staff if you need emergency treatment after being raped or sexually assaulted. Some ERs also have rape kits to collect evidence and can help you file a police report if you wish to make one. (For more information, see
“Rape.”
)

Unless you really need emergency care, however, the ER isn't the best place to go. Since ERs focus on trauma and life-threatening illnesses, the hospital emergency staff won't be able to give you the time, expertise, and sensitivity you may need to deal with STI issues. Also, test results will likely take longer when performed in the ER.

•
Find a health care provider you trust.
Some providers are uncomfortable talking about sex, or may make assumptions about whether we might have an STI or not based on their own cultural biases.

Though we're often limited by cost or insurance restrictions, try to find a provider who is comfortable discussing sexual health and with whom you are comfortable (public-health and family-planning clinics, listed in the previous section, have staff trained in discussing all sexual issues). Ask for recommendations and look for someone who provides complete and understandable information, encourages and answers questions, and accepts your sexuality and gender identity.

•
Call ahead or look online.
Find out what services are offered and how much you'll have to pay. Tests may involve only a small co-payment, but there may be a fee for the visit.

•
Think ahead about confidentiality.
Everyone is entitled to confidentiality regarding STI medical care and records, and every state has laws guaranteeing minors the right to confidential STI care. However, if you are a minor and have insurance through your parent(s), be aware that your parent, as the insurance policy holder, will receive notification from the insurance company that includes an explanation of the charges or benefits. If this is unacceptable, look for a clinic that provides free or low-cost testing. (See
“Where to Go for Care.”
)

•
Self-care.
It's fine to use an ice pack or take over-the-counter pain medicines for genital pain. However, don't put any cream or ointment on a sore, as that could make it more difficult for the test to detect the organism. If you have trouble urinating, avoid drinking alcohol and eating spicy foods (both of which may irritate your urinary tract) until you have received treatment and the infection has cleared up. In some cases, a hot bath may make the pain less intense.

•
Don't have unprotected sex or douche.
Douching before STI testing can make the test results less accurate and your infection worse. So can unprotected sex.

•
Ask for support.
Some people arrange to bring a friend with them to write down information and offer emotional support. Make sure that anyone who accompanies you is someone whom you trust and with whom you can be honest about anything your provider might ask, including the range of your sexual practices and relationship issues, such as intimate partner violence. If there are things you would like only your provider to know, you may want to go into the appointment alone. Or you can arrange to have a private time with the provider (apart from your support person). Some facilities/providers do not allow another person in the room, even at the patient's request. This is in order to prevent any barrier to the honest exchange of information or potential compromise to patient confidentiality.

•
Be honest.
It is important for your provider to know if your sex partners include men, women, or both; whether you have had new partners since the last visit; and the sites of exposure. Although some women engage in anal sex, many health care practitioners do not ask about it. Don't wait for your provider to bring up specific sexual practices. Be forthcoming in order to get the most comprehensive and accurate care.

•
Make sure you get all the tests you need.
Although providers may be able to diagnose herpes by sight, for example, lab tests can provide more specific information. Ask exactly which STIs you are being tested for; some have to be diagnosed from symptoms because there's no reliable screening test. (For more information on recommended tests, see
“Screening, Testing, and Treating STIs,”
)

•
Ask about vaccinations.
As of 2011, there were two effective vaccines on the market to prevent HPV. One is against the two cancer-linked types of HPV, while the other covers the same high-risk types and, in addition, the two types that usually cause genital warts. It's important for women who receive an HPV vaccine to continue with recommended cervical cancer screening (such as Pap tests). Vaccines are also available against hepatitis A and B infections. (For more information, see
“Vaccinations to Prevent STIs.”
)

•
Make sure you understand your diagnosis and what you need to do to get well.
If you've been diagnosed with an STI, it's important that you know what medication you will be taking and for how long; the potential side effects, including drug interactions with hormonal birth control and other medications; how long to wait before resuming sex; and any follow-up tests or treatment required. Don't be embarrassed to ask questions.

•
Don't leave with unanswered questions.
If your provider is too busy to answer questions, ask to speak to someone else. Find out how long it will take for your symptoms to clear up and what you should tell your sex partner(s) and when you can resume sexual activity. If the office will try to reach you later with test results, provide an appropriate phone number or email address where you can be reached, and discuss whether a message may be left for you. Or schedule a date to call or to return for your results. Make it easy for your provider to reach you and treat you if needed.

•
Call with more questions.
It's hard sometimes to think of everything to ask on the spot. If you have more questions after your visit, call back and ask for the information you need.

•
Take
all
prescribed medication.
Even if you feel better or the symptoms disappear, finish taking the full course of medication. Incomplete treatment can result in drug-resistant strains of the infections growing in your body, and these can cause more complications.

•
Make a plan with your partner.
If you or your partner has a bacterial STI (such as chlamydia, gonorrhea, or syphilis), you and all your partners (and their partners) must be treated, and take all medication as prescribed, before you have sex again. If not, you can keep reinfecting each other. Your partner(s) may not need to see a provider: You may be able to provide antibiotics to your partner(s). Ask your provider if he or she can give you medication that you can give to your partner(s). Also ask how long you need to wait after you and your partner(s) have been treated before resuming sexual activity.

•
Hang in there:
You may feel uncertain about your treatment. Tests are not perfect; sometimes treatments are a burden or they don't work, and that means more medical visits, time, and money. But the alternative—not getting treatment—is worse, because it puts your long-term health, and that of your partner(s), at risk.