Screening for STIs
- High-Yield
- Chlamydia & Gonorrhea: All sexually active females ≤ 24 yo and females ≥ 25 yo at increased risk.
- HIV: Screening for all individuals aged 15–65 yo at least once; high-risk groups screened annually or more frequently.
- Syphilis: High-risk individuals and all pregnant women at 1st prenatal visit (repeat at 28 wks & delivery if high risk). c
- Hepatitis B & C: Universal HCV screening (all adults 18–79 yo); HBV screening for high-risk individuals and pregnant women.
- Chlamydia trachomatis & Neisseria gonorrhoeae
- Screening targets:
- Females ≤ 24 yo: Annual routine screening.
- Females ≥ 25 yo: Annual screening only if high risk (e.g., new/multiple partners).
- MSM: Annual screening at all exposed sites (pharyngeal, rectal, urethral).
- Pregnancy: All pts at 1st prenatal visit (repeat in 3rd trimester if < 25 yo or high risk).
- Test: NAAT (first-catch urine or site-specific swab).
- HIV (Human Immunodeficiency Virus)
- Screening targets:
- General population: Universal 1-time screening for ages 15–65 yo.
- High-risk (MSM, IVDU): At least annually.
- Pregnancy: All pts at 1st prenatal visit.
- Test: 4th-generation HIV-1/2 Ag/Ab combo assay → confirm w/ HIV-1/2 differentiation assay.
- Syphilis (Treponema pallidum)
- Screening targets: High-risk adults (MSM, IVDU) and all pregnant pts at 1st prenatal visit (repeat at 28–32 wks and delivery if high risk).
- Test: Nontreponemal test (RPR/VDRL) → confirm w/ Treponemal test (FTA-ABS/TP-PA).
- Hepatitis B & C Viruses (HBV & HCV)
- HBV: Screen all pregnant pts (1st visit) and high-risk adults with HBsAg.
- HCV: Universal 1-time screening for all adults 18–79 yo and each pregnancy with HCV Ab (→ HCV RNA PCR if (+)).
- Cervical Cancer & HPV
- < 21 yo: No screening regardless of sexual activity.
- 21–29 yo: Pap smear q3y alone (no HPV co-testing).
- 30–65 yo: Pap q3y OR hrHPV q5y OR co-testing q5y.
- > 65 yo / Post-hysterectomy (for benign indications): Discontinue if adequate prior negative screens and low risk.
- Herpes Simplex Virus (HSV) & Trichomoniasis
- HSV: Routine screening NOT recommended in asymptomatic pts.
- Trichomonas: Screen annually in HIV(+) females (NAAT or wet mount).