What set of labs is recommended for a comprehensive sexually transmitted disease (STD) evaluation?

Comprehensive STD Laboratory Testing Panel

A comprehensive STD evaluation should include testing for HIV, syphilis, gonorrhea, chlamydia, trichomoniasis, and hepatitis B, with additional tests based on risk factors and presentation. 1

Core STD Testing Panel

Essential Tests for All Patients:

• HIV antibody/antigen test - Screen all sexually active patients aged 13-64 1
• Syphilis serology - Most labs use reverse screening algorithm (treponemal test first, followed by non-treponemal test) 1
• Gonorrhea NAAT - Preferably using nucleic acid amplification testing 1, 2
• Chlamydia NAAT - Preferably using nucleic acid amplification testing 1, 2

Additional Tests for Women:

• Trichomonas testing - All women should be screened 1
• Bacterial vaginosis testing - Consider for symptomatic women or those at high risk for preterm labor 1
• Cervical cytology/HPV testing - Per age-appropriate screening guidelines 1

Additional Tests for Pregnant Women:

• Hepatitis B surface antigen (HBsAg) - All pregnant women at first prenatal visit 1
• Group B Streptococcus - Vaginal and rectal swabs at 35-37 weeks gestation 1

Specimen Collection Considerations

Specimen Types by Gender:

• Women:

  • Vaginal swabs (provider or self-collected) for chlamydia, gonorrhea, and trichomonas
  • Cervical samples during pelvic exam if indicated
  • First-void urine as an alternative for NAAT testing 2, 3

• Men:

  • First-void urine for chlamydia and gonorrhea NAAT
  • Urethral swabs if symptomatic 2, 4

Special Anatomic Sites:

• For MSM and other high-risk individuals:
  • Rectal swabs for gonorrhea and chlamydia NAAT
  • Pharyngeal swabs for gonorrhea NAAT 1

Risk-Based Additional Testing

For Patients with Genital Lesions:

• HSV PCR or culture from lesions
• Darkfield examination or PCR for Treponema pallidum if primary syphilis suspected 1

For High-Risk Populations:

• Hepatitis C antibody - Particularly for MSM, HIV-positive individuals, and people who inject drugs 1
• Mycoplasma genitalium testing - Consider for persistent urethritis/cervicitis 1

Testing Frequency Recommendations

• Annual screening for sexually active individuals
• Every 3-6 months for those with multiple partners, history of STDs, or high-risk behaviors 1
• During pregnancy: First trimester for all tests; repeat in third trimester for those at continued risk 1

Clinical Pearls and Pitfalls

• Self-collected specimens are highly acceptable to patients and have comparable sensitivity to provider-collected specimens for NAAT testing 2, 3
• Asymptomatic infections are common - 81-98% of chlamydia and gonorrhea infections may be missed if testing only symptomatic patients 4
• Partner testing and treatment is essential to prevent reinfection 1
• Antimicrobial resistance in N. gonorrhoeae is an emerging concern; culture may be needed for treatment failures 1

NAATs have revolutionized STD testing with higher sensitivity and the ability to use non-invasive specimens like urine and self-collected vaginal swabs 2, 3. This makes screening more acceptable to patients and allows for testing outside traditional clinical settings, potentially increasing detection rates of these often asymptomatic infections.