What is the recommended timing for STD screening?

Recommended Timing for STD Screening

STD screening should occur at least annually for all sexually active individuals at risk, with more frequent screening (every 3-6 months) for those at higher risk, including men who have sex with men (MSM) who have multiple partners or engage in high-risk behaviors. 1, 2

Population-Specific Screening Recommendations

Adolescents and Young Adults

• Females aged ≤25 years:

  • Annual screening for chlamydia and gonorrhea regardless of reported risk factors 1
  • More frequent screening if new or multiple partners
  • Retest approximately 3 months after treatment for any STD 1

• Males aged ≤25 years:

  • Annual screening for chlamydia in sexually active young men in high-prevalence settings (e.g., correctional facilities, STD clinics) 1, 2
  • Consider annual gonorrhea screening based on individual and population risk factors 1

Men Who Have Sex With Men (MSM)

• Annual screening for:

  • Chlamydia (pharyngeal, rectal, urethral based on exposure sites)
  • Gonorrhea (pharyngeal, rectal, urethral based on exposure sites)
  • Syphilis
  • HIV 1, 2

• Every 3-6 months screening for those at higher risk:

  • Multiple or anonymous partners
  • Sex in conjunction with illicit drug use
  • Methamphetamine use
  • Partners who engage in high-risk activities 1

Pregnant Women

• First prenatal visit: Screen for chlamydia, gonorrhea (if at risk), and syphilis 1
• Third trimester: Retest women who:
  • Tested positive at first visit
  • Have continued risk for infection
  • Live in areas with high syphilis prevalence 1
• At delivery: Additional syphilis screening in high-prevalence areas 3

Higher-Risk Adults (any age)

• Annual screening for:
  • Those with multiple sex partners
  • New sex partners
  • History of STDs
  • Inconsistent condom use
  • Commercial sex work
  • Illicit drug use
  • Those in correctional facilities 1

Post-Diagnosis Rescreening

• Retest all patients diagnosed with chlamydia or gonorrhea 3 months after treatment, regardless of whether partners were treated 1
• Consider rescreening females previously diagnosed with trichomoniasis 3 months after treatment 1
• If retesting at 3 months isn't possible, retest at next healthcare visit within 12 months 1

Special Considerations

HIV-Positive Individuals

• Screen at least annually for curable STDs (gonorrhea, chlamydia, syphilis, and trichomoniasis in women) 1
• More frequent screening if continued risk behaviors or if new STDs are detected 1

Correctional Settings

• Universal screening of adolescent females for chlamydia and gonorrhea at intake 1
• Universal screening of adult females up to age 35 years 1
• Universal syphilis screening based on local prevalence 1

Common Pitfalls to Avoid

1. Failing to screen extragenital sites: Pharyngeal and rectal infections are common, especially among MSM, and may be missed with urogenital-only screening 4

2. Overlooking rescreening after treatment: Reinfection rates are high, making the 3-month post-treatment test critical 1

3. Relying solely on reported symptoms: Many STDs are asymptomatic but can still cause complications and be transmitted 5

4. Neglecting high-risk populations: Young people, MSM, and those with HIV require more vigilant screening schedules 1, 2

5. Using inappropriate testing methods: Nucleic acid amplification tests (NAATs) are preferred for chlamydia and gonorrhea screening due to superior sensitivity 2

By following these evidence-based screening recommendations, clinicians can significantly reduce morbidity and mortality associated with STDs through early detection and treatment.