What screenings are most appropriate for a 23-year-old cisgender female with HIV (Human Immunodeficiency Virus) on Antiretroviral Therapy (ART) with a stable CD4 (Cluster of Differentiation 4) count and undetectable HIV RNA, who reports two new sexual partners since her last clinic visit?

Screening Recommendations for HIV-Positive Patient with New Sexual Partners

This patient should receive gonorrhea/chlamydia testing at each site of reported intercourse and syphilis screening (Answer A).

Rationale for Site-Specific STI Screening

This 23-year-old woman with well-controlled HIV and two new sexual partners meets clear criteria for comprehensive STI screening based on multiple risk factors:

• Age-based risk: She is under 25 years old and sexually active, which automatically qualifies her for chlamydia and gonorrhea screening regardless of HIV status 1

• Multiple partners as a risk factor: The presence of multiple new partners since her last visit is specifically identified as a risk factor that should prompt repeated STI screening 1

• Site-specific testing is essential: Guidelines explicitly recommend testing at each site of reported intercourse (vaginal, rectal, and pharyngeal if applicable) because infections can be anatomically isolated and asymptomatic 1

Required Screening Components

Gonorrhea and Chlamydia Testing

• Vaginal swab (preferred method for women) or cervical swab with NAAT 1
• Rectal NAAT if receptive anal sex is reported 1
• Pharyngeal NAAT if receptive oral sex is reported 1

Syphilis Screening

• Serologic testing is recommended for all sexually active HIV-infected persons at least annually 1
• Given new partners, this patient warrants syphilis screening at this visit 1
• Both nontreponemal (RPR or VDRL) and treponemal tests (EIA or CIA) should be performed 1

Why Other Options Are Incorrect

Option B (HBV serologies and syphilis): While syphilis is appropriate, HBV serologies should have been performed at initial HIV diagnosis, not routinely at follow-up visits with new partners 1

Option C (Gonorrhea/chlamydia and Pap smear): Although both are important, Pap smear timing is not dictated by new sexual partners but rather by cervical cancer screening intervals for HIV-positive women 1

Option D (HBV and HCV serologies): These are baseline or risk-specific screenings (particularly HCV for injection drug users), not routine screenings triggered by new sexual partners 1

Screening Frequency Considerations

For HIV-infected individuals with ongoing risk behaviors:

• More frequent screening (every 3-6 months) is appropriate for patients with multiple partners, as this patient demonstrates 1
• The presence of new partners indicates she should be on an accelerated screening schedule rather than annual screening 1
• If any STI is detected, rescreening should occur 3 months after treatment to detect reinfection 2

Critical Clinical Pearls

Common pitfall: Failing to screen all anatomic sites of exposure leads to missed infections, as many STIs are asymptomatic and site-specific 1

Prevention counseling: This visit should also include discussion of condom use, partner notification, and the increased risk of HIV transmission when STIs are present 1

Documentation: Note that continued risk behavior warrants more frequent STI screening at future visits 1