STI Testing in Sexually Active Patients with Urinary Symptoms

Indications for STI Testing

The American College of Physicians recommends testing all sexually active patients under 25 years with urinary symptoms, regardless of urinalysis findings, as this age group has the highest STI prevalence 1, 2
The U.S. Preventive Services Task Force strongly recommends annual screening for chlamydia and gonorrhea in all sexually active women under 25 years and older women with risk factors, which includes those presenting with any genitourinary symptoms 1

The European Association of Urology guidelines emphasize that diagnosis of uncomplicated cystitis can be made on symptoms alone in low-risk women, but this explicitly excludes sexually active young women where STI prevalence is high 2
The Centers for Disease Control and Prevention recommends using nucleic acid amplification tests (NAATs) for both chlamydia and gonorrhea on the same specimen, as these have the highest sensitivity and specificity 1, 4

The Centers for Disease Control and Prevention recommends specimen collection as follows: for women, vaginal swab (preferred, can be self-collected) or first-catch urine; for men, first-catch urine or urethral swab 1, 4
The Centers for Disease Control and Prevention also recommends testing all exposure sites (urethra, rectum, pharynx) based on sexual practices for men who have sex with men 3, 4
The U.S. Preventive Services Task Force recommends HIV and syphilis screening if not tested within the past year and sexually active 3, 4

The Centers for Disease Control and Prevention recommends treating STIs according to CDC guidelines, notifying and treating partners from the preceding 60 days, and retesting at 3 months regardless of partner treatment due to 25-40% reinfection rates 1, 4, 5