Male STD Screening Tests
Recommended Screening Tests for Sexually Active Males with New or Multiple Partners
All sexually active males with new or multiple partners should be screened annually at minimum for chlamydia, gonorrhea, syphilis, and HIV using nucleic acid amplification tests (NAATs) for bacterial STIs and serologic testing for syphilis and HIV, with increased frequency to every 3-6 months for those with ongoing high-risk behaviors. 1, 2, 3
Core Screening Panel
Bacterial STIs
- Chlamydia and Gonorrhea: Urine NAAT is the standard specimen for men 1, 2, 3
- Syphilis: Both nontreponemal (RPR or VDRL) and treponemal tests (EIA or CIA) should be performed 1, 2
- NAATs are strongly preferred over culture due to superior sensitivity 3, 4
Viral Infections
- HIV: Baseline testing with laboratory-based Ag/Ab test is essential 1, 2
- Hepatitis B: Serologic testing recommended if not previously vaccinated 1, 2
- Hepatitis C: Screen if additional risk factors present (drug use, multiple partners) 2
Additional Testing for Women
Site-Specific Testing Based on Sexual Practices
For Men Reporting Receptive Anal Sex
- Rectal specimens for gonorrhea and chlamydia using NAAT (if laboratory has validated testing) 1, 4
- Failing to test at exposure-specific sites misses a substantial proportion of infections 2
For Men Reporting Receptive Oral Sex
- Pharyngeal swab for gonorrhea using NAAT or culture 1, 4
- Pharyngeal chlamydia testing is not generally recommended 2
- Annual pharyngeal screening is recommended for men who have sex with men (MSM) engaging in receptive oral intercourse 4
Screening Frequency Algorithm
Annual Screening (Minimum)
- All sexually active males with new or multiple partners require annual screening for chlamydia, gonorrhea, HIV, and syphilis 1, 2, 3
Every 3-6 Months (High-Risk Indicators)
Screen more frequently if any of the following are present: 1, 2, 3
- Multiple or anonymous partners
- Substance use during sex (especially methamphetamine)
- Previous STI diagnosis
- Sex work or transactional sex
- Partners who engage in high-risk behaviors
- Men who have sex with men
Reinfection Screening
- Mandatory retesting at 3 months after any positive chlamydia or gonorrhea result, even if partner was treated, due to reinfection rates of 25-40% 2, 3
- This applies to all anatomical sites initially positive 4
Post-Exposure Screening Timeline
Immediate Testing (Within 72 Hours)
- Baseline testing for chlamydia, gonorrhea, syphilis, and HIV should be performed immediately 2
- NAATs can detect bacterial STIs even within 72 hours of exposure 2
- Post-exposure prophylaxis (doxycycline 200 mg) must be initiated within 72 hours if considering prophylaxis for MSM 2
Follow-Up at 1-2 Weeks
- Repeat testing for bacterial STIs if initial tests were negative and no presumptive treatment was given 2
Follow-Up at 3 Months
- Second HIV screening is essential due to window period 2
- Repeat syphilis serologic testing at 6-12 weeks if initial test was negative 2
Special Population: Men Who Have Sex With Men
Comprehensive Screening Requirements
- Urethral/urine specimen for chlamydia and gonorrhea 1, 4
- Rectal swab for those engaging in receptive anal intercourse 1, 4
- Pharyngeal swab for gonorrhea in those engaging in receptive oral sex 1, 4
- Annual screening at minimum, with increased frequency to every 3-6 months for higher-risk individuals 1, 4
Additional Considerations
- HSV-2 serologic testing should be considered for those who wish to consider suppressive antiviral therapy 1
- Hepatitis A vaccination is recommended 2
Vaccination Recommendations
Hepatitis B
- Initiate vaccination immediately if unvaccinated, as HBV is frequently sexually transmitted 2
- Complete full 3-dose series (0,1-2 months, 6 months) 2
Hepatitis A
- Recommended for men who have sex with men 2
Critical Pitfalls to Avoid
Testing Errors
- Don't rely solely on urogenital testing in MSM or bisexual individuals—extragenital infections are frequently asymptomatic 3
- Don't test too early and stop there—a negative test at 1 week does not rule out infection 2
- Don't assume low risk based on reported condom use—condoms provide incomplete protection and reported use may not reflect actual use 2
Follow-Up Failures
- Don't skip 3-month retesting after positive chlamydia or gonorrhea results—reinfection rates are extremely high 2, 3
- Don't forget partner management—all sexual partners within preceding 60 days must be evaluated and treated 2
Documentation Issues
- Among HIV-infected MSM reporting condomless sex, STI testing was not documented in up to 25% of patients in the following year 5
- Exploring barriers to testing completion is essential for improving care 5
Evidence Quality Considerations
The screening recommendations are based on high-quality CDC guidelines published in JAMA 1 and MMWR 1, with additional support from recent comprehensive guideline summaries 2, 3, 4. Research data consistently demonstrate that prevalent and incident asymptomatic STIs are common among sexually active males, particularly MSM, with baseline prevalence of 14% and incidence of 20.8 cases per 100 person-years 6. Modeling studies suggest that biannual screening of all sexually active MSM could avert 72% of gonorrhea and 78% of chlamydia infections over 10 years 7.