What is the recommended frequency for sexually transmitted disease (STD) checks in a patient suspected of a new infection?

From the Guidelines

For a patient suspected of a new STD infection, testing should be done immediately upon suspicion, with follow-up testing based on the specific infection, and patients with ongoing risk factors should consider routine screening every 3-6 months regardless of symptoms. When it comes to bacterial infections like chlamydia and gonorrhea, retesting is recommended 3 months after treatment to check for reinfection 1. For HIV, if the initial test is negative but exposure is suspected, repeat testing should occur at 4-6 weeks, 3 months, and 6 months. Syphilis requires follow-up testing at 3,6, and 12 months after treatment to ensure cure. For viral infections like herpes or HPV, testing is typically done when symptoms appear, with no standard retesting schedule unless new symptoms develop. During treatment for any STD, patients should abstain from sexual activity or use barrier protection consistently to prevent transmission. The frequency of testing varies because different pathogens have different window periods (time between infection and detectability) and different risks of reinfection. Some key populations, such as sexually active female adolescents and young adults (≤25 years), should be screened for C trachomatis annually, and sexually active adolescent and young adult MSM should be screened for pharyngeal, rectal, and urethral gonorrhea infection annually if engaging in receptive oral or anal intercourse or insertive intercourse, respectively 1. More frequent periodic screening (eg, at 3-month to 6-month intervals) is recommended if any of the following factors are present: multiple or anonymous sex partners, past history of any STD, identification of other behaviors associated with transmission of HIV and other STDs, sex or needle-sharing partner(s) with any of the above-mentioned risks, development of changes in life that may lead to behavioral change with increased risky behavior, or high prevalence of STDs in the area or in the patient population 1. Key considerations for screening include:

• The patient's risk factors and behaviors
• The prevalence of STDs in the community
• The presence of other STDs in the patient or their partner(s)
• The patient's history of previous STDs
• The patient's adherence to treatment and prevention measures. Ultimately, the goal of STD screening is to detect and treat infections early, prevent transmission, and improve patient outcomes, with a focus on morbidity, mortality, and quality of life.

From the Research

STD Check Frequency

The frequency of STD checks for a patient suspected of a new infection is crucial in preventing the spread of sexually transmitted infections (STIs) and ensuring timely treatment.

• According to 2, approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018, highlighting the need for regular screening.
• The Centers for Disease Control and Prevention (CDC) provides guidelines for STI testing and treatment, including recommendations for screening high-risk populations such as men who have sex with men and sexually active women under 25 years old 3.
• A study published in the International Journal of STD & AIDS found that women with a history of syphilis, gonorrhea, or chlamydia were at higher risk of acquiring HIV, emphasizing the importance of regular STD checks for individuals with a history of STIs 4.

Screening Recommendations

The American College of Obstetricians & Gynecologists recommends syphilis screening three times during pregnancy, regardless of risk, and suggests considering extragenital screening for gonorrhea and chlamydia in women at high risk 5.

• The CDC guidelines recommend testing for gonorrhea, chlamydia, and syphilis in individuals with symptoms or who are at high risk of infection 3.
• A study published in Sexually Transmitted Diseases found that STI testing rates decreased during the COVID-19 pandemic, but diagnosis rates remained stable, highlighting the need for continued screening efforts 6.

Treatment and Prevention

Effective treatment and prevention of STIs are critical in reducing the spread of infection and preventing long-term health consequences.

• According to 2, nucleic acid amplification tests have high sensitivities and specificities for the diagnosis of gonorrhea, chlamydia, and other STIs.
• The CDC guidelines recommend treatment with antibiotics such as ceftriaxone, doxycycline, and penicillin for gonorrhea, chlamydia, and syphilis, respectively 3.
• Prevention interventions, including screening, contact tracing, and promoting effective barrier contraception, can help reduce the spread of STIs 2, 3.