STD Screening Tests for Sexually Active Adults with New or Multiple Partners
For sexually active adults with new or multiple partners, order nucleic acid amplification tests (NAATs) for chlamydia and gonorrhea from all sites of sexual contact (urine/genital, rectal if receptive anal sex, pharyngeal for gonorrhea if receptive oral sex), plus serologic testing for syphilis (RPR/VDRL with treponemal confirmation) and HIV, with annual screening at minimum and every 3-6 months for those with ongoing high-risk behaviors. 1, 2
Core Screening Panel
Bacterial STI Testing
- Chlamydia and gonorrhea via NAAT should be collected from all anatomical sites of sexual contact, as failing to test exposure-specific sites misses a substantial proportion of infections 1, 3
- For men: urine specimen or urethral swab for urogenital testing 1
- For women: vaginal NAAT (can be self-collected) is the preferred specimen 2
- Rectal specimens are mandatory for anyone engaging in receptive anal intercourse 1, 3
- Pharyngeal swab for gonorrhea (not chlamydia) for anyone engaging in receptive oral sex 1, 3
Serologic Testing
- Syphilis screening using both nontreponemal (RPR/VDRL) and treponemal tests at initial presentation 1
- HIV testing for all patients aged 13-64 years, with laboratory-based Ag/Ab test as the preferred method 1, 2
- Hepatitis B serologic testing if not previously vaccinated 1, 2
Additional Testing for Women
- Trichomonas testing via vaginal NAAT for all women 1
Screening Frequency Based on Risk Level
Standard Risk (New or Multiple Partners)
- Annual screening minimum for all sexually active individuals under 25 years and those with risk factors including new partners, multiple partners, or inconsistent condom use 4, 2
High-Risk Populations Requiring Every 3-6 Months
- Men who have sex with men with multiple or anonymous partners 4, 1, 2
- Individuals using substances during sex 1, 2
- History of previous STIs 1, 2
- Commercial sex work involvement (either as provider or client) 1
- Partners who engage in any of these behaviors 1
Special Considerations for Men Who Have Sex With Men
Comprehensive Site-Specific Testing
- Annual screening at all sites of sexual contact is the baseline recommendation, with increased frequency to every 3-6 months for those with higher risk factors 3, 2
- Pharyngeal gonorrhea screening is essential, as positivity doubled from 7.3% to 14.8% during recent surveillance periods 5
- Rectal chlamydia and gonorrhea screening detected infections in 15-18% of MSM tested 5
Follow-Up and Reinfection Screening
Mandatory 3-Month Retesting
- All patients with positive chlamydia or gonorrhea tests require retesting at 3 months after treatment, regardless of whether partners were treated, due to high reinfection rates occurring within 3.6 months for chlamydia and 6 months for gonorrhea 4, 1, 2
- This applies to all anatomical sites initially positive 3
HIV and Syphilis Window Periods
- HIV testing requires follow-up at 4-6 weeks if initial exposure is suspected, with definitive testing at 12 weeks due to window period limitations 1
- Syphilis repeat testing at 6-12 weeks if initial test was negative and exposure suspected 1
Critical Pitfalls to Avoid
Testing Too Few Sites
- The most common error is testing only urogenital sites when sexual history indicates oral or anal exposure 1, 3
- Among MSM, extragenital infections account for the majority of missed diagnoses 5
Inadequate Sexual History
- Assess specific sexual practices including receptive oral sex, receptive anal intercourse, and insertive intercourse to determine which anatomical sites require testing 1, 3
- Ask about partner characteristics: number of partners, anonymous partners, partners' STI history, and substance use during sex 2
Accepting Patient Reassurance About Condom Use
- Comprehensive screening is required regardless of reported consistent condom use, as condoms provide incomplete protection against all STIs and reported use often differs from actual use 1