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Sexual Health Screening

Regular monitoring of your sexual health is essential if you want to identify the presence of STI’s early. STI’s can produce a very wide range of symptoms or none at all.

Any of the following signs and symptoms could be the result of an infection with an STI:
Unusual discharge from the vagina, anus or penis
Pain when passing urine
Sore or red vulva, vagina or perineum
Sores, ulcers, itching or growths on or around the genitals
Swollen glands
Rashes
Sore throat
Pain, sores, itching or lumps in the anus and rectum
Diarrhoea
Pain or cramps in the gut or womb area
Excessive wind in the gut
Whitish poo
Unusual or strong odours from the vagina, penis or anus
None of the above

However, as it is possible to be infected with an STI and yet have no signs or symptoms at all it is advisable to have occasional check-ups even if you feel completely well, if may have been exposed to contracting an STI. Many diseases may not have clear symptoms and early identification of infection can prevent long-term health problems. Similarly, some symptoms may remain hidden or disguised therefore not noticed by the individual or his or her sexual partners.

Women in particular are likely to experience no symptoms from many STI’s, and are consequently much more vulnerable to their long-term complications. Therefore, frequent full gynaecological check-ups are strongly recommended. How often you decide to go for a check up will obviously depend on how often you have sex with new partners and what you do with them sexually. Due to this, a full sexual health screening is recommended annually for sexually active people.

Sexual Health Screening Procedure

In this section you will find:

  • How To Book an STI Screen
  • Preparation
  • Arriving
  • Pre-test Consultation
  • Screening Stage 1
  • Screening Stage 2
  • Screening Stage 3
  • Post-test Consultation
  • Results
  • Follow Up

Finding out your sexual health status is the first step towards maintaining your sexual health. This can only be done with a full sexual health screen. Once you know your sexual health status you can make more informed decisions about sexual activity you wish to engage in.

How to Book an STI Screen

Once you have made the decision to have a full sexual health screen the first thing you will need to do is find out if you need to make an appointment. Contact information for most STI Clinics can be found  by logging on to the HIV Ireland website.

For now we will focus on the Limerick, Clare and North Tipperary services.

Screenings in Limerick, Clare and North Tipperary are only available by appointment. In order to make an appointment, call 061482382. This number will get you through to reception in the Limerick STI Clinic.

When you are talking to the receptionist you will be asked for three things:
  • Your name
  • Your gender identification
  • A contact telephone number

If you have symptoms then it is advisable to tell the receptionist this as it may be possible to fit your test in earlier if necessary.

If you wish to book an appointment in Nenagh or Ennis you must ask for your preferred location at this stage. Once you have attended a clinic within the Mid-Western region, you will be expected to always attend that clinic. It is not normally possible to get tested in one clinic and have follow-on appointments in another clinic.

At the time of making your appointment you will be given an identification number and all the information you need for the next stage.

Preparation

Arriving at the STI clinic can sometimes feel quite daunting. Remember, everyone is there for the same reason; to check or maintain their sexual health. If you would like someone from our project to accompany you please contact us.

The appointment you receive will be for a certain day; clinics run between certain hours and are similar to attending a doctor’s surgery, first come, first served!

If you get there early you will be out quicker. If you get there at 11am it may be 1pm or 2pm before you leave. Only you can know what is best for you but we would recommend that you give yourself the whole morning so you are not put under extra pressure with regards to time.

You might like to bring your own reading material, although there are usually magazines available.

Part of the screening procedure involves a urine test. Men need to make sure that they hold their urine for 4 hours prior to being tested. This is because men ejaculate through the same tube (urethra) as they pee. Passing urine (peeing) may wash out bacteria and lead to inaccurate test results.

Some women may need to book a second appointment if they are menstruating (on their period). Part of the STI screening procedure may be a cervical smear test. This result can be inaccurate if there is menstrual blood (period blood) present at the time of testing.

Arriving

When you enter the clinic you will need to tell the receptionist you have arrived. The queue will move in rotation of first come, first served, so find out who arrived before you and follow after them.

The receptionist will ask you to fill out a form with details like address, age, etc on it. You will be given a card with your identification number. This number is how the clinic guarantees your name is kept confidential. On it will be the year, whether you are male or female and a number that signifies which number attendee you are.

For Example 07/EM/662 means:
  • You first attended the clinic in 2007
  • You are attending the Ennis clinic and you are male
  • You are the 662nd new male attendee in Ennis during 2007

The testing procedure happens in three stages. For each stage you will be called by your number, not your name. This is so as to keep your identity confidential. It does mean that you need to watch for the nurses and listen when they call out numbers.

Pre-test Consultation

The first thing that happens is your risk will be assessed so the exact kinds of tests you require can be determined. You will be asked about your sexual history by a doctor, in private. Some of these questions can be quite personal like, ‘do you have anal sex?’ and ‘when was the last time you had unprotected sex?’ If you can, be as honest as possible with the doctor.

If you perform oral sex without using a barrier, then say so, and they will swab the back of your throat. If you receive anal penetration then say so, they will give you an anal swab. If you are a man who has sex with men, say so and they will offer you a Hepatitis B vaccination. If you have a history of IV drug use then say so, and they will make sure to test you for Hepatitis C as well.

The more honest you can be at this stage, the more appropriate your testing will be.

Screening Stage 1

Urine Test: Urinary tract infections.

You will be given a plastic container and asked to urinate into it (pee). Catching the pee mid stream is often the easiest and you don’t need to fill the container completely.

Dry off the container after you have finished and wash your hands before leaving the toilet cubicle.

The nurse should be waiting for you to pass your container over, but if they are busy just be patient and wait outside the toilet before taking your seat.

The urine is tested for cloudiness, smell and finally for bacterial infections.

Screening Stage 2

Clinical examination:
  • Genital Warts
  • Genital Herpes
  • Molluscum Contagiosum
Swab Test:
  • Chlamydia
  • Gonorrhoea
  • Trichomoniasis (TV)
  • Thrush
  • Bacterial Vaginosis (BV)
  • Cervical Cancer – Women Only
  • Non-Specific Urethritis (NSU) – Men Only

You will be asked to go into a small consultation room and remove your clothing from the waist down. People often feel uncomfortable at this stage so if you are nervous, tell the nurse. They should be able to make you feel more at ease and talk you through where to put your clothes and where to sit. Feeling embarrassed at this stage is understandable.

Clinical Examination:

The first part of this is a simple visual examination. The doctor will look at your genitals to discover if there are any visual signs of STI’s. As medical professionals who work with STIs every day they are very good at identifying STI’s on sight.

If an STI is discovered you will be informed of it at this stage. You may also receive initial treatment at this stage.

Swab test:

Some STI’s can only be discovered by swabbing inside your body and testing that swab in a laboratory. Whilst this can sometimes feel uncomfortable, it is rarely painful.

Places that may be swabbed are:
  • Mouth
  • Penis
  • Vagina
  • Anus

You may not need all of these swabs, depending on your sexual history. You may be informed during your first consultation with the doctor about which swabs will be taken. If you are unsure please ask the nurse or doctor. They will be more than happy to tell you what they wish to swab for and where those swabs need to be taken from.

For Women:

You will be asked to settle back on the doctor’s exam-table with your legs in the stirrups provided. The doctor will do a visual examination. The doctor will then proceed to do a vaginal swab.

If during your first consultation it is agreed that a cervical swab is necessary the doctor will insert a speculum, it will be opened slightly so the doctor can see your cervix and has access to take the swab. The doctor will use lubrication on the outside of the speculum but you may still feel tightness and a slight push against your vaginal opening. As soon as the swab is taken the speculum will be gently removed. This may be uncomfortable but it is not usually painful.

If you are not used to having something inside your vagina or have difficulty being penetrated:
  • Tell the doctor you are not used to being penetrated
  • Ask if they can use the small speculum
  • Ask them to warm the speculum up a little
  • Try to lie back and relax, concentrate on your breathing
  • If you experience pain please tell the doctor because there can be many reasons for this

NB: Women who have never slept with a man may feel that a cervical screen is unnecessary. At the end of the day it is up to you but not all cervical cancer is caused by a sexually transmitted virus. Also recent research suggests that HPV (the virus that causes cervical cancer) can be transmitted in vaginal fluid present on fingers so a cervical screen is recommended.

For the anal swab you will asked to raise your bottom slightly and the swab will be gently inserted into your anus (ass).

For a mouth swab you will be asked to sit up and open your mouth, the swab will be gently rolled around the roof of your mouth.

For Men:

The doctors and nurses in the STI Clinic are used to examining men of all shapes and sizes.

You will be asked to sit on the doctor’s couch with your feet on the floor. The doctor will do a visual examination. The doctor will then proceed to do the penile swab.

If during your first consultation with the doctor you decided that an anal swab was necessary, this will happen after the penile swab.

The penile swab is like a cotton bud that is gently circled around the underneath of the head of the penis. Then a new cotton bud (swab) will be gently inserted into the very tip of the urethra (pee hole). There can be some discomfort but it is not usually painful. If you experience pain please tell the doctor because there can be many reasons for this.

For the anal swab you will need to bend over the doctor’s couch and the swab will be gently inserted into your anus (ass).

For a mouth swab you will be asked to open your mouth, the swab will be gently rolled around the roof of your mouth.

Screening Stage 3

Blood Test:
  • HIV
  • Hepatitis B
  • Hepatitis C
  • Syphilis
  • Full blood count (FBC)

The nurse will bring you into a small room and ask you to sit down and relax. The nurse will ask you to either roll up your sleeve or remove your top depending on what you are wearing and whether it will get in the way of taking your blood.

Important: If you are afraid of needles it is always better to tell the nurse and look away whilst the blood is being taken.

The nurse will put on a pair of rubber gloves. This is standard practice and part of universal precautions/procedures. For more information on this please visit our universal procedures section. You may also notice that the needle is taken out of a sealed bag and has not been used before. This is for your protection.

The nurse will tell you when to expect the needle. This usually is only a small tight feeling, sometimes like a pin prick. If you feel anything else please talk to the nurse about what you are feeling whilst she is taking the blood.

Each test requires a certain amount of blood so you may need to give more than one vial of blood. You will normally only have one needle as the nurses have a special tool to keep the hole open which the vials are attached to draw out the blood.

Once the blood is taken, the needle is removed and this rarely hurts or causes any discomfort. The needle is then disposed of in front of you.

Each vial is labelled in different colours according to the test that is required and sent off to the laboratory for testing.

Post-test Consultation

Sometimes you may be asked to wait after the initial tests have been completed. You may be asked by the doctor for another private chat. At this stage the doctors and nurses may have found an STI in your urine or noticed an STI during the clinical examination in Stage 2.

You will be given treatment for the STI that has been found. You will also be provided with information about how to prevent further transmission of the STI. You may be asked questions in order to determine if your partner also needs testing.

If you have any questions at all at this stage, now can be a good time to ask the doctor.

Sometimes people are quite shocked and cannot ask any questions. If you do receive a positive result for an STI and wish to know more about it, or wish to talk about how that can have happened, you can call our confidential helpline on 061316661.

Results

Results for STI screening can take up to two weeks. If you are feeling anxious or concerned and you would like to talk to someone about how you are feeling please contact us on our confidential helpline 061316661.

Important: The results for Cervical Smear test take approximately 6-8 weeks.

The Doctor will inform you as to how you will receive your results. Part of receiving results is also about learning how to protect yourself from future infections.

The STI Clinic also like to ask whether you know where the infection came from so they can determine if anyone else you may have had sexual contact with needs to be tested. This process is called partner tracing and depending upon the infection, the nurses might be able to take contact details for your sexual partner(s) and call them.

If you receive a positive result for HIV or Hepatitis you will be given a follow up appointment for further testing, to see at what stage the infection is. You will also be given our contact details for future support.

When you receive a positive result for an STI it can be difficult to come to terms with you may have lots of questions. If you are feeling anxious or concerned and you would like to talk to someone about how you are feeling please contact us on our confidential helpline 061316661

A number of STI’s can remain in our bodies undetected for years and unless we have been tested previously we might not be able to determine the route of transmission. For example, Genital Warts (HPV) is a virus that lives in your blood stream. Stress and any other changes in your general health can cause an outbreak of genital warts, so you may carry the virus for a long time and not know it, never see a wart, and then one starts to develop.

You can talk to the doctor at the STI clinic or contact us if you wish to talk through how you are feeling about your STI screening results.

Follow Up

A follow up is sometimes necessary. If the last time you had risky sexual activity prior to screening was less than 3 months, then you will need to return after three months to make sure your results are accurate.

This is because of the ‘window period’. The window period is the time an STI can remain incubated in your body. This means that it may be undetectable as it has not fully developed.

For example, the window period for HIV is 3 months. This test does not test for HIV but for the antibodies that appear in the bloodstream as a result of HIV being present. It takes 3 months for these antibodies to develop in the bloodstream

If you get tested but your last risky sexual activity was 6 weeks before, then you will need to wait another three months after receiving your results to cover those other 6 weeks of the window period.

If you engage in unprotected sexual activity whilst waiting for your second screening appointment then you may need to have another test 3 months later.

If you are having difficulty with your results at the time of you follow up appointment, please mention this to the doctor who may refer you to the appropriate agency for support.

Where To Go

If you are looking to have an STI screening, we would recommend that you attend your local STI Clinic. This will provide you with a free and confidential STI screening. In the Mid-West region of Ireland, the STI clinic is based in Limerick Regional Hospital but also runs sessions in Ennis and Nenagh hospitals.

Screenings take place in Limerick on Tuesday and Thursday, Ennis on Monday and Nenagh on Wednesday. All screenings with the STI clinic are by appointment only and in order to make an appointment in Limerick, Ennis or Nenagh you must contact the STI Clinic in Limerick on 061 482382, you can leave a message if nobody is available to answer your call. Alternatively you can email theclinic@hse.ie

If you live outside the Mid-West region of Ireland, please look at our useful contacts section in order to find the details for your nearest STI Clinic.

FAQ

There is no such thing as a stupid question; every question is valid and reasonable. Here are some examples of the type of questions we are asked on a regular basis about STI screening.

Do they have a men’s day and a women’s day?

No, not in Limerick, Clare or Tipperary North. Other places might do specific days for people but you will need to call them to find out.

Why don’t they have a men’s day and a women’s day?

The team of people who run the STI Service in the Mid-West have to split their time between each county. If we had more resources so Limerick STI Clinic could be staffed full time they might have the facility to do a men’s clinic, a women’s clinic and any other requirements.

Can I just turn up?

No, in Limerick, Clare or Tipperary North you must make an appointment in order to be screened.

Is there a waiting time to get an appointment?

Normally you are seen within a week, sooner if you have symptoms and mention these. However, waiting times can vary depending on the time of year.

Is it confidential?

Yes. Everything that happens in the STI Clinic is confidential. Your results are not recorded on your medical history with your family GP unless you ask them to be.

OK, but is it private? Will I know anyone?

As the waiting area is for all appointments, there will be other people present in this area and you may see people you know. If you are worried about this you can book an appointment in an area where you do not live. The important thing to remember is that everyone you see at the STI Clinic is there for similar reasons, either they are finding out their sexual health status or they are maintaining their sexual health.

Who needs to know I am getting screened?

The only people who need to know you are getting screened are only the people you wish to tell. There is no requirement for you to tell anybody that you are getting tested. An STI screening is the same as going to your doctor for an appointment.

How much does it cost?

There is no fee if you go to the STI Clinic. Everything there is free, the appointment, tests, treatment and the follow up. You may choose to go to a private doctor and pay if you wish, however, this may have implications for your medical history.

Will it hurt?

Testing should not hurt. It may be uncomfortable at times but this discomfort should not last long.

When will I know my results?

You will have all your results within two weeks apart from the cervical smear (women only), which can take between 6 and 8 weeks. You may receive some results on the day.

How old do I have to be?

Legally you can make your own medical decisions at 16 but anyone, of any age, can call and ask about being screened.

If I get screened will they know I am not a virgin?

They only know what you choose to tell them and what they find in the test results. Some STI’s can develop without sexual contact, like Thrush, BV and NSU’s so you may require an STI screening without ever having had sexual contact with someone else.

Will it be embarrassing?

You might feel embarrassed yes, after all, your genitals are going to be looked at and you are going to have to talk about your sexual history. Try not to worry about being embarrassed because the doctors and nurses who work at the STI Clinic have seen all sorts of people and all kinds of genitals every day. They are friendly and relaxed about what they do and they make it as easy as they can for their patients.

I heard they put a huge umbrella down the end of your penis – is that true?

No. The only time an ‘umbrella’ may be used is if you have a blockage in your urethra that needs clearing. This is not an umbrella but a medical tool designed especially for the job! This kind of treatment is rarely necessary but may be required in some cases.

What if I get a hard on?

The STI Clinic is not that sexy a place. It is quite difficult to feel horny when you’re in the clinical examination room. If you do get a hard on, it won’t get in the way of being screened.

What if I get wet?

You can ask to wipe before they take a look at you. If you’re worried you might think about wearing a panty liner that day.

How long will it take?

The test themselves are quite quick but there can be a long wait in the waiting room. We would recommend that you give yourself all morning and get there as early as you can. The sooner you get in, the sooner you get out.

Do I have to pee in a cup?

Yes you do. There is a urine test for both men and women. Men need to hold their urine for 4 hours before getting tested.

Will they take blood?

Yes they will. Certain tests can only be done with a blood sample. These are HIV, Hepatitis and Syphilis. They will also do a full blood count (FBC).

Will I be able to go back to work?

Yes you will. None of the test should cause you the inability to return to work, however, some women do not respond well to the cervical smear so be aware of yourself and your own needs, and if you do not feel like going back to work try to arrange to have the whole day off.

Will it hurt?

Testing should not hurt. It may be uncomfortable at times but this discomfort should not last long.