Do I need special tests to see if I have an anal STD?

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Question: Do I need special tests to see if I have an anal STD?

There are a lot of anal sex risks. Numerous STDs are easily spread by anal sex. Furthermore, if you have an anal STD it may not be detected by regular STD testing. That's why it's important to tell your doctor if you're having anal sex so that she can test you accordingly.

Answer: Special testing is needed to detect many anal STDs

Not all STD tests work in the same way.

Some tests, like the ones for HIV, test your blood for signs that your body has been exposed to the virus. If you wait long enough after infection for your body to have time to develop a response to the infection, a test like this will detect a disease no matter how you have been exposed. In other words, you wouldn't need to have a special anal STD test to detect HIV, syphilis, or hepatitis. 

In contrast, the most common tests for gonorrhea, chlamydia, and many other STDs look for the pathogen that causes the disease rather than your body's response to it. These tests, when performed the usual way, will not always be able to detect an STD that you have contracted through anal sex. That's because they only test in the locations that they sample.  

The fact that standard STD testing will not always detect an anal STD is one of the biggest anal sex risks. That's why it's so important to tell your physician if you are having receptive anal sex -- particularly if you are not having safe anal sex.

If your doctor knows that you are at risk of contracting an anal STD, she can test you accordingly. This testing may include an anal Pap smear. Testing may also include swabs of the rectum to look for specific bacterial STDs that are frequently transmitted when individuals don't practice safe anal sex.

Anal sex risks are not just an issue for gay men. Many heterosexual couples and lesbians also have anal sex. That is why all sexually active adults should be aware of the possibility of anal STDs and know that these STDs require separate testing. Physicians also need to do a better job of asking their patients if they are having anal sex and encouraging them to have safe anal sex as part of their sexual health discussions. Detecting anal STDs is difficult during a standard screening exam if doctors don't know their patients are at risk. There may also be specific treatment concerns for anal STDs, such as rectal chlamydia and gonorrhea.

In conclusion, if you are having anal sex, talk to your doctor. Let her know that you're interested in getting special tests to check for anal STDs. These tests generally involve a few swabs of your rectum with something no larger than a q-tip. They should neither be painful nor anything to fear.

Don't be too embarrassed to discuss your anal sex and safe anal sex practices with your doctor. There's no other way for her to know how to treat you appropriately. The anal sex risks are great enough that most doctors will appreciate your being up front about your habits.

It's the only way that they can give you the best care possible.

Sources:

Drummond F, Ryder N, Wand H, Guy R, Read P, McNulty AM, Wray L, Donovan B. Is azithromycin adequate treatment for asymptomatic rectal chlamydia? Int J STD AIDS. 2011 Aug;22(8):478-80. doi: 10.1258/ijsa.2011.010490.

Hoover KW, Butler M, Workowski K, Carpio F, Follansbee S, Gratzer B, Hare B, Johnston B, Theodore JL, Wohlfeiler M, Tao G, Brooks JT, Chorba T, Irwin K, Kent  CK; Evaluation Group for Adherence to STD and Hepatitis Screening.. STD screening of HIV-infected MSM in HIV clinics. Sex Transm Dis. 2010 Dec;37(12):771-6. doi: 10.1097/OLQ.0b013e3181e50058.

Leeds IL, Fang SH. Anal cancer and intraepithelial neoplasia screening: A review. World J Gastrointest Surg. 2016 Jan 27;8(1):41-51. doi: 10.4240/wjgs.v8.i1.41.

Tao G, Hoover KW, Nye MB, Peters P, Gift TL, Peruvemba R, Body BA. Rectal Infection With Neisseria gonorrhoeae and Chlamydia trachomatis in Men in the United States. Clin Infect Dis. 2016 Nov 15;63(10):1325-1331.

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