“So… how does this work?” I often got that question whenever a person first came in for HIV/STI testing at the public health clinic where I worked. After a year of being an HIV/STI tester, I found that lots of people know they want to get tested, but have no idea what actually happens at the appointment. If you’re unsure of the logistics of STI tests, don’t let this stop you from caring for your health! We testers are really happy to help and are ready to answer all of your questions about the process. 

After speaking to Dr. Amesh Adalja, MD, an infectious disease physician and Senior Scholar at the Johns Hopkins Center for Health Security, and Kenny Screven, an HIV/STI tester at a Pennsylvania LGBTQ+ center, I’ve incorporated their expertise so I can walk you through the nitty-gritty of what getting tested really entails.

First, if you’re about to head down to the clinic, let me commend you for getting tested! STI tests are an empowering way to take charge of your own sexual health. You’re protecting your partners and yourself, and you’re ensuring you have the knowledge to make educated decisions about any kinds of protection you may want to use with each other.

Your first step will be finding a clinic where you’re going to get tested. AIDSVu.org and the CDC have lists of testing sites you can search by zip code, or you can google “free STI testing.” You’re going to want to consider cost and privacy when making your selection, as well as which tests these sites provide. To get tested, you can go to:

• Your regular doctor
• A public health clinic
• A Planned Parenthood location
• Your college/university’s health center
• A walk-in clinic like a CVS MinuteClinic
  

Privacy‍

I bring up privacy when selecting a location because, while all places are mandated by law to keep test results confidential, you might have a family doctor who you don’t want knowing your sexual history or you might feel uncomfortable being seen at the campus clinic. If you feel more comfortable going to a health center where you’re less likely to be recognized, that’s fine.

Privacy, which Screven mentioned as a top client concern, is very important to any clinic or doctor you visit (and it’s legally required), so rest assured that your results and the fact that you got tested are not going to be shared with other individuals without your consent. However, I recommend that you do ask what information may get reported to agencies like a state Department of Public Health or the CDC. While those agencies will also not share your private information with any individuals, you should be aware if some of the information you give a tester will be passed on for funding and government reporting reasons. Sometimes a clinic can make sure your testing is completely anonymous, but sometimes it will be necessary for your information to be shared with these public health agencies. If you call and ask a clinic this question before you go, then you can be sure to choose a testing site that’s most comfortable for you.‍

Cost‍

Some places provide totally free testing, but many will want to run your health insurance beforehand. Since STI testing is a preventative service, it is often covered by health insurance plans. Keep this in mind for privacy as well because you may have a co-pay and get a bill in the mail, just like any other medical service, and your test may show up on the Explanation of Benefits mailed to your plan’s subscriber. If you are on an insurance plan with your parents or spouse and don’t want them to see the test, then you may want to travel to a free clinic that will not require your insurance. Still have questions? Call your insurance provider and/or the clinic where you plan to get tested and ask them because answers vary by plan and testing site.‍

Different Tests‍

To get the right tests, you’ll also want to know what you want to get tested for. Some of the most common STIs to check for besides HIV are hepatitis, syphilis, chlamydia, gonorrhea, herpes, and trichomoniasis, but there are more, too. Do you have a specific concern about a new discharge or sores? Do you want a “just in case” check for as much as possible? Talk with your tester about which tests to get, and be aware that not all testing sites test for all STIs.

Depending on where you go, some specific parts of the process will vary. For example, some sites require appointments, others are walk-in, and if you’re at your primary doctor’s office, then you just have to ask for HIV/STI tests to be added on to your visit. While you should typically plan on testing taking around 20-60 minutes, this can vary as well. But no matter where you’re getting tested, the order of events will  probably go something like this:

1. Intake questions
2. Specimen collection
3. Receive results
   

That’s it! But there can be a lot involved in each of these three steps.‍

Intake Questions‍

The intake questions preceding the test can be very personal, but your honest answers help us provide you with the best care possible. No matter where you go for testing in the United States, the tester will be bound by HIPAA (Health Insurance Portability and Accountability Act) to maintain confidentiality. Questions you might be asked include:

• How old are you?
• What was your sex at birth? What is your gender?
• Are you pregnant? Have you ever been pregnant?
• What is the sex of your sexual partner(s)?
• When was the last time you had sex?
• What kind of sex do you have? Vaginal? Anal? Oral? Top? Bottom? 
• Have any of your sexual partners been HIV-positive? Or injection drug users? 
• Have you been tested before? When? Where?
• Have you ever been diagnosed with HIV or any STI before? When? Where?
• Have you ever heard of PrEP? Have you ever taken PrEP? Are you interested in getting on PrEP?
• Have you ever used drugs by injection? Have you ever shared injecting equipment?
• Do you have health insurance?
• What do you want to get tested for today?
• Is there any particular reason you want to get tested today?
  

You may also be asked screening questions to see if you would like referrals to other services, like:

• Are you currently stably housed?
• Do you feel safe in your relationship?
• Do you have access to clean needles and Narcan?
• Do you need help signing up for health insurance?
  

There may also be demographic questions asking for your race and the country you were born in. If you are going to a state-funded testing site in the U.S. (which pretty much any free clinic would be), then your answers are being reported back to the state but your name and contact information may be stripped from the data. We’re required to ask you some of these questions in order to fill out the paperwork for the state — but remember, you have the right to decline any question! If we have to leave an answer blank on the form, so be it.

If you’re wondering why we want to know when you last had sex, that’s because it takes 2-3 weeks for most STIs to show up on a test. So if you contracted gonorrhea from sex you had last night, your gonorrhea test today will come back negative. It’s important to be upfront about timing with your tester for accurate results, and they may recommend you come back in a month with or without getting tested today. When you get your results, keep in mind what window those results actually cover, and when you should next get tested.‍

Specimen Collection‍

Once testing begins, your tester might:

• Draw your blood or prick your finger
• Ask you to pee in a cup
• Swab a part of your body (Swabs may be done on visible sores, inside the anal canal, inside the vaginal canal, on the cervix, on the urethra, on the inside of your cheek, or at the opening of your throat in the back of your mouth)
  

The way your provider collects specimen for testing depends on your body, how you have sex, and what you’re being tested for. This is why we need the intake questions! Without them, we don’t know which tests to give you.

Testing for the most common STIs - chlamydia and gonorrhea - involve testing each orifice you use for sex. Unlike some other STIs, chlamydia and gonorrhea are “site-specific.” What does that mean? These STIs live in specific places in your body. So you can have chlamydia in your vagina and nowhere else - it doesn’t spread around your body. For example, if you have vaginal chlamydia and only perform oral sex on somebody, then your partner is not at risk of contracting chlamydia from you because they did not have contact with your vagina. This is different from something like an HIV infection, since that is present in several bodily fluids.

If you’re getting tested for chlamydia and gonorrhea, we have to check for them in up to three places depending on your sexual activity. If you perform oral sex, we’ll want to do a throat swab. If you receive anal sex, we’ll want to do a rectal swab. If you use your vagina for sex, we’ll want to do a vaginal swab. If you use your penis for sex, we’ll have you pee in a cup. Some testing sites will have people with vaginas pee in a cup instead of doing a vaginal swab, but the vaginal swab is preferred. If you have a vagina and don’t want to do a swab for any reason, you can request a urine test. (FYI, having your period at the time of the swab is not an issue.) 

If you seek chlamydia and/or gonorrhea testing at the clinic where I work, we’ll perform the throat swab, but send you to the bathroom (with instructions) for you to do your own vaginal and rectal swabs (or pee in a cup). Other testing sites, like a gynecologist, might do these swabs for you while your feet are in stirrups. 

Some STIs, like genital warts, are often simply diagnosed by a practitioner seeing symptoms in an exam, and no further tests are necessary.‍

Receive Results‍

Every testing site has different processes in place for results, so it’s a good idea to ask your tester what to expect. You may find out your results in a matter of minutes, like with the rapid HIV test, but in most cases, your specimens will be sent to a lab and it will take a few days or more to get your results.

You might get your results over the phone, in an online portal, or in person if your testing site asks you to come back. You can also ask for a print-out of your results if you want to show partners. Again, check in at the time of testing to find out what you can expect.

If a test comes back positive, your tester will have information on how to proceed. First, remember that there’s no shame in any of these diagnoses and that all of these infections can be managed, if not completely cured. In cases of the more common STIs like chlamydia, you’ll simply take some antibiotic pills once, refrain from sex for a week while the infection clears, and you’re done. Your clinic or office should be able to refer you to a case manager, medical treatment, or other resources as necessary. (And remember that the “site-specific” STIs will have multiple results. So you might be negative for gonorrhea anally and orally, but positive vaginally.) 

You also have a responsibility to inform any sexual partners (or needle-sharing partners) about any positive results. Some clinics are able to write a prescription for antibiotics to treat the infection for a partner, and some states have services that can anonymously inform your partners of their exposure. This all varies depending on where you got tested.‍

And Repeat‍

HIV/STI testing is not a one-time deal. If you continue having sex, then continue getting tested. Not all STIs are guaranteed to be 100% preventable with condom use and many STIs can have no symptoms, so regular testing is important for you and your partners. Some folks go every three months, some every six, some once a year, and some with every new partner. Always go if you develop a new symptom like burning when you pee, pain with sex, a rash or sores, or a genital discharge that’s not typical for you. Do what feels right for you based on what safer sex methods you use, if any.

Since STIs often show no symptoms, getting tested is the only way to know your status. Why do you need to get tested if you don’t have any symptoms bothering you? Besides  potentially putting your partners at risk, also remember that, if left untreated, certain STIs can lead to long-term health problems like infertility. You don’t want those infections going undetected.

HIV/STI testing is just another part of a healthy sexual life. Like getting and giving enthusiastic consent and peeing after sex, it just comes along with the fun and pleasure of gettin’ busy. Plus, it’s a great opportunity to talk to a sexual health expert in person about any other questions you may have. So ask away!