Top 10 Questions I Get From People Who Think They Might Have an STD

Most of the e-mail I get falls into two categories. The first are letters from people saying, "I think I might have an STD." The second are  letters from people who just found out they have an STD. Both types of letters have one thing in common. Their writers desperately need information that can help them figure out how to move on with their lives in a safe and healthy way. That's why I've put together this quick reference. It contains answers to the most common questions I get from people who are worried about the realities of having an STD.

I just had unprotected sex. How soon will I know if I have an STD?

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The simplest answer to this question is that you can't know if you got an STD during any episode of unprotected sex until you get tested because many STD infections are asymptomatic. However, what you probably actually want to know is how long you have to wait until symptoms show up if you're going to see them. The answer varies from disease to disease. It could be anywhere from a few days to a few years

To make things even more confusing, there's also a window period between when you are infected with a disease and when you can first test positive for it. That varies with every STD and may extend to six months or more.

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Could my partner really not have known he had herpes before he gave it to me?

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A lot of people who are newly diagnosed with herpes refuse to believe their sexual partners when they say they didn't know they had genital herpes. Some of them may be lying. However, there are a lot of people who really have no clue they are infected with one of the herpes viruses. Infections often have no symptoms, and doctors do not regularly perform blood tests for herpes unless someone has a known exposure. Some doctors aren't even willing to test people who specifically ask!

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I've already had unprotected sex. Is there any point in using a condom now?

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There is a common misconception that if you sleep with someone with an STD, you will automatically get that STD the first time. That isn't true. Still, people often use that belief as a reason to continue not using condoms or other forms of protection after they've slipped up. "After all," they rationalize, "if I was really at risk from this person, then I'm already in trouble." Fortunately, however, that isn't true. It's certainly best to practice safer sex every single time you have sex. However, messing up once doesn't mean that you can't go back to doing it right. It's always worth using a condom the next time you have sex -- even if you didn't this time.

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There's discharge coming from my penis -- do I have gonorrhea?

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Penile discharge can be a symptom of any of a number of common STDs. The only way to tell which one you have, or if you have an STD at all, is to go visit your local doctor or free clinic and get tested. There is no way for someone to diagnose what STD is causing a discharge without doing laboratory tests. Don't worry, though. These days, that mostly means giving a urine or blood sample rather than being subjected to a urethral swab.

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Do I have to tell my partner I have an STD?

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Disclosing an STD to a potential partner is a good thing to do. That's true both because it's right and kind and because not disclosing could lead to a lawsuit. People deserve to have the opportunity to make informed decisions about their sex lives. That requires an open and honest discussion about risks.

Acknowledged STD infections, even with life-long infections such as HIV and herpes, aren't necessarily relationship deal-breakers for people. Lying about them almost always is. You don't need to bring up these topics on the first date. Just don't put the conversations off until the night you plan to first have sex. Having to deal with a heavy discussion in the heat of the moment is a bad idea. It may make it more likely your partner will make a decision they'll regret.

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How do I reduce the risks of oral sex (and do I really have to)?

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A lot of people don't really think of oral sex as sex. However, it can pose a significant STD risk. That's why, unless you have both been comprehensively tested, it's a good idea to use condoms or dental dams whenever you have oral sex.

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There isn't an HPV test for men, so they don't need to worry about it, right?

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Although men can't get cervical cancer, that doesn't mean they aren't at risk of other HPV-related diseases. That includes a variety of sexually transmitted cancers and genital warts. There is not yet a commercial HPV test for men, but that doesn't mean it's not important. It's just that it's hard to figure out how to implement population-wide testing in a useful way. Fortunately, even if a test isn't available for men, a vaccine is.

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Wouldn't I know if I had an STD?

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The truth is, it's quite easy to be infected with an STD and have absolutely no idea. STD testing is not part of the standard health care routine. Furthermore, many STDs can have no symptoms for years. So the only way you'd know for certain if you had an STD would be if you'd asked your doctor to test you and gotten the results. Even then, your certainty would only last as long as you continued to avoid potentially risky behavior.

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My partner says he didn't cheat on me. How is that possible?

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When someone who has been in a long-term relationship is diagnosed with an STD, it can be heartbreaking. Their first instinct is almost always to assume that their partner has cheated on them. While in many cases that may be true, it isn't always. If you both weren't tested before starting the relationship, or earlier during the relationship, it's possible that your partner might have had an asymptomatic infection since before you got together. They also might have only infected you recently -- even if you've been involved for years.

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I just had oral sex with a prostitute. Do I have HIV?

Scanning electron micrograph of HIV-1 budding from cultured lymphocyte. Photo Courtesy of the Public Health Image Library; C. Goldsmith

It's a little dismaying how often I get asked this specific question. (It's most often asked by men who have just returned from trips abroad.) It actually conflates several misconceptions that are discussed in more detail above: 

  • that the main STD risk of oral sex is HIV
  • that all prostitutes have HIV
  • that STDs are transmitted every time you have sex.

None of those things are true. Still, it's a good idea to use protection whenever you engage in any type of commercial sex (or casual sex). These things do potentially have substantial risks. Besides, if you're aware enough to be worried about HIV after you've purchased oral sex, then you should know enough to take precautions in advance. The risk of acquiring HIV through a blow job may be relatively low. However, diseases like herpes, gonorrhea, and syphilis can all be spread quite easily during oral sex.

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