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Why Monogamous Couples Need Regular STD and STI Testing

Get tested. Committed relationships aren't foolproof protection from STIs and STDs..
María Cristina Lalonde
Written by

María Cristina Lalonde

Monogamy is a relationship between just two partners—rather than having multiple partners—that can be emotional or sexual but is often both. The concept is believed to have arisen in Eurasian societies about 12,000 years ago when humans shifted from traditional nomadic, hunter-gatherer lifestyles to establishing permanent homes based on agriculture and domesticated animals.

While many factors likely contributed to the rise of monogamy—including changes to the way women chose their partners and pathogen stress—some researchers believe one possibility may have been the spread of sexually transmitted infections (STIs).

The theory that STIs might have helped drive humans to monogamy goes like this: In small, polygamous societies, infectious outbreaks were contained and didn't tend to have lasting effects on the overall population. But as agricultural advancements fostered denser populations and greater connectivity between groups, sexually transmitted diseases (STDs) such as syphilis, gonorrhea and chlamydia became endemic. In the absence of antibiotics, infertility from these diseases would have been high, and mating with many different overlapping partners would have ceased to be the most effective strategy for maximizing reproduction. As populations in larger towns and cities began to fall, groups that enforced monogamy grew and outcompeted their polygamous rivals.

Thousands of years later, monogamy remains the norm in Western societies, and the belief that long-term, committed relationships help prevent the spread of STDs remains commonplace. The Centers for Disease Control and Prevention (CDC) even lists "mutual monogamy" as a top prevention strategy against the spread of sexually transmitted diseases.

But plenty of research suggests monogamous partnerships might not be as effective for prevention as once believed. Research published in 2015 in the Journal of Sexual Medicine found people in exclusive relationships are no safer from infection than couples in open or consensually nonmonogamous relationships. The study indicated monogamous couples were less likely to use condoms, get tested for STIs and disclose extradyadic sexual encounters to their partners than those in consensually nonmonogamous relationships.

This is not an indictment of monogamy, but rather an illustration of the importance of routine testing for sexually transmitted infections, even if you're in a committed relationship.

Here's why you need routine STI/STD testing

"Regardless of what type of trust and relationship boundaries you have established with your partner, you want to incorporate regular STI testing as part of your routine health screenings because there's a lot of complexity in STI testing that's not well known," said Jenelle Marie Pierce, executive director of The STI Project and spokesperson for Positive Singles in Asheville, North Carolina.

OK, but how can you get an STD in a monogamous relationship?

Pierce stressed that it's common for STIs to go undetected, in part, because of a difference between the incubation period (the time it takes for symptoms to present themselves) and the window period (the time it takes for an infection to show up on a test). For example, HIV infections have a window period of 45 days, meaning it may take up to 45 days before they are detectable by modern lab tests.

"If you test too soon, you might think you are negative but actually have an undetected infection," Pierce explained. "STI tests look for the pathogen or for your body's response to the pathogen, and either the infection itself needs enough time to replicate in order to be detectable or your body needs enough time to respond to the infection in order for your body's response to be detectable."

Many STIs have latency periods, meaning it can take weeks, months or years before they show symptoms. For example, syphilis, hepatitis B and HIV are common conditions that can remain dormant for years after contraction. Others, including HPV, chlamydia and gonorrhea, are often asymptomatic.

"Most people assume they'll know if they have an STI, but the most common symptom is no symptom, so the only way to know is to get tested," Pierce noted.

Certainly married couples don't need to get tested for STD and STIs, right? Well, there are STIs with multiple transmission methods.

"What designates something as an STI is quite literally only related to how it is primarily contracted," Pierce added. "There are some infections that are almost exclusively transmitted through sexual activities, there are some infections that can be transmitted both sexually and nonsexually, and there are others that are rarely transmitted sexually."

For example, hepatitis B and HIV can be transmitted through blood-to-blood contact, the sharing of syringes or equipment to inject drugs, body piercing equipment and tattooing needles. Herpes and syphilis can be spread through skin-to-skin contact. There are even STIs such as molluscum contagiosum that can be spread not just through skin contact, but also with wet towels, gym equipment and tanning beds.

When and how to bring up STI/STD testing

Tami M. Prince-Clarke, M.D., an OB-GYN based in Atlanta, recommended getting tested at least once per year.

Pierce added that as a general rule of thumb, you always want to be seen by a provider when or if you notice symptoms.

"But if you have no recognizable symptoms, you want to get testing done at least three to four weeks after your most recent sexual activity," Pierce said.

Ideally, you should get tested at the beginning of a monogamous relationship, but it's never too late to have the STI talk, even with an exclusive partner.

"It doesn't have to feel super-serious or awkward, but it's also OK to admit a bit of vulnerability because that's how intimacy is built," Pierce said. "Rather than approaching the conversation with assumptions or accusations, speak in the first person and make it about your needs.

"Use whatever language and modality—whether that be face to face, text, etcetera—feel authentic to you, but make sure it's a reciprocal and mutual discussion," she added. "The goal is to feel empowered about your conversation and your next steps and to be able to truly enjoy what is happening in the present. Sometimes that takes a little effort up front and some practice with your approach, but it's worth it in the end."

And if one partner tests positive?

"First, resist the urge to point fingers or assign blame," Pierce advised. "It's almost impossible to know if someone cheated or who had an STI first when all parties involved test positive for infection. From there, work toward which treatment approaches are necessary and open dialogue."