What is the standard list of labs to test for sexually transmitted diseases (STDs)?

Standard Laboratory Tests for Sexually Transmitted Diseases

The standard list of laboratory tests for sexually transmitted diseases (STDs) should include screening for syphilis, gonorrhea, chlamydia, HIV, and hepatitis B, with additional testing for trichomoniasis in women and consideration of extragenital site testing in high-risk individuals. 1

Core STD Screening Tests

For All Sexually Active Individuals:

• Syphilis screening:

  • Serologic testing using treponemal-specific test (EIA/chemiluminescence immunoassay) followed by nontreponemal test (RPR) for confirmation 1
  • Annual screening for sexually active individuals, with more frequent screening (every 3-6 months) for those with multiple partners or high-risk behaviors 1

• HIV testing:

  • All sexually active patients aged 13-64 seeking STD evaluation should be screened 1
  • Repeat testing based on ongoing risk factors 1

• Gonorrhea testing:

  • Nucleic acid amplification tests (NAATs) from appropriate anatomic sites 1
  • Annual screening for all sexually active individuals at risk 1

• Chlamydia testing:

  • NAATs from appropriate anatomic sites 1
  • Annual screening for all sexually active individuals, with priority for women ≤25 years and men who have sex with men (MSM) 1

• Hepatitis B screening:

  • HBsAg testing for those without documented vaccination 1

For Women:

• Trichomoniasis screening:

  • All women should be screened 1
  • NAAT or culture testing from vaginal specimens 1

• Cervical cancer screening:

  • Pap test at appropriate intervals based on age and risk factors 1
  • Consider HPV co-testing for women >30 years 1

For High-Risk Populations:

• Extragenital site testing (rectal, pharyngeal) for gonorrhea and chlamydia:

  • For MSM and individuals reporting receptive anal or oral sex 1
  • Based on sexual practices and exposure sites 1

• Hepatitis C screening:

  • For MSM with HIV and those with risk factors 1

• Mycoplasma genitalium testing:

  • Consider in cases of persistent urethritis or cervicitis 1

Testing Frequency

• Initial visit: Complete STD panel as outlined above
• Annual screening: For all sexually active individuals
• More frequent testing (every 3-6 months): For high-risk individuals including:
  • Multiple sex partners
  • MSM
  • History of STDs
  • Sex workers
  • Partners of individuals with STDs 1
• Retesting at 3 months: For individuals treated for gonorrhea, chlamydia, or trichomoniasis due to high reinfection rates 1

Special Considerations

For Pregnant Women:

• Syphilis, HIV, hepatitis B, gonorrhea, and chlamydia testing at first prenatal visit 1
• Repeat testing in third trimester for high-risk women 1

For Individuals with Genital Lesions:

• Serologic testing for syphilis
• Testing for genital herpes
• Consider testing for Haemophilus ducreyi in areas where chancroid is prevalent 1

Important Clinical Pitfalls

1. Asymptomatic infections: Many STDs present without symptoms but can still cause serious complications and be transmitted to partners 1

2. Inadequate anatomic site testing: Failure to test extragenital sites (rectum, pharynx) in MSM and other at-risk individuals can miss up to 70% of infections 1

3. Partner notification: Failure to test and treat partners leads to high reinfection rates 1

4. Window periods: Recent infections may not be detected during early stages; consider repeat testing after appropriate window periods 1

5. Test selection: Using inappropriate tests (e.g., non-NAAT methods for chlamydia/gonorrhea) can result in decreased sensitivity 1

By implementing comprehensive STD screening based on these guidelines, clinicians can effectively identify and treat infections, prevent complications, and reduce transmission in the community.