STD Testing and Treatment Recommendations
Sexually transmitted infection (STI) testing should be tailored to specific populations based on risk factors, with all sexually active women under 25 years and those with high-risk behaviors receiving annual screening for chlamydia, gonorrhea, HIV, and syphilis. 1, 2
Population-Specific Screening Recommendations
Nonpregnant Women
- Screen all sexually active women younger than 25 years for chlamydia and gonorrhea annually 1, 2
- Screen women with high-risk sexual behaviors (multiple partners, new partners, inconsistent condom use, sex under influence of substances, commercial sex) for chlamydia, gonorrhea, HIV, and syphilis 1
- Test for trichomoniasis in women with symptoms or risk factors 2
- Test for bacterial vaginosis in women with vaginal discharge or odor 2
Pregnant Women
- Screen all pregnant women for hepatitis B, HIV, and syphilis at first prenatal visit 1
- Screen pregnant women at increased risk (younger than 25 years or with new/multiple partners) for chlamydia and gonorrhea 1
- Repeat syphilis testing in the third trimester and at delivery for high-risk women 1
- No infant should be discharged without determination of the mother's syphilis status at least once during pregnancy 1
Men
- Screen sexually active men at increased risk for HIV and syphilis 1
- For men who have sex with men (MSM):
High-Risk Populations
- Screen persons entering correctional facilities for syphilis, gonorrhea, and chlamydia 1
- Screen adolescents in institutional settings (schools, community programs, employment/training programs) for gonorrhea and chlamydia 1
- Screen high-risk persons in street settings for gonorrhea, chlamydia, and syphilis when feasible 1
Treatment Recommendations
Chlamydia
- Preferred treatment: Doxycycline 100 mg orally twice daily for 7 days 5
- Alternative: Azithromycin 1 gram orally in a single dose 6, 5
- Test-of-cure recommended for rectal chlamydia if treated with azithromycin 5
Gonorrhea
- Preferred treatment: Ceftriaxone IM, with dosing based on body weight 7, 5
- Test-of-cure recommended for all cases of pharyngeal gonorrhea 5
Syphilis
- Primary, secondary, or early latent (<1 year): Benzathine penicillin G 2.4 million units IM as a single dose 8, 5
- Late latent (>1 year) or unknown duration: Benzathine penicillin G 2.4 million units IM weekly for 3 weeks 8, 5
- Thorough evaluation for otic, ophthalmic, and neurologic symptoms is essential as these complications require 10-14 days of IV penicillin G 5
Trichomoniasis
- Seven-day regimen of metronidazole is recommended for vaginal trichomoniasis 5
Partner Management
- Sex partners of persons with STIs should be evaluated and treated 1
- Consider presumptive treatment for partners of persons with curable STIs 1
- Partner notification can be performed by the patient, healthcare provider, or public health officials 1
Reporting Requirements
- Syphilis, gonorrhea, and AIDS are reportable in every state 1
- Chlamydial infection is reportable in most states 1
- Clinicians should be familiar with local STD reporting requirements 1
Common Pitfalls to Avoid
- Inadequate extragenital testing: Only 16% of MSM report extragenital STI testing despite high prevalence at these sites 3
- Failure to rescreen: Patients diagnosed with chlamydia or gonorrhea should be rescreened 3 months after treatment 2
- Incomplete screening in pregnant women: Ensure all recommended tests are performed at appropriate intervals 1
- Overlooking STI screening during routine care: Consider clustering STI screening at periodic health examinations 1
STI testing rates remain suboptimal, with fewer than half of at-risk individuals receiving recommended screening 9, 10. Implementing these evidence-based recommendations can significantly reduce STI transmission and prevent serious complications including infertility, chronic pain, and increased HIV transmission risk.