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Some U.S. states require premarital blood testing for all couples who apply for a marriage license. This requirement is often unexpected and can be an unpleasant surprise for the couple-to-be. Not all states require premarital testing. In those that do, the test may not need to performed depending on past medical history or gender. Many states have dropped this requirement entirely, but some still retain it. Couples who can’t get their blood tests performed on time must wait to be legally married, a requirement that can range from annoying to disastrous. Here’s what everyone should know about premarital blood testing.

Myths About the Blood Test
Many people believe that premarital blood tests exist to establish biological compatibility between spouses for the purposes of having children. While it may be convenient for people to learn their blood types and potential compatibility before marriage, the law actually exists to manage disease. Another myth suggests that premarital blood testing prevents related people from marrying one another. The test does not look for this information, though it is illegal to marry close relatives.

Reasons for Marriage Blood Tests
The premarital blood test was first instituted in the late 1930s in response to widespread fear of venereal disease. Some publications in the early 20th century estimated that as much as 80 percent of the male population suffered from gonorrhea or syphilis. In an age before reliable antibiotic treatment for sexually transmitted infections, such statistics were frightening.

Moralists worried that men who contracted diseases from prostitutes or mistresses might transmit the infection to their wives upon marriage. About 25 percent of all cases of blindness at the time were caused by gonorrhea transmitted from mothers to their babies during childbirth, and there were many other possible health problems as well. Connecticut was the first state to put a premarital testing law on the books, with surrounding states following suit over the course of the next few years.

Why Testing Has Been Eliminated in Some States
Despite the fact that premarital testing was obligatory throughout most of the 20th century, many states have abandoned it as a requirement for marriage. This is in part because testing and treatment for STIs have improved greatly. Individuals are no longer afraid or ashamed to have themselves tested independently, so the premarital test isn’t as necessary as it once was. Most people have tests performed whenever they suspect they may be at risk for infection.

The test also failed to be as effective as its creators had hoped. Only about a tenth of a percent of the people tested for STIs before marriage showed positive results. This is in part because the population most likely to seek a marriage license was at relatively low risk for infection. The people most likely to develop diseases like syphilis and gonorrhea were unlikely to be married. Most U.S. states have now eliminated premarital testing, though not all offices issuing marriage certificates are aware of this fact.

Where Couples Must Be Tested
While most states no longer require couples to have a premarital blood test before they can receive their marriage certificate, a few still do. As of 2002, seven states plus Washington, D.C. Still required a blood test to get a marriage license. This number fell throughout the 2000s, however.

By late 2010, the only two states that still required any kind of premarital blood test for marriage were Mississippi and Montana. The syphilis test is required for both male and female applicants in Mississippi. In Montana, only women must be tested, and rubella is the only required screening. According to the State of Massachusetts, which discontinued premarital blood testing in 2005, detection rates among people who want to get married have dropped to almost zero.

Why Get Tested?
Even if blood testing isn’t required by state law, it’s still a good idea for people who want to get married to have their blood tested for STIs and other communicable or inherited diseases. Many patients aren’t aware of their risk for disease and can unknowingly spread it to the people they love. Some conditions can even be a problem for potential children. Taking the time to have an STI or other blood test performed is a smart decision, whether or not a patient intends to get married, and even if the law doesn’t require it.