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STI screening recommendations by gender and population

STI screening recommendations by gender and population
Gender Population Routine screening recommendation Screening frequency Additional screening recommendations and comments
Women Age <25 years Genital chlamydia* Annually

Screen for syphilis, trichomoniasis, and HBV if at increased risk.

Screen for HCV if age >18 years (in areas with HCV positivity >0.1%).
Genital gonorrhea* Annually
HIV At least once
Age ≥25 years HIV At least once

Screen for gonorrhea, chlamydia, syphilis, trichomoniasis, and HBV if at increased risk.

Screen for HCV if age >18 years (in areas with HCV positivity >0.1%).
Pregnant Genital chlamydia

First trimester

(if <25 years or at increased risk)

Repeat screening for these infections in third trimester if at increased risk.

All pregnant women at risk for HCV infection should be screened at the first prenatal visit.

Pregnant women with HIV are also screened for trichomoniasis at the first prenatal visit.
Genital gonorrhea

First trimester

(if <25 years or at increased risk)
Syphilis First trimester
HIV First trimester
HBV First trimester
With HIV infection Genital chlamydia Annually  
Genital gonorrhea Annually
Genital trichomoniasis Annually
Syphilis Annually
HBV First visit
HCV First visit
WSW and WSWM WSW and WSWM should not be assumed to be at lower risk for STIs on the basis of their sexual orientation. Screening for cervical cancer and STIs should be conducted according to guidelines for women, based on an open discussion of sexual and behavioral risk factors.    
Men MSW without HIV infection HIV At least once

Screen for gonorrhea, chlamydia, syphilis, and HBV if at increased risk.Δ

Targeted screening venues for chlamydia include adolescent clinics, STI clinics, and correctional facilities.
MSM without HIV infection Genital chlamydia At least annually More frequent screening (every three months) for chlamydia, gonorrhea, and syphilis is recommended in those with risk factors. More frequent screening for HIV and HCV may also be warranted.◊
Rectal chlamydia (if exposed) At least annually
Genital gonorrhea At least annually
Rectal gonorrhea (if exposed) At least annually
Pharyngeal gonorrhea (if exposed) At least annually
Syphilis At least annually
HIV At least annually
HAV First visit
HBV First visit
HCV At least once
MSW with HIV infection Genital chlamydia Annually  
Genital gonorrhea Annually
Syphilis Annually
HBV First visit
HCV First visit
MSM with HIV infection Genital chlamydia At least annually More frequent screening (every three months) for chlamydia, gonorrhea, and syphilis is recommended in those with risk factors. More frequent screening for HCV may also be warranted.◊
Rectal chlamydia (if exposed) At least annually
Genital gonorrhea At least annually
Rectal gonorrhea (if exposed) At least annually
Pharyngeal gonorrhea (if exposed) At least annually
Syphilis At least annually
HAV First visit
HBV First visit
HCV At least annually
Transgender and gender-diverse individuals Screening for STIs should be based on an individual's anatomy and sexual practices. Recommendations for genital gonorrhea, chlamydia and cervical cancer screening in cisgender women should be extended to all transgender men and gender-diverse individuals with a cervix. Screening for other STIs should be based on risk factors and exposures.
All adults over 18 years of age should be screened for HCV except in settings where the HCV positivity is <0.1%.
STI: sexually transmitted infection; HBV: hepatitis B virus; HCV: hepatitis C virus; MSW: men who have sex only with women; MSM: men who have sex with men; HAV: hepatitis A virus; WSW: women who have sex with women; WSWM: women who have sex with women and men.
* Screening for nongenital infections in females (eg, rectal chlamydial infection, pharyngeal and rectal gonococcal infection) can be considered based on reported sexual behaviors and exposure, via shared clinical decision-making between the patient and the provider.
¶ Factors conferring increased risk for gonorrhea, chlamydia, and trichomoniasis in females include transactional sex, new sex partner, multiple sex partners, a sex partner with concurrent partners, or a sex partner with an STI. Increased risk for syphilis may be based on geography, race/ethnicity, history of incarceration, or transactional sex work. STI screening may also be considered in high-prevalence settings (eg, STI clinic or correctional facility).
Δ Factors conferring Increased risk for gonorrhea and chlamydia in MSW include an infection in the preceding 24 months. Screening for chlamydia in young males can be considered in high-prevalence clinical settings (adolescent clinics, correctional facilities, STI/sexual health clinic). Increased risk factors for syphilis may be based on geography, race/ethnicity, history of incarceration, transactional sex work, or age <29 years.
◊ Increased risk factors for gonorrhea, chlamydia, syphilis, and HIV among MSM include multiple or anonymous partners; intravenous drug use; sex in conjunction with illicit drug use, including methamphetamines; and sex partners who engage in these activities. Increased risk factors for hepatitis C infection among MSM include HIV infection, high community HCV prevalence and incidence, high-risk sexual behaviors, and concomitant ulcerative STIs or STI-related proctitis.
Adapted from: California Department of Public Health, Sexually Transmitted Diseases Branch. California STD screening recommendations, 2015. Available at: https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CA_STD-Screening-Recs.pdf#search=std%20screening%20recommendations (Accessed on August 30, 2017).
Additional information from:
  1. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1.
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