Gonorrhea and Chlamydia are the most commonly reported notifiable sexually transmitted diseases (STDs) in the US territory of Puerto Rico (PR). STD rates in PR have increased significantly over the past ten years. It is worth noting that the most common infectious disease in PR is often an STD.
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Why Testing Matters?
Sexually transmitted infections (STIs) are the initial stage of STDs. The infection could be caused by a virus, bacteria, or parasites, and it is usually transmitted via unprotected vagina, oral, or anal sex. Furthermore, skin-to-skin genital contact and needle exchange can also become causes of infection. Do you know that Zika Virus is also a sexually transmitted disease?
Syphilis, gonorrhea, and chlamydia are the most commonly reported STDs in the USA and PR. In most cases, these infections can be transmitted unknowingly since a person may be asymptomatic and exhibit no specific symptoms of infection. Depending on the infection, symptoms may appear within a few days or take several weeks to be detected. Such as chlamydia, genital herpes, and gonorrhea symptoms may appear after several weeks while syphilis, hepatitis B, and HIV symptoms could take several months to appear,
Some of the common symptoms that may appear on their own or in combination are burning sensation when urinating, abnormal genital discharge, bleeding following intercourse, rashes or sores in or around anal and genital areas, sudden fever and flu-like symptoms and swollen lymph glands.
You can prevent yourself from getting affected by STDs if only you make STD testing a regular part of your annual health checkup. If you are infected, it could be diagnosed early and receive treatment immediately. If diagnosed and treated at the right time, it is possible to prevent further progression of an STD and its transmission to another individual.
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Use our confidential STD symptom checker to get an idea of what STDs/STIs your symptoms align with and what STD tests are recommended to you.Start Symptom Checker
Which Method of STD Testing is Suitable for Me?
Every sexually active individual must protect their sexual health. Regular STD testing is the only way to care for your sexual health. However, sometimes it becomes confusing to select the right testing method as there are so many options available. For your convenience, we have gathered information about all available STD testing methods in Puerto Rico. Check them out to find out which option is suitable for you.
This is one of the most popular ways to get tested for STDs today. These tests combine the best of both worlds for convenience and accuracy. You will order the test online at home, but you can walk into a professional lab testing center to get tested.
Another option is to simply visit your regular clinic and talk to your doctor.
If you do not want to visit a testing center, then a great alternative is an at-home test kit. You don’t even need to leave your house to get tested for STDs this way, which makes it the most discreet option. Everything is done through email and snail mail.
One last option for STD testing is a trip to a free clinic. If you go to a public STD-testing clinic, then you may get a free or discounted test, depending on your financial situation.
Learn more in our ultimate guide to STD testing.
It can be, but it does not necessarily have to be. What many people need to understand is that laboratory tests would most often than not be relatively pricey due to the technology that is being utilized behind these diagnostic techniques. However, opting for specific laboratories that offer more convenient testing procedures and discounted prices for diagnostic tests would help ensure that the price will not be much of an issue in providing you with the conclusive diagnosis of your condition. It might take some independent scanning to find the right testing center for you in the most acceptable price range, but it is not as impossible as many people make it out to be.
Considering that a wide variety of testing kits and laboratory procedures can be performed to determine conclusively whether you have a particular STD or not, the time that it will take for your results to return will also be subject to the same inconsistency. Although there are specific laboratories that could produce your results even by the end of the day (albeit, it is extremely rare for institutions to do so unless necessary), most would often take a few days to a week before the results are either delivered or posted online through your secure personal profile (in the case of online transactions). In addition to that, the capability of the laboratory performing the test may also contribute to the overall timeframe of result delivery – causing delays in cases where there are several requests or understaffed to provide expedited results.
For more information, skip to the FAQs section on this page.
Know all about STD testing options, and the costs of different STD tests.
Puerto Rico STD Data
Chlamydia is the most frequently reported STD in PR, and gonorrhea is the second most commonly reported notifiable disease in this region, according to the statistics shared by the PR STD Surveillance Office and the US Census Bureau. From 1991 to 2004, the reported chlamydia infection rates increased from over 2 to more than 92 cases/100,000 people. In 2004, gonorrhea and chlamydia infection rates in Fajardo and Metro health regions were the highest amongst all health regions in the territory.
According to the PR STD Surveillance Office, between 1991 and 2004, the chlamydia rate increased by a staggering 4,376%, and gonorrhea cases dropped by over 56% in PR. The decrease in gonorrhea rates indicates changes in screening practices, reporting practices, and diagnostic tests with diverse sensitivities. This could be because of an increase in the number of people getting screened for STDs after expanding testing facilities and clinics across the region.
As per social and epidemiological statistics, the high prevalence of HIV and other STDs in Puerto Rico is more concentrated among the underserved and vulnerable populace. Hence a larger disparity is created between these populations. High-risk sexual practices in these vulnerable groups increase the rate of disease transmission. Moreover, the lack of screening and access to better health care services.
In Puerto Rico, syphilis rates among men and women were almost the same in 2001, but by 2008, the rate among males was six times higher. This disparity could be due to the growing incidence rate of syphilis in men who have sex with men (MSM).
Since the last few decades, HIV has become a cause of concern for health authorities worldwide. HIV first found its way to the united states in the 1980s and has claimed the lives of more than 700,00 people in the United States alone. According to data recorded in 2020, there are currently around 37.7 million people living with the virus worldwide. The same data indicates that 680,000 people have died of HIV globally in 2020 alone.
Considering the rising numbers of HIV, Puerto Rico stands no different. According to a data source, HIV/AIDS has been a leading cause of death in residents of this island. According to the epidemiological report by the Centers for Diseases and Control, Puerto Rico has been ranked in the top ten U.S territories and states for having the highest numbers of people living with HIV and highest diagnosis per year.
In 2016, Puerto Rico was ranked 6th state/territory for having the highest numbers of HIV diagnoses, and in 2017 it was ranked in 10th place. Owing to the rising numbers of HIV and considering the number of mortalities, health authorities have been trying to reduce the numbers of HIV new diagnoses and improve the living conditions of people living with the virus in Puerto Rico in line with the national HIV eradication policy. It is therefore imperative that every sexually active individual should make HIV testing a mandatory part of their annual health checkup.
According to the data from the epidemiological report formulated by CDC, the total number of reported cases of HIV and AIDS in Puerto Rico from 1980 to 2018 was 49,639. The total number of mortalities related to the complications from HIV/AIDS was 29,391. However, the total number of people living with HIV/AIDS in Puerto Rico by the end of 2018 was 18,117. The same report indicates that in 2018 alone, 440 people were newly diagnosed with the disease in Puerto Rico. The rate of new diagnosis per 100,000 populations was 15.7, which is indeed a huge number.
Considering the data from another report by AIDSVu, the total number of people living with the virus in Puerto Rico was 15,837 as calculated by the end of 2019. In 2019 the total number of newly diagnosed cases of HIV on this island was 383. The same report indicates that the rate of people living with the virus in Puerto Rico in 2019 per 100,000 population was 563.
HIV has been affecting specific populations, ethnicities and genders. Following a similar trend, the majority of the total people living with HIV are male residents of the island, most of whom are gay, bisexual, and transgender women with Hispanic backgrounds.
Between 2000 and 2004, chlamydia rates were the highest among females and males aged 20-24 years. Conversely, gonorrhea rates in PR decreased from 1991 and 2004, going from over 16 to 7 cases per 100,000 people, and the rates were highest among males and females aged 20-24 years.
Chlamydia positivity and co-infection rate with gonorrhea in Puerto Rican women between 2003 and 2005 was 6.6% among females aged 15-30 years and those aged 15-22 years, and the positivity rate was 8.4%. Among women aged 23-30 years, this rate was 4.5%. The positivity rate was highest in the Detention Centers with 14.9%, followed by STD clinics with 12.4%, and Prenatal Clinics reported an 11.7% positivity rate. For women with gonorrheal infection, the positivity rate for co-infection with chlamydia was highest in STD clinics, with 1.9% for women aged 15-22 years and 2% for those aged 23-30 years.
PR STD surveillance data indicate that MSM are disproportionately impacted by sexually transmitted infections and HIV, and they account for an increasing number of new STD cases. As mentioned above, syphilis rates among PR males were six times higher than females, and the rate has increased substantially since 2001. This increase in the male/female incidence ratio is attributed to a sharp incline in syphilis among MSM.
According to the data from the report by AIDSVu, the total number of people living with HIV in Puerto Rico by 2019 was 15,837. Of the people living with the virus, 70.7% were males, and 29.3% were females. Puerto Rico is dominated by Latino and Hispanic populations, so the numbers aren't very surprising. Of the total people living with HIV, 99.6% belonged to Hispanic backgrounds. The rate of people living with HIV on the island per 100,000 population was 563.
As per the data from the same report, 383 people were newly diagnosed with HIV in Puerto Rico in 2019. 80.2% of the new diagnosis was males, while 19.8% were females. 98.7% of the new diagnosis belonged to Hispanic /Latin backgrounds, while 1 % were white residents and 0.3% of the total numbers were Black/African residents of Puerto Rico.
Many people living with the virus were aged 55 years and above (46.2%). 27.1% of the people living with HIV in Puerto Rico were between 45 to 54 years, 15.4% between 35 to 44 years, while 9.7% and 1.7% were between the ages 25 to 34 years and 13 to 24, respectively.
HIV/AIDS in Puerto Rico has been identified as the fourth leading cause of death. According to the data from AIDSVu, the total number of HIV related mortalities in 2019 in Puerto Rico were 346, while the rate of mortalities due to HIV related complications per 100,000 population was calculated to be 12.
The same report has shown that in males, the most popular transmission mode of the virus was male to male sexual contact, which accounted for 42.9% of the spread. 20.5% of the cases were reported due to heterosexual contact, while 28.7% of the cases in males were reported due to contaminated syringe use for drug purposes. In females, the most common transmission mode of HIV was heterosexual contact 78.0%, while the less popular modes of transmission included injection drug use, 19.6%.
PROFAMILIA has been addressing public health problems linked to the increase in unwanted pregnancies among adolescents, particularly the rise in STDs rates. In PR, sexual activity among the youth starts from 12 years of age and the incidence rate of AIDS and other notifiable STDs was higher in people aged 15-29 years. Therefore, in response, the organization developed a program to offer preventive education to PR youth, enabling young teens and adults to use peer counseling techniques to utilize peer counseling methods and teach others about responsible sexual practices and prevention of STDs and HIV/AIDS.
The AIDS Project for Adolescents is another important initiative by PROFAMILIA in which peer education is provided to young people about STDs and HIV/AIDS prevention. This is a unique way to offer education, as adults don't provide sex education from an authoritative point of view. PROFAMILIA has established eight Family Planning Information Centers across the territory to increase PR residents' accessibility to family planning.
STDcheck.com is a widespread statewide service in PR offering STD testing facilities. In PR, STDcheck.com's test results are delivered within two days, and the facility is compliant with local and federal privacy mandates, such as the HIPSS Privacy Rule. Testing is offered in a completely confidential environment, and results are not added to the individual's permanent medical record. More than four thousand confidential STD testing centers are established around PR, where STI tests are carried out with complete accuracy and authenticity, and medications are prescribed by a specialist if required.
Since the 1990s, the Pan American Health Organization's Program on AIDS/STD has carried out activities focused on vulnerable populations, particularly females. The Latin American Center for Sexually Transmitted Diseases (Centro Latinoamericano de Enfermedades de Transmisión Sexual or CLETS) is among the territory's largest publicly funded STI clinics operating in PR.
Among the primary activities of CLETS include epidemiological surveillance and direct technical cooperation. In 2007 a research collaboration was commenced between researchers at the University of Puerto Rico's School of Public Health and CLETS to assess STI/HIV screening facilities in the San Juan metropolitan area. Since then, the organization has focused its efforts on expanding PR residents' access to quality STD/HIV screening, diagnosis, and treatment.
Several organizations are working in Puerto Rico and providing essential care to HIV positive residents. Like other U.S states, several agencies are receiving funding from the Federal initiative specially designed for HIV/AIDS funding, The Ryan White Part B program and the Aids Drug and Assistance Program. The funds received from these programs are used to provide basic medical care, financial assistance to the underinsured or underinsured, case management, mental health support, and housing for all people living with HIV in Puerto Rico.
AHF Health Care Center in Puerto Rico, in line with the global goals of eradicating HIV, is actively participating in creating awareness of the virus and education regarding the prevention strategies. This is a global nonprofit organization working for 30 years in around 45 countries to improve the living conditions of people living with the disease. It provides services like free HIV testing, HIV treatment, Blood testing services, case management, and community referrals to all the residents of Puerto Rico.
Center for HIV Identification, Prevention, and Treatment Services, CHIPTS, is yet another organization actively working in Puerto Rico for research and innovation in interventions to provide better care options for HIV patients. It works in the provision and devising innovative treatment methods for communities at risk with HIV.
How Does it Work?
Most people experience feelings of hesitation when going to get tested for STD, despite knowing they might have contracted one. EasySTD was created to change that.
Visit your nearest lab or clinic, order your home testing kit online, and follow the given instructions from an STD testing provider.
After ordering your STD test, visit the testing center to get tested or take a self sample including urine, cotton swab, or finger prick with the home testing kit and mail it back.
Receive the lab-certified results of your STD test from your test provider via mail or phone within 2 to 3 days. If the test comes positive, consult your doctor immediately.
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A nucleic acid amplification test is a laboratory procedure that professionals often perform to make detecting a particular nucleic acid or gene being targeted easier and more convenient while still ensuring that the sample being collected is relatively minimal. Nucleic acid amplification tests, or NAATs, are usually the mainstay diagnostic test for most STDs due to their ability to detect the presence of pathogenic nucleic acids and genes in the patient sample with utmost accuracy and speed. NAATs depends on their ability to replicate the target RNA and DNA to create numerous copies – resulting in an increased convenience in the detection of the desired molecules instead of trying to either blindly look for one strand in a minuscule sample or collecting a large sample that could make the patient uncomfortable throughout the process. Although NAATs are often preferred for a more conclusive diagnosis of STDs, certain exceptions such as the availability of resources and instances of intermittent viral shedding could make NAATs less desirable than other tests. Fret not, however, as your physician is knowledgeable regarding these instances and would often request the best diagnostic procedure for your instances.
Although NAATs are well-known for their accuracy and sensitivity in detecting most STDs, it is also subject to certain inconsistencies, especially in the case of herpes infections. In Herpes, outbreaks often result in a relative increase in the patient’s viral load – leading to a timeline that usually has specific peaks at certain intervals instead of a consistent rise in viral load throughout. As such, sensitive tests such as NAATs are still unable to accurately diagnose herpes conditions, especially in cases where the patient has recently become asymptomatic and is currently between outbreaks. Other tests such as culture testing and type-specific virologic tests are often employed instead as a confirmatory diagnosis for the patient’s condition.
It does vary on a case-to-case basis. Insurance policies are often particular with the instances that they would be covering with their program. Some may cover severe accidents, some may even consider “orphan disease,” and yes, some may also cover the expenses for performing STD diagnostic tests. However, considering that your insurance provider will have to verify the person's identity availing of the program, STD testing laboratories that employ a minimal collection of patient information may not accept insurance policies to prioritize privacy over affordability.
Depending on the test being performed and the testing physician's targeted diseases, various types of samples can be requested from you. In some instances, a minuscule blood sample of a few milliliters will be collected, some might ask for a urine sample, and others may opt for a genital swab. Again, the sample being collected will depend on the test being conducted and the outcome that is being targeted for this particular procedure.
Similar to what was previously mentioned, herpes infections are known for their recurring tendencies – causing outbreaks now and then and thus causing an intermittent spike in the patient’s viral load for specific instances. In addition to that, other STDs also take time to proliferate and produce a sufficient viral load that could warrant a positive and, more importantly, accurate diagnosis and detection from the tests being administered. As such, detecting an STD a few days following exposure is often complex and unpredictable – leading physicians to follow a certain timeframe instead for testing STDs instead of blindly testing immediately following exposure. Physical exams, however, may supplement inaccurate laboratory diagnoses, especially in cases where the test is prone to false results.
Help stop the spread of STDs by knowing your status. Get tested today!