Chlamydia and gonorrhea test refusal

june2016baby

So today at my appointment, the medical assistant told me to undress from the waist down, because the midwife was going to do a culture for chlamydia and gonorrhea. I was like, "No thank you." So she tells me it's mandatory and that they do it to everyone. So I politely decline again, explaining to her that I've been married 12 years, and that this is my fourth baby. She then insists it has to be done.

So when the midwife walks in, I say that "I don't understand why patients don't have the right to refuse unnecessary testing." (I used these words on purpose, of course.) She was a little flustered, and then said that of course I could decline.

I was glad she didn't take this further. Has anyone else had trouble declining these tests? I think I had them during my first pregnancy, but since then declined them. This was the first office that gave me trouble.

LizM61409

Whats the downside to just doing the damn test? They tested you for HIV and syphilis. One more isnt a big deal

alysemci

I've been married for 7 years and had them 2 years ago with my son. I get them because the doctor recommends it and it doesn't bother me. I know what the result will be but I go with the flow unless I actually care.

VikingGirl12

My OB pushes it too since those STD's can be extremely dangerous for baby. I always go with it.. Why not? I know I don't have either since I was tested with DS and I know my husband hasn't been around. But i guess I just go with it so my dr can personally rule it out if anything happens. I would hate for her to misdiagnose a miscarriage if there's something deeper going on. That's probably not likely to happen, just my way of thinking.

on3in2015

I always decline a pap smear/pelvic exam at the first appointment as they warn bleeding and cramping as a side effect.  Im not up for any unnecessary stress. Never had an "issues" but I have had side eyes. Your body, your choice. I say good on you for standing your ground. 

goldie987

In my state, they legally require all pregnant women to be tested for syphillis, gonorrhea and chlamydia, no if ands or buts about it, its law. I don't know where you live but its entirety possible that a similar situation is present in your state and they are waiting an appointment to make sure they legally have to do it. My husband and I are both each others only sexual partner (ever) but I still have to get it done.

They let me turn down the test at my annual exams but not during pregnancy because those diseases pose a risk to a developing fetus.

june2016baby

LizM61409 said:

Whats the downside to just doing the damn test? They tested you for HIV and syphilis. One more isnt a big deal

Well it wouldn't be horrible, but I appreciate saving a bit of money on the portion my insurance doesn't pay!

Also, it's just the principle of the matter. I should have some say. It's my body and baby.

MynaBird

If you know for sure you don't have it (are there other ways to contract these STIs besides sex? I'm not sure) and they're going to charge you for it (and make no mistake, they are going to charge you for it), you're right that you're well within your rights to refuse. It's unfortunate that the medical assistant wasn't trained to respond more appropriately.

Personally, I'll probably get them if they're recommended by my OB, but it's smart to think and ask questions about medical tests like this. Part of the reason healthcare costs are so inflated is that there are lots of tests people just agree to without really questioning whether they need to be done.

cattlebride

Thank the government. Your practice has to meet a standard of care. Alot of times refusals cause more paperwork and if your chart gets audited it causes more problems on the paperwork side of things. That's why many practices push things a bit more. If you have to pay I get it though.

HBamama2B

OP, I understand your frustration. I don't know of a specific state mandate or law requiring Pap smears but they are standard in most locations at the first prenatal and for very good reasons--most insurances cover them. I did not want the prenatal pap due to the risk of bleeding and my sensitive cervix, so I made sure to get one within the year prior to pregnancy as part of a 'preconception' appointment and my OB, same on who performed the pap several months ago, was entirely on board at our first prenatal apt Bc we planned ahead. Of course, not everyone has that foreknowledge so this isn't always possible.

The reason they test is Bc it's a huge risk not to. If you have more children, make sure to get testing shortly before trying to conceive and it shouldn't be an issue. But plan to be tested for every child, regardless of who you've slept with. We all want to believe in monogamy, but cheating does happen. For instance, I know for a fact that my husband will never cheat and have zero worries about it (he has very very strong feeling about infidelity) but I'm not willing to stake my baby's sight on it to avoid a pap.

RMLandy

I allowed it even though I knew what the result would be. I seriously have a hard time believing they can force you by law to do it. What state is that???

goldie987

RMLandy said:

I allowed it even though I knew what the result would be. I seriously have a hard time believing they can force you by law to do it. What state is that???

I live in Virginia but the practice is in VA, MD and DC so it could be any one (or all). I attached a pic from the packet I was given at my first appointment regarding STD testing. Essentially they are treatable diseases that can cause significant issues in utero or post partum if they go undetected. Many states mandate vaccination, I don't see how this is any different.

alysemci

I didn't know your insurance didn't cover it, that changes things

msuzannah

I can understand where you are coming from op. It is your body and you have the right to say no, BUT for me personally I will have whatever test that needs to be done. I 100% trust my husband and know the results are going to come back negative but I've worked too damn hard to get this baby to stick to leave any stone unturned. Like I said though this is just my personal preference so I don't understand why you would refuse. I do think it's weird that they pushed you so much. Maybe the MA just wasn't sure how to handle the situation.

goldie987

Just was looking around and its possible that the ACA requires insurance to cover all STD testing during pregnancy, at the very least syphillis, chlamydia and hepB (I think). I would check with your insurance because it may be 100% covered

RMLandy

I guess I shouldn't be surprised at that level of government intrusion at this point, but I will never get used to the idea of the government forcing unwanted medical procedures on people.

LizM61409

It's because even one case of preventable infant blindness from chlamydia is too many

goldie987

RMLandy said:

I guess I shouldn't be surprised at that level of government intrusion at this point, but I will never get used to the idea of the government forcing unwanted medical procedures on people.

Idk, I don't mind it. It's not invasive (not really) and, God forbid it comes back positive, I can treat the infection before it has a chance to damage my child and deal with my husband before the baby gets here. If insurance didn't cover it, that's one thing but I am pretty sure it is required to be covered by the ACA. The only medical things mandated by the government (state or federal) are things that are public health issues, the preventative measures help more than just you. Just my opinion, I totally understand if you disagree, everyone is entitled to their own, for or against it.

MynaBird

Interesting. CDC says most states require syphilis testing in pregnant women. More from ACOG here. And it does look like the ACA requires that hep B and syphilis are covered with no copay at the first prenatal visit. (It's less clear on chlamydia and gonorrhea.) CDC only recommends screening for gonorrhea in patients with risk factors, though.

SweetMamaJune

You are totally within your right to refuse unnecessary testing. The office, if they participate with certain insurance companies will get a 'ding' on their quality report for not testing you for this during a prenatal appt. it's weird that insurance companies dictate our care-chalk it up to a poor healthcare system in general. But speak up for yourself for sure!

In some instances the hospital you go to will use certain precautions for you and your baby if you have not had this testing done. It's good to ask questions!

Yoda923

It's one test that is simple and is covered by insurance...God forbid something is wrong then the dr would know if it's having to do with one of these & could be the cause .... I knew mine would come back fine ... Married 16 years and good to go but that's not to say it can't happen ... Better safe then sorry...

HBamama2B

Thanks for the info @MynaBird

@Sgoldberg247 The state law VA § 32.1-60 requires liscensed practitioners to perform the std tests during care for pregnancy, but does not obligate the pregnant woman to accept the exam. DRs are required to offer, but you have the right to refuse. The way they phrased it on your sheet is a bit misleading as here is no law requiring you to submit to a Pap smear during your pregnancy (or hopefully at any other point of your life as this is far more invasive than peeing in a cup or getting a vaccine).

Others facing the decision: Health-wise it's a good idea to do. The risks are minimal and the benefits are strong. But the decision is always yours.

goldie987

@HBamama2B Perform means they have to do it, not have to offer it. There is a provision to opt out of HIV testing if you sign a form acknowledging you understand the risk but not the others.

Also, pap smears aren't mandated, just STD testing. Unless I'm wrong (I may be) pap smears check cervical cells for cancer, they don't check for STDs.

HBamama2B

@Sgoldberg247 it is not a positive law. There is no transference to the part of the patient. You are in no way required to submit to the testing by the wording of that law. That means they are required to provide it in every instance but have no means of enforcement.

And for chlamydia testing on women, a speculum is inserted into the vagina to open the walls and present a clear view of the cervix. A swab is then taken from the cervix cells to provide cultures for the test.

goldie987

HBamama2B said:

@Sgoldberg247 it is not a positive law. There is no transference to the part of the patient. You are in no way required to submit to the testing by the wording of that law. That means they are required to provide it in every instance but have no means of enforcement.

And for chlamydia testing on women, a speculum is inserted into the vagina to open the walls and present a clear view of the cervix. A swab is then taken from the cervix cells to provide cultures for the test.

I'll have to agree to disagree on this one. IMO (not a lawyer) when the law says physicians are required to perform the testing on a patient, it means they must do it regardless of the patient refusing. Just the way I see it.

As far as the testing procedure, its basically the same as a pap but that doesn't make it a pap. I think a pap scratches with a little brush, not just swabs the surface. Also, mandating a pap is different than mandating STD screening. Having an abnormal pap doesn't pose a risk to the baby. Having an STD does.

mrsschmity

The way I look at it, the doctor is just doing their job. It's nothing personal. They are covering all of the bases. How shitty would it be if a woman (any woman) came in refusing the tests and the baby was born with something wrong that was a direct result of an STD? The medical staff is just doing their dudiligence to make sure both mom and baby are healthy - it's not like they secretly think that your husband is cheating on you or anything. It's just standard practice.

And I guess my insurance has always covered preventative care, so I'm not sure about the insurance side of things you're worried about.

HBamama2B

@Sgoldberg247 (the only reason I responded/ am responding is to correct misinformation. This is important as others may read this and feel now that they must submit to the exam based on your posts.) You're stating that the physician must forcibly perform a vaginal exam against the patient's wishes. That constitutes sexual battery (VA §18.2-61) for which the dr would be liable.

You and I and others may disagree or agree with OPs decision, but that's personal opinion--doesn't have an impact on whether she could have been forced to submit to the exam or whether you could have been. If you felt that you didn't have a choice, I'm very very sorry. What the Drs are required by law to do is gain informed consent from the patient by discussing the pros and cons of the procedure and each patients' specific risk factors, which in this case seem to have been low.

Every adult patient has the right to refuse treatment under US federal law. OP thoughtfully and rationally excersized that right, then came here for support after the emotionality of verbalizing that right. That doesn't mean others should refuse, but they do retain that right regardless of what state they live in. I understand you were speaking from your experience in your first post, that's fine. You don't need to be a lawyer, just please avoid stating laws if you don't understand them as it leads to misinformation for other people who may be facing this decision soon. Please keep it to opinions instead and simply support OP in what sounds like a difficult office visit. (Or, as pp did, provide links to credible information on why and for whom the test is recommended and the factors that led you to elect for the procedure...that's another way to be helpful.)

goldie987

HBamama2B said:

@Sgoldberg247 (the only reason I responded/ am responding is to correct misinformation. This is important as others may read this and feel now that they must submit to the exam based on your posts.) You're stating that the physician must forcibly perform a vaginal exam against the patient's wishes. That constitutes sexual battery (VA §18.2-61) for which the dr would be liable.

You and I and others may disagree or agree with OPs decision, but that's personal opinion--doesn't have an impact on whether she could have been forced to submit to the exam or whether you could have been. If you felt that you didn't have a choice, I'm very very sorry. What the Drs are required by law to do is gain informed consent from the patient by discussing the pros and cons of the procedure and each patients' specific risk factors, which in this case seem to have been low.

Every adult patient has the right to refuse treatment under US federal law. OP thoughtfully and rationally excersized that right, then came here for support after the emotionality of verbalizing that right. That doesn't mean others should refuse, but they do retain that right regardless of what state they live in. I understand you were speaking from your experience in your first post, that's fine. You don't need to be a lawyer, just please avoid stating laws if you don't understand them as it leads to misinformation for other people who may be facing this decision soon. Please keep it to opinions instead and simply support OP in what sounds like a difficult office visit. (Or, as pp did, provide links to credible information on why and for whom the test is recommended and the factors that led you to elect for the procedure...that's another way to be helpful.)

You're of course welcome to refuse a state mandated test, I'm not saying they're going to hold you down and force you to do it, I agree that is likely battery, but they are likely more than within their rights to remove you from the practice and finding s new (legitimate) practice that is willing to violate state law may not be easy.

I posted to explain to OP that in many states, it is legally required to have the testing done including in my state and that she may not actually have a choice in the matter depending where she lives. She is not alone in this considering that many of us also are required to undergo what is essentially unnecessary testing.

State law isn't open to opinions, I'm going based on the way I read the wording. It gives explicit leighway for opting out of HIV testing with informed consent but no such thing for any of the other mandated tests. Seems like quite the oversight, no? Those suggesing OP has every right to deny the tests may be wrong, we have no idea where OP lives, and sending her into her midwife with the impression that she can do whatever she wants is irresponsible.

OP, I suggest looking up laws where you live to see what tests are legally mandated. Many of them are required to be covered by insurance now, so I suggest giving your insurance a call to see what they cover.

TrejoBaby2016

I must agree with you. It's an unnecessary test that could cause a miscarriage (high risk pregnancy)and also I'm with you on the insurance part! They really do milk it. I mean, for those women that arent 100% sure that they are clean, its great, but it can pose as a major threat for women like me. One of those "mandatory" tests caused me to go into preterm labor and i lost my son at 21 weeks. They did some damage to my cervix. So im totally against unnecessary tests.

LizM61409

TrejoBaby2016 said:

I must agree with you. It's an unnecessary test that could cause a miscarriage (high risk pregnancy)and also I'm with you on the insurance part! They really do milk it. I mean, for those women that arent 100% sure that they are clean, its great, but it can pose as a major threat for women like me. One of those "mandatory" tests caused me to go into preterm labor and i lost my son at 21 weeks. They did some damage to my cervix. So im totally against unnecessary tests.

Ummmm i'm pretty sure touching a qtip to your cervix does nothing do damage it. Just because an event happened after a particular action doesn't mean the action caused the event. Correlation is not the same as causation

adiaz132003

Surprised no one has said this yet but... God forbid you had a cheating partner. Obviously you wouldn't know about it and you would assume that everything is fine but look at it from their perspective, they see this happen. They're not gonna say "well we understand you've been married so long but what if he's not faithful?" But I bet you they think it. They just want is to be safe. And OP, please don't think that I'm suggesting anyone's DH is cheating. They just have to think of worst case scenario and it's their job to protect you and your baby. I know I'll be doing all these tests even though I know they'll be fine cause I want to take zero chances.

LoveNeverFailsYou27

adiaz132003 said:

Surprised no one has said this yet but... God forbid you had a cheating partner. Obviously you wouldn't know about it and you would assume that everything is fine but look at it from their perspective, they see this happen. They're not gonna say "well we understand you've been married so long but what if he's not faithful?" But I bet you they think it. They just want is to be safe. And OP, please don't think that I'm suggesting anyone's DH is cheating. They just have to think of worst case scenario and it's their job to protect you and your baby. I know I'll be doing all these tests even though I know they'll be fine cause I want to take zero chances.

adiaz132003 said:

Surprised no one has said this yet but... God forbid you had a cheating partner. Obviously you wouldn't know about it and you would assume that everything is fine but look at it from their perspective, they see this happen. They're not gonna say "well we understand you've been married so long but what if he's not faithful?" But I bet you they think it. They just want is to be safe. And OP, please don't think that I'm suggesting anyone's DH is cheating. They just have to think of worst case scenario and it's their job to protect you and your baby. I know I'll be doing all these tests even though I know they'll be fine cause I want to take zero chances.

True story. My parents were married for 18 years. My mom went in for her yearly and they found STDs. She was faithful. My dad swore he was faithful. Turns out he wasn't.

RMLandy

I agree that unless you have a particular reason or medical issue that would preclude you, getting the test is no big deal and most should do it just to be on the safe side. I was only commenting on my personal ideological beliefs about a government mandate of invasive medical procedures, which I understand I'm likely in the minority on. I'm not disputing the purpose for and benefit from pregnant women undergoing these tests

adiaz132003

LoveNeverFailsYou27 said:

adiaz132003 said:

Surprised no one has said this yet but... God forbid you had a cheating partner. Obviously you wouldn't know about it and you would assume that everything is fine but look at it from their perspective, they see this happen. They're not gonna say "well we understand you've been married so long but what if he's not faithful?" But I bet you they think it. They just want is to be safe. And OP, please don't think that I'm suggesting anyone's DH is cheating. They just have to think of worst case scenario and it's their job to protect you and your baby. I know I'll be doing all these tests even though I know they'll be fine cause I want to take zero chances.

adiaz132003 said:

Surprised no one has said this yet but... God forbid you had a cheating partner. Obviously you wouldn't know about it and you would assume that everything is fine but look at it from their perspective, they see this happen. They're not gonna say "well we understand you've been married so long but what if he's not faithful?" But I bet you they think it. They just want is to be safe. And OP, please don't think that I'm suggesting anyone's DH is cheating. They just have to think of worst case scenario and it's their job to protect you and your baby. I know I'll be doing all these tests even though I know they'll be fine cause I want to take zero chances.

True story. My parents were married for 18 years. My mom went in for her yearly and they found STDs. She was faithful. My dad swore he was faithful. Turns out he wasn't.

OMG that sucks! My best friend got a call from her ex telling her she needs to get tested cause he was positive. It's sad that it happens.

TwoBadMice

Just like the ER doctors offices have rules for the safety of the patient, you include a baby with you. So they have rules to protect the baby. When my son swallowed the dogs blood pressure meds we had to submit him for a drug test and he had to get an IV. Not because it was necessary but bc the ER staff dosent k ow us from Adam and my kid could have eaten a bag of meth and we told them it was blood pressure meds. While I don't think k you need to get unnecessary tests, it's easier to pick your battles. I had to switch doctors at 34 weeks with my first LO bc she wanted to schedule me for a c section because he was large. I researched and weighed the risks and fought that battle. Don't worry you will have plenty to argue about down the road.

Knottie86418473

Good for you for standing up for yourself OP! (I get this crap every time I refuse a flu shot.) I understand the need and desire to test for everything under the sun to be on the safe side, but the thought of someone trying to force you into something you clearly stated you did not want, especially while in an arguably vulnerable state, does not sit well with me, regardless of my personal thoughts on accepting the tests or not. Especially if it's government mandated. I think we've all learned by now that just because "the government" makes a decision, it's not automatically a good one. Politicians set these laws and regulations into place, not doctors. I never assume anything required by law has me, or my baby's health, as their primary motivator. (Notice I said 'primary' motivator - not saying it doesn't come into play at all.)

That being said, I'm going to get all the tests because I'm a FTM, paranoid about everything, and figure why not? 

Good luck to you!

tripledaggerWed95976

TrejoBaby2016 said:

I must agree with you. It's an unnecessary test that could cause a miscarriage (high risk pregnancy)and also I'm with you on the insurance part! They really do milk it. I mean, for those women that arent 100% sure that they are clean, its great, but it can pose as a major threat for women like me. One of those "mandatory" tests caused me to go into preterm labor and i lost my son at 21 weeks. They did some damage to my cervix. So im totally against unnecessary tests.

There is no link that these tests CAUSE miscarriage. I'm so sorry for your loss and you totally have the right to your opinion, but let's not spread false information.

Arwen0503

I had my annual in June and my OB still had me take the test in October.  She said they do the test with every new pregnancy, I just rolled my eyes and did the test.

wbwells

I get it, and I get the point of it being your body your choice, but they're finding that gonorrhea, chlamydia, and syphilis can be spread through toilet seat contaminations now.  I asked my OB and she said while it's not common, it is possible if someone had it, their urine was on the seat and somehow got into an open spot on you.  I squat after sanitizing the seat in public anyway, but yea I'll test just to make sure.  And I'm paying for all of my OB/delivery/epidural etc out of pocket

Gwyneddlesliegrace

Your body is your body and you have the right to decline whatever you want. Many things are totally unnecessary. Remember that they work for you, not the other way around. Educate yourself and stand behind your choices.

FinePlacentaPie

tripledaggerWed95976 said:

TrejoBaby2016 said:

I must agree with you. It's an unnecessary test that could cause a miscarriage (high risk pregnancy)and also I'm with you on the insurance part! They really do milk it. I mean, for those women that arent 100% sure that they are clean, its great, but it can pose as a major threat for women like me. One of those "mandatory" tests caused me to go into preterm labor and i lost my son at 21 weeks. They did some damage to my cervix. So im totally against unnecessary tests.

There is no link that these tests CAUSE miscarriage. I'm so sorry for your loss and you totally have the right to your opinion, but let's not spread false information.

I'm going a step further (I'm lurking BTW) and I'm going to ask which test. No standard test I can think of would correlate to PTL.