Routine STI Screening for Bisexual Individuals
Bisexual individuals should receive comprehensive annual STI screening that includes testing at all anatomic sites of sexual exposure—urogenital, pharyngeal, and rectal—based on their specific sexual practices, with more frequent screening every 3-6 months if high-risk factors are present. 1, 2
Core Annual Screening Panel
All sexually active bisexual individuals should receive the following tests at minimum annually:
- Chlamydia and gonorrhea using nucleic acid amplification tests (NAATs) at all sites of sexual exposure 1, 2
- Syphilis serologic testing with both nontreponemal (RPR or VDRL) and treponemal tests (EIA or CIA) 1
- HIV testing for all individuals aged 13-64 years 1
- Hepatitis B and C screening based on vaccination status and risk factors 1
Site-Specific Testing Based on Sexual Practices
For All Bisexual Individuals
- Urogenital testing: Urine NAAT for chlamydia and gonorrhea (or vaginal swab for those with vaginas, which is preferred over urine) 1
For Those Engaging in Receptive Anal Intercourse
For Those Engaging in Receptive Oral Sex
- Pharyngeal swabs for gonorrhea using NAAT or culture (if laboratory has validated testing) 1, 2
- Note: Pharyngeal chlamydia testing is generally not recommended 3
For Individuals with Vaginas
- Trichomoniasis screening using vaginal swab NAAT should be considered for those with high-risk behaviors (multiple partners, new partners, history of STIs) 1, 2
Increased Screening Frequency (Every 3-6 Months)
Screen every 3-6 months if any of the following risk factors are present:
- Multiple or anonymous sexual partners 1, 2
- Substance use, especially methamphetamine, during sexual activity 1, 2
- Unprotected sex outside a mutually monogamous relationship 1
- Recent diagnosis of any STI 1, 2
- Sex work or exchanging sex for money or drugs 1, 2
- Partners who engage in any of these high-risk behaviors 1, 2
Post-Treatment Rescreening
- Rescreen at 3 months after treatment for chlamydia or gonorrhea, regardless of whether sexual partners were treated 1, 2
- Consider rescreening at 3 months for trichomoniasis in those with vaginas 1, 2
- If 3-month rescreening is not feasible, retest at the next healthcare visit within 12 months 1, 2
Age-Specific Considerations
For Bisexual Individuals ≤25 Years with Vaginas
- Annual screening for chlamydia and gonorrhea is mandatory regardless of reported risk behaviors 1, 2
For Bisexual Individuals >25 Years with Vaginas
- Screen annually if any risk factors are present (new partner, multiple partners, inconsistent condom use) 1
For Bisexual Men
- Annual screening should be based on sexual practices and risk factors 1, 2
- Consider screening in high-prevalence settings (≥2% prevalence) even without specific risk factors 1
Critical Clinical Pitfalls to Avoid
Do not assume screening needs based on sexual orientation identity alone—bisexual individuals may identify as heterosexual, gay, or bisexual, but their actual sexual practices determine screening sites. 1, 4 Always obtain an explicit sexual history asking about specific sexual behaviors (vaginal, oral, anal) with partners of all genders. 1, 5
Do not rely solely on urogenital testing—extragenital infections (pharyngeal and rectal) are frequently asymptomatic and account for 6-10% of infections in at-risk populations. 6 Missing these sites leads to ongoing transmission and complications.
Do not use inferior testing methods—NAATs are strongly preferred over culture or wet mount for chlamydia, gonorrhea, and trichomoniasis due to superior sensitivity. 2, 7 Ensure your laboratory has validated NAAT testing for extragenital sites before ordering. 1
Do not screen syphilis with a single test—both treponemal and nontreponemal tests are required for proper diagnosis and staging. 1, 7 A positive screening test always requires confirmatory testing and clinical correlation.