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 something hurts to get tested, you've already spread it.
Syphilis rates have been rising sharply since the late 2010s across both North America and Europe — you're statistically more likely to encounter it than any generation of gay men before you. The 90-day protocol is your primary defence.
The 90-Day Standard (The Golden Rule)
If you're sexually active, you test every 3 months. Two reasons:
- Window periods: It takes time for HIV and syphilis to show up. Quarterly testing catches everything in a safe timeframe.
- PrEP: If you're on PrEP, you have to test kidneys and HIV every 3 months anyway — so align your full panel with it.
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 |
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)
A lot of doctors default to urine and blood only because it's faster. This misses 50% of infections.
The standard is the "3-Site Test" — use the script below to make sure you get it:
- Urine: Checks the penis/urethra.
- Throat Swab: Checks for oral Gonorrhea/Chlamydia.
- Rectal Swab: Checks for anal Gonorrhea/Chlamydia.
- 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 — testing together is one of the more solid things a couple can do.
Why test if you're monogamous?
- Baseline: It confirms where you both stand. For serodiscordant couples, it confirms the viral load stays undetectable and PrEP/kidney markers stay healthy. For concordant couples, it catches anything that slips through.
- Health: It checks kidney function (creatinine), liver health, and bacterial STIs that can be asymptomatic.
- Routine: Make it a habit. Go to the clinic, confirm your numbers, go get brunch.
Testing isn't an accusation. It's maintenance. If your partner refuses because "don't you trust me?" — that's 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 there was any risk of HIV exposure: Get on PEP — you have a 72-hour window and every hour counts. Don't wait for a test result before acting; there's nothing to detect yet, but PEP can still stop an infection from taking hold. See PEP: The Emergency Brake.
- If there was risk of bacterial STI exposure: DoxyPEP within 72 hours significantly cuts your risk for chlamydia and syphilis — but has limited effect on gonorrhoea due to rising antibiotic resistance, which is also why European guidance is more cautious about its use. Only if you have it prescribed and ready. See Doxycycline After Sex: A Controlled Failsafe.
- Then: Test HIV at the 4-week mark, syphilis at 6 weeks to confirm.
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