Standard STD Testing for Sexually Active Men
Core Annual Screening Panel
All sexually active men should receive at least annual testing for chlamydia, gonorrhea, syphilis, and HIV, with screening frequency increased to every 3–6 months for those with multiple partners, new partners, substance use during sex, or prior STI history. 1
- Chlamydia and gonorrhea: Use first-catch urine specimen tested by nucleic acid amplification test (NAAT), which provides 86-100% sensitivity and 97-100% specificity 1
- Syphilis: Perform both a nontreponemal test (RPR or VDRL) AND a treponemal test (EIA or CIA) together—a single test is insufficient for diagnosis 2, 1
- HIV: Laboratory-based antigen/antibody combination test at minimum annually, with high-risk individuals requiring more frequent screening 1, 3
- Hepatitis B: Serologic testing (HBsAg and antibodies) for men not previously vaccinated 1
- Hepatitis C: Screen when additional risk factors present, such as injection drug use or multiple sexual partners 1
Site-Specific Testing Based on Sexual Practices
Testing must be performed at all anatomic sites of exposure—relying solely on urine specimens misses the majority of rectal and pharyngeal infections, which are often asymptomatic. 1
- Receptive anal intercourse: Rectal swab NAAT for both chlamydia and gonorrhea (laboratory must have validated the assay) 2, 1
- Receptive oral sex: Pharyngeal swab NAAT or culture for gonorrhea only—pharyngeal chlamydia testing is not recommended due to limited clinical utility 2, 1
- Insertive intercourse: Urine NAAT adequately detects urethral infections 1
Screening Frequency Algorithm
Standard Risk (Annual Screening)
- Sexually active men with stable, mutually monogamous relationships and no other risk factors: comprehensive testing once per year 1
High-Risk (Every 3–6 Months)
Intensify screening to every 3–6 months when ANY of the following are present: 2, 1
- Multiple or anonymous partners
- New sexual partners
- Substance use during sex (especially methamphetamine)
- Prior STI diagnosis within the past year
- Unprotected sex outside mutually monogamous relationship
- Exchange of sex for drugs or money
- Partner with known STI or high-risk behaviors
- Incarceration or high-prevalence settings (jails, STD clinics, adolescent clinics) 2
Men Who Have Sex With Men (MSM): Enhanced Protocol
MSM require comprehensive anatomic-site testing at minimum annually, with 3–6 month intervals strongly recommended for those with higher-risk profiles. 2, 1
Minimum Annual Testing for All Sexually Active MSM:
- Urine/urethral NAAT for chlamydia and gonorrhea 1
- Rectal NAAT for chlamydia and gonorrhea (when receptive anal intercourse occurs) 2, 1
- Pharyngeal NAAT or culture for gonorrhea (when receptive oral intercourse occurs) 2, 1
- Syphilis serology (both nontreponemal and treponemal) 2, 1
- HIV testing 1, 3
Every 3–6 Months for Higher-Risk MSM:
- Frequent partner change 2, 1
- Anonymous partners 2, 1
- Substance use during sex 2, 1
- Sex work or transactional sex 1
Common pitfall: The CDC recommends at least annual HIV screening for MSM, but evidence remains insufficient to mandate more frequent than annual HIV screening—however, clinicians may consider 3–6 month intervals for individual MSM at increased risk based on local epidemiology and patient risk factors 3, 4
Post-Treatment Retesting
Mandatory repeat test at 3 months after any positive chlamydia or gonorrhea result, regardless of whether the partner was treated, because reinfection rates range from 25% to 40%. 1, 5
- If 3-month rescreening is not feasible, retest at the next healthcare visit within 12 months 5
- Women previously diagnosed with trichomoniasis should be rescreened 3 months after treatment 5
Heterosexual Men Without Symptoms
Routine universal screening is not recommended for asymptomatic heterosexual men without risk factors. 5
- Consider annual screening in high-prevalence settings (≥2% prevalence) such as jails, juvenile correction facilities, STD clinics, high school clinics, and adolescent health clinics 2, 5
- Screen annually if high-risk behaviors present: multiple partners, inconsistent condom use, substance use during sex, or partners with high-risk behaviors 5
Critical Pitfalls to Avoid
- Missing extragenital sites in MSM: Urine-only testing misses the majority of rectal and pharyngeal infections 1
- Single annual screen for ongoing high-risk behavior: Insufficient—3–6 month intervals are required 2, 1
- Incomplete syphilis testing: Both nontreponemal and treponemal tests must be performed together; a single test cannot diagnose syphilis 2, 1
- Forgetting 3-month retest after positive results: Reinfection is common even when partners are treated 1, 5
- Not obtaining sexual history: Disclosure of sexual behavior is significantly associated with receiving recommended screening services—providers must actively elicit sexual practices to determine appropriate testing sites 6