Sexual Health & STI Screening: Confidential and Compassionate Care

Sexual health is a fundamental and inseparable part of overall health, and yet stigma, embarrassment, and the fear of being judged still prevent many women from seeking the testing and care they need. I see this regularly in my clinic — women who have been worried for months, who have talked themselves out of booking because they think their situation is unusual, or who have been made to feel shame about something that is simply part of being human.

In my practice, there is no judgment. Sexual health assessments are conducted with the same professionalism, discretion, and compassion as any other gynaecological consultation. Seeking testing is not a sign that something has gone wrong; it is a sign that you are taking your health seriously. That deserves to be encouraged, not stigmatised.

Who should be screened?

The straightforward answer is: anyone who is sexually active. The more nuanced answer is that different women have different patterns of risk, and the frequency and scope of testing should reflect your personal circumstances.

I find that many women underestimate their need for screening, either because they are in what they consider a long-term relationship, or because they feel they have no symptoms. Both of these assumptions can be misleading. Many STIs — chlamydia in particular — are entirely asymptomatic; you can carry an infection for months or years without being aware of it. Regular testing is simply good practice, regardless of your relationship status, the number of partners you have had, or how “unlikely” you feel infection to be. There is no risk profile that is too low to warrant screening, and none that is too high to be seen with anything other than professionalism.

I generally recommend annual screening for sexually active women, or screening after any new sexual contact, after a change in partner, or whenever there is a clinical reason to investigate symptoms.

What a comprehensive STI screen includes

A thorough sexual health screen in my clinic covers the following, tailored to your history and concerns:

Blood tests:

• HIV (fourth-generation combination antigen/antibody test, which detects both the p24 antigen and HIV antibodies for early and accurate diagnosis)
• Syphilis (TPPA/TPHA serology)
• Hepatitis B (surface antigen and core antibody)
• Hepatitis C (antibody test)
• Herpes simplex virus (HSV) serology, where clinically indicated

Swabs (vaginal or cervical):

• Chlamydia and gonorrhoea by nucleic acid amplification testing (NAAT) — the most sensitive method available
• Trichomonas vaginalis
• Bacterial vaginosis (BV)
• Candida (thrush)

Urine sample:

• Chlamydia and gonorrhoea NAAT testing is available via urine sample for those who prefer this to a swab

Additional:

• HPV testing can be incorporated within cervical screening at the same appointment, providing a comprehensive picture of your cervical and sexual health simultaneously

Common STIs in women

Chlamydia is the most frequently diagnosed STI in the UK. It is caused by the bacterium Chlamydia trachomatis and is often completely without symptoms — many women discover it incidentally during routine screening. If untreated, chlamydia can cause pelvic inflammatory disease (PID) and, in some cases, affect future fertility. It is straightforwardly treated with antibiotics.

Gonorrhoea, caused by Neisseria gonorrhoeae, has become more common in recent years and increasingly presents diagnostic challenges due to antibiotic resistance. It can cause an unusual discharge, pelvic pain, and dysuria, though it is also frequently asymptomatic. Treatment requires specific antibiotic regimens, and test-of-cure is recommended.

Syphilis has seen a significant resurgence in the UK in recent years. It presents in stages and can be easily missed; serological testing is the only reliable way to detect it. When caught early, it is curable with penicillin.

HIV remains an important part of any STI screen. With modern antiretroviral therapy, a diagnosis of HIV is now a manageable long-term condition rather than the crisis it once was — but early diagnosis remains essential for individual health and preventing onward transmission.

Herpes simplex virus (HSV) is very common and, for most people, causes manageable episodes of genital sores or blisters. Suppressive antiviral treatment is available for those who experience frequent recurrences.

Bacterial vaginosis (BV) is not technically a sexually transmitted infection, though it is often influenced by sexual activity. It results from a disruption to the normal balance of vaginal bacteria and is the most common cause of altered vaginal discharge. It is readily treated with antibiotics, though recurrence is common.

Symptoms that warrant assessment

You should seek a sexual health assessment if you notice any of the following:

• Unusual vaginal discharge — a change in colour, consistency, quantity, or smell
• Pelvic pain or lower abdominal discomfort
• Pain or burning on urination
• Genital ulcers, sores, blisters, or unusual skin changes
• An unusual rash, particularly if on the palms of the hands or soles of the feet (which can be a sign of secondary syphilis)
• Post-coital bleeding — bleeding after sex
• Intermenstrual bleeding

However, as I emphasise to all my patients, the absence of symptoms is not reassurance. The most important reason to test is not because you have symptoms — it is because you are sexually active and your health matters.

Results and treatment

Most results are available within a few days, and many can be returned more quickly. In my practice, all results — positive or negative — are discussed with you directly. If a test returns positive, I will explain clearly what it means, what treatment is appropriate, and what you need to know about onward management. Antibiotics and antiviral medications are straightforward, effective, and the vast majority of STIs are entirely curable or very well managed.

Partner notification — letting sexual partners know they may need testing — is handled sensitively and can be discussed in detail during your consultation. I will not contact partners on your behalf; that conversation belongs to you, and I am here to help you navigate it if needed.

For women at elevated risk of HIV, I can also discuss PrEP (pre-exposure prophylaxis) — a daily medication that is highly effective at preventing HIV acquisition in people at risk. This is available on the NHS for those who qualify, and privately for those who prefer that route.

Vaginal symptoms beyond STIs

Not all vaginal symptoms are caused by sexually transmitted infections, and I see many women who have been treating themselves for recurrent thrush or spending months worrying unnecessarily. Accurate diagnosis matters. Recurrent vulvovaginal candidiasis (thrush) is an extremely common and often frustrating condition; when it recurs, it warrants proper investigation rather than repeated courses of over-the-counter treatment. Bacterial vaginosis is frequently misdiagnosed as thrush, and they require completely different treatments. Vulval conditions — such as lichen sclerosus or vulvodynia — can cause symptoms that are initially attributed to infection.

A thorough assessment distinguishes between these causes and ensures you receive the right diagnosis and treatment rather than the most readily available one.

What to expect at your appointment

Your appointment begins with a confidential conversation about your sexual history, any symptoms you have noticed, and what you would like the screen to include. I do not require an internal examination unless there is a clinical reason for one; many components of the screen require only a blood test and self-taken swab or urine sample, which you can perform yourself in privacy.

Where an examination is clinically useful — for example, if you have symptoms of discharge or pelvic pain — I will explain the reasons clearly and proceed only with your consent. The consultation is led by your needs and your comfort.

Everything discussed and every result remains strictly confidential. Your notes, like all medical records, are subject to the same privacy protections as any medical consultation.

Your sexual health is part of your whole health. I am here to provide expert, unhurried, and entirely non-judgmental care, wherever you are in your journey.