Screening

Providers should offer screening for STIs in accordance with CDC treatment guidelines and USPSTF recommendations for STI and HIV screening that are summarized in Exhibit 11, which is not intended to be comprehensive.123 

Individuals should be engaged in decision making about STI testing and allowed access to the testing they want and the ability to opt out of testing they do not want to receive. Testing for specific STIs should be provided to all individuals upon request, regardless of risk factors. It is important to note, however, that the risk-benefit ratio of some types of screening requires careful consideration (for example, asymptomatic herpes screening).

Providers should clearly communicate all screening recommendations with patients, including the rationale for any recommended tests and the reasons why testing for some STIs may not be indicated. Opt-out screening can be implemented as a strategy to normalize testing, decrease stigma, and increase screening rates. When employing opt-out screening, the provider informs the patient that a test will be performed as routine unless the patient declines. Opt-out strategies are frequently used to support screening in adolescent populations or in geographic locations with a high prevalence of STIs.

Exhibit 11. STI Screening Recommendations for Asymptomatic Individuals

Chlamydia and Gonorrhea

Age: Under 25 years

• At least annually for sexually active persons assigned female at birth (AFAB). Extragenital (pharyngeal and rectal) screening can be considered based on reported sexual behaviors and exposure.
• All pregnant people.
• Routine screening is not recommended for asymptomatic persons assigned male at birth (AMAB) who have sex with persons assigned female at birth (AFAB). However, screening for persons assigned male at birth (AMAB) and younger than age 25 should be offered in high-prevalence clinical settings (such as adolescent clinics, correctional facilities, and STI and sexual health clinics).

Age: 25 years or older*

• At least annually for sexually active persons assigned female at birth (AFAB) who are at increased risk.* Extragenital (pharyngeal and rectal) screening can be considered based on reported symptoms, sexual behaviors, and exposure.
• All pregnant people.

All ages:

• At least annually for sexually active persons assigned male at birth (AMAB) who have sex with persons assigned male at birth (AMAB); every three to six months if at increased risk.**
• At least annually for persons with HIV.

*Per USPSTF, women age 25 years or older are at increased risk for chlamydial and gonococcal infections if they have a new partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI; practice inconsistent condom use when not in a mutually monogamous relationship; have a previous or coexisting STI; have a history of exchanging sex for money or drugs; or have a history of incarceration.

**Adapted from CDC Guidelines. Per the CDC, men who have sex with men are at increased risk for chlamydial and gonococcal infections if they are on PrEP, with HIV infection, or if they or their sex partners have multiple partners.

Syphilis

All ages:

• All pregnant individuals serologically for syphilis at the first prenatal care visit, followed by universal rescreening during the third trimester and again at birth.124***
• Asymptomatic persons assigned female at birth (AFAB) and at increased risk (geography, history of incarceration, and transactional sex work).
• Asymptomatic persons assigned male at birth (AMAB) and at increased risk (history of incarceration, transactional sex work, geography, and younger than age 29).
• At least annually for sexually active persons assigned male at birth (AMAB) who have sex with persons assigned male at birth (AMAB).
• At least annually for sexually active individuals with HIV

***Per USPSTF, risk of syphilis infection is increased among men who have sex with men; persons with HIV infection or other sexually transmitted infections; persons who use drugs; and persons with a history of incarceration, sex work, or military service. Clinicians should be aware of how common syphilis infection is in their community and assess each person’s individual risk.

Herpes

All ages:

• Evidence does not support routine serologic screening for adolescents and adults.^
• Type-specific HSV serologic testing can be offered for individuals presenting for an STI evaluation based on individual risk.
• Type-specific HSV serologic testing can be offered for people with HIV presenting for an STI evaluation.

^ Genital Herpes Infection: Serologic Screening

Trichomonas

All ages:

• Screening should be offered for persons assigned female at birth (AFAB) receiving care in high-prevalence settings (for example, STI clinics and correctional facilities).
• Screening should be offered for persons assigned female at birth (AFAB) at high risk for infection.**** 

****Per the CDC, individuals at risk for trichomonas include women with multiple sex partners and those with a history of transactional sex, drug misuse, STI, or incarceration.

HIV/AIDS

Age: 13−64

• At least once for all individuals

All ages:

• At least annually for persons assigned male at birth (AMAB) who have sex with persons assigned male at birth (AMAB) if the patient and their sex partner(s) have had more than one partner since most recent HIV test.
• All individuals who seek evaluation and treatment for STIs.
• All pregnant people.

Hepatitis B

• All individuals at increased risk.*****
• All persons assigned male at birth (AMAB) who have sex with persons assigned male at birth (AMAB) should be tested for HBsAg, anti-HBc, and anti-HBs.
• Individuals with HIV should be tested for HBsAg, anti-HBc, and anti-HBs.

Per USPSTF, individuals at increased risk for hepatitis B include individuals born in countries or regions with an HBsAg prevalence of 2 percent or greater (regardless of vaccination history in their country of origin) and adolescents and adults born in the United States who did not receive the HBV vaccine as infants and whose parents were born in regions with an HBsAg prevalence of 8 percent or greater (regardless of their biological mother's HBsAg status); persons who have injected drugs in the past or are injecting drugs currently; men who have sex with men; persons with HIV; and sex partners, needle-sharing contacts, and household contacts of persons known to be HBsAg positive.

Hepatitis C

Age: 18−79 years

• All individuals except in areas where the hepatitis C infection (HCV) positivity is <0.1%.

All ages:

• All individuals except in areas where the hepatitis C infection (HCV) positivity is <0.1%.
• Pregnant people except in settings where the hepatitis C infection (HCV) positivity is <0.1%.
• Serologic testing at initial evaluation for persons with HIV.
• Annual testing for persons assigned male at birth (AMAB) who have sex with persons assigned male at birth (AMAB) with HIV infection.

Mpox

• Recommended for all persons who had known or suspected exposure to someone with Mpox125.
• Recommended for all persons who had a sex partner in the past two weeks who was diagnosed with Mpox.
• Recommended for gay, bisexual, or other MSM, and transgender and gender-diverse people (including adolescents) who had in the past six months, or anticipate having:
  • A new diagnosis of one or more STI
  • More than one sex partner
• People who had in the past six months, or anticipate having:
  • Sex at a commercial sex venue
  • Sex in association with a large public event in an area where Mpox transmission is occurring
  • Sex in exchange for money or other items
• People who are sexual partners of people with the above risks.
• People with HIV infection or other cause of immunosuppression who have recent or who anticipate potential Mpox exposure.
• People who work in settings where they may be exposed to Mpox.