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 sexually transmitted infections (STIs) and risk communication concerns with your partner. It’s great to see how much priority you’re 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 (which include the potential for STI transmission), and then a mutual decision by you and your partner as to the course of action.

More to the latter part of your question, yes — there are 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 result in symptoms, if they ever develop at all. For example, a hormonal change or a particular stressor could spur symptoms of an STI to appear at a specific time. Chlamydia, gonorrhea, syphilis at certain stages, herpes (between outbreaks), and human papilloma virus (HPV) (the virus that can cause genital warts and certain types of cancer) can all be asymptomatic. Human immunodeficiency virus (HIV) can have an incubation period of up to ten years before symptoms of advanced HIV (sometimes called acquired immunodeficiency syndrome or AIDS) appear, although usually the antibodies show up on a test within six months of transmission of the virus.

Though it sounds like your partner has been tested for HIV, if neither of you have been tested for other STIs, you can’t know for sure if you’re infected or not. In addition to the HIV test, both you and your partner can be tested for gonorrhea, syphilis, and chlamydia. As for other STIs, though there’s no routine tests available, a visual exam of the genitals and other potentially impacted areas can be done to look for signs of HPV and herpes.

Given all of this information, it sounds as if you have enough to start a discussion about your options, determine your comfort level with each one, and make a decision together. You may decide to have the other round of testing done (whether there are visible symptoms or not) 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 unless you decide to have children in the future and still significantly reduce the chances of transmitting an STI. Further, using a back-up to a primary contraceptive method (such as using condoms in conjunction with the birth control pill or IUD) to prevent an unintended pregnancy might be worthy of consideration as well.

Over all, the best decision for the two of you will depend on a mutual assessment of the risks involved in switching to and relying on another form of contraception and you and your partner’s willingness to take on those risks. Perhaps you can speak with a health care provider or a health promotion professional together to learn more about the risks and benefits of each type of contraception to help you decide. You might also inform your decision-making process by taking a look at the related Q&As as well as those under the Contraception category of the Go Ask Alice! Sexual and Reproductive Health archives.

All the best to you both!

Alice!

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