From the Guidelines
The recommended approach for screening patients at high risk of Sexually Transmitted Infections (STIs) involves comprehensive testing based on sexual history and risk factors, with high-risk individuals receiving annual screening for HIV, syphilis, gonorrhea, and chlamydia, and more frequent testing (every 3-6 months) for those with multiple partners or engaging in unprotected sex. This approach is supported by the most recent and highest quality study, which emphasizes the importance of routine screening for common STIs, including syphilis, gonorrhea, and chlamydia infections, for persons at high risk for HIV acquisition, particularly men who have sex with men (MSM) 1.
Key Components of STI Screening
- Annual screening for HIV, syphilis, gonorrhea, and chlamydia for high-risk individuals
- More frequent testing (every 3-6 months) for those with multiple partners or engaging in unprotected sex
- Site-specific testing based on sexual practices, including pharyngeal, rectal, and genital specimens as appropriate
- Use of nucleic acid amplification tests (NAATs) for gonorrhea and chlamydia, and fourth-generation antigen/antibody combination assays for HIV screening
- Consideration of additional screening for hepatitis B, hepatitis C, and trichomoniasis based on risk factors
Importance of Risk Assessment and Patient Education
- A relevant sexual history should direct STI screening toward specific anatomic sites and screening for sexual acquisition of HCV, which is associated with high-risk anal sex practices 1
- Patient education about safer sex practices, consistent condom use, and the importance of partner notification are essential components of comprehensive STI prevention
- Pre-exposure prophylaxis (PrEP) evaluation should be offered to those at substantial risk for HIV
Supporting Evidence
- The HIV Medicine Association (HIVMA) recommends routine screening for common STIs, including syphilis, gonorrhea, and chlamydia infections, for persons at high risk for HIV acquisition, particularly MSM 1
- The American Academy of Pediatrics recommends routine annual screening for chlamydia and gonorrhea in all sexually active females aged 25 years or younger, and routine annual screening for rectal and urethral chlamydia in sexually active adolescent and young adult males who have sex with males 1
From the Research
STI Screening Approach
The recommended approach for screening patients at high risk of Sexually Transmitted Infections (STIs) involves routine testing for patients with high-risk sexual behaviors (HRSB) 2. This includes testing for chlamydia, gonorrhea, syphilis, and HIV.
Screening Recommendations
Screening recommendations are summarized from various organizations and apply to asymptomatic individuals 3. Once an individual has symptoms, testing becomes diagnostic. It is essential to know the prevalence of STIs within the population, as this may influence screening decisions.
Diagnostic Tests
Nucleic acid amplification tests (NAATs) are highly sensitive and specific for diagnosing gonorrhea and chlamydia 4, 5. These tests can use alternative sample types, such as urine or self-collected genital specimens, making them suitable for non-clinic screening venues. NAATs can identify asymptomatic infections, which are often missed by symptom-based diagnosis.
Risk Scores
Using sociodemographic and sexual behavior data to construct risk scores may not accurately predict asymptomatic STIs among HIV PrEP users 6. A study found that a risk score using these covariates resulted in low sensitivity and specificity, highlighting the need for alternative methods to identify individuals at high risk of STIs.
Key Considerations
- Patients with HRSB should be tested and continue testing based on recommendations 2
- NAATs can be used for routine diagnosis of STIs, especially in asymptomatic individuals 4, 5
- Screening recommendations should consider the prevalence of STIs within the population 3
- Alternative methods may be needed to increase predictive capacity for STI risk scores 6