How STDs Are Diagnosed

Diagnosing and treating a sexually transmitted disease (STD) in the early stages is important to avoid complications and prevent transmission of the infection. Most STDs, such as chlamydia, gonorrhea, HIV, and HPV, are diagnosed with a blood test, urine test, or swab culture performed in a doctor's office or sexual health clinic.

STDs cause a diverse variety of symptoms or may present with no symptoms at all. If you think you may have been exposed to an STD it is important to get tested.

More than 20 million new cases of sexually transmitted diseases (STDs) are diagnosed annually in the United States, according to the Centers for Disease Control and Prevention (CDC). Left untreated, STDs can lead to serious issues such as infertility, pelvic inflammatory disease, and birth defects.

Self-Checks/At-Home Testing

You may recognize what you believe to be symptoms or signs of an STD, such as discharge or pain. Many of these symptoms can be mistaken for another health condition such as a urinary tract or yeast infection.

So, while symptoms of an STD should prompt you to see a doctor, they alone are not enough for you to confirm that you have an STD. Likewise, a lack of symptoms isn't enough to confirm that you don't.

At-home testing is available for many STDs, including chlamydia, gonorrhea, syphilis, hepatitis C, herpes simplex virus-2, HIV, and HPV. You collect urine, blood, and/or vaginal, rectal, or oral swabs and mail the sample(s) to a laboratory. Results are usually available in two to 10 days and are typically viewable online. 

Self-tests cost between $50 and $300, depending on the number of STDs they screen for. The kits can be ordered online and may be available at your local pharmacy.

Many people prefer the privacy of at-home STD testing. However, research shows that results are not as accurate as those of tests performed by a healthcare professional, likely due to user-error when collecting samples. 

If selecting an at-home STD test, look for products that have been approved by the U.S. Food and Drug Administration (FDA) and certified by the Clinical Laboratory Improvement Amendments (CLIA).

If you test positive for an STD using a self-test, it is important to see a doctor for confirmatory testing.

Labs and Tests 

STD screening is not an automatic part of a routine physical or annual gynecologic exam as standard health care. Be proactive about your sexual health and ask your doctor to test you for STDs.

There is no standard STD panel, so talk honestly with your doctor about your risk factors and be clear about STDs you may have been exposed to. All STDs that affect both men and women can be screened for in both sexes with the exception of human papillomavirus (HPV), which can only be screened for in women.

Your doctor will take a detailed sexual-health history and perform a physical examination before deciding on what tests to order and collecting samples for the lab. These may include:

  • Urine
  • Blood
  • Cheek swab
  • Discharge from sores
  • Cell cultures from the penis, vagina, urethra, cervix, anus, or throat

Don't assume that you've been tested for something unless your doctor explicitly states it. And don’t hesitate to ask for additional tests if you think they are appropriate.

Bacterial & Fungal STDs

Bacterial/Fungal STD Blood Test Urine Test Swab/Culture
Bacterial vaginosis No No Yes
Chlamydia No Yes Yes
Gonorrhea No Yes Yes
Syphilis Yes No No
Trichomoniasis No Yes Yes

Gonorrhea and Chlamydia Testing

Gonorrhea and chlamydia are the easiest STDs to test for. Young women are sometimes screened for these automatically. Anyone with a new partner or multiple partners should probably be screened for these STDs as well.

You'll probably get results of a urine test back in a few business days. Swab tests, which are done with culture techniques, may take up to a week.

Syphilis Testing

Syphilis testing is typically performed with a blood test and is recommended for pregnant women and certain high-risk groups such as patients with another STD, men who have high-risk sex with men, and prison inmates. In the absence of symptoms, however, other people are not usually tested for syphilis due to a risk of false positives.

If you are tested using a VDRL test (blood test), you should get your results in under a week. There is also a rapid test, which can provide results in less than 15 minutes, but it is not available at all doctor's offices.

Trichomoniasis and Bacterial Vaginosis Testing

For women, rapid tests are available for trichomoniasis and bacterial vaginosis (BV). (Though not classified as an STD, a women's risk of BV increases with the number of sexual partners she has had.) These tests are performed in the doctor's office and done using a vaginal swab. Results can be available in as little as 10 minutes and conveyed to you before you leave. Swabs can also be sent to a laboratory for testing; your doctor can share results when they're returned.

Trichomoniasis can also be detected in a urine sample that is sent to a lab for testing. The results can take a day to a week to be available. Men are unlikely to be screened for trichomoniasis unless their partner is positive, but a urine test can be requested.

Viral STDs

Viral STD Blood Test Urine Test Swab/Culture
Hepatitis Yes No No
Herpes Yes No Yes
HIV Yes No Yes
HPV No No Yes

Hepatitis Testing

Hepatitis is diagnosed with a series of blood tests. Test results usually take a day or more, depending on where the sample needs to be sent.

There is a rapid test that gives results in 20 minutes, but it must be confirmed with an additional blood test. 

Herpes Testing

Herpes can be diagnosed with a blood test or a swab culture of sores if symptoms are present. Due to the possibility of false positives, the CDC does not recommend testing for herpes in the absence of symptoms, unless you have knowingly been exposed to herpes. You can, however, request herpes testing if you have had multiple sexual partners and want to be screened for all STDs.

Depending on the lab, results can come back as quickly as one day for blood tests and three days for cultures. It's important to note that a herpes blood test can only confirm the infection is present, but cannot differentiate between oral and genital herpes. 

HIV Testing

HIV tests are almost always blood tests, but some clinics can test a swab of your oral fluid. Everyone should be tested, at least once, for HIV. People who engage in risky behavior should be tested more often.

Rapid HIV tests, which are only available in certain settings, can give results in as little as 30 minutes. More often, a blood or saliva sample will be sent out and you'll get your results in under a week.

Timing Matters

Standard herpes and HIV tests look for antibodies in the blood, but they are not detectable immediately after contracting the virus. It takes at least two weeks and as much as six months post-exposure for herpes to render a positive test result. HIV takes four to six weeks to be detectable in blood, though it can take up to three months.

If you are being screened after a risky encounter, it is important to let your doctor know. There may be other testing options to detect very new infections. If you test negative after exposure, it is a good idea to get retested after six months to be sure.

HPV Testing

HPV is easier to detect in women than men because the only FDA-approved test for diagnosing HPV uses cervical cells. Women can be tested for HPV during a Pap smear. Results typically take one to three weeks.

While other viral STDs can be diagnosed through blood work, the viral load of HPV changes over time as the body fights the virus. This makes HPV blood tests unreliable and not recommended by the FDA.

How to Ask for an STD Test

Asking for STD testing can feel awkward, but it is an important part of your sexual health. Since there is no such thing as a standard comprehensive STD screening, tell your doctor the specific STD(s) you think you've been exposed to so they can be tested for. If you aren't sure about what tests you need, be honest with your doctor about your risk of exposure and concerns.

If helpful, here are a few ways to consider stating your request:

  • "Although I always practice safer sex, I like to be screened on a yearly basis for my own peace of mind. Therefore, I would like to be tested for chlamydia, gonorrhea, syphilis, herpes, hepatitis, HIV, and trichomoniasis."
  • "I'm about to start having sex with a new partner and we'd both like to be tested beforehand. Could you test me for the bacterial STDs, HIV, HPV, hepatitis, and herpes?"
  • "I recently had unprotected sex and I'm worried that my partner may have exposed me to something. Could you give me a full battery of STD tests including chlamydia, gonorrhea, syphilis, HIV, herpes, and hepatitis? I know it might take some of those tests a bit of time to turn positive, but it would make me feel better to do something."

Access, Coverage, and Privacy

STD testing is often, but not always, covered by insurance. If your insurance does not cover it, testing is usually available for free at a health clinic.

Most doctors are willing to screen you for STDs if you ask, but some doctors may decide not to test you. If this happens, you can find another doctor or visit a Planned Parenthood or STD clinic. 

STD test results are covered by the Health Insurance Privacy and Portability Act (HIPPA). That means that access to your results is limited to you, your healthcare provider, and anyone you choose to share them with.

Chlamydia, gonorrhea, syphilis, HIV, and hepatitis are nationally notifiable diseases, which means cases are reported to the CDC for surveillance tracking. The database tracks the number of cases of many communicable diseases including measles, Lyme disease, and food poisoning, but it does not track personal information such as your name. 

If you are diagnosed with a notifiable STD, your doctor will contact the state health department, which may contact you for a list of sexual partners in order to track an outbreak. Due to healthcare privacy laws, your STD status cannot be disclosed by anyone other than yourself.

Differential Diagnoses

What appears to be an STD symptom can be caused by a different condition. For example, genital itching can be caused by a yeast infection, menopause, irritants or allergens, scabies, or pubic lice. A lump or sore in the genital region can be due to an infected hair follicle or a Bartholin gland cyst (in women).

If you have these or other symptoms of an STD and have had unprotected sex or engaged in other high-risk behaviors, talk to your doctor about getting tested for STDs. A negative test can give you peace of mind and get you closer to getting a proper diagnosis, and a positive test will help you get treatment and prevent spreading the infection to your partner.

A Word From Verywell

If you are open and upfront about your reasons for wanting to test, most doctors will respect you and your desire to take care of your health. However, if you get any other reaction from your doctor, it is OK to look elsewhere for medical care. Your sexual decisions are your own. Your doctor's job is to take care of your health and help you to do the same.

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Article Sources
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Additional Reading