What are the recommended screenings and interventions for a 25-year-old patient (twenty-five years old) presenting for an annual exam?

Annual Exam for a 25-Year-Old

For a healthy 25-year-old, focus on cervical cancer screening (for females), blood pressure measurement, and risk-based STI screening—comprehensive laboratory panels and routine physical examinations are not supported by evidence at this age. 1, 2

Essential Screenings

Cervical Cancer Screening (Females Only)

• Pap test every 3 years starting at age 21 is the only cancer screening recommended at age 25 1
• HPV co-testing is not recommended until age 30; use Pap test alone at this age 1
• This applies regardless of sexual history or other risk factors 1

Blood Pressure Measurement

• Measure blood pressure at every visit for all adults 2, 3
• For low-risk patients (age 18-39 with no risk factors), screening every 3-5 years is acceptable 1
• Annual screening is indicated if the patient is African American, has high-normal blood pressure, is obese/overweight, or has other cardiovascular risk factors 1

Sexually Transmitted Infection Screening

• Screen sexually active females under age 25 for chlamydia annually 1
• Screen for gonorrhea in sexually active individuals at risk (multiple partners, new partners, inconsistent condom use) 1
• HIV screening should be offered based on risk factors, not routinely at annual exams 1
• Syphilis, hepatitis B, and hepatitis C screening only if specific risk factors are present 4

What NOT to Do

Laboratory Tests Not Indicated

• Complete blood count (CBC), comprehensive metabolic panel (CMP), and lipid panels are not recommended for healthy 25-year-olds without specific risk factors 2, 3
• Hemoglobin A1C screening is only indicated if BMI ≥25 kg/m² with additional diabetes risk factors (family history, high-risk ethnicity, hypertension, dyslipidemia) 2, 3
• Urinalysis is not part of routine screening at this age 2, 3

Cancer Screenings Not Yet Indicated

• No breast cancer screening (mammography starts at age 40, clinical breast exams in the 20s-30s can be done every 3 years but are optional) 1
• No colorectal cancer screening (starts at age 45 for average-risk individuals) 1, 3
• No lung cancer screening (only for ages 55-80 with significant smoking history) 1

Cardiovascular Screening

• Routine ECG screening is not recommended for asymptomatic young adults aged 12-25 years 1
• Lipid screening is not indicated until approaching age 40 unless specific cardiovascular risk factors are present 2

Risk-Based Considerations

When to Add Diabetes Screening

• Screen with hemoglobin A1C if BMI ≥25 kg/m² AND any of the following: 3
  • First-degree relative with diabetes
  • High-risk race/ethnicity (African American, Latino, Native American, Asian American, Pacific Islander)
  • History of cardiovascular disease
  • Hypertension (≥140/90 mmHg or on therapy)
  • HDL cholesterol <35 mg/dL or triglycerides >250 mg/dL
  • Physical inactivity
  • History of gestational diabetes or polycystic ovary syndrome

When to Add Lipid Screening

• Consider lipid profile if multiple cardiovascular risk factors are present (family history of premature cardiovascular disease, smoking, hypertension, diabetes) 2, 3
• Otherwise, lipid screening typically begins around age 40 2

Counseling and Prevention

Essential Health Maintenance

• Provide counseling on diet, physical activity, tobacco cessation, and alcohol use at every visit 3
• Discuss contraception and family planning for sexually active individuals 1
• Review immunization status (ensure tetanus-diphtheria-pertussis is up to date, consider HPV vaccine if not previously completed) 1
• Screen for depression and intimate partner violence as appropriate 1

Common Pitfalls to Avoid

• Do not order "routine" laboratory panels (CBC, CMP, lipids) without specific clinical indications—this is not evidence-based and leads to false positives and unnecessary follow-up 5, 6
• Do not perform comprehensive annual physical examinations with head-to-toe organ system reviews; focus on targeted history and indicated screenings 5, 7
• Do not start cervical cancer screening before age 21 regardless of sexual activity 1
• Do not use single stool samples collected during digital rectal examination for fecal occult blood testing—this is not an acceptable screening method 1