STI Testing
Commonly asked questions related to STIs, testing procedures and treatment.
General Questions
What are the next steps after ordering an STD test online?
Simply click the link at your scheduled appointment time to chat with our doctors.
When should I get checked for STIs?
The following section outlines common incubation periods and appropriate early intervals for testing, and re-testing after treatment. If you get tested too early, a negative test result is not reliable and you may have repeat testing to ensure a valid result. Engaging in sexual activity if you are premature in testing may mean transmitting an STI unknowingly. See Window Periods below. Don't worry - we've got a window period calculator for you when you enter your consultation that will give you your preferred testing dates.
What tests are routinely covered under the STD testing?
The standard STD/STI testing or treatment through TeleTest includes routine tests for the following:
Chlamydia, Gonorrhea, and Trichomoniasis (for females only, as men often clear trichomoniasis infection spontaneously) via a urine sample
HIV and VDRL (syphilis) via a blood sample
Please note that Hepatitis B and Hepatitis C tests are NOT routinely included unless you meet criteria under current Canadian guidelines for screening.
I was exposed to STI. Do I need to test to get medications?
No testing is required, but it is recommended to ensure you don't have other infections. TeleTest doctors can provide upfront antibiotic treatment if you have had exposure to an STI.
What is a window period?
A window period represents the time after being exposed to an infection before a test can become positive. Testing too early can result in a false negative result. We recommend repeat testing after the window period has closed, and in the case of HIV and syphilis, 12 weeks from the exposure to the individual.
I took my test before the recommended window period. Should I retake it?
Testing after the window period ensures the most reliable results. If you were tested earlier than the advised timeframe, retaking the test after the window period has passed is recommended for accuracy.
Do I need a swab to test for STDs?
You don't. Urine STI screening looks for the DNA of chlamydia, gonorrhea, and trichomonas and bloodwork looks for HIV, Syphilis and Hepatitis C. All you need is a urine sample to test for STIs, and bloodwork if you'd like to screen for blood-borne STIs. You do not need a cervical or penile swab.
How frequently should I test?
That depends on your sexual habits. Some patients test after every partner, while others test every 3 months. You're entitled to access STI testing any time you want.
I had a PAP test. Does that mean I don't need STI screening?
Not all doctors complete STI screening at the time of your PAP test. You can inquire with a prior provider if you were screened, or repeat testing to ensure you're safe.
How should I provide a urine STI sample?
If you are providing a urine sample for STI testing, for improved detection, please provide the 1st catch (1st part of the stream) after holding your urine for 2 hours. While there is emerging evidence that holding urine prior to testing is not required, it remains the 'standard' recommendation.
What happens if I test positive for chlamydia, gonorrhea or trichomonas?
If you have a positive STI result, you're invited to a follow-up chat with a doctor and prescription medication is faxed to your preferred pharmacy, and you can ask any follow-up questions at that time.
I don't have OHIP. How much are additional lab fees for testing?
Lab fees vary between each lab you select (i.e. LifeLabs, Dynacare, Alpha Labs, etc). Generally speaking, urine STI screening is approximately $40-45 per visit and urine with bloodwork screening is approximately $70. These fees are separate from the fees TeleTest charges for your consultation.
I noticed a comment on my labwork about my urine volume being outside of the reference range. What should I do?
In mid-2023, labs started adding a comment to urine STI testing for many patients as follows: '(Your) volume of urine sample received in the lab was outside of the manufacturer recommended range. Urine volume of 20 - 30 ml is recommended for optimal sensitivity'. A large number of patients have been noticing this finding, even though they report providing the volume specified by the lab technician at the time they provided the sample.
Officially, any test that isn't conducted according to a manufacturer's recommendation isn't strictly accurate. However, there is no guidance from the manufacturer of the test assay (Aptima Hologic) whether +/-5 or 10 millilitres of urine volume affects the test performance. The test is a PCR DNA based test.
In the absence of clear evidence of how meaningfully this comment about urine volume affects your results, you can request a repeat sample if you wish to provide another sample. Please ensure your 2nd sample contains no more than the specified 20-30ml of urine.
From our experience, some patients have returned to the lab for a 2nd sample and provided the exact volume specified, with the results returning the same comment. If this occurs, we suggest reaching out to the laboratory and leaving a message with their customer service team.
Does 'STI Testing Subscription' expire?
Yes, the STI Testing Subscription includes 6 tests and is valid for 2 years from the date purchased.
What is the difference between urine culture for chlamydia and Urine NAAT for Chlamydia?
A urine culture for chlamydia and a urine NAAT (nucleic acid amplification test) for chlamydia are two different ways to detect the infection. A NAAT test looks for the genetic material of the bacteria and is highly accurate, making it the preferred method for diagnosing chlamydia. It uses a urine sample and can detect even small amounts of bacteria, with results usually ready in a day or two.
In contrast, a culture tries to grow the bacteria in a lab, which is less sensitive because chlamydia needs living cells to grow. Cultures take longer, often several days, and are not as reliable as NAAT. While urine cultures exist, they are rarely used today except in special cases, like legal investigations or when testing for antibiotic resistance.
What is the difference between standard STI/STD testing and STI swab test available through TeleTest?
The standard STI/STD testing or treatment through TeleTest includes routine testing for Chlamydia, Gonorrhea, and Trichomoniasis(only for females as men spontaneously clear trichomoniasis infection) via a urine sample, and HIV/VDRL through a blood sample. Once you select a test panel, pay, and complete your intake history in the portal, a link will open allowing you to schedule a same-day messaging conversation with a doctor. After this appointment, your paperwork will be sent directly to the lab of your choice in Ontario, and you can visit for testing.
The STI swab kit, on the other hand, is site-specific screening for anal and oral Gonorrhea/Chlamydia. The testing kits are sent to your mailing address, each containing a pair of swabs for each site and instructions for self-testing. Once you've collected the samples, you can drop them off at your preferred lab in Ontario. Alternatively, if you prefer to complete the testing with a doctor, you can take the swabs to any walk-in clinic and have the physician complete them on-site. The results will be uploaded to your portal once received.
Chlamydia and Gonorrhea
What are the common symptoms of chlamydia and gonorrhea?
Chlamydia and gonorrhea often exhibit similar symptoms, but many individuals may be asymptomatic. For those who do experience symptoms, they may include pain or discharge from the genitals, pain during urination, and itching or irritation around the genital area. Women may experience irregular periods, abdominal pain, or pain during intercourse, while men may notice testicular pain or swelling. If left untreated, both infections can lead to serious long-term health issues, such as pelvic inflammatory disease in women and epididymitis in men.
How are chlamydia and gonorrhea transmitted?
Both chlamydia and gonorrhea are sexually transmitted infections (STIs) caused by bacteria. They can be transmitted through vaginal, anal, or oral sex with an infected person, and can also be passed from a pregnant woman to her baby during childbirth. Using condoms and practicing safe sex can significantly reduce the risk of transmission.
How are chlamydia and gonorrhea diagnosed?
Chlamydia and gonorrhea can be diagnosed through laboratory testing, usually by analyzing a urine sample or a swab from the affected area. It is important to get tested if you suspect you may have either infection, as early diagnosis and treatment can prevent complications.
What is the treatment for chlamydia and gonorrhea?
Both chlamydia and gonorrhea are typically treated with antibiotics. A single dose of azithromycin or a week-long course of doxycycline is often prescribed for chlamydia, while gonorrhea is usually treated with a single dose of ceftriaxone and azithromycin. It is crucial to complete the prescribed course of antibiotics and abstain from sexual activity until the infection has been cleared.
Can chlamydia and gonorrhea be cured?
Yes, both chlamydia and gonorrhea can be effectively treated and cured with antibiotics if caught early. However, it is important to note that successful treatment does not provide immunity, and you can be re-infected if exposed again.
Can chlamydia and gonorrhea cause long-term health problems if left untreated?
Yes, if left untreated, both chlamydia and gonorrhea can lead to serious long-term health issues, including pelvic inflammatory disease in women, which can cause chronic pain, infertility, and ectopic pregnancies. Men may develop epididymitis, which can result in infertility.
How can I prevent chlamydia and gonorrhea infections?
Practicing safe sex, using condoms consistently and correctly, and having open communication with your partner(s) about STI testing and prevention are key to reducing the risk of chlamydia and gonorrhea infections. Regular STI testing and prompt treatment, if necessary, can also help prevent transmission.
If I test negative for chlamydia, but I had a confirmed exposure should I continue my antibiotics?
You have the option to stop all antibiotics if you have had a negative STI result. However, it's important to be aware that there is a false negative rate with testing, meaning your test results didn't pick up on your infection but one exists. In many instances, it's important to continue treatment for this consideration.
Additionally, if you haven't had site-specific screening for anal and oral sites and have had exposure at these sites, you may harbour an infection that isn't diagnosed on routine testing. This is another reason to continue antibiotics.
We understand that many people prefer to avoid antibiotics if not necessary, but given these other considerations, it's important that you make an informed choice to stop antibiotics in light of negative test results.
HIV
What kind of HIV testing is done on blood samples?
Public Health Laboratories in canada use a 4th generation screening test which looks for p24 antigen (HIV protein) and antibodies. HIV can be detected in 50% of people by day 18, and 99% of people by day 44 (6.5 weeks). The p24 antigen is detectable in blood before HIV antibodies. Most people will get accurate results by 4 weeks after an exposure, but it is important to test again at the end of the window period to rule out an infection.
What is the window period for HIV?
Window Period for testing: 14 days and 90 days
Confirmatory test: 12 weeks
Is there a medication to prevent HIV transmission?
There is a medication called PreP that is 99% effective in reducing HIV transmission from unprotected sex. The drug isn't right for everyone, but it's worth discussing with your provider if you're in a higher-risk group or engage in higher-risk sexual activities (i.e. sex work, multiple unprotected partners, etc). There are a number of providers like "The Prevention Clinic" who can provide more information about PreP.
What type of testing does Public Health Ontario use?
Public Health Ontario uses the newest generation HIV test, called a p24 antigen-antibody test. This is the best test currently available for HIV testing. If you are outside of the late testing window, you can complete a test at either day 18 (50% detection) or day 44 (99% detection). We know the anxiety period can be provoking, but please remember that HIV rates are quite low, and the risk per sexual act further reduces your probability of infection.
Trichomonas
What is Trichomonas?
Trichomonas is a single-celled parasite, specifically a flagellated protozoan, which causes a common sexually transmitted infection (STI) called trichomoniasis. The parasite responsible for the infection is called Trichomonas vaginalis.
How is trichomoniasis transmitted?
Trichomoniasis is primarily transmitted through sexual contact with an infected person. It can be spread during vaginal, oral, or anal sex, although vaginal transmission is the most common route. Sharing sex toys without proper cleaning can also lead to transmission. The infection is not transmitted through casual contact like hugging, kissing, or sharing utensils.
What are the symptoms of trichomoniasis?
Many people with trichomoniasis do not show any symptoms. However, when symptoms do occur, they can include:
For women: itching, burning, or soreness in the vagina; a foul-smelling, frothy, greenish-yellow vaginal discharge; pain during urination or sexual intercourse; and lower abdominal pain.
For men: itching or irritation inside the penis; burning after urination or ejaculation; and discharge from the penis.
Can trichomoniasis be treated?
Yes, trichomoniasis can be effectively treated with prescription medication, usually an antibiotic called metronidazole or tinidazole. Both sexual partners should be treated simultaneously to avoid reinfection. It is important to complete the full course of medication, even if symptoms disappear before the treatment is finished.
Why Trichomonas is not tested in men?
Trichomonas is not a routine STI test as Canadian guidelines do not recommended routine testing for men, as men spontaneously clear the infection (i.e. they get rid of it on their own). It can be arranged if you have had exposure or symptoms.
What can happen if trichomoniasis is left untreated?
If left untreated, trichomoniasis can lead to more severe health problems, including:
Increased risk of contracting or transmitting other STIs, including HIV.
In women: pelvic inflammatory disease (PID), which can cause chronic pain and infertility.
In men: prostatitis, epididymitis, and urethritis, which can cause pain and fertility issues.
My Partner is Diagnosed with Trichomonas. Do I Need Testing or Can I Receive Treatment Directly?
If your partner has been diagnosed with Trichomonas and prescribed antibiotics, it is advisable for you to be tested as well. Our healthcare providers are unable to access another patient's medical records to confirm their diagnosis or treatment. To receive appropriate care, please book an appointment and volunteer your exposure to Trichomonas, specifically requesting medication for this condition if necessary.
Testing Process
Does TeleTest send out home kits?
We do not send out home test kits, unless you request oral or anal swab testing. Lab testing for STIs is done at local labs - Life Labs, Dynacare and Alpha Labs.
I requested oral and anal swabs. How long do they take to arrive?
Swabs will arrive at your home in Amazon packaging, typically within 2 days in most cities along the Ottawa-Windsor corridor. Delivery times for swabs increase to 5 days in Northern Ontario and are typically 10-15 days for PO box addresses.
How can I get swab tests for site-specific screening(oral and anal)?
Site-specific screening for anal and oral gonorrhea/chlamydia are sent to your mailing address. Each package contains a pair of swabs for each site and instructions on self-testing. After self-sample collection, you can drop it off at your preferred lab(Lifelabs, Dynacare or Alpha labs). If you prefer to complete testing with a doctor, you can take the swabs to any walk-in clinic and have a physician complete them on-site. The results will be uploaded to the portal when received.
How soon after an appointment can I go to the lab for testing?
You can go to the lab immediately after your messaging chat.
Window Periods
Chlamydia
Window Period for testing: 7 – 14 days after exposure
Test of cure: repeat a test of cure 3 weeks after treatment to ensure clearance.
Resumption of sexual activity: you and your partner(s) should abstain from intercourse for 7 days after treatment is completed for all partners, and until all symptoms have resolved for all individuals.
Treatment:
1st Line: Doxycycline 100mg tablets taken twice daily for 7 days (preferred)
1st Line: Azithromycin 4 x 250mg tablets taken as a single dose (pregnancy)
Gonorrhea
Window Period for testing: 7 days – 14 days after exposure
Test of cure: repeat a test 3 weeks after treatment to ensure clearance
Resumption of sexual activity: you and your partner(s) should abstain from intercourse for 7 days after treatment is completed for all partners, and until all symptoms have resolved for all individuals.
Treatment:
1st Line: Ceftriaxone 0.25g (Injection) + Azithromycin 4 x 250mg (pill) taken as a single dose (preferred)
2nd Line: Cefixine 800mg (pill) + Azithromycin 4 x 250mg (pill) taken as a single dose
Trichomoniasis
Window Period for testing: 7 days – 30 days after exposure
Test of cure: repeat a test 3 months after treatment to ensure clearance.
Resumption of sexual activity: you and your partner(s) should abstain from intercourse for 7 days after treatment is completed for all partners, and until all symptoms have resolved for all individuals.
Treatment:
1st line: Metronidazole 500mg tablet twice daily for 7 days
Syphilis
Window Period for testing: 30 days – 90 days after exposure
Test of cure: repeat a test at 12 weeks to ensure clearance.
Resumption of sexual activity: transmission only occurs when the infected individual has oral or skin lesions. We recommend a clearance of the infection and guidance from an infectious disease specialist before the resumption of sexual activity. All partners should be tested and seek medical care.
Rectal and Throat Gonorrhea and Chlamydia
Urine PCR testing specifically tests for exposure to gonorrhea and chlamydia in the urinary/vaginal tracts. It does NOT provide a diagnosis about oral or rectal gonorrhea.
Testing is recommended only for individuals who have had unprotected site exposure & have at least one of the following risk factors:
Gay, bisexual, or men who have sex with men, including trans-women
Engage in sex work or have had sexual contact with someone engaging in sex work
Known contact of those infected with chlamydia or gonorrhea
Signs or symptoms of rectal infection (constipation, anal discharge, urgency to have a bowel movement) following unprotected sex
Signs or symptoms of oral or pharyngeal infection (throat pain) following unprotected performative oral sex
Hepatitis B
Window Period for testing: 21 days – 42 days after exposure
Test of cure: while your immune system may clear Hepatitis B, your antibody test will remain positive for life. We advise you to seek treatment with an infectious disease specialist if you test positive for guidance regarding treatment options.
Resumption of sexual activity: we recommend guidance from an infectious disease specialist before resuming sexual activity. Factors include your partner(s) immunity status and your viral load.
Hepatitis C
Window Period for testing: 60 days – 180 days after exposure
Test of cure: while your immune system may clear Hepatitis C, your antibody test will remain positive for life. We advise you to seek treatment with an infectious disease specialist if you test positive for guidance regarding treatment options.
Resumption of sexual activity: we recommend guidance from an infectious disease specialist before resuming sexual activity. Factors include your partner(s) immunity status and your viral load.
HIV
Window Period for testing: 9 days – 12 weeks after exposure, depending on the test used by the laboratory. If you believed you were exposed to someone with HIV, we suggest seeking care with a health care provider for post-exposure prophylaxis (PEP) evaluation at an emergency room or walk-in clinic. We always recommend repeat testing for HIV at 12 weeks to confirm a negative result is a true negative test.
Test of cure: HIV cannot be cured at present time, however, we recommend ongoing surveillance and treatment with an HIV specialist in your area.
Herpes
Window Period for testing: 30 days – 180 days after exposure via blood testing; active genital or oral sores can be swabbed if you have an outbreak at a local walk-in clinic or urgent care center immediately.
Test of cure: your antibody test will remain positive for life. If you are experiencing multiple recurrent outbreaks, you may qualify for suppressive therapy and we suggest seeking care with a local walk-in clinic or urgent care center.
Does a urine STI sample tell me if I have chlamydia in my oral or anal site?
Please note that urine PCR testing for gonorrhea, chlamydia and trichomonas only tests for those organisms in the site tested (i.e. genital infection). These tests do not test for them in other areas like the throat or rectum. Special swabs are available for testing in these areas.
I was advised to do bloodwork at a later date. Do I need 2 separate requisitions?
You can visit the lab and complete urine testing first. Notify the technician you will return for the bloodwork, and that part of your requisition will remain unused for a future date. Two separate requisitions are not required.
I submitted a urine sample for testing but realized I was not being tested for Trichomoniasis, which can be detected through urine. Can this test be added to my existing requisition?
Once an initial consultation is completed and a lab requisition is provided, no additional tests can be added to that requisition. If you wish to be tested for Trichomoniasis or any other condition not included in your initial testing, you will need to undergo a new consultation process.
To obtain testing for additional conditions after completing an initial set of tests, please follow these steps:
Request New Paperwork: Initiate a new consultation request through your TeleTest account.
Select a New Test Panel: Choose the appropriate test panel that includes the additional tests you require.
Complete the Intake History: Fill out the necessary medical history and specific testing requests.
Book a Consultation Time: Schedule a time to message a physician through the TeleTest platform.
Please note that TeleTest physicians do not issue new requisitions or add tests outside of a consultation. Each set of requested tests must be processed through a formal consultation to ensure accuracy and appropriateness based on medical guidelines.
Testing Methods
Syphilis Testing
How is syphilis tested?
Syphilis is a blood test, and all syphilis testing is completed through Public Health Ontario.
What types of tests does Public Health Ontario Complete?
Public health does a few tests:
Initial Syphilis Screening: Chemiluminescent microparticle immunoassay (CMIA) – a qualitative enzyme immunoassay that detects treponemal antibodies (IgG and IgM) to Treponema pallidum. This test does not distinguish between IgG and IgM.
If a screen is positive, then the lab does confirmatory testing:
Rapid plasma reagin (RPR) - a semi-quantitative flocculation assay that detects non-treponemal antibodies to cardiolipin-lecithin- cholesterol (Reagin antibodies).
Treponema pallidum particle agglutination (TP.PA) - a qualitative gelatin particle agglutination assay that confirms antibodies (IgG and IgM) to Treponema pallidum. This test does not distinguish between IgG and IgM. TP.PA reactivity is used as an aid in the diagnosis of current/past syphilis infection.
Why does Public Health use a 'Reverse Algorithm Syphilis Test'?
The traditional algorithm starts with a non-treponemal test (such as Rapid Plasma Reagin, RPR, or Venereal Disease Research Laboratory, VDRL test) followed by a confirmatory treponemal test (like Treponema pallidum particle agglutination assay, TPPA, or fluorescent treponemal antibody absorption, FTA-ABS test).
The "reverse algorithm" flips this order, starting with a treponemal test (CMIA) for screening. This is followed by a non-treponemal test (like RPR or VDRL) for confirmation. If the results of these two tests are discordant (one positive, one negative), a different treponemal test (like TPPA or FTA-ABS) is performed as a tie-breaker.
The reverse algorithm has been increasingly adopted in recent years due to the automation allowing for more efficient initial screening.
It's worth noting that both algorithms have pros and cons. The traditional algorithm is more likely to avoid false-positive results, but can miss cases in the early and late stages of the disease. The reverse algorithm is less likely to miss cases, but can yield more false positives. Careful interpretation of the results is always needed.
Can I get medication for exposure to Syphilis?
Treatment for syphilis typically involves a shot of penicillin. While you can volunteer information about your exposure, we still recommend undergoing testing to confirm the diagnosis and ensure appropriate treatment.
You have the option to receive the penicillin shot from a walk-in clinic or an STI clinic at the Health Unit. We advise you to call ahead and book an appointment for this purpose.
HIV Testing
Does Public Health Ontario use a 4th Generation HIV Test?
Public Health Ontario uses the newest generation HIV test, called a p24 antigen-antibody test. This is the best test currently available for HIV testing. If you are outside of the late testing window, you can complete a test at either day 18 (50% detection), day 28, or day 44 (99% detection). We know the anxiety period can be provoking, but please remember that HIV rates are quite low, and the risk per sexual act further reduces your probability of infection.
Does TeleTest offer HIV RNA testing?
TeleTest does not currently offer HIV RNA testing. HIV RNA testing is currently only completed for individuals who are HIV positive who require viral load testing.
Positive Test Results
What happens if I have a positive STI result?
You will get a link to book a follow-up chat with a doctor. In that chat, you can discuss any questions you might have and are prescribed medication which is sent to a pharmacy of your preference.
I was exposed to chlamydia. Can I get medication before testing?
Yes, you can request upfront treatment for chlamydia. Treatment for chlamydia is an antibiotic called azithromycin (250mg pill x 4 taken at once) or doxycycline (100mg pill taken twice daily for 7 days). Testing is still recommended to ensure you do not have other STIs.
I have a positive chlamydia result. What are the chances of a false positive result?
Most labs use Aptima Hologic PCR testing for chlamydia / gonorrhea testing. Based on available study data, there is a 98.5% likelihood that your result is a true positive, and a < 1.5% chance of a false positive result. A sample can be repeated if you're concerned your result was a false positive.
What is the preferred treatment for chlamydia?
Doxycycline is the preferred treatment for chlamydia, in part because it has been shown to result in a higher clearance rate for oral anal sites. In some women, inadequately treated rectal chlamydia can result in 'auto-inoculation where chlamydia from the rectal site migrates into the urogenital area, causing urinary and vaginal symptoms.
Can I get chlamydia or gonorrhea from receiving oral sex?
Yes. You can get a new chlamydia or gonorrhea infection from receiving unprotected oral sex.
Do labs do PAP testing? I think I need one.
PAP testing is not currently completed at labs like Life Labs or Dynacare. If you don't have a family doctor, you can call ahead to a walk-in clinic and ask if they do PAP tests. We recommend calling ahead, as unfortunately, some walk-in clinics do not perform pap tests as a policy.
You can also access PAP testing through a health unit. Just Google 'Health Unit near me'. Going to a health unit is the preferred route instead of getting a referral to a gynecologist, as there are long wait lists for gynecologists.
What is Pelvic Inflammatory Disease (PID)?
Pelvic Inflammatory Disease (PID) is an infection of a woman's reproductive organs, typically affecting the uterus, fallopian tubes, and/or ovaries. It occurs when bacteria, often sexually transmitted, travel from the vagina or cervix to the upper reproductive organs. The most common bacteria associated with PID are Chlamydia trachomatis and Neisseria gonorrhoeae, which cause chlamydia and gonorrhea, respectively. However, other types of bacteria can also cause PID.
Symptoms of PID can vary but may include:
Abdominal or pelvic pain
Pain during intercourse
Painful or difficult urination
Unusual vaginal discharge (often with an unpleasant odor)
Irregular menstrual bleeding
Fever and chills
Nausea and vomiting
It is important to note that some women with PID may have mild symptoms or no symptoms at all, making the condition difficult to diagnose in some cases.
If left untreated, PID can lead to severe complications, including chronic pelvic pain, ectopic pregnancy, and infertility. Early diagnosis and treatment are essential to prevent these complications. Treatment for PID usually involves a course of antibiotics, and in some cases, hospitalization may be required.
I tested positive for chlamydia or gonorrhea. What's the earliest I can test after treatment?
Testing for clearance of infection can be completed using PCR testing on your urine same, the same way you were originally diagnosed. We advise waiting a minimum of 21 days post-treatment (after your last pill) to test, as your urine passes trace quantities of the DNA from chlamydia/gonorrhea and can result in a false positive result (i.e. we think you still carry an infection but you do not).
It you test the day after completing treatment, you will almost certainly still test positive even though you have cleared the infection.
Syphilis
Background
What are the different stages of syphilis?
Syphilis can manifest in different ways at different stages. It's typically divided into primary, secondary, latent, congenital, neurosyphilis, and tertiary syphilis.
What happens during the primary stage of syphilis?
The primary stage usually starts three weeks after exposure but can range from three to 90 days. It typically starts with a painless sore or sores (chancre) at the spot where the infection was transmitted. These sores may be inside or outside of your body like in your mouth or anal area, and might go unnoticed. Swollen lymph nodes in the area may also be seen.
What should I expect during the secondary stage of syphilis?
In this stage, which typically occurs two to 12 weeks after infection, you might see a rash on your body. Often this rash shows up as rough, red or reddish-brown spots on the palms of your hands and the bottoms of your feet. Other symptoms can include fever, feeling tired or unwell, headaches, body sores, wart-like growths on your genitals (Condylomata lata), swollen lymph nodes, hair loss, and symptoms similar to meningitis (like severe headaches), eye symptoms (like blurry vision or redness), or ear symptoms (like hearing loss or a ringing in the ears).
What is latent syphilis?
Latent syphilis is when the infection is present but you do not show any symptoms. If the latency lasts less than one year, it's called early latent syphilis. If it lasts more than one year, it's called late latent syphilis.
What is neurosyphilis?
Neurosyphilis occurs when the syphilis bacteria infect the central nervous system, which includes the brain and spinal cord. This can occur at any stage if the infection is not treated. Symptoms can include poor coordination, dizziness, memory problems, headaches, personality changes, hearing loss, and vision problems.
Treatment
How is syphilis treated?
Syphilis is usually treated with a specific type of antibiotic called penicillin. The bacteria that cause syphilis are very sensitive to penicillin and usually become non-infectious within 24 hours of treatment. The kind of penicillin used is a long-lasting one called benzathine penicillin G.
Does the length of treatment change based on the stage of syphilis?
Yes, the length of treatment depends on how long you've had the infection. Infections that have been present for a longer time (like late latent or tertiary syphilis) require a longer course of treatment.
Can other types of penicillin be used to treat syphilis?
Short-acting penicillin treatments are not enough to cure syphilis. Oral penicillin pills cannot replace injection therapy.
Can other antibiotics be used if I can't take penicillin?
Yes, alternative treatments like doxycycline and ceftriaxone can be used if you cannot take penicillin, but they may take longer to work. If you're using these, it's recommended to avoid unprotected sexual contact until treatment has been completed and ideally for seven days after that. However, these alternatives should only be used when absolutely necessary and with close follow-up.
How is syphilis treated in people with HIV?
People with HIV can be treated for syphilis in the same way as people without HIV, using the same penicillin treatment. However, some experts recommend a longer course of treatment for people with HIV (1 dose weekly for 3 weeks).
Why is it important to know your treatment history for syphilis?
Knowing your past treatment history for syphilis and any previous test results can help avoid unnecessary retreatment. This information can be crucial in deciding the best course of action for your current situation.
How do doctors check if the treatment for syphilis is working?
After treatment, doctors evaluate how well it's working based on your symptoms and changes in blood test results (called NTT titres). They'll keep checking these blood tests until they show that there is no more active infection or only a very titre level.
How often will I need to get tested after treatment if I had primary, secondary, or early latent syphilis, or if I have HIV?
For primary, secondary, or early latent syphilis, you'll typically have tests done at 3, 6, and 12 months after treatment. If you have HIV, the same testing schedule is followed.
How often will I need to get tested after treatment if I had late latent syphilis or tertiary syphilis?
If you were treated for late latent syphilis or tertiary syphilis (except neurosyphilis), testing would usually happen at 12 and 24 months after treatment.
How often will I need to get tested after treatment if I had neurosyphilis?
If you were treated for neurosyphilis, tests would generally be done at 6, 12, and 24 months after treatment.
How often will I need to get tested after treatment if I have HIV, regardless of the stage of syphilis?
If you have HIV, regardless of the stage of syphilis, you'll need testing at 3, 6, 12, and 24 months after treatment, and then yearly thereafter.
How long should I abstain from unprotected sex after syphilis treatment?
f you were treated with a single dose of benzathine penicillin G, you should avoid unprotected sexual contact for seven days after treatment. This is to ensure a margin of safety.
What if I'm treated with doxycycline or ceftriaxone instead of penicillin?
If you were treated with doxycycline or ceftriaxone, which might take longer to clear the infection, it's recommended to abstain from unprotected sexual contact until treatment has been completed and ideally for seven days after completion of treatment.
Partner Notification
Why is it important to find and notify partners after a syphilis diagnosis?
Notifying and testing all sexual or perinatal (from mother to child) contacts is critical to controlling syphilis. This allows these contacts to be evaluated and tested, and if needed, treated, preventing further spread of the infection.
How long should I and my partners abstain from unprotected intercourse after treatment?
People diagnosed with syphilis and their partners should abstain from unprotected intercourse until treatment is complete for the person diagnosed (the index case) and all current partners. Ideally, this should continue for seven days after completion of treatment.
If I have primary syphilis, how far back should I consider my sexual partners for potential syphilis exposure?
If you have been diagnosed with primary syphilis, you should consider partners from the past 3 months for potential syphilis exposure.
If I have secondary syphilis, how far back should I consider my sexual partners for potential syphilis exposure?
If you have been diagnosed with secondary syphilis, you should consider partners from the past 6 months for potential syphilis exposure.
If I have early latent syphilis, how far back should I consider my sexual partners for potential syphilis exposure?
If you have been diagnosed with early latent syphilis, you should consider partners from the past year for potential syphilis exposure.
If I have late latent or tertiary syphilis, who should I consider for potential syphilis exposure?
If you have been diagnosed with late latent or tertiary syphilis, you should assess other long-term partners and children as appropriate. The decision to test these contacts depends on how long you've had the infection.
What should I do if I don’t know what stage my syphilis infection is at?
If your syphilis stage is unknown, consult a healthcare professional experienced in syphilis management. They can guide you on who to notify based on your specific situation.
Swab testing
I completed my consultation but started having throat symptoms. Can I get a prescription before the throat swab results are available?
If you're concerned about oral STI exposure, our doctors can provide treatment without testing. Typically treatment is provided following a confirmed exposure, or following a high risk encounter (i.e. performing sex on a sex worker). Most sore throats following new partners are not STI related. Our doctors do not currently provide antibiotics for infections like Strep throat at this time. If you feel you would benefit from oral STI treatment and the above exposure matches your concern, you can certainly request a new appointment.
I completed my consultation. If it’s hard to get a swab test, should I take antibiotics to be safe?
You are entitled to request antibiotic treatment at the time of your consultation if you've had a partner confirm an oral or anal site exposure and cannot obtain site-specific screening.
To request medication after a consultation is completed, you must complete a new consultation request. This process involves selecting a new test panel, completing an intake history, and booking a consultation time again. Please note that you may not be reconnected with the same physician you originally consulted with.
I have a sore throat - can I complete a self-swab at the lab?
Sore throats are caused by viruses, strep throat and rarely oral STIs like Chlamydia and Gonorrhea. Currently, labs do not carry the required swabs to complete oral STI screening (AKA site-specific swab testing). These are special swabs called Roche Cobas PCR swabs, which are processed at the lab by Public Health Ontario.
If you have symptoms of a sore throat and are concerned about an oral STI, you will need to find a local walk-in clinic or your family doctor to complete the swab, and possibly also one for Strep throat.
Mycoplasma Genitalium
What labs offer Mycoplasma Genitalium testing?
Life Labs is the sole provider of M.Gen testing in Ontario; this service isn't available at Dynacare or Alpha labs. There have been cases where patients visited the lab with our paperwork for Mycoplasma Genitalium testing and were mistakenly asked to undergo large colony mycoplasma tests at these facilities.
It's crucial to understand that testing for large colony mycoplasma is different from Mycoplasma Genitalium testing.
If you see this result, it means the lab ordered the correct testing:
Correct Pending Lab Result
If you see this result, it means the lab made an error in selecting your testing:
Incorrect Pending Lab Result
While we don't control how the labs conduct their testing, if you're aware of common laboratory mistakes you can ask for reassurance at the time of your visit that they're ordering the right testing.
Common Questions
Does everyone get tested for Hepatitis B and C?
No, not all patients qualify for Hepatitis B and C screening. These tests are ordered if there are risk factors present in your medical history that suggest you should be screened for these conditions. If there are no risk factors on your medical history, TeleTest physicians do not arrange further testing than is indicated by our Clinical Practice Guidelines.
Does TeleTest offer PEP (Post-Exposure Prophylaxis)?
TeleTest does not currently offer PEP. If you are concerned about exposure to HIV or Hepatitis B, it is important for you to go to the Emergency Room for PEP. The doctors will draw baseline labwork which includes kidney and liver function testing required for the medication you will be prescribed.
I started on treatment before test results were completed. My test results are normal - should I continue on antibiotics?
It is best to discuss your options with a health care provider, but patients generally have two options:
Continue antibiotics
Even though your test results were negative, if you had a confirmed unprotected exposure there is a possibility that:
Your test results represent a false negative (A false negative rate means you have an infection but the test did not identify one. Urine STI screening can have a 3%+ false negative rate.)
Your tested site (i.e. genital with urine screening) was clear of infection, but another site (i.e. oral or anal) carries the infection if you had exposure and didn't screen at that site.
It would be reasonable to continue the antibiotics if you would like to consider the above possibilities.
Stop antibiotics
If you had a confirmed unprotected exposure but had negative results, it is possible the individual you were notified about contracted the STI after they were active with you.
It would be reasonable to stop the antibiotics, but we would recommend repeat testing in 4 weeks to ensure a true negative result and consider site-specific screening to rule out infections in oral or anal areas if you had exposure.
It is important to discuss this information with a doctor before deciding on what is right for you.
I have normal STI test results. Does this mean I can have unprotected sex with my partner?
The presence of negative STI test results indicates you do not have the infections we screened you for. You can have a conversation with your partner about having unprotected sex, but understanding unprotected sex comes with some caveats:
Some infections like Herpes (HSV) or the Human Papillomavirus (HPV) are not screened for with routine STI testing. You can still transmit or acquire these infections with unprotected (or protected) sex.
If your prior STI testing was not completed after the end of the window period (i.e. the time after which we get the most reliable results), there is a possibility that you have an infection that wasn’t detected but is present. For the most reliable STI results, we advise waiting for the closure of your window period to have the most accurate results.
There is a possibility of a false negative result (i.e. you have an infection that the testing didn’t pick up on). This rate is low, but if you would like to be extra certain of a result, it’s reasonable to repeat testing before you become unprotected with a part
When should I repeat the test if I tested too early with my prior screening?
The window period for different STIs are listed below:
HIV and Syphilis: 12 weeks
Chlamydia and Gonorrhea: 2 weeks
Hepatitis C: 180 days
If you tested before the end of your window period, you should repeat testing after that date. For example, if you had sex on January 1, and tested on January 3, you should repeat a urine STI test on January 15 and bloodwork after April 3.
Does TeleTest fill out school/work immunization forms?
To obtain vaccination or complete forms, you can take a copy of your bloodwork to any local clinic. TeleTest does not complete forms at this time. If you require any vaccines, walk-in clinics carry these on-site and can provide you with the vaccination when your paperwork is completed.
Footnotes
1. https://actt.albertadoctors.org/CPGs/Lists/CPGDocumentList/hepatitis-guideline.pdf
2. https://www.ndhealth.gov/hiv/Docs/CTR/TimePeriodsReference_HIVSTDsHep.pdf
3. https://www.std.uw.edu/go/pathogen-based/chlamydia/core-concept/all
4. https://www.catie.ca/en/pif/spring-2017/canadian-hiv-testing-and-prevention-guidelines
5. https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm
6. https://www.catie.ca/hiv-testing-technologies
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