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Notes on Women's Health
Notes on Women's Health

STI Testing: What Will and What Won’t Show Up in Your Annual Well-Woman Exam

STI Testing Your annual well-woman examination from your OB-GYN is an assessment of your reproductive health as well as the condition of your genitourinary system (the reproductive system and the urinary organs), and for adult women under the age of 65, will routinely include a pelvic exam and Pap smear. Many women mistakenly think that a Pap smear checks for multiple sexually transmitted infections (STI), also known as sexually transmitted diseases (STD), but in reality, this is not the case. In fact, STI testing is not a standard part of an annual well-woman examination.

STI Testing on Annual Exams

A human papillomavirus (HPV) test will accompany many Pap smears, but this test is intended to detect cancer-causing strains of HPV rather than strains responsible for genital warts. The fact is that STI testing by your OB-GYN is typically done on a case by case basis. Your OB-GYN will conduct specific STI testing based on your risk factors, symptoms or by your request.

Because your STI risk factors are largely determined by sexual history, it is crucial that you are open and honest with your OB-GYN about your sexual history and current practices.  It’s understandable if you’re uncomfortable having these personal conversations, , but your OB-GYN is not there to judge, only to provide you with the best possible healthcare.

STI Testing Recommendations

So, what tests do you need? The Centers for Disease Control and Prevention (CDC) recommend that everyone between the age of 13 and 64 get tested at least once for HIV (human immunodeficiency virus), the pathogen that causes AIDS (acquired immune deficiency syndrome). Depending on your sexual risk factors, you may need more frequent testing.

Also, all women under 25 who are sexually active should have a yearly screening for both chlamydia and gonorrhea. Women older than 25 also need these tests if they have multiple sexual partners, a new partner or a partner who has this STI. Remember that it is possible to contract an STI at any age.

Pregnant women should also receive STI screening that includes tests for HIV, syphilis, and hepatitis B. Chlamydia and gonorrhea tests may be added if indicated.

What are the Most Common STIs?

HPV

HPV is the most common STI by far. In fact, more than 79 million Americans have HPV and approximately 14 million are becoming infected each year. In addition to causing cervical cancer in women, certain strains of HPV can also lead to genital warts. This STI is transmitted through skin to skin contact, usually during genital sexual intercourse. HPV testing typically occurs during cervical cancer screening, which consists of a pelvic examination, Pap test, and sometimes HPV testing. The HPV test is usually only given to women age 30 and older, or women who have had abnormal Pap test results. HPV testing is not recommended in women under the age of 30 unless their Pap smear is abnormal.

Genital Herpes

This STI is also caused by a virus and may appear as blisters or sores in the genital area. However, genital herpes can also “lie dormant” for long periods with no apparent symptoms. While there is no complete cure for genital herpes, there are medications that can reduce outbreaks and reduce your chances of transmitting the virus to another person. Herpes is not screened for in an annual women’s exam. The CDC advises against routine screening for Herpes, unless a patient is symptomatic. 

Chlamydia

This STD is a very common bacterial infection. Chlamydia may cause no symptoms, so testing is important if you are sexually active. When symptoms do occur, they are usually in the form of genital pain, itching, and vaginal discharge. If a chlamydia infection becomes severe, it can lead to infertility in women.

Gonorrhea

Gonorrhea is another bacterial STI. It may cause vaginal discharge and, like chlamydia, can result in infertility if not treated. A series of antibiotics are prescribed to treat gonorrhea. If left untreated, gonorrhea can cause serious health problems, such as pelvic inflammatory disease (PID), organ damage and infertility.

Hepatitis A and B

These viruses can be spread through sexual contact or blood contact. Hepatitis attacks the liver and can cause chronic disease. Sexually active women should be screened annually regardless of condom use and every 3-6 months if there are increased risk factors such as, having a new sex partner, having multiple sex partners or having a sex partner with an STI.

HIV

HIV is transmitted through sexual contact and blood contact. With AIDS, the immune system is compromised, leaving you open to deadly infections. HIV was once incurable, but effective treatments for HIV exist today.

Syphilis

Syphilis is a bacterial STI that usually begins as a painless sore in the genital area. However, syphilis can advance rapidly, eventually affecting your nervous system. Untreated syphilis can lead to death.

STI Prevention

The best prevention for STIs is to always practice safe sex using a condom. You should also be upfront and honest with your healthcare providers about your sexual history and practices so that they can accurately assess your risk factors and make appropriate STI screening recommendations. If you have had an unprotected sexual encounter or notice possible symptoms of an STI, contact your OB-GYN to discuss next steps.

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About the Connecticut OBGYN Practice

Dr. John Garofalo, M.D., is a CT OBGYN based in Fairfield County, providing care for Norwalk, Darien, New Canaan, Weston, Rowayton and the surrounding areas. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Women undergoing signs and symptoms of menopause can make an appointment with Laury for Hormone Replacement Therapy. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.