STI Testing
Commonly asked questions related to STIs, testing procedures and treatment.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
- 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)
- 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
- 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
- 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.
- 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
- 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.
- 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.
- 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.
- 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.
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.
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.
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:
- 1.Rapid plasma reagin (RPR) - a semi-quantitative flocculation assay that detects non-treponemal antibodies to cardiolipin-lecithin- cholesterol (Reagin antibodies).
- 2.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.
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.
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.
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.
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.
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.
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.
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:
- 1.Abdominal or pelvic pain
- 2.Pain during intercourse
- 3.Painful or difficult urination
- 4.Unusual vaginal discharge (often with an unpleasant odor)
- 5.Irregular menstrual bleeding
- 6.Fever and chills
- 7.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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
Footnotes
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