What a routine STI check doesn’t test for

Why some STIs aren’t tested routinely

The Australian STI Management Guidelines (opens in new tab) recommend testing people without symptoms only where it helps: where an infection is common, often silent and worth treating early, and where the test gives a clear answer. Chlamydia, gonorrhoea, HIV and syphilis meet that bar. For the infections below, testing someone without symptoms either has no reliable test, or a positive result wouldn’t change what happens next.

Herpes

Herpes simplex virus is very common: the guidelines estimate 70–80% of people have HSV-1, the type that usually causes cold sores, and 12–15% have HSV-2. Most never have symptoms, or have ones mild enough to go unnoticed, and HSV-1 now causes more than half of first genital infections in young people.

The guidelines advise against blood tests for herpes in people without symptoms, as the result rarely changes anything. If you have a sore or blisters, a doctor swabs it and the lab tests the swab by PCR, which is very accurate. Herpes isn’t notifiable, and contact tracing isn’t recommended.

Genital warts and HPV

Genital warts are caused by human papillomavirus (HPV), usually types 6 and 11. Most HPV infections cause no symptoms, and there’s no routine test for them: warts are diagnosed by how they look, and HPV testing isn’t used to diagnose them. Warts can take a long time to appear, so they don’t necessarily mean a recent partner.

The HPV vaccine protects against the types that cause most warts, and cervical screening, recommended from age 25, checks for the types linked to cervical cancer.

Mycoplasma genitalium

The guidelines say screening people without symptoms for Mycoplasma genitalium isn’t recommended. It’s tested when someone has urethritis, cervicitis, pelvic inflammatory disease or bleeding after sex, and in ongoing partners of someone who has it. Its resistance to antibiotics is rising, so treatment is chosen with care.

Trichomonas

Trichomonas is a parasite that can cause vaginal discharge and irritation, though up to half of vaginal infections have no symptoms. The guidelines recommend screening only in communities where it’s common, mostly in remote Australia, and testing anyone with symptoms.

Bacterial vaginosis

Bacterial vaginosis (BV) is an imbalance of vaginal bacteria that behaves much like an STI, and an ongoing partner with a penis is now treated too. It’s tested only when there are symptoms, such as a thin grey or white discharge or a fishy smell. It often has no symptoms, and the guidelines don’t support testing people without them.

If you have symptoms

Sores, blisters, lumps, discharge, itching or pain need an examination, which is how most of these are diagnosed. See someone in person at a sexual health clinic (opens in new tab), GP clinic (opens in new tab) or urgent care clinic (opens in new tab). For a list of symptoms, see STI symptoms.

How at-home testing works with Prickly

Prickly is an Australian at-home STI testing service for people without symptoms. It tests for chlamydia and gonorrhoea, with an optional HIV self-test; syphilis needs a blood test at a clinic or GP.

• Request online. Complete a five-minute online request, or book a short call with a doctor – bulk billed with Medicare. Either way, a doctor confirms that at-home STI testing is suitable for you.
• Receive your equipment. Collection equipment tailored to your exposures ships the same or next business day in an unmarked mailer box with Australia Post tracking.
• Collect at home. Follow the included STI testing self-collection guide – swabs and urine for the lab, and, if you’ve added HIV testing, a fingerprick HIV self-test you read at home in 15 minutes.
• Post to the lab. Post your lab samples back the same day using the included prepaid return label – at any Australia Post Office, red street posting box or Parcel Locker.
• Get your results. A doctor reviews every lab test result and emails you privately. Telehealth follow-up included – with help accessing treatment and telling partners, if needed.

The same steps are on the home page under How it works, and fees are under Pricing.

When at-home testing isn’t right

See someone in person at a sexual health clinic (opens in new tab), GP clinic (opens in new tab) or urgent care clinic (opens in new tab) instead if you have symptoms or if you’re under 16. And if you may have been exposed to HIV in the last 72 hours, don’t wait for a test – visit www.getpep.info (opens in new tab) or go to a sexual health clinic (opens in new tab) or emergency department (opens in new tab) as soon as you can. If something happened without your consent, 1800RESPECT (opens in new tab) is also available 24/7 for free, confidential support.