STI Testing: Patient Education Guide
All sexually active individuals should undergo regular screening for sexually transmitted infections, with specific tests and frequency determined by age, sexual behaviors, and risk factors.
Who Should Be Tested
Women Under 25 Years
- Annual screening for chlamydia and gonorrhea is recommended for all sexually active women under 25 years 1, 2, 3
- Testing should include cervical specimens 1
- Women in this age group have higher infection rates due to more frequent partner changes and cervical immaturity 1
Women 25 Years and Older
- Screen annually if you have risk factors including new or multiple sex partners, inconsistent condom use, sex while using drugs or alcohol, or a partner with these behaviors 1, 3
- Without risk factors, routine screening is not recommended 1
Men
- Screen for HIV and syphilis if you are sexually active and at increased risk 1, 3
- Risk factors include multiple partners, new partners, inconsistent condom use, or sex in conjunction with drug use 1
- Men who have sex with men require more comprehensive testing (see below) 1
Men Who Have Sex with Men (MSM)
- Comprehensive screening every 3-6 months is recommended for those with multiple or anonymous partners, methamphetamine use, or sex in conjunction with drug use 1
- Testing must include specimens from all exposure sites: pharynx (throat), urethra, and rectum 1, 2
- Annual screening at minimum for all sexually active MSM 1
Complete STI Panel Components
HIV Testing
- Recommended for all persons aged 15-65 years regardless of risk 4
- More frequent testing (every 3-6 months) for those with ongoing high-risk behaviors 2
- Younger than 15 or older than 65 should be tested if at increased risk 4
Syphilis Testing
- Annual screening for all sexually active HIV-infected persons 1
- Every 3-6 months for those with multiple partners, unprotected sex, or drug use 1
- All pregnant women should be tested at first prenatal visit, with repeat testing in third trimester and at delivery for high-risk women 1, 3
- Testing uses blood tests that detect antibodies 1
Chlamydia Testing
- Annual screening for sexually active women under 25 1, 2
- Older women with risk factors should be screened annually 1, 2
- Retest 3 months after treatment if diagnosed to detect reinfection 1, 2, 3
- Pregnant women should be tested at first prenatal visit and again in third trimester if at increased risk 1
Gonorrhea Testing
- Annual screening for sexually active women under 25 1, 2
- Older women and men should be screened based on risk factors 1, 2
- Retest 3 months after treatment if diagnosed 2, 3
- For MSM, test all exposure sites (throat, urethra, rectum) 1
Hepatitis B Testing
- All pregnant women should be tested at first prenatal visit 1, 3
- High-risk individuals including injection drug users should be screened 1
- Repeat testing late in pregnancy for high-risk women who initially tested negative 1
Hepatitis C Testing
- All persons who inject drugs should be offered screening, even if only once or many years ago 1
- Testing recommended based on risk factors 2
Trichomoniasis Testing
- All women should be screened at baseline 1
- Periodic screening based on symptoms or risk factors 1, 2
- Testing particularly important for women with vaginal discharge or odor 2
Testing Frequency Guidelines
Standard Risk Individuals
- Annual screening for most at-risk populations 2, 3
- HIV testing at least once for all adults aged 15-65 4
High-Risk Individuals
- Every 3-6 months for those with ongoing high-risk behaviors including multiple partners, inconsistent condom use, or drug use 1, 2
- MSM with multiple or anonymous partners should follow this more frequent schedule 1
After Diagnosis
- Retest 3 months after treatment for chlamydia or gonorrhea to detect reinfection 1, 2, 3
- This is critical as reinfection rates are high 3
Special Populations
Pregnant Women
- Universal screening at first prenatal visit for hepatitis B, HIV, and syphilis 1, 3
- Test for chlamydia and gonorrhea if under 25 or at increased risk 1, 3
- No infant should be discharged without the mother's syphilis status determined at least once during pregnancy 1, 3
- Repeat syphilis testing in third trimester and at delivery for high-risk women 1, 3
HIV-Infected Individuals
- Annual syphilis screening at minimum, with testing every 3-6 months for those with high-risk behaviors 1
- All women should be screened for trichomoniasis 1
- More frequent screening needed due to increased STI susceptibility 1
Persons Who Use Drugs
- Routine screening for all common STIs including chlamydia, gonorrhea, syphilis, and trichomoniasis 1
- Hepatitis C screening for all who inject drugs, even if only once 1
- Hepatitis B screening for those at risk 1
Important Testing Details
Specimen Collection Sites
- For MSM, specimens must be collected from all exposure sites based on sexual practices 1
- Rectal specimens for those reporting receptive anal intercourse 1
- Pharyngeal (throat) specimens for those reporting receptive oral sex 1
- Urethral specimens for all sexually active men 1
Testing Methods
- Nucleic acid amplification tests (NAATs) have high sensitivity (86-100%) and specificity (97-100%) for gonorrhea, chlamydia, and trichomoniasis 5
- Syphilis testing uses sequential blood tests to detect antibodies 1
- HIV testing uses blood or oral fluid specimens 4
Common Pitfalls to Avoid
Incomplete Site Testing
- Failing to test all exposure sites in MSM misses up to 70% of infections 5
- Extragenital infections (throat and rectal) are often asymptomatic 5
Missing Follow-Up Testing
- Not retesting 3 months after chlamydia or gonorrhea treatment misses reinfections 3
- Reinfection rates are substantial and require detection 3
Inadequate Frequency
- Annual testing is insufficient for individuals with ongoing high-risk behaviors 1, 2
- These individuals require testing every 3-6 months 1, 2
Pregnancy Screening Gaps
- Failing to retest high-risk pregnant women in third trimester can result in infant infections 1, 3
- Syphilis status must be documented before infant discharge 1, 3
Partner Notification and Treatment
Partner Management
- All sexual partners of persons diagnosed with STIs should be evaluated and treated 3
- Presumptive treatment for partners is recommended for curable STIs 3
- Notification can be performed by the patient, healthcare provider, or public health officials 3
Prevention Measures
Risk Reduction
- Consistent condom use reduces STI transmission 1
- Limiting number of sexual partners decreases risk 1
- Avoiding sex while under the influence of drugs or alcohol 1
Vaccination
- Hepatitis B vaccine is available and recommended for those at risk 1
- Complete the 3-dose series for full protection 1