Recommended Frequency for Routine STI Screening
All sexually active individuals should undergo routine STI screening based on their risk factors, with sexually active women ≤25 years and men who have sex with men (MSM) requiring annual screening at minimum, and higher-risk individuals needing more frequent testing every 3-6 months. 1
General Screening Recommendations by Population
Women
- All sexually active women ≤25 years should be screened annually for chlamydia and gonorrhea regardless of reported risk behaviors 1
- Women >25 years should be screened annually if they have risk factors (multiple partners, new partner, inconsistent condom use, substance use during sex, sex work) 1
- Routine trichomoniasis screening is not recommended for asymptomatic adolescents but should be considered for women with high-risk behaviors 1
Men Who Have Sex with Men (MSM)
- Annual screening for pharyngeal, rectal, and urethral gonorrhea and chlamydia is recommended for all sexually active MSM based on sexual practices 1, 2
- More frequent screening (every 3-6 months) is recommended for MSM with higher risk factors (multiple or anonymous partners, sex with drug use) 1, 2
- Annual syphilis screening is recommended for all sexually active MSM, with more frequent screening (every 3-6 months) for those at higher risk 1
Heterosexual Men
- Routine screening is not universally recommended for heterosexual men without symptoms 1
- Consider annual screening for sexually active young men in settings with high prevalence (≥2%) 1
- Screen men with high-risk behaviors (multiple partners, inconsistent condom use, substance use during sex) 1
Risk-Based Screening Frequency
Higher Risk Individuals (requiring more frequent screening)
- Screen every 3-6 months for individuals with:
Post-Treatment Rescreening
- Rescreen all individuals 3 months after treatment for chlamydia or gonorrhea, regardless of partner treatment status 1
- Consider rescreening females previously diagnosed with trichomoniasis 3 months after treatment 1
- If 3-month rescreening is not possible, retest at next healthcare visit within 12 months 1
Site-Specific Screening Considerations
- Collect specimens based on sexual practices and exposure sites 1, 2
- For MSM, include pharyngeal swabs for those engaging in receptive oral sex 2
- Include rectal swabs for individuals engaging in receptive anal intercourse 2, 6
- Nucleic acid amplification tests (NAATs) are preferred for all specimen types due to higher sensitivity 2
Special Populations
HIV-Infected Individuals
- Screen all HIV-infected individuals for syphilis at initiation of care and periodically thereafter based on risk 1
- Screen all HIV-infected women for trichomoniasis and all women ≤25 years for chlamydia 1
- Screen men and women for gonorrhea and chlamydia at initial presentation and annually if at risk 1
- Retest in 3 months for those found positive for gonorrhea, chlamydia, or trichomoniasis due to high reinfection rates 1
Clinical Implications
- Quarterly STI screening in high-risk populations can significantly reduce the number of asymptomatic infections that would otherwise go undetected and potentially be transmitted 5
- Model simulations suggest that increasing screening frequency to biannually for all sexually active MSM could avert 72% of gonorrhea and 78% of chlamydia infections over 10 years 3
- Self-collected samples may increase screening rates in populations with limited access to clinical settings 6
The evidence strongly supports tailoring STI screening frequency to individual risk factors, with annual screening as the minimum for most sexually active individuals and more frequent screening (every 3-6 months) for those with higher risk profiles.