What are the typical orders for a sexually transmitted infection (STI) confidence check on a 20-year-old active duty female with high risk for STIs?

STI Screening Orders for a 20-Year-Old High-Risk Active Duty Female

Order comprehensive STI screening including chlamydia, gonorrhea, HIV, syphilis, and trichomonas testing now, with mandatory repeat screening at 3 months for any positive results and annual screening thereafter given her high-risk status. 1, 2

Immediate Laboratory Orders

Bacterial STI Testing (Priority)

• Chlamydia and gonorrhea NAAT (nucleic acid amplification test) on vaginal swab or urine specimen 1, 2
  • Vaginal swab is preferred and can be self-collected with equivalent sensitivity to endocervical specimens 2
  • The same specimen tests for both infections simultaneously 2
  • If positive, mandatory retest at 3 months regardless of partner treatment due to 25% reinfection rates within 3.6 months for chlamydia 3

Serologic Testing

• Syphilis serology (both nontreponemal RPR/VDRL and treponemal tests) 1, 3

  • High-risk populations include those with multiple partners, inconsistent condom use, or drug use 1
  • If initially negative but exposure occurred recently, repeat at 6-12 weeks 3

• HIV screening (laboratory-based Ag/Ab test) 1

  • All persons aged 13-64 should be screened routinely 1
  • High-risk individuals require annual rescreening at minimum 1
  • If recent exposure suspected, repeat at 4-6 weeks and definitively at 12 weeks due to window period 3

Additional Testing

• Trichomonas NAAT on vaginal specimen 3

  • Reinfection occurs in 25% within 4.8 months if initially positive 3

• Hepatitis B serologic testing if not previously vaccinated 1, 3

• Hepatitis C screening for those with risk factors including drug use or multiple partners 1

Critical Screening Intervals

For This Patient (High-Risk, Age 20)

• Annual screening minimum for chlamydia, gonorrhea, HIV, and syphilis given her age under 25 and high-risk status 1
• Every 3-6 months if ongoing high-risk behaviors persist (multiple partners, substance use, history of STIs) 3
• Active duty servicewomen have documented higher chlamydia rates than the general population and increased risky sexual behaviors 4, 5

Post-Treatment Follow-Up

• 3-month retest mandatory for any positive chlamydia or gonorrhea result, even if partner was treated 1, 2
• This is non-negotiable due to extremely high reinfection rates in young women 3

Specimen Collection Considerations

Standard Collection

• Vaginal NAAT is the preferred specimen for women and can be self-collected 2
• Urine specimen is acceptable alternative but vaginal swab has superior sensitivity 2

Site-Specific Collection (If Relevant Exposures)

• Rectal specimens for chlamydia and gonorrhea if receptive anal intercourse 3
• Pharyngeal specimens for gonorrhea (not chlamydia) if receptive oral sex 3
• Failing to test exposure-specific sites misses substantial infections 3

Common Pitfalls to Avoid

• Do not accept negative initial testing as definitive if recent exposure occurred—bacterial STIs may not be detectable immediately and require repeat testing at 1-2 weeks 3
• Do not skip the 3-month retest after positive results—this is when reinfection is most likely detected 2, 3
• Do not rely on patient report of consistent condom use as sufficient reassurance—condoms provide incomplete protection and usage reports are unreliable 3
• Do not screen only at symptomatic presentation—most STIs in young women are asymptomatic, making routine screening essential 1

Military-Specific Considerations

Active duty servicewomen represent a documented high-risk population with elevated STI rates compared to civilian women 6, 4, 5. Chlamydia and gonorrhea prevalence is particularly high in this demographic, with multiple studies showing rates exceeding general population benchmarks 4, 5. The military environment, deployment settings, and documented high-risk behaviors (inconsistent condom use, multiple partners, binge drinking) necessitate aggressive screening protocols 4, 5.