Ask Aunt ABby: the morning-after STD test

Time: Surprisingly complicated!

Spring has sprung here at Abortioneers HQ, and there's a new feature on the block! You've got questions. We've got answers. And we received a comment that may or may not deserve its own post.

After reading VV's post on the importance of Backing Up Your Birth Control, Virginia commented:
So much concern about getting pregnant and been able to terminate it...what about getting HIV and STDs while having unprotected sex, do you go check if you got those as fast as you go get a day after pill??


Dear Virginia,

It's hard to tell if you're being snarky or simply not very knowledgeable. Either way, welcome to our new advice column, and thanks for giving us an opportunity to clear up potential misconceptions!

Testing for STIs the morning after unprotected sex (especially HIV, which can take up to 6 months to be detectable) is like testing for pregnancy the morning after unprotected sex -- you won't get a positive result when you test that soon, even though you're not in the clear. So to directly answer your question: No, of course you don't "go check if you got those as fast as you go get a day after pill" [AKA the morning-after pill, emergency contraception, EC, the brand-name Plan B, or any number of generic-label names], as you put it. You literally CAN'T do it right away; whereas with the morning-after pill, you MUST.

That's why, instead of rushing out for a meaningless "morning-after HIV test," many people make it a habit to seek testing at regular intervals. I usually do mine at my yearly physical, because I consider it part of a complete checkup. Many providers suggest you only need to test when exposure is suspected, for example IF you had unprotected sex in the past 6 months or year and haven't yet had a test in that time.

Contraception, on the other hand, is important to seek out as soon as possible after unprotected sex, in order to prevent ovulation -- because that's how ALL birth control pills work, including emergency contraception. The longer you delay, the more time for ovulation to occur, and if it does, then EC won't work and you're left at risk for pregnancy. (This is why taking a regular birth control daily is still most effective -- you've targeted ovulation BEFORE the approach of sperm even begins.) If you miss that window and one of your ovaries does release an egg into its fallopian tube, then at that point all you can do is wait a couple weeks to see if a pregnancy does result, and if so, then (potentially) seek abortion care.

It's important to realize that the "morning after pill" is NOT the same as "getting pregnant and be[ing] able to terminate it." You can only use the morning-after pill to PREVENT pregnancy, and it's only effective in the first 5 days after unprotected sex; abortion, on the other hand, can only take place AFTER pregnancy has begun.

I sure do hope this helps, Virginia. Feel free to follow up with lingering questions, and definitely feel free to share this knowledge with your friends and family.

Yours,

Placenta Sandwich
VP of Taking You At Face Value
Head Know-It-All
Abortioneers

Fear Tactics!!!

Fear Tactics, scare tactics, fear-mongering, etc etc etc. More and more we see fear tactics being used in public health to educate, motivate, guide, and shape fill-in-the blank behavior change. Living in New York City I am quite familiar with the Department of Health and Mental Hygiene's constant assault on innocent subway riders with their love of smokers using talking machines, legless diabetics, HIV-infected individuals who also have anal cancer, soda pop that turns into mounds of fat, and the list goes on and on (but read here for a quick overview).

In the abortioneering world, I have seen many fear-based campaigns regarding sex, and specifically on avoiding teen pregnancy and HIV/STIs. How many of you have seen the ad with the crying baby? Or the billboard that tabulates how much a baby costs in their first year alone? Or the genitalia laden with sores? I think just about every high school or college sex ed course shows those squicky STI slides. What about images/videos of the penis swab testing that used to be standard for male STI testing? Any of this sound appealing?

Ok, so then lets say you either ignored those messages or were not scared by them...and you wind up with an unwanted pregnancy. Where do I even begin to list all the scare things we are told about abortion? Breast cancer anyone? Perforated uterus? Lifelong infertility? Depression? Suicide? Our family/friends/lovers/clergy will be disgusted with us? Have you heard these?

So, the million dollar question is, do these fear-based campaigns work? Well, the research is mixed, and it generally depends on the health issue and the duration and saturation of ads. In the field of sexual and reproductive it ultimately does not matter, because until there is universal access to family planning and safe sex, all the scare tactics in the world do not matter. Same goes for abortion. And then there are the large numbers of people who are raped, so once again a fear tactic about an itchy crotch won't change things.

What fear tactics have you heard of or seen (or used yourself to persuade others)???

Reserving all the judgment for ourselves

You know that saying: the best-laid plans of mice and men go oft awry? Well, because of our extensive experience with the going-awry, many of us abortioneers have pretty firm ideas of safer sexual practices, and some of us might have a certain trepidation about using anything other than "highly effective contraceptive methods" (see here for a ranked chart of options and explanation of its use in contraceptive counseling). 

At the same time, we all spend our days hearing every version of sexual history under the sun, and recognizing that women are not evil or dumb or fuckups when their practices or situations diverge from our own. We counsel clients about methods that are easier to remember or longer-lasting or invisible to an abusive partner; we brainstorm with them about ways to approach a partner about getting testing for STIs, condom negotiation, and respect for boundaries; we remind them about transmission methods of various infections and how to treat or manage existing diseases. We don't scold or scoff. The words "stupid" and "crazy" and "irresponsible" may exist in the world outside our walls, but not in here. 

But have you ever seen what happens when WE fuck up? 

This weekend I had a crazy, stupid, irresponsible experience: unprotected sex. The first of my life. I've been with my partner for ages, but we hadn't had sex in quite a while, and -- it seems crazy but -- somehow this time protection just slipped my mind. And afterward my partner asked if I had gone back on the pill, because he'd been expecting me to pause for condom-time but then I didn't. OMGWTFBBQ, said I. How can someone spend years and years trying so hard to avoid pregnancy, working in the world of unplanned pregnancy, and devoutly practicing protection habits -- then just FORGET? Needless to say, I was about as embarrassed and irritated at myself as your average patient who sheepishly tells you her story of one night of abandon, or one vomited pill. 

Well, I headed right to my medicine cabinet, looking for the pack of emergency contraception that I obtained nearly four years ago and set aside for just this purpose -- or more likely, I thought, for some friend who had a more unpredictable social life and might find herself unprepared. Ha. What was that I said about best-laid plans? I couldn't find the pack! I've moved three times since I first picked it up, and it must be in a box somewhere. So I texted a couple work friends, thinking they were likely to have a spare too -- but they didn't, and our clinic is closed on Sundays so it wouldn't be a snap to get it for cheap or free. No problem: I'll skip down to the pharmacy and buy it over-the-counter---Holy shit! I forgot the full price was fifty dollars. And my insurance doesn't have any coverage for non-prescription meds. 

It's so weird being one of the hoi polloi, the everywoman who faces everyday obstacles and needs to decide if she can afford to protect herself and has to deal with an awkward pharmacist. And really weird realizing I'm judging myself for being "such a dumbass" when I would never think that about someone else. 

Later that day, I heard from a friend: 

               um, how much do you know about herpes?

               i engaged in some high risk irresponsible behavior last night due to drunkeness

               ughhhhhh

               i feel like i need to kick myself out of my [sexual-health-related occupation]

My god! We all make mistakes sometimes, and here we are feeling like something is deeply wrong with us -- like we don't belong in the profession! -- now that we have joined the ranks of those who "should have known better [but presumably didn't]."

Well, good thing it was my turn to blog, said my friend: 

              write about how we in sex/repro health expect ourselves to be models of responsibility and healthy sexuality

               but get down on ourselves when we slip up

               you can talk about your plan b

               and my herpes!

Well, there you go. Turns out this unpleasant incident was a good reality-check: it only takes a weird moment of forgetfulness and some bad luck to end up in the patient's seat or the pharmacy, and I must have had some unacknowledged belief that I was "too smart" to wind up there, or maybe "too smart" to get a pass on making a mistake. 

I know some of us have had the good fortune (so to speak) of being in a "dumb" situation early on, and having lots of compassion as a result. If you'd like to tell that story, please do so in the comments...and I promise I won't think you're stupid!