joreth (joreth) wrote,

Local STD Testing Update

I haven't done an update on local testing options in a few years, so even though that post is still here in my journal, it's time to do a new one.

First, Planned Parenthood Eastside Clinic is no longer an establishment I wish to support. For a few years now, I have paid $79 for HIV, syphilis, gonorrhea, chlamydia (what I will henceforth call The Big Four), and HSV-2. I went there because they are the only clinic in town that offers the HSV test at all. Previously, for an additional twenty-something dollars (I forget the exact amount), I could also get the HSV-1 test.

Well, this week I discovered that they no longer do this and that they were never supposed to do that in the first place. First of all, they tried to tell me that they did not test for HSV-1 at all. But I was prepared for a fight about HSV-1 because I always have to fight for it. So I came with a copy of my most recent test results that are less than a year old. The receptionist then said that they could test for HSV-1, but it would cost an additional $85 for HSV-1 alone, on top of the $79 STD package, PLUS a $75 "clinician fee" because I could not have that test done without speaking to a clinician.

To make a long story short, I argued, they maintained their position, and I lost my appointment so I couldn't even get their standard $79 package. Their staff was completely uninterested in working with me on finances or testing options. So, although I continue to support PP as an organization, I do not support the Orlando Eastside clinic and I do not recommend using them for your testing needs.

In the past, I have recommended using the Orange County Health Department as the most affordable option. I only stopped using them because they only test for the Big Four and I wanted an HSV test and it was easier to get all 5 done at the same location. They are still the most affordable option and I still recommend them. They open at 7:30 AM and take the first 10 patients or until 9 AM, whichever comes first, and then they start again at 12:30 PM with the first 10 patients or 3 PM, whichever comes first.  They are open Monday through Thursday and some Fridays.  See the website for details.  They are walk-in only, no appointments.

Their sign says they charge "between $20-$60 MORE or less depending on tests and medications" (they do more than just STD testing). They also offer a sliding scale for financial assistance, but they don't make it clear that you have to choose financial assistance as your method of payment right up front. I opted to pay in full with no financial assistance and my final bill was $21.95 for The Big Four. Very reasonable. Several years ago, I also got the Hepatitis A/B vaccine there. I don't know if they still offer it, but I recommend asking about it while there if you're interested, and I definitely recommend getting all vaccines possible.

Because I could not get tested at PP, I looked around for alternate HSV testing. There is still no clinic in Orlando that tests for it (private physicians will, but be prepared to argue about why you need it and about which version of the test you want), but there is a lab that offers the test without a doctor. There are several new online services that offer testing packages online, who then locate a local lab for you and send you there to get the bloodwork done. Most of these are safe and reputable and I think Poly Weekly is advertising right now for one service in particular, if you want a referral. But I found most of these services to be out of my price range and certainly more expensive than either PP or the county.  You also need to know which tests they do and which tests you want, not just which STDs they test for, but which tests they do for each STDs.  Some STDs have multiple kinds of tests, each with their own efficacy rate and sensitivity.  Some only test for HSV-2 and not -1, others do the combo test that can't distinguish between the two, while a few test for both and can distinguish between them.

I found one service called AnyLabTest Now! that is located in Winter Park. It offers an 8-test package as well as individual tests. The HSV-1 and -2 test alone is only $49, the results come in 48 hours, and the visit takes 15 minutes.

So, the most affordable option in Orlando is to visit the county clinic for $22 to get The Big Four, and then visit AnyLabTest Now! for HSV-1/2 for $49. If you feel that you need or want to be tested for more than the bare minimum and you don't have your own GP or insurance-approved healthcare provider, get the AnyLabTest Now! 8-test panel for $229, which also then includes Hepatitis B & C.

Here is my opinion on necessary testing:

I recommend getting tested for the following if you have never been tested or have only had HIV testing -

  • HIV

  • Hepatitis B

  • Hepatitis C

  • Syphilis

  • Gonorrhea

  • Herpes Simplex Virus (I & II) (HSV IgG test)

  • Chlamydia

  • Genital HPV (women)

  • Oral HPV (must obtain from a dentist)

Unfortunately, the US does pap smears first to determine if you have abnormal cervical cells, and then does the HPV DNA test to determine if the abnormal cells are caused by HPV. It really should be the other way around because the DNA test will tell you how often you should have a pap smear. If you are low-risk for cervical cancer (including not having HPV), you don't need to have a pap more often than once every two or three years.  But for most people, the HPV test will require a pap smear so you will need to see an OB-GYN or similar pap-approved medical professional.  Sometimes PP offers this (check your local office, as options and prices differ by location), sometimes local government clinics offer well-woman exams, and sometimes you will have to find a private clinic or physician for this service.

There is no genital or anal HPV test for men, but there is an HPV test that can be done orally on any gender. This is only available at select dental offices, not at clinics or STD offices or general practitioner offices. So get your biannual teeth cleaning and get an HPV test while you're there.

I use the terms "men" and "women" for this discussion of HPV because that's how the medical community refers to who is eligible for what, in spite of the fact that it's really more about types of membranes. I don't want to get bogged down or sidetracked in a discussion of transgender issues or women without cervices. I'm aware this is problematic. Please speak to your healthcare practitioners if you want clarification for who they treat for what or if you want to educate them on trans health issues.

A note about HSV:  There are several tests available.  If you believe you have been recently exposed, you can get the IgM test, which can test almost immediately for very recent exposures but does not distinguish between type 1 and 2.  If you have not been recently exposed or do not know if you have been exposed or not, get the IgG test, which cannot detect very recent exposures of a few days but can distinguish between type 1 and 2.  If you actually have symptoms, I think there may be another test that they do, a cell culture.  The IgM and IgG are both antibody tests and check your blood.  I think there is even one more type of test, but for regular testing with no symptoms just for peace of mind, the IgG is best.  Even though IgG can distinguish between 1 and 2, some places will offer IgG for both 1 and 2 but other places will only offer IgG for type 2.  So make sure you are getting tested for HSV (herpes) type 1 and 2, IgG.

After you have established your baseline sexual health status above, then, assuming that you have all negative results, I recommend the following:

The Big Four annually and 3 months after new partners that includes fluid transfer or genital contact -

  • HIV

  • Syphilis

  • Gonorrhea

  • Chlamydia

It is not necessary to get the others if you have not had any new partners and/or have not knowingly been exposed to the others and/or do not have symptoms for the others. If you are particularly vigilant, you can get the others done roughly every 2-3 years, around the same schedule for the pap smear. If you require seeing test results from potential new partners prior to engaging in transmissible activity, then I find it acceptable to skip getting new tests 3 months after a new partner since the new partner would have provided results that say s/he doesn't have anything to transmit (individual circumstances depending). But I then recommend getting new tests prior to taking a new partner if you have had a change in partner or partner safety status after your most recent test results, so that when you share your test results with your potential new partner, your most recent test results always reflect your current status.

It is also not necessary to continue getting tested if you are monogamous and have had no changes in partners since your last testing. But as I am of the "trust but verify" camp, I would still get tested every few years or so, just to keep current on my own status in the same way that I would have a regular physical exam every few years even if I had no health problems.  Better to catch something sneaky than to be surprised when it's too late.

Remember that these tests have different windows. That means that they cannot detect a recent exposure, and how recent depends on the test. So, for example, some tests cannot detect the STD if you were exposed within the last 3 months, so your test results will always be approximately 3 months old, never reflecting your status for the past 3 months. Some tests have much smaller windows, able to detect within a couple of weeks or in some cases a few days, but 3 months is the longest, I think. That's why I qualified the list above for "3 months after new partners".

If any of your test results come back positive, you should speak to your healthcare provider about future testing schedules and management of your STD(s). Each STD will be different and each case may also differ, depending on your health and the expression of that particular strain of that particular STD.

If you have a partner who comes back with positive test results, you should speak to your healthcare provider about a recommended testing schedule for you and how to minimize transmission if you do not currently test positive for that STD. Many STDs are manageable and there are transmission reduction techniques that can be used. I have had partners who tested positive for HSV, both 1 and 2, who nevertheless managed to avoid passing it on to me. It is possible to have a partner with an STD and reduce your own chances of contracting it. But that's what this testing is for - not to stigmatize people with STDs, but to make informed decisions about your own sexual activity.

Regular and proper condom use is excellent for reducing transmission rates for most STDs, including the scarier ones. I've started saying that the STDs that are most likely to kill you are also the easiest to avoid with regular and proper condom use. Creative sexual activity is another method that significantly reduces STD transmission. There are lots of activities that are sexual that do not require rubbing mucus membranes and body fluids together. Regular testing is merely one more tool for making informed decisions and choosing activities that best suit your individual preferences and health needs.

I am offering my somewhat-educated opinion on what I believe is the best compromise between sexual safety and sexual expression - regular testing on the above schedule and barriered activity when appropriate for you and your partners. This combination is as effective or more effective than limiting the number of partners is alone. With this guideline, you will be safer than being monogamous with no testing at all and/or no safer sex practices such as barriers, alternate activities, etc.

To sum up:

Get tested for everything listed above at least once to establish a baseline. Then get tested for The Big Four approximately once a year and 3 months after new sexual partners.

If you don't have a GP or health insurance for a full STD screening, visit one of the online services like AnyLabTest Now! for a complete workup to set your baseline. Then, if you are in the Orlando area, I recommend using the Orange County Health Department on Center Ave. for the minimum Big Four to maintain your regular testing schedule and AnyLabTest Now! for the HSV test for the most economical options. If you skip any of the steps, get another full workup as soon as possible to reset your baseline known health status. If you test positive for anything, discuss your case with your STD counselor, your clinician, or your GP for the appropriate measures for you.

For more information about HPV, about HPV research, or about other testing posts that I have made, click on my STI tag below.  I focus on HPV research and occasionally I post about local testing options and general testing information to give non-local people enough information to research their own local testing options.
Tags: me manual, polyamory, recommendations, relationships, science, sex, sti, updates
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