Comprehensive STD Panel Testing and Treatment
A comprehensive STD panel should include testing for chlamydia, gonorrhea, syphilis, HIV, hepatitis B, and additional tests based on risk factors such as trichomoniasis and herpes simplex virus. This approach ensures detection of both symptomatic and asymptomatic infections, which is crucial since most untreated STDs are asymptomatic.
Core STD Panel Components
Standard Testing for All Patients
- Serologic test for syphilis (RPR or equivalent) 1
- Testing for Neisseria gonorrhoeae (urine, cervical/urethral swabs) 1
- Testing for Chlamydia trachomatis (urine, cervical/urethral swabs) 1
- HIV testing 1
- Hepatitis B surface antigen (HBsAg) testing 1
Site-Specific Testing Based on Sexual Practices
- For men who have sex with men (MSM):
Additional Testing Based on Risk Factors
- Trichomoniasis testing for women with multiple partners or other risk factors 3
- Hepatitis C testing for those with risk factors 1
- Herpes simplex virus (HSV) testing for those with symptoms or high-risk exposure 4
- Bacterial vaginosis testing for symptomatic women 1
Treatment Recommendations for Common STDs
Gonorrhea
- Ceftriaxone monotherapy given intramuscularly with weight-based dosing 3
- Test-of-cure recommended for all cases of pharyngeal gonorrhea 3
Chlamydia
- Doxycycline is the preferred treatment 3
- Test-of-cure recommended for rectal chlamydia if treated with azithromycin 3
Syphilis
- For syphilis of less than one year's duration: single dose of intramuscular penicillin G benzathine, 2.4 million units 3
- For syphilis of more than one year's or unknown duration: three consecutive weekly doses of intramuscular penicillin G benzathine, 2.4 million units each 3
- Thorough evaluation for neurologic, ophthalmic, and otic symptoms is essential at any stage 3
Trichomoniasis
- Seven-day regimen of metronidazole for vaginal trichomoniasis 3
Special Considerations
Pregnant Women
- All pregnant women should receive:
- Syphilis testing at first prenatal visit and third trimester for high-risk women 1
- HBsAg testing at first prenatal visit 1
- Gonorrhea testing at first prenatal visit for at-risk women 1
- Chlamydia testing in the third trimester for women under 25 or with risk factors 1
- HIV testing at first prenatal visit 1
Adolescents
- Confidential services are available to adolescents without parental consent for STD diagnosis and treatment 5
- Testing approach should be adapted to developmental level 5
- Special attention needed for this population as they have high rates of STDs but decreasing clinic attendance 2
Importance of Screening
- The primary reason STDs remain untreated is that infected persons often never develop symptoms 6
- Approximately 45% of gonorrhea and 77% of chlamydial infections are never symptomatic 6
- Regular screening is essential for high-risk populations even in the absence of symptoms 7, 6
Testing Technology
- Multiplex PCR testing allows for simultaneous detection of multiple STDs from a single sample 4
- Modern STD panels can detect Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Trichomonas vaginalis, Mycoplasma genitalium, Ureaplasma urealyticum, and herpes simplex virus types 1 and 2 4
- This technology shows high concordance with standard testing methods (98% for chlamydia, 97% for gonorrhea) 4
Follow-up and Reporting
- All positive cases of syphilis, gonorrhea, and HIV must be reported to local health departments in all states 1
- Chlamydia is reportable in most states 1
- Partner notification and treatment are essential components of STD management 1
- Repeat testing is recommended after treatment, especially for certain infections like pharyngeal gonorrhea 3