Recommended Screenings for a 23-Year-Old Male Establishing Care
For a healthy 23-year-old male with no significant medical history, routine screening should include HIV testing, blood pressure measurement, and assessment of sexual health risks—while avoiding unnecessary laboratory tests and cancer screenings that provide no benefit at this age. 1
Essential Screenings
HIV Testing
- All males aged 13-64 years should receive routine opt-out HIV screening as a standard component of care 1
- For sexually active males with multiple partners or high-risk behaviors, rescreening should occur at least annually 1
- This is the single most important screening test for this age group 1
Cardiovascular Assessment
- Blood pressure measurement should be performed at this visit and at every subsequent clinical encounter 2
- Lipid screening is not indicated at age 23 for average-risk males; this begins at age 40-49 years 2
Sexually Transmitted Infection Screening
The approach depends entirely on sexual activity and risk factors:
- For heterosexual males: Chlamydia screening only if seen at sites with high STI prevalence 1
- For men who have sex with men (MSM): Screen for chlamydia, gonorrhea, and syphilis at multiple anatomical sites (pharyngeal, rectal, urethral) 1, 3
- Screening frequency for MSM should be at least annually, or every 3-6 months for those with multiple partners 3
Immunization Review
- Verify hepatitis B vaccination status and offer routine vaccination if unvaccinated with no documented history of infection 1
- HPV vaccination may be offered if not previously vaccinated or incomplete series (though optimal age is before 22) 1
Cancer-Related Physical Examination
- A cancer-related checkup every 3 years is recommended for ages 20-39, including examination of thyroid, testicles, lymph nodes, oral cavity, and skin 1
- This is a physical examination only—no laboratory or imaging tests are indicated 1
Preventive Health Counseling
Address these behavioral health topics at the visit:
- Tobacco use and cessation counseling if applicable 1
- Diet and nutrition guidance 1
- Physical activity recommendations 1
- Alcohol and substance use assessment 1
- Depression and anxiety screening 1
Tests to AVOID at Age 23
Laboratory Tests NOT Indicated
- Do not order routine CBC or comprehensive metabolic panel without specific clinical indications 2, 4
- These tests lead to false positives and unnecessary follow-up in asymptomatic young adults 2
- Hepatitis C screening is NOT indicated unless high-risk factors are present (injection drug use, HIV-positive, incarceration history) 1
Cancer Screenings NOT Indicated
- Do not perform PSA testing or prostate cancer screening—discussions about screening don't begin until age 50 for average-risk men (age 45 for African American men or those with strong family history) 1, 5
- Colorectal cancer screening does NOT begin until age 45 for average-risk individuals 1, 5
- Testicular cancer screening is not recommended by the USPSTF despite the physical examination component of the cancer-related checkup 6
Common Pitfalls to Avoid
The most common error is ordering unnecessary laboratory panels (CBC, CMP, lipid panel) in healthy young adults, which provides no benefit and leads to false positives requiring additional testing 2, 4
Do not skip the HIV screening conversation—this is often overlooked but represents the highest-yield screening test for this age group with clear mortality benefit 1
Ensure explicit sexual history taking rather than making assumptions about sexual orientation or practices, as this determines appropriate STI screening 3, 7
Avoid ordering hepatitis C screening routinely—this is only indicated for specific high-risk populations at age 23 1