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Some of the most common viral STIs are caused by HIV and human papillomavirus (HPV). The most common bacterial STIs are chlamydia, gonorrhea, and syphilis. Protozoans may also cause STIs; the most common example of this type of infection is trichomoniasis (a potential cause of vaginitis). STIs can have severe health consequences and, if left untreated, can lead to complications that include pelvic inflammatory disease, infertility, cervical cancer, and chronic pelvic pain. Additionally, STIs such as syphilis and trichomoniasis are associated with an increased risk of HIV acquisition and transmission. Laboratory testing is important for the screening and diagnosis of STIs. Appropriate screening prevents the spread of disease, and accurate diagnosis enables appropriate treatment and patient management.
Quick Answers for Clinicians
Trichomoniasis (a potential cause of vaginitis), herpes simplex virus (HSV), hepatitis B virus (HBV), hepatitis C virus (HCV), and human papillomavirus (HPV) may also be sexually transmitted and are often included in a sexually transmitted infection (STI) screening or workup. More information about these conditions can be found in the associated ARUP Consult topics.
Indications for Testing
Laboratory testing to screen asymptomatic individuals is appropriate for most individuals. The Screening section provides detailed screening recommendations based on population.
Laboratory testing for the diagnosis of an STI is appropriate for individuals experiencing:
- Urgency, frequency, or dysuria in the absence of a documented urinary tract infection (UTI)
- Vaginal or penile discharge
- Pelvic pain
- Prostatitis symptoms
- Genital lesions such as painful vesicles or nonpainful shallow ulcers
Laboratory Testing
Screening
Screening for STIs is important to control the spread of these diseases because many STIs may be asymptomatic. The recommendations for screening vary by disease and population. The following tables detail the screening recommendations for chlamydia and gonorrhea in women, pregnant individuals, men, men who have sex with men (MSM), other men, and persons with HIV; the last table details screening recommendations for trichomoniasis in women, men, and those with HIV. For transgender individuals, STI screening should be based on current anatomy and sexual practices.
For detailed information about screening for syphilis, HIV, herpes simplex virus (HSV), and trichomoniasis, refer to the corresponding ARUP Consult topics.
| Population | Testing Recommended in These Patients/Circumstancesa |
|---|---|
| Women | Sexually active women <25 yrs and sexually active women ≥25 yrs who are at increased riskb; retest approximately 3 mos after treatment Consider pharyngeal and rectal screening based on reported sexual behavior |
| Pregnant individuals | All pregnant individuals <25 yrs and those ≥25 yrs who are at increased riskb; retest individuals<25 yrs or those at risk in third trimesterb |
| MSM | Annually at sites of contact Repeat testing every 3-6 mos in those at increased riskc |
| Other men (not MSM) | No screening recommended for individuals at low risk,d but consider screening young men in high-prevalence clinical settings or in populations with high burden of infection |
| Transgender and gender-diverse persons | Adapt screening recommendations based on anatomy; consider rectal screening based on reported sexual behavior and exposure |
| Persons with HIV | All sexually active individuals at first HIV evaluation, then at least annually More frequent screening may be appropriate depending on risk behaviors and local epidemiology |
aUnless otherwise noted, all recommendations come from the CDC. bThe CDC defines persons at increased risk as those who have a new sexual partner, >1 sexual partner, a sexual partner with concurrent partners, or a sexual partner who has an STI. cAll MSM, including those with HIV infection, if risk behaviors persist or if they or their sexual partners have multiple partners. dThe U.S. Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening men for chlamydia and gonorrhea. | |
| Population | Testing Recommended in These Patients/Circumstancesa |
|---|---|
| Women | Sexually active women <25 yrs and sexually active women ≥25 yrs who are at increased riskb,c; retest approximately 3 mos after treatment Consider pharyngeal and rectal screening based on reported sexual behavior |
| Pregnant individuals | All pregnant individuals <25 yrs and those ≥25 yrs who are at increased riskb |
| MSM | All sexually active MSM: annually at sites of contact Repeat testing every 3-6 mos in those at increased risk |
| Other men (not MSM) | No screening recommended for men who are not MSM and are at low risk for infectiond |
| Transgender and gender-diverse persons | Adapt screening recommendations based on anatomy; consider rectal screening based on reported sexual behavior and exposure |
| Persons with HIV | All sexually active individuals at first HIV evaluation, then at least annually More frequent screening may be appropriate depending on risk behaviors and local epidemiology |
aUnless otherwise noted, all recommendations come from the CDC. bThe CDC defines persons at increased risk as those who have a new sexual partner, >1 sexual partner, a sexual partner with concurrent partners, or a sexual partner who has an STI. cAdditional risk factors for gonorrhea include inconsistent condom use among persons who are not in mutually monogamous relationships, previous or coexisting STIs, 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 to identify groups that are at increased risk. dThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening men for chlamydia and gonorrhea. | |
| Population | Testing Recommended in These Patients/Circumstances |
|---|---|
| Women | Screening is not recommended for asymptomatic women but may be considered in women receiving care in high-prevalence settings or at high risk for STIs |
| Men | No screening recommended |
| Persons with HIV | Routine screening for T. vaginalis recommended in asymptomatic persons with HIV infection |
| Source: Workowski, 2021 | |
Diagnosis
Specific testing recommendations for syphilis, HIV, HSV, and vaginitis caused by trichomoniasis can be found in the corresponding ARUP Consult topics. Accurate diagnosis is important to determine appropriate treatment and medical management. Nucleic acid amplification testing (NAAT) is recommended for the diagnosis of most STIs, although in some cases, culture and serology may be useful.
ARUP Laboratory Tests
Qualitative Transcription-Mediated Amplification (TMA)
Qualitative Transcription-Mediated Amplification (TMA)
Qualitative Transcription-Mediated Amplification
Transcription-Mediated Amplification
Qualitative Transcription-Mediated Amplification
Qualitative Transcription-Mediated Amplification
Qualitative Polymerase Chain Reaction (PCR)
Qualitative Transcription-Mediated Amplification (TMA)
Qualitative Transcription-Mediated Amplification (TMA)
Qualitative Polymerase Chain Reaction
Cell Culture/Immunofluorescence
Culture
References
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Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021 [published correction appears in MMWR Morb Mortal Wkly Rep. 2023;72(4):107-108].MMWR Recomm Rep. 2021;70(4):1-187.
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34519796
US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for chlamydia and gonorrhea: US Preventive Services Task Force recommendation statement. JAMA. 2021;326(10):949-956.