STI Screening Guidelines

Key Recommendations

• The American College of Physicians recommends screening all sexually active women under 25 years annually for chlamydia and gonorrhea, and screening women over 25 years plus all men based on specific high-risk behaviors and demographics 1, 2
• The American Academy of Family Physicians suggests asking about number and gender of sexual partners in the past 60 days and past year, as multiple or new partners increase risk 3, 4
• The Centers for Disease Control and Prevention recommends screening for HIV and syphilis if any high-risk behaviors are present 3, 4
• Women ≤24-25 years should be screened annually for chlamydia and gonorrhea regardless of reported risk factors, according to the American College of Obstetricians and Gynecologists 2, 6, 1
• Men who have sex with men (MSM) should be screened annually at minimum for urethral, rectal, and pharyngeal gonorrhea and chlamydia based on sexual practices, as recommended by the American College of Physicians 6, 1
• The American Academy of Family Physicians recommends screening all pregnant women for hepatitis B, HIV, and syphilis at the first prenatal visit 4, 7
• The Centers for Disease Control and Prevention suggests applying screening based on actual sexual practices, not identity label alone, for bisexual individuals 5
• The American College of Physicians recommends retesting all patients 3 months after treatment for chlamydia or gonorrhea, regardless of whether partners were treated, due to reinfection rates of 25-40% 2, 1, 10
• Nucleic acid amplification tests (NAATs) are strongly preferred over culture or other methods due to superior sensitivity, according to the American Society for Microbiology 1, 5, 10

Population-Specific Screening

• Sexually active women under 25 years should be screened annually for chlamydia and gonorrhea, according to the American College of Obstetricians and Gynecologists 2, 6, 1
• Women over 25 years should be screened for chlamydia and gonorrhea only if high-risk behaviors are present, as recommended by the American College of Physicians 2, 6, 1
• MSM should be screened annually at minimum for urethral, rectal, and pharyngeal gonorrhea and chlamydia based on sexual practices, according to the American College of Physicians 6, 1
• Pregnant women should be screened for hepatitis B, HIV, and syphilis at the first prenatal visit, as recommended by the American Academy of Family Physicians 4, 7

Screening Frequency and Timing

• Annual screening is recommended for most sexually active individuals meeting age/risk criteria, according to the American College of Physicians 1
• Increased frequency (every 3-6 months) is indicated for multiple or anonymous sexual partners, sex in conjunction with illicit drug use, partners who engage in high-risk behaviors, recent STI diagnosis, or sex work/transactional sex, as recommended by the Centers for Disease Control and Prevention 1, 5

Testing Methods and Anatomic Sites

• NAATs are strongly preferred over culture or other methods due to superior sensitivity, according to the American Society for Microbiology 1, 5, 10
• Specimen collection should be done from all sites of sexual exposure, not just urogenital, as recommended by the American College of Physicians 1, 5

Critical Pitfalls to Avoid

• Don't assume low risk based on age alone, as persons as young as 12 may be sexually active and at risk, according to the American Academy of Family Physicians 8, 9
• Don't rely solely on urogenital testing in MSM or bisexual individuals, as extragenital infections are frequently asymptomatic, as recommended by the Centers for Disease Control and Prevention 5
• Don't skip screening in young women with urinary symptoms, as UTI and STI symptoms overlap, according to the American College of Physicians 10