Ensure You Get Proper Testing

Are you sure you were even tested for what you need to know? One important fact that everyone must know before seeking a standard medical physical is that not every patient seeking a physical or blood work will automatically receive a test for HIV and/or STD’s.

Doctors can sometimes have good reasons for not performing additional STD and HIV tests. Other times, doctors can simply be ill informed about the direct and indirect risks that certain persons have or report, which can cause even a person at substantially high risk to not be tested without even knowing it. Below, we list some key reasons why doctors make the choice not to conduct regular STD or HIV testing. Regardless of the doctors decision to test or not to test, individuals at any level of potential risk should proactively ask their doctors for STD and HIV testing even if the doctor doesn’t state the need or desire to test upfront.

Most Common Reasons Doctors Don’t Always Test

Doctors sometimes follow screening guidelines that may not capture all risks and testing needs

The medical screening guidelines doctors use exist for a reason. Their goal is to target the highest risk populations and maximize testing efficiency while minimizing waste of time, money, and resources. The only problem is that people aren’t populations.

There are many reasons why people might wish to be tested for STD’s (including HIV) more often than recommended by guidelines. There are also reasons why people might be tested at an age when the guidelines don’t recommend testing at all. Such reasons might include:

  • Multiple sexual partners
  • A history of unprotected sex
  • Starting a new sexual relationship
  • Finding out that a past partner was unfaithful

If you have a good reason why doctors should ignore screening guidelines in your case, you should always tell them. They’ll probably listen. If they don’t, you may want to find a new doctor.

Doctors sometimes don’t have access to a lab that can do the test

Some diagnostic tests require particular types of collection equipment, doctor expertise, or laboratory supplies. Not all supplies are available to all physicians. If you want, or need, to be tested for a disease where that is the case, and your doctor doesn’t have the materials he/she needs to perform the test, then the only solution is to go to another doctor or laboratory for testing.

This will mainly be an issue for certain urine tests, bacterial cultures, and smears rather than blood tests. However, some blood tests do require special collection tubes or types of preparation that may not be available in all doctors’ offices.

Doctors occasionally do not know the screening guidelines for a particular disease

Sometimes you think you should be screened for an STD/HIV, the CDC thinks you should be screened for that STD/HIV, and your doctor doesn’t want to give you the test. This may be because your doctor knows something about your individual risk factors that both you and the CDC don’t. It may also be that he/she is unaware of current guidelines.

For example, very few doctors actually follow the current universal HIV testing guidelines proposed by the CDC. Even in populations that are at high risk, doctors may be hesitant to test for HIV for a variety of reasons explained herein. Sometimes, they simply don’t realize that they should.

Doctors may be worried that if they screen, they will have to treat

In regards to STD’s specifically, one of the reasons testing guidelines changed recently is the problem of over treatment. The Pap smear screening test itself is very safe. However, follow up biopsies and treatments can cause unnecessary damage to a woman’s cervix and long term reproductive health. Studies have shown that, if left untreated, various types of lesions can eventually and spontaneously resolve on their own.

Unfortunately, many doctors are afraid to screen and not treat. If that turns out to be the wrong decision instead of the smart decision, they’re likely to get sued. This is a real and understandable fear that may make it easier for them to simply screen less often in the first place. This includes screening for HIV.

Some doctors do not understand your motives for wanting testing

Although in general, most people don’t get tested for STD’s and HIV nearly often enough, others go too often. Certain individuals may excessively worry about infection every single time they have sex. If so, your doctor may be concerned about exacerbating this kind of fear.

If you are seeking frequent screening either because you have a known exposure, or because you are considering starting a new relationship and want to know where you stand, explain your logic to your doctor. He or she may be more willing to screen you in the absence of symptoms if understood that you have a good reason to want to know your status. It is harder to turn down someone’s reasonable testing request when you know it’s because that person is trying to keep others safe.

They do not realize certain tests are available

“Lisa” recently asked her doctor to test her for herpes and was told it was impossible to test her since she didn’t have any symptoms. She promptly grabbed her chart, pointed to the results from the last few times she had received a blood test for herpes at the same practice, and raised her eyebrow. The doctor ordered the test.

The diagnostic tests that are available change over time. As such, doctors may not be aware of every new test as it appears (i.e., urine testing for chlamydia and gonorrhea).

Your doctor may also know that a test exists, but doubt whether it is smart to use on you. If that is the case, discuss his/her concerns. They may be legitimate. There are, for example, good reasons rapid HIV tests are only used in high risk populations.

They see no benefit to screening if you are asymptomatic

Some doctors may be unaware that STD’s and HIV can be transmitted even when people have no symptoms. They may thus be hesitant to screen people for asymptomatic diseases, particularly those without serious long term health risks. This may be particularly true for herpes testing. Many doctors are extremely concerned about the potential emotional consequences of a false positive test.

Since suppressive therapy, however, may be able to reduce the risk of herpes transmission, even in the absence of symptoms, there may truly be advantages to knowing your status even when you have no symptoms. That’s particularly true if your behavior may be putting a new sexual partner at risk.

They believe the potential stigma is more harmful than knowing

One of the biggest issues surrounding testing for extremely common and highly socially stigmatized diseases is that some doctors believe that the emotional trauma of a diagnosis causes more harm than the potential for spreading a disease asymptomatically.

It’s true that finding out you have the disease can be a life changing experience. It can induce major depression, affect social and romantic relationships, and overall have a highly negative impact on someone’s life even if they never have symptoms. Combined with the fact that you may live your whole life never knowing you are infected with one of these diseases, some doctors question if there is really benefit to doing the test.

They do not see you as “At Risk”

It’s easy to get tested if you’re young and unmarried, but if you’re older whether or not you’re married many physicians may not be as worried about you as they should be. In part, this is because young people are actually at greater risk of STD’s and HIV. It’s also because the older you get, the less sex your doctor tends to think you are having. Doctors are more likely to suggest screening, or agree to screen you, if they think of you as “at risk.” It’s a false choice, though, because even many people who seem to be at low risk are far from risk free.

They think testing you is another doctor’s responsibility

Who should test you for sexually transmitted diseases and HIV? Your primary care physician? Your gynecologist? Your urologist? The doctor who sees you in the emergency room when you’ve dropped a stove on your foot? Realistically speaking, any of those doctors could test you for most viruses. In fact, there are circumstances in which any one of them might.

In the U.S., STD and HIV screening isn’t standard care except in certain types of clinics in certain types of populations. Some blood tests are easily performed by any doctor. Other urine and swab tests require skills or expertise that they may not all have. If you’re looking for STD or HIV testing because you have symptoms, your best bet is a gynecologist, urologist, your primary care physician, or a local testing site.

(Made possible by Elizabeth Boskey, PhD, reviewed by Susan Olender, MD, updated February 12, 2018)

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