Recommended Tests for Diagnosing Sexually Transmitted Diseases (STDs)
All sexually active individuals at risk for STDs should receive screening for chlamydia, gonorrhea, HIV, and syphilis, with specific testing recommendations varying by age, gender, and risk factors. 1, 2
Core STD Testing Panel
- Serologic test for syphilis (RPR or equivalent) 2, 3
- Testing for Neisseria gonorrhoeae (urine, cervical/urethral swabs) 2, 3
- Testing for Chlamydia trachomatis (urine, cervical/urethral swabs) 2, 3
- HIV testing 2, 3
- Hepatitis B surface antigen (HBsAg) testing 2, 3
Population-Specific Testing Recommendations
Women
- All sexually active women under 25 years: Annual screening for chlamydia and gonorrhea regardless of reported risk behaviors 1
- Women 25 years and older: Screen for chlamydia, gonorrhea, HIV, and syphilis if engaging in high-risk sexual behavior (multiple partners, new partner, inconsistent condom use, sex under influence of substances, or sex work) 1, 2
- Women with chlamydia or gonorrhea infection: Rescreen 3 months after treatment to detect reinfection 1, 2
Men
- All men with high-risk sexual behaviors: Screen for HIV and syphilis 1, 2
- Men who have sex with men (MSM):
- Screen for chlamydia and gonorrhea at anatomic sites of exposure 1
- Consider more frequent screening (every 3-6 months) for those with multiple or anonymous partners 4
- Test for rectal gonorrhea and chlamydia if reporting receptive anal intercourse 4
- Test for oropharyngeal gonorrhea if reporting receptive oral intercourse 4
Pregnant Women
- All pregnant women at first prenatal visit: Test for syphilis, hepatitis B (HBsAg), and HIV 1, 3
- Pregnant women at increased risk: Test for chlamydia and gonorrhea 1, 3
- High-risk pregnant women: Repeat syphilis testing in third trimester and at delivery 1, 2
- No infant should be discharged without determination of mother's syphilis status at least once during pregnancy 1, 2
Special Populations
- Individuals in correctional facilities: Screen for syphilis, gonorrhea, and chlamydia 2
- Adolescents in institutional settings: Screen for gonorrhea and chlamydia 2
- High-risk individuals in street settings: Screen for gonorrhea, chlamydia, and syphilis when feasible 2
Important Considerations for Testing
- Many STIs are asymptomatic or have minimal symptoms (70% of HSV and trichomoniasis infections, 53-100% of extragenital gonorrhea and chlamydia) 5
- STI co-infections are common, particularly among those with syphilis, gonorrhea, or chlamydia, suggesting the importance of comprehensive testing 6
- Nucleic acid amplification tests (NAATs) have high sensitivity (86.1%-100%) and specificity (97.1%-100%) for diagnosing gonorrhea, chlamydia, M. genitalium, trichomoniasis, and symptomatic HSV 5
- Serology remains the recommended method to diagnose syphilis, typically using sequential testing to detect treponemal and nontreponemal antibodies 5
Reporting Requirements
- Syphilis, gonorrhea, and AIDS are reportable diseases in every state 1, 2
- Chlamydial infection is reportable in most states 1, 2
- Clinicians should be familiar with local STD reporting requirements 1, 2
- STD reports are maintained in strictest confidence and in many jurisdictions are protected by statute from subpoena 1
Common Pitfalls to Avoid
- Failing to screen asymptomatic individuals who meet age or risk criteria 2, 7
- Not testing all appropriate anatomical sites in MSM (urethral, rectal, pharyngeal) 4
- Neglecting to rescreen patients after treatment for chlamydia or gonorrhea 2
- Missing opportunities for STI screening during routine health examinations 2
- Failing to consider STI co-infections when one STI is diagnosed 6