USPSTF Screening Recommendations for a 19-Year-Old
A 19-year-old should receive screening for sexually transmitted infections (chlamydia and gonorrhea if female and sexually active), HIV infection, depression, and behavioral counseling to prevent STIs if sexually active.
Sexually Transmitted Infection Screening
Chlamydia and Gonorrhea
- All sexually active females aged 19 should be screened annually for both chlamydia and gonorrhea, as this age falls within the high-risk group of women 24 years or younger 1, 2.
- Nucleic acid amplification tests (NAATs) are the preferred testing method, with vaginal swabs being optimal for females 1, 3.
- For males aged 19, routine screening for chlamydia and gonorrhea is not recommended unless they are men who have sex with men (MSM) or have specific high-risk behaviors, as the evidence remains insufficient to support universal screening in men 1, 2.
- For MSM aged 19, annual screening for urethral, rectal, and pharyngeal gonorrhea and chlamydia is recommended based on sexual practices 3.
HIV Screening
- All 19-year-olds should be screened for HIV infection regardless of perceived risk, as the USPSTF recommends routine screening for all persons aged 15 to 65 years 1.
- This represents a critical expansion from risk-based screening alone, recognizing that many HIV-infected individuals are unaware of their status 1.
Mental Health Screening
Depression
- Screen all 19-year-olds for major depressive disorder (MDD), as this age falls within the 12 to 18 years recommendation for adolescents 1.
- Screening should only be implemented when systems are in place for accurate diagnosis, effective treatment, and appropriate follow-up 1.
- This recommendation is based on moderate certainty that screening combined with adequate treatment systems provides moderate net benefit 4.
Behavioral Counseling
STI Prevention
- Provide intensive behavioral counseling to all sexually active 19-year-olds to prevent sexually transmitted infections 5.
- These interventions have been shown to reduce STI acquisition, decrease risky sexual behaviors, and increase condom use 6, 5.
Substance Use Screening
Drug Use
- Screen for unhealthy drug use by asking questions about prescription or illegal drug use 7.
- This screening should only be performed when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred 7.
Gynecologic Considerations (Females)
Pelvic Examination
- Routine pelvic examinations are not necessary for asymptomatic 19-year-old females 1, 8.
- STI screening can be accomplished with urine-based or vaginal swab tests without requiring a speculum examination 8.
Cervical Cancer Screening
- Do not perform Papanicolaou (Pap) testing at age 19, as cervical cancer screening should begin at age 21 years for immunocompetent individuals 8.
- The exception is for immunosuppressed patients or those with HIV, who should initiate testing at the start of sexual activity 8.
Important Clinical Caveats
Rescreening Intervals
- Rescreen 3 months after treatment for any patient diagnosed with chlamydia or gonorrhea, regardless of whether their partner was treated 3.
- For individuals with multiple partners, anonymous partners, or substance use during sex, consider screening every 3-6 months rather than annually 3.
Risk Assessment
- Obtain a comprehensive sexual history to identify behaviors that increase STI risk, including number of partners, condom use consistency, and substance use during sexual activity 6, 5.
- Consider community and population risk factors when determining screening frequency 6.