What laboratory tests are recommended for comprehensive Sexually Transmitted Disease (STD) testing?

Comprehensive STD Testing: Individual Laboratory Tests

For comprehensive sexually transmitted disease (STD) testing, specific laboratory tests should include nucleic acid amplification tests (NAATs) for chlamydia, gonorrhea, and trichomonas, as well as serologic testing for syphilis and HIV, with site-specific testing based on sexual practices. 1

Core STD Laboratory Tests

Bacterial Infections

• Chlamydia (Chlamydia trachomatis)

  • Test type: NAAT (nucleic acid amplification test)
  • Specimen: Vaginal/endocervical swabs for women; urethral swab or urine for men
  • Notes: Gold standard with highest sensitivity (86.1%-100%) and specificity (97.1%-100%) 1

• Gonorrhea (Neisseria gonorrhoeae)

  • Test type: NAAT
  • Specimen: Vaginal/endocervical swabs for women; urethral swab or urine for men
  • Notes: Same specimen can often be used for both chlamydia and gonorrhea testing 1

• Syphilis (Treponema pallidum)

  • Test type: Serologic testing (typically RPR or VDRL, followed by treponemal-specific test)
  • Specimen: Blood sample
  • Notes: Essential for all patients seeking STI evaluation 1

Viral Infections

• HIV (Human Immunodeficiency Virus)

  • Test type: Serologic testing (antibody/antigen test)
  • Specimen: Blood sample
  • Notes: Should be offered to all patients being tested for STDs 2

• Hepatitis B

  • Test type: Serologic test for hepatitis B surface antigen (HBsAg)
  • Specimen: Blood sample
  • Notes: Particularly important for pregnant women 2

• Herpes Simplex Virus (HSV)

  • Test type: Type-specific HSV-2 serologic testing
  • Specimen: Blood sample
  • Notes: Consider for high-risk individuals, particularly MSM 1

Parasitic/Other Infections

• Trichomoniasis (Trichomonas vaginalis)
  • Test type: NAAT
  • Specimen: Vaginal swab for women; urine for men
  • Notes: Often included in comprehensive STI panels 1

Site-Specific Testing

Extragenital Testing

• Rectal Testing

  • Tests: NAAT for chlamydia and gonorrhea
  • Specimen: Rectal swab
  • Notes: Essential for MSM and others engaging in receptive anal intercourse 1

• Oropharyngeal Testing

  • Tests: NAAT for gonorrhea (and sometimes chlamydia)
  • Specimen: Throat swab
  • Notes: Important for those engaging in oral sex 1

Additional Testing to Consider

• Hepatitis C

  • Test type: Antibody test with reflex to RNA testing if positive
  • Specimen: Blood sample
  • Notes: Consider for MSM and those with risk factors 1

• Human Papillomavirus (HPV)

  • Test type: HPV DNA test
  • Specimen: Cervical sample (women)
  • Notes: Not typically part of routine STD screening but may be performed with cervical cancer screening 2

• Bacterial Vaginosis

  • Test type: Gram stain (Nugent criteria)
  • Specimen: Vaginal discharge
  • Notes: Consider for symptomatic women 1

Testing Frequency Recommendations

• Annual screening for all sexually active women ≤24 years and those >24 with risk factors 1
• Every 3-6 months for high-risk individuals (multiple partners, previous STIs, substance use) 1
• Retesting approximately 3 months after treatment due to high reinfection rates 1

Important Considerations

• Failing to screen partners can lead to reinfection (25-40% of treatment "failures") 1
• Positive tests for chlamydia, gonorrhea, syphilis, chancroid, and HIV require reporting to public health authorities 1
• Asymptomatic infections are common, particularly at extragenital sites, making comprehensive testing crucial 1

This testing approach ensures comprehensive coverage of the most common STDs while allowing for individualized testing based on risk factors and sexual practices.