How do you get tested for STDs? Part II: Sexually Transmitted Viral Infections
In our STD testing Part I post we covered the three main non-viral STI, Chlamydia, Gonorrhoea & Trichomoniasis. This post—Part II covers the most common viral STDs, which are known as the 'four H's' and include Human Immunodeficiency Virus (HIV), Herpes Simplex Virus (HSV), Hepatitis (HBV and HCV), and Human Papillomavirus (HPV). If you asked yourself, “how to be tested for HPV?” or “how much does an HIV test cost?” You’d find all the required information to keep yourself and your partner safe using affordable lab testing services.
How do you get tested for viral STI?
Approximately 1.2 million people in the U.S. have HIV. About 13 percent of them don’t know it and need testing. HIV can affect anyone regardless of sexual orientation, race, ethnicity, gender, age, or where they live. In 2019, an estimated 34,800 new HIV infections occurred in the United States, an 8% decrease since 2015. HIV diagnoses are not evenly distributed across states and regions. The highest rates of new diagnoses continue to occur in the South. The virus can be transmitted through contact with infected blood, semen, or vaginal fluids. Within a few weeks of HIV infection, flu-like symptoms such as fever, sore throat, and fatigue can occur. Then the disease is usually asymptomatic until it progresses to AIDS. AIDS symptoms include weight loss, fever or night sweats, fatigue, and recurrent infections. No cure exists for AIDS, but strict adherence to antiretroviral therapy (ART) can dramatically slow the disease's progress and prevent secondary infections and complications.
Genital herpes is an STD caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). The Centres for Disease Control and Prevention (CDC) estimated that in 2018 there were 572,000 new genital herpes infections in the United States1. About 12% of people aged 14 to 49 years have HSV-2 infection. The overall number of cases of genital herpes infection is even higher than that because an increasing number of genital herpes infections are caused by HSV-1 (which normally is an oral infection acquired in childhood). Infections are transmitted through contact with HSV in herpes lesions, mucosal surfaces, genital secretions, or oral secretions. Generally, a person can only get an HSV-2 infection during genital contact with someone who has a genital HSV-2 infection. However, receiving oral sex from a person with an oral HSV-1 infection can result in getting a genital HSV-1 infection. Most individuals infected with HSV are asymptomatic or have very mild symptoms. Genital herpes may cause painful genital ulcers that can be severe and persistent in persons with HIV or other suppressed immune systems.
Hepatitis is an inflammation of the liver most often caused by a virus. In the U.S., the most common types of viral hepatitis are hepatitis A, B, and C. An estimated 2.4 million adults are living with HCV infection in the U.S. Effective vaccination can help prevent hepatitis A, B, and antiviral treatment can cure most cases of hepatitis C. However viral hepatitis is on the rise. Hepatitis A incidence increased by 1,325% from 2015 through 2019. No specific treatment exists for hepatitis A. Your body will clear the hepatitis A virus on its own. In most cases of hepatitis A, the liver heals within six months with no lasting damage.
The COVID-19 pandemic has disrupted healthcare services, reducing opportunities to conduct routine hepatitis C virus antibody screening, clinical care, and treatment. Compared with the 2018 and 2019 months, hepatitis C virus antibody testing volume decreased 59% during April 2020 and rebounded to a 6% reduction in July 2020. The number of hepatitis C virus RNA–positive results fell by 62% in March 2020 and remained 39% below the baseline by July 20202.
HPV is the most common STI. There were about 43 million HPV infections in 2018, many among people in their late teens and early 20s. More than 40 types of HPV can be spread sexually. You can get them through vaginal, anal, or oral sex. You can get them by skin-to-skin contact, too. In most cases (9 out of 10), HPV goes away on its own within two years without health problems. But when HPV does not go, some types can cause health problems, including genital warts and cancers. HPV preteen (age 11-12) vaccination and through the age of 26 (if not vaccinated earlier) can prevent HPV health issues.
How do you get tested for HIV?
HIV tests can be performed on blood or oral fluid or even using urine.
Molecular testing, also called Nucleic Acid Amplification Test (NAAT), detects the genetic material (RNA) of the virus. A NAAT HIV test tells if a person has HIV and tells how much virus is present in the blood (e.g., HIV viral load test). NAAT HIV is the fastest way and the most accurate test for HIV as it looks at the actual virus presence in blood, but it is relatively expensive and costs ~$120-200, so it is not routinely used for screening. Several labs offer HIV RNA test online and can be purchased without a doctor, but it requires an in-person visit to a patient service station to draw blood from your vein.
An antigen/antibody test looks for both HIV antibodies and antigens. Antibodies are generated by your immune system when you’re exposed to viruses like HIV. Antigens are substances from the virus itself. Antigens can be proteins, lipids or glycans that are part of the virus envelope and as foreign particles cause the immune system to react against them. If you have HIV, an antigen called p24 is produced even before antibodies develop. That is the reason the combination of both Antigen/antibody tests is recommended, as these tests are relatively accurate and relatively cheap. There are several generations based on the time these tests were developed and the accuracy. The most advanced Antigen/antibody test is also called the 4th generation HIV test. Several lab providers offer both in-person visits and at-home fingerpick blood collection of the HIV 4th generation Antigen/antibody test with a cost range of $39-89. The median window period of detection for the 4th generation HIV tests is 18 days (an overall range of 13 to 24 days). This indicates that half of all infections would be detected between 13 and 24 days after exposure. 99% of HIV-infected individuals would be detectable within 44 days of exposure.
HIV rapid tests are also available but mainly at clinics. Most of the HIV rapid tests are antibody tests only and use finger-pick blood. Rapid tests are usually reliable for long-standing infections. Most of the rapid tests are based on older 2nd generation technology detecting only IgG antibodies and if results are positive would require confirmation. Some rapid 3rd generation includes both IgG and IgM antibodies, which enables these tests a median window period of 26 days (an overall range of 22 to 31 days). This indicates that half of all infections would be detected between 22 and 31 days after exposure and 99% of infections within 50 days of exposure. The OraQuick In-Home HIV Test is a rapid 3rd generation test and uses salvia. Results can be obtained within 20 minutes and can be done at home at a cost of ~$40. The OraQuick can detect HIV if used at least 3 months following the risk event.
How do you get tested for herpes?
HSV testing can be done using a swab test, blood test, or lumbar puncture. For a swab test, a health care provider or you at home will use a swab to collect fluid and cells from a herpes sore. For a blood test, a health care professional will take a blood sample from a vein in your arm or you at home from your finger, using a small needle. A lumbar puncture, also called a spinal tap, is rare and only done if your doctor thinks you may have a herpes infection of the brain or spinal cord.
Most HSV testing is done using antibody tests. Some tests measure antibodies only to HSV-1 and others only to HSV-2. Some for both and will be called HSV 1 & 2. Many providers offer the HSV tests as part of an STD panel, but individuals tests can be also be ordered at a price range of $45-89 for one type and $89-99 for both types
How do you test for Hepatitis?
All Hepatitis viruses are measured in blood. Screening tests are done by either antibody or antigen tests. Hepatitis tests usually use antibodies your body will generate after exposure to the viruses. The cost of hepatitis tests is as low as $24 for a single test and up to $99 for an at-home test.
IgM antibodies to Hepatitis A suggest a current, acute or recent Hepatitis A infection, while IgG antibody test or HAV antibody indicates prior or acute infection with, or immunization to, Hepatitis A virus.
Hepatitis B core-specific IgM class antibody has been detected in most acute infections and is a reliable marker for acute disease. Hepatitis B Surface Antibody or anti-HBs is indicative of prior immunologic exposure to the antigen or vaccine. Hepatitis B Surface Antigen appears in the serum after an incubation period of 1 to 6 months following exposure to the Hepatitis B virus and peaks shortly after the onset of symptoms. It typically disappears within 1 to 3 months. Persistence of Hepatitis B Surface Antigen for greater than six months is a prognostic indicator of chronic Hepatitis B infection.
Hepatitis C Antibody (Anti-HCV) test is used as a primary screening test for the diagnosis of acute or chronic hepatitis due to Hepatitis C virus (HCV) infection.
Hepatitis B can be measured by a molecular (PCR) test that detects the DNA of the virus in the blood. Hepatitis B Virus DNA PCR test is normally used for the management of patients with chronic HBV infection undergoing antiviral therapy. The test can be used to measure HBV DNA levels at baseline and during treatment to assess the response level to treatment. The cost of the HCV RNA test is about $329 and requires an in-person visit for a venous blood draw. It can be ordered online without a doctor.
Similarly, the Hepatitis C PCR test that detects the RNA of the virus in the blood is used in monitoring therapy and/or disease progression. The cost of the HCV RNA test is about $180 and requires an in-person visit for a venous blood draw. It can be ordered online without a doctor.
How to be tested for HPV?
The HPV test checks cells for infection with high-risk HPV types. For women is done by collecting samples using a vaginal swab. There are over 100 different HPV strains. Usually, the HPV screening test is a molecular test and test screens for 14 high-risk HPV genotypes (strains), including HPV 16 or HPV 18. The presence of E6/E7 messenger RNA from 14 high-risk HPV types indicates the incorporation of HPV DNA into the host cells. Proteins expressed from E6-E7 polycistronic mRNA alter cellular p53 and retinoblastoma protein functions, leading to disruption of cell-cycle checkpoints and cell genome instability. This information, together with the physician’s assessment of cytology history, other risk factors, and professional guidelines, may be used to guide patient management. An at-home HPV test costs range from $49-89.
How much do STD tests cost?
The cost for the four ‘H’ virus tests varied depending on the test type and the virus. It can be as low as $24 for a single Hepatitis antibody test and up to $329 for a Hepatitis B DNA PCR test for therapeutic monitoring. Many lab providers offer these STD tests as part of a broader panel which decreases the price per test dramatically. Most panels are used for screening tests and do not include the more expensive tests – the molecular tests that are done by PCR or NAAT. STD lab test prices vary a lot between the lab providers and it is recommended to compare the lab test prices before you order.
STD viruses are the leading cause of serious diseases like AIDS (HIV), Liver cancer (HCV + HBV) and Liver Cirrhosis (HCV) and Cervical Cancer (HPV). For people with a weakened immune system, HSV can also cause health complications. To prevent the spread, it is important to test yourself and your sex partner/s regularly. Many lab providers offer these tests online and keep your privacy. You can either test yourself at home with a rapid test or collect your sample at home and ship it to the lab for analysis, getting the results on a secured portal. Some viral STD tests would require an in-person visit to draw venous blood, but the privacy level is the same.
Did you check your partner/s?
1. Kreisel KM, Spicknall IH, Gargano JW, Lewis FM, Lewis RM, Markowitz LE, Roberts H, Satcher Johnson A, Song R, St. Cyr SB, Weston EJ, Torrone EA, Weinstock HS. Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2018. Sex Transm Dis 2021
2. Kaufman et al. American Journal of Preventive Medicine 2021 DOI: https://doi.org/10.1016/j.amepre.2021.03.011