What tests are recommended for screening females for Sexually Transmitted Infections (STIs)?

Recommended STI Screening Tests for Females

For sexually active females, comprehensive STI screening should include annual testing for chlamydia and gonorrhea, with additional testing for syphilis, HIV, and trichomoniasis based on risk factors. 1

Core Screening Recommendations

For All Sexually Active Females:

• Chlamydia screening:

  • Annual testing for all sexually active females ≤25 years 2, 1
  • Testing for women >25 years with risk factors (multiple partners, new partner, or partner with other partners) 2
  • Specimen: Vaginal swab or urine using nucleic acid amplification test (NAAT) 1

• Gonorrhea screening:

  • Annual testing for all sexually active females ≤25 years 2, 1
  • Testing for women >25 years with risk factors 2
  • Specimen: Vaginal swab or urine using NAAT 1

• Syphilis screening:

  • Serologic testing for all pregnant women at first prenatal visit 2
  • Testing for non-pregnant women with high-risk behaviors 1
  • Repeat testing in third trimester for high-risk pregnant women 2

• HIV screening:

  • Testing should be offered to all pregnant women at first prenatal visit 2
  • Annual testing for sexually active women with risk factors 1

Based on Risk Assessment:

• Trichomoniasis screening:

  • Not recommended for routine screening of asymptomatic women 2
  • Consider for women with high-risk behaviors (multiple partners, history of STIs, exchange of sex for payment, injection drug use) 2
  • Specimen: Vaginal swab using NAAT preferred over wet mount (higher sensitivity) 2

• Hepatitis B screening:

  • All pregnant women at first prenatal visit 2
  • Repeat testing late in pregnancy for high-risk women 2

Anatomic Site-Specific Testing

• For women reporting receptive oral sex:

  • Consider pharyngeal gonorrhea testing 1

• For women reporting receptive anal intercourse:

  • Rectal testing for chlamydia and gonorrhea 1

Special Populations

Pregnant Women:

• First prenatal visit:

  • Syphilis serology
  • Hepatitis B surface antigen
  • HIV test
  • Chlamydia and gonorrhea tests for women at risk or in high-prevalence areas 2

• Third trimester:

  • Repeat chlamydia testing for women at increased risk 2
  • Repeat gonorrhea testing for those at continued risk 2
  • Repeat syphilis and hepatitis B testing for high-risk women 2

Women Living with HIV:

• More frequent STI screening (every 3-6 months) 2, 1
• Annual trichomoniasis screening 2
• Cervical cancer screening with Pap smear 2

Rescreening Recommendations

• After positive test results:
  • Rescreen all women diagnosed with chlamydia or gonorrhea 3 months after treatment, regardless of partner treatment status 2, 1
  • Consider rescreening women previously diagnosed with trichomoniasis 3 months after treatment 2
  • If 3-month rescreening isn't possible, retest at next healthcare visit within 12 months 2, 1

High-Risk Factors Warranting More Frequent Testing

• Multiple or anonymous sexual partners
• New partner or partner with other partners
• History of previous STIs
• Inconsistent condom use
• Sex under the influence of drugs/alcohol
• Sex in exchange for money or drugs
• Injection drug use 1

Important Clinical Considerations

• Any positive STI test should prompt consideration for additional STI testing, as the presence of one STI increases risk for others 1

• Verify hepatitis B vaccination status and offer vaccination if not previously completed 1

• Consider HPV vaccination for eligible women 1

• Partner notification and treatment is essential to prevent reinfection, especially for patients who are pregnant or HIV-positive 2

• False negatives and positives can occur with any testing method; clinical correlation is important, especially in low-prevalence populations 2

By following these evidence-based screening recommendations, clinicians can effectively identify and treat STIs in female patients, reducing morbidity and preventing long-term complications such as pelvic inflammatory disease, infertility, and increased risk of HIV acquisition.