Recommended Screening Tests After High-Risk Sexual Behavior
After engaging in high-risk sexual behavior, individuals should be screened for chlamydia, gonorrhea, HIV, and syphilis, with additional testing based on specific risk factors and anatomic sites of exposure. 1, 2
Core Screening Recommendations
For All Individuals After High-Risk Sexual Exposure:
- Chlamydia - Nucleic acid amplification test (NAAT) of appropriate sites
- Gonorrhea - NAAT of appropriate sites
- HIV - Serum antibody testing
- Syphilis - Serum testing (treponemal and non-treponemal tests)
Site-Specific Testing Based on Sexual Practices:
- Urogenital testing - For all individuals with genital exposure
- Pharyngeal testing - For gonorrhea in individuals who engaged in receptive oral sex
- Rectal testing - For chlamydia and gonorrhea in individuals who engaged in receptive anal intercourse 2
Timing of Screening
- Initial screening should occur as soon as possible after high-risk exposure
- Follow-up testing should be performed:
- For HIV: If initial test is negative, repeat at 4-6 weeks and 3 months post-exposure
- For bacterial STIs: If symptomatic, test immediately; otherwise test at 1-2 weeks post-exposure
- Rescreening at 3 months after treatment for those diagnosed with chlamydia or gonorrhea 2
Additional Screening Based on Risk Factors
Hepatitis Testing:
- Hepatitis B - Check vaccination status and screen if not vaccinated
- Hepatitis C - Screen if additional risk factors present (e.g., IV drug use, HIV-positive status) 2
For Women:
- Trichomoniasis - Particularly for women with multiple partners or other high-risk factors 3
- Cervical screening - Consider HPV testing/Pap smear at regular intervals 1
Special Population Considerations
Men Who Have Sex with Men (MSM):
- More frequent screening (every 3-6 months) recommended for those with multiple or anonymous partners 2, 4
- Testing at all potential exposure sites (urethral, pharyngeal, rectal) 2
Pregnant Women:
- All pregnant women should be screened for hepatitis B, HIV, and syphilis
- Chlamydia and gonorrhea testing for pregnant women with high-risk exposure 1, 2
Factors That Define High-Risk Sexual Behavior
- Multiple or anonymous sexual partners
- Inconsistent condom use
- Sex under the influence of alcohol or drugs
- History of previous STIs
- Sex in exchange for money or drugs
- Injection drug use 2
Important Clinical Considerations
- STI prevalence varies by geographic location and community; consider local epidemiology when determining screening approach 1
- Up to 70% of infections with herpes and trichomoniasis and 53-100% of extragenital gonorrhea and chlamydia infections may be asymptomatic 5
- The presence of one STI increases the risk for others and should prompt comprehensive testing 2
- Studies have found high STI rates among high-risk populations, with incidence rates for gonorrhea and chlamydia exceeding 39/100 person-years in some high-risk MSM populations 4
By implementing comprehensive screening after high-risk sexual exposure, clinicians can identify and treat infections early, reducing complications and preventing further transmission of STIs and HIV.