Sexual health and testing took a back seat this past year. Even though physical distancing presented an opportunity to reverse the trend of increasing sexually transmitted infections (fewer sexual contacts, fewer transmissions), the pandemic is sure to still have an impact on sexually transmitted infections (STIs), especially as physical distancing begins to relax, and people seek intimacy and pleasure after a very stressful time.
It has become clear that we need to better optimize prevention of STIs among gay, bi and other men who have sex with men (GBM), and regular and accessible screening is essential. However, new research out of Montreal suggests that we may be missing opportunities for screening and prevention. According to results from a recent study by Engage—a national collaboration between researchers and community-based organizations on sexual health among GBM in Canada—it was found that among GBM in Montreal, most STI checkups used urine samples (89%), whereas the use of throat and rectal swabs were much lower (at 70% and 56%, respectively).
The problem is that for some STIs, urine testing alone is not adequate to detect all infections, for example when they are located within someone’s rectum or throat. This means that solely relying on urine screening is likely to miss a very large proportion of infections. This is the case for chlamydia, for which urine samples alone missed 88% of infections, and even more so for gonorrhea, where urine testing alone fails to detect up to 94% of infections. Not only are these missed opportunities to cure an infection, but because people often have no symptoms, they unknowingly transmit the infection to others, resulting in more infections. Also, these untreated infections make the individual more susceptible to other STIs like HIV, due to mucosal inflammation caused by the existing infections.
The good news is that we can do something about this. If you’re sexually active, make sure your doctor is screening the right way (or giving you the swab to do yourself). It’s not easy to talk to your healthcare provider about sex, much less oral and anal sex. This is why healthcare professionals are recommended to ask you about your sexual behaviour and to screen related body sites, as part of a complete sexual history and STI check. However, if this does not happen, be sure to tell your healthcare professional that you believe you should not only provide a urine sample, but a throat and rectal swab too.
Being able to have open, honest, and shame-free conversations about sexual health with our healthcare providers is important. It’s one of the ways we can decrease the number of STIs in our communities. That will require patients to self-advocate when necessary (you can’t expect your healthcare provider to know where to test if you don’t tell them), and a commitment from healthcare providers to be better informed about STI testing and treatment (and to ask the tough, sometimes intimate, questions).
Colleges and medical schools also need to do more to teach new healthcare workers the importance of sexual health for all communities. Sexual health is more than reproductive health, and sexual health education must consider the sexual health needs of many communities, including Two Spirit, queer and trans people. As COVID-19 continues to expose the health inequities in our society, we should keep in mind that not every public health problem requires a new solution. Sometimes we just need to better use the tools we already have.
Written by Joseph Cox, MD, Principal Investigator, Engage Study; and Jody Jollimore, Executive Director, Community-Based Research Centre and Principal Knowledge User, Engage Study.
A French version of this article appeared in the July 2021 edition of Fugues magazine.