STD Screening Guidelines

Introduction to STD Screening

• The Centers for Disease Control and Prevention (CDC) and other health organizations recommend comprehensive STI screening for all sexually active individuals, particularly those with risk factors, to prevent and control the spread of STDs 1, 2, 3, 4, 5

Serologic Testing

• The CDC recommends serologic testing for HIV, which includes antibody/antigen tests, and should be offered to all patients being tested for STDs 4, 5
• The CDC recommends serologic testing for hepatitis B, which includes tests for hepatitis B surface antigen (HBsAg), particularly for pregnant women 4, 5
• Serologic screening for syphilis is recommended for all patients seeking STI evaluation, particularly important for pregnant women and high-risk individuals, such as men who have sex with men (MSM), as recommended by the CDC and IDSA 1, 6, 5

DNA Testing

• The CDC recommends HPV DNA testing for cervical samples in women, although it is not typically part of routine STD screening, but may be performed with cervical cancer screening 7
• Nucleic acid amplification tests (NAATs) are the recommended method for diagnosing gonorrhea and chlamydia in females, due to their high sensitivity and specificity, and can be performed on vaginal swabs, endocervical, and urine specimens 1, 8, 2
• NAAT testing is the gold standard with highest sensitivity (86.1%-100%) and specificity (97.1%-100%) for chlamydia and gonorrhea 1

Screening Recommendations

• Annual screening is recommended for all sexually active women ≤24 years old and women >24 years with risk factors, such as new or multiple sex partners, previous STI, inconsistent condom use, sex work, or drug use, by the American College of Obstetricians and Gynecologists (ACOG) 2
• The American College of Physicians recommends annual screening for all sexually active patients, and more frequent screening (every 3-6 months) should be considered for patients with multiple or anonymous partners, previous STI diagnosis, substance use, especially methamphetamine, unprotected sex outside monogamous relationships, or sex work or partners who engage in sex work 3
• Comprehensive STI screening should include NAATs for chlamydia, gonorrhea, and trichomonas, serologic testing for syphilis and HIV, and appropriate site-specific testing based on sexual practices, as recommended by the CDC and IDSA 1, 6, 5

Special Considerations

• Type-specific HSV-2 serologic testing and hepatitis C screening should be considered, particularly for men who have sex with men (MSM), as recommended by the CDC 3
• Extragenital site testing (rectal, oropharyngeal) is essential for high-risk individuals, particularly MSM, as asymptomatic rectal carriage of pathogens is common and testing only urogenital sites would miss these infections 1, 8

Follow-up and Reporting

• Retesting is recommended approximately 3 months after treatment due to high reinfection rates, by the American Academy of Pediatrics 9
• Positive tests for chlamydia, gonorrhea, syphilis, chancroid, and HIV require reporting to public health authorities according to local requirements, with the IDSA and American Society for Microbiology guidelines recommending that high-risk individuals, particularly MSM, should have extragenital sites evaluated (rectal, oropharyngeal) for gonorrhea and chlamydia 1, 5, 8

Screening Test Summary