Testing for STIs

I am impressed when a patient says that she and her partner tested for "everything" before starting a new sexual relationship. What is the test for "everything", and for which sexually transmitted infections (STIs) should or can a woman be tested? With modern technology, there are a variety of ways of testing for STIs and I will mention some of them.

Chlamydia

Chlamydia trachomatis is the most common bacterial sexually transmitted infection in the United States. The majority of women with this infection have no symptoms, but some women may have a vaginal discharge, bleeding after sex or between periods, and lower abdominal pain. Women can be tested for this infection with a swab from the cervix or a urine specimen, depending on the capabilities of the laboratory.

Gonorrhoea

Neisseria gonorrhoea is another common sexually transmitted bacterial infection which can also be evaluated with a cervical swab. Symptoms include vaginal discharge, burning with urination, or burning or itching in the genital area.

Both chlamydia and gonorrhoea can be easily treated with oral antibiotics. However, women who are not treated may develop pelvic inflammatory disease,which can lead to infertility, chronic pelvic pain or ectopic pregnancies.

Hepatitis B

Hepatitis B is a virus that is carried in the blood. Women can get infected through sexual contact or through injection with a contaminated needle which can occur in illegal drug use or even as a needle-stick injury for women who work in health care. Hepatitis B infection can cause severe liver disease, but it is preventable by a vaccine.

Syphilis and HIV

Syphilis, caused by the bacteria Treponema pallidum, is a very contagious STI. It can be a devastating disease which, in the late stages, may affect many organs of the body. Fortunately, because of screening and treatment, it is less common than it has been in the past.

HIV (human immunodeficiency virus) readily comes to mind when women decide to be screened. Although a vaccine to prevent this disease has not yet been identified, modern treatment allows people to live with the disease in excess of 20 years. HIV, syphilis and hepatitis B are usually detected using a blood test.

All these sexually transmitted infections can be transmitted to a baby during childbirth and some can cause serious illness and sometimes death of a baby. The Centers for Disease Control and Prevention in the United States recommends that pregnant women be tested for all these infections to avoid these consequences.

There is no one test that can screen for all STIs. However, with a combination of blood and cervical testing, women can be confident in knowing that the common infections can be readily identified and treated.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.