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Treatment Sexually Transmitted Diseases

Screening Recommendations and Considerations Referenced in Treatment Guidelines and Original Sources

  ** USPSTF recommends screening in adults and adolescents ages 15-65

Chlamydia
Women
  • Sexually active women under 25 years of age1
  • Sexually active women aged 25 years and older if at increased risk2
  • Retest approximately 3 months after treatment3
Pregnant Women
  • All pregnant women under 25 years of age1
  • Pregnant women, aged 25 and older if at increased risk2
  • Retest during the 3rd trimester for women under 25 years of age or at risk3,4
  • Pregnant women with chlamydial infection should have a test-of-cure 3-4 weeks after treatment and be retested within 3 months1
Men
  • *Consider screening young men in high prevalence clinical settings5 or in populations with high burden of infection (e.g. MSM)6
Men Who have Sex With Men (MSM)

  • At least annually for sexually active MSM at sites of contact (urethra, rectum) regardless of condom use6

  • Every 3 to 6 months if at increased risk7
Persons with HIV

  • For sexually active individuals, screen at first HIV evaluation, and at least annually thereafter8

  • More frequent screening for might be appropriate depending on individual risk behaviors and the local epidemiology8
Gonorrhea
Women
  • Sexually active women under 25 years of age1
  • Sexually active women age 25 years and older if at increased risk9
  • Retest 3 months after treatment10
Pregnant Women
  • All pregnant women under 25 years of age and older women if at increased risk11
  • Retest 3 months after treatment10
Men Who have Sex With Men (MSM)

  • At least annually for sexually active MSM at sites of contact (urethra, rectum, pharynx) regardless of condom use10

  • Every 3 to 6 months if at increased risk7
Persons with HIV

  • For sexually active individuals, screen at first HIV evaluation, and at least annually thereafter10

  • More frequent screening for might be appropriate depending on individual risk behaviors and the local epidemiology10
Syphilis
Pregnant Women
  • All pregnant women at the first prenatal visit11
  • Retest early in the third trimester and at delivery if at high risk12
Men Who have Sex With Men (MSM)

  • At least annually for sexually active MSM13

  • Every 3 to 6 months if at increased risk7
Persons with HIV

  • For sexually active individuals, screen at first HIV evaluation, and at least annually thereafter14,15,16

  • More frequent screening might be appropriate depending on individual risk behaviors and the local epidemiology13
Trichomonas
Women
  • *Consider for women receiving care in high-prevalence settings (e.g., STD clinics and correctional facilities) and for women at high risk for infection (e.g., women with multiple sex partners, exchanging sex for payment, illicit drug use, and a history of STD)17
Persons with HIV

  • Recommended for sexually active women at entry to care and at least annually thereafter14
Herpes
Women
  • *Type-specific HSV serologic testing should be considered for women presenting for an STD evaluation (especially for women with multiple sex partners)17
Pregnant Women
  • *Evidence does not support routine HSV-2 serologic screening among asymptomatic pregnant women. However, type-specific serologic tests might be useful for identifying pregnant women at risk for HSV infection and guiding counseling regarding the risk for acquiring genital herpes during pregnancy17
Men
  • *Type-specific HSV serologic testing should be considered for men presenting for an STD evaluation (especially for men with multiple sex partners)17
Men Who have Sex With Men (MSM)

  • *Type-specific serologic tests can be considered if infection status is unknown in MSM with previously undiagnosed genital tract infection17
Persons with HIV

  • *Type-specific HSV serologic testing should be considered for persons presenting for an STD evaluation (especially for those persons with multiple sex partners), persons with HIV infection, and MSM at increased risk for HIV acquisition17
HIV
Women
  • All women aged 13-64 years (opt-out)**18
  • All women who seek evaluation and treatment for STDs19
Pregnant Women
  • All pregnant women should be screened at first prenatal visit (opt-out)20
  • Retest in the third trimester if at high risk21
Men
  • All men aged 13-64 (opt-out)**18
  • All men who seek evaluation and treatment for STDs19
Men Who have Sex With Men (MSM)

  • At least annually for sexually active MSM if HIV status is unknown or negative and the patient himself or his sex partner(s) have had more than one sex partner since most recent HIV test22
Cervical Cancer
Women
  • Women 21-29 years of age every 3 years with cytology
  • Women 30-65 years of age every 3 years with cytology, or every 5 years with a combination of cytology and HPV testing23,24,25
Pregnant Women
  • Pregnant women should be screened at same intervals as nonpregnant women23,24,25
Persons with HIV

  • Women should be screened within 1 year of sexual activity or initial HIV diagnosis using
    conventional or liquid-based cytology; testing should be repeated 6 months later26
Hepatitis B Screening
Women
  • Women at increased risk27
Pregnant Women
  • Test for HBsAg at first prenatal visit of each pregnancy regardless of prior  testing; retest at delivery if at high risk27,28
Men
  • Men at increased risk27
Men Who have Sex With Men (MSM)

  • All MSM should be tested for HBsAg27
Persons with HIV

  • Test for HBsAg and anti-HBc and/or anti-HBs27
Hepatitis C Screening
Women
  • Women born between 1945-196529,30
  • Other women If risk factors are present30
Pregnant Women
  • Pregnant women born between 1945-196529,30
  • Other pregnant women if risk factors are present30
Men
  • Men born between 1945-196529,30
  • Other men If risk factors are present30
Men Who have Sex With Men (MSM)
  • MSM born between 1945-196529
  • Other MSM if risk factors are present30
  • Annual HCV testing in MSM with HIV infection31
Persons with HIV
  • Serologic testing at initial evaluation32,33

  • Annual HCV testing in MSM with HIV infection31

References 

  * Please note that portions of this table marked with an asterisk are considerations and should not be interpreted as formal recommendations.

  ** USPSTF recommends screening in adults and adolescents ages 15-65

  1. LeFevre ML. Screening for Chlamydia and Gonorrhea: U.S. Preventive Services Task Force Recommendation Statement. Annals of internal medicine. Sep 23 2014.
  2. Those who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection.  Screening for Chlamydia and Gonorrhea: U.S. Preventive Services Task Force Recommendation Statement. Annals of internal medicine. Sep 23 2014.
  3. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  4. e.g., those with a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  5. Adolescent clinics, correctional facilities, and STD clinics.  Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  6. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  7. More frequent STD screening (i.e., for syphilis, gonorrhea, and chlamydia) at 3–6-month intervals is indicated for MSM, including those with HIV infection if risk behaviors persist or if they or their sexual partners have multiple partners. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  8. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  9. Those who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI. Additional risk factors for gonorrhea include inconsistent condom use among persons who are not in mutually monogamous relationships; previous or coexisting sexually transmitted infections; and exchanging sex for money or drugs. Clinicians should consider the communities they serve and may opt to consult local public health authorities for guidance on identifying groups that are at increased risk.  Screening for Chlamydia and Gonorrhea: U.S. Preventive Services Task Force Recommendation Statement. Annals of internal medicine. Sep 23 2014.
  10. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  11. US Preventive Services Task Force. Screening for syphilis infection in pregnancy: reaffirmation recommendation statement. Annals of internal medicine. 5/19/2009 2009;150(10):705-709.
  12. American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and March of Dimes Birth Defects Foundation. Guidelines for Perinatal Care. 6th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2007
  13. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  14. CDC, Health Resources and Services Administration, National Institutes of Health, HIV Medicine Association of the Infectious Diseases Society of America, HIV Prevention in Clinical Care Working Group. Recommendations for incorporating human immunodeficiency virus (HIV) prevention into the medical care of persons living with HIV. Clin Infect Dis. Jan 1 2004;38(1):104-121.
  15. Aberg JA, Gallant JE, Ghanem KG et al.  Primary Care Guidelines for the Management of Persons Infected With HIV: 2013 Update by the HIV Medicine Association of the Infectious Diseases Society of America.  CID. Jan 1 2014;58: e1-e34.
  16. Centers for Disease Control and Prevention, Health Resources and Services Administration, National Institutes of Health, American Academy of HIV Medicine, Association of Nurses in AIDS Care, International Association of Providers of AIDS Care, the National Minority AIDS Council, and Urban Coalition for HIV/AIDS Prevention Services. Recommendations for HIV Prevention with Adults and Adolescents with HIV in the United States, 2014. 2014. http://stacks.cdc.gov/view/cdc/26062. December 11, 2014.
  17. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  18. CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR. 9/22/2006 2006;55(No. RR-14):1-17.
  19. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  20. Moyer VA, US Preventive Services Task Force. Screening for HIV: US Preventive Services Task Force Recommendation Statement. Annals of internal medicine. 2013;159:51–60.
  21. Women who use illicit drugs, have STDs during pregnancy, have multiple sex partners during pregnancy, live in areas with high HIV prevalence, or have partners with HIV infection. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.
  22. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  23. Moyer VA. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. Annals of internal medicine. Jun 19 2012;156(12):880-891, W312.
  24. American College of Obstetricians and Gynecologists (ACOG). Screening for cervical cancer. ACOG Practice Bulletin Number 131. Obstet Gynecol. Nov 2012;120(5):1222-1238.
  25. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. May-Jun 2012;62(3):147-172.
  26. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.Available at: http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf
  27. Those at increased risk include persons born in regions of high endemicity (>=2% prevalence), IDU, MSM, persons on Immunosuppresive therapy, Hemodialysis patients, HIV positive individuals, and others.  For detailed recommendations refer to: Centers for Disease Control and Prevention. Recommendations for Identification and Public Health Management of Person swith Chronic Hepatitis B Virus Infection,2008.  MMWR September 19th, 2008; 57(RR-8);1-21.  Available at: https://www.cdc.gov/mmwr/pdf/rr/rr5708.pdf
  28. U.S. Preventive Services Task Force. Screening for Hepatitis B Virus Infection in Pregnancy: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. Ann Intern Med 2009;150:869-73
  29. Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR. Aug 17 2012;61(No. RR-4):1-32.
  30. Past or current injection drug use, receipt of blood transfusion before 1992, long term hemodialysis, born to mother with Hep. C, intranasal drug use, receipt of an unregulated tattoo, and other percutaneous exposures. Moyer VA. Screening for hepatitis C virus infection in adults: US Preventive Services Task Force recommendation statement. Annals of internal medicine. Sep 3 2013;159(5):349-357.
  31. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015.  
  32. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.Available at: http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf
  33. Aberg JA, Gallant JE, Ghanem KG et al.  Primary Care Guidelines for the Management of Persons Infected With HIV: 2013 Update by the HIV Medicine Association of the Infectious Diseases Society of America.  CID. Jan 1 2014;58: e1-e34.

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