You can't feel an STI.

  • Syphilis is painless in stage 1.
  • Gonorrhea in the throat has no symptoms.
  • Chlamydia in the rectum is often silent.
  • Hepatitis C can be asymptomatic for years while silently damaging your liver.

If you wait until "it hurts" to get tested, you've already spread it.

Context: Syphilis rates in both North America and Europe have been rising sharply since the late 2010s. You are statistically more likely to encounter it than any generation of gay men before you. The 90-day protocol is your primary defense.

The 90-Day Standard (The Golden Rule)

If you are sexually active, you test every 3 months. Why?

  • Window Periods: It takes time for HIV/Syphilis to show up. Testing quarterly catches everything in a safe timeframe.
  • PrEP Requirement: If you are on PrEP, you must test kidneys/HIV every 3 months anyway.

How Often Should I Test? (Frequency Guide)

The 90-day rule is the baseline. Your actual interval depends on your activity level.

Your Situation Recommended Interval Panel Required
On PrEP Every 3 months (mandatory — PrEP requires it) Full 3-site panel + creatinine + HIV
Sexually active, multiple partners Every 3 months Full 3-site panel
Occasional sex, consistent condoms Every 6 months Full 3-site panel
In a relationship, both tested at start Every 6–12 months Full 3-site panel
High-frequency play (clubs, saunas, apps weekly) Every 6–8 weeks Full 3-site panel + Hep C
Chemsex / drug-facilitated sex sessions Within 2 weeks of each session Full 3-site panel + Hep C
After a condom broke or PEP course Follow PEP testing timeline: 4 weeks (HIV), 6 weeks (Syphilis), 3 months (confirmation) Full 3-site panel
After possible blood exposure (fisting, rough sex, shared equipment) 4 weeks (RNA test) + 12 weeks (antibody test) Hep C RNA/PCR specifically
ℹ Note

When in doubt, test more often. The cost of a negative result is a short clinic visit. The cost of a missed infection is potentially weeks of untreated transmission.

The Full Panel (Don't Let Them Skip Swabs)

Many doctors default to urine and blood only because it's faster. This misses 50% of infections.

You must demand the "3-Site Test":

  1. Urine: Checks the penis/urethra.
  2. Throat Swab: Checks for oral Gonorrhea/Chlamydia.
  3. Rectal Swab: Checks for anal Gonorrhea/Chlamydia.
  4. Blood: Checks HIV (4th Gen), Syphilis, Hepatitis A, B, and C.

On Hepatitis C specifically: There is no vaccine. It spreads via blood contact—shared toys, fisting, rough sex with bleeding, or shared drug equipment. It is now fully curable with an 8–12 week course of direct-acting antivirals (DAAs), but only if you catch it. If you engage in any of these higher-risk activities, make sure Hep C is explicitly on your blood panel.

Script: "I need a full sexual health screen including throat and rectal swabs, not just urine. Please also include Hepatitis C in the blood panel."

For Couples: The "Audit Date"

Being in a relationship doesn't mean you stop testing. In fact, testing together is the ultimate sign of a solid relationship.

Why test if we are monogamous?

  1. Baseline: It confirms where you both stand. For serodiscordant couples (one HIV-positive, one HIV-negative), regular testing confirms viral load stays undetectable and PrEP/kidney markers stay healthy. For concordant couples, it catches anything that slips through.
  2. Health: It checks kidney function (creatinine), liver health, and bacterial STIs that can be asymptomatic.
  3. Routine: Make it a habit. Go to the clinic, confirm your numbers, go get brunch.

The Psychology: Testing isn't an accusation. It's maintenance. If your partner refuses to test because "don't you trust me?", that is a red flag. Trust is for emotions. Tests are for biology.

The "Window Period" (Timing Your Test)

If you had a risk event last night, testing today is useless.

  • Chlamydia/Gonorrhea: Wait 2 weeks.
  • HIV (4th Gen Test): Wait 4–6 weeks (for 99% accuracy; virtually all infections detectable by 45 days).
  • Syphilis: Wait 3–6 weeks.
  • Hepatitis C: Wait 8–12 weeks for reliable antibody detection. If there was definite blood-to-blood exposure, ask for an RNA (PCR) test at 4 weeks for earlier detection.

Strategy: If you have a scare, go on PEP/DoxyPEP immediately. Then test HIV at the 4-week mark, and syphilis at 6 weeks to be safe.

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