What STI (Sexually Transmitted Infection) screening is recommended for a sexually active female?

STI Screening for a 26-Year-Old Sexually Active Female

Screen annually for chlamydia and gonorrhea, and assess for additional risk factors that would warrant screening for HIV, syphilis, and trichomoniasis. 1, 2

Core Screening Recommendations

Chlamydia and Gonorrhea - Screen Annually

• All sexually active women aged 24 years or younger should be screened annually for both chlamydia and gonorrhea. 1, 2

• For women aged 25-26 years, annual screening is recommended if any risk factors are present, including: 1

  • New or multiple sex partners
  • Inconsistent condom use
  • History of previous STIs
  • Sex partner with concurrent partners
  • Sex while under the influence of alcohol or drugs
  • Sex in exchange for money or drugs

• Use nucleic acid amplification tests (NAATs) on either urine or vaginal swab specimens - vaginal swabs are optimal for women. 1

• If she tests positive for either infection, rescreen 3 months after treatment regardless of whether partners were treated, due to high reinfection rates. 1, 2

Risk-Based Screening

HIV and Syphilis

• Screen for HIV and syphilis if she has high-risk sexual behaviors, including those listed above or if she has new partners. 1
• Do not routinely screen for syphilis in heterosexual women without risk factors. 1

Trichomoniasis

• Routine screening for trichomoniasis is not recommended for asymptomatic women. 1, 2
• Consider screening if she has high-risk factors such as multiple partners, history of STIs, exchanging sex for payment, or injection drug use. 1, 2

Practical Implementation

Specimen Collection

• Collect a vaginal swab or first-void urine specimen for chlamydia and gonorrhea NAATs. 1, 2
• Vaginal swabs (including patient-collected) have superior sensitivity compared to urine specimens. 1

Screening Frequency Algorithm

• If no risk factors present at age 26: Annual chlamydia and gonorrhea screening may be discontinued after age 25 unless risk factors develop. 1
• If any risk factors present: Continue annual screening for chlamydia and gonorrhea, and add HIV and syphilis screening. 1, 2
• If multiple or anonymous partners, substance use during sex, or history of recent STIs: Consider screening every 3-6 months for all bacterial STIs. 1, 2

Common Pitfalls to Avoid

• Don't skip screening based solely on age - a 26-year-old with risk factors still warrants screening even though she's technically over 25. 1, 2
• Don't forget the 3-month retest if she tests positive - reinfection rates are extremely high (up to 20-30% within months). 1
• Don't rely on symptoms - up to 70% of chlamydial infections in women are asymptomatic, making screening essential. 3
• Don't use inferior testing methods - NAATs are far superior to older culture or antigen-based tests. 1, 4