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I have no specific reason to believe that I have an STD, nor do I have any symptoms. I've been in a monogamous relationship for almost four years. I've been to the gynecologist for exams (including pap) on an annual basis since I was 18 (eight years), and have had my blood tested by my general practitioner as part of routine physical exams twice in the past few years, with nothing to report. I'm wondering whether or not STDs would show on a blood test or during a gynecological exam or if it's possible that I could have one and not know. Thanks.
— Concerned About Testing
I think this is a fantastic issue to discuss as sexually transmitted diseases (STDs) continue to be a cause for concern in sexually active individuals, whether in monogamous relationships or not. First, I'd like to applaud you for seeing your gynecologist and primary care physician on a yearly basis to get pelvic exams/pap smears and routine blood tests. I cannot stress enough the importance of having at least a primary care physician and seeing him or her on a routine basis for yearly physicals and screening.
To learn more about screenings for STDs, keep on reading.
There are many infections that fall under the umbrella diagnosis of STDs. These include chlamydia, gonorrhea, trichomoniasis, HIV/AIDS, genital herpes, genital warts (caused by human papillomavirus (HPV)), hepatitis B and C, and syphilis. According to Planned Parenthood, your gynecologist or primary care physician will not routinely or automatically test for STDs; you must ask your health care provider to give you an STD test. Thus, unless your gynecologist saw physical signs or you complained of symptoms consistent with an STD, he or she more than likely only performed the standard Pap smear screening test. Also, typically your general primary care physician would not routinely order STD blood tests unless you specifically request it or if you show signs and symptoms of an STD. The routine blood testing generally performed on an annual basis includes complete blood cell counts, cholesterol panels, and blood chemistries (to check for high blood glucose, electrolytes, and kidney function).
However, all practitioners are different in terms of what they routinely screen for, so you could ask them whether or not they screened for the most common diseases in women under 25 (gonorrhea and chlamydia). According to the American Cancer Society, routine HPV testing is not done in women under 30 as the disease is quite uncommon in women under 30. Typically HPV testing is reserved for women over 30 (as it is much less common) or if a Pap smear was abnormal in a woman under 30. Again, you can ask your gynecologist if he or she performed HPV testing for you, however, since you are under age 30 and your Pap smears have been normal, your gynecologist likely did not test for it.
Additionally, different diseases require different types of testing, which means that testing for all of the above mentioned diseases would likely require blood tests, urine tests, cultures of vaginal discharge, and scraping of cervical tissue. The Mayo Clinic has a great website that gives an overview of STD testing, and I will quickly summarize it now. Chlamydia, gonorrhea, and trichomoniasis are diagnosed by analyzing a swab culture from the cervix in a laboratory. Chlamydia and gonorrhea can also be detected by urine testing. HIV, syphilis, and hepatitis are tested by analyzing a sample of your blood. Syphilis can also be tested by swabbing a genital sore if present. There is no good screening test for herpes, which can be transmitted even when a person doesn’t have any symptoms. Testing may include tissue scraping or culture of blisters or ulcers, if present. Also, blood tests can help detect a herpes infection. However, both tests can have false positive and false negative results. HPV testing involves Pap testing and a DNA test of the HPV virus. These are collected with a brushing sample from the cervical canal.
To answer your final question, yes, you can have an infection and not know it. Many of the infections can be present without any signs or symptoms. The Mayo Clinic also has information on all of the STDs and their signs and symptoms (if present). It is important to get tested for STDs, as if they are present and are left untreated they can lead to infertility or increase your risk of contracting other STDs.
The good news is you are in a monogamous relationship and do not have multiple sex partners. However, if you want to make certain that you are free of STDs, you should discuss this with your gynecologist and primary care physician in order to get proper screening and tests.
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