HIV and Syphilis Screening Frequency
Screen for HIV and syphilis at least annually if you are sexually active, with more frequent screening every 3-6 months if you have any high-risk behaviors.
Standard Annual Screening for All Sexually Active Individuals
- All sexually active adults should receive HIV screening at least once annually, regardless of perceived risk, as recommended by the CDC 1.
- All sexually active men who have sex with men (MSM) require annual syphilis serologic testing at minimum 1.
- For HIV-infected individuals who are sexually active, annual screening for both syphilis and other STIs is mandatory 1, 2.
Increased Frequency Screening Every 3-6 Months
You need more frequent screening (every 3-6 months) if you have ANY of these risk factors:
- Multiple or anonymous sexual partners 1, 3
- Unprotected intercourse outside a mutually monogamous relationship 1
- Sex in conjunction with illicit drug use (particularly methamphetamine) 1, 3
- Partners who engage in any of these high-risk activities 1
- Recent diagnosis of any STI 3, 4
- Sex work or exchanging sex for money or drugs 1, 3
- Previous syphilis infection 5
The evidence strongly supports this increased frequency: Studies in HIV-positive men and MSM demonstrate that screening every 3 months versus annually detects significantly more early syphilis cases (53% vs 16% asymptomatic detection, P=0.001) 5. This more frequent interval catches infections earlier when they are more treatable and less likely to cause complications.
Special Considerations for HIV-Infected Individuals
- HIV-infected persons require at minimum annual syphilis screening, but the threshold should be lower for moving to 3-6 month intervals given the bidirectional relationship between HIV and syphilis 1.
- The reinfection rate for syphilis is extremely high at 42.7% in high-risk populations, making frequent rescreening critical 6.
- Testing should include both treponemal and nontreponemal tests (such as RPR/VDRL plus EIA/CIA) for accurate diagnosis 1, 3.
Practical Algorithm for Your Situation
If you are sexually active with only one mutually monogamous partner and no other risk factors:
- Screen annually for both HIV and syphilis 1
If you have even ONE of the high-risk factors listed above:
If you are HIV-positive:
- Screen at least annually, but strongly consider every 3-6 months given your increased vulnerability 1
Critical Pitfalls to Avoid
- Don't assume you're low-risk based on sexual orientation identity alone—your actual sexual practices and partner behaviors determine your screening needs 3.
- Don't skip screening just because you lack symptoms—the majority of syphilis cases detected through screening are asymptomatic, and nearly half (47%) of new diagnoses occur during routine screening rather than symptomatic presentation 7.
- Don't rely on a single positive test—syphilis diagnosis requires both treponemal AND nontreponemal testing for confirmation 1.
- Don't forget that the window period matters for HIV—if you had a recent high-risk exposure, you need follow-up testing at 3 months even if initial testing is negative 8.
When to Rescreen After Last Test
Since you mentioned your last screening was in [YEAR], if that was more than 12 months ago, you need screening now. If you have any of the high-risk factors listed above and it's been more than 3-6 months, you should be screened immediately 1, 3, 5.