Sexual health testing for transgender people

Reviewed by Dr Bhavini Shah

In the UK, sexually transmitted infections (STIs) are common and on the rise. In 2022 there were over 392,000 new STI cases in England, that’s an increase of 23% since 2021.

If you’re someone who is sexually active and you’re having sex with new or casual partners, it’s really important to get regular STI tests. This is because there are lots of different infections you can catch during sex, and not all of them can be prevented by using condoms. What’s more, not all STIs initially cause symptoms, which means you might not know you have anything.

In this article we’ll share why trans people are more at risk of catching STIs and how you can get tested in your local area.

Why should you get regular STI tests?

For trans people, STI testing is just as important as it is for cis people. In some parts of the world up to 40% of transgender women have HIV and transgender men are also more at risk.

Getting regularly tested for STIs is important as:

• It can prevent the spread of STIs
• It keeps you and your partner(s) healthy
• Condoms don’t protect against all STIs
• Not all STIs have symptoms so you may not always know if you or your partner have one
• Testing is quick and easy 

You can take an STI test at home, at your local sexual health clinic or GP surgery. Many tests look for more than one STI at a time, so you can get a bigger picture of your overall sexual health.  

Why are trans people more at risk of STIs? 

Trans women are 14 times more likely to have HIV than other adult women. There are a few reasons why trans men and women might be more high-risk for STIs. For example, a lack of access to testing services.

“If you’re having sex you should make sure you feel happy and comfortable, and you should get to know the ways to do it safely so you’re protecting yourself and others.” - Dr Bhavini Shah

Reduced condom use

For trans people living in the UK, difficulties with condom use rather than access to healthcare means people are more high-risk of STIs.

Although often labelled as male or female condoms, it makes more sense to think of these as external or internal condoms.

For oral or anal sex you could also use dental dams. Find out more about safe sex for transgendered people.  

Misconceptions about pregnancy

There may also be a misconception that sex with someone who is trans can’t lead to pregnancy. This thought often results in reduced condom use.

Transgender men can become pregnant even if they’re using hormone replacement therapy. Testosterone is not a form of contraception. If you or your partner don’t want to get pregnant, condoms are 98% effective at preventing pregnancies. They can also stop you getting certain STIs.

Lower surgery as a transwoman

If you’re a trans woman and you’ve had lower surgery, you may be more susceptible to infection while you’re healing or when using vaginal dilators. STI transmission may also be more likely if your vagina was made using part of your colon, as opposed to skin from the penis or scrotum. 

Lower surgery as a transman

If you’re a trans man and you’ve had lower surgery, you may be more susceptible to infection while you’re healing. If you’re healing from surgery or experiencing tearing or bleeding during sex, it’s a good idea to speak to your surgeon or doctor about what to do. And when in doubt, always use condoms.  

Transmen and testosterone

Trans men who are using testosterone are more prone to some STIs because testosterone weakens the lining of the front hole/ vagina. This could mean that viruses such as HIV can enter the blood stream more easily. 

Which STIs should you be testing for regularly?

Generally, it’s a good idea to get a general STI check-up about every three months if you’re having sex with new or casual partners. 

If you visit your nearest sexual health or GUM clinic for an appointment you can be checked and tested for a few different STIs. You can also get tested for multiple STIs using home test kits like those available from Online Doctor. 

STIs that you might be tested for include: 

• HIV 
• Chlamydia 
• Gonorrhoea

• Syphilis

• Trichomoniasis 

You might also need to be checked for genital warts and genital herpes if you’ve got any growths or sores around your genitals. 

Do trans men need to have cervical screenings?

If you’re a trans man and you’ve had a hysterectomy to remove your uterus and cervix, you don’t need to attend cervical screenings. However, if you still have a cervix, it’s strongly recommended that you attend your scheduled screenings. This can help prevent cervical cancer. Find out more about trans men and cervical screenings.

Cervical cancer is caused by certain high-risk strains of HPV, which is a common virus affecting humans. Most strains are harmless, but some can lead to cell changes which can cause cancer of the cervix, penis, vagina, anus, throat and mouth.

It’s not easy to avoid catching HPV, which is why people with cervixes need to have scheduled checks to make sure they aren’t at risk of developing cancer. Trans men and trans women can also benefit from getting the HPV vaccine if they didn’t get it during school – depending on your risk level, you might be able to get it for free on the NHS.

How to opt out of cervical screenings

Your GP can take you off the cervical screening list if:

• You no longer have a cervix but are still getting invited to cervical screenings
• You still have a cervix but don’t want to be invited for screenings  

Contact your GP surgery to opt out.

Sexual health testing when you’re non-binary

If you’re non-binary having safer sex by using condoms can help you stay in control of your sexual health. You can also look after your sexual health with regular STI tests. These can be ordered online through services like Online Doctor, or you can get tested in person at a sexual health clinic. The Terrance Higgens Trust have a list of resources including sexual health clinics that trans and non-binary people can use.  

What happens when I visit a clinic for STI testing?

When you visit a clinic for an STI test you can request a male or female nurse or doctor if that makes you feel more comfortable. You’ll then need to have a chat with the health advisor, nurse or doctor about your medical and sexual history. They’ll ask you:

• when you last had sex
• whether it was protected
• whether you have any symptoms
• why you think you might be at risk of an infection 

If you have an STI test you’ll usually need to give a few samples, which might include:

• Urine
• Blood
• Swabs of the urethra, vagina/front hole, anus or throat  

You might also need an examination of your genitals. 

Where can you get STI tests as a trans or non-binary person?

You don’t have to go to a specific type of clinic if you’re trans or non-binary – anybody can walk into an NHS sexual health or GUM clinic and ask for a test. However, you might feel more comfortable going to a clinic that’s specifically for trans and non-binary people, like Clinic T in Brighton or the Butterfly Clinic in Liverpool.

To find your nearest NHS sexual health clinic, click the links below: 

• England
• Northern Ireland
• Scotland 
• Wales 

To find your nearest trans and non-binary clinic, you can contact the Terrence Higgins Trust directly.

You can also get tested through Online Doctor. We stock a range of easy and reliable home test kits for HIV, chlamydia, gonorrhoea, syphilis and trichomonas. You can use these tests provided you’re not having any STI symptoms.

Can you test for STIs at home?

Yes, you can test for STIs for several STIs at home, including:

• Chlamydia
• HIV
• Gonorrhoea
• Trichomonas
• Syphilis 

At-home STI tests include everything you need to take your samples and step-by-step instructions. Depending on the type of test you do you may need to collect blood, urine and swab samples. But you can do these privately and in your own time. Then simply post these to the lab for testing. All test results are also confidential and with discreet delivery no one will know what’s inside the box but you.

If you’ve not got symptoms have a look at our range of home STI tests. We also offer a photo assessment which allows a doctor to diagnose a sexual health condition without needing to see you.

Conclusion

Regular STI testing, using condoms and having open honest discussions with partners can help keep everyone safe during sex. Whether you’re exploring what sex looks like for you, whether you need a cervical screening or how to get tested. 

References

https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2022-report
https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/trans-people/trans-feminine/safer-sex
https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/trans-people/trans-masculine/safer-sex
https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/trans-people/trans-feminine/testing-hiv-stis
https://www.nhs.uk/live-well/sexual-health/visiting-an-sti-clinic/
https://www.nhs.uk/common-health-questions/sexual-health/should-trans-men-have-cervical-screening-tests/
https://www.beintheknow.org/understanding-hiv-epidemic/community/hiv-and-transgender-people
https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2022-report
https://www.lgbthero.org.uk/trans-stis