Dear Alice,

If my partner and I have been monogamous for three years (and I was a virgin before we met) and my partner tested negative for the HIV virus (twice, about two years ago, with a six-month gap between the tests) is it safe for us to use a birth control method other than a condom? That is, are there still any STDs that my partner might have without knowing it, that we should be worried about, even though nothing whatsoever has seemed wrong with either of us for three years and my partner has had several regular annual physicals in that time?

— Losing the condom?

Dear Losing the condom?,

First, congrats for being so on top of the STI and risk communication concerns with your partner. It’s great to see how much priority you are placing on this issue. Now, this is a decision that only you and your partner can make. The situation you described calls for an assessment of the inherent risks, and then a mutual decision by you and your partner as to the course of action.

More specifically, yes — there are many sexually transmitted infections (STIs) that are asymptomatic (have no symptoms). This means that you can have them and transmit them to others without ever knowing it. There are other STIs that may take years to manifest themselves, if they ever show symptoms at all. For example, it may be a hormonal change or stress or a life change that causes symptoms of an STI to appear at a specific time. Chlamydia, gonorrhea, syphilis at certain stages, herpes (between outbreaks), and HPV (the virus that can cause genital warts and certain types of cancer) all can be asymptomatic. HIV can have an incubation period of up to ten years before symptoms of advanced HIV (sometimes called AIDS) appear, although usually the antibodies show up on a test within six months of transmission of the virus. There is currently no cure for herpes, genital warts, or HIV.

In addition to the HIV test that your partner has already done, a primary care provider can conduct tests for asymptomatic gonorrhea, syphilis, and chlamydia. Additionally, a visual exam of the genitals and other potentially impacted areas can be done to look for signs of HPV and herpes. If you don’t have a primary care provider, there are clinics in most communities that can do these tests.

Given all of this information, it sounds like the two of you need to sit down, discuss the situation, determine your comfort level with the options, and make a decision together. You may decide to have the other testing done before making any changes to your current plan. You also might decide to switch to another form of birth control. You can even continue using condoms until you're ready to have children and make absolutely sure that neither of you ever transmits an STI to the other. Given that no birth control method is 100 percent (other than abstinence, of course), a common recommendation is for couples to use two methods (like birth control pills and condoms) to prevent an unplanned pregnancy.

It depends on your personalities, your willingness to take risks, and your mutual assessment of the risks involved in switching to another form of contraception. You might want to consult with a health professional or a health educator to learn about the risks and benefits of each type of contraception. Regardless, this is ultimately a decision that the two of you get to make together.

Congrats again on your attention to your health and that of your partner. Check out the related Q&As to help inform your decision making process.

All the best to you both!


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