Asking for testing for STDs and HIV

Q: My daughter goes to the gynecologist once a year when she’s home from college. When she gets her annual exam, do they automatically screen for STDs—or does she have to request certain types of testing?

This is an excellent question and an important topic to bring up to your daughter if she is sexually active. The answer is yes, she should definitely request testing for sexually transmitted disease (STD). Up until age 30, routine Pap screening includes vaginal swab for chlamydia and gonorrhea—the two most common forms of STD. If a patient has concerns about exposure to other types of STDs, however, including syphilis, HIV, hepatitis B and hepatitis C, additional blood work is needed and must be requested. Also, we only do culture for herpes when there are visible lesions; otherwise, this is not routinely checked. STD testing is often covered by insurance. You can request an STD screen at any age if you have concerns about your risk. The CDC STD screening recommendations for men and women may be helpful.

HPV screening and risks if untreated

Human papillomavirus (HPV) is the most prevalent STD and is often acquired early in life. We do Pap smears with DNA testing for HPV in all age groups so this is part of your annual screening. If HPV goes undiagnosed and untreated, there is some risk of cervical cancer and other types of gynecological cancer in women as well as risk in men for genital warts and genital cancer—although most cases of HPV are asymptomatic (produce no symptoms) and do not lead to cancer or other health problems.

We see HPV in all age groups and there is no cure for it. It is simply something the immune system learns to control over time. To minimize risk, the CDC recommends HPV vaccination for children starting at 11 or 12 years old. The vaccine includes two shots received six to twelve months apart. If the shots are received less than five months apart, a third dose of the vaccine is needed. If your child was not vaccinated in adolescence, the HPV vaccine is recommended for young women through age 26, and young men through age 21.

Rising trend in STDs in the United States

The CDC reported a steady increase in STDs between 2015 and 2016. There are different viewpoints as to why we’re seeing these numbers go up, including some that point to the popularity of Internet dating and hookup apps that allow more people to have more (unprotected) sex with strangers more easily. It is also possible that we’ve gotten better at screening and better at reporting, so therefore the numbers are higher. Whatever the reasons for the rise in STDs, they’re still around and many sexually active people are at risk—especially women under 25 with new or multiple sex partners, and women who are pregnant. (STDs in pregnant women can lead to life-debilitating and –threatening conditions for the fetus and newborn baby.) Men who have sex with men (MSM) and men with multiple sex partners are also at higher risk for STDs and should be tested regularly.

Keep in mind that there are often no symptoms of STDs and the problems may not show up until later in life, for example, when a woman is being cared for during pregnancy. It’s important to advise your daughter to be open with her doctor and ask for the testing she needs. This can help protect her health now and in the future—and it’s simply good practice to be proactive about her health and well-being.

It is important to find a gynecologist that you and your daughter trust and are comfortable talking to. We are happy to team you with a Main Line Health gynecologist in your area. Call 1.866.CALL.MLH (225.5654).