A Straight Dope Classic from Cecil's Storehouse of Human Knowledge

What's the purpose of premarital blood testing?

April 19, 1996

I am getting married later in the year and to do so must get a blood test. What is the purpose of this? What kind of information could the government possibly be looking for? Is this test to ensure that Americans aren't running around marrying their kin?

Cecil replies:

Got news for you, kid. Premarital blood tests haven't been required in California since 1994. The test used to be required to ensure that you and your betrothed were free of venereal disease, chiefly syphilis. The tests were a holdover from a New Deal-era anti-VD campaign and were once required in virtually all states. But maybe a third have now repealed the requirement, on the grounds that the handful of cases detected doesn't justify the exorbitant expense.

Venereal disease was one of a handful of maladies (tuberculosis was another) that were deemed to have such horrible public-health consequences that they justified compulsory testing and other drastic measures. According to medical historian Allan Brandt (No Magic Bullet, 1985), a 1901 study claimed that 80 percent of New York City men had been infected with gonorrhea and 5 to 18 percent had syphilis. These numbers were probably exaggerated (then, anyway), but maybe not by much. In 1909 VD afflicted nearly 20 percent of army recruits and accounted for a third of all sick days. In the 1920s 500,000 new cases of syphilis and 700,000 cases of gonorrhea were reported each year. Some experts believed VD was more widespread than all other infectious diseases combined.

The first effective treatment for syphilis had been discovered in 1909 but wasn't widely used, partly because of side effects, but also because of reluctance to deal with the subject openly. Moralists viewed the situation with growing alarm, fearing that men would all get the clap from hookers (who, in fact, had high infection rates) and subsequently infect their innocent brides. The women would then pass the disease along to their babies or become sterile, and poof — there goes the human race, or at least the white middle-class part of it. To this day newborns get drops in their eyes to prevent blindness due to maternal gonorrhea, which at one time accounted for 25 percent of all blindness in the U.S.

During the late 1930s surgeon general Thomas Parran was able to overcome national squeamishness and crank up an anti-VD crusade similar to that surrounding AIDS 50 years later. One result of his efforts was the requirement of premarital VD testing by the states, starting with Connecticut in 1935.

The only problem with these tests was that they didn't turn up many cases of venereal disease. Even in New York City, that pesthole of promiscuity, the positive rate for syphilis during the first year of compulsory testing was only 1.34 percent. In part that was because many couples sought to avoid the expense by getting their marriage licenses in neighboring states that didn't require testing. And of course it's possible the prevalence of the disease was exaggerated. But probably the main reason was that the respectable types who got marriage licenses were at low risk for sexually transmitted disease (or at least for the STDs being tested for).

Some anti-VD measures were more successful. VD testing of pregnant women, for example, greatly reduced the incidence of congenital syphilis. But premarital testing has largely been a waste. A study in California found that of 300,000 persons tested in 1979, just 35 cases of syphilis (0.012 percent) were found--at a cost of $240,000 per case.

The ineffectiveness of premarital VD testing deterred most states from requiring tests for today's sexual scourge, HIV. Only two states, Illinois and Louisiana, enacted premarital HIV testing laws, and both repealed them when, predictably, few new cases turned up. Illinois repealed its syphilis testing requirement at the same time. A lot of people apparently are unaware that California repealed its requirement as well--even the folks at the state department of health services were surprised when we inquired about this. If some local county clerk gives you grief, tell him to look up Assembly Bill 3128, approved by the governor July 15, 1994.

Why the government wants your blood

Dear Cecil:

In a recent column you advised a young Los Angeleno on the real reason for premarital blood testing. Although you hit the nail on the head about venereal disease, you left out an important fact. Premarital blood tests are done for another reason as well, namely to test for blood type, including Rh factor.

Rh factor was first isolated from rabbits inoculated with rhesus (hence Rh) monkey blood. It turns out that 85 percent of the population tests positively for the Rh antigen in their red blood cells (i.e., they're Rh-positive). The other 15 percent are Rh-negative. If you are an Rh-negative female and your husband is Rh-positive, as revealed by your premarital blood test, you run the risk of having an Rh-positive child. If so, you would produce antibodies against your own child's blood. The first child might be anemic, and a second or third might well die in utero or soon after birth (erythroblastosis fetalis). If you are planning to have children it is important to know if you are Rh-positive or negative so the proper precautions may be taken.

Cecil replies:

Rh testing isn't the reason most states require premarital blood tests. According to the most recent list I have, Rh testing is required only in Colorado. No question it's a good idea though.

They all look the same in the snow

Dear Cecil:

Did they really uproot ol' McGill University from Montreal, with all those ancient buildings, and move it to Toronto? Or is G. Dellaire, who wrote you about Rh factor, so much of an idiot that he doesn't know where he lives?

Cecil replies:

G. Dellaire's note didn't indicate the city of origin, so we stuck it in, based on where we thought McGill University was. It appears we were a little off. It's always embarrassing to have the universe drift out of alignment with this column's take on it, and we mean to make amends. As I see it, the options basically boil down to: (1) move the university, or (2) blame little Ed. Little Ed having balked at option two, this may not be a matter we can quickly resolve. So for now let's say that what you have up there in Quebec is McGill University at Toronto, Montreal branch.

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