Screening for sexually transmitted infections

Combined cases of syphilis, gonorrhea, and chlamydia reached an all-time high in the United States in 2018,1 and screening rates remain lower than they should be.2 Research suggests that patient discomfort in discussing STIs may be one of the barriers to identifying risk and screening accordingly.3 Quest offers the resources, tests, and insights to help you provide the best care for your patients.

Frank, direct conversations are critical:

Start with “just the facts” to lessen discomfort
Stress medical guidelines to avoid “screening stigma
Make it about “we” rather than “you
Instruct all clinical staff to follow your lead
Start with “just the facts” to lessen discomfort
Stress medical guidelines to avoid “screening stigma
Make it about “we” rather than “you
Instruct all clinical staff to follow your lead
 
This article offers more tips

Universal screening for patients 15-24

The CDC estimates that people ages 15-24 account for half of the 20 million new STIs that occur in the US each year.4 Despite these high numbers, 86% of women in this age group don’t think they’re at risk.5 At Quest, we believe It’s Best to Test.

Offering testing as part of routine screening can help patients feel more comfortable

Explaining to your patients that it’s your policy to universally screen all sexually active patients in this age group can help mitigate patient concerns about a stigma or being targeted.

72% of women under age 25 want their doctors to automatically test them for chlamydia and gonorrhea once a year5

72% 72%

72% of women under age 25 want their doctors to automatically test them for chlamydia and gonorrhea once a year5

It’s Best to Test

Leading health guidelines recommend universal screening for all sexually active females under the age of 25.6 Implementing a universal screening program with It’s Best to Test from Quest Diagnostics can help you easily integrate screening into your practice.

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It’s covered for lower patient costs

The US Preventive Services Task Force recommends screening for chlamydia and gonorrhea in sexually active women age 24 and younger6

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It’s allowed

Currently, all states allow minors to consent to their own STI services, except in limited or unusual circumstances. Review an updated list of state laws and policies

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It’s easy to order

Screening for chlamydia and gonorrhea is easy—and so is treatment with help from the It’s Best to Test program from Quest

Identifying high-risk patients

Nearly 1 in 5 Americans have a sexually transmitted infection.7 While patients aged 15-24 may be part of your universal screening program, guidelines recommend screening for sexually active women ages 25 and older if at increased risk for infection.8

Download our brochure to help identify and care for your high-risk patients Download our brochure to help identify and care for your high-risk patients

Asking the right questions to identify risk

1.

Do you use condoms: never, sometimes, or always?

2.

In the past 12 months, how many partners have you had sex with?

3.

Have you ever had an STI? Has a partner had an STI?

For more information, you can also view the AAFP STI practice manual.

This webinar by Dr Stephanie Taylor offers tips on how to take a good sexual history

Ordering the right test at the right time

Screening for STIs is recommended for women at all stages of their lives. The intuitive tables below can help guide your discussions and make patient-focused testing recommendations.

Chlamydia/Neisseria gonorrhoeae
Test code 11363
Trichomonas Vaginalis
Test codes 19550, 90521
Chlamydia/Neisseria gonorrhoeae
Test code 11363
  • Annual screening is recommended for all sexually active women aged <25 years9
  • Screening is recommended for women 25 and over at increased risk factorsa,9
  • Panel components can be ordered separately:
    • Test code 11361—Chlamydia trachomatis RNA, TMA, Urogenital
    • Test code 11362—Neisseria gonorrhoeae RNA, TMA, Urogenital
Trichomonas Vaginalis
Test codes 19550, 90521
  • Screening for Trichomonas vaginalis should be performed on women seeking care for vaginal discharge10
  • Screening might be considered for women receiving care in high-prevalence settings and for asymptomatic persons at increased riska for infection
  • The use of highly sensitive and specific tests, such as NAAT, are recommended over less-sensitive methods including wet-mount microscopyb,10
Chlamydia Trachomatis
Test code 11363
Neisseria Gonorrhoeae
Test code 11363
Trichomonas Vaginalis
Test codes 19550, 90521
Chlamydia Trachomatis
Test code 11363
  • All pregnant women aged <25 years or older women at increased riska for infection should be screened during their first prenatal visits9
  • Those aged <25 years and those at increased riska for chlamydia should be retested during their third trimester9
  • Those found to have chlamydial infection should have a test-of-cure (preferably by NAAT) 3 to 4 weeks after treatment and retested at 3 months9
Neisseria Gonorrhoeae
Test code 11363
  • All pregnant women aged <25 years and older women at increased riska for gonorrhea should be screened at their first prenatal visits9
  • Women found to have gonococcal infection should be treated immediately and retested within 3 months9
  • Those who remain at high riska for gonococcal infection should be retested during the third trimester11
Trichomonas Vaginalis
Test codes 19550, 90521
  • Women who report symptoms should be evaluated and treated appropriately
  • Evidence does not support routine screening for Trichomonas vaginalis in asymptomatic pregnant women
Chlamydia/Neisseria gonorrhoeae
Test code 11363
Trichomonas Vaginalis
Test codes 19550, 90521
Chlamydia/Neisseria gonorrhoeae
Test code 11363
  • For sexually active individuals, screen at first HIV evaluation, and at least annually thereafter9
  • Panel components can be ordered separately:
    • Test code 11361—Chlamydia trachomatis RNA, TMA, Urogenital
    • Test code 11362—Neisseria gonorrhoeae RNA, TMA, Urogenital
  • Specific testing includes NAAT for C trachomatis at the anatomic site of exposure as the preferred approach
Trichomonas Vaginalis
Test codes 19550, 90521
  • Recommended for sexually active women at entry to care and at least annually thereafter9
Chlamydia Trachomatis
Test code 11363
Neisseria Gonorrhoeae
Test code 11363
Trichomonas Vaginalis
Test codes 19550, 90521
Chlamydia Trachomatis
Test code 11363
  • Women and men should be retested approximately 3 months after chlamydia treatmentc,12
  • If retesting at 3 months is not possible, you should retest whenever your patient next receives medical care in the 12 months following the initial treatment12
Neisseria Gonorrhoeae
Test code 11363
  • Patients with symptoms that persist after treatment should be evaluated by culture for gonorrhea and for antimicrobial susceptibility13
  • Clinicians should advise patients with gonorrhea to be retested 3 months after treatment or when they next seek medical care within the following 12 months13
Trichomonas Vaginalis
Test codes 19550, 90521
  • Retesting for Trichomonas vaginalis is recommended for all sexually active women within 3 months following initial treatment regardless of whether they believe their sex partners were treated10

Practitioners are reminded that they may need to report positive test results for minors (generally under 16 years old) to state or local authorities. Check your local laws for requirements.

a People with increased risk are women who have had a history of sexually transmitted diseases (STDs), exchange sex for payment, or use injection drugs; and men and women with a new sex partner, more than 1 sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection.

b When highly sensitive testing (eg, nucleic acid amplification test [NAAT]) is not feasible, a testing algorithm (eg, wet mount first, followed by NAAT if negative) can improve diagnostic sensitivity.

c The use of chlamydial NAATs at <3 weeks after completion of therapy is not recommended because the continued presence of nonviable organisms can lead to false-positive results.9

These helpful resources can provide additional information and guidelines:

​References:

  1. CDC. New CDC report: STDs continue to rise in the US. Published October 8, 2019. Accessed February 3, 2021. https://www.cdc.gov/nchhstp/newsroom/2019/2018-STD-surveillance-report-press-release.html
  2. American Academy of Family Physicians. Screening for Sexually Transmitted Infections Practice Manual 2019. Accessed December 16, 2019. https://www.aafp.org/dam/AAFP/documents/patient_care/sti/hops19-sti-manual.pdf
  3. Data on file. Quest Diagnostics. Drivers and barriers to testing at-risk women for STIs: full report. December 2018.
  4. CDC. Sexually transmitted disease: adolescents and young adults. Reviewed January 25, 2021. Accessed February 3, 2021. https://www.cdc.gov/std/life-stages-populations/adolescents-youngadults.htm/
  5. Data on file. Quest Diagnostics. Universal STI testing research among young women and moms: topline report. Accessed September 22, 2021.
  6. US Preventive Services Task Force. Final recommendation statement; chlamydia and gonorrhea: screening. Published September 22, 2014. Accessed June 10, 2019. https://uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening
  7. CDC. CDC estimates 1 in 5 people in the US have a sexually transmitted infection. Published January 25, 2021. Accessed March 15, 2021. https://www.cdc.gov/nchhstp/newsroom/2021/2018-STI-incidence-prevalence-estimates-press-release.html
  8. Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137.
  9. CDC. Screening recommendations and considerations referenced in treatment guidelines and original sources. Reviewed June 4, 2015. Accessed March 24, 2021. https://www.cdc.gov/std/tg2015/screening-recommendations.htm
  10. CDC. Trichomoniasis. Reviewed June 4, 2015. Accessed March 24, 2021. https://www.cdc.gov/std/tg2015/trichomoniasis.htm
  11. CDC. Special populations. Reviewed June 4, 2015. Accessed March 24, 2021. https://www.cdc.gov/std/tg2015/specialpops.htm
  12. CDC. Chlamydia infections. Reviewed June 4, 2015. Accessed March 24, 2021. https://www.cdc.gov/std/tg2015/chlamydia.htm
  13. CDC. Gonococcal infections. Reviewed December 18, 2020. Accessed March 24, 2021. https://www.cdc.gov/std/tg2015/gonorrhea.htm

Test codes may vary by location. Please contact your local laboratory for more information.