STD screening involves looking for sexually transmitted diseases (STDs), now called STIs (sexually transmitted infections). Among the dozen existing STIs, some cause symptoms, others do not. Hence the importance of screening them in order to treat them and avoid, for some, serious complications.

STD screening involves screening for different STDs (sexually transmitted diseases), now called STIs (sexually transmitted infections). This is a set of conditions caused by viruses, bacteria or parasites that can be transmitted during sexual intercourse, with penetration or for some, without.

There are different STIs:

• infection with HIV or AIDS virus;
• hepatitis B;
• syphilis (“pox”);
• chlamydia, caused by the germ Chlamydiae trachomatis ;
• lymphogranulomatosis venereal (LGV) caused by certain varieties of Chlamydia thrachomatis particularly aggressive;
• genital herpes;
• papillomavirus (HPV) infection;
• gonorrhea (commonly called “hot piss”) caused by a very contagious bacteria, Neisseria gonorrhoeae (gonocoque) ;
• vaginitis at Trichomonas vaginalis (or trichonomase);
• mycoplasma infections, caused by different bacteria: Mycoplasma genitalium (MG), Mycoplasma hominis, Mycoplasma urealyticum ;
• some vulvovaginal yeast infections can be transmitted during sex, but it is also possible to have yeast infection without having sex.

Condoms protect against most STIs, but not all. Simple skin-to-skin contact can be enough to transmit chlamydia, for example.

Testing for STDs is therefore extremely important. Often silent, they can be the source of various complications: 

• general with other localization of the disease: damage to the eyes, brain, nerves, heart for syphilis; cirrhosis or liver cancer for hepatitis B; evolution towards AIDS for HIV;
• a risk of progression to a precancerous or cancerous lesion for certain HPVs;
• tubal, ovarian or pelvic involvement which can lead to tubal sterility (following salpingitis) or ectopic pregnancies (chlamydia, gonococcus);
• maternal-fetal transmission with involvement of the newborn (chlamydia, gonococcus, HPV, hepatitis, HIV).

Finally, it should be noted that all STIs weaken the mucous membranes and considerably increase the risk of contamination by the AIDS virus.

The clinical examination may point to certain STIs, but the diagnosis requires laboratory tests: serology via a blood test or bacteriological sample depending on the STI.

• HIV screening is done by blood test, at least 3 months after risky intercourse, if applicable. The combined ELISA test is used. It consists of a search for antibodies produced in the presence of HIV, as well as a search for a virus particle, the p24 antigen, detectable earlier than the antibodies. If this test is positive, a second test called Western-Blot should be done to find out if the virus is really present. Only this confirmatory test can tell if a person is truly HIV positive. Note that today there is an orientation self-test for sale without a prescription in pharmacies. It is performed on a small drop of blood. A positive result must be confirmed by a second laboratory test;
• gonococcal gonorrhea is detected using a sample at the entrance to the vagina for women, at the end of the penis for men. A urinalysis may be sufficient;
• the diagnosis of chlamydia is based on a local swab at the entrance to the vagina in women, and in men, a urine sample or a swab at the entrance to the urethra;
• screening for hepatitis B requires a blood test to perform serology;
• the diagnosis of herpes is made by clinical examination of typical lesions; to confirm the diagnosis, cell samples from the lesions can be cultured in the laboratory;
• papillomaviruses (HPV) can be detected on clinical examination (in the presence of condylomata) or during a smear. In the event of an abnormal smear (ASC-US type for “squamous cell abnormalities of unknown significance”), an HPV test may be prescribed. If it is positive, a colposcopy (examination of the cervix using a large magnifying glass) is recommended with a biopsy sample if an abnormality is identified;
• Trichomonas vaginitis is diagnosed quite easily on gynecological examination in the face of various suggestive symptoms (sensation of vulvar burning, itching, pain during sexual intercourse) and the characteristic appearance of vaginal discharge (abundant, smelly, greenish and foamy) . If in doubt, a vaginal sample can be taken;
• the diagnosis of lymphogranulomatosis venereal requires a sample from the lesions;
• mycoplasma infections can be detected using a local swab.

These different biological examinations can be prescribed by the treatment or specialist doctor (gynecologist, urologist). It should be noted that there are also dedicated places, the CeGIDD (Free Information, Screening and Diagnosis Center) authorized to carry out screening for hepatitis B and C and STIs. Maternal and Child Planning Centers (PMI), Family Planning and Education Centers (CPEF) and Family Planning or Planning Centers can also offer free screening.

STD screening can be prescribed for different symptoms:

• vaginal discharge that is unusual in color, smell, quantity;
• irritation in the intimate area;
• urinary disorders: difficulty urinating, painful urination, frequent urge to urinate;
• pain during intercourse;
• the appearance of small warts (HPV), a chancre (small painless sore characteristic of syphilis), blister (genital herpes) in the genitals;
• pelvic pain;
• metrorrhagia;
• fatigue, nausea, jaundice;
• burning and / or yellow discharge from the penis (bennoragia);
• genital discharge as a morning drop or a light, clear oozing (chlamydiae).

Screening can also be requested by the patient or prescribed by the doctor after risky sex (unprotected sex, relationship with a person of doubtful fidelity, etc.).

As some STDs remain silent, STD screening can also be done routinely as part of gynecological follow-up. As part of the prevention of cancer of cervical cancer via HPV screening, the High Authority of Health (HAS) recommends a smear every 3 years from 25 to 65 years after two consecutive normal smears made one year apart. In a September 2018 opinion, the HAS also recommends systematic screening for chlamydia infections in sexually active women aged 15 to 25, as well as targeted screening in certain situations: multiple partners (at least two partners per year) , recent change of partner, person or partners diagnosed with another STI, history of STIs, men who have sex with men (MSM), people in prostitution or after rape.

Finally, in the context of pregnancy monitoring, some screenings are mandatory (syphilis, hepatitis B), others strongly recommended (HIV).

In case of positive results, the treatment depends of course on the infection:

• the HIV virus cannot be eliminated, but a combination of treatments (triple therapy) for life can block its development;
• trichomonas vaginitis, gonorrhea, mycoplasma infections are easily and effectively treated with antibiotic therapy, sometimes in the form of “quick treatment”;
• lymphogranulomatosis venereal requires a 3 week course of antibiotics;
• syphilis requires treatment with antibiotics (injection or oral);
• HPV infection is treated differently depending on whether or not it has caused lesions, and the severity of the lesions. The management ranges from simple monitoring to conization in the event of high-grade lesions, including local treatment of warts or treatment of lesions by laser;
• the genital herpes virus cannot be eliminated. The treatment makes it possible to fight the pain and to limit the duration and the intensity of the herpes in the event of attack;
• in the majority of cases, hepatitis B resolves spontaneously, but in some cases it can progress to chronicity.

The partner must also be treated to avoid the phenomenon of re-contamination.

Finally, it should be noted that it is not uncommon to find several associated STIs during screening.