STI Testing Guidelines
All sexually active individuals should receive regular STI screening based on their risk factors, with annual testing recommended at minimum for those who are sexually active and more frequent testing (every 3-6 months) for high-risk populations. 1
General STI Screening Recommendations
Who Should Be Tested
- All sexually active individuals should receive appropriate STI screening
- Higher risk populations requiring more frequent testing:
- Men who have sex with men (MSM)
- Individuals with multiple partners
- Persons who exchange sex for drugs
- Individuals with a history of STIs
- Sexual partners of persons with STIs
Testing Frequency
- Standard recommendation: Annual testing for sexually active individuals
- High-risk individuals: Testing every 3-6 months 1
- MSM: Biannual screening has been shown to avert up to 72% of gonorrhea and 78% of chlamydia infections compared to current recommendations 2
Recommended STI Tests
Blood Tests
- HIV: Testing should be offered to all sexually active individuals, especially those with risk factors 1
- Syphilis: Serologic testing using Rapid Plasma Reagin (RPR) or similar test, with confirmatory testing if positive 1
- Hepatitis B: Testing for hepatitis B surface antigen (HBsAg) 1
Site-Specific Testing
- Gonorrhea and Chlamydia:
- Trichomoniasis: NAATs from urine or vaginal specimens 3
Special Populations
Pregnant Women
Pregnant women should receive comprehensive screening including:
- Syphilis testing at first prenatal visit (repeat in third trimester for high-risk women)
- Hepatitis B surface antigen testing
- HIV testing
- Gonorrhea testing for women at risk or in high-prevalence areas
- Chlamydia testing for women under 25 or with new/multiple partners 3
Men Who Have Sex With Men (MSM)
- Annual testing is suboptimal - only one-third report regular testing despite high risk behaviors 5
- Asymptomatic STIs are common (19.9% prevalence in one study of HIV-positive MSM) 6
- Screening should include extragenital sites (pharyngeal, rectal) as 53-100% of extragenital gonorrhea and chlamydia infections are asymptomatic 4
Sexual Assault Survivors
Initial examination should include:
- NAATs for chlamydia and gonorrhea
- Testing for trichomoniasis
- Serum samples for HIV, hepatitis B, and syphilis 3
Treatment Considerations
For common STIs, standard treatments include:
- Gonorrhea: Ceftriaxone 250mg IM single dose 3
- Chlamydia: Azithromycin 1g orally single dose or doxycycline 100mg twice daily for 7 days 7, 8
- Syphilis: Penicillin (doxycycline 100mg twice daily for 2 weeks for early syphilis in penicillin-allergic patients) 7
- Trichomoniasis: Metronidazole 2g orally in single dose 3
Common Pitfalls to Avoid
- Inadequate site sampling: Failing to test all potential exposure sites (oral, rectal, genital) can miss infections
- Relying on symptom-driven testing: 70% of HSV and trichomoniasis infections and up to 100% of extragenital gonorrhea/chlamydia are asymptomatic 4
- Insufficient testing frequency: Annual testing may be inadequate for high-risk populations
- Overlooking partner notification: Partner notification is essential for preventing reinfection and ongoing transmission 3
- Ignoring antimicrobial resistance: Resistance limits oral treatment options for gonorrhea and M. genitalium 4
Reporting Requirements
- Syphilis, gonorrhea, and AIDS are reportable in every state
- Chlamydia is reportable in most states
- Clinicians should be familiar with local reporting requirements
- Reports are maintained in strict confidentiality and in most jurisdictions are protected by statute from subpoena 3
Regular STI screening is crucial for early detection and treatment, which can significantly reduce transmission rates and prevent long-term complications such as infertility, increased HIV risk, and other serious health outcomes.