STBBI Screening in Monogamous Relationships: Is it Necessary?

People have a tendency to attribute several benefits to monogamy, including a lower – or even non-existent – risk of contracting a sexually transmitted or blood-born infection (STBBI).

In principle, if we use a conservative definition of monogamy, that is, lifelong sexual and romantic exclusivity, this belief holds water for most (yep, there’s an exception!) ) STBBIs. However, this type of monogamy is rarely practiced today: most of us will have (or have had) more than one long-term partner in our lives.

Because our “serial” monogamy is imperfect, it’s not an infallible protection strategy against STBBIs.

The “dating period”

When people start dating someone new, many tend to have sex before making the relationship “official” or having a discussion about expectations regarding exclusivity (for example, establishing what each person means by “being monogamous”; Civic, 2000). Furthermore, during these sexual encounters, condoms and dental dams (a thin square of latex) are often not used.

According to Club Sexu’s survey data, 44% of people who were not in a committed relationship reported not having used protection against STBBIs the last time they had sex (this figure rises to 74% among people in committed relationships).

Data from the Institut national de santé publique du Québec (INSPQ, 2017), which present similar findings, also show that, among young people aged 17 to 29 who used a condom the last time they had sex, 20% engaged in penetrative sex before taking the condom out of its packaging. Come on folks! Protecting yourself after sexual contact is a bit like wearing your face-mask below your nose: it’s downright ineffective at preventing transmission!

A matter of trust

Condoms and dental dams are often given up for reasons that have nothing to do sexual health: (1) when we want the relationship to become “serious” (Bauman et al., 2007; East et al., 2007), (2) when, in different-sex relationships, the partner who has a uterus gets on hormonal birth control or has an IUD inserted (Morroni et al., 2013), or (3) when we feel safe and comfortable with our partner (Sparling & Cramer, 2015), as opposed to waiting until after having had a frank and open discussion about our sexual health and actually being tested for STBBIs.

According to a Canadian study, people consider familiar people, such as acquaintances and friends, to be more trustworthy and at lower risk of having an STBBI compared to strangers, without knowing anything about their sexual health (Sparling & Cramer, 2015).

So, the more we know a person, the less we feel at risk. Which incidentally, can put us more at risk.

Research shows that the less you feel at risk, the less likely you are to use protection and get tested (Cuffe et al., 2016; INSPQ, 2017; McDonagh et al., 2018).

Because these two steps – (1) having sex before being “officially” exclusive or without having had an explicit discussion regarding sexual exclusivity and (2) abandoning condoms and dental dams when we want to establish a “serious” relationship when the risk of pregnancy is reduced or when we feel safe – are repeated from one new relationship to another, some studies suggest that the likelihood of contracting and transmitting an STBBI may increase from one monogamous relationship to next (e.g., Ott et al., 2011).

The elephant in the room: infidelity

Beyond serial monogamy as described above, sexual infidelity also introduces a risk of contracting one or more STBBIs. Although we rarely think that our partner will cheat on us – or vice versa – research on infidelity suggests that it is relatively common. On average, one in four people report having cheated (Mark et al., 2011). According to our own data, this increases to one in two people.

In addition to being a breach of trust and relationship agreement, sexual infidelity increases the risk of contracting and transmitting an STBBI, especially in relationships with a monogamous agreement.

According to one study, people in monogamous relationships were less likely to use protection with their other partner(s) and less likely to get tested than people in consensually non-monogamous relationships (open relationships, polyamory, etc.; Conley et al., 2012). Therefore, although people in consensually non-monogamous relationships report having more sexual partners, they receive as many STBBI diagnoses as people in monogamous relationships (Lehmiller, 2015). Wait, what????

Why are people in monogamous relationships at risk?

Unfortunately, no study has yet examined why condoms and dental dams tend to be used less frequently during infidelity in a monogamous context than during sex with a new partner in the consensually non-monogamous context. That said, there are a few plausible explanations:

1. Most people in a monogamous relationship are not used to using condoms, much less buying them, which means that a majority don’t have them at their disposal.
2. Since buying condoms and dental dams involves some planning, it can induce guilt in monogamous people: “If I bought condoms/dental dams, it’s because I planned the infidelity, which must mean I’m a bad person. On the other hand, without condoms/dental dams, I can tell myself that it was unplanned, that it was spontaneous, or that it was not entirely my fault.” Thus, guilt may lead many to avoid buying protection.

All this being said, if our partner receives a positive test result, it doesn’t necessarily mean that they cheated on us! It’s possible, for example, that our partner contracted the STBBI before being in a relationship with us and that they were simply not aware of it, since several STBBIs don’t show any symptoms

 It’s also possible that they actually did get screened, but that the result was a false negative. As with COVID-19, a false negative usually occurs when a person goes in for testing soon after exposure, when the virus or bacteria didn’t have enough time to multiply and therefore become detectable by a test.

So, while learning that our partner has an STBBI may be surprising and upsetting, it’s best to keep an open mind, give them the benefit of the doubt, and have a frank conversation with them.

To better take care of our sexual health, it’s a good idea to:

• Talk about STBBI screening history with our partner before first having sex.
• Get tested before abandoning condom or dental dam use, even if no one has any symptoms, since many STBBI cases are asymptomatic.
• Get tested after unprotected sexual contact.
• Go get tested at least once a year when you are in a monogamous relationship (or more often if you have more than one partner).

Asking our family doctor to get screened for STBBIs (or being asked by our doctor!) can be difficult or feel awkward, especially if they have been our doctor for a long time and know that we are in a monogamous relationship. If this is the case for you, rest assured that there are other options. For example, Prelib is an inclusive clinic specializing in STBBI screening and self-testing that offers free (covered by RAMQ), confidential, and quality services. CLSCs are another confidential option.

In summary

Getting tested when in a monogamous relationship is a bit like driving on a deserted road: Just because there aren’t any other cars around doesn’t mean you can ignore red lights or not turn on your turning signal before making a turn or changing lanes. On the contrary, we continue to be mindful of our actions for the sake of safety – our own as well as that of others. After all, we go to the dentist’s office and see our family doctor regularly for routine check-ups, even if everything’s fine, because we value our health.

So why not add a yearly STBBI test to our list of habits? It’s much less time consuming  and painful than a dentist’s appointment! And just as cavities aren’t always painful, STBBIs don’t always show symptoms. In short, it’s better to treat sooner rather than later. And it’s empowering to take charge of your sexual health!