Official reprint from UpToDate®
www.uptodate.com ©2015 UpToDate®

Screening for sexually transmitted infections

Khalil G Ghanem, MD, PhD
Susan Tuddenham, MD, MPH
Section Editor
Noreen A Hynes, MD, MPH, DTM&H
Deputy Editor
Allyson Bloom, MD


Sexually transmitted infections (STIs) are a major public health problem in both resource-rich and limited settings. STIs are frequently asymptomatic and can lead to various complications. The immediate goal of screening for STIs is to identify and treat infected persons before they develop complications and to identify, test, and treat their sex partners to prevent transmission and reinfections.

In this topic, we discuss screening for STIs among asymptomatic individuals. In its 2015 guidelines on the treatment of sexually transmitted infections, the United States Centers for Disease Control and Prevention (CDC) also made recommendations on screening [1]. The US Preventive Services Task Force (USPSTF) has also released guidelines on screening for various STIs [2-4]. The Infectious Diseases Society of America's HIV Medical Association has published STI screening recommendations for HIV-infected persons [5]. The recommendations in this topic are largely consistent with these guidelines. Other subspecialty group guidelines and national guidelines may be more pertinent in certain settings [6-9].

The approaches to patients with specific genitourinary symptoms and signs are discussed elsewhere. (See "Approach to women with symptoms of vaginitis" and "Pelvic inflammatory disease: Clinical manifestations and diagnosis" and "Approach to the patient with genital ulcers" and "Acute uncomplicated cystitis and pyelonephritis in women".)

Information on the clinical presentation, diagnosis, and treatment of specific STIs are reviewed in detail separately (see related topics). Sexually transmitted infections and HIV infection in adolescents are also discussed separately. (See "Sexually transmitted diseases: Overview of issues specific to adolescents" and "The adolescent with HIV infection".)

The prevention of STIs is also discussed elsewhere. (See "Prevention of sexually transmitted infections".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2015. | This topic last updated: Sep 15, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2015 UpToDate, Inc.
  1. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
  2. LeFevre ML, U.S. Preventive Services Task Force. Screening for Chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 161:902.
  3. US Preventive Services Task Force. Screening for syphilis. Agency for Healthcare Research and Quality, Rockville, MD. Release date 2004. http://www.ahrq.gov/clinic/uspstf/uspssyph.htm (Accessed on June 05, 2006).
  4. US Preventive Services Task Force. Screening for herpes. Agency for Healthcare Research and Quality, Rockville, MD. Release date 2005. http://www.ahrq.gov/clinic/uspstf/uspsherp.htm (Accessed on June 05, 2006).
  5. 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. Clin Infect Dis 2014; 58:e1.
  6. Committee on Adolescence, Society for Adolescent Health and Medicine. Screening for nonviral sexually transmitted infections in adolescents and young adults. Pediatrics 2014; 134:e302.
  7. Australian Sexual Health Alliance. Australian STI management guidelines for use in primary care. http://www.sti.guidelines.org.au/ (Accessed on July 31, 2015).
  8. Public Health Agency of Canada. Canadian guidelines on sexually transmitted infections. http://www.phac-aspc.gc.ca/std-mts/sti-its/ (Accessed on July 31, 2015).
  9. British Association for Sexual Health and HIV. Guidelines. http://www.bashh.org/BASHH/Guidelines/Guidelines/BASHH/Guidelines/Guidelines.aspx (Accessed on July 31, 2015).
  10. Low N, Broutet N, Adu-Sarkodie Y, et al. Global control of sexually transmitted infections. Lancet 2006; 368:2001.
  11. Kohl KS, Markowitz LE, Koumans EH. Developments in the screening for Chlamydia trachomatis: a review. Obstet Gynecol Clin North Am 2003; 30:637.
  12. Nsuami M, Taylor SN, Sanders LS, Martin DH. Missed opportunities for early detection of chlamydia and gonorrhea in school-based health centers. Sex Transm Dis 2006; 33:703.
  13. Scholes D, Stergachis A, Heidrich FE, et al. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996; 334:1362.
  14. Oakeshott P, Kerry S, Aghaizu A, et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ 2010; 340:c1642.
  15. Ostergaard L, Andersen B, Møller JK, Olesen F. Home sampling versus conventional swab sampling for screening of Chlamydia trachomatis in women: a cluster-randomized 1-year follow-up study. Clin Infect Dis 2000; 31:951.
  16. Gottlieb SL, Berman SM, Low N. Screening and treatment to prevent sequelae in women with Chlamydia trachomatis genital infection: how much do we know? J Infect Dis 2010; 201 Suppl 2:S156.
  17. Low N, Hocking J. The POPI trial: what does it mean for chlamydia control now? Sex Transm Infect 2010; 86:158.
  18. van den Broek IV, van Bergen JE, Brouwers EE, et al. Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation. BMJ 2012; 345:e4316.
  19. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2013. Atlanta: U.S. Department of Health and Human Services; 2014. http://www.cdc.gov/std/stats13/default.htm (Accessed on December 31, 2014).
  20. Barbee LA, Dombrowski JC, Kerani R, Golden MR. Effect of nucleic acid amplification testing on detection of extragenital gonorrhea and chlamydial infections in men who have sex with men sexually transmitted disease clinic patients. Sex Transm Dis 2014; 41:168.
  21. Rieg G, Lewis RJ, Miller LG, et al. Asymptomatic sexually transmitted infections in HIV-infected men who have sex with men: prevalence, incidence, predictors, and screening strategies. AIDS Patient Care STDS 2008; 22:947.
  22. Gunn RA, O'Brien CJ, Lee MA, Gilchick RA. Gonorrhea screening among men who have sex with men: value of multiple anatomic site testing, San Diego, California, 1997-2003. Sex Transm Dis 2008; 35:845.
  23. Tongtoyai J, Todd CS, Chonwattana W, et al. Prevalence and Correlates of Chlamydia trachomatis and Neisseria gonorrhoeae by Anatomic Site Among Urban Thai Men Who Have Sex With Men. Sex Transm Dis 2015; 42:440.
  24. Lewis DA. Will targeting oropharyngeal gonorrhoea delay the further emergence of drug-resistant Neisseria gonorrhoeae strains? Sex Transm Infect 2015; 91:234.
  25. Gaydos CA, Kent CK, Rietmeijer CA, et al. Prevalence of Neisseria Gonorrhoeae among men screened for Chlamydia Trachomatis in four United States cities, 1999-2003. Sex Transm Dis 2006; 33:314.
  26. McClelland RS, Sangare L, Hassan WM, et al. Infection with Trichomonas vaginalis increases the risk of HIV-1 acquisition. J Infect Dis 2007; 195:698.
  27. Van Der Pol B, Kwok C, Pierre-Louis B, et al. Trichomonas vaginalis infection and human immunodeficiency virus acquisition in African women. J Infect Dis 2008; 197:548.
  28. Reynolds SJ, Risbud AR, Shepherd ME, et al. High rates of syphilis among STI patients are contributing to the spread of HIV-1 in India. Sex Transm Infect 2006; 82:121.
  29. Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999; 75:3.
  30. Götz HM, van Doornum G, Niesters HG, et al. A cluster of acute hepatitis C virus infection among men who have sex with men--results from contact tracing and public health implications. AIDS 2005; 19:969.
  31. van de Laar T, Pybus O, Bruisten S, et al. Evidence of a large, international network of HCV transmission in HIV-positive men who have sex with men. Gastroenterology 2009; 136:1609.
  32. van der Helm JJ, Prins M, del Amo J, et al. The hepatitis C epidemic among HIV-positive MSM: incidence estimates from 1990 to 2007. AIDS 2011; 25:1083.
  33. Centers for Disease Control and Prevention (CDC). Sexual transmission of hepatitis C virus among HIV-infected men who have sex with men--New York City, 2005-2010. MMWR Morb Mortal Wkly Rep 2011; 60:945.
  34. Taylor LE, Holubar M, Wu K, et al. Incident hepatitis C virus infection among US HIV-infected men enrolled in clinical trials. Clin Infect Dis 2011; 52:812.
  35. van de Laar TJ, van der Bij AK, Prins M, et al. Increase in HCV incidence among men who have sex with men in Amsterdam most likely caused by sexual transmission. J Infect Dis 2007; 196:230.
  36. Tohme RA, Holmberg SD. Is sexual contact a major mode of hepatitis C virus transmission? Hepatology 2010; 52:1497.
  37. Ness RB, Smith KJ, Chang CC, et al. Prediction of pelvic inflammatory disease among young, single, sexually active women. Sex Transm Dis 2006; 33:137.
  38. Lofy KH, Hofmann J, Mosure DJ, et al. Chlamydial infections among female adolescents screened in juvenile detention centers in Washington State, 1998-2002. Sex Transm Dis 2006; 33:63.
  39. Kerani RP, Handcock MS, Handsfield HH, Holmes KK. Comparative geographic concentrations of 4 sexually transmitted infections. Am J Public Health 2005; 95:324.
  40. Niccolai LM, Ethier KA, Kershaw TS, et al. New sex partner acquisition and sexually transmitted disease risk among adolescent females. J Adolesc Health 2004; 34:216.
  41. Klausner JD, Kent CK, Wong W, et al. The public health response to epidemic syphilis, San Francisco, 1999-2004. Sex Transm Dis 2005; 32:S11.
  42. Kahn RH, Voigt RF, Swint E, Weinstock H. Early syphilis in the United States identified in corrections facilities, 1999-2002. Sex Transm Dis 2004; 31:360.
  43. Beymer MR, Weiss RE, Bolan RK, et al. Sex on demand: geosocial networking phone apps and risk of sexually transmitted infections among a cross-sectional sample of men who have sex with men in Los Angeles County. Sex Transm Infect 2014; 90:567.
  44. Lewnard JA, Berrang-Ford L. Internet-based partner selection and risk for unprotected anal intercourse in sexual encounters among men who have sex with men: a meta-analysis of observational studies. Sex Transm Infect 2014; 90:290.
  45. Datta SD, Sternberg M, Johnson RE, et al. Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002. Ann Intern Med 2007; 147:89.
  46. Torkko KC, Gershman K, Crane LA, et al. Testing for Chlamydia and sexual history taking in adolescent females: results from a statewide survey of Colorado primary care providers. Pediatrics 2000; 106:E32.
  47. Boekeloo BO, Marx ES, Kral AH, et al. Frequency and thoroughness of STD/HIV risk assessment by physicians in a high-risk metropolitan area. Am J Public Health 1991; 81:1645.
  48. Phipps W, Stanley H, Kohn R, et al. Syphilis, chlamydia, and gonorrhea screening in HIV-infected patients in primary care, San Francisco, California, 2003. AIDS Patient Care STDS 2005; 19:495.
  49. Hoebe CJ, Rademaker CW, Brouwers EE, et al. Acceptability of self-taken vaginal swabs and first-catch urine samples for the diagnosis of urogenital Chlamydia trachomatis and Neisseria gonorrhoeae with an amplified DNA assay in young women attending a public health sexually transmitted disease clinic. Sex Transm Dis 2006; 33:491.
  50. Trebach JD, Chaulk CP, Page KR, et al. Neisseria gonorrhoeae and Chlamydia trachomatis among women reporting extragenital exposures. Sex Transm Dis 2015; 42:233.
  51. Joesoef MR, Weinstock HS, Kent CK, et al. Sex and age correlates of Chlamydia prevalence in adolescents and adults entering correctional facilities, 2005: implications for screening policy. Sex Transm Dis 2009; 36:S67.
  52. Pathela P, Hennessy RR, Blank S, et al. The contribution of a urine-based jail screening program to citywide male Chlamydia and gonorrhea case rates in New York City. Sex Transm Dis 2009; 36:S58.
  53. CDC. Evaluation of large jail STD screening programs, 2008 - 2009.Atlanta, GA: CDC, NCHHSTP; 2011. http://www.cdc.gov/std/publications/JailScreening2011.pdf (Accessed on August 02, 2015).
  54. Hobbs MM, van der Pol B, Totten P, et al. From the NIH: proceedings of a workshop on the importance of self-obtained vaginal specimens for detection of sexually transmitted infections. Sex Transm Dis 2008; 35:8.
  55. Geisler WM, Wang C, Morrison SG, et al. The natural history of untreated Chlamydia trachomatis infection in the interval between screening and returning for treatment. Sex Transm Dis 2008; 35:119.
  56. Hopkins RS, Jajosky RA, Hall PA, et al. Summary of notifiable diseases--United States, 2003. MMWR Morb Mortal Wkly Rep 2005; 52:1.
  57. Golden MR, Whittington WL, Handsfield HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med 2005; 352:676.
  58. Peterman TA, Tian LH, Metcalf CA, et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: a case for rescreening. Ann Intern Med 2006; 145:564.
  59. Centers for Disease Control and Prevention (CDC). Chlamydia screening among sexually active young female enrollees of health plans--United States, 2000-2007. MMWR Morb Mortal Wkly Rep 2009; 58:362.
  60. Heijne JC, Tao G, Kent CK, Low N. Uptake of regular chlamydia testing by U.S. women: a longitudinal study. Am J Prev Med 2010; 39:243.
  61. Berry SA, Ghanem KG, Page KR, et al. J Acquir Immune Defic Syndr 2015; :in press.
  62. Hall CS, Marrazzo JD. Emerging issues in management of sexually transmitted diseases in HIV infection. Curr Infect Dis Rep 2007; 9:518.
  63. Seña AC, Mertz KJ, Thomas D, et al. A survey of sexually transmitted diseases/HIV coinfection testing and reporting practices among health care providers in New Jersey. Sex Transm Dis 2005; 32:406.