What tests and treatment are recommended for individuals at risk of or showing symptoms of sexually transmitted diseases (STDs)?

From the Guidelines

Individuals at risk of or showing symptoms of sexually transmitted diseases (STDs) should undergo comprehensive testing, including blood tests for HIV, syphilis, and hepatitis B; urine tests for chlamydia and gonorrhea; and physical examinations with swabs of potentially infected areas, as recommended by the most recent guidelines 1.

Recommended Tests

• Blood tests for HIV, syphilis, and hepatitis B
• Urine tests for chlamydia and gonorrhea
• Physical examinations with swabs of potentially infected areas
• Syphilis serologic testing, including nontreponemal and treponemal tests 1
• Gonorrhea testing, including urine NAAT for men and vaginal swab, cervical swab, or urine NAAT for women 1
• Chlamydia testing, including urine NAAT for men and vaginal swab, cervical swab, or urine NAAT for women, especially if sexually active and aged 25 years or younger, regardless of symptoms 1

Treatment

• Azithromycin (1g single dose) or doxycycline (100mg twice daily for 7 days) for chlamydia
• Ceftriaxone (500mg intramuscular single dose) for gonorrhea
• Penicillin G benzathine (2.4 million units intramuscular) for syphilis
• Acyclovir, valacyclovir, or famciclovir for herpes outbreaks
• Antiretroviral therapy for HIV, typically a combination of medications determined by a specialist

Prevention and Screening

• Regular testing is recommended for sexually active individuals, especially those with multiple partners, with frequency ranging from every 3-12 months depending on risk factors 1
• All patients tested for gonorrhea should be tested for other STDs, including chlamydia, syphilis, and HIV 1
• Dual therapy for gonococcal and chlamydial infections is recommended 1
• Retesting is recommended 3 months after treatment for chlamydial or gonococcal infections, regardless of whether partners have been treated 1

From the FDA Drug Label

All patients with sexually-transmitted urethritis or cervicitis should have a serologic test for syphilis and appropriate cultures for gonorrhea performed at the time of diagnosis. Appropriate antimicrobial therapy and follow-up tests for these diseases should be initiated if infection is confirmed Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae. Genital ulcer disease in men due to Haemophilus ducreyi (chancroid).

Recommended tests and treatment for individuals at risk of or showing symptoms of STDs:

• Serologic test for syphilis
• Cultures for gonorrhea
• Antimicrobial therapy for urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae
• Treatment for genital ulcer disease in men due to Haemophilus ducreyi (chancroid)
• Follow-up tests to confirm infection and monitor treatment efficacy 2

From the Research

Screening Tests for STDs

• The US Preventive Services Task Force (USPSTF) recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection 3
• The USPSTF also recommends screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection 3
• Screening for gonorrhea and chlamydia is important because many cases are asymptomatic, and untreated infections can lead to complications such as pelvic inflammatory disease and increased risk of acquiring or transmitting HIV 3, 4

Asymptomatic STDs

• Asymptomatic STDs are a significant public health concern, with an estimated 45% of gonorrhea cases and 77% of chlamydial infections being asymptomatic 4
• Routine screening at high-volume sites is an effective method to control asymptomatic STDs 4
• National guidelines recommend asymptomatic routine screening for STDs in HIV-infected persons, but screening rates are often suboptimal, particularly for rectal and pharyngeal gonorrhea and chlamydia 5

Diagnostic Tests for STDs

• Diagnostic tests with high sensitivity and specificity are available for bacterial STDs such as syphilis, gonorrhea, and chlamydia, but access to these tests is limited in developing countries due to expense and lack of laboratory capacity 6
• There is a need for simple, cheap diagnostic tests for STDs that can be performed at the point of care, enabling treatment to be given immediately 6
• Recent advances in understanding the pathogenesis of STDs and the availability of complete genome sequences for causative organisms may lead to the development of improved point-of-care tests 6

Treatment and Recommendations

• The USPSTF recommends screening for chlamydia and gonorrhea in asymptomatic, sexually active adolescents and adults, including pregnant persons 3
• Screening recommendations only apply to asymptomatic individuals, and testing becomes diagnostic once an individual has symptoms 7
• It is essential to know the prevalence of STDs within a population, and screening may be recommended regardless of guidelines if the population has a high prevalence of a specific disease 7