“I just want everything checked out Doctor”
Back in the UK these words bring to mind a patient who fears they have CANCER and they come asking for a “TOTAL body scan”.
In Palma, amongst our yachting friends, the same words usually mean that the patient fears an STI or “Sexually Transmitted Infection” They want the “all clear” after the end of a relationship, the start of a new one, or where their partner has told them they have something “down below”!
As with the folks in the UK…….it is impossible with one test to check “everything” and it is important to know what is necessary and worthwhile, how much it will cost, and are the tests reliable?
So….What is necessary?
Common things are common but many people want complete reassurance that they don’t have any STI.
STIs can cause discomfort, embarrassment and shame- a concern that if revealed, a partner may desert you, and also a fear that (like cancer) some are “incurable”.
Herpes, genital warts and HIV are almost impossible to eradicate once contracted and given the fact, that over 50% of most STIs produce no symptoms while still being infectious to an unsuspecting partner, the stage is set for confusion and anxiety.
The good news is that there are effective treatments if not complete cures for all STIs.
The more serious conditions such as HIV/AIDS, hepatitis and more rarely syphilis (or “the Great Pox” as it used to be called) are all much more common in homo- or bi-sexual men, intravenous drug users and in heterosexual people from sub Saharan Africa so if you haven’t had sexual contact with any of these groups, you are less likely to have picked them up. However, one infection can predisposes to others so it is sensible to test for all likely infections if one is detected.
Rapid diagnosis and treatment not only protects YOU from the short and longer-term complications of the infection, such as painful recurrent genital ulcers (herpes), infertility (chlamydia) or nerve and kidney damage (syphilis), but it will also prevent your partner from catching whatever it is, and help to prevent the spread of the infection. If you don’t tell your partner, you may catch it back and the whole exercise is a waste of time and money. Early diagnosis and treatment of HIV can prevent progression to full blown AIDS for many years and maintain good health and active life.
How much will it cost?
Testing for every possible STI can run up hundreds of euros in laboratory costs, and it is important therefore to have a chat with your doctor first to see which diseases you are at risk of and when the various tests should be done. Sometimes treatment can be started before the results of tests are received if the clinical diagnosis is obvious (eg in herpes infections). Discussion with your doctor also means that you both know how results are going to be sent to you and that you have the necessary support if a serious problem is discovered.
Are the tests reliable?
It is usually better to actually see the bug under a microscope or grow it on a special jelly (culture medium) rather than just do blood tests. This means taking swabs from the area if infection (usually genital but occasionally mouth or rectum). Sometimes a urine specimen can be used but these are not always quite as accurate as swab tests. Blood tests depend on detecting antibodies the body has developed over time and can mean that the infection occurred years ago, or if you check them too soon, they may be negative—ie falsely reassuring when actually you have contracted an infection!
For STI screening, it is worth getting an HIV and a syphilis blood test, since both these diseases can be difficult to diagnose– both mimic a lot of ordinary conditions like flu, sore throat, faint rash or swollen glands. However, the antibody tests may take from 2 weeks (syphilis) to 12 weeks (HIV) to become positive, so it is no good having a test immediately after the episode of exposure and then assuming you have the “all clear”.
So…What are the take home messages?
Take care! If you are at risk of an STI, use a condom every time, seek medical help as soon as possible if you notice any problems down there!- blisters, rash, lumps, discharge, pain on passing urine, bleeding between periods, swollen glands in the groins or if you know your partner has an infection. If you are diagnosed, tell your partner and get the tests and treatment!
And now the hard bit!
Avoid sex even using a condom until both of you have completed the advised course of treatment.
Dr Rosemary Prudhoe, can be contacted at Club de Mar Medical Centre, Palma de Mallorca.