Essential Features
- • Most sexually transmitted diseases (STDs) are asymptomatic. Persons with asymptomatic STDs are at risk for complications and transmission of infection to others.
- • In some cases, screening is the only means to detect and treat infection to prevent adverse outcomes.
- • The judicious use of screening tests relies on appreciation of disease epidemiology and accurate assessment of a patient’s sexual risk behavior.
General Considerations
Most sexually transmitted diseases are asymptomatic. Patients often acquire infection from sex partners who exhibit no symptoms. Persons with asymptomatic infection may develop complications or sequelae without knowledge of being infected. The epidemiology of STDs—how those diseases are distributed within a population—is not random; risk factors that include age, gender, and sexual activity dictate who is likely to be infected. Screening and timely treatment have been shown to reduce the consequences of infection. National organizations, including the US Preventive Services Task Force and the Centers for Disease Control and Prevention (CDC), as well as professional medical societies, regularly review the current scientific literature and make evidence-based recommendations for STD and HIV screening. Individuals are advised to undergo STD testing not only to identify and treat asymptomatic infection (screening) but to monitor trends in the population (surveillance) and confirm a diagnosis. Table 1–1 summarizes current STD and HIV screening recommendations.
| Disease | Recommending Group | Population | Frequency | Considerations |
|---|---|---|---|---|
| Cervical cancer | Centers for Disease Control and Prevention (CDC), US Preventive Services Task Force (PSTF) | All women who have been sexually active and have a cervix | Within 3 y of onset of sexual activity or age 21 (whichever comes first) and screening at least every 3 y | Routine screening for cervical cancer is not recommended in women older than 65 y if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer |
| Chlamydia | CDC, PSTF | All sexually active women aged 25 y and younger, and other asymptomatic women at increased risk for infection (Age important risk marker. Other patient characteristics associated with a higher prevalence of infection include being unmarried, African-American race, having a prior history of STD, having new or multiple partners, having cervical ectopy, and using barrier contraceptives inconsistently); sexually active men who have sex with men (MSM) should be screened at relevant anatomic sites (rectum) every 3–12 months | Yearly | More frequent screening may be required in those with increased risk, recent partners with chlamydia, and recent prior history of chlamydia. CDC recommends that all women treated for chlamydia undergo repeat testing 3 mo after treatment. |
| Genital herpes | CDC, PSTF | Persons with HIV infection and at increased risk for acquiring HIV infection,b and those with a sex partner known to have genital herpes | Yearly | Although serologic screening is not recommended in asymptomatic pregnant women at any time during pregnancy to prevent neonatal HSV infection, the American College of Obstetricians and Gynecologists and state of California recommend obtaining a history of genital herpes disease or potential exposure in all pregnant women |
| Gonorrhea | CDC, PSTF | All sexually active women, including those who are pregnant, with increased risk for infection (ie, young age or other individual or population risk factors)b; sexually active MSM should be screened at relevant anatomic sites (throat and rectum) every 3–12 mo | ||
| Hepatitis | ||||
| A or C | CDC, PSTF | None | ||
| B | CDC, PSTF | Pregnant women at their first prenatal visit | ||
| HIV | CDC, PSTF | All adolescents and adults seeking evaluation and treatment for STDs or those at increased risk for HIV infectionc; All 13–64 year olds at least once; repeat based on risk behaviour | Yearly, but no optimal frequency clearly defined | CDC recommends routine testing in medical settings (ie, without required written informed consent or specific pre- or post-test counseling); results may be disclosed over the telephone. State laws regarding HIV testing requirements may vary. |
| Human papillomavirus | CDC, PSTF | None | ||
| Syphilis | CDC, PSTF | Persons at increased risk for syphilis infection (MSM and those who engage in high-risk sexual behavior, commercial sex workers, persons who exchange sex for drugs, and those in adult correctional facilities); all pregnant women at their first prenatal visit, with testing repeated in the third trimester and at delivery in those in high risk groups | ||
| Trichomonas vaginalis | CDC | None | Some experts recommend screening of pregnant women with a history of adverse outcomes in pregnancy (eg, premature rupture of membranes; preterm labor; low-birth-weight infant) |
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