STI Screening for a 54-Year-Old Sexually Active Female with One Partner
For a 54-year-old sexually active woman with one partner, routine STI screening is generally not recommended unless specific risk factors are present. 1
Risk Assessment Required
The key determinant for screening in women over 25 years is the presence of risk factors, not just sexual activity. 1 You must assess for:
- New sex partner (even if monogamous now) 1
- Partner with concurrent partners or unknown sexual history 1
- Inconsistent condom use in a non-mutually monogamous relationship 1, 2
- History of STIs in patient or partner 1, 2
- Commercial sex work 1, 2
- Illicit drug use 1, 2
- Partner who uses drugs or has multiple partners 1
Screening Recommendations Based on Risk
If NO Risk Factors Present:
No routine screening for chlamydia or gonorrhea is recommended. 1 The USPSTF explicitly recommends against routine screening in low-risk women over 24 years, as potential harms may outweigh benefits in low-prevalence populations. 1
If Risk Factors ARE Present:
Screen annually for: 1
- Chlamydia using nucleic acid amplification test (NAAT) on vaginal swab (self-collected or clinician-collected), endocervical swab, or urine 1, 3
- Gonorrhea using NAAT on the same specimen 1, 3
- HIV should be offered as part of comprehensive STI screening 1, 4
- Syphilis serology if at increased risk (multiple partners, partner with STI history, drug use) 1, 4
Testing Methodology
- NAATs are the preferred test for both chlamydia and gonorrhea due to superior sensitivity and specificity 1, 3
- The same specimen can test for both infections 1
- Vaginal swabs (including self-collected) are as sensitive as endocervical specimens and may be preferred for patient comfort 1, 3
Important Clinical Caveats
Common Pitfall:
Do not assume that "one partner" equals low risk. 1 The critical question is whether this is a mutually monogamous relationship with an uninfected partner. 1 If the partner's sexual history is unknown or if this is a new relationship (within the past year), screening is warranted. 1
If Screening is Performed and Positive:
- Retest at 3 months after treatment regardless of whether the partner was treated, due to high reinfection rates 1, 4, 3
- Treat partner empirically to prevent reinfection 3
Geographic Considerations:
Gonorrhea prevalence varies significantly by geographic location and community. 1 Consult local public health data if the patient lives in or has partners from high-prevalence areas. 1