What tests should be included for a 20-year-old male requesting comprehensive sexual testing?

Comprehensive Sexual Health Testing for a 20-Year-Old Male

Core Testing Panel

For a 20-year-old male requesting comprehensive sexual testing, collect first-void urine for chlamydia and gonorrhea nucleic acid amplification testing (NAAT), and draw blood for syphilis serology and HIV testing. 1

Standard Testing Components

• Chlamydia and Gonorrhea: First-void urine using NAAT is the optimal specimen type, offering superior sensitivity and specificity while being non-invasive and patient-friendly 1
• Syphilis: Blood test using RPR or VDRL serology 2
• HIV: Blood test with appropriate counseling 2

Risk-Based Assessment and Additional Testing

Sexual Practice-Specific Testing

The testing approach must be modified based on sexual practices identified through the "Five P's" risk assessment (Partners, Practices, Prevention of Pregnancy, Protection from STDs, Past History) 3:

For men who have sex with men (MSM):

• Urethral: First-void urine NAAT for chlamydia/gonorrhea 1
• Rectal: Rectal swab NAAT if receptive anal intercourse 1, 4
• Pharyngeal: Pharyngeal swab NAAT if receptive oral intercourse 1, 4
• Frequency: Screen at least annually, or every 3-6 months if multiple or anonymous partners, illicit drug use during sex, or partners who engage in these activities 3, 4

For heterosexual males:

• Urine NAAT for chlamydia and gonorrhea is sufficient for routine screening 1
• Blood tests for syphilis and HIV based on individual risk factors 1

Additional Considerations Based on Risk Factors

• Hepatitis B and C: Serologic testing should be performed based on risk assessment, particularly for those with history of injection drug use or multiple partners 2, 4
• Trichomonas vaginalis and Mycoplasma genitalium: Consider in high-prevalence populations or symptomatic patients 1

Critical Testing Protocols

Timing and Follow-Up

• Immediate testing: Can detect bacterial STIs (chlamydia, gonorrhea, syphilis) even shortly after exposure 1
• 3-month follow-up: Essential for HIV and syphilis due to window periods 1
• Rescreening at 3 months: Recommended if initially positive for chlamydia or gonorrhea due to high reinfection rates of up to 39% in young adults 2, 1

Important Clinical Pitfalls

• Single urine specimen is insufficient for MSM: Testing must be site-specific based on sexual practices, as urethral testing alone misses 70-85% of rectal and pharyngeal infections 1, 4
• Confidentiality assurance: Reassure patients about confidentiality to encourage disclosure of sensitive information about sexual practices 3
• Partner notification: If any test is positive, sex partners must be evaluated and treated to prevent reinfection 2

Practical Implementation

Standard Heterosexual Male (Low-Risk)

1. Collect first-void urine for chlamydia/gonorrhea NAAT 1
2. Draw blood for syphilis serology 2, 1
3. Offer HIV testing based on risk assessment 1

Men Who Have Sex With Men or High-Risk Heterosexual Males

1. Collect first-void urine for urethral chlamydia/gonorrhea NAAT 1
2. Collect rectal swab for chlamydia/gonorrhea NAAT (if receptive anal intercourse) 1, 4
3. Collect pharyngeal swab for gonorrhea NAAT (if receptive oral intercourse) 1, 4
4. Draw blood for syphilis serology 2, 4
5. Draw blood for HIV testing 2, 4
6. Consider hepatitis B and C serology 2, 4

Annual Screening Recommendations

• All sexually active males at risk for STDs should undergo annual screening at minimum 2
• More frequent testing (every 3-6 months) is indicated for MSM with multiple or anonymous partners 3, 4